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24 Cards in this Set

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Assessing Respiratory Control in Infants and Children

Musculo-Skeletal Assessment :
•Ribs-
Rib flare (medial? lateral?)
Chest wall ___

•Spine-
Scoliosis
Kyphosis
Axial rotation
excursion
Musculoskeletal (cont.)

•Sternum
Pectus excavatum
Other deformities of interest

•Pelvis-tilt
Anterior
Posterior
Unilateral elevation
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Anatomy of Respiratory Musculature and Related Structures:

Skeleton of the Thorax:
•Ribs-12 individual pieces; numbers 11 and 12 do not insert on sternum
•Sternum-___
•Spine-stability

Potential for mobility of the rib cage increases as you move ___
mobility

inferiorly and anteriorly.
Muscles of Ventilation:

Diaphragm:
•concentric contraction-___

•___ contraction-controlled exhalation and speech
inhalation

eccentric
Muscles of Ventilation:

Intercostals:

•external-___

•internal-expiratory
inspiratory
Muscles of Ventilation:

Abdominals:
•___ lower rib cage
•provide ___ support for diaphragm
stabilize

positive pressure
Accessory Muscles:

Erector Spinae
Pectoralis muscles
___ muscles
Scalenes
Sternocleidomastoid
Trapezius
Serratus
Accessory muscles: Locations and functions

Physical exertion and pulmonary disease usually increase the work of breathing, taxing the diaphragm and external intercostal muscles. when this happens, accessory muscles provide the extra effort needed to maintain respirations.

the upper accessory muscles assist with ___, whereas the upper chest, sternum, internal intercostal, and abdominal muscles assist with expiration.
inspiration
Accessory muscles: Locations and functions

With ___, the scalene muscles elevate, fix, and expand the upper chest. the sternocleidomastoid muscles raise the sternum, expanding the chest's anteroposterior and longitudinal dimensions. the pectoralis major elevates the chest, increasing its anteroposterior size, and the trapezius raises the thoracic cage.
inspiration
Accessory muscles: Locations and functions

With expiration, the internal intercostals depress the ribs, decreasing the chest size. the ___ muscles pull the lower chest down, depress the lower ribs, and compress the abdominal contents, which exerts pressure on the chest.
abdominal
Normal Chest Development:

Newborn:
•Rib cage is ___
•Rib alignment is horizontal
•Intercostal spaces are narrow
•Rib cage makes up 1/3 of trunk
triangular
Normal Chest Development:

Three to Six Months:
•Rib cage is ___
•Rib cage moves as a block during rolling
rectangular
Normal Chest Development:

Six to Twelve Months:
•Rib cage is more rectangular
•Rib cage is elongating and rotating
•Rib cage now makes up ___ of trunk
1/2
Normal Chest Development:

Over Twelve Months:
•Lower ribs become ___ with abdomen
•Rib cage now makes up greater than 1/2 of trunk
integrated
Assessing Talking/Breathing
1. How many syllables per breath?
2. How long can patient hold a vowel sound?
3. Does voice change as posture changes?
4. Is patient's voice volume greater in supine?
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Assessing Talking/Breathing-continued-
5. Is patient's voice volume less in supine?
6. Is patient's voice volume less when sitting?
7. Is breathing coordinated with movement?
8. Is there breath holding with activity?
9. How stable are vital signs (e.g. blood pressure, heart rate, respiratory rate)?
ok
Use of Positioning Strategies to Influence Breathing Patterns:

Pelvis/Mid Trunk:

Anterior tilt-facilitates ___ breathing

Posterior tilt-facilitates ___ breathing
upper chest breathing (anterior tilt)

diaphragmatic breathing (posterior tilt)
Use of Positioning Strategies to Influence Breathing Patterns:

Shoulders/Upper Extremities:

Shoulder flexion, abduction and external rotation-facilitates ___ muscles

Shoulder extension, adduction, internal rotation-facilitates ___ and lower chest muscles
upper accessory

diaphragm
Use of Positioning Strategies to Influence Breathing Patterns:

Head Alignment:

Forward head may open airway.

___ is best position for vocal cords
Neutral chin-tuck
Effect of Vision and Movement on Breathing Patterns:

Eyes up-inhalation
Eyes down-exhalation

Rolling with extension-inhalation
Rolling with flexion-exhalation

Reaching up-inhalation
Reaching down-exhalation
this will be on the competency
Assessment of Breathing
In Supine, Sidelying, and Standing:

Observe sequence of breathing
Observe primary breathing pattern
Observe respiratory rate
Palpate upper, middle and lower rib cage
Palpate intercostal spaces (sidelying)
ok
Assessment of Talking
In Sitting, Supine, Stance:

Assess Volume
Assess number of syllables per breath
Assess ability to maintain a vowel sound
Assess breath holding
Assess ability to talk while moving
ok
Treatment

Positioning
Stretching/Mobilization
Strengthening
Facilitation of desired patterns
Integrate neuromuscular, respiratory, musculoskeletal and visual systems.
ok
Equipment to Assist Rx:
Abdominal binder
Towel roll
Bench
Thera-band
Bolster
Ball
Hands!
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