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
2
Q
Sinuses and head structures visceral afferent/SNS
A
T1-4
3
Q
Bronchioles visceral afferent/SNS
A
T1-6
4
Q
Ribs at
A
T1-12
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)
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)
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
8
Q
Musckuloskeletal structural changes in COPD
A
- barrel chest
- hypertrophied accessory muscles
- increased kyphosis
- T spine immobility and dysfunction
- rib and diaphragm restrictions
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
10
Q
Decreased ciliated epithelial cell efficiency in COPD
A
-small airway plugging due to decreased clearance of the thick mucous
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
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
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
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
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
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
17
Q
Asthma
A
- obstructive process secondary to bronchospasm and mucous plugging
- hyperparasympathetic drive, impaired lymphatic drainage
18
Q
Chapman’s reflex points for lungs, viscerosomatic reflexes in
A
T1-6 region bilaterally
19
Q
Treatment of Astham acute exacerbation
A
- short-acting bronchodilators
- PO/IV steroids
20
Q
Maintenance therapy for asthma
A
-inhaled steroids, long-acting bronchodilators, leukotriene inhibitors
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
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
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
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
25
Lymphatic treatment for pulmonary problems
- 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
Pedal Pump for pulmonary problems
- 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
Doming the diaphragm
- 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
Tapotement
- 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
Effects of SNS on cardiac tissue
- tachycardias
- vasoconstriction
- increases workload
30
Effects of PNS on cardiac tissue
- bradycardias
| - limited vasodilation
31
Effects of PNS on pulmonary tissue
- increased ciliated epithelial cells
- clear, thin mucous
- bronchoconstriction
32
Effects of SNS on pulmonary tissue
- increased goblet cells
- thick, tenacious mucous
- bronchodilation, vasoconstriction
33
Cardiac SNS
-T1-5
-R=SA node
L=AV node
-sympathetic chain ganglion
34
Cardiac PNS
- midbrain
- vagus nerve
- R=SA node
- L=AV node
35
Pulmonary SNS
- T2-7
- upper thoracic sympathetic chain ganglion
- ipsilateral
36
Pulmonary PNS
- midbrain (medulla oblongata)
- vagus nerve
- ipsilateral
37
Sympathetic treatment for pulmonary patient
- rib raising
- decrease facilitation
- increase the motion of the thoracic cage
- also a lymphatic treatment
- thins secretions
38
Rib raising seated
- 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
Rib raising supine
- 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
SNS treatment for pulmonary patient: relax thoracolumbar junction
- 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
Pulmonary treatment: treat anterior and posterior cervical soft tissue
- 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
PNS treatment for pulmonary patient: cranial
- CV4
| - V spread of the frontal suture
43
CV4
-relieve headache
relieve congestion in sinuses and lungs
-reduces fever
-also a lymphatic treatment and addresses sympathetics
44
V-spread off the frontal suture
- establishes good motion of the ethmoid bone in the ethmoid notch of the frontal bone
- improves sinus drainage
45
PNS treatment for pulmonary patient: sphenopalatine ganglia
- 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
Treat vagus nerve
- 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
Scalene stretches
- 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
Posterior scalene stretch
-rotation of head away from side being stretched
49
Anterior scalene stretch
-rotation of head toward the side benign stretched
50
Middle scalene stretch
-with head looking forward
51
Exhalation pump handle rib
- 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
Exhalation bucket handle rib
- 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
Rib 2-10 exhalation pump handle
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
Ribs 2-10 exhalation bucket handle
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
Ribs 11 and 12 exhalation dysfunction
- 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
inhalation dysfunction rib 1 pump handle
- 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
inhalation dysfunction rib 1 bucket handle
- 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
Inhalation dysfunction ribs 2-10 pump handle
- 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
Inhalation dysfunction ribs 2-10 bucket handle
- 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
Inhalation dysfunction ribs 11-12
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
