systemic tx -- respiratory Flashcards

Question

(sinusitis) NEUROLOGICAL:

Answer 1

Sympathetic innervation to sinuses in the upper t-spine pass through the c-spine ganglion. (??)

Answer 2

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

Answer 3

Transillumination test Palpation

Answer 4

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.)

Answer 5

* 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” * Other:

Answer 6

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 fremitus, 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 7

 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

Answer 8

Diaphragm Pec mj and mn (mj??) scalenes

Answer 9

Serratus anterior Subclavius Intercostals Pectoralis mj and mn (mj??)

Answer 10

Progressive form of obstructive lung disease characterized by irreversible destruction and dilation of airways Generally associated with chronic bacterial infections and cystic fibrosis

Answer 11

Any condition that produces a narrowed lumen of the bronchioles E.g. ---> TB, viral infections, pneumonia, structural anomalies Immunodeficiency Genetic conditions Cystic Fibrosis -- Almost everyone with CF

Answer 12

All the causative conditions impair airway clearance mechanisms and host defenses, resulting in an inability to clear secretions and predisposing patients to chronic infection and inflammation. Due to frequent infections, airways become filled with viscous mucous that contains inflammatory mediators and pathogens. Airways slowly become dilated, scarred, and distorted. Histologically, bronchial walls are thickened by edema, inflammation, and neovascularization. Destruction of surrounding interstitium and alveoli causes fibrosis, emphysema, or both.

Answer 13

Persistent coughing with large amounts of purulent sputum Dyspnea Fatigue Weight loss Anemia Fever Hemoptysis Weakness Clubbing Foul-smelling sputum

Answer 14

Diagnosis: Imaging History Clinical manifestation Genetic testing Treatment: Bronchodilators Antibiotics Corticosteroids Hydration Surgery

Answer 15

Chronic airflow limitation Chronic bronchitis is defined as a productive cough lasting for at least 3 months per year for two consecutive years. Etiology and Risk Factors Exposure to environmental irritants Age Genetics Smoking*** Specifically tobacco

Answer 16

Inflammation and scarring of bronchial lining leads to obstruction of airflow and increased mucous production Irritants cause an increase in size and number of mucous producing glands and hypertrophy of smooth muscle cells Leads to obstruction of airways Impaired ciliary function predisposed to infection Infection results in increased mucous production, bronchial inflammation and thickening

Answer 17

Productive cough SOB Recurrent infection Fever Malaise Cyanosis Cor pulmonale Barrel chest (uncommon)

Answer 18

Characterized by conducting passageways that are extremely sensitive to irritation Airways respond by constricting smooth muscles along bronchial tree, edema/swelling of mucosa, increased mucus Breathing difficult; resistance markedly increased Triggers include allergies, toxins, exercise ___ Increased responsiveness of bronchial tree to certain stimuli Can be classified as reversible COPD Chronic inflammatory condition with acute exacerbations Complex disorder involving biochemical, autonomic, immunologic, infectious, endocrine and psychological factors

Answer 19

Environment Small families Lack of pets Antibiotics Age Gender Smoking while pregnant Viral infections Obesity Urban settings Low SE status Overcrowding BMI Family history Atopy

Answer 20

Genetics Viruses Risk factors

Answer 21

Results from an allergy to specific triggers Occurs mostly in children and young adults Hypersensitivity disorders

Answer 22

No known triggers Adult onset Possibly viral exposure ---> Post-viral asthma

Answer 23

Narrowing of the airways caused by workplace exposure

Answer 24

Bronchoconstriction can occur in those without other forms of asthma ---> Up to 20% of the healthy population More common in cold temperatures

Answer 25

"Pleurisy, also known as pleuritis, is inflammation of the membranes that surround the lungs and line the chest cavity (pleurae)."

