Respiratory Lecture 1

Question 1

Sinusitis

Answer 1

inflammation of the sinuses that occurs with an infection from a virus, bacteria, or fungus.

Question 2

Sinusitis causes, risk factors, incidence

Answer 2

Usually, mucus is able to drain out and air is able
to circulate.

When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.

Question 3

Sinusitis can occur from

Answer 3

• Deviated septum, nasal bone spur, nasal polyps
• Small hairs (cilia) not working properly
• Colds and allergies

Question 4

Ethmoid sinusitis

Answer 4

(between/behind the eyes)

– Nasal congestion with discharge or postnasal drip (mucous drips down the throat behind the nose)
– Pain or pressure around the inner corner of the eye or down one side of the nose
– Headache in the temple or surrounding the eye
– Pain/pressure symptoms worse when coughing, straining, or lying on the back & better when head is upright
– Fever is common

Question 5

Maxillary sinusitis

Answer 5

(behind the cheek bones)

– Pain across the cheekbone, around the eye, or around the upper teeth, pain/pressure on 1 side or both
– Tender, red, or swollen cheekbone
– Pain and pressure symptoms are worse with the head upright and bending forward & better when reclining
– Nasal discharge or postnasal drip
– Fever is common

Question 6

Frontal sinusitis

Answer 6

(behind forehead, one or both sides)

– Severe headaches in the forehead
– Fever is common
– Pain is worse when reclining and better with the head upright
– Nasal discharge or postnasal drip

Question 7

Sphenoid sinusitis

Answer 7

(behind the eyes)
– Deep headache with pain behind and on top of the head, across the forehead, and behind the eye
– Fever is common
– Pain is worse when lying on the back or bending forward
– Double vision or vision disturbances if pressure extends into the brain
– Nasal discharge or postnasal drip

Question 8

Ethmoid sinusitis S&S

Answer 8

– Chronic nasal discharge, obstruction, and low-grade discomfort across the bridge of the nose

– Pain is worse in the late morning or when wearing glasses

– Chronic sore throat and bad breath

Question 10

Maxillary sinusitis S&S

Answer 10

• Discomfort or pressure below the eye
• Chronic toothache
• Pain possibly worse with colds, flu, or allergies
• Increased discomfort throughout the day with increased cough at night

Question 11

Frontal sinusitis S&S

Answer 11

• • Persistent, low-grade headache in the forehead
• History of trauma or damage to the sinus area

Question 12

Sphenoid sinusitis S&S

Answer 12

• Low-grade general headache is common

Question 13

Sinusitis Red flags

Answer 13

• Fever
• Facial trauma
• Intense, severe swelling affecting vision, hearing
• Ongoing symptoms

Question 14

Sinusitis HISTORY:

Answer 14

• Do you have a fever?
• Does this affect vision, hearing?
• Have you been dx by your doctor?
• Do you have a history of sinusitis? How long?
• Where do you feel the pain? How does it feel?
• Have you had any dental work recently? Trauma to face?
• Do you have any nasal discharge?

Question 15

Sinusitis OBSERVATION:

Answer 15

• Swelling over sinuses/eyes/runny nose
• Squinting eyes
• Breathing through mouth

Question 16

Sinusitis Palpation

Answer 16

• Gentle palpation over the frontal in the orbit of eye (superiorly) and maxillary sinuses under the zygomatic arch can be used to detect sinusits. There may be possible tenderness, heat and swelling.

Question 17

Sinusitis Movement

Answer 17

• Differentiate between tension HA and sinus HA –position change with increase sinus HA
• DDX between other headaches, trigger points and facet
• Decompression, compression

Question 18

Sinusitis NEUROLOGICAL:

Answer 18

• Sympathetic innervation to sinuses in the upper t-spine pass through the c-spine ganglion.

Question 19

Sinusitis Referred pain

Answer 19

• There may be referred pain in the eyes, ears, neck, temples, teeth,
  cheeks back of head.

Question 20

Sinusitis Special Tests

Answer 20

• Transillumination test
• Palpation

Question 21

SINUSITIS TREATMENT GOALS:

Answer 21

• Relieve obstruction and pain
• Effect reflex change
• Improve mucociliary clearance
• Treatment to all sinuses to assist drainage of all sinuses (although only one sinus may be infected.)

