Pulmoary

• Nasal Cavity
• Pharynx
• Larynx

• Trachea
• Bronchi
• Bronchioloes
• Alveoli

• Right - 3 lobes, 10 segments
• Left - 2 lobes, 8 segments
• Visceral pleura - around the lungs
• Parietal Pleura - lining the thoracic wall
• Pleura space can get infected
• Lower lobes get congested 1st and are harder to clear

• 1. conducts air to alveolar system for gas exchange
• 2. Mucosal linging traps small particles
• 3. Humidification
• 4. Moves mucous upward with cilia
• 5. Warms air with vascular supplu
• 6. Elicits cough reflex

Movement of Air

exchange of gas

• Increased when diameter of the airway is decreased due to mucous, edema, contraction or spasm of smooth muslces
• Increases the energy cost of breathing

• Obstruction of air flow in the respiratory tract
• Affects ventilation and respiration
• Ex: COPD, asthma, CF, Bronchiectasis
• Problems include: DOE, Decreased exercise tolerance, chronic productive cough, frequent respiratory infections, postural defects
• INSIDE THE LUNGS

• Inability of he lungs to fully expand due to extrapulmonary or pulmonary restrictions
• Ex: pleural disease, chest wall injury, ms. weakness, tumer, atelectasis, pulm ffusion
• Problems include: SOB, increased RR, shallow breathing, increased use of accessory ms. ineffective cough, fatigue, weaknees, weight loss,
• EXTERNAL TO TH LUNGS

• Bronchodilators - increased size of airway
• Corticosteroids - decreases inflammation
• Cromolyn Sodium - prevents bronchospasm
• Mucolytics and Expectorants - results in thinner mucous, increased action of mucin which increases cough

• 6000ml
• Th total amount of air contained in the lngs after a maximum inspiration

• 500 ml
• Amount of air exchange during a relaxed inspiration followed by a relaxed expiration

• 1500 ml
• Amount of air left in the lungs after max expiration

• 4500 ml
• The amount of air within lungs that is under volitional control

Requires effort to breath

Deep rapids breathing

Difficult breathing in supine

no expiratory phase

No inspiratory phase

Gradual increas then decrease in TV followed by apnea

• Prevent accumulatin of secretions
• Increases mobilization fo secretions
• Increased breathing pattern & ventilation
• Increased exercise tolerance
• Improve overall function

• Acute or chronic respiratory problems
• Inability to expel secretions
• Ineffective cough
• Increase in secretions
• Pneumonia or atelectasis
• Neurological problems that affect swallowing and or breathing

• Recnet acute MI
• Untreated pneumothorax
• Unstable cardiac or neurological condition
• Rib Fracture
• Severe osteoporosis
• Pulmonary Embolus
• Bone Cancer
• Skin Grafts

• Beathing Exercises
• Percussion and postural drainage
• Assisted coughing
• Cardiopulmonary endurance training
• Pt and Family education

• Supine with HOB up
• Hand on stomach
• In through the nose and out through the mouth

• Diaphragmatic Breathig with resistance
• Resistors
• Incentive spirometry

Manual Contacts or tactile cues to increase breathing to certain parts of the lungs

• Specific breathing sequence followed by a "huff" forced exhalation to clear secretions
• 3-5 deep breaths
• holds 1-3 secs
• put through perced lips
• normal inhale
• "HUFF"

• Relaxed diaphragmatic breathing follwed by deep inspirations relaxed exhalations
• as secrestion move to larger airways, huff technique to clear the secretions

• No forced or prolonged expiration
• Avoid use of accessory muscle for nspiration
• Repeat only 3-4 times to avoid hyperventilation

• Prevent accumulation of secretion
• Remove those already accumulated

• Severe hemoptysis
• Untreated acute conditions
• Cardiovascular Instability
• Recent nureosurgery - ICP > 20mm (normal =10)

• Percussion
• Vibration
• Shaking

• Sputum production
• HR, BP, RR
• Skin color
• O2 saturation
• ICP if applicable
• any c/o discomfort
• EKG