Management of Pulmonary Conditions: Review and Treatment

1. 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