Term
| What are the strategies of Mobilizations that can be used to facilitaed airway clearance? |
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Definition
Basic Mobility: sitting the person up or exercise
Vigorous mobility: i.e. jumping on trampoline for cystic fibrous
Acapella ro Flutter devices
Vibrating Vest
Chest PT (postural dranage, purcussion, shaking, virbration)
Active Cycles of Breathing ( includes the expectortation component as well)
Autogenic Drainage (self drainage) |
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Term
| When doing postural drainage how do you prioritize which segment to do first? |
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Definition
| the most effected segement is do be done first |
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Term
| What are the potiential signs of intolerance of Postural Drainage? |
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Definition
SOB, anxiety, nausea, dizziness, HTN, bronchospams
SAND HB |
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Term
| When is the most approperaite time for postural drainage? |
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Definition
Around when the patient is eating/tube feeding.
I image this is because they are up, i.e. bc I usually would not want to ly someone head down just after eating? |
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Term
| When Posteral drainage is used in isolation what length of time should be used? |
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Definition
10 min if tolerate
preferably 15-20 but might take whole session just to do this |
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Term
| What are some precautions for postural drainage? |
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Definition
Pulmonary Embolism
Hemoptysis (coughing up blood)
Large pleural effusion
Massive Ascites (a large accumulation of fluid between tissues and organs in abdomen |
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Term
| what are relative contraindications to postural drainage? |
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Definition
Increase ICP (perticularly >20 mmHg)
Head and neck injury until stabilized
Active hemorrhae with hemodynamic instability
Recent esophageal anatomosis(hole in esposgous)
Recent spinal fusion/injury
Diaphragmatic hernia
Recent eye surgerty
active hemoptysis
Empyema
PE
Aged confucsed or anxious pt
Recent head trauma |
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Term
| What is the use of percussion? |
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Definition
Loosen secretions
can be mechanical or amnually
100-480x/min during normal inspiration exspiration |
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Term
| Precautions for precussion? |
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Definition
Uncontrolled bronchospasm
Osteoporosis
Rib fractures
Metastic cancre to ribs
TUmor obstruction of airway
Anxiety
Coagulopathy
Convulsive or seizure disorders
Recent pacemaker
Taking blood thinner want to look at INR |
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Term
| What are the relative contraindications for percussion? |
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Definition
hemoptysis
Untreated tension pneumothorax
platelet count below 20,000/mm3
Unstable hemodynamic status
Open wounds burns in thoracic area
PE
Subcutaneous emphysema
Recent skin grafys or glaps on thorax
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Term
| How is virbration preformed? |
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Definition
| At the end of deep inspiration the clnician exerts pressure on the patients chest wall and gently oscillates |
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Term
| WHo is active secretions preformed by? |
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Definition
the Patinet
secretion clearance through thoracic expansion independently |
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Term
| What is the technique for active cycles of breathing? |
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Definition
1. breathing control: quiet relaxed breathing; normal/gentle TV for 5-10 seconds
2. Thoracic expansion exercise: deep inhalation w/ relaxed exhalation
3. Forced expiratory techniques (huffing and chicken wings) : patient perfomrs 1-2 huffs at mid to low lung volumes, focusing on abdominal contraction |
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Term
| When are active cycles of breathing most effective? |
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Definition
ACB are most effective when the patient is in a gravity assisted position
Can be done in sitting as well though |
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Term
FOr active cycles of breathign is it ok jsut to do a buntch of heavy breath right in a row?
