Respiratory conditions are a very common presentation in community and hospital settings, with a wide variety of diagnoses being assessed and treated by physiotherapy. Conditions which can present include pneumonia, chronic bronchitis, asthma, bronchiectasis, cystic fibrosis, hyperventilation and chronic obstructive pulmonary disease. Physiotherapists are trained to assess respiratory conditions and manage, treat and advise on them. Respiratory skills are an important part of every physiotherapist's training and early work, if they have a job in an acute area of practice. It is a difficult skill to learn and physiotherapists have a lot of responsibility for managing acutely unwell patients in hospitals.
The patient's notes and observation charts are first reviewed by the physiotherapist before going to see the patient, so as to be clear about the medical diagnosis, opinion and treatment. The blood test results will be important and the physiotherapist should have a good understanding of these. The physiotherapist will introduce themselves to the patient and whilst questioning the patient about their illness will be observing their condition at the same time, looking for the rate of respiration, hand, nose and lip colour, oxygen or nebuliser treatments, the overall wellness of the patient, their weight, the effort of breathing they are making and if they are using arm and neck muscles to help breathing.
The observation gives the physiotherapist a lot of information very quickly about the patient's condition and what they need to concentrate on in the examination. They can then move on to the objective examination, starting with assessing the lung expansion and air entry. By holding the chest on both sides, the physiotherapist can assess how well the expansion is occurring and whether it is symmetrical. Auscultation, listening to the chest with a stethoscope, tells the examiner about how well the air is entering the lungs, whether there is a blockage, collapse, consolidation or wheeze. The results of this will determine any further examination and the type of treatments suggested.
The physiotherapist initially looks at the patient's oxygen concentration as the correct level is critical for the patient's respiratory and overall status. If the blood oxygen saturations are below normal then the doctors will prescribe oxygen at a specific percentage such as 24 percent or 28 percent via a venturi type administration device which maintains a constant oxygen concentration as variations in concentration would be damaging. Continuous gas delivery can dry the airways and the secretions, making treatments more difficult, so oxygen should always be administered humidified and heated to body temperature by the appropriate gas delivery circuit.
The next clinical aspect for the physiotherapist to address is the air entry to the peripheral airways of the lungs. The airways can collapse or become occluded by swelling or sputum, blocking air entry and reducing the lungs' ability to maintain oxygen concentrations. Physiotherapists initially use breathing exercises to attempt to re-inflate the collapsed areas, instructing the patient to attempt to breathe deeply every hour or so. If this is not sufficient then intermittent positive pressure breathing may be attempted, using a pressure device to deliver gas at varying pressures into the lungs to re-inflate the desired areas passively.
Sputum retention in the lungs occurs when the patient is unable to expectorate the secretions which are formed by infections and worsened by lying in bed in hospital. Active cycle of breathing is a typical physiotherapy technique taught to patients, allowing them to move secretions from peripheral airways to the central airways where they can be removed by huffing or coughing. The technique involves steadily increasing depth of inspiration with longer expirations under slight pressure, avoiding the tendency to increase the bronchospasm of the airways. Patients can become very good at practicing this technique, allowing them to self treat effectively.
Physiotherapists can also apply manual techniques directly to the chest, using vibration or clapping to mechanically disturb the secretions and make coughing and expectoration more likely. Flutter devices are useful to mechanically disturb the sputum as the patient breathes in the vibrating air, again promoting coughing. Surgery to the thorax or abdomen or fractured ribs can inhibit deep breathing and coughing and physiotherapists will encourage patients to take regular pain control medication and to support the wound or painful part whilst practicing their inspiration and huffing.
Autor: Jonathan Blood-Smyth
Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiothrapists in Southampton.
Added: January 27, 2009
Source: http://ezinearticles.com/
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