Checklists for Assessment and Treatment

GENERIC EXPECTATIONS

The points outlined in the table below are expected for every patient interaction and therefore will be

included in each practical exam.

Generic expectations Total

Behaves in a professional manner

Introduces self

Appropriate conduct during examination-courteous, appropriate language and

dress

*Seeks consent

*Infection control

Washes hands before touching patient

Ensure assessments tool and treatment devices are clean prior to use

Maintain cleanliness with the appropriate handling of device.

Adhere to safe cough/huff etiquette

Provide patient with gel to clean hands after cough/huff

Respects patient's modesty/dignity

Draping, returning clothes

Effective communication

During assessment communicates to patients what they are going to do, how

they are going to do it, provides patients with clear and correct instructions on

what the patient should do, provides patient with information on their findings.

During implementing of treatment physiotherapist communicates to patient

what they are going to do, how they are going to do it, provides patients with

clear directions, provides patient with information on effective of treatment

and instructions on self management.

*Ensures patient and therapist safety

Provides warnings and checks for any contraindications and precautions to

interventions

Ensures patient is safe and comfortable at all times. Provides assistance to

change position etc if required.

Monitors during intervention and evaluates

Ensure the therapists and others adopts correct body mechanics throughout

all procedures

Preparation of environment

Ensure that all equipment is available, clean and safe to use. Ensure that

environment set up to ensure patient and self are safe with transfers

NB All items highlighted in grey are safety items. If these items are not performed in the practical

exam it is an automatic fail according to safety criteria.

ASSESSMENT SKILLS

Safety items are highlighted in grey. If these items are not performed in the practical exam it is an

automatic fail according to safety criteria.

1. OBSERVATION/PALPATION OF CHEST WALL MOVEMENT

In a clinical situation you would perform observation and palpation during both tidal and deep

breathing. For your practical examination you will be asked to observe and palpate chest wall

movement for one breathing pattern only (you will be told which one).

Hand position is very important. Hands should be placed directly on the chest wall where the

movement you wish to assess should occur. Accessory muscles should be palpated BILATERALLY.

You will be expected to be able to describe attachment sites for these muscles. Take care when

palpating the trachea as this can be uncomfortable for the patient.

OBSERVATION/PALPATION OF CHEST WALL MOVEMENT Total

EXPLANATION Purpose Procedure Consent Checks precautions

and contraindications Warnings

Assess how well chest expands (Requires removal of clothing to expose chest - consent) Place hands on chest (- consent) Pain, SOB, dizzy

PREPARATION Environment Patient

Patient is supported & positioned appropriately (feet supported) Gains consent (Requests removal of clothes as appropriate) (Washes hands - infection control) All of chest is visible

TECHNIQUE Visually inspects chest from - front - side (R & L) - back Palpates chest wall - anterior/posterior movement (R & L) sides - lateral basal movement (ant or post) - abdominal movement Palpates muscles (R + L) - sternocleidomastoid - scalenes - pectoralis - trapezius - abdominals Palpates trachea Counts respiratory rate

MONITORS

During examination Checks at end of examination

SPECIAL QUESTIONS (examples)

Why might the trachea deviate to one side? What pattern of breathing might you see if your patient had a (R)LL collapse?

2. AUSCULTATION

Used in patient assessment to listen for:

1. the presence or absence of normal breath sounds (BS)

2. the presence of abnormal and added sounds (eg, BBS wheeze, crackles)

3. the quality of all of the above i.e. pitch, intensity.

The patient should be instructed to take deeper breaths than normal through an open mouth during

auscultation and rest periods must be allowed to prevent hyperventilation and dizziness.

Comparisons are made between and within both the (L) and the (R) sides. This is easiest if the

procedure is performed systematically. For comparison purposes, you should auscultate at least two

areas of each lung zone. You will be expected to be able to describe which lung segment lies

beneath your stethoscope, given the underlying anatomy is normal. Each time you re-position the

stethoscope you should listen to both inspiration and expiration.

Inferences can be made about the underlying problem from the auscultation findings. You will be

expected to know and be able to describe what are normal findings and the possible causes of

reduced breath sounds, absent breath sounds, bronchial breath sounds, wheezes & crackles.

