| Question | Answer |
|---|---|
| Anterior upper segment (upper lobes) | Sitting up slightly with pillow under legs |
| Anterior segments | laying supine with pillow under legs |
| Left lingular (left lower) | Raise bed about 12 inches (on the feet) (Trendelenburg) with left arm and back raised a little |
| Posterior segments (lower lobes) | Legs raised about 18 inches (30 degrees) (Trendelenburg) prone with pillow under stomach |
| superior segments (middle) | prone with a pillow under stomach |
| Question | Answer |
|---|---|
| Goals of CPT | 1. Prevent accumulation of secretions. 2. improve mobilization of secretions 3. regain most efficient breathing pattern 4. improve distribution of ventilation 5. improve cardiopulmonary exercise tolerance |
| Techniques utilized in CPT | Clearance techniques, exercise protocols, breathing retraining methods |
| What position do your hands go for manual percussion | Slow rhythmic clapping with cupped hands, over lung segment for 3-5 minutes |
| Diseases that benefit from CPT | CF, bronchiectasis, chronic bronchitis, aspiration pneumonia, ciliary dyskinetic syndrome, COPD with decreased exercise tolerance |
| Volume of sputum produced per day that indicates need for CPT | more than 25- 30 ml per day |
| PD (postural drainage) | position them to have gravity do it’s job |
| CPT (chest physical therapy) | clearance techniques, exercise protocols, and breathing retaining methods |
| How long should each postural drainage be held | 3-5 minutes for each position |
| procedure for performing chest wall percussion and vibration | Percussion-Cupping on lung segment. have them do purse lip breathing Vibration- done after percussion and vibrate towards the carina (have them inhale and do this while they are exhaling) |
| When should vibration be performed? | When the patient exhales |
| 4 chronic conditions that may cause copious secretions | cystic fibrosis, atelectasis, bronchitis, aspiration pneumonia |
| Contraindications for postural drainage | unstabilized head neck injury, hemorrhage, hemoptysis, rib fracture, flail chest, surgical wound, pulmonary embolism |
| Contraindications for percussion and vibration | recent pacemaker placement, lung contusion, blood clotting, burns, wounds, osteoporosis, chest wall pain |
| When patient is hooked up to EKG, IV, or other devices what do you do? | Notify someone i;e nurse or monitor. |
| What should be charted after completing CPT | position and time, sputum, tolerance, and problems |
| Adverse reactions that can occur | hypoxemia, increased ICP, acute hypotension, pulmonary hemorrhage, pain, vomiting, aspiration, bronchospasm, arrhythmias |
| What do you if any adverse reactions occur | stop treatment, put them back to normal position, and notify Dr. |
| When is the best time to do CPT (relating to food) | Before means or 1.5 to 2 hours after meals |
| Most common adverse reaction to Trendelenburg position | hypertension |
| Advantage on mechanical percussors | easier on therapist, more consistent percussion, some pt tolerate it better |
| disadvantage of mechanical percussors | not always easy to find, some pt don’t tolerate it well |
| How do administer CPT on children or neonates | one hand or smaller cups or use the flapper |
| Most commonly affected lung segment in aspiration | superior basal segment |
| How do you know where to CPT | x-rays, progress reports, auscultation (listening) |
| Indications for positive outcome of CPT | mobilization of secretions, increased breath sounds, clearer chest x-ray, increased sat of O2 |
| Appropriate frequency and pressure settings on vest | 10 Hz is most common |
| Define autogenic drainage | method of directed cough, Pt uses diaphragmatic breathing to mobilize secretions |
| 3 phases of autogenic drainage | 1. unstick secretions 2. collect secretions 3. evacuate secretions |
| What can you use instead of CPT | 1. insufflation/exsufflation device 2. flutter valve, 3. IPV intrapulmonary percussive ventilation |
| PEP therapy | Positive expiratory pressure; similar to CPAP and EPAP. High-frequency oscillations created as pt exhales |
| hazards or complications from PEP therapy | pulmonary barotrauma, increased ICP, air swallowing, vomiting, aspiration |
