Resume
Samenvatting CRK 2 - Respiratoir (Coremans)
- Établissement
- Universiteit Antwerpen (UA)
Samenvatting van de lessen Respiratoire Kinesitherapie (Coremans)
[Montrer plus]
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PR 1 - Respiratory techniques1. Peak expiratory flow (PEF) measurement
Peak expiratory flow measurement is a simple measure of the maximal flow rate that can be achieved during forceful
expiration following full inspiration.
PEF values indicate the degree of obstruction in the larger airways (till the 4th generation). (obstructie grote LW)
PEF measurement is inexpensive: cheap devices!
Mostly used in asthma patients: effect of therapy, medication. -> want vaak obstructie eerste 4 generaties
Performance: Interpretation
Clean material / new mouthpiece. normwaarden based on:
Patient stands upright or sits upright. age, length, sex
Patient inhales full (to TLC). PEF 80 – 100% van norm = OK
Patient encloses the mouthpiece with mouth (and teeth). PF < 80% = te laag/ pathologisch
Patient exhales as quickly and as hard as possible.
Measurements are taken 3 times, best result counts.
What can go wrong?
Patient doesn’t understand the instructions.
Therapist gives wrong instructions.
No full inspiration before the quick exhalation.
Leak at the mouthpiece.
2. Analytical breathing exercises (local breathing)
= A normal breathing movement will ensure that, when inhaling, the thorax expands in 3D and consists of various
subcomponents. Local breathing will emphasize 1 particular sub-component of this normal breathing movement.
Goals:
Make the patient aware of his breathing.
Immobilisation of a specific area, mainly postoperative. vb pijn na peratief
Correction of a breathing type in certain pathologies. vb hyperventlatie borst- ipv buikAH aanleren
In preparation of active drainage techniques.
Abdominal breathing
Chest breathing
Meestal moet die afgeleerd worden/ wordt dit niet geaccentueerd muv abdominale chirurgie (pijn abdominaal) dus
borst AH aanleren
Flank breathing
Voor vulling van de bovenste long in zijlig bvb bij atelectase if zwangerschap (meer ruimte creëren) -> 100% isolatie
niet mogelijk
Unilateral of bilateral flank breathing.
Bilateral: Pt active sitting position. Th stands behind Pt and places hands on the flanks. Ask the Pt to breath in
to your hands.
Unilateral: Active sitting position: Pt places one arm in a “stretch” position past the opposite shoulder. Th
places hand on flank and asks the Pt to breath to his hand. Side lying position: Th places both hands on the
upper flank and asks the Pt to breath in his hands.
Rescue-breathing: Combination flank – abdominal breathing. Pt places elbow past knees. When? -> bij
kortademigheid (acuut) (na inspanning) -> ellebogen voorbij de knieen plaatnsen, handen in elkaar + evt
tippenstand
,3. Cough education
Goals: Pain relief / Pain prevention → postoperative very important!
In combination with airway clearance techniques : more efficient coughing up slimes (door verdoving ligt
mucociliair transport even stil)
How? Manual support (Th or Pt) around the painful area (you can also use other aids like a pillow).
Coughing at the right level: modulation of inspiration before coughing. -> op juiste niveau ademen, mate van
inademen bepaalt diepte van de hoest
Modulation: Coughing at the right level, taking into account the level of the mucus. -> Important: modulation of the
level of inspiration before coughing.
Mucus central: deep inspiration before coughing.
Mucus more peripheral: very small inspiration before coughing.
→ If the mucus is not yet central enough, and coughing at this level is not effective enough, then first use other
airway clearance technique.
→ always use a combination of techniques!
Manual support: By Th or Pt.
Pt places hands or pillow around the wound or on the painful zone while coughing. This can be done in all positions.
This can also be done by the Th. Use a contact surface as large as possible. Apply a small, tolerant counterpressure
already before Pt is coughing, while coughing give a little bit more pressure. Give continue pressure – not with pulses.
4. Thoracic expansion exercises
Goals: Optimizing ventilation.
Prevention and treatment of atelectasis!!! (Use of collateral ventilation!!!!) -> adempauze
Atelectase = obstructie in de luchtwegen -> deel van long geraakt niet geventileerd -> klapt in ->
verhoogde kans op mortaliteit
Increase TLC!
Postoperative use!
How to perform? → based on slow, deep inspirations and breathing pause !
SMI (Sustained Maximal Inspiration): performance
Technique can be performed in any position.
Patient exhales calmly (at TV level).
Patient makes a slow, deep (maximal) inspiration (at TLC level).
Patient holds his breath for 5 seconds.
Patient exhales calmly (to TV level).
SMI technique including visual feedback: IS
IS (Incentive spirometry): performance & explanation to the patient doel = totale longcapaciteit normaliseren
This is a device to improve your lung capacity, it will help you to expand your lungs better.
You have to inhale in the device, not exhale!
, Depending on which device your Pt will use, you explain what will happen.
Pt is in an upright posture (sitting, standing) RECHTOP!
Pt exhales (to TV level) next to the device.
Pt places mouthpiece in his mouth and makes a slow (not to slow!), deep inspiration (to TLC level).
Pt holds his breath for 5 sec (difficult!)
Pt exhales next to the device (to TV level)
5. Manual techniques in respiratory patients
Also non respiratory techniques are regularly used in respiratory patients: multidisciplinary approach!!
Active and passive mobilisations (mostly cervical and thoracic)
Manipulations (sometimes necessary, but be careful with respiratory patients! Why? -> patienten nemen veel
medicatie (met coritose) die votten brozer maken -> osteoporose)
Diaphragm stretch
Main inspiratory muscle
Anatomy: O (3 parts): Sternal part: xyphoid process of sternum
Costal part: lower 6 costal cartilages
Lumbar part: L1-L3
I: Central tendon
Inhalation: contraction + Exhalation: relaxation (passive)
Diaphragm movements TV: 1 - 2cm TLC: 10cm
Importance of stretching??
In respiratory patients: Effective in al respiratory patients!!! -> Improvement of lung volumes (FEV1, FVC),
improvement of flexibility and mobility of the thorax.
In other patients: When? (1x om de 2 weken) Who? (chronisch hikken? Boeren laten?) Think multidisciplinary,
think about the anatomy and innervation (N. Phrenicus C3-4-5)!
BILATERAL STRETCH
Position patient -> Sitting position, relaxed. IN ZIT
Position therapist -> Stands behind the patient.
Performance -> Both hands are placed under the rib cage. All fingers (except thumbs) are placed below.
First try to palpate gently the diaphragm when the Pt is breathing at a TV level.
Ask the Pt. to inhale a little deeper. During the exhalation Th. makes a scooping sustained movement
(to lateral and cranial) = stretching. (Th opens arms: movie)
When Pt breathes in again, keep up this stretch and when Pt exhales again, give some extra stretch.
Try to do this 3-5x in a row. This can be a painful, often unpleasant technique.
Tijdens expiratie rekken met schepbeweging -> aanhouden en telkens verder gaan bij volgende AH
UNILATERAL STRETCH
Position pt -> Supine position with legs bent or on a rol. RUGLIG PT benen gebogen -> ontspant buikspieren
Position therapist -> Behind the head end of the patient on the side being stretched
Performance Both hands are placed under the rib cage, over each other.
First try to palpate gently the diaphragm when the Pt is breathing at a TV level.
Ask the Pt to inhale deeper. During the exhalation Th makes a scooping movement (to lateral and
cranial) = stretching. (Th uses his body weight!)
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