Answer 26

"Pneumonia is an infection that inflames the air sacs in one or both lungs." "Pneumonia is inflammation and fluid in your lungs caused by a bacterial, viral or fungal infection." "Pneumonia is an infection that affects one or both lungs. It causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus."

Answer 27

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 28

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

Answer 29

the therapist must have MD’s referral to proceed with treatment

Answer 30

fever, sudden changes in patient’s condition

Answer 31

 History questions  CIs and precautions (Rattray & Ludwig P 881, 893 and 904)  Pre-treatment hydrotherapy  During treatment hydrotherapy  Post-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.

Answer 32

-Durations: if client is fragile, shorter tx may be appropriate -Tapotement/shaking/vibrations/rib springing etc appropriate? -Breathing exercises/training -Productive cough? As appropriate

Answer 33

(consider cardiac health)

Answer 34

 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 35

 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

Answer 36

 Observation/inspection  Palpation  Percussion  Auscultation

Answer 37

 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 38

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

Answer 39

 Nerve entrapment TOS from overuse of accessory respiratory muscles

Answer 40

 Trigger points from overuse of accessory respiratory muscles

Answer 41

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

Answer 42

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 43

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.

Answer 44

 Stand facing your guest  Tips of thumbs at midsternal line, at sternal notch  Fingers above clavicles  Guest fully exhales, then inhales deeply

Answer 45

 Face your guest  Place tips of thumbs at xyphoid, extend fingers laterally around the ribs  Guest exhales fully, deep inhalation

Answer 46

 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 47

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 48

sound is dull/flat is there is too much solid matter (tumour, consolidation) in the lungs, compared to amount of air sound is tympanic (hyper-resonant) is there is more air in the area (e.g. emphysema)

Answer 49

judgement is unique to the therapist; comes with percussing MANY chest walls

Answer 50

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 51

"The word "fremitus," meaning a palpable vibration, originates from New Latin and Latin, derived from the verb "fremere" meaning "to roar, murmur" with the suffix "-tus" forming a noun of action."  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

Answer 52

 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 53

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”.

Answer 54

May be most effective to do breath training after a relaxing massage treatment.

Answer 55

 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 56

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.

Answer 57

 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.

Answer 58

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).

Answer 59

Repeat with your hands just below the axilla (right or left)

Answer 60

Apply pressure, usually unilaterally, below the clavicle with the fingertips.

Answer 61

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 62

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 63

 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 64

 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

Answer 65

 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 66

 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”  Other:

Answer 67

Habitual breathing rate in excess of 18 breaths per minute

Answer 68

 Erratic heartbeats and/or chest pain  Breathless “attacks” at rest for no reason  Frequent sighing and/or yawning (average is once every 5-10 minutes)  Irritable coughing and chest tightness  Dizziness and “spaced out” feelings  “pins and needles” or numbness in lips, fingertips and toes  Gut disturbances – indigestion, nausea, wind or irritable bowel  Muscles aches, pains, or tremors  Tiredness, weakness, disturbed sleep, and nightmares  Phobias  Clammy hands, flushed face, feelings of high anxiety  Sexual problems

Answer 69

12 regular breaths/minute (10-14 acceptable)  70-80% of the work of respiration is done by the diaphragm  Accessory muscles of respiration are used during or shortly after extreme effort or stress  Inspiration: 2-3 seconds  Expiration: 3-4 seconds  Little or no upper chest movement  Nose breathing  This is reversed in chronic hyperventilators

