2nd semester " Pulmonary Rehabilitation"
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What is postural drainage?
patient positioning so that secretions drain from specific segments and lobes of the lung toward gravity-dependent central airways where they can be removed by cough or mechanical aspiration
What are indications for postural drainage? (5)
1. patients that produce more than 25 ml of mucus per day that have difficulty clearing them
2. presence of atelectasis caused by mucus plugging
3. patients with acute/stable CF
4. patients with bronchiectasis
5. patients with other conditions characterized by excessive sputum production
1.) how many positions ?
2.) how long should each position be held for?
3.) how often should you perform this?
4.) what 2 things can enhance this?
1. 11-12 positions
2. held for 3-15 min
3. perform every 4-6 hours
4. can be enhanced by external manipulation : percussion ( cupping, clapping) or vibrations (fine tremorous action)
What are 8 hazards and complications associated with postural drainage?
- 1. hypoxemia
- 2. increased ICP ( greater than 20 mm Hg)
- 3. acute hypotension
- 4. pulmonary hemorrhage
- 5. pain or injury to muscles, ribs, and spine
- 6. vomiting and aspiration
- 7. bronchospasm
- 8. dysrhythmia
What is "Autogenic drainage" ?
where do the secretions move from?
drainage based on lung volumes and expiratory flow rate rather than patient position.
It moves secretions from small peripheral airways to large central airways
what does autogenic draining employ? (5)
1. variable lung volumes
2. breath holding
3. controlled expiratory flow rates
4. huff cough
5. inspiration is slow and controlled using diaphragmatic breathing
** what are the 3 phases of autogenic drainage?
1. "unsticking" phase - moves sections from the lung periphery by breathing at low lung volumes
2. "collecting" phase - moves secretions from the middle airways by breathing larger lung volumes in inspiratory reserve volume range
3. "evacuating" phase - huff cough at mid to high lung volumes
Name two types of High frequency chest compression therapies
can aerosol treatment be given during therapy?
1. Vest & Air pulse generator
1. What is the "ThAIRapy Vest" ?
2. what do the pressure pulses do?
3. what is the pulse frequency?
4. how much pressure/Hz does it exert?
1. a large-volume, variable- frequency air pulse delivery system attached to a non-stretchable inflation vest
2. pressure pulses fill the vest and vibrate the chest wall
3. pulse frequency adjustable from 5-25 Hz
4. pressure in vest vary from 28 mmHg /5 HZ - 39 mmHg/25 Hz
High frequency chest compressions treatment:
-progress through low frequency of __ to __Hz
-through medium frequency of __ to __ Hz
-through high frequency of __ to __ Hz
-can be ________ or ________.
-length of treatment is __ to ___ min.
- 1. low 7-10 Hz
- 2. medium 10-15 Hz
- 3. high 15-25 Hz
- 4. can be continuous or intermittent
- 5. length of treatment is 3-15 minuets
what is PEP therapy?
Use of positive pressure during exhalation o prevent premature collapse of he airway and move secretions
1. what does the Positive Expiratory Therapy - PEP device do?
2. how much pressure does it generate?
3. what kind of breathing technique is best used with this device?
1. positive pressure is generated as patient exhales through a fixed orifice resistor
2. 10-20 cm H2O
3. relaxed diaphragmatic inspiration to a volume larger than tidal breath but less than TLC
Positive Expiratory Therapy - PEP device:
1. how much should you exhale?
2. how many series of breaths should you do this for?
3. what should you follow it up by?
4. sessions should last for how many minuets and how many times per day?
5. what is the therapeutic goal?
6. what should the fixed orifice be at?
1. exhalation to FRC that is active but not forced through resistor
2. series of 10-20 breathes performed
3. followed by a huff cough
4. sessions 10-20 min /1-4 times per day
- 5. therapeutic goal : 10-20 cm H2O
- I:E 1:3- 1:4
6. fixed orifice 2.5-4.0 mm
Notes : smaller orifice = generates more pressure & only device that has pressure upon exhalation )
Positive Expiratory Therapy - PEP device:
1. if you need more pressure what should you do?
2. what are the contraindications?
1. turn up the flow if you need more pressure
2. contraindications: acute sinusitis, ear infections, epistaxis, recent facial, oral or skull injury/therapy.
(aerosol therapy may be performed simultaneously with MDI or SVN during therapy)
What should you do for the initial therapy vest treatment ?
start low and gradually go higher
NIF (negative inspiratory force) is the same as what?
MIP - Maximum inspiratory pressure
What therapies include "Oscillation" ? (5)
1. Flutter Valve
3. Percussive Neb (Pneb)
5. High frequency chest wall oscillation (HFCWO)
What therapies is PEP involved in?
1. Thera PEP
7. PEP therapy
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