Roles of Ot in Respiratory Disorder 1

8/8/2019 Roles of Ot in Respiratory Disorder 1

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ROLES OF OT IN RESPIRATORY

DISORDER

BY:

SITI NUR HAMIZAH BT. IDRIS


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CONDITION

COPD (chronic bronchitis, emphysema,

bronchiectasis).

Asthma. Cystic fibrosis.

Interstitial lung disease.

Thoracic cage abnormalities.


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EQUIPMENT

Spirometer.

Pulse oximeter.


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SPIROMETER

An apparatus for measuring the volume of airinspired and expired by the lungs.

The spirometer records the amount of air and

the rate of air that is breathed in and out over

a specified time.

The output produced by a spirometer is called

a kymograph trace.

From this, vital capacity, tidal volume,breathing rate and ventilation rate can be

calculated.


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Sit on the edge of bed.

Hold the incentive spirometer in an uprightposition.

Place the mouthpiece in mouth and seal lipstightly around it.

Breathe in slowly and as deeply as possible,raising the yellow piston toward the top of thecolumn.

The yellow coach indicator should be in the blueoutlined area.

Hold breath as long as possible (for at least fiveseconds). Allow the piston to fall to the bottom ofthe column.

Rest for a few seconds and repeat steps one tofive at least 10 times every hour when awake.

Position the yellow indicator on the left side ofthe spirometer to show best effort. Use theindicator as a goal to work toward during eachrepetition.

After each set of 10 deep breaths, practicecoughing to be sure lungs are clear. If have anincision, support incision when coughing byplacing a pillow firmly against it.

Once are able to get out of bed, walk in thehallway and cough well. You may stop using theincentive spirometer unless otherwise instructedby your health care provider.


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PULSE OXIMETER

A medical device that indirectly measures theoxygen saturation of a patient's blood andchanges in blood volume in the skin producing aphotoplethysmograph.

Oxygen saturation is the amount of oxygenbound to hemoglobin in the blood.

It is often attached to a medical monitor so staffcan see a patient's oxygenation at all times.

Hemoglobin is red and the more red hemoglobinin the blood, the less light is able to penetratethe fingertip.


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The oxymeter always give a false reading.

If the patient is anemic, wears nail polish

and has poor circulation, the pulse

oxymetry maybe inaccurate. If the palpated pulse and the oximetry

machine pulse match, oxygen saturation is

likely to be accurate.


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A probe is wrapped around a

fingertip.

A light shines through the finger

and the amount of light reachingthe other side indicates the

amount of oxygen in the blood.


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SABERS APPROACH

S= sleep

Quality and quantity of sleep are important to theability to handle effort and emotion.

Adequate sleep eases daytime activities andallows the general arousal level to be set at alower level and in turn assists in performancedaily activities.

Sleep decreases the secretion of cortisol andcatecholamine and enables left ventricularhealing.


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A= Arousal

Each patient learns to become aware of arousallevels and to regulate them through

Body massage

Hypnosis

Dance therapy Biofeedback techniques

Communication skills are also important.

Ability of patient to articulate feelings of anxiety,

anger and despair prevent the retention of thosefeeling.


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B= Breathing

Correct breathing is an important aspect of

arousal management. Control breathing patterns can control

autonomic influences that cause coronary arteryconstriction and thus is able to reduce heart rate

and blood pressure responses to effort. The patient will often hold breath when

performing isometric activity such as liftingobject.

To avoid this incident: Teach pursed lip breathing

Thought to talk or sing during exertion


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E= Effort, R=Rest

Nixon and King(1980)

Be honest about functional activities, to recoverhealthy respect for fatigue, to know when to goforward and to acquire the discipline to changecourse or back off effort when overloaded. Thepatient should learn to keep a reserve of energy

in hand for dealing with contingencies andemergencies.

Examiner exhausting and time wasting habitsand learn to conserve energy. Daily activitiesshould be paced and speed in such a way as toavoid unnecessary time pressure displacementactivity and the compulsive drive to do severalthings at once.


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Avoid angina and become familiar with the

effects of different levels and varieties of

effort by self checking the various effects

of emotional tension and isometric and

isotonic effort for example:

Using a sphygmomanometer to learn howblood pressure responds to different sorts of

effort, both in untired conditions and in various

levels of fatigue.