why or why not? |
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Definition
no, bc the pt need to have control between phases inorder to prevent bronchospasm
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Term
| How does Active cycles of breathing help to alliviate secretions? |
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Definition
| Promotes collateral ventilation (helping the air get behind the secretions by)increasing lung volume which allows air to get behind secretions and ssists in their mobilizations |
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Term
| Autogenic drainage tries to accomplish what? |
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Definition
| Decreasing dyspnea by quiet expirations in a relaxed state without use of postural drainage positions |
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Term
| How does autogenic drainage use diaphragmatic breathing to mobilize secretions? |
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Definition
Diaphragmatic breathing mobilizes secretions by barying expiratory airflow
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Term
| What are the 3 phases of autogenic drainage? |
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Definition
1. Breathing at low lung volumes to unstick mucus
2. Breathing at mid lung volumes (tidal volume) to collect mucus
3. Breathing at high lung volumes to evacuate mucus |
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Term
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Definition
| Postive Expiratory PRessure |
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Term
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Definition
| Using an device (mask or a mouthpiece) a cylce of ~10 TV breaths are taken with a sligth forced expiration and then after the 10 are done huff or cough to get the crud out |
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Term
| PEP adds + pressure and vibration on exhalation to improve secretion mobilization |
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Definition
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Term
| What are some PEP mechinical devices? |
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Definition
Flutter (steel ball in plastic tube)
Acapella
Thera-PEP?
ABI vest (Ther AIR apy vest
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Term
| how does exercise improve mucociliary tansport? |
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Definition
Increases transpulmonary pressure with aerobic exercise
may open closed bronchi as well as increase collateral
ventilation to allow mucus to be moved |
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Term
| How can you tell if a patients cough is ineffeinct and therefore need your assistance? |
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Definition
If the cough is:
Non-productvie
impairment to one or more of the four stages of effective coughint ( inspiration, hold, pressure build up, expiration) |
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Term
How can soemones cough be improved?
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Definition
| Improving the individual stages of cough will inheretly improve the cough over all |
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Term
Costophrenic assist: what do you do?
What stage of cough are you helping with? |
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Definition
Hands on the lateral aspect of the lower ribs--> move dwn
and in toward the naval on exhalation--> hold pressure
long and firm in order to prolong expusion phase |
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Term
Anterior chest compression: describe
how many planes is the depression |
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Definition
Forearms across anterior chest
Upper arm @ sternal angel
Lower arm above xiphoid process or just on the abdomen
When the patient coughs apply pressure as in a V shape on chest maximizeing expulsion phase
two planes are being depressed (posterior, superior.inf |
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Term
Counter-rotation assist: describe :
plane of compression
good chest wall mobilize or not
Precautions |
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Definition
compresses all 3 planes
Very effectvie as cough technique and chest wal mobilizer
Patient needs to be cleared of spinal precautions!* |
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Term
| Counter-rotation assist technique? |
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Definition
Stretch the torso out while they breath in with upper hand on shoulder/on scapula lower hand on iliac crest
Breath out, lower hand glut fossa upper hand top of shoulder compress |
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Term
Are self assist cough technique taugh early or later in pt rehab process?
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Definition
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Term
What is the difference between a long sitting self assist cough for a tetrapelgic or paraplegic?
Patient vary in theri ability to do this |
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Definition
paralegic: upper extremities in butterfly position, extending trunk with inspiration--> patient throws uppper body onto the legs
Tetrplegic: extend body backward while inhaling macimally
Then cough as they throw their upper body forward, using shouldr IR f possible |
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Term
Where can the short sitting self assisted cough be done?
How is it to be prefromed? |
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Definition
Wheel Chair or Sitting in bed
Grap opposite handed wrist place in lap
Ext trunk backwards while inhaling
Cough--> during cough patinet pulls hands up into diaphragm like the heimlich man. |
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Term
| What are some downsides and upsides to suctions as a method for secrection removal? |
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Definition
Invasive
Traumatic to the soft tissue of the airways
can only clear secretions in large airways
effective in removal
within the scope of practice for PT but must be trained |
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Term
Mechanical In-exsufflation AKA?
what is the benifit of this?
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Definition
Cough Assist
Can clear secretions distal to the large airways
current research shows that it is as effective as suctioning
non-envasive |
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