Cardiopulmonary Physical Therapy

Haneul Lee, DSc, PT

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

전세계적으로호흡기질환의발생률해마다증가추세

미국 : 전체사망원인중 4번째

캐나다 : 전체호흡기질환의 10% 병원입원그중 16% “사망”

대한민국 : 6세미만 – 65% 급성호흡기질환경험70세이상-약 70% 기관지천식

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

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

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

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

People with acute respiratory disorders benefit from physical therapy.

maintaining or improving mobility preventing complications

poor gas exchange / deconditioning

: is the collapse or closure of the lung resulting in reduced or absent gas exchange.

http://www.yale.edu/imaging/findings/atelectasis_lul/

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

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

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

: 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

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

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

: is an acute inflammation of the lungs.

http://www.medtogo.com/bronchitis-pneumonia.html

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)

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

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

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.

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

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

: is an infectious, inflammatory systemic disease caused by exposure to mycobacterium tuberculosis that infects lungs

https://www.haikudeck.com/title-uncategorized-presentation-SUWT6V7WSr

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

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

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

: is abnormal accumulation of fluid in the airspaces and parenchyma of the lungs impaired gas exchange

Etiology and Pathophysiology

Cardiogenic

▪ Increased pressure in pulmonary capillaries associated

with left ventricular failure, aortic valvular disease, or

mitrial valve disease

Signs and Symptoms

Dyspnea on exertion

( when lying down, in the upright position)

Fatigue

Hypoxemia

Pink frothy sputum

Positive chest x-ray

Crackles

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

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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Elsevier3. Cardiovascular and pulmonary Physical Therapy Evidence to Practice, 5th

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Company, 1888)6. PTEXAM the complete study guide, Scott M Giles, Scorebuilders