Lec 4 Pt Internal PDF

# Lec. 4 Devices ## Devices Used in Treatment of Chest Diseases: - Incentive Spirometer - Positive Expiratory Pressure Vest Therapy - Flutter - Respiratory Muscle Trainers ### Incentive Spirometer - Improve Lung Function - Has movable piston, connected to a dial with numbers, small ball to. #...

# Lec. 4 Devices ## Devices Used in Treatment of Chest Diseases: - Incentive Spirometer - Positive Expiratory Pressure Vest Therapy - Flutter - Respiratory Muscle Trainers ### Incentive Spirometer - Improve Lung Function - Has movable piston, connected to a dial with numbers, small ball to. #### Types of Incentive Spirometers: - **Volume Oriented:** Ensure volume of inhaled air is gradually inspired and the inspiratory volume is determined. Patient must suck slowly. - **Flow Oriented:** Contain movable balls. - **Tri-Flow Device:** - 600 ml to elevate 1st ball. - 900 ml to elevate 2nd ball. - 1200 ml to elevate 3rd ball. #### Contraindications: - Hyperventilation - Severe Dyspnea - Hypoxemia secondary to O2 therapy - Very young patients with developmental delay. #### Indications: - Pulmonary atelectasis - Restrictive Lung Disease - Pre and Postoperative Inspiratory Capacity (2.5 L) - Neuromuscular disease - Spinal Cord Injury #### How to Use It: - Patient position is semi-Fowler's or upright. - Use diaphragmatic breathing. - Inhale slowly, exhale normally. - Ball must be at middle chamber. Hold breath for 3 to 5 seconds. - Take 10 to 15 breaths every 1 to 2 hours. #### What are Wrong Ways to Use It: - Blow into device very rapidly or slowly. - Not use it in sets of less than 2 to 3 times per day. ## Positive Expiratory Pressure - Breathing - Breathing against resistance during exhalation. - Deliver medication deep to lung. ### Types: - **Low Pressure:** 5-20 cm H20 at inspiration, forced expiration - **High Pressure:** 26-102 cm H20 inspiration, followed by forced expiration. ### Classification: - **Breath Against Exp. Resistance:** Increase ERC, Tidal Volume - **High PEP & USIAD FVC:** - Oscillatory Positive Expiratory Pressure: Create vibration. ### Indications: - Acute or Chronic Respiratory Failure - Neurological - Musculoskeletal Dysfunction - Old Age - Immobility - ↑ Lung Volume - Emphysema - ↑ Delivery of bronchodilators ### Contraindications: - Like Pneumothorax ### How to Use It: - Sitting or any PO position. - Position should be changed for each lung. - Add huffing. - Repeat 3 to 5 times. - Cycle should continue for 10 to 20 minutes. ## Devices Like Flutter: - **A Capella Cornet** - **Vest Therapy:** - Pneumatic Vest - Loosen more secretions from proximal to peripheral. - Create positive and negative oscillatory pressure. - Frequency 5 - 20 times/second. - **Respiratory Resistance Training:** - Improve endurance, strength of muscles of ventilation. - Used for athletes ## Postural Drainage | Location | Percussion | Vibration | Shaking | |---|---|---|---| | **Upper Lobe** | | | | | Apical segment of both lungs | Cupped hands | 1 hand on top of the other | Thumbs poked together, open hand fingers | | *Anterior bronchiole* - Directed upward and laterally | Alternating Thrythmic patterns | Higher frequency, lower power | Stronger but slower vibration | | Position | Sitting, supported with the back slightly backwards | leaning backwards over a pillow | | | | Percussion | Anterior above the clavicle | Posterior above the scapula | Isometric contraction of U.L muscles | Compress and shake the chest | | *Posterior bronchiole* - Directed forward and downward | | | | | Position | Supine lying with the knees slightly flexed | | | | Percussion | At the nipple or above the breast | | | | **Posterior Segment** | | | | | Directed backward and laterally | | | | | *Right* | | | | | Position | Half oblique side lying on the left | | | | No elevation of the foot of the bed | | | | | Percussion | Right scapula | | | | *Left* | | | | | Position | Half oblique side lying on the right | | | | Elevation of the head of the bed 15cm | | | | | Percussion | Left scapula | | | | **Middle Lobe Right Lung (lateral and medial bronchi)** | | | | | Directed downward, forward, and laterally | | | | | Position | Quarter turn from supine | | | | Supported by pillows under the right side from the shoulder to the hip | | | | | Foot of the bed is elevated 35cm | | | | | Percussion | Under the nipple or below the breast | | | | **Lingula of the left Lung (superior and inferior segment)** | | | | | Similar position and percussion of the middle lobe, but at the opposite direction | | | | ## Indications for Postural Drainage 1. Prevent Accumulation of Secretions in Patients at Risk For Pulmonary Complications: - Patients with pulmonary diseases that are associated with increased production or viscosity of mucus, such as chronic bronchitis and cystic fibrosis. - Patients who are on prolonged bed rest. - Patients who have received general anesthesia and who may have painful incisions that restrict deep breathing and coughing postoperatively. - A patient who is on a ventilator if he or she is stable enough to tolerate the treatment. 2. Remove Secretions already accumulated in the Lungs: - Patients with acute or chronic lung disease, such as pneumonia, atelectasis, acute lung infections, COPD. - Patients who are generally very weak or are elderly, Patients with artificial airways. ## Discontinue if: - Chest X-ray is relatively clear. - Patient is a febrile for 24-48 hours. - Normal or near-normal breath sounds are heard by auscultation.