AUSCULTATION Total



To listen to sounds in the lung (Requires removal of clothing to expose chest - consent) Use stethoscope Pain, SOB, dizzy


Patient is supported & positioned appropriately (feet supported) (Requests removal of clothes as appropriate - consent) Washes hands All of chest is visible

TECHNIQUE Ensures earpieces are directed forward & tests stethoscope Warms head and cleans diaphragm (- infection control) Requests breathe slightly deeper in & out through open mouth Ensures patient will not breathe on examiner (- infection control) Listens systematically anteriorly: - RUZx2 - LUZx2 - RMZx2 - LMZx2 - RLZx2 - LLZx2 Listens systematically posteriorly: - RUZx2 - LUZx2 - RMZx2 - LMZx2 - RLZx2 - LLZx2

MONITORS

During examination Checks at end of examination

SPECIAL QUESTIONS (examples)

What do coarse crackles indicate? Where would you hear bronchial breath sounds in a normal person?

3. PEAK FLOW METER

A peak flow meter, as the name suggests, measures peak expiratory flow rate (PEFR). That is, "how

quickly you can get air out of your lungs". The test should be performed 3 times, allowing the patient

to rest between trials. Nomograms are available for PEFR and you will be expected to use these in

the exam.

PEFR is determined in part by the calibre of the airways and is, therefore, used as a basic indicator of

bronchoconstriction and/or effects of medication in asthmatics.

Most flow meters require:

1. manual recording of the result after each trial

2. manual resetting to zero after each trial.

You should bear in mind that in some patients their condition may be aggravated when the test is

performed, therefore, symptoms of dyspnoea or wheeziness must be checked for between each

trial. The best performance should be recorded in the patient's history.

If the patient's performance deteriorates progressively this also should be recorded as it may indicate

airways narrowing induced by the forced expiratory manoeuvre. If the deterioration is sudden and/or

severe the assessment should be ceased and medical opinion sought.

PEAK FLOW METER Total



To measure how quickly you can blow air out Use this piece of equipment Pain, SOB, dizzy, wheeze


Patient is supported & positioned appropriately (feet supported) Obtains clean mouthpiece, does not touch patient end (- infection control) Obtains and records age, sex, height

TECHNIQUE Describes procedure - biggest breath in - seal lips around mouth piece - blow out as hard and fast as you can Demonstrates correct technique Uses nose peg Provides feedback - technique correct / corrects mistakes Records score Allows rest time between trials Performs 3 trials in total Compares to nomogram and demonstrates how to record in history

MONITORS

During examination (asks specifically about wheeziness & SOB) Checks at end of examination

SPECIAL QUESTIONS

3. SPIROMETRY

Spirometry is performed to assess the normality of certain dynamic lung volumes and

inspiratory/expiratory flow rates i.e assess how much air you can get into your lungs, and how quickly you can get it out. There are many modes/makes of spirometers.

The technique and instructions remain the same and a nose peg should always be used.

The minimal measurements required (in body temperature pressure saturated - BTPS) are:

- Forced Expiratory Volume in one second (FEV1)

- Forced Vital Capacity (FVC)

- FEV1/FVC% (the Forced Expiratory Ratio (FER))

Spirometry should be performed 3 times, allowing the patient to rest between trials. The best

performance should be recorded in the patients history. These values are compared to those obtained from nomograms to assist in making a diagnosis,

eg, airflow obstruction or restriction. To use a nomogram the patients age, sex and height are required.

If the patients performance deteriorates progressively this also should be recorded as it may indicate airways narrowing induced by the forced expiratory manoeuvre. If the deterioration is

sudden and/or severe the assessment should be ceased and medical opinion sought.

You will be expected to be able to:

interpret the spirometry curve and compare it to predicted values

be able to describe the patterns observed in:

the normal lung

obstructive lung diseases

restrictive lung disorders

SPIROMETRY Total



To measure lung volumes Use this piece of equipment Pain, SOB, dizzy, wheeze


Patient is supported & positioned appropriately (feet supported) Obtains clean mouthpiece, does not touch patient end (- infection control) Obtains and records age, sex, height

TECHNIQUE Describes procedure - biggest breath in - seal lips around mouth piece - blow out as hard and fast as you can - keep blowing until you cannot blow out any more Demonstrates correct technique Uses nose peg Uses machine correctly Provides feedback to patient, eg - technique correct / corrects mistakes Records score Allows rest time between trials Performs 3 trials in total Compares to nomogram and demonstrates how to record in history

MONITORS

During examination (asks specifically about wheeziness & SOB) Checks at end of examination

SPECIAL QUESTIONS

Draw the curve for someone who has a restrictive/obstructive lung condition.

TREATMENT TECHNIQUES

Safety items are highlighted in grey. If these items are not performed in the practical exam it is an

automatic fail according to safety criteria.

