CARDIOPULMONARY Management and rehab .pptx

Cardio pulmonary physical therapy and it's mangemnet

1. interventions for acute cardiopulmonary conditions

2. Presented by ;- MUBEEN ZAFAR MISBAH SHAHEEN AWAIS MUSHTAQ AMINA KHALIL SHAMA ALMAS SAMSON GILL

3. Breathing exercises Introduction A number of breathing strategies can be used in treatment of a patient with cardio pulmonary Impairments. The following breathing techniques have been described for use in rehabilitation and acute care setting as well.

4. Pursed –Lip Breathing I nhale through your nose for two counts, then exhale through pursed lips for four counts. This can be done with or without abdominal muscle contraction. This can help improve airflow and oxygen exchange.

5. Paced Breathing Paced breathing involves consciously controlling the rhythm of your breaths for relaxation. Choose a specific count for inhalation and exhalation (e.g., inhale for four, exhale for six), and focus on breathing rhythmically. Find a comfortable position, concentrate on your breath, and repeat the pattern for several minutes to promote relaxation and reduce stress.

6. Inspiratory Hold Technique The inspiratory hold technique involves briefly holding your breath after a deep inhalation. After inhaling deeply through your nose, pause for a moment before exhaling. This technique can help improve lung capacity and enhance oxygen absorption.

7. Stacked Breathing Stacked breathing involves taking several shallow breaths in quick succession without fully exhaling. It is typically used as a respiratory exercise to increase lung capacity and promote a more controlled breathing pattern. The technique entails taking a series of rapid, shallow breaths, holding the breath briefly, and then exhaling slowly. This process can be repeated to enhance respiratory function.

8. Diaphragmatic Controlled Breathing Diaphragmatic controlled breathing, also known as deep breathing, involves using the diaphragm for deep inhalations and exhalations. Sit or lie comfortably, place a hand on your chest and another on your abdomen, inhale slowly through your nose allowing your abdomen to rise, and exhale through your mouth. This technique promotes efficient oxygen exchange, reduces reliance on chest muscles, and is beneficial for relaxation and respiratory health.

9. Lateral Coastal Breathing Lateral coastal breathing is a breathing technique where emphasis is placed on expanding the ribcage sideways during inhalation. In a comfortable position, inhale slowly through your nose, focusing on expanding the ribcage laterally. Exhale gradually through your mouth. This technique encourages fuller use of the lungs, promoting better airflow and respiratory function.

10. Counterrotation Counterrotation of breathing involves combining lateral coastal breathing with diaphragmatic breathing. In this technique, one focuses on expanding the ribcage laterally while also engaging the diaphragm for deep breaths. It aims to maximize lung capacity and promote a well-coordinated breathing pattern. Practicing this technique can enhance respiratory efficiency and overall breathing control.

11. Butterfly Butterfly breathing technique is a rapid and explosive action that can take place every stroke or every second stroke, depending on the swimmer's ability and the distance and pace of the swim. Inhalation occurs as the arms complete their upsweep and begin to recover as the body starts to rise. The head is lifted enough for the mouth to clear the water, and the chin should be pushed forward but remain at the water surface. Some exhalation underwater takes place during this phase. The head is lowered quickly into the water again as the arms recover in line with the shoulders to resume an overall streamlined position and maintain minimal frontal resistance.

12. Thoracic Mobilization Techniques Placing a towel roll vertically down the thoracic spine while the patient is in supine position can improve anterior chest wall mobility. Similarly, placing patient in side lying over a towel can increase lateral chest wall mobility .upper extremity movement is either actively or passively elevated with each position to increase mobility .

13. To Mobilize one side of chest While sitting ,have the patient bend away from the tight side to lengthen tight structures and expand that side of chest during inspiration, Then, have the patient push the fisted hand into the lateral aspect of chest, and breath out.

14. To Mobilize upper chest & Stretch pectoralis major While the patient in sitting in a chair with hands clasped behind the head, then horizontally abduct the arms during the deep inspiration. With patient sitting in chair, have him or her reach with both arms over head (180 degrees bilateral shoulder flexion and slight abduction) during inspirational. Then have the patient bend forward at the hips and reach for floor during expiration.