To count heart rate in order to learn about

tolerance of effort and to ensure that it is kept

within healthy levels


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Increase general mobility and body awarenessthrough graded walking programs, promoting

stamina rather than speed. Exercise should notbe taken after large meal.

When appropriate, fitness training may be takenup as a pleasurable activity to enable patients to

return to sport and recreation. Warming up isessential. A healthy training level is usually at60%-70% of maximum heart rate. Sports thatput sudden severe demands upon the left

ventricle should be discouraged as well as thosethat depend upon isometric effort and exposureto cold. Train, dont strain is the watch word.


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BRUCE PROTOCOL

Aim: evaluate cardiac function and fitness.

Equipment: treadmill, stopwatch andelectrocardiograph.

Procedure:

Exercise is perform on a treadmill.

Starts at 2.74 km/hr (1.7 mph) and at the

gradient 10%. At three minutes intervals, the gradient of the

treadmill increase by 2%.


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The speed increases as shown in the table

below.

Stage Speed (km/hr) Speed (mph) Gradient

1 2.74 1.7 10

2 4.02 2.5 12

3 5.47 3.4 14

4 6.76 4.2 16

5 8.05 5.0 18

6 8.85 5.5 20

7 9.65 6.0 22

8 10.46 6.5 24

9 11.26 7.0 26

10 12.07 7.5 28


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The test score is the time taken on the test

in minutes. This can also be converted to an

estimated VO2max score using the

calculator below and the followingformulas.

The value "T" is the total time completed

(expressed in minutes and fractions of a

minute e.g. 9 minutes 15 seconds = 9.25

minutes).


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VO2 max refers to the maximum amountof oxygen that an individual can utilize

during intense or maximal exercise. It is

measured as "milliliters of oxygen used inone minute per kilogram of body weight"

(ml/kg/min).


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VO2max (ml/kg/min) = 14.76 - (1.379 T)

+ (0.451 T) - (0.012 T) (this formulais the one used for the calculator below)

Women: VO2max (ml/kg/min) = 2.94 x T +3.74

Young Women: VO2max (ml/kg/min) =4.38 T - 3.9

Men: VO2max (ml/kg/min) = 2.94 x T +7.65Young Men: VO2max (ml/kg/min) = 3.62 xT + 3.91


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During the test, heart rate, blood pressure

and ratings of perceived exertion are oftenalso collected.


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COMMON PROBLEM

1. Chronic bronchitis

Cough

Expectoration of mucus Cyanosis

Abnormal lung signs

Edema


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2. Emphysema

Short of breathness (SOB)

Cough Fatigue

Anxiety

Sleep problems

3. Bronchiectasis

SOB

Wheezing

Cough Fever

Hemoptysis


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GOALS

ADL evaluation and training to increasefunctional endurance.

Instruction and training in appropriate breathingtechniques while doing ADL.

Evaluation and strengthening of the upper extremities.

Work simplication and energy conservation.

Evaluation of the need for adaptive equipment.

Assistance in adapting leisure activities. Education in stress management and relaxation

techniques.


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ADL EVALUATION AND

TRAINING

Patient with COPD usually have difficulty

to perform ADL because they have

dyspnea.

Note the patients breathing pattern during

the ADL evaluation.

Many patient with COPD hold their breath,

breath shallowly and fast or elevate their

shoulders as they breathe.


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Oxygen saturation with activity should also

be noted. If the oxygen saturation falls below 90%

during the ADL, the use of oxygen with the

activity should be considered. Measurement of heart rate and blood

pressure should be taken.


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FORM


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Eg of ADL training in bathroom

Avoid scented soaps, colognes and othergrooming products if find they bother

breathing.

If steam in the shower bothers you, try

turning on the cold water first and then

slowly adding the hot.


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Eg of ADL training for shaving and combing

hair Take a deep breath when lift arms and

expand chest.

While exhaling, shave or comb two orthree strokes.

Lower arms and rest before run out of air


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BREATHING TECHNIQUES

2 techniques: 1) Diaphragmatic Breathing

2) Pursed-Lip Breathing

After familiar with these technique, patientshould apply during the activity that

caused them to breathless.

The pulse oximeter helps to reinforce theimprovement in oxygen saturation with use

of a breathing technique.


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Timing the breath with work is also helpful.

Eg: Breathe out while pushing the vacuum

cleaner and breathe in while pulling the

vacuum cleaner.


