Table Of Content
Physiotherapy in
Respiratory Care
For Roger
Physiotherapy in
Respiratory Care
A problem-solving approach to
respiratory and cardiac management
Second edition
ALEXANDRA HOUGH
Freelance lecturer, Senior Physiotherapist, Whittington Hospital, London,
former Senior Lecturer, North London School of Physiotherapy
I~nl
SPRINGER-SCIENCE+BUSINESS MEDIA, B.v.
First edition 1991
Reprinted 1992, 1993, 1994
Second edition 1996
© 1996 Alexandra Hough
Originally published by Chapman & Hall in 1996
Typeset in by 10/12 Palatino by Photoprint, Torquay, S. Devon
ISBN 978-1-56593-131-2 ISBN 978-1-4899-3049-1 (eBook)
DOI 10.1007/978-1-4899-3049-1
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A catalogue record for this book is available from the British Library
Library of Congress Catalog Card Number: 95-70862
@
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Contents
Preface ix
Acknowledgements ix
1 Overview of physiology in relation to clinical practice 1
1.1 Introduction 1
1.2 Defence 1
1.3 Control 3
1.4 Mechanics 3
1.5 Ventilation 6
1.6 Diffusion 7
1.7 Perfusion 8
1.8 Ventilation/perfusion relationships 9
1.9 Arterial blood gases 9
1.10 Oxygen delivery, consumption and extraction 15
1.11 Effect of ageing 15
1.12 Effect of obesity 16
1.13 Effect of smoking 17
1.14 Effect of exercise 18
1.15 Effect of bed rest 18
1.16 Effect of sleep 19
Recommended reading 19
2 Assessment of the respiratory patient 20
2.1 Introduction 20
2.2 Background 21
2.3 Subjective assessment 21
2.4 Observation 23
2.5 Auscultation 28
2.6 Palpation 31
2.7 Exercise testing 33
2.8 Chest X-ray 35
2.9 Respiratory function tests 43
Recommended reading 50
3 Respiratory disorders S1
3.1 Introduction 51
3.2 Obstructive disorders 51
3.3 Restrictive disorders 75
3.4 Other disorders 82
Recommended reading 88
4 General management 89
4.1 Introduction 89
4.2 Oxygen therapy 89
4.3 Nutrition 97
vi Contents
4.4 Drug therapy 99
4.5 Bronchoscopy and biopsy 107
Recommended reading 108
5 Physiotherapy management 109
5.1 Introduction 109
5.2 Methods to increase lung volume 109
5.3 Methods to decrease the work of breathing 122
5.4 Methods to clear secretions 128
Recommended reading 144
6 Management of breathlessness and pulmonary rehabilitation 145
6.1 Does pulmonary rehabilitation work? 145
6.2 The concept of breathlessness 147
6.3 Assessment for rehabilitation 149
6.4 Education 150
6.5 Breathlessness management 154
6.6 Breathing re-education 156
6.7 Exercise training 158
6.8 Inspiratory muscle training 162
6.9 Energy conservation 163
6.10 Home management, self-help and follow-up 166
6.11 Evaluation 167
Recommended reading 167
7 Physiotherapy for specific groups of people 169
7.1 People undergoing surgery 169
7.2 Elderly people 197
7.3 People who are dying 198
Recommended reading 203
8 Physiotherapy for people with hyperventilation syndrome 204
8.1 Introduction 204
8.2 Causes 204
8.3 Effects 205
8.4 Assessment 206
8.5 Education 208
8.6 Breathing re-education 210
8.7 Progression and home management 213
Recommended reading 214
9 Intensive care 215
9.1 Introduction 215
9.2 The environment 215
9.3 Mechanical ventilation 219
9.4 Monitoring 232
9.5 Support 239
Recommended reading 244
10 Physiotherapy in intensive care 245
10.1 Preliminaries 245
10.2 Assessment 246
10.3 Motivation and stress reduction 248
10.4 Handling patients who are critically ill 251
Contents vii
10.5 Techniques to increase lung volume 252
10.6 Techniques to clear secretions 256
10.7 End of treatment session 259
10.8 Recognition and management of emergencies 259
10.9 On calls 266
Recommended reading 268
11 Conditions in intensive care 269
11.1 Lung disease 269
11.2 Neuromuscular disorders 270