A. TECHNIQUES TO IMPROVE O2 GAS MOVEMENT IN THE LUNGS 1. DEEP BREATHING EXERCISES (LATERAL BASAL EXPANSION) The aim of this technique is to obtain a long, slow, deep breath in, followed by a relaxed expiration. This will aid in distribution of gas to dependent lung regions and increase lung volume. For lateral basal expansion, hands should be placed anterolaterally on the chest wall at the level of the diaphragm. Respiratory rate must be considered as it is possible to hyperventilate if too many deep breaths are performed in a row. Probably no more than 5 deep breaths in a row should be performed, or the patient may hyperventilate and become dizzy Sustained maximal inspiration (SMI) or inspiratory hold (IH) can be added to this technique. This is a hold of the inspiratory effort at the end of the maximal breath in, usually for 3 seconds, followed by relaxed expiration. The aim of the IH is to increase gas movement to poorly ventilated lung segments via collateral airways. Therapists hand position provides proprioceptive feedback to patients

DEEP BREATHING EXERCISES Total

EXPLANATION Purpose Procedure Consent Warnings Checks

precautions/ contraindications

PREPARATION Environment Patient Infection Control

issues

TECHNIQUE Demonstrates technique on self Teaches correct technique - slow deep breath in - relaxed expiration - allows rests Therapist hand position appropriate Provides feedback to patient - technique correct - corrects mistakes

MONITORS

During treatment Checks at end of treatment

2. POSITIONING TO IMPROVE O2 GAS MOVEMENT This is a technique to help alter the distribution of ventilation, in particular to improve gas movement in a lung region that has been assessed as having reduced gas movement. The lung region with reduced gas movement (eg, with a collapsed lung) is placed in a "non dependent position" (ie, uppermost). This creates a more negative intrapleural pressure in the non dependent lung region and allows gravity to help open the air spaces by "stretching" the lung. With the alveoli now more open, the compliance of the affected lung increases due to the altered pressure/volume parameters, allowing improved gas movement to the area. When positioning the patient you must ensure that the patient is safe by: * Checking any precautions/contraindications to the head down position (eg. raised intracranial

pressure, hypertension, after a meal etc) PRIOR to the patient adopting the position * Checking the stability of plinth if blocks are being used * Ensuring that the patient won't roll off the plinth * Ensuring that they are adequately supported by pillows (eg in side-lying their head, upper arm

and leg are supported). * Monitoring for abnormal symptoms such as dizziness, nausea or increased SOB. Positioning to improve gas movement can be combined with: 1. thoracic expansion exercises

POSITIONING TO IMPROVE GAS MOVEMENT Total



PREPARATION Environment Patient Infection control

issues

TECHNIQUE Correct position for region named Ensures patient is safe & comfortable Assists patient out of position

MONITORS


NOTE: If the position does not require a head down tilt, there are still a few things you should check prior to positioning the patient. Consider what you might check if you were putting to patient prone, supine or upright, for example.

B. TECHNIQUES TO ASSIST WITH THE MOVEMENT OF SECRETIONS

COUGH and HUFF

Both of these techniques are forced expiratory manoeuvres used to clear/expectorate secretions.

The therapist should be positioned so they will not be coughed/huffed upon by the patient.

Both techniques can be performed with overpressure and/or wound support, where appropriate.

1. COUGH Coughing clears secretions from more centrally located airways. The components of an effective cough are:

1. A deep breath in slowly 2. Closure of the glottis 3. Contraction of the abdominal muscles to build up intra-abdominal pressure and therefore

intra-thoracic pressure 4. Opening of the glottis and an explosive breath out.

Coughing must not be paroxysmal ("coughing attack")

COUGH Total


and contraindication Warnings


issues

TECHNIQUE Describes technique - take a deep breath in - hold your breath - tighten abdominal muscles & cough Demonstrates correct technique Ensures patient will not cough on therapist (- infection control) Provides feedback to patient - technique correct / corrects mistakes

MONITORS


2. HUFF This is a separate technique and can be performed from various lung volumes. A huff is also a component of FET (when it is a forced expiration from mid to low lung volume.) The components of an effective huff are:

1. A breath in (to specified lung volume) slowly 2. The glottis is kept open 3. A hard sharp breath out (to specified lung volume)

A huff from high lung volume (ie after a deep breath in) tends to clear secretions from the larger airways. A huff from a low lung volume tends to clear smaller/more peripheral airways. You will need to understand the mechanism by which a huff clears the secretions.