15. special considerations for Mechanically ventilated patients require careful attention to various aspects: Ventilator Settings: Regularly monitor and adjust parameters like tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP) to optimize ventilation and prevent complications. Oxygenation: Maintain adequate oxygen levels, balancing FiO2 to avoid hypoxia while minimizing the risk of oxygen toxicity. Sedation and Analgesia: Administer sedatives and analgesics judiciously to ensure patient comfort and prevent selfextubation, while minimizing the risk of oversedation. Infection Control: Implement strict infection prevention measures to reduce the risk of ventilator-associated pneumonia (VAP) and other healthcare-associated infections. Mobility and Positioning: Promote early mobility and position changes to prevent complications such as ventilator-associated lung injury and muscle atrophy.

16. To be Continue Monitoring: Continuously monitor vital signs, ventilator parameters, and laboratory values to detect changes promptly and adjust the management accordingly. Weaning Protocols: Implement weaning protocols to assess readiness for extubation and facilitate a smooth transition to spontaneous breathing. Nutritional Support: Provide adequate nutrition to support the patient's energy needs and promote recovery. Communication: Establish effective communication strategies, considering sedation levels and utilizing tools like communication boards or electronic devices. Psychosocial Support: Address psychological and emotional needs, considering the potential anxiety and stress associated with mechanical ventilation

17. Intubation is a medical procedure where a flexible tube is inserted into a patient's airway, typically through the mouth or nose, to assist with breathing or administer anesthesia. This is often done in critical situations or during surgery to maintain an open airway and ensure adequate oxygen supply. Mechanical ventilation refers to the use of a mechanical device, such as a ventilator, to assist or replace spontaneous breathing. This life-support system supports patients who may have difficulty breathing on their own due to various medical conditions, surgeries, or respiratory failure. It helps deliver oxygen to the lungs and removes carbon dioxide, supporting respiratory function

18. Weaning criteria Weaning criteria are used to assess a patient's readiness to be removed from mechanical ventilation. Common criteria include: Respiratory Parameters: Stable and adequate oxygenation with a low fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP). Additionally, acceptable levels of arterial blood gases, respiratory rate, and tidal volume. Hemodynamic Stability: Stable cardiovascular status with appropriate heart rate, blood pressure, and fluid balance. Mental Status: Awake and able to follow commands, indicating sufficient neurological function. Secretions: Manageable airway secretions and effective cough reflex to prevent aspiration.

19. TO BE CONTINUE.,,,,, Muscle Strength: Adequate respiratory muscle strength and endurance for sustained spontaneous breathing. Lung Function Tests: Favorable results in tests such as spontaneous breathing trials (SBT) to assess the ability to breathe without full ventilatory support. Chest Radiography: No new or worsening infiltrates on chest X-ray, indicating improved lung status. Overall Clinical Stability: Absence of acute or worsening conditions that may compromise the patient's ability to sustain spontaneous breathing. Weaning criteria refer to the parameters used to determine if a patient is ready to be successfully removed from mechanical ventilation. Common methods include: Spontaneous Breathing Trials (SBT): Assess the patient's ability to breathe without assistance for a set period, usually 30-120 minutes. Respiratory Rate and Pattern: Monitor stable respiratory rate and pattern during spontaneous breathing. Arterial Blood Gas (ABG) Analysis: Evaluate oxygenation and ventilation status through arterial blood gas measurements. Hemodynamic Stability: Ensure stable blood pressure, heart rate, and cardiac output during the weaning process. Lung Function Tests: Assess lung function with tests like forced vital capacity (FVC) and negative inspiratory force (NIF). Cuff Leak Test: Evaluate the ability to protect the airway by temporarily deflating the endotracheal tube cuff.

20. Exercise &Breathing pattern In the acute care setting patient often have limitations in strength and endurance that prevent optimal functional mobility and efficient breathing pattern. Breathing pattern: Breathing pattern should include an assessment of rate (12to 20 breaths per minute) depths ratio of inspiration and expiration (one to two is normal) Sequence of chest wall movement during inspiration and expiration comfort' presence accessory muscle use and symmetry. Normal breathing ratio :- Men 1:1.21 Women 1:1.14 Deep breathing ratio : Men 1:1.23 Women 1:1.40

21. Critical illness:- Neuromuscular disorder profound extremity and respiratory muscle weakness. Neuromuscular weakness can result from systemic inflammation ' hyper glycemia . Medication:_ 1) Corticosteroids 2) Bed Rest Functional limitations:- After discharge to perform strength training exercises in the acute setting should be used to in the effort to both prevent and treat negative neuromuscular critical illness. Goal of endurance training:- The goal of endurance training in acute care is to maximize the independent and efficient by which the patient performs ADLS and functional mobility.

