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OS3 Exam II > Pulmonary Patient > Flashcards

Pulmonary Patient Flashcards

1
Q

Respiratory infections

A
  • begin with decreased host resistance
  • initially PSN activity is increased–mucous secretion becomes more profuse and watery, this is the body’s attempt to flush the pathogens or irritations out of the area
  • eventually visceral afferent impulses to the spinal cord increase
  • share pathways with sympathetic system
  • leads to autonomic imbalance and thus facilitated segments at the level affected
  • permits viscerovisceral and viscerosomatic reflexes to occur, increase the SNS output to the respiratory epithelium, increase motor output to somatic structures
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2
Q

Sinuses and head structures visceral afferent/SNS

A

T1-4

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3
Q

Bronchioles visceral afferent/SNS

A

T1-6

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4
Q

Ribs at

A

T1-12

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5
Q

Goals for osteopathic manipulative management of pulmonary infections

A
  • normalize autonomic tone (neurologic model)
  • improve thoracic cage compliance (biomechanical model)
  • enhance lymphatic return to the heart (fluid and respiratory model)
  • reduce contributions to the facilitated cord segments and reduce hyper sympathetic tone to the lungs (neurologic model)
  • maximize efficiency of the diaphragm (fluid and respiratory model)
  • treat secondary effects (metabolic model)
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6
Q

Characteristic pathologic changes in COPD

A
  • destruction of septal walls of alveoli
  • loss of elastic recoil
  • destruction of vascular bed
  • fusion of adjacent alveoli producing large abnormal airspaces (blebs or bullae)
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7
Q

CXR findings in COPD

A
  • flattened diaphragms, hyperinflated lungs, thin appearing heart and mediastinum
  • parenchymal bullae or suprapleural blebs in patients with emphysema
  • increased AP diameter (on a lateral CXR)
  • increased pulmonary vasculature
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8
Q

Musckuloskeletal structural changes in COPD

A
  • barrel chest
  • hypertrophied accessory muscles
  • increased kyphosis
  • T spine immobility and dysfunction
  • rib and diaphragm restrictions
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9
Q

increased Sympathetic tone in COPD

A
  • hypertrophy of the mucosa
  • increased goblet cells
  • increased secretion of mucous (thick)
  • mucus plugs hard to expectorate
  • causing air trapping, bronchiectasis
  • can trap bacteria and allow secondary infection
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10
Q

Decreased ciliated epithelial cell efficiency in COPD

A

-small airway plugging due to decreased clearance of the thick mucous

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11
Q

Reactive bronchospasm in COPD

A
  • couples with thick mucous and decreased cilia action to worsen mucous plugging
  • can lead to for pulmonale if respiratory function further decreases
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12
Q

Forced vital capacity in COPD

A
  • decreases
  • forced exhalation collapses small bronchi and further traps air
  • patient exhales with pursed lips to maintain high intrabronchial pressure
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13
Q

Sympathetic innervation T2-7 in COPD

A
  • activation of somatic afferents from the lungs results in widespread tissue texture changes
  • resulting somatic dysfunction further increases afferent drive
  • more stress–exacerbates the inflammatory response
  • more inflammatory and neuroendocrine/immune responses
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14
Q

Increased AP diameter in

A

COPD

  • accommodate the trapped air and increase lung residual volume capacity
  • resting diaphragmatic tone increases and diaphragm becomes flattened
  • Length-tension relationship
  • decrease in blood supply and O2 delivery/consumption ratio
  • muscles forced into aerobic metabolism, increased lactic acid
  • transitional ares of spine are placed under increased stress
  • respiratory motion in these segments reduced
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15
Q

Overuse of accessory muscles in COPD leads to

A
  • cervicothoracic and rib somatic dysfunction

- irritation of the phrenic nerve from cervical somatic dysfunction can reduce diaphragm function