HUFF Total




issues

TECHNIQUE Describes technique - take a breath in (to specified volume) slowly - keep mouth open - hard sharp breath out Demonstrates correct technique Ensures patient will not huff on therapist (- infection control) Provides feedback to patient - technique correct / corrects mistakes

MONITORS


C. TECHNIQUES TO ASSIST WITH THE MOVEMENT OF EXCESSIVE SECRETIONS 3. FORCED EXPIRATION TECHNIQUE (FET) FET can be used to help clear secretions from the airways. When used properly it should not induce the airways narrowing that can result when using other forced expiratory manoeuvres. The order of the components in FET is:

1. breathing control 2. one or two huffs 3. breathing control (to prevent bronchospasm and desaturation)

Breathing control is gentle relaxed breathing, which in a normal person should result in normal chest and abdominal wall movement. To achieve this, the patient needs to be positioned comfortably with all body parts well supported. Breathing rate should be slow but set by the patient. The therapist should provide feedback (manual and verbal) and encouragement to facilitate relaxation (thus you need to see the chest wall/abdomen). Following a huff, there is no specific time/number of breaths within the breathing control that the patient should do they should continue until they feel they have "got their breath back". A huff is a forced expiratory manoeuvre WITHOUT closing the glottis. To achieve this, the mouth remains open during the forced expiration. The huff can be either from mid to low lung volume in order to facilitate the movement of secretions from small airways into larger airways, or at high lung volumes which will clear secretions in the larger airways. The patient may cough once or twice to clear secretions from larger airways after the FET if needed, but this must always be followed by a period of breathing control. It is important to stress that no more than 2 huffs (or coughs) are to be done in a row as this can cause airways narrowing and respiratory distress.

FORCED EXPIRATION TECHNIQUE (FET) Total




issues

TECHNIQUE Describes technique Demonstrates correct technique - breathing control - huff Teaches breathing control - patient in a supportive, relaxed and safe position - correct hand position - patient and therapist - relaxed inspiration & expiration - comments on respiratory rate Teaches huff (to and from specified lung volume) - take a breath in (to specified volume) slowly - keep mouth open - hard sharp breath out - no more than 2 huffs Ensures patient will not huff on therapist (- infection control) Provides feedback - technique correct / corrects mistakes

MONITORS During treatment

Checks at end of treatment

4. ACTIVE CYCLE OF BREATHING TECHNIQUES (ACBT) When FET is combined with thoracic expansion exercise, the technique is referred to as THE ACTIVE CYCLE OF BREATHING TECHNIQUES (ACBT). The order of the components in ACBT is:

1. breathing control 2. thoracic expansion exercises(eg x 3 -5) 3. breathing control (steps 1-3 can be repeated as many times as necessary) 4. FET (Huff(s) and breathing control)

Steps 1-4 can be repeated as many times as necessary, i.e. continue the cycle until patient clears all secretions or is too tired to continue. FET on its own or within the ACBT can be used with patients whilst they are in specific or generalised postural drainage positions.

ACTIVE CYCLE OF BREATHING TECHNIQUE (ACBT) Total




issues

TECHNIQUE Demonstrates correct technique & performs completed ACBT with patient Teaches 1. Breathing control - Patient in a comfortable supported and safe position - relaxed breath in & out - hand position appropriate - patient and therapist - comments on respiratory rate 2. Thoracic expansion exercises - slow deep breath in - relaxed expiration - therapist hand position appropriate 3. Huff - take a breath into a specified volume slowly - keep mouth open - hard sharp breath out - no more than 2 huffs in a row Ensures patient will not huff on therapist (- infection control) Provides feedback to patient - technique correct / corrects mistakes

MONITORS


SPECIAL QUESTIONS

5. POSTURAL DRAINAGE (PD) or GRAVITY ASSISTED POSITIONING This is a technique used to facilitate removal of excessive secretions. The patient is positioned so that the main bronchus to the segment that is to be drained is perpendicular to the horizontal and the segment is non-dependent relative to the trachea. This allows gravity to assist drainage of secretions towards the larger airways where they can be cleared by using a forced expiratory manoeuvre, eg cough, huff, FET. When positioning the patient you must ensure that the patient is safe by: * Checking any precautions/contraindications to the head down position (eg. raised intracranial

pressure, hypertension, after a meal etc) PRIOR to the patient adopting the position * Checking the stability of plinth if blocks are being used * Ensuring that the patient won't roll off the plinth * Ensuring that they are adequately supported by pillows (eg in side-lying their head, upper arm

