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Upper Respiratory Tract
- Nasal Cavity
- Pharynx
- Larynx
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Lower Respiratory Tract
- Trachea
- Bronchi
- Bronchioloes
- Alveoli
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Right vs. Left Lobes
- 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
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Function of Respiratory System
- 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
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Ventilation
Movement of Air
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Respiratrion
exchange of gas
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Airway Resistance
- Increased when diameter of the airway is decreased due to mucous, edema, contraction or spasm of smooth muslces
- Increases the energy cost of breathing
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Obstructive Pulmonary Disease
- 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
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Restrictive Pulmonary Disease
- 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
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Pulmonary Meds
- 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
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Total Lung Capacity
- 6000ml
- Th total amount of air contained in the lngs after a maximum inspiration
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Tidal Volume
- 500 ml
- Amount of air exchange during a relaxed inspiration followed by a relaxed expiration
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Residule Volume
- 1500 ml
- Amount of air left in the lungs after max expiration
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Vital Capacity
- 4500 ml
- The amount of air within lungs that is under volitional control
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Dyspnea
Requires effort to breath
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Hyperventilation
Deep rapids breathing
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Orthopnea
Difficult breathing in supine
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Apnea
no expiratory phase
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Apneusis
No inspiratory phase
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Cheyn Stokes
Gradual increas then decrease in TV followed by apnea
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General Goals of Treatment
- Prevent accumulatin of secretions
- Increases mobilization fo secretions
- Increased breathing pattern & ventilation
- Increased exercise tolerance
- Improve overall function
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Indications for Therapy
- 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
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Contraindicationf for Thearpy
- Recnet acute MI
- Untreated pneumothorax
- Unstable cardiac or neurological condition
- Rib Fracture
- Severe osteoporosis
- Pulmonary Embolus
- Bone Cancer
- Skin Grafts
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Techniques of Treatment
- Beathing Exercises
- Percussion and postural drainage
- Assisted coughing
- Cardiopulmonary endurance training
- Pt and Family education
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Diaphragmatic Breathing
- Supine with HOB up
- Hand on stomach
- In through the nose and out through the mouth
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Ventilatory Muscle Training
- Diaphragmatic Breathig with resistance
- Resistors
- Incentive spirometry
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Segmental Breathing
Manual Contacts or tactile cues to increase breathing to certain parts of the lungs
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Forced Expiratory Techniques
- 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"
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Active Cycel of Breathing Technique
- Relaxed diaphragmatic breathing follwed by deep inspirations relaxed exhalations
- as secrestion move to larger airways, huff technique to clear the secretions
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Precautions for Therapy
- No forced or prolonged expiration
- Avoid use of accessory muscle for nspiration
- Repeat only 3-4 times to avoid hyperventilation
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Postural Drainage Indications
- Prevent accumulation of secretion
- Remove those already accumulated
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Contraindications to Postural Drainag
- Severe hemoptysis
- Untreated acute conditions
- Cardiovascular Instability
- Recent nureosurgery - ICP > 20mm (normal =10)
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Manual Techniques for precussion
- Percussion
- Vibration
- Shaking
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Parameters to Monitor
- Sputum production
- HR, BP, RR
- Skin color
- O2 saturation
- ICP if applicable
- any c/o discomfort
- EKG
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