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16
Q

COPD treatment

A
  • risk factor modification
  • symptomatic relief with short-acting bronchodilators
  • bronchdilation with anticholinergics
  • inhaled steroids for decreased inflammatory response
  • PO steroids for severe exacerbation
  • Abx as needed for infection/infection prevention in acute exacerbation
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17
Q

Asthma

A
  • obstructive process secondary to bronchospasm and mucous plugging
  • hyperparasympathetic drive, impaired lymphatic drainage
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18
Q

Chapman’s reflex points for lungs, viscerosomatic reflexes in

A

T1-6 region bilaterally

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19
Q

Treatment of Astham acute exacerbation

A
  • short-acting bronchodilators

- PO/IV steroids

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20
Q

Maintenance therapy for asthma

A

-inhaled steroids, long-acting bronchodilators, leukotriene inhibitors

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21
Q

OMT and Respiratory Disease

A
  • many musculoskeletal patterns arise as a reflex or mechanical response to pulmonary dysfunction and respiratory disease
  • the osteopathic physician should address these considerations as well as supply any necessary pharmacologic or supportive measures
  • OMT can reduce the pain and immobility associated with somatic dysfunction related to pulmonary disease as well as enhance or accelerate the healing process
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22
Q

OMT Respiratory treatment in general

A
  • emphasis on maximizing homeostasis
  • normalize sympathetic tone: rib raising, paraspinal inhibition
  • normalize PNS tone: sub occipital release
  • Address lymphatics
  • address specific SDs: normalize rib motion; thoracic dysfunction
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23
Q

Specific areas of need in OMT treatment of respiratory problems

A
  • upper T spine, ribs, sternum
  • T1-6
  • OA/vagus nerve course
  • accessory muscles
  • anterior cervical fascia
  • thoracic diaphragm
  • chapman’s reflexes
  • cranial mechanism
  • T10-L2/lower ribs/quadratus lumborum
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24
Q

Contraindications and Precautions to OMT in pulmonary problems

A
  • don’t treat in supine position (relative)
  • avoid forceful direct methods acutely
  • do not over treat and tire the patient
  • avoid positions that may restrict respiratory efforts
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25
Q

Lymphatic treatment for pulmonary problems

A
  • thoracic inlet: MFR–hold the pt into the restrictive barrier
  • thoracic pump with vacuum: patient supine; physician standing at the head of the bed, with his/her hands on the anterior chest, resist inhalation and exaggerate exhalation, relatively contraindicated in COPD
26
Q

Pedal Pump for pulmonary problems

A
  • patient supine
  • physician at the foot of the bed
  • grasp the patient’s feet placing the palms of your hands on the soles of the feet
  • press cephalad on the feet then release in a rhythmic fashion to produce a gentle rocking of the body
27
Q

Doming the diaphragm

A
  • patient supine, physician at side of table
  • place thumbs, avoiding the xiphoid process pointing medially and superiorly
  • resist inhalation and increase pressure with each exhalation for 4-5 respiratory cycles pushing the thumbs cephalad on the final cycle of treatment
28
Q

Tapotement

A
  • patient prone, or if unable, laying on one side, with doc standing and facing patient
  • there are 3 components to tapotekment: hacking, slapping, and cupping. Each of these treatments begins cephalad, moves ciudad, and returns cephalad (always ending toward the thoracic duct)
  • hacking is applying a karate chop over the posterior rib cage in a superior to inferior and back to superior direction
  • in slapping, flat, open hands are used in the same direction
  • cupping–hands are in a cupcake position
29
Q

Effects of SNS on cardiac tissue

A
  • tachycardias
  • vasoconstriction
  • increases workload
30
Q

Effects of PNS on cardiac tissue

A
  • bradycardias

- limited vasodilation

31
Q

Effects of PNS on pulmonary tissue

A
  • increased ciliated epithelial cells
  • clear, thin mucous
  • bronchoconstriction
32
Q

Effects of SNS on pulmonary tissue

A
  • increased goblet cells
  • thick, tenacious mucous
  • bronchodilation, vasoconstriction
33
Q