and leg are supported). * Monitoring for abnormal symptoms such as dizziness or nausea. Precautions to head down tip position: (for both PD and Positioning for Gas Movement)

hypertension (eg BP > 150/100)

unstable CV system (eg cardiac arrhythmias, labile BP)

immediately following oesophageal surgery (risk of gastric aspiration and places strain on anastomoses)

immediately following pneumonectomy (dont lie of non-operated side)

immediately following a meal

GORD (gastro-oesophageal reflux disease)

hiatus hernia (protrusion of stomach above the diaphragm)

orthopnea (breathless when lying flat)/severe dyspnoea

recent head injury and/or neurosurgery, raised ICP (increases cerebral oedema)

if patient is distressed, or is distressed by the position

pulmonary oedema/severe cardiac failure

severe obesity/abdominal distension - increases pressure on diaphragm and compresses lung volumes

recent head/neck surgery or facial trauma where there is risk of upper airway obstruction.

known cerebral aneurysm Consider HOW you will ask the patient about some of these conditions (ie, use layman's terms) and WHICH ones you would ask the patient and which ones you would check in the patient's notes. You should also endeavour to understand WHY it would be considered a precaution to put the patient head down in these situations. Postural drainage can be combined with:

FET (Forced Expiration Technique)

ACBT (Active Cycle of Breathing Techniques)

coughing, huffing

thoracic expansion exercises

percussion, vibrations, shaking

PEP

Acapella

POSTURAL DRAINAGE Total




issues

TECHNIQUE Correct position for region named Ensures patient is safe & comfortable Assists patient out of position

MONITORS


6. PERCUSSION, VIBRATIONS, SHAKING These techniques are all used to loosen excessive secretions and thus facilitate their removal. The proposed mechanism is that mechanical energy is imparted to the airways and, therefore, to the secretions, helping to make them easier to move. Percussion The patient's chest wall is rhythmically tapped using cupped hands and relaxed arms. It is usual to perform this through one or more layers of towel. Percussion is applied over the specific segment being treated. It is performed throughout inspiration and expiration during tidal breathing or thoracic expansion exercises. Vibrations The therapist's hands are placed directly on the chest wall over the segment to be treated and in line with the direction of movement of the chest wall. The technique is usually applied during DB exercises, where a rapid oscillatory movement is performed during expiration only. Encourage inspiratory to be a slow as possible. Shaking Shaking is performed as for vibrations, however, with greater amplitude of oscillation and as such tends to produce more movement of the whole chest wall. Encourage inspiratory to be a slow as possible. The above techniques can be used with postural drainage, before a FET and during the thoracic expansion exercises of ACBT. Precautions to percussion, vibrations and shaking:

fractured (#) ribs, flail ribs (where there are 2 fractures so a piece of rib is loose)

frank haemoptysis (coughing up frank (fresh) blood)

over rib cancer (Ca)

osteoporosis or long term steroid use (as this causes osteoporosis)

over burns, a surgical incision or an intercostal drain

severe bronchospasm

severe pleuritic pain (without adequate pain relief)

very low platelet levels

PERCUSSION / VIBRATION Total

EXPLANATION Purpose Procedure Consent Check precautions



issues

TECHNIQUE Therapist appropriately positioned Performs technique over segment named (uses towel as appropriate) Performs technique rhythmically and with appropriate force

MONITORS


D. DEVICES TO ASSIST WITH THE MOVEMENT OF EXCESSIVE SECRETIONS

POSITIVE EXPIRATORY PRESSURE (PEP)

FLUTTER (Flutter VRP1 valve )

ACAPELLA

Positive expiratory pressure (PEP) masks/mouthpieces, Acapella and Flutter use an increase in airway resistance to apply positive expiratory pressure to the airways. The resistance is either constant (PEP) or oscillating (Acapella or Flutter). This positive expiratory pressure is proposed to 1) stabilise or dilate the floppy narrowed airways to maintain airway patency to increase expiratory flow and 2) provide a backflow of pressure through the collateral channels to increase airflow behind completely obstructed airways, resulting in movement of the secretion to central airways.. The oscillatory PEP is proposed to result in oscillation of airways and expiratory airflow to mechanically dislodge secretions by increasing expiratory flow rates, altering the rheological properties of the secretions and/or augment cilial beat. During use of all 3 devices inspiration should be slightly greater that a tidal breath, with an end inspiratory pause of 2-3 seconds. Inspiration should be through the nose or mouth not the device. Encourage inspiration to be as slow as possible and comfortable for patient. Expiration is slightly active (not forceful), lasting for approximately 5 seconds. Use of all three devices increases airway resistance which increases expiratory workload. Therefore it is important to monitor respiratory effort, SOB and to be cautious prescribing these interventions in patients who have acute decreases in CO2 movement.