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Diaphragmatic Breathing

Place hand on abdomen

Inhale through nose, try to feel abdomen

push out as lungs fill with oxygen.

Next, feel abdomen go down as slowlybreathe out through pursed lips.

Continue to repeat this process until

become comfortable doing it.


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Another method of Diaphragmatic Breathing

Increased use of the diaphragm toimprove chest volume.

Procedure:

Place a paperback novel on the abdomen just

below the xiphoid process.

The novel provide a visual cue for diaphragmatic movement.

Patient lies supine and instructed to inhaleslowly and make the book rise.

Exhalation through pursed lips should causethe book to fall.


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Pursed-Lip Breathing

Prevent tightness in the airway providingresistance to expiration.

Increase use of the diaphragm anddecrease accessory muscle recruitment.

Procedure:

Breath in through nose.

Exhale slowly with lips pursed (whistle). Some

resistance should felt. Take twice as much time to exhale as to

inhale.


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When can use the breathing

technique??

Household tasks

Bedmaking

Window washing Mopping

Moving furniture

Meal preparation or clean up


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Exercise

Breathing exercise Walking

Bicycle riding

Swimming Body improvement exercises

Bronchial drainage

Relaxation exercises


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Garden work

Digging or planting

Raking leaves

Weeding

Hobbies

Golfing

Bowling

Swimming

Crafts


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Personal hygiene

Dressing Brushing teeth

Showering


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UPPER EXTREMITY FUNCTION

Many pulmonary patients take steroids becauseof their shoulder girdle, trunk and hip musclesare usually weak.

Patients with COPD commonly use theaccessory muscles of the shoulder girdle to helpthem breathe.

Upper extremity strengthening help increase the

capacity to work and reducing the oxygenrequirement when doing the upper extremityactivity.


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Theraband and free weight can be used to

increase upper extremities strength. Measure improvement in upper extremity

strength with the arm ergometer.


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WORK SIMPLICATION AND

ENERGY CONSERVATIVE

Odgen identified 6 factors that will

increase oxygen demand

Increased rate

Increased resistance

Increased use of large muscles

Increased involvement of trunk musculature

Raising ones arms

Isometric work


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Plan the daily activities so that will not feel

rushed or have to push beyond limitations. Decide which jobs are absolutely

necessary and which are desirable to

make home comfortable and attractive.

Adopt a cooperative work-sharing attitude

within family. Assign tasks and

responsibilities.

Pace all work to awn breathing comfort

and speed.


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Distribute tedious tasks throughout the

week. Alternate easy and difficult activities and

take a rest periods between to prevent

over fatigue. Sit down to do work.

Prepare food for two or more meals at one

cooking session. Refrigerate or freeze

individual size meals for another time.


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Minimize clutter in storage area,

cupboards, closets, wardrobes and toolsheds so that can easily find and reachwhat you need.

Vacuuming may leave fine dust in the air.

Lighting misting the bag will reduce thenumber of escaping particles. To minimizebreathing these particles in, try using amoist handkerchief in front of mouth and

nose while vacuuming. Opens windowsand let the room air out for at least anhour. Use only disposable vacuum bagsand change them often.


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PROMOTING SELF-

ENHANCEMENT ROLES

Leisure activities.


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STRESS MANAGEMENT

Patient usually feel panic when they experiencebreathlessness.

Other than teaching the breathing technique tothe patient with SOB, visualization also can calm

the patient. This maybe scene, real or imagined.

Eg: A landscape with rolling hills

Green grass Trees with their leaves gently moving in the wind

The beach, poolside or mothers kitchen


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OTHER TECHNIQUE OF STRESS

MANAGEMENT Mind-over-matter

Simply concentrate on a certain part ofbody.

Eg: Concentrate on right hand and envision that it

is becoming very limp, soft, heavy or light.

Try first with one hand and when havesuccesses in warming it, proceed up thearm, shoulder, other hand until body relaxand has obeyed you.


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OTHER TECHNIQUE OF STRESS

MANAGEMENT

Repeated the word (free).

Repeat each time breathe out.

Dont bother how deep a relaxation levelreach by yourself.


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RELAXATION TECHNIQUE

Avoid excessive oxygen consumptioncaused by tension of overworked.

Effective in decreasing anxiety and

controlling shortness of breath.

The environment must calm, quietand comfortable.


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THANK YOU

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Roles of Ot in Respiratory Disorder 1

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