| MetaNeb | aka percussionaire…delivers both continuous airway pressure and high mini bursts…. Delivers bursts of gas at rates of 100-225 cycles/min |
| Question | Answer |
|---|---|
| Levels | Chemical level -> cellular -> Tissue |
| Levels | organs -> system -> organism (whole human) |
| Knee-chest(on stomach) | rectal exam |
| lithotomy(on the back, feet in stirrups) | women PAP |
| Dorsal Recumbent(on back, knees bent) | women- vagina /men- rectal |
| Sim(on side) | ” “ |
| Prone(belly down, flat) | Back exam (spine) |
| Fowler(sitting up) | 45-60 higher fowler/ 30- semi fowler |
| Supine(on back, arms to the side or above head) | chest, heart, abdomen, and extremities |
| erect | same as anatomic |
| trendelenburg | head lower than feet- drainage |
| Anatomic | standing erect, arms at the side, looking straight ahead |
| Cardiologist | Treat heart disease |
| Heart weight | 1 lb |
| 3 Layers of heart | 1) Endocardium- Inner2) Myocardium- Middle3) Pericardium- outermost (alphabetical) |
| Ishemia | damage to the heart |
| necrosis | dead tissue |
| 3 Routes | veins, capillaries, and arteries |
| veins | toward the heart |
| capillaries | Nourish, and remove waste, |
| Arteries | Away from the heart |
| systole (BP) | contraction of heart |
| diastole (BP) | relaxation |
| avarage BP | 120/80 |
| average BPM | 60-100 |
| Question | Answer |
|---|---|
| How long after a patient has had a meal is it ok to perform CPT? BK | 1 Hour |
| What is the primary reason for performing CPT? BK | To loosen secretions in the lungs |
| How long is a patient generally left in a position? BK | 3-15 minutes |
| What type of patients is CPT most effective with? BK | Patients with copious secretions |
| Is it necessary to drain parts of the lungs that do not have secretions? BK | No |
| What is Trendelenburg position? BK | Head down with feet raised 18 inches |
| What is an ABSOLUTE CONTRAINDICATION of CPT? BK | Untreated pneumothorax |
| If you are draining a patient’s left lateral segment, should the patient be on their right or left side? BK | Right side |
| Is the patient lying supine or prone when giving therapy to the superior segments? BK | Prone |
| Which of the following is not a contraindication of CPT: COPD, Obesity, Copious secretions, or Head injury? BK | Copious secretions |
| Should a therapist coordinate therapy with administering pain medication? BK | Yes, therapists should not perform therapy on their patients if they are in pain |
| What should you do if a patient has had surgery or bad pains where you need to perform therapy? BK | You should modify the position needed for the therapy so you are still able to give them the therapy they need. |
| Question | Answer |
|---|---|
| What should CPT include | postural drainage, chest percussion, chest vibration |
| Goals | approve secretions, better RR, and distribution |
| What do you chart after treatment | position and time, sputum, tolerance, and problems |
| When is vibration performed | on exhalation or expiration |
| HOw much is considered copious for secretion | more than 25- 40 ml per day |
| Diseases that cause copious secretion | CF, atelectasis, bronchitis, aspiration pneumonia |
| How do you know what position to put the patient | Progress notes, auscultation (listening), and x-ray |
| What is considered a flail chest | 2 or more fractures on the same rib; on 2-3 ribs |
| Most common side effect from Trendelburg? | hypertension |
| When do you monitor more aggressively while CPT | If the patient has cardiac problems, |
| How many minutes do you do CPT | 3-5 for each position |
| Basal | lower |
| Supine | flat on back |
| prone | flat on stomach |
| trendleburg | head down / |
| What does purse lip breathing do | creates back pressure and therefore the alveoli opens up |
| where is the lingula | upper left lower lobe |
| How does PEP therapy move secretions (acapella) | fills under aerated or nonaerated segments through collateral ventilation – prevents airway collapse during expiration |
| Chest x-rays on COPD | more blackness (air trapping) -angle of rib decreases (straighter) – heart shadow is compressed (long and narrow) – Diaphragm is flat |
