1. Management of Pulmonary Conditions
Chapter 25
Management of Pulmonary Conditions

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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

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

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

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

12. 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

13. 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

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

15. 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

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

17. 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

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

19. 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

20. 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

21. 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

22. 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