Cardiac SNS

A

-T1-5
-R=SA node
L=AV node
-sympathetic chain ganglion

34
Q

Cardiac PNS

A
  • midbrain
  • vagus nerve
  • R=SA node
  • L=AV node
35
Q

Pulmonary SNS

A
  • T2-7
  • upper thoracic sympathetic chain ganglion
  • ipsilateral
36
Q

Pulmonary PNS

A
  • midbrain (medulla oblongata)
  • vagus nerve
  • ipsilateral
37
Q

Sympathetic treatment for pulmonary patient

A
  • rib raising
  • decrease facilitation
  • increase the motion of the thoracic cage
  • also a lymphatic treatment
  • thins secretions
38
Q

Rib raising seated

A
  • patient crosses arms,t hen leads forward,r eating crossed arms on physicians shoulders
  • physician reaches around patient and grapes posterior inferior rib angles bilaterally
  • apply a lateral and upward traction bilaterally at the rib angles while pulling the patient toward you and asking the patient to inhale deeply
  • start with the inferior ribs and move superiorly
39
Q

Rib raising supine

A
  • place hands (palms up) under the patient’s thorax, contacting the rib angles with the pads of your fingers
  • apply lateral and upward traction while leaning backward, bending your knees and lowering your trunk. This is a fulcrum/lever action
  • treatment begins in the lower ribs and moves upward to subsequent rib angles until all ribs are treated. Treat bilaterally
40
Q

SNS treatment for pulmonary patient: relax thoracolumbar junction

A
  • place patient lateral recumbent, supine, or prone
  • gently pull paravertebral muscles anterolaterally inducing a perpendicular stretch in the lower thoracic and upper lumbar segments
41
Q

Pulmonary treatment: treat anterior and posterior cervical soft tissue

A
  • reduces sympathetic stimulation to the head and neck causing congestion and prepares the c-spine for further treatment techniques
  • treat C3-5 addresses the phrenic nerve facilitation
42
Q

PNS treatment for pulmonary patient: cranial

A
  • CV4

- V spread of the frontal suture

43
Q

CV4

A

-relieve headache
relieve congestion in sinuses and lungs
-reduces fever
-also a lymphatic treatment and addresses sympathetics

44
Q

V-spread off the frontal suture

A
  • establishes good motion of the ethmoid bone in the ethmoid notch of the frontal bone
  • improves sinus drainage
45
Q

PNS treatment for pulmonary patient: sphenopalatine ganglia

A
  • influence the outflow to the sinus and respiratory epithelium to thin secretions
  • treated with rhythmic intramural pressure over the ganglia, aided by patient position and motion
46
Q

Treat vagus nerve

A
  • accomplished with various treatment modalities to the OA and AA regions of the cervical spine
  • MFR, ME, Still’s technique
  • headaches are often associated with respiratory complaints due to association of vagus nerve with spinal nerves I and II (OA/AA)
  • normalize PNS influence on lungs
47
Q

Scalene stretches

A
  • upper T spine, ribs, sternum
  • T1-6
  • OA/vagus nerve course
  • accessory muscles
  • anterior cervical fascia
  • thoracic diaphragm
  • chapman’s reflexes
  • cranial mechanism
  • T10-L2/lower ribs/quadratus lumborum
48
Q

Posterior scalene stretch

A

-rotation of head away from side being stretched

49
Q

Anterior scalene stretch

A

-rotation of head toward the side benign stretched

50
Q

Middle scalene stretch

A

-with head looking forward

51
Q

Exhalation pump handle rib

A
  • patient supine with dorsum of hand, on involved side, resting on the forehead
  • doc at side of table on side of dysfunction
  • cephalad hand rests on the patient’s had that is on the forehead
  • the caudal hand contacts the rib angle of dysfunctional rib
  • on inhalation doc pulls inferior ont he rib angle with the caudal hand while resisting the patient’s attempting flex his/her head
  • apple steps of ME
52
Q