Answer 70

Immediate:  Adrenalin pours into the bloodstream  Heart and breathing rates speed up  Muscles become tense  Eyesight and hearing sharpen  The pain threshold drops and pain is less intense Chronic:  More carbon dioxide is breathed out; carbon dioxide levels in the blood start to drop  Normal pH becomes more alkaline = respiratory alkalosis  Smooth muscle cells are galvanized into action by lowered carbon dioxide levels, which leads to tightening or constriction of the blood vessels  The heart and pulses start pounding; the hyperventilator may feel panic stricken, with palpitations and chest pain  The brain may have its oxygen supply cut by as much as 50%  Habitual mouth breathers develop irritable upper airways, with the risk of repeated throat infections  A very common sign of hyperventilation is repeated throat clearing – the AAHHRRRRMMMMM bug  Triggers increased histamine levels in the blood – sweaty palms and armpits, clammy skin, flushed face are all signs of this  People with allergies such as hayfever, skin rashes, food intolerances, or asthma find their symptoms much worse  Response to pain is amplified – stiffness in muscles and joints feels rheumatoid-type pain  Heart disease-type symptoms, like tight chest pain or pounding pulses  Mental fuzziness, headaches, or loss of concentration can erode self-confidence, especially if work suffers  Making love can be a nightmare – for both partners – if the “heavy breathing” that precedes orgasm leads to a panic attack  Vivid dreams, nightmares, and disturbed sleep patterns commonly accompany hyperventilation – creates distress 24/7

Answer 71

“BETTER”  Breath retraining  Esteem  Total body relaxation  Talk  Exercise  Rest and sleep 1) Becoming aware of faulty breathing problems 2) Learning to nose-diaphragm breathe 3) Suppressing upper-chest movement during normal breathing 4) Reducing breathing to a slow, even, rhythmic rate

Answer 72

 Place your dominant hand on your abdomen, between the lower ribs and umbilicus  Other hand on the sternum; just below the clavicles  Take a deep breath  Notice which part of your chest moved first? Which part moved the most? Did you breathe through your nose or your mouth? ___ If you breathed in through your nose, your abdomen expanded first, and you felt almost no upper-chest movement, you are a good breather. If you breathed in fast through your mouth, your upper chest heaved first, and you felt little or no movement, or your abdomen drew IN, you are a weak breather

Answer 73

☺Frontal sinuses, milking, symmetrical, with thumbs ☺Frontal sinuses, draining/sweeping laterally toward the temples ☺Supraorbital notch; gentle pressure (analgesic effect) ☺Supraorbital notch/eyebrow ridge; sweeping bilaterally ☺Maxillary sinuses, milking, symmetrical, with thumbs ☺Maxillary sinuses, draining/sweeping caudad along each side of the nose to the corners of the mouth ☺Temporal areas: direct pressure; thenar eminences in the temporal fossae and gentle rhythmic bilateral pressure/release/pressure/release etc ☺Central structures: indirect pressure; interlaced fingers, palm up, under patient’s head, thenar eminences on lateral aspects of occiput; gentle rhythmic pressure/release etc. ☺Central structures: counterstrain technique; same hold, 90 seconds gentle pressure, then slow release (once only) ☺Central structures: one hand cups occiput, heel of other hand on patient’s forehead, gentle rhythmic compress/release/compress/release etc ☺Nasal decongestion: hands in “bird-like” formation, thumbs crossed on opposite sides of nose; alternate pressure, moving down length of nose; several times, then switch: same thumb, same side of nose, caudad sweeping down length of nose to corners of mouth, to drain ☺Maxillary sinuses: counterstrain technique; faced interlaced above nose, thenar eminences on lateral curve of zygomae; gentle medial pressure through the zygomae, compressing/lifting motion, anterior direction, hold 90 seconds ☺Maxillary sinuses: “fascial facial” technique (not included in DiGiovanna’s handout): suction-like “spidey-sensing” tips of all fingers/thumbs, gently grasp the zygomae and apply anterior suction-like pressure to “lift” the zygomae and create space at all articulating surfaces of the zygomae ☺Supraorbital tender points: one arm rests gently on forehead, gentle superior nudge; while other hand gently grasps/pinches bridge of nose and distracts it caudally Appropriate supplementary techniques include manual lymph drainage, suboccipital release (cranial base decompression), and others at your discretion.

systemic tx -- respiratory Flashcards

(100 cards)