Chest Physio Therapy

General Hazards for CPT

1. Hypoxemia 2. Dyspnea 3. Increased ICP 4. Fracture Ribs 5. Hemoptysis 6. Cardiovascular instability

Bronchial Hygiene

- Used for mobilization for secretions (PEP, FLUTTER, IPV) -Can be used as an alternative for CPT or postural drainage Indicated when - VC is > 15 ml/kg or IC is > 33%

Flutter Patient Instructions

-Have the patient sitting -Have them inhale slowly, slightly more than a normal breath and hold for 2-3 seconds. - Patient should then exhale at a reasonably fast speed, yet not too forcefully through the flutter device. - Repeat 5-10 times to loosen secretions then take a breath and cough. - Treatment should last for 10-15 minutes.

EzPAP Positive Airway System

-Positive pressure during inspiration and patient exhales against the adjustable spring loaded valve creating positive expiatory pressure. - Inspiratory pressure comes from the rate of flow set at the flow meter 5-10 LPM

Acapella Oscillatory PEP device

-This is a combination of the PEP and Flutter valve. - Employs a counterweight plug and a magnet that send the patients exhalation down a cone and generates vibrations which transmits to the tracheobronchial tree. The PEP level can be adjusted on the side opposite of the mouthpiece.

high frequency Chest Wall Oscillation (HFCWO)

-This is a technique employing an inflatable vest that wraps around a patients chest area and intermittently delivers short bursts of air into the vest and ejects them at a high rate of speed. - Duration of therapy is 30 Minutes - 1 Hertz = 60 cycles - Frequency of oscillation is between 5-25 Hz (300-1500 cycles/min)

What are the indications for CPT?

1. Accumulated or retained secretions. 2. Ineffective cough 3. Ciliary dysfunction 4. Prophylactic care of patients. (COPD or prolonged bed rest)

PEP patient Instructions

1. Patient should be sitting 2. Instruct the patient to take a larger than normal VT and then actively exhale gently with expiration lasting 2-3 times longer than inspiration. 3. Patient should repeat 10-20 times and follow with a breath and cough.

What are the goals (purpose) for CPT

1. Prevent accumulation of secretions. 2. Improve Mobilization of secretions 3. Improve ventilation

CPT

Chest Physio Therapy

What are the hazards & contraindications for postural drainage?

1. Unstable Cardiovascular system 2. Unstable pulmonary system 3. Unstable Post-op status Absolute Contraindications -Head and neck injury Relative Contraindications 4. Rib Fracture 5. Hemoptsis 6. Empyama 7. ICP>20 mmHg

What are the contraindications for percussion?

1. osteoporosis 2. Lung Contusion 3. Burns or open wounds 4. Recent skin grafts. 5. Osteomyelitis of ribs 6. Subcutaneous emphysema.

Parameters to Monitor during postural drainage ( what are we watching for while we are performing CPT on the patient?

1. sputum production 2. cough effectiveness 3. HR, BP, and EKG 4. Breathing pattern and rate 5. Breath sounds 6. Skin color 7. Subjective response.

What are the pep levels??

10-20 cmH20

What is the most appropriate pressure range for PEP therapy?

10-20 cmH20

Flutter

A pipe shaped PEP device. Patient exhales to produce PEP between 10-25 cmH20 Angle of the device is held determines the PEP. The more upright = Higher the PEP generated to the airways.

what Vital capacity indicates inadequate volume for a cough?

A vital capacity less than 10 to 15 ml/kg of ideal body weight (IBW) indicates inadequate volume for a cough?

Mechanical Insufflation Exsufflation (MIE)

Assist patients with neuromuscular disorders in producing a strong enough expiratory flow to generate a cough and mobilize secretions. Uses a positive pressure from 30-50 cmH20 through a face mask or trach tube hold for 2-3 seconds and administer about 5 cycles. Contraindicated in COPD patients secondary to potential to rupture bullae and result in barotrauma.

Where should you avoid clapping over?

Breast tissue, kidneys, and the spine.

diaphragmatic breathing

Diaphragmatic breathing may be accomplished on both inspiration and expiration. For this technique, the patient is encouraged to distend the abdomen with the inspiratory effort. Use the abdomen muscles in this way helps to lower the diaphram, expanding the lungs further. A patient may also be caoched to observe the intercostal margin and encouraged to expand it outward. On expiration, the patient is encouraged to flatten the abdomen and pushing the diaphragm up and improving the strength of exhaltation.

What are examples of DC?

Forced Expiratory Technique Huff coughing Manually assisted cough

positive expiratory pressure (PEP)

Form of Bronchial hygiene therapy to manage secretions and post-op atelectasis. This is achieved by asking patient to exhale through a mask or mouth piece which has a resistance valve. The valve generates back pressure which transmits into the airway.

What should you do if the pressure appears to be ineffective for PEP therapy?

Increase the pep levels by 3-5 cmH20 and monitor response.

Vibration

Isometric maneuver performed with the arm and hand and it is only performed on exhale only.

Postural Drainage

Method used to remove pooled secretions by positioning the patient to allow gravity to assist in movement of secretions.

supine position

Patient laying on spine

Intrapulmonary percussive ventilation (IPV), flutter valve therapy and PEP therapy may be alternatives for what other popular therapy?

Pep therapy, Flutter therapy, and IPV can be utilized as an alternative for CPT or postural drainage.

What are the hazards of Vibration?

Rib cage Trauma and soft tissue trauma.

percussion

Technique of clapping on the chest wall with cupped hand.

pursed lip breathing

The patient is instructed to take a deep breath and exhale through pursed lips. The narrowing of the airway generates a resistance to exhaltion, causing pressure to be maintained throughout the bronchial tree. This sustained pressure prevents air trapping and keeps the alveoli infalted for a longer period on exhaltion. This is a natural phenomenon that may be observed when a patient is short of breath.

Explain the technique to assist a patient in performing a Quad Cough, and provide 2 patient disease examples of when it would be used.

To assist a patient in performing a quad cough, you need to have the patient lay flat in their bed and have them inhale as deep as they can three time in a row. On the third time, The caregiver will push up on the patients abdomen as they cough on the exhale. Two patient diseases include: A quadriplegic patient, and a patient who is unable to cough.

Directed Cough

To clear or mobilize secretions is a component of bronchial hygiene therapy when spontaneous cough is inadequate. The patient is instructed to take three breaths as deep as possible. This maneuver will help reverse atelectasis and to increase the volume abailalbe for the cough effort. At the end of the thrid breath, the patient is encouraged to cough twice very firmly. With the larger volume behind the cough, flow can be improved and the cough becomes more effective.

Intrapulmonary percussive ventilation (IPV)

Utilization of a pneumatic ventilator to provide a series of small VT's in rapid frequency (110-225 cycles/min) These small puffs are delivered by a mouth piece. Nebulized medications such as bronchodialators and mucolytic agents can be given with the percussive puffs. Tx lasts for 15-20 min.

How would you know the assessment of outcome for postural drainage? When would you know if you could discontinue the treatment because they are doing better?

You can discontinue the treatment if they have a change in - Sputum production -breath sounds - Vital signs -Arterial Blood gas - Performing a spirometry test

prone position

lying face down

quad cough

technique is for patients without abdominal muscle control such as those with spinal cord injuries. While the patient breathes out with a maximal expiratory effort, the patient or nurse pushes inward and upward on the abdominal muscles toward the diaphragm, causing the cough.