Management of Pulmonary Conditions Chapter 25 Management of Pulmonary Conditions

Review of Respiratory Structure and Function Thorax and chest wall: structure and function Muscles of ventilation Inspiration Diaphragm Scalenes Parasternal intercostals Accessory muscles of inspiration Expiration Abdominals

Review of Respiratory Structure and Function (cont.) Mechanics of ventilation Movements of the thorax during ventilation Increase in the anteroposterior dimension Increase in the transverse (lateral) dimension Increase in vertical dimension Movement of air Compliance Airway resistance Flow rates

Review of Respiratory Structure and Function (cont.) Anatomy and function of the respiratory tracts Upper respiratory tract Lower respiratory tract Trachea Mainstem bronchi Lobar bronchi

Review of Respiratory Structure and Function (cont.) Anatomy and function of the respiratory tracts Segmental bronchi Bronchioles Alveoli Summary of function of the upper and lower respiratory tracts The lungs and pleurae

Review of Respiratory Structure and Function (cont.) Lung volumes and capacities Total lung capacity Tidal volume Inspiratory reserve volume Expiratory reserve volume Residual volume Inspiratory capacity Functional residual capacity Vital capacity

Components of the Examination History and systems review General appearance of the patient Analysis of chest shape and dimensions Symmetry of the chest and trunk Mobility of the trunk Shape and dimensions of the chest

Components of the Examination (cont.) Posture or preferred positioning Breathing pattern Chest mobility Symmetry of chest movement Extent of excursion

Components of the Examination (cont.) Palpation Tactile (vocal) fremitus Chest wall pain Mediastinal shift Mediate percussion

Components of the Examination (cont.) Auscultation of breath sounds Classification of breath sounds Cough and cough production Additional areas of examination

Breathing Exercises and Ventilatory Training Guidelines for teaching breathing exercises Diaphragmatic breathing Segmental breathing Lateral costal expansion Posterior basal expansion

Breathing Exercises and Ventilatory Training (cont.) Pursed-lip breathing Preventing and relieving episodes of dyspnea Positive expiratory pressure breathing Respiratory resistance training Inspiratory resistance training Incentive respiratory spirometry Glossopharyngeal breathing

Exercises to Mobilize the Chest Specific techniques To mobilize one side of the chest To mobilize the upper chest and stretch the pectoralis muscles To mobilize the upper chest and shoulders

Coughing The normal cough pump Factors that decrease the effectiveness of the cough mechanism and cough pump Teaching an effective cough

Coughing (cont.) Additional techniques to facilitate a cough and improve airway clearance Manual-assisted cough Therapist-assisted techniques Self-assisted technique Splinting Humidification Tracheal stimulation Suctioning: alternative to coughing

Postural Drainage Manual techniques used with postural drainage therapy Percussion Relative contraindications to percussion Vibration Shaking Postural drainage positions

Postural Drainage (cont.) Guidelines for implementing postural drainage General considerations Time of day Frequency of treatments Preparation for postural drainage Postural drainage sequence Concluding a treatment Criteria for discontinuing postural drainage Modified postural drainage Home program of postural drainage

Treatment of Patients with Chronic Obstructive Pulmonary Disease Types of obstructive pulmonary disorders Peripheral airway disease Chronic bronchitis and emphysema Asthma Bronchiectasis Cystic fibrosis

Treatment of Patients with Chronic Obstructive Pulmonary Disease (cont Pathological changes in the pulmonary system Impairments and impact on function Chronic, productive cough Shortness of breath (dyspnea) related to the inability to remove air from the lungs Management guidelines: COPD

Treatment of Patients with Restrictive Pulmonary Disorders Acute and chronic causes of restrictive pulmonary disorders Pulmonary causes Extrapulmonary causes Pathological changes in the pulmonary system

Treatment of Patients with Restrictive Pulmonary Disorders (cont.) Management guidelines: post thoracic surgery Factors that increase the risk of pulmonary complications and restrictive lung dysfunction after thoracic surgery General anesthesia Intubation (insertion of an endotracheal tube) Incisional pain Pain medication General inactivity, postoperative weakness, and fatigue Other risk factors

Treatment of Patients with Restrictive Pulmonary Disorders (cont.) Management guidelines: post thoracic surgery Thoracic surgery: operative and postoperative considerations during management Co-morbidities and related dysfunction Surgical approach Additional considerations