Breathing Exercises PDF

Cardiovascular and Pulmonary Interventions 399 Breathing Exercises Diaphragmatic breathing Increase ventilation, improve gas exchange, decrease workload, facilitate relaxation, improve mobility of the chest wall...

Cardiovascular and Pulmonary Interventions 399 Breathing Exercises Diaphragmatic breathing Increase ventilation, improve gas exchange, decrease workload, facilitate relaxation, improve mobility of the chest wall Facilitate outward motion of the abdominal wall while reducing upper rib cage motion during inspiration Used for obstructive and restrictive pulmonary diseases, excessive secretions, tachypnea, postoperative care, posttrauma treatment Not the best technique for chronic pulmonary dysfunction Procedure 1. Patient supine, sitting, or in semi-Fowler position ➤ Maintain posterior pelvic tilt (PPT), which can help facilitate use of the diaphragm 2. Place hand over subcostal angle of the thorax → apply gentle pressure throughout exhalation (increase to firm pressure) 3. Ask patient to inhale against resistance of PT’s hand → release pressure, allowing for full inhalation ➤ Note: Sniffing can be added to engage the diaphragm (patient sniffs 3 times and exhales slowly) Lateral costal breathing Asymmetrical chest wall expansion; relieves localized lung consolidation or secretions Most commonly in side-lying position with uninvolved side against the bed and arm of the involved side abducted over the head Segmental breathing Improve ventilation to hypoventilated lung segment, alter regional distribution of gas, maintain or restore functional residual capacity Used with pleuritic, incisional, or posttrauma pain that causes decreased movement in a portion of the thorax (splinting) and for those at risk of developing atelectasis Procedure 1. Position patient to facilitate inhalation to certain segment (PD position, upright) 2. Apply gentle pressure to thorax over area of hypoventilation during exhalation (increase to firm pressure before inhalation) 3. Ask patient to breath in against resistance of PT’s hand → release resistance, allowing for full inhalation Sustained maximal inspiration (SMI) or inspiratory hold Increase inhaled volume, restore functional residual capacity Used in acute situations (posttrauma pain, postsurgery, acute lobar collapse, ineffective cough) Can be used during vibration techniques Procedure 1. Inhale slowly through nose or pursed lips to maximal inspiration; hold for 3 seconds 2. Passively exhale Incentive spirometers (encourage deep inspiration) can help patient achieve maximal inspiration during SMI Prevent alveolar collapse Commonly used after surgery Pursed-lip breathing Increase TV, reduce RR, reduce dyspnea, facilitate relaxation Better gas exchange! Book_5566_Ch12.indd 399 18-04-2024 22:22:24  400 NPTE Final Frontier – Mastering the NPTE Used for patients with obstructive disease who experience dyspnea at rest or with mini- mal activity Positive back pressure due to pursed lips helps in preventing early airway collapse Used to slow RR and decrease resistive pressure Procedure 1. Slowly inhale through the nose 2. Passively exhale through pursed lips for 4 to 6 seconds (as if blowing out candle) Stacked breathing Series of deep breaths that build on top of previous breaths without expiration until maxi- mal volume can be tolerated Each inspiration is held with a minor hold Used for hypoventilation, atelectasis, ineffective cough Also used for uncoordinated breathing patterns during ADLs Upper chest inhibition technique Used only after all other techniques have been attempted Apply pressure to upper chest to limit excursion Add more pressure each time Abdominal strengthening Used when abdominal muscles are too weak to provide effective cough Abdominal support: used when the abdominal muscles cannot provide necessary sup- port for passive exhalation (high thoracic spine or cervical spine SCI) Make sure that binder does not restrict inspiration Glossopharyngeal breathing (air gulping): can be taught to assist coughing Good for high-level cervical spine SCI (eg, C4) Positioning for dyspnea relief Leaning forward with arms supported → accessory muscles can act on rib cage and tho- rax, allowing for expansion and inspiration Activities for Increasing Functional Abilities General conditioning 3 parameters can be used to prescribe exercise intensity: Oxygen consumption (VO2 max) ➤ Most accurate method ➤ Moderate intensity → 40% to 60% of VO2 max (achieved on ETT) ➤ Moderate to vigorous intensity → > 60% of VO2 max (achieved on ETT) HR reserve (HRR) ➤ Able to monitor intensity during actual performance ➤ Note: Patients with severe pulmonary impairment will reach their ventilatory maximum before reaching their cardiovascular maximum (unable to reach MHR) ‡ Using HR to prescribe does not always directly address physical limitations with low ventilatory reserve ➤ Karvonen formula: used for calculating target HR ‡ MHR = 208 – (0.7 × age) ‡ Target HR = (MHR – RHR) × (desired intensity [%]) + RHR Rate of perceived exertion (6–20) ➤ Borg RPE scale ➤ Dyspnea is a limiting factor in the ability to exercise Book_5566_Ch12.indd 400 18-04-2024 22:22:24