sinus resp Flashcards

Question

How many breaths per minute do you take?

Answer 1

12 regular breaths/minute (10-14 acceptable)

Answer 2

The typical respiratory rate for a healthy adult at rest is 12–20 breaths per minute. Average resting respiratory rates by age are: birth to 6 weeks: 30–60 breaths per minute. 6 months: 25–40 breaths per minute.

Answer 3

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)

Answer 4

the external intercostals and the diaphragm | The muscles of inspiration elevate the ribs and sternum

Answer 5

The internal intercostals, intercostalis intimi and subcostals. muscles of expiration depress the ribs and sternum

Answer 6

the sternomastoid, the scalenus anterior, medius and posterior, the pectoralis major and minor, the inferior fibres of serratus anterior and latissimus dorsi, the serratus posterior anterior may help in inspiration also the iliocostalis cervicis

Answer 7

the abdominal muscles: rectus, abdominis, external oblique, internal oblique and transversus abdominis. And in the thoracolumbar region the lowest fibres of iliocostalis and longissimus, the serratus posterior inferior and quadratus lumborum.

Answer 8

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 CAUTION: with advanced COPD, the therapist must have MD’s referral to proceed with treatment

Answer 9

: fever, sudden changes in guest’s condition

Answer 10

 History questions  CIs and precautions (Rattray & Ludwig P 881, 893 and 904)  Pre-treatment hydrotherapy  During treatment hydrotherapy  Negotiate long term and short term goals  Positioning for treatment, is there any modifications required? Bolsters? Slanted table? Other?  Is postural drainage appropriate? If so, perform the assessment to identify areas that need to be addressed.  Treatment techniques and modifications to treatment -Durations: if client is fragile, shorter tx may be appropriate -Tapotement/shaking/vibrations/rib springing etc appropriate? -Breathing exercises/training -Productive cough? As appropriate  Post-treatment hydrotherapy  Remedial exercise recommendations (consider cardiac health)

Answer 11

```  Diagnosis, when did they last see physician, have they been cleared for tx  Are they seeing other health practitioners (respiratory therapist, physiotherapist etc)  Medications  Episodes of dyspnea  Cardiac health history  Current physical exercise  ADLs  Cough, is it productive?  Triggers?  How long have they had the condition?  Xrays?  Areas of pain, soreness or discomfort?  Which lobe is affected?  Fever? Other symptoms? ```

Answer 12

 Rate, rhythm, and effort of breathing  Colour – nail beds, lips (periphery, central)  Mouth or nose breathing  Jugular vein engorgement – associated with increased venous pressure and a sign of potential right ventricular heart failure  Shape of chest and the way it moves – location of breath  Musculature – tone  Posture – head forward? t/s kyphosis, rounded shoulders?  Shape and movement of nostrils  Shape of lips (smaller upper lip may indicate chronic hyperventilator)  Pursed lip breathing – may be COPD  Shape of face – longer lower third may indicate chronic hyperventilator Compare one side to the other, work proximal to distal

Answer 13

 Identify areas of tenderness, hypertonicity, atrophy – note them down  Palpate spine (feel for hyperlordosis/hyperkyphosis)  Assess abnormalities in ribs, spine etc  Elicit vocal or tactile fremitus

Answer 14

 Assess rib excursion (if using measuring tape, note down measurements)  C/Spine and T/Spine

Answer 15

 Nerve entrapment TOS from overuse of accessory respiratory muscles

Answer 16

 Trigger points from overuse of accessory respiratory muscles

Answer 17

```  Rib excursion  Lobe expansion test  Percussion  Auscultation  Vocal/tactile fremitis ```

Answer 18

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.

