Assistive Devices for Chest Patients PDF

 Devices used in the treatment of chest diseases Incentive spirometer Positive expiratory pressure(PEP) Flutter Vest therapy Respiratory muscle trainer  Incentive spirometer A plastic device used to help patients improve lung function. It consist...

 Devices used in the treatment of chest diseases Incentive spirometer Positive expiratory pressure(PEP) Flutter Vest therapy Respiratory muscle trainer  Incentive spirometer A plastic device used to help patients improve lung function. It consists of a clear tube which contains a movable piston. The tube is marked with a graduated scale to measure progress. The tube is connected to an inhalation nozzle and another tube with a small ball to indicate whether the user is inhaling with the proper force.  Types of incentive spirometer 1. The volume-oriented incentive spirometer The inspiratory volume is predetermined to the patient and a sliding pointer guide patient to inhale slowly. The purpose of the device is to ensure that the volume of air inhaled is increased gradually as the patient takes deeper and deeper breaths.  2. The flow-oriented incentive spirometer Contains a number of movable balls that are pushed up by the force of breath ( Triflow device ) 600 mL/s is required to raise the first ball, 900 mL/s is required to elevate the first and second balls, 1200 mL/s is required to elevate all three balls.  Indication of using an Incentive Spirometer Pre-operative screening and post operative rehabilitation. pulmonary atelectasis. Restrictive lung disease. Inspiratory capacity less than 2.5 liters Neuromuscular disease or spinal cord injury.  Contraindications: Patients who cannot use the device appropriately or require supervision at all times.. Patients who do not understand how to use the device. Very young patients or pediatrics with developmental delay. Fatigue. Hypoxemia secondary to interruption of oxygen therapy. Hyperventilation. Severe dyspnea. Heavily sedation or comatosed patient.  Position the patient in semi-fowler’s position or in an upright position (although any position is acceptable). Demonstrate how to use diaphragmatic breathing. Place the mouthpiece of the spirometer in your mouth, Make sure you make a good seal over the mouthpiece with your lips. Breathe out (exhale) normally. Breathe in (inhale) SLOWLY.  Make sure this ball stays in the middle of the chamber while you breathe in. If you breathe in too fast, the ball will shoot to the top. If you breathe in too slowly, the ball will stay at the bottom. Hold your breath for 3 to 5 seconds. Then slowly exhale. Take 10 to 15 breaths with your spirometer every 1 to 2 hours.  Blowing into the device (most devices will not work if this is done). Rapidly inhaling and exhaling off of the device. Inhaling too fast or too slow off of the device and not allowing the piston to completely fall to baseline before repeating. Not using it often (less than 2 -3 times per day). Not using the device in sets of 10.  Positive Expiratory Pressure Breathing (PEP) PEP device introduce resistance during expiration in the mouth piece of the device so, it builds up positive expiratory pressure in the alveoli and airways preventing their collapse. Helping to keep airway open. Move the mucus toward the larger airways, where it can be coughed out. Deliver medication deeper into the lungs.  Types of PEP A. Low pressure PEP : B. high-pressure PEP 5-20cm H2O 26-102cm H2O At mid-expiration The patient need to take maximal inspiration followed by maximal expiration into PEP mask.  Classification of PEP according to respiratory resistance A) A) Involves breathing against expiratory resistance and temporarily increase Functional Residual Capacity (FRC)and Tidal Volume. B) B) Hipep involve breathing against resistance by augmenting expiratory flow using FVC  C) Oscillatory PEP Has the benefit of pep plus it can create vibrations in the airways during expiration through the oscillating ball of the device.  Brand name include flutter , acapella , aerobic A and RC-Cornet.  Indications for PEP Acute and chronic respiratory failure. Neurological or musculoskeletal dysfunction. Old age and immobility. To increase lung volume by increasing TV and FRC. Reduce hyperinflation as in cases of emphysema. Improve airway clearance. Maximise the delivery of bronchodilator.  Intracranial pressure > 20mm Hg. Active haemoptysis. Recent trauma or surgery to skull, face, mouth, or oesophagus. Patient with acute asthma attack or acute worsening (COPD) unable to tolerate increased work of breathing. Acute sinusitis or epistaxis. Suspected inner ear pathology. Nausea. Untreated pneumothorax. 1. Treatment can be carried out in sitting or any postural drainage position. 2. Relax your stomach muscles and take a few normal breaths before using the PEP device. 3. Close your lips around the mouthpiece of the PEP device, making sure there is a good seal. 4. Take a slightly bigger breath in through your nose and then blow out through the PEP device, You may feel vibrations on your chest wall. 5. Repeat eight to 10 times. 6. Following this you should put the PEP device down and do huffing and coughing to clear any sputum. You should then have a period of relaxed breathing before continuing. This cycle should continue for 10-20 minutes or until you have cleared all your sputum.  Flutter Device (Oscillatory PEP) Controlled vibration system. Produces positive expiratory pressure and cyclic oscillation of the airways. Vibrate the airway walls (loosening mucus). Decrease the collapsibility of the airways. Facilitating movement of mucus to proximal airways. Improve lung function and oxygenation.  Flutter device must be used in the sitting or supine lying position. The patient is instructed to inhale deeply and hold his breath for 2 to 3 sec. Expiration should be slow through the Flutter valve, causing oscillations of the steel ball inside the cone of the Flutter Patients apply repeated exhalations through the Flutter valve. Routinely, three sets of 15 exhalations are performed over 12–20 min. After each series of exhalations, patients were instructed to “huff” and cough, thereby aiding expectoration. Other devices producing similar effect such as Flutter device but with different mechanism (Acapella and Cornet).  Vest therapy (HFCWO) pneumatic vest worn over the thorax. Frequency ranges from 5-20 times/sec. It can create either positive or negative trans respiratory oscillatory pressure across chest wall. loosen and moves trapped secretions from the peripheral to proximal airways, which can be removed through coughing or suctioning  Respiratory Resistance Training (RRT) Improving the strength or endurance of the muscles of ventilation, inspiratory or expiratory. Include tubes of different diameters and different resistance. Can be used in atheletes to increase muscle endurance and improve lung vital capacity.