Exhalation bucket handle rib

A
  • patient rotates head 30 degrees and places hand on head
  • physician contact with caudal hand the rib posteriorly while placing the cephalad hand on the patient’s hand
  • patient inhales and with inhalation tries to flex his/her head
  • simultaneously the physician resists head flexion and pulls inferiorly on the contacted rib
  • steps of ME applied
53
Q

Rib 2-10 exhalation pump handle

A

patient places palm up on the affected side

  • physician stand on side of dysfunction and contacts rib posteriorly with caudal hand and places cephalad hand on hand of patient
  • during inhalation the patient raises the hand toward the ceiling and the physician resists this motion while simultaneously pulling inferiorly on the rib posteriorly
  • apply steps of ME
54
Q

Ribs 2-10 exhalation bucket handle

A

patient place hand palm up on the affected side

  • physician stand on side of dysfunction and contacts rib posteriorly with caudal hand and places cephalad hand on hand of patient
  • during inhalation the patient raises the hand at a 45 degree angle toward the wall and physician resists this motion while simultaneously pulling inferiorly on the rib posteriorly
  • steps of ME
55
Q

Ribs 11 and 12 exhalation dysfunction

A
  • patient prone
  • physician stand on the opposite side of dysfunction
  • physician pulls patient’s legs toward him/her, and abducts the patient’s arm on the side of dysfunction
  • physician contacts the contralateral ASIS and pulls it toward him/her, while contacting the affected rib with the cephalad hand using the respiratory motion as the isometric contraction
  • ME
56
Q

inhalation dysfunction rib 1 pump handle

A
  • patient supine with doc seated at head of table
  • patient’s neck is bent forward, supported by physician
  • Doc contacts the superior anterior aspect of the dysfunctional rib with thumb (between the 2 heads of the SCM)
  • patient inhales deeply, while doc resists
  • with exhalation, doc follows rib motion inferiorly
  • doc continues to resist inhalation, and exaggerates motion into exhalation
  • repeated until motion of the rib is restored
57
Q

inhalation dysfunction rib 1 bucket handle

A
  • patient supine with doc at head of table
  • doc contacts the superior surface of the first rib posteriolaterally (lateral to SCM)
  • with the other hand, doc flexes the head forward, side-bends toward the dysfunctional rib (relieving tension from the scalene muscles)
  • patient takes an deep breath–with exhalation, doc follows the rib down and forward into exhalation
  • with next breath, doc resists inhalation and follows into exhalation
  • repeated until motion restored
58
Q

Inhalation dysfunction ribs 2-10 pump handle

A
  • patient supine–doc at head of table with knee under patient at the level of the affected rib
  • doc contacts the superior aspect of the rib with the first and second digits on the anterior chest wall-lateral to the sternum
  • through several respiratory cycles, the doc follows into exhalation and resists inhalation
  • repeated until motion restored
59
Q

Inhalation dysfunction ribs 2-10 bucket handle

A
  • patient supine–doc stands on affected side with knee under patient at level of affected rib
  • patient is side-bent toward the affected rib until relief of tissue tension is felt at the rib
  • doc contacts the superior aspect of the rib with the first and second digits in the midaxillary line
  • throughs several respiratory cycles, the doc follows into exhalation and resists inhalation until motion of the rib is restored
60
Q

Inhalation dysfunction ribs 11-12

A

patient prone–doc standing opposite the affected side

  • patient’s legs are brought toward the physician–arms are left at patient’s side, inducing side-bending away from the rib
  • with caudad hand, doc grasps ASIS and pulls posteriorly, inducing rotation toward the side of dysfunction
  • cephalad hand is placed not eh posterior aspect of the involved rib
  • doc exerts a lateral distraction force on the affected rib as patient forcefully exhales
  • these steps are repeated until motion of the rib is restored

OS3 Exam II (10 decks)

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