What part contains epiglottis and vocal cords?
larynx
*connects pharynx to trachea
Is the diaphragm arched or flat when it is at rest?
Arched
When it contracts, central tendon pulled downward and flattens the dome-->protrustion of abdominal wall for INHALATION
What muscles are active with "resting" exhalation?
None- passive relaxation of inspiratory muscles
Is the diaphragm in a more advantageous position in supine or sitting?
Supine
Sitting- at a lower position- decreases the inspiratory capactiy (more flat starting position)
What is a normal FEV1 for an adult?
70%
***FEV1= amount of air exhaled in first second of FVC
=FEV1/FVC x 100
What % of air is oxygen?
21%
What is Partial Pressure of oxygen in atmosphere?
760 x .21 = 159.6 mmHg
What is partial pressure of oxygen in arterial blood of normal health person at room air?
95-100 mmHg
When is supplemental oxygen typically supplied?
PaO2 <55 mmHg
Normal pH in healthy adult?
7.35-7.45
Normal PaCo2 in healthy adult?
35-45 mmHg
Normal HCO3 in healthy adult?
22-28 mEq/L
An increase in HCO3 increases or decreases pH?
Increases (> 7.45)
An increase in PaCO2 increases or decreases pH?
Decreases (< 7.35)
Classifications for Chronic Obstructive Lung Disease
All stages <70% +
Mild: FEV1>/= 80% predicted
Mod: 50 < FEV1 < 80
Severe: 30% < FEV1 < 50%
Very Severe: FEV1 <30% predicted, PaO2 <60, PaCo2 >50
Indications for postural drainage
increased pulmonary secretions
aspiration
atelectasis or collapse
How long should you stay in a position for postural drainage?
up to 20 min
How long should percussion be used for in each position?
3-5 min
How many times should shaking be performed in each position?
5-10 deep inhalations
What is the purpose of huffing?
Prevents the high intrathoracic pressure that causes premature airway closure
When should an assisted cough be performed?
When the patient's abdominal muscles cannot generate an effective cough
PT pushes inward and upward just below the sternal notch
Why is tracheal stimulation used?
When the patient is unable to cough on command, such as pt's with brain injuries or infants
How is tracheal stimulation performed?
PT places finger/thumb just above the suprasternal notch
A quick inward and downward pressure on the trachea elicits a cough reflex
When is endotracheal suctioning used? And what are the parameters?
Used when all other airway clearance techniques fail to remove secretions
Suction catheter:
Adults 14 gauge
Kids 8 gauge
Infants 5-6
Suction set at 120 mmHg for 10-15 sec
Active Cycles of Breathing
Breathe in controlled, diaphragmatic fashion
Perform thoracic expansion exercises
controlled, diaphragmatic breathing
Huff from mid-low lung volume, then high
controlled breathing
Repeat as necessary
Autogenic Drainage
Unstick phase:quiet breathing low lung volumes (peripheral airways)
Collect phase: breathing mid volumes (middle airways)
Evacuation phase: breathing mid-high volumes (central airways)
Repeat as necessary
*no coughing involved- allow secretions without ir
FLUTTER/Acapella device
Breathe at normal tidal volume and exhale through device x 5-10 times
Breathe in full inhalation, then forced exhalation through device, x 2-3 times
Huff or cough to clear secretions
Repeat as necessary
Positive expiratory pressure devices
LOW:
face mask 10-20 cm H20
Breathe tidal volume x 10 reps
Remove mask and cough/huff
Repeat
HIGH:
face mask 50-120 cm H20
Breathe tidal volume x 10 reps
Huffing from high to low volumes with MASK ON
Why use High vs Low PEP device?
High is used when the patient's airways are unstable
Leave mask on with huffing because it allows person to exhale a larger FVC
Diaphragmatic Breathing
Increase ventilation
Improve gas exchange
Decrease work of breathing
Facilitate relaxation
Maintain or improve mobility of chest wall
PT places hand over subcostal angle of thorax and applies gentle-firm pressure on exhalation
Provide resistance with inha
Segmental Breathing
Improve ventilation to hypoventilated lung segments
Alter regional distribution of gas
Maintain/restore FRC
Maintain/improve mobility chest wall
Prevent pulmonary compromsise
Pt breathes into segment that PT is placing gentle resistance on
Sustained Maximal Inspiration
Increase inhaled volume
sustain/improve alveolar inflation
maintain/restore FRC
Used in acute situations
Inhale through nose or pursed lips to max inhale
Hold 5 sec
Passively exhale
*Can use incentive spirometers to encourage deep inhale
PUrsed lip breathing
Reduce respiratory rate
Increase tidal volume
Reduce dyspnea
Decrease mechanical disadvantages of impaired ventilatory pump
Improve gas mixing at rest for pts with COPD
Facilitate relaxation
Inspiratory Muscle Training
Determine Max inspiratory pressure
Use aperture close to 30-50% MIP
Pt breathes w normal RR and TV
Start 10-15 min of training
Progress by increasing time to 30 min
Then increase intensity with smaller aperture
Paced Breathing (activity pacing)
Performing activities/movements and exerting force as pt exhales