Treatment 3.0

Question 1

Indications for proning?

How many people does it require?

Answer 1

For patients in ARDS (last ditch effort to get VQ matching)

requires 4-6 people

Question 2

Contraindications to proning

Answer 2

• facial trauma, or open wound in chest or abdomen
• unstable spinal cord injury
• controlled cerebral hypertension

Question 3

Precautions to proning

Answer 3

• Hemodynamic instability

- active intra-abdominal processes

Question 4

Proning procedure

Answer 4

• slide patient away from ventilator side
• position arms close to or slightly on top of body
• place 4 pillows on legs, hips, belly and chest, wrap all together in sheet
• two way roll to prone, untangle arms and sheet
• place arms in cactus position, head in R or L rotation, change position every 2 hours, can be prone for 2-10 hours

Question 5

Purpose of percussions

Answer 5

remove secretions

Question 6

Percussion procedure

Answer 6

used cupped hands, in conjunction with other techniques, check skin before and after for redness; duration: 2-5 minutes

Question 7

Percussion contraindications/precautions

Answer 7

• # ribs
• prone to hemorrhage
• metastatic bone cancer
• osteoporosis
• burns,
• subcutaneous emphysema of neck and thorax
• poor/unstable CV condition
• recent skin graft or flap
• resectable tumor
• pneumothorax

Question 8

Vibrations purpose

Answer 8

Remove bronchial secretions and improve tidal volume

Question 9

Vibrations procedure

Answer 9

done on exhalation, in conjunction with other techniques, duration: 5 minutes * can use mechanical vibrator machines but they are not very effective (may be appropriate for fragile patients: osteoporotic, or elderly `

Question 10

Rib springing purpose

Answer 10

to to increase chest expansion and therefore a bigger inspiration

Question 11

Rib springing procedure

Answer 11

chest compression followed by overpressure and quick release at end expiration, can be combined with percs and vibs

Question 12

Indications for manual hyperinflation

Answer 12

acute lobar collapse and sputum clearance

Question 13

What do you need for manual hyperinflation

Answer 13

Ambu bag, O2 tubing, pressure manometer (cannot go over 30-40 cm H2O), skill

Question 14

Contraindications to manual hyperinflation

Answer 14

• acute pneumonectomy (unless surgeon says yes)
• undrained pneumothorax
• proximal tumor or obstruction
• unstable head injury
• HFOV

Question 15

Precautions to manual hyperinflation

Answer 15

Hemoptysis 
Bullae 
High RR 
PEEP 
Severe bronchospasm 
CVS instability

Question 16

Indications for active cycle of breathing

Answer 16

for secretion removal, allow inc pressure behind the huff, not forceful at all

Question 17

Active cycle of breathing procedure

Answer 17

have patients do this 15-20 minutes per day

• normal breathing for 1 minute
• deep breathing for 3-4 breaths, and hold 3 seconds
• normal breaths for 2-3 breaths
• huff: medium breath in and repeat 2-3 times
• if sputum not produced go back to normal breathing and repeat, if sputum, then repeat huff 2-3 times
• repeat 10-15 x or for 15 minutes * if two have gone by and have not been productive don’t continue*

Question 18

Autogenic drainage indication

Answer 18

alter rate and depth of breathing to produce highest possible airflow in bronchi while maintain stability

Question 19

Autogenic drainage stages

Answer 19

Unsticking
Collecting
Evacuating

Question 20

Autogenic drainage procedure

Answer 20

• slow diaphragmatic breathing slow breaths, take slightly deeper breaths than normal, then exhale normally for 10-20 breaths, then take 10-20 breaths at a higher lung volume
• try not to cough, then practice coughing and huffing, takes longer 30-45 mins, 2x a day

Question 21

Positive expiratory pressure indications

Answer 21

one-way valve mask that creates resistance on expiration, to keep airways open to get behind mucus via collateral airways and help secretion

Question 22

Positive expiratory pressure procedure

Answer 22

Inspiration 5-10 times with active exhalation at 1:3 or 1:4 usually followed by huffing or FET
- can also do two cycles then go back to percussion

Question 23

What is oscillating PEP? What population is it commonly used in?

Answer 23

• handheld device that oscillates and vibrates during inspiration that will help dislodge mucous in the small and large airways
• *used in CF patients a lot (acapella, PEP with flutter)

Question 24

What are the different types of suctioning

Answer 24

• Indwelling or not
• Trach, nasopharyngeal, oral pharyngeal
• Sterile, modified sterile, clean technique

Question 25

What are the suctioning pressures for adults, children, and infants?

Answer 25

Adults: 120-150mmHg
Children: 80-120 mmHg
infants: 60-80 mmHg

Question 26

What is the indications for suctioning

Answer 26

• patient can’t clear secretions
• loss of airway control
• lung pathologies
• obtain sputum sample

Question 27

Contraindications to suctioning

Answer 27

• worsening clinical conditions
• nasopharyngeal: basal skull #, nasal bleeding or bleeding disorders, epiglottitis or croup, CSF leakage, nasal stenosis

Question 28

What are 3 outcome measures used in pulmonary rehab

Answer 28

Dyspnea scale 0-4, measure of functional dyspnea

BORG breathlessness scale 0-10, dyspnea during activity

RPE 0-10, fatigue or breathlessness in muscles

Question 29

Aerobic exercises prescription for pulmonary rehab

Answer 29

1-2 x per day to 3-5 days per week, interval training (5-10 minutes, 2-5 min rest work up to 10-40 mins of continuous exercise), dynamic activity using large muscle groups

Question 30

Strength prescription for pulmonary rehab

Answer 30

• 1,3, or 10 reps, respiratory muscle retraining, functional (TUG, BERG)
• light weight higher reps, 1-5 lbs. (tubing) for 8-10 reps, 50-80% max strength

Question 31

For all exercises…

SpO2 should not fall under _____

Borg should not exceed ____

No abnormal changes in….

No presence of …

Answer 31

88%

5

rhythm, heart rate;

no pain, nausea, dizziness or headache, monitor blood sugar