7. POSITIVE EXPIRATORY PRESSURE (PEP) PEP is applied by setting the resistance between 15-20cmH2O. The resistance is initially determined by placing a pressure manometer between the valve and resistance to measure the pressure mid expiration and adjusting the resistance until desired pressure is achieved. Patients can either perform PEP in upright sitting or in postural drainage positions. Dosage of 10-15 breaths is usually interspersed with ACBT, FET or huffing and coughing. Patients continue with treatment cycles until secretions are cleared or patient becomes fatigued.

PEP Total




issues

TECHNIQUE Demonstrates the expiration technique on self Teaches correct technique - Instructs patients to do 2-3 lateral basal expansion prior to

using device - inspire slow slightly deeper than normal breath in not through

the device - place lips tightly around mouthpiece - expiration (slightly forced) to appropriate pressure level to FRC - force is from respiratory muscles not cheek muscles - selects the correct resistance using pressure manometer to set

expiratory load - provides correct instructions on dose - allows rests - explain it is followed by FET to clear secretions. Provides feedback to patient - technique correct - corrects mistakes

MONITORS/ EVALUATION

During treatment Checks and evaluates at end of treatment

8. FLUTTER (Flutter VRP1 valve ) Flutter applies an oscillating pressure and flowrate is caused by the oscillation of an enclosed stainless steel ball bearing within a pipe shaped device. The resistance is variable which is altered by patients expiratory effort and the position (incline) of the device. The oscillation frequency ranges between 8-26 Hz (cycles per second). Ideal position of the device is specific to the patient and when maximal vibration is felt in the chest.

Dosage is 10-15 breaths are usually interspersed with ACBT, FET or huffing and coughing. Patients continue with treatment cycles until secretions are cleared or patient becomes fatigued.

FLUTTER Total




issues


using device - inspires slow slightly deeper than normal breath in not through

the device - followed by an end inspiratory hold 3-5 seconds - place lips tightly around mouthpiece - expiration (slightly forced) to FRC - performs 6-8 breaths through device for purpose of practical

exam - followed by 1 inspiration to TLC and forced expiration - force is from respiratory muscles not cheek muscles - position of device to maximise vibration felt on chest - provides correct instructions on dose - allows rests and spontaneous coughs to occur Provides feedback to patient - technique correct - corrects mistakes



9. ACAPELLA Acapella applies an oscillating pressure and flowrate. The Acapella device is a cone shaped device that incorporates a counterweighted lever and a magnet. The oscillation of pressure is caused by impeding the expiratory airflow by the connection between the lever and magnet. When the pressure builds up the lever and magnet disconnect which results in airflow. The subsequent decrease in pressure causes the magnet and lever to reconnect. The connection and disconnection results in oscillation of the expiratory airflow. The resistance is adjustable for individual patients by adjusting the resistance dial at the back. Clockwise movement of dial increases the resistance and anticlockwise decreases the resistance. The level of resistance is set where the patients can exhale for 3-4 seconds while feeling the vibratory effects. The oscillation frequency ranges between 8-30Hz and resistance pressure of 3-24cmH2O. Dosage is 10-15 breaths are usually interspersed with ACBT, FET or huffing and coughing. Patients continue with treatment cycles until secretions are cleared or patient becomes fatigued.

ACAPELLA Total

EXPLANATION Purpose Procedure Consent Check

precautions/contraindication

Warnings


issues


using device - Inspires slow slightly deeper than normal breath in, not through

the device - followed by a short end inspiratory hold 2-3 seconds - Place lips tightly around mouthpiece - expiration (slightly forced) to FRC - performs 6-8 breaths through device for purpose of practical

exam - Followed by 1 - 2 deeper inspirations and forced expiration - force is from respiratory muscles not cheek muscles - adjusts resistance to appropriate level for expiration to last 3-4

seconds and maximise vibratory effect felt on chest - provides correct instructions on dose - Explain it may be followed by FET to clear secretions - allows rests Provides feedback to patient - technique correct - corrects mistakes



Checklists for Assessment and Treatment

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