Treatment 2.0

Question 1

Why do you perform breathing exercises

Answer 1

• Increase ventilation
• to prevent atelectasis
• Decrease WOB and O2 consumption
• to remove secretions,
• Increase chest wall mobility and for relaxation

Question 2

When performing breathing exercises:

Breath in through ____ and breath out through _____

Answer 2

nose

mouth

Question 3

Indications for diaphragmatic breathing

Answer 3

post op patients, respiratory failure, chronic respiratory distress

Question 4

Benefits of diaphragmatic breathing

Answer 4

Increase lung expansion and compliance
reduces VQ mismatch
Increases respiratory muscle strength

Question 5

How do you do diaphragmatic breathing

Answer 5

o Slow inspiration to lower lung lobes (start with patient in lying or sitting, you use your hand then they use their own hand for feedback), expansion of belly is PASSIVE monitor upper chest movement, do 3-4 cycles of deep breaths, prescription: 10 breaths per hour

Question 6

What are some possible additions to diaphragmatic breathing

Answer 6

end inspiratory hold (hold 3-5 seconds before relaxed expiration)
single percussion
sniff
lateralcostal breathing (use hands for feedback)

Question 7

Pursed lip breathing indications

Answer 7

good for COPD patients

Question 8

Pursed lip breathing how

Answer 8

Inhale with lips in pucker position for 2 counts, exhale for 4 counts (exhalations 2x longer then inhalations)

Question 9

Segmental breathing indications

Answer 9

healthy individuals can direct O2 in the upper or lower lung fields upon instruction

Question 10

Segmental breathing HOW?

Answer 10

Tactile stim or pressure to increase expansion of specific areas

**pressure on inspiration and relax on expiration

Question 11

Incentive spirometry/sustained max inspiration indications

Answer 11

same uses as diaphragmatic breathing, just as good

Question 12

Incentive spirometry/sustained max inspiration how?

Answer 12

Sustain inspiratory effort for 3 seconds, then relax expiration, max inspiration to TOC, give a visual reminder and an incentive goal; can be flow or volume sensitive

Question 13

Breath stacking indications

Answer 13

When breathing is painful, vent dependent patients NOT COPD PATIENTS!!

Question 14

Breath stacking HOW?

Answer 14

Take a breath, hold, add another breath, hold and repeat until capacity is reached (can follow up with pursed lip breathing), slow exhalation

Question 15

Indications for SOS for SOB

Answer 15

For respiratory distress in COPD patient

Question 16

Steps for SOS for SOB

Answer 16

1. stop and rest in comfortable position
2. get head down
3. get shoulders down
4. breathe in through mouth
5. breathe out through mouth
6. breath in and out as fast as you want
7. begin to blow out longer, but not forcibly, used pursed lip breathing if you find it effective
8. begin to slow breathing
9. begin to use nose
10. begin diaphragmatic breathing
11. stay in position for 10 minutes longer

Question 17

Indications for assisted cough

Answer 17

an ineffective cough seen in patients SCI, NMD, chemically paralyzed, weak respiratory muscles

Question 18

Contraindications to assisted cough

Answer 18

ruptured diaphragm

Question 19

Precautions to assisted cough

Answer 19

inferior vena cava filter

• rib #
• abdominal or thoracic surgery
• pneumothorax
• perforated bowel *
• use clinical judgment may only have to change hand position

Question 20

Assisted cough procedures

Answer 20

• consent
• hand placement (1-2 people, landmark xiphoid process and umbilicus), or upper chest
• position as indicated
• palpate breathing pattern, tell patient plan for 3 big inspirations then on the 4th you will cough * watch body mechanics
• after coughing, ensure proper secretion removal (suction or patient spit)

Question 21

What might you combine a plain cough with for treatment

Answer 21

manual techniques
splinting (for pain, use pillow)
tracheal tickle

Question 22

Indications for huffing

Answer 22

For improving secretion clearance, as an adjunct to manual techniques

Question 23

Huffing procedure

Answer 23

• 2 reps of huffing (not forceful enough to cause pain, just to move a tissue away from you if you held one up), mouth is in “O” shape, glottis remains open
• arms can be by side or in chicken wing position
• abdominals and chest wall will tighten
• follow with diaphragmatic breathing

Question 24

What is important to know before doing any postural drainage

Answer 24

the unique contraindications of the patient: spinal injury, blood pressure

Question 25

What is the best postural drainage position

Answer 25

Upright and mobile

Question 26

Indications for the use of postural drainage

Answer 26

to put patient in position that drains the airway in gravity directed movement

Question 27

How long do you maintain the positions in postural drainage

Answer 27

3-10 minutes

Question 28

Contraindications and precautions to postural drainage positions

Answer 28

• untreated pneumothorax, hemoptysis, unstable CV status, inc ICP
• esophageal anastomosis, aneurism, PE or CHF, patient upset or agitated
• Recent laminectomy
• large Pulmonary embolism

Question 29

Postural drainage position for RUL/LUL

Answer 29

sitting upright in bed, back supported

Question 30

Postural drainage position for LUL anterior

Answer 30

Semi-fowler’s (supine HOB at 45)

Question 31

Postural drainage position for RUL anterior

Answer 31

Supine, hips in ER

Question 32

Postural drainage position for posterior LUL

Answer 32

Semi-prone (lt side elevated by pillows), HOB 30 degrees

Question 33

Postural drainage position for RUL posterior

Answer 33

semi-prone (Rt side elevated by pillows), bed flat

Question 34

Postural drainage position for LUL lingula (middle)

Answer 34

Rt sidelying (semi-supine, Lt side elevated by pillows), bed inverted 30°

Question 35

Postural drainage position for RML

Answer 35

Lt sidelying (semi-supine, Rt side elevated by pillows), bed inverted 30°

Question 36

Postural drainage position for RLL/LLL superior

Answer 36

Prone

Question 37

Postural drainage position for RLL/LLL anterior

Answer 37

Supine, bed inverted 30 deg.

Question 38

Postural drainage position for RLL/LLL posterior

Answer 38

prone, bed inverted 30 deg.

Question 39

Postural drainage position for RLL lateral

Answer 39

Lt sidelying, bed inverted 30 deg

Question 40

Postural drainage position for LLL lateral and RLL medial (cardiac)

Answer 40

Right sidelying bed inverted 30