22. Intervention Consideration In cardiopulmonary physical therapy , intervention consideration involve Assessing and implementing appropriate strategies to address cardiovascular and respiratory conditions. Here are some key points included in Intervention consideration :- Patient Assessment Exercise prescription Breathing exercises Patient education Monitoring and progression Psychosocial support Environmental factors

23. Components of exercise There are mainly 4 components of exercise 1)Intensity 2)Duration 3)Frequency 4)Modes Important: 1)Patient response 2)Monitoring and notice 3)sign and symptoms 4)Medication

24. Intensity Intensity Can be measure in several ways 2 are below borg RPE by scale by level of shortness of breath Monitor complaints Duration: Amount of time pt can tolerate while performing certain activity Cardiovascular response help to determine the duration of activity during exercise session Self monitoring

25. Frequency: Multiple short interval of exercise by rest period will be better than a long session Air way clearance technique Modes of exercise: 1)Refer to the method of exercise use for training 2)Most pt have limited exercise capacity 3)To maximize independence of pt therapist should choose functional activities as preferred mode of exercise

26. Functional mobility training .Initiated when patient roll bilaterally in bed maintain blood pressure and oxygen level . Patient medical status check by lab values x ray reports vital signs last dose of medications past medical surgical history. Therapist coordinate with patient and staff to prepare mentally the patient to start physical therapy. Goals of functional mobility: Patient perform as much as activity can long for possible. Clinical decision making for activity progression is based on patient's response .

27. Bed Mobility .Beginning an exercise program starts at patient's bedside with first level of functional mobility, bed mobility. Activities that include is:, Bridging:- Helps in removal and placement of bedpan , linen changes and positioning in bed . First step for independence of patient . Next therapist can have the patient actively assist with rolling. To perform rolling some therapist use bedrail to most upright position so patient can use it to assist with the activity . Patient progressed to sitting at edge of bed .Therapist must care about proper body mechanics. Therapist may want assistance of other staff or raise the bed for prevention of forward flexed posture . Again patient's vital signs are monitored.

28. Transfer and Ambulation When patient able to sit at edge of bed unsupported for 5 minutes and can perform full knee extension bilaterally for at least 3 minutes with acceptable responses in vital signs the patient may progress to standing and ambulating . Four wheeled walker allows the patient to walk with support . Patient should be educated how to use walker complete with verbal and visual instruction. One person needed to assist the patient physically . Another person is required for bagging the patient and supplement oxygen bag . Third person is required for intravenous poles and watching for adequate slack . Therapist must note resting vital signs. Vital signs measure frequently during abnormal responses to heart rate , blood pressure or fatigue by patient. Progression of activity is based on patient's response. Therapist - patient work toward goals of increasing ambulation and decrease the level of assistance. Goal of patient is to ambulate independently without an assistive device or oxygen. Therapist determine patients course of action to attain these goals .

29. Discharge plane A discharge plane include the following key steps : Assessment: - Evaluate the patient's progress and functional abilities. - Consider the patient's cardiopulmonary status and overall health. 2)Education: - Provide comprehensive information on self-care and ongoing management. - Ensure the patient understands their condition and how to prevent complications. 3) Home Exercise Program: - Prescribe exercises tailored to the patient's needs. - Emphasize the importance of continuing exercises at home.

30. TO BE CONTINUE,… 4)Medication Management: - Review medications, their purpose, and proper usage. - Discuss potential side effects and the importance of adherence. 5)Follow-up Appointments: - Schedule any necessary follow-up appointments with healthcare providers. - Monitor progress and address any emerging issues. 6)Lifestyle Recommendations: - Provide guidance on diet, activity levels, and stress management. - Encourage positive lifestyle changes to support overall well-being. 7)Emergency Action Plan: - Outline steps to take in case of emergency or worsening symptoms. - Ensure the patient knows when and how to seek immediate medical attention. 7)Collaboration with Other Healthcare Providers: - Communicate with other members of the healthcare team involved in the patient's care. - Ensure a smooth transition between different levels of care. A well-developed discharge plan aims to empower the patient with the knowledge and skills needed for continued recovery and effective self-management.