Cardiopulmonary Physical Therapy -...
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Cardiopulmonary Physical Therapy
Haneul Lee, DSc, PT
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OBJECTIVE
1. Describe the definition, etiology, pathophysiology of pulmonary disease
2. Describe the pathophysiology that is reversible by treatments provided by physical therapist and other health professionals
3. Outline the medical interventions and physical therapy management that can be provided for different respiratory disorders
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전세계적으로호흡기질환의발생률해마다증가추세
미국 : 전체사망원인중 4번째
캐나다 : 전체호흡기질환의 10% 병원입원그중 16% “사망”
대한민국 : 6세미만 – 65% 급성호흡기질환경험70세이상-약 70% 기관지천식
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1. Auscultation Listening to the respiration for breath sounds using stethoscope Breath sounds can be decreased or adventitious sounds such as
crackles, wheezes, rhonchi, etc.
2. Deconditioning Decrease in aerobic fitness, vital capacity, muscle strength and range of
motion as a result of prolonged bed rest or inactivity Occasionally, it may be accompanied by orthostatic hypotension
3. Hyperventilation Occurs when there is an increased inspiration and expiration of air as a
result of an increase in rate or depth of respiration Depletion in carbon dioxide (respiratory alkalosis) with accompanying
symptoms
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4. Orthopnea Difficulty breathing except in the sitting or standing position
5. Orthostatic hypotension (postural hypotension) Decrease in blood pressure upon assuming an erect posture Normal, but may be of such degree as to cause gaining,
especially in persons who first stand up after lying flat in bed for a while
6. Percussion The use of fingertips to tap the body lightly Sharply to determine position, size, and consistency of an
underlying structure and the presence of fluid or pus in a cavity
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7. Perfusion The volume of blood that circulates through the lungs
8. Sputum Substance expelled by coughing Contain a variety of materials from the respiratory track The amount, color and conditions of the sputum can be used in
the differential diagnosis
▪ Foul smell – anaerobic infection▪ Purulent (yellow or green) – infection▪ Frothy – pulmonary edema▪ Mucoid (clear, thick) – cystic fibrosis or conditions with a chronic cough▪ Hemoptysis – blood in the sputum
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Normal – clear
Rales (crackles) Extra breath sounds Discontinues sounds heard primarily during inspiration
Wheezes Continuous breath sounds that are high-pitched Often with asthma
Friction rub Caused by the rubbing of pleural surfaces against one another Accompanied by pain during inspiration
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People with acute respiratory disorders benefit from physical therapy.
maintaining or improving mobility preventing complications
poor gas exchange / deconditioning
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: is the collapse or closure of the lung resulting in reduced or absent gas exchange.
http://www.yale.edu/imaging/findings/atelectasis_lul/
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Etiology and Pathophysiology
Blockage of bronchus or bronchiole
Compression from a pneumothorax, a pleural effusion, or
other space-occupying lesion
Post-anesthetic- the combined effects of anesthesia and
recumbency result in hypoventilation, decreased sighing,
and mobility, which increase the risk of infection
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Signs and Symptoms
Needs to be managed poor gas exchange
arterial blood (PaO2) and O2 saturation
Increased opacity apparent on x-ray with volume loss
Fever
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Medical Intervention Bronchoscopy can clear an obstructed airway
O2 therapy
Mechanical ventilation (MV) may be required in severe cases
Physical Therapy Management Deep breathing with inspiratory hold, positioning, and
mobilization as tolerated
If atelectasis is due to surgery or trauma,
coordination of treatment with pain medication
and supporting the incision site is essential
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: previously known as respiratory distress syndrome (RDS), adult respiratory distress syndrome, or shock lung, is a severe, life-threatening medical condition
Widespread inflammation
in the lungs
Triggered by a trauma or
lung infection
https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome
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Etiology and Pathophysiology
Damage to the alveolar epithelium and capillary
endothelium
Fluids, proteins, and blood cells moved from the capillaries into the alveolar spaces
severe pulmonary edam or lung collapse
Shock, pneumonia, drowning, sepsis, aspiration, drugs multiple leg of pelvic fracture, extensive burns, and cardiopulmonary bypass
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Signs and Symptoms Dyspnea Fast breathing Very dyspenic Disoriented Hypoxemia Pulmonary shunting
Medical Interventions Supplement of O2 – Mechanical Ventilation Medication
Physical Therapy Management Fluid management Position - prone
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: is an acute inflammation of the lungs.
