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Gupta
MELIHAT PROFIL
Semua konten berikut halaman ini diunggah oleh Lalit Gupta pada 27 September 2018.
* Penulis yang sesuai: Dr Lalit Gupta, Departemen Anestesi, Maulana Azad Medical College & Associated Rumah Sakit New Delhi, India, Tel no:
Abstrak
Fisioterapi adalah anggota penting klinis tim di unit perawatan intensif, bangsal pernapasan, klinik rawat jalan dan layanan perawatan paliatif [1]. Dalam
beberapa tahun terakhir, bukti-bukti dasar penggunaan fisioterapi berupa latihan yang tepat telah berkembang di banyak daerah, mulai dari perawatan
intensif dengan kondisi pernafasan kronis [2,3]. fisioterapi pernapasan bukanlah konsep baru. latihan pernapasan telah dipraktekkan selama lebih dari
satu abad untuk memperkuat dada, paru-paru, dan perut. fisioterapi pernapasan terutama berkaitan dengan menjaga dan memulihkan kemampuan
individu maksimum pernapasan fungsional [4]. Ini melibatkan pemeriksaan / penilaian, perencanaan dan pelaksanaan pengobatan berupa latihan
pernapasan dengan langkah demi langkah intervensi dan penilaian ulang.
singkatan: IPPV: Berselang Positif-Tekanan Ventilasi; CPAP: Continuous i. Mobilizing secretions leading to effective coughing
Positive Airway Pressure; COPD: Penyakit Paru Obstruktif Kronik. and removal of secretions.
ii. To teach appropriate breathing patterns and control.
iii. To mobilize thorax and shoulder girdle with proper
pengantar postural awareness.
iv. Reduce breathlessness and the work of breathing
kondisi pernapasan penyebab paling umum dari berkepanjangan
v. Improve the efficiency of ventilation
tinggal dalam pengaturan rumah sakit, dengan berbagai macam
vi. Support weaning from ventilators and support further noninvasive
diagnosis klinis yang dinilai dan perlu kontribusi fisioterapi bersama
mechanical ventilation
dengan perawatan medis. Kondisi yang memerlukan keterlibatan
keharusan fisioterapi termasuk pneumonia, vii. Improve functional abilities and exercise tolerance ( i.e. carrying
bronkitis kronis, asma, out daily tasks)
bronkiektasis, fibrosis kistik, hiperventilasi dan penyakit paru obstruktif viii. Home management advice.
kronik [5]. Peran fisioterapis dalam perawatan pasien meliputi
penilaian, saran, pendidikan dan tangan-aktif intervensi. Secara A physiotherapist should achieve the above aims with the goal of
tradisional, evidence-based practice in mind, i.e. [7] they should know the most
fisioterapi pernapasan membantu effective intervention, based on the evidence, and integrate this
mobilization and removal of secretions [6]. However, their scope knowledge and its application with clinical judgment and patient
extends to an array of measures for further betterment of patients like: preference.
Kutipan: Lalit Gupta dan Himani Gupta. Fisioterapi untuk Kondisi pernapasan. Adv Keperawatan Pasien Perawatan Int J Copyright © 2018 Lalit Gupta dan Himani Gupta.
2018, 1 (1): 180.003.
2
Advanced Nursing & Patient Care International Journal
Methods of Treatment programme of acute and chronic pulmonary disorders. They are
basically designed
Physiotherapists often use mechanical devices, such as intermittent a. To retrain respiratory Muscles
positive-pressure (IPPV) and CPAP b. To improve ventilation
equipment; tools that have been used in the profession since the c. To decrease work of breathing
mid-20th century. With the resurgence of interest in physiotherapy and
knowledge of lung Types of breathing exercises
segments physiotherapists have a greater armory to deliver. Many a. Diaphragmatic breathing
individuals with life-threatening b. Respiratory muscle training
respiratory failure can be successfully managed in this way, avoiding
c. Segmental breathing or local basal expansion exercises
intubation. Similarly, carefully selected devices can assist in mucus
clearance and improvement in respiratory parameters. Exercise i. Apical expansion exercises
equipments have long been used in pulmonary rehabilitation ii. Upper lateral costal expansion exercises
programmes in different forms; however, physiotherapists may also use iii. Lower lateral costal expansion exercises
supplementary
iv. Posterior basal expansion exercises
oxygen, noninvasive mechanical
ventilation, complex training modalities or d. Gloss pharyngeal breathing
neuromuscular electrical stimulation to enhance the effectiveness of e. Purse lip breathing
exercise training in respiratory patients [8].
Postural drainage: It consists of positioning with the gravity assistance
for draining of a specific area /segment of the involved lung (Figure 1).
Some of the commonly used exercises and principles employed in day Positioning is done in such a way to assist the required bronchus
to day chest physiotherapy are summarized as: perpendicular to the ground for mobilizing secretions from involved
segment to central airways, which are then suctioned out or removed
by active coughing (Figure 2). Postural drainage technique involved the
For mobilizing secretions Breathing exercises: Breathing basic techniques of percussion, vibration and shaking [9].
exercises play an important role in overall pulmonary rehabilitation
Positions: Many respiratory diseases are characterized by the common technique. This is where the physiotherapist will teach a
continuous production of sputum/mucus in the lungs. In cases like patient to lie at certain angles or get into certain positions in order to
these, postural drainage is a very help drain the lungs of fluid.