Question 22

Treatment Goals for Respiratory Conditions

Answer 22

• Reduce workload of breathing
• Ease removal of accumulated bronchial secretions and phlegm
• Improve lymphatic and venous flow
• Improve arterial circulation to carry immune system products to
  lungs
• Restore and maintain thoracic mobility
• Decrease hypertonicity of accessory muscles of respiration
• Reduce pain and discomfort by decreasing muscle spasm, TP’s and
  adhesions
• Identify and treat chronic hyperventilation
• Increase client’s awareness of “good breather”

Question 23

Contraindications to percussion:

Answer 23

• Osteoporosis
• Malignancy (and/or potential malignancy)
• Inflammation in the area to be treated/percussed
• Recent trauma in the area to be percussed
• Pain during application of percussion

Question 24

Breathing Sequence

Answer 24

1. diaphragm contracts
2. lateral costal expansion as the ribs move up and out
3. upper chest rises (accessory respiratory muscles should be at rest)

Question 25

Accessory breathing mm

Answer 25

* SCM - elevates sternum * Scalenes - elevate upper rib * Pec minor

Question 26

Principal mm of inspiration

Answer 26

* External intercostals * Internal intercostals (interchondral part) * Diaphragm

Question 27

mm of expiration Quiet breathing

Answer 27

Expiration results from: * Elastic recoil of lungs, rib cage, diaphgram

Question 28

mm of expiration Active breathing mm

Answer 28

* Internal intercostals (except interchondral part) * Abdominals * QL (pulls ribs down)

Question 29

COPD Assessment caution

Answer 29

Must have MD referral to proceed

Question 30

Indications for Respiratory Assessment and Treatment

Answer 30

1. COPD 2. post-operation 3. client who has been confined to bedrest 4. abnormalities / decreased mobility of thorax 5. postural disorders (extreme kyphosis, scoliosis) 6. voice training, breath control (singers, actors) 7. client who’s trying to quit smoking 8. allergies 9. chronic pain 10. improved breathing awareness 11. post traumatic stress disorder 12. athletes

Question 31

1. RIB EXCURSION

Answer 31

Measure at the axilla, xiphoid process at the top of the inhale and at the end of the exhale with a tape measurement. Note that the measurements should be 3-7 cm apart for the inhale to exhale at each location.

Question 32

LOBE EXPANSION TEST

Answer 32

Check upper lobe expansion * Stand facing your guest * Tips of thumbs at midsternal line, at sternal notch * Fingers above clavicles * Guest fully exhales, then inhales deeply Check middle lobe expansion * Face your guest * Place tips of thumbs at xyphoid, extend fingers laterally around the ribs * Guest exhales fully, deep inhalation Check lower lobe expansion * Go to the back of your guest * Place tips of your thumbs along their back, at the spinous processes (lower T/S); extend your fingers around their ribs * Guest exhales fully, deep inhalation

Question 33

PERCUSSION test

Answer 33

Assesses lung density – i.e., air to solid ration in the lungs. Determines whether underlying tissues are air-filled, fluid-filled or solid. Only penetrates 5-7 cm – can’t detect deep-seated lesions * Place middle finger of non-dominant hand flat against chest wall along an intercostals space * Use tip of the middle finger of the dominant hand to tap firmly on the finger positioned along the intercostals space * Repeat at several points on right and left, anterior and posterior * Percussion produces resonance – pitch varies with density of underlying tissue Abnormal: sound is dull/flat is there is too much solid matter (tumour, consolidation) in the lungs, compared to amount of air Abnormal: sound is tympanic (hyper-resonant) is there is more air in the area (e.g. emphysema) Normal: judgement is unique to the therapist; comes with percussing MANY chest walls

Question 34

AUSCULTATION

Answer 34

Listening to breath sounds -> indicate movement of air in the airways of the lungs during inspiration/expiration Use a stethoscope  Allows therapist to identify where congestion exists, so that postural drainage can be performed properly  Allows therapist to evaluate whether postural drainage has been properly/effectively performed  Guest sits in comfortable, relaxed position  Stethoscope is placed directly on guest’s skin, anterior and posterior chest wall  Follow a PATTERN along the right and left sides of the chest wall, anterior/posterior, so that you can accurately re-evaluate  Ask your guest to breathe in deeply and out quickly through the mouth as you move the stethoscope from point to point  Record your findings: note quality, intensity, and pitch  See text for detailed explanation of breath sounds  Deep breath through mouth – follow percussion path  Location, pitch and intensity ** note them down!  Normal vs abnormal and adventitious (extra): e.g. crackles, wheezes

Question 35

VOCAL/TACTILE FREMITIS

Answer 35

* Place palms of your hands lightly on the chest wall * Ask the guest to speak a few words or repeat “99” * Normal: fremitus (vibration) is felt uniformly on the chest wall * Abnormal: fremitus increases in the presence of secretions in the airways; * decreases/absent when air is trapped (obstructed airways)

Question 36

Lateral Costal Expansion

Answer 36

* As the client breaths out, place a firm downward pressure into the ribs with the palms of your hands. * Just prior to inspiration, apply a quick downward and inward stretch to the chest. * This places a quick stretch on the external intercostals to facilitate their contraction. * These muscles move the ribs outward and upward during inspiration.

Question 37

Pursed Lip Breathing

Answer 37

Taught to clients with COPD to help deal with shortness of breath

Question 38

Segmental Breathing

Answer 38

because of pain and muscle guarding after surgery, collapsed lung, pneumonia, prolonged bed rest, etc.