Background

The cardiopulmonary system plays a very important role within our body. It is responsible for obtaining, transporting, and delivering nutrients and oxygen, as well as removing carbon dioxide and wastes. In this section, we offer two videos for the occupational therapy practitioner (OT) to review that address how to measure vital signs, such as heart rate, oxygenation, and blood pressure using the correct tools; and how to teach their client to perform specific breathing strategies, such as pursed-lip breathing, diaphragmatic breathing, and recovery breathing. Breathing strategies are important to know because of the many benefits. Certain strategies help with shortness of breath, energy conservation, calming the body and mind, and even reducing pain levels.

This section also builds upon previously learned information from 1140 Physical Dysfunction l. There, the OT practitioner learned a bit about the cardiovascular system. In that lecture, you learned that clients may have regular or irregular vital signs with exercise, which is one of the reasons it is important to know how to read and measure them. If a client is performing exercises and, after taking measurements, responds with a decreased heart rate and/or blood pressure, there is a problem. Breathing strategies can be connected to our 1150 Physical Dysfunction l Lab. In that lab, you learned how to perform both pursed-lip breathing and diaphragmatic breathing. This section teaches these two skills once again, with the addition of recovery breathing.

Measuring Vital Signs

This video explains how the OT practitioner can take various vital signs, which include heart rate, oxygenation, and blood pressure.

Measuring Vital Signs Video Transcript

Heart Rate Tips

• To measure your client’s radial pulse, press your index and middle finger against the area just proximal to your client’s wrist creases on the radial side of their arm.
• Once you feel the pulse, count the number of beats for twenty seconds. Then, multiply that number by three to give you an estimate of your client’s heart rate (HR).
• If your client’s HR is irregular, measure for at least one minute to get a better estimate.

Oxygenation Tips

• Place the oxygenation sensor on your client’s finger.
• The sensor will measure both the percentage of blood oxygenation (SpO2) and HR.
  • If your client has poor circulation, the sensor readings may not be accurate.
  • The sensor will not tell you if your client has an irregular HR.

Blood Pressure Tips

• Place the blood pressure (BP) cuff around your client’s upper arm with the artery arrow over their radial artery.
• Place the stethoscope earpieces in your ears and the stethoscope’s diaphragm or flat piece on your client’s radial artery at the elbow.
• Pump the blood pressure cuff until the pressure reads approximately 160 mmHg.
• Slowly release the pressure from the blood pressure cuff.
• The first pulse that you hear escape through the cuff when you release pressure is the systolic BP.
• The last beat that you hear is your client’s diastolic BP.

Normal Vital Signs

Breathing Strategies

This video explains how the OT practitioner can teach breathing strategies to their clients who have cardiopulmonary impairments. The three breathing strategies are called pursed-lip breathing, diaphragmatic breathing, and recovery breathing.

Breathing Strategies Video Transcript

Pursed Lip Breathing Tips

• Pursed-lip breathing is for clients with mild shortness of breath and will help them get their breathing under control.
• Breathe in through your nose like you are smelling a rose, and breathe out through your mouth like you are blowing out a candle.
• The out-breath is two times longer than the in-breath.

Diaphragmatic Breathing Tips

• Teaching your client how to do diaphragmatic breathing before a task can help them to slow down their shortness of breath because it’s going to help them pace the task better.
• Clients with COPD have stopped diaphragmatic breathing. Their diaphragm actually flattens out and becomes less efficient—they transition to accessory-muscle breathing. Diaphragmatic breathing teaches them to use that diaphragm again because it’s still more efficient.
• Place your client’s hands on their stomach. Instruct them to breathe in through the nose—their belly inflates. Instruct them to breathe out through their mouth—their belly collapses.
• Diaphragmatic breathing helps improve oxygenation. It helps regulate the sympathetic nervous system, also helping with anxiety.

Recovery Breathing Tips

• Recovery breathing is used when your client is severely short of breath.
• Prop your client’s arms up, and lay their head down. You can do this while they are sitting down at a table, standing at a table, or standing against a wall.
• In accessory breathing, the muscles that attach to the rib cage—the scalene and pectoralis muscles, help inflate the upper part of the chest. When you are propping and stabilizing your client’s arms up, the scalene and pectoralis muscles are taken out of the picture, forcing the oxygen to transmit into their chest
• Recovery breathing helps your client to maximally inhale into the chest.

Resources

● Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure) by Johns Hopkins
Medicine, CC BY
● How to Take Vital Signs- Step by Step Manual Instruction by USA Medical and Surgical Supplies, CC BY
● Breathing Exercises by American Lung Association, CC BY