Chest Physical Therapy Flashcards
Typical goals of chest PT
Prevent airway obstruction and ateclasis Improve airway clearance and ventilation thru drainage Improve endurance Reduce energy costs during respiration Prevent or improve postural deformities Improve cough Promote relaxation
What is ateclasis
Collapse of lung
Obstructive disorders
COPD Chronic bronchitis Emphysema Asthma Bronchiectasis Cystic fibrosis
COPD
Term used to describe chronic lung diseases that are characterized by progressive obstruction of airflow into or out of lungs and SOB
Usually combo including chronic bronchitis and emphysema
Chronic bronchitis
Airway narrowing, excessive mucus secretion, productive cough for 3+ months at a time over 2 consecutive yrs.
Blue bloaters Hypoxemia Inadequate gas exchange? Edema Mortality rate 2x as high as pink puffers
Thought to be related to long term irritation of tracheobronchial tree; most commonly smoking
Pt is stocky, breathes w accessory mm, may wheeze, & have neck vein distention
Emphysema
Disease of alveoli which become hyperinflated
Tend to become pink puffers who maintain near normal blood gases at the expense of breathlessness & weight loss
Pt is dyspneic (difficulty breathing), thin, used accessory mm, pursed lips in expiration, commonly with chronic bronchitis
Rare among non smokers
Males are more likely to get it
Asthma
Increased reactivity of tracheobronchial tree in presence of various stimuli manifested in episodic attacks of wheezing and dyspnea
Extrinsic stimuli- pollen, animals, feathers, molds, dust, food
Intrinsic stimuli- weather (high humidity, cold air), Resp. Infections, drugs, emotions, exercise.
1st attack is usually after age 35 & has evidence of chronic airway obstruction w/episodes of acute bronchospasm (abnormal contraction of smooth mm, causing obstruction if airway)
Lumen is narrowed or occluded b inflammation
Tachypnea, use accessory mm, audible wheezing, frequent unproductive cough, c/o chest tightness
Bronchiectasis
Chronically dilated airways as a result of damage manifested in obstructed airflow, excess mucus, frequent infections that destroy cilia
Cystic fibrosis
Inherited disorder of excess exocrine gland activity affecting many organ systems.
Viscous secretions obstruct airways and pancreatic ducts
Restrictive disorders
Differing etiologies result in difficulty expanding the lungs and reduction in lung volume
Anything that affects elasticity or compliance of lung
Acute restrictive disorders
Atelectasis
ARDS
Pulmonary edema
Pneumonia
Atelectasis
Aka pneumothorax
Collapse of segments of lobes or lungs
Can be caused by compression of lung tissue or obstructed airway with absorption of trapped air which collapses lung tissue distal to obstruction.
Common after thoracic or abdominal surgery
S/s: decreased chest movement, absent breath sounds over involved area, mediastinal shift to involved side, rapid breathing, cyanosis.m
ARDS - Acute or adult respiratory distress
Increased permeability of alveolar capillary membrane and sever hypoxemia
May show: Resp. Distress, severe hypoxia that doesnt respond to high O2 concentration, decreased lung compliance
Pulmonary edema
Accumulation of fluid in the extra vascular space, which can initially occur in the interstitium and then go to alveolar spaces
Chest PT not indicated
Pneumonia
Acute inflammation of lung parenchyma (abnormal tissue growth of a structure) which fills alveoli with exudates and leads to conSOLIDation
Chest PT possibly for obtaining sputum samples
Deep breathing and positioning to improve gas exchange
Supported caught to remove secretions
Pleural effusion
Restrictive disorder where fluid accumulates in pleural cavity and compresses lungs
Mobilization helps prevent undue atelectasis
Deep breathing for gas exchange
Interstitial lung disease
Restrictive disorder group if about 130 disorders associated with immune disturbances
Chest PT rarely indicated except for maintaining fx activities
Neuromuscular & skeletal disorders
Restrictive disorder with kyphoscoliosis, ankylosing spondylitis, rib fx, & other trauma
Obesity
Restrictive disorder limits diaphragm movement
Can include ascites which is abnormal accumulation of fluid in abdomen
S/P abdominal or thoracic surgery
Restrictive disorder where pain limits respiratory movement and coughing
CNS depression
Restrictive disorder where respiration is depressed
Abscess
Focal collection of pis caused by infection; deep breathing & positioning to improve gas exchange.
Pulmonary TB
Potentially serious infectious disease that affects mostly ur lungs.
Spread thru tiny droplets
External respiration
Exchange of gas at alveolar capillary membrane between atmospheric air and pulmonary capillaries
Internal respiration
Exchange of gas at tissue level between RBC and tissue cells
Inspiration muscles
Diaphragm- moves down as it contracts
External intercostals- prevent intercostal space being sucked in by negative pressure and it lifts ribs
Accessory inspiration muscles
Sternocleidomastoid Upper traps Scalenes Serratus ant Pec major Pec minor Erector spinae
Expiratory muscles
Abdominal s
Internal intercostals
Right lung
Has upper, middle, and lower lobe
Left lung
Upper and lower lobes and lingula coming off upper lobe
Total lung capacity
Volume of air in lungs at full inspiration
Tidal volume
Amount of air inspired and expired during normal resting ventilation- about 500 mL/breath for young healthy male.
350 take part in gas exchange and 150 remain in conducting airways
Inspiratory reserve volume
Volume of air that can be inspired in excess of tidal inhalation
Expiratory reserve volume
Volume of air that can be expired in excess of tidal exhalation
Residual volume
Volume of air remaining after ERV has been exhaled
Inspiratory capacity
Tidal volume + inspiratory reserve volume- volume of air that can be inspired
Functional residual capacity
Residual volume + expiratory reserve volume- volume of air remaining at end of tidal exhalation.
Vital capacity
Tidal volume + inspiratory reserve volume + expiratory reserve volume - total volume of air within lungs that is under volitional control
FEV1
Forced expiratory volume in 1 second
Thought to reflect status of larger airways of lungs
FEF 25-75%
Flow rate in middle of forced expiratory flow volume curve
Thought to reflect status of smaller more fragile airways
Vital signs to be aware of
Awareness Color Facial signs Mouth breathing Jugular vein engorgememt Hypertrophy of accessory mm Edema
Barrel chest
Upper chest circumference larger than lower chest. Sternum is prominent
Pectus excavatum
Breastbone sunken into chest. Lower part of sternum is depressed and lower ribs flare out. Cm,on in diaphragmatic breathers
Pectis carinatum
Pigeon breast
Deformity where sternum is prominent and protrudes anteriorly
Normal ratio of inspiration to expiration at rest, with activity, and with chronic lung disease
Rest 1:2
Activity 1:1
Disease 1:4
Bradypnea
Slow rate with shallow or normal depth.
May be associated with drug overdose
Orthopnea
Abnormal condition in which a person must sit or stand to breathe deeply or comfortably
Apnea
Cessation of breathing in respiratory phase
Apneusis
Cessation of breathing in inspiratory phase
Cheyne- Stokes
Cycles of gradually increasing tidal volumes, followed by a series of gradually decreasing tidal volumes, and then a period of apnea; somewhat associated with severe brain injury
Good and bad coughing
Effective: sharp and deep
Ineffective: may be soft, throaty, shallow, dry
Sputum color
Clear is normal
Yellow/green is infection
Blood streaked is described as hemoptysis
