PT Interventions 3

Question 1

Who should not perform diaphragmatic breathing?

Answer 1

• Moderate to severe COPD
• marked hyperinflation of lungs without diaphragmatic movement
• Pts with paradoxical breathing patterns or who demonstrate increased inspiratory muscle effort

pts with increased dyspnea during DB

Question 2

What are the expected outcomes of diaphragmatic breathing?

Answer 2

• Decreased respiratory rate
• Decreased use of accessory muscles of inspiration
• Decreased respiratory flow rate
• Increased tidal volume
• Improved dyspnea and tolerance for activity

Question 3

IMT =

Answer 3

Inspiratory muscle training

Question 4

IMT attempts to strengthen:

Answer 4

• Diaphragm

- Intercostals

Question 5

2 different types of IMT devices

Answer 5

• Flow resistive breathing

- Threshold breathing

Question 6

Flow resistive breathing

Answer 6

• pt inspires through mouthpiece and adapter with adjustable diameter
• decreased diameter increases resistance to breathing

Question 7

Threshold breathing

Answer 7

Requires buildup negative pressure before flow occurs through a valve that opens at a critical pressure

Question 8

Inspiratory muscle training: expected outcomes

Answer 8

• increased inspiratory mm strength and endurance
• increased functional exercise capacity
• decreased dyspnea at rest and during exercise

Question 9

Paced breathing used for

Answer 9

• decrease work of breathing

- prevent dyspnea during activity

Question 10

Paced breathing: walking

Answer 10

Inhale 2 steps, pause

Exhale 4 steps

Question 11

Paced breathing: stairs

Answer 11

• Inhale through nose while standing
• Exhale through pursed lips while stepping up/down 1-2 stairs
• Remain on step until breathing control restored

Question 12

Paced breathing: lifting

Answer 12

• Inhale through nose while standing or sitting
• exhale through pursed lips while bending to reach the object, pause
• Inhale through nose while grabbing object
• Exhale through pursed lips while standing up

Question 13

Pursed lip breathing (PLB) used for

Answer 13

• Reduction in respiratory rate
• Reduction in dyspnea
• Maintain small positive pressure in bronchioles

Question 14

Why is it good to maintain small positive pressure in bronchioles?

Answer 14

May help prevent airway collapse in pts with emphysema

Question 15

Pursed lip breathing: expected outcomes

Answer 15

• Decreased RR
• Relieve dyspnea
• Reduce PaCO2
• Improve tidal volume
• Improve SpO2
• Prevent airway collapse in emphysema pts
• Increase activity tolerance

Question 16

What is segmental breathing used for?

Answer 16

To improve regional ventilation and prevent/treat pulmonary complications after surgery

Question 17

Segmental breathing positioning

Answer 17

• Sitting position for basal atelectasis
• Sidelying with affected lung uppermost
• Postural drainage positions with affected lung uppermost to assist with secretion removal

Question 18

How does the therapist help with segmental breathing?

Answer 18

1. Apply firm pressure at end of exhalation to chest wall overlying area to be expanded
2. Pt inhales deeply and slowly expands ribcage under therapist’s hands
3. Therapist reduces hand pressure during pt’s inhalation

Question 19

Indications for incentive spirometers (Sustained maximal inhalation -SMI)

Answer 19

• Decreased lung volume
• Decrease chest wall lung compliance
• Increased flow resistance from decreased lung volume
• Ventilation: perfusion mismatch
• Atelectasis or risk of atelectasis due to thoracic and upper abdominal surgery
• Restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm

Question 20

Who should not use incentive spirometry?

Answer 20

Pts with mod to severe COPD with increased respiratory rate and hyperinflation

Question 21

Incentive spirometry: expected outcomes

Answer 21

• absence of or improvement in signs of atelectasis
• decreased respiratory rate
• resolution of fever
• normal pulse rate
• normal chest x-ray
• improved PaO2
• Increased FVC and PEF

Question 22

Why does the forward leaning position often provide relief from dyspnea for pts with lung disease?

Answer 22

• Optimizes length-tension relationship of the diaphragm

- Allows pec minor and pec major to assist in elevating the rib cage during inspiration

Question 23

What is the reverse Trendelenburg position and what is it used for?

Answer 23

• Supine with head above trunk and LEs

- Decreases weight of abdominal contents on diaphragm and reduces resistance to movement during breathing

Question 24

What is the Semi-Fowler’s position and what is it used for?

Answer 24

• pt supine with head of bed elevated to 45˚, pillows under knees for support
• used for pts with CHF or other cardiac conditions