1、Physiotherapy Diagnosis & Management of Cardiopulmonary DysfunctionLecture 3Introduction to Assessment of the Respiratory SystemGoals of Physiotherapeutic InterventionTo maintain or improve the clients cardiopulmonary function Lung volume Airway patency開放Oxygenation Ventilation Functional capacity-

2、ability to meet an increase in exercise/activity demand (exercise tolerance) Aims of the assessment processTo assess the functional status of the respiratory or associated system(s)To identify pathology or factors limiting the function of the respiratory system (source of problems)To assist in the p

3、lanning of intervention for normalization of the function of the respiratory systemrst priority is to ensure patient safetytherefore, rst question should be: Is the patient in immediate danger? A- Airway, is it patent（開放的） and protected? What are their oxygen saturations （飽和）and are they on oxygen?I

4、f not: Call for help and establish an airwayB- Breathing, are they ventilating effectively?If not: Call for help and support ventilationC- Circulation, do they have an adequate cardiac output?If not: Call for help and support outputDecision-making ProcessOnce you have established that the patient is

5、 in no immediate danger, your next goal should be to nd out whether the patient has (or is at risk of developing) one or more of the following four key problems:Sputum retention（痰液潴留）Loss of lung volumeIncreased work of breathingRespiratory failurePlease follow:SOAPI-the level of consciousnessMini-M

6、ental State Examinationthe Glasgow Coma ScaleThere are ve main symptoms of respiratory disease: breathlessness (dyspnoea) cough sputum wheeze喘息 chest painduration- both the absolute time since rst recognition of the symptom (months, years) and the duration of the present symptoms (days, weeks)severi

7、ty- in absolute terms and relative to the recent and distant pastpattern- seasonal or daily variationsassociated factors- including precipitants, relieving factors, and associated symptoms, if any1, Shortness of Breath (Dyspnoea)Causes PulmonaryCardiacMixedOthers Metabolic Acidosis Pain Neuromuscula

8、r Disorder Functional (Anxiety , Panic)1, Shortness of Breath (Dyspnoea)Adverse Consequencesdecreased tissue oxygen delivery increased work of breathingdecreased functional capacity loss of muscle bulk 1, Shortness of Breath (Dyspnoea)The New York Heart Association classication of breathlessnessThe

9、Borg Rating of Perceived Exertion ScaleCoughing your Lungs Up!2, Coughis a protective reexImportant features concerningits effectiveness or notwhether it is productive or dryseverity: occasional or continual trouble2, CoughAdverse Consequences Irritation and weakening of airways Fractured ribs and H

10、ernias Stress incontinence壓力性尿失禁2, CoughPlease NotePostoperative手術(shù)后Drugsbeta-blockers -受體阻斷劑some other antihypertensive agents降壓藥3, SputumIn a normal adult, up to 100ml are produced daily cleared by swallowingImportant features concerningcolourconsistency 粘度quantity each dayOdour氣味the Grading System

11、s for Mucoid類黏蛋白 (Miller, 1963)M1: mucoid with no suspicion of pus膿M2: predominantly mucoid, suspicion of pusP1: 1/3 purulent膿, 2/3 mucoidP2: 2/3 purulent, 1/3 mucoidP3: 2/3 purulentHow to describe the mucoid in clinical?Mucoid粘液Mucopurulent粘液膿痰Purulent膿痰the volume 1 teaspoon 1 egg cup half a cup 1

12、cup4, Wheezeproduced by turbulent紊亂的 airow through narrowed airwaysWhistling吹笛 or musical soundheart failure may also causeStridor喘鳴the sound of an upper airway obstruction5, Chest painusually originates from musculoskeletal, pleural or tracheal inammationAngina pectoris is a major symptom of cardia

13、c diseasecharacteristically causes a dull central retrosternal gripping or band-like sensation, which may radiate to either arm, neck or jawOther symptomsFeverHeadache Peripheral oedemasuggests right heart failurealso occur in patients taking high-dose corticosteroidsFunctional abilityQuality of lif

14、eSF-36disease-specic QOL scalesthe Basic Steps of the Objective Examinationcan be remembered with the mnemonic IPPA:Inspection Palpation Percussion Auscultation Early Warning ScoresTo highlight changes in the physiological status of the patient with routine observationsTo empower staff to act and se

15、ek additional support for patients whose status has deteriorated an Early Warning Score (Morgan et al. 1997, Subbe et al. 2001)Clubbing Finger（杵狀指）normalearly clubbingadvanced clubbingCyanosisCentral CyanosisHypoxaemia Anaemic貧血Polycythaemia紅細(xì)胞增多Peripheral CyanosisPoor peripheral circulationCyanosis

16、Adverse consequences Lethargy 嗜睡Dyspnoea on mild exertion（費(fèi)力） Decreased functional capacityJugular Venous Pressurein right heart failure with chronic lung disease complicated by cor pulmonale45TIP: dehydrated patients may only have a visible JVP when lying atObservation of the chestSurface anatomy/s

17、urface markingChest shapeBreathing patternChest movementObservation of the chestSurface anatomy/surface markingChest shapeBreathing patternChest movementSurface MarkingSurface MarkingObservation of the chestSurface anatomy/surface markingChest shapeBreathing patternChest movementChest shapeKyphosis脊

18、柱后凸Kyphoscoliosis脊柱側(cè)彎pectus excavatum/ funnel chest漏斗胸pectus carinatum / pigeon chest雞胸hyperination / barrel chest桶狀胸funnel chestpigeon chestObservation of the chestSurface anatomy/surface markingChest shapeBreathing patternChest movementObservation of the chestSurface anatomy/surface markingChest s

19、hapeBreathing patternChest movementthe Basic Steps of the Objective Examinationcan be remembered with the mnemonic IPPA:Inspection Palpation Percussion Auscultation Palpationthe Basic Steps of the Objective Examinationcan be remembered with the mnemonic IPPA:Inspection Palpation Percussion Auscultation can help in the