11.3 Fractured ribs and lung contusion 272
11.4 Acute head injury 273
11.5 Smoke inhalation 279
11.6 Poisoning, pulmonary aspiration and near-drowning 280
11.7 Shock 280
11.8 Disseminated intravascular coagulation 281
11.9 Acute respiratory distress syndrome 281
Recommended reading 285
12 Physiotherapy for children and infants 286
12.1 Physiotherapy for children 286
12.2 The neonatal unit 292
12.3 Physiotherapy for infants 295
12.4 Modifications for specific neonatal disorders 300
12.5 Emergencies in the neonatal unit 301
Recommended reading 302
13 Evaluation of chest physiotherapy 303
13.1 Introduction 303
13.2 Standards 304
13.3 Audit 305
13.4 Self-assessment 305
13.5 Outcome evaluation 306
13.6 Literature criticism 307
13.7 Research 309
13.8 Continuing education 310
Recommended reading 311
Glossary of definitions, abbreviations, symbols and normal values 312
Appendix A Transatlantic dictionary 321
Appendix B Postural drainage positions 322
Appendix C Resources and organizations 325
Appendix D Articles by patients 327
Appendix E Articles on outcome measures for
pulmonary rehabilitation 328
Further reading 330
References 331
Index 357
Preface
Respiratory care is an immensely satisfying branch of physiotherapy. It
challenges our intellect, exploits our handling skills and employs our
humanity to the full.
Respiratory physiotherapy is both art and science. It is not an exact science,
and effective treatment therefore depends on problem-solving. Analytic
problem-solving requires the ability to define a problem and the knowledge to
address it. Creative problem-solving requires a clear perspective of the
individual patient's need. These are the aims of this book.
Clinicians now expect explanations that are referenced and physiologically
sound, meticulous attention to detail of technique and a patient-centred
approach. This book is written for such readers and those who question
fundamental assumptions and traditional rituals.
Evaluation of practice is emphasized so that we are equipped to justify our
protocol to ourselves and others. Carefully reasoned explanations and updated
physiotherapy techniques are covered in precise detail. There is integration of
theory and practice and emphasis on the hands-on aspect of physiotherapy.
The glossary serves as a quick reference guide and an explanation of
abbreviations, which are usually defined once only in the text. It has been
greatly extended for the second edition and can be read in its own right as an
extra physiology chapter.
The text is enthusiastically written, highly readable and enlivened by
quotations from patients whose experiences are a central theme throughout.
The book is suitable for physiotherapists from student level to accom
plished clinician because problem-solving requires thinking rather than
experience. It is also aimed at specialist respiratory nurses. All readers will
benefit from the patient quotations which enrich the text throughout. The
clinician will find here the opportunity to achieve clarity of thought, breadth
of vision and mastery in respiratory care. Enjoy it.
Acknowledgements
Profound thanks to the patients who have taught me much over the years. I
am also indebted to Veronica Bastow for her perceptive insights, Clare Pain
for her wisdom, John Widdicombe for his meticulous scrutiny of the
physiology and Mel CaIman for his cartoons.
Heartfelt thanks also to Alison Brown, Fiona Bryden, Joy Conway, Diana
Davis, Stephanie Enright, Nicky Harvey, Bernadette Henderson, Avril
Imison, Sue Pirrie, Marylin Place, Carolyn Roskell, Irene Rowbottom and
Judith Sweeney, for their specialist advice.
And to the students with whom it has been my privilege to work and learn,
thank you.