Left upper lobe-posterior Side-lying with elevation of left side of the chest
segment with pillows/support
Right upper lobe-posterior Side-lying with pillows under the right side of the
segment chest for elevation
Both lower lobes-anterior Laid flat on the back (supine position) with foot
segments end of the bed raised
Left lower lobe lateral position Right side-lying with foot end of the bed raised
Right lower lobe lateral position Left side-lying with foot end of the bed raised
Body position has also been shown to affect oxygenation. Alterations ii. Make suitable position as per the force of gravity to
in ventilation–perfusion inequality drain out bronchial secretions from affected lung segments to the
have been suggested as the main reason for improved oxygenation in dependent central airways.
these body positions. iii. The required positions are determined depending on
the location, severity, and duration of mucous obstruction.
Basic requirements
a. Pillows iv. The physiotherapy exercises are performed atleast
b. Tilt table twice or thrice a day before meals and bedtime and each position
c. Sputum cup is done for 5-15 minutes.
d. Paper tissues v. If patients develops signs of hypoxemia (tachycardia, palpitations,
e. Vibrators / massagers approved for physiotherapy dyspnea, or chestpain) the procedure should be discontinued if
occurs. Immediate
Steps discontinue the exercise if hemoptysis occurs.
i. Nebulize the patient with saline / bronchodilator / vi. Comfort of the patient must be of paramount
mucolytic agents before starting any physiotherapy exercise to consideration for active participation for positional physiotherapy
reduce bronchospasm, decrease viscosity of mucus and sputum, exercises.
and thereby liquefying them for enhancing secretion removal [10]. vii. Must ensure to auscultate the chest before and after
the positional exercises to ascertain effectiveness of exercises
and to further determine the areas of needed drainage.
viii. Encourage deep breathing and coughing after energy transfer between the high airflow velocity and the mucus layer
spending the adequate time in each position. thus dislodging the mucus and leading to its removal.
ix. Diaphragmatic breathing should be encouraged
throughout the postural drainage (this helps in widening of airways
foe effective secretions Coughing: It involves a deep breath (full lung volume), with the help of
drainage). abdominal muscles to ensures that the expiration is sufficient to
remove secretions from airways.
Massage manipulations
Huffing: It is a forced expiration again open glottis. It generates less
Manual or mechanical percussion and vibration are based on the
intrathoracic pressure than coughing. The patient is instructed to take a
assumption of transmission of oscillatory forces to the bronchi. This
medium size breath in (mid lung volume), involving the abdominal
helps in mucus transport in addition to postural drainage and coughing.
muscles with fast expiration making a strong sighing sound. It is
performed with pursed lips with mouth slightly open.
Progression is made by altering the phasing to ‘one, two out-one in’ Conclusion
then ‘one, two out-one in’ then ‘one,two,three out,-one two in’. The
patient’s position is then altered to reduce support until he or she is Physiotherapy is cornerstone for non-medical treatment of patients with
able to stand, walk and go up or down stairs with breathing control. respiratory disease. In addition to its traditional role in the treatment of
Such patients are taught to breathe out when bending down and to airflow obstruction and mucus retention, other aspects of respiratory
breathe in when straightening up during everyday activity (e.g. taking disorders such as in ventilatory dysfunction, dyspnoea and quality of
water bottles from refrigerator, mopping the floor, etc). life are also benefitted by physiotherapy interventions. Respiratory
physiotherapy aims to improve ventilation in respiratory diseases with a
variety of techniques by improving inspiratory muscle strength and that
also aid in clearance of sputum by bronchopulmonary techniques. It
Postural awareness involves a variety of strategies aimed at reducing the work of breathing,
improving ventilation, increasing function, and enabling relief of
Rounded shoulders, kyphosis, lordosis, scoliosis and head thrust
dyspnoea. Exercise training, peripheral and respiratory muscle training,
forward are common postural abnormalities. Such abnormalities limit
airway clearance techniques, and breathing retraining have been
thoracic spine mobility and hence decrease chest expansion. Therefore
shown to be effective treatments in a variety of conditions affecting the
it is essential to teach patients to relax the upper tar so, straighten the
respiratory system, if properly employed.
spine and keep the head erect while walking or sitting. This must be
applied in positions of work and when sitting resting, e.g. reading or
watching television.
8. Nici L, Donner C, Wouters E, Zuwallack R ,Ambrosino management of the adult, medical, spontaneously breathing
N, et al. (2006) American Thoracic Society/European Respiratory patient. Thorax 64(Suppl 1): i1-51.
Society statement on pulmonary rehabilitation. Am J Respir Crit
Care Med 173(12): 1390-1413. 13. Policy statement (2011) Description of physical
therapy. World Confederation for Physical Therapy, pp. 1-12.
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