http://www.medtogo.com/bronchitis-pneumonia.html
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Etiology
Inhalation of airborne infectious agents, such as bacteria,
viruses, mycoplasma, or fungi
Hematogenous (infection via the circulation)
Direct extension (eg, pathogen enters chest via trauma or
chest tube)
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Pathophysiology
Pathology
▪ Alveolar : Often bacterial
▪ Lobar pneumonia : Localized to the lobe of the lung
▪ Bronchopneumonia : Where initially infection is centered on bronchi and surrounding alveoli
▪ Interstitial : Often viral or mycoplasma
Etiology
▪ Streptococcal pneumonia is named after the causative organism
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Origin of the pathogen
▪ Community-acquired pneumonia
▪ Hospital-acquired pneumonia
▪ Aspiration
▪ Opportunistic
Presentation
▪ Typical : Bacterial in origin and is usually in conjunction with community-acquired conditions
▪ Atypical : Often viral or has mycoplasma etiology and
Is usually in conjunction with nosocomial pneumonia
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Signs and symptoms Associated with pneumonia vary but can include
fever, chills, pleuritic pain, headache, general fatigue, w
eight loss, aches and pains, cough with or without expect
oration of sputum or blood
Sever Acute Reparatory distress Syndrome (SARS) in an
atypical pneumonia of viral origin that can progress to
ARDS in its end stages.
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Risk factors that will lead readmission in pneumonia patients Temperature above 37.8 degree C
HR above 100 bpm
Respirations of more than 24/min
SBP below 90 mm Hg
O2 saturation below 90%
Inability to maintain oral intake
Abnormal mental status
Overall, 32.8% of pneumonia patients were not bale to return to their preadmission activity level within 30days of discharge from hospital
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Medical Interventions
Aimed at identifying the etiologic agent and treating with appropriate antimicrobial agent
O2 therapy, IV fluids, nutritional support
SARS is highly infectious-protective clothing are required
Physical Therapy Management
Improve poor gas exchange in affected regions
Minimize the adverse effects of immobility
Suprahyoid muscle strengthening exercise - swallowing
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: is an infectious, inflammatory systemic disease caused by exposure to mycobacterium tuberculosis that infects lungs
https://www.haikudeck.com/title-uncategorized-presentation-SUWT6V7WSr
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Etiology and Pathophysiology
Several population groups having risks
People who are in close contact
Inhalation of the mycobacterium tuberculosis into the lungs
Weakened immune system
* Increased incidence of TB in patients with HIV
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Signs and symptoms
Unaware they have been infected with the TB
Only sign of the infection – positive skin test
Productive cough / Dyspnea /Weight loss / Fever
Chest wall pain / Fatigue /
http://www.medtogo.com/bronchitis-pneumonia.html
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Medical Interventions
Prevention of TB is important – limiting contact
TB pharmacotherapy is available – long term
Physical Therapy Management
Highly infectious condition – PROTECTION
Hospitalized patients with active TB may be placed in a negative pressure room
Teach patients cough-assist techniques
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: is abnormal accumulation of fluid in the airspaces and parenchyma of the lungs impaired gas exchange
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Etiology and Pathophysiology
Cardiogenic
▪ Increased pressure in pulmonary capillaries associated
with left ventricular failure, aortic valvular disease, or
mitrial valve disease
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Signs and Symptoms
Dyspnea on exertion
( when lying down, in the upright position)
Fatigue
Hypoxemia
Pink frothy sputum
Positive chest x-ray
Crackles
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Medical Interventions
Mechanical Ventilation
Medication
Physical Therapy Management
Preventing the deleterious effects of inactivity
Not responsive to any physical therapy technique
Bed rest
O2 therapy
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Respiratory conditions are extremely prevalent in developing and developed countries.
A key clinical manifestation of acute and chronic respiratory conditions is abnormal gas exchange.
Physical therapists assess, treat, and monitor individuals with acute and chronic respiratory conditions. These conditions affect the airways, the alveoli, and the chest wall.
Several respiratory disorders is not reversible by physical therapy interventions. In these situations, the PT may not have a role to play, but help to minimize the adverse effects of best rest and hospitalization.
PT intervention typically improve gas exchange, increase mobility, and facilitate airway clearance of pulmonary secretions.
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1. National Physical Therapy Examination, O’sullivan&Siegelman, TherapyEd2. Essentials of Cardiopulmonary Physical Therapy, 3rd edition, Ellen Hillegass,
Elsevier3. Cardiovascular and pulmonary Physical Therapy Evidence to Practice, 5th
edition, Donna Frownfelter, Elizabeth Dean, Elsevier4. Cardiopulmonary Physical Therapy Management and Case Studies, 2nd edition,
W.Darlence Reid, Frank Chung, Kylie Hill, SLACK Inc.5. Steele, Joel Dorman Hygienic Physiology (New York, NY: A. S. Barnes &
Company, 1888)6. PTEXAM the complete study guide, Scott M Giles, Scorebuilders