Answer 19

notes adapted from Therapeutic Exercise text – please refer to this text for a complete discussion of respiratory assessment The purpose of this test is to assess the symmetry of the moving chest to consider the mobility of the thorax. It may indicate indirectly what areas of the lung may be or may not be responding. 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

Answer 20

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

Answer 21

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

Answer 22

 Place palms of your hands lightly on the chest wall  Ask the guest to speak a few words or repeat “99” or blue balloons  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

Answer 23

 Improve or redistribute ventilation  Increase the effectiveness of the cough mechanism and promote airway clearance  Prevent post-operative pulmonary complications  Improve the strength, endurance, and coordination of the muscles of ventilation  Maintain or improve chest and thoracic spine mobility  Correct inefficient or abnormal breathing patterns and decrease the work of breathing  Promote relaxation and relieve stress  Teach the client how to deal with episodes of dyspnea  Improve a client’s overall functional capacity for ADLs

Answer 24

Clients should be in comfortable, relaxed positions with loose clothing on. (no tight bras, belts etc). Advise the client to never force or prolong expiration – the breath should be relaxed and passive. Work in cycles of 3-4 breaths at one time. Try to bring awareness to natural breathing pattern: 1)abdominal 2)lateral costal 3)chest Bring awareness to habit of initiating breathing with accessory muscles and upper chest (if they do so). I.e. during inspiration, upper chest should be “quiet”. May be most effective to do breath training after a relaxing massage treatment.

Answer 25

 First the therapist uses their hand on the rectus abdominus, below the anterior costal margin, then the client does this.  Breath in through the nose, out through the mouth  Practice in different positions of their ADLs

Answer 26

This is most effective when used to emphasize expansion of the problem areas of the lung and chest wall. E.g. because of pain and muscle guarding after surgery, collapsed lung, pneumonia, prolonged bed rest, etc. Lateral Costal Expansion:  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. Posterior Basal Expansion Repeat with hands over the posterior aspects of the lower ribs (especially important for bedridden post-surgical clients, who has to be in a semi-upright position for an extended period of time). Right Middle Lobe or Lingula Expansion Repeat with your hands just below the axilla (right or left) Apical Expansion Apply pressure, usually unilaterally, below the clavicle with the fingertips.

Answer 27

Creates a back pressure in the airways Taught to clients with COPD to help deal with shortness of breath Must not force the expiration The client is taught not to contract abdomen – place your hands here to detect contraction Instruct the client to breathe in slowly and deeply Then have them loosely purse lips and exhale. (use the bending the flame analogy)

Answer 28

Have your client lean forward in a supported sitting position. This stimulates diaphragmatic breathing – the viscera drops forward so the diaphragm can descend easier

Answer 29

The client sits or leans forward with their neck slightly flexed  Therapist demonstrates: take a deep diaphragmatic breath and demonstrate 2 short coughs, contracting the abdomen  The client puts their hands on their abdomen and takes 3 “huffs” on expiration/exhalation, feeling his/her abdomen contract  The client practices making the “k” sound to experience tightening of the vocal cords and closing of the glottis  Ask the client to take a deep but relaxed inspiration/inhalation, followed by a double cough – the 2nd cough is more productive  NOTE: no gasping should occur

Answer 30

Self-Assisted  Sitting position: the client crosses arms over abdomen  After a deep breath in, push up and in on the abdomen, lean forward and try to cough Therapist Assisted  Therapist stands behind the seated client, with heel of one hand on the epigastric area of the client’s abdomen; the other hand is on top of the first  After a deep inhale, abdomen is compressed upward and inward

Answer 31

* 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”

Answer 32

Prior to performing postural drainage technique you need to: 1. Rule out any CI’s to performing postural drainage (see below) 2. identify which lobe(s) are/is affected with patient case history and special tests (vocal/tactile fremitis, percussion or auscultation) 3. Teach patient to diaphragmatically breath and cough effectively 4. Set up a signal for your patient to tell you to stop if they need a break 5. Set up pillowing/table for the correct position, have garbage and tissues near by

Answer 33

 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

sinus resp Flashcards

(57 cards)