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22 Cards in this Set
- Front
- Back
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Primary mm of respiration and nerve root innervations/functions
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Disphragm (C3-C5): descends caudally to inc dimension of thoracic cavity.
Intercostals (T1-T12): Elevate ribs when upper ribs are stabilized for deep inspiration and forced expiration |
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What is an effective cough?
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Loud/forceful, 2 or more coughs/exhalation, cough shit up. You need to inhale an adequate volume of air and use the mm of forced expiration with glottis closed
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Steps in a respiratory exam
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1. Evaluate breathing and determine ratio of diaphragm:intercostal and note RR by pretending you are taking HR
2. Ask pt to cough hard (sitting and supine) 3. Meausre chest excursion at axilla or xiphoid (normal = 2 inches) 4. Assess posture |
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Why is posture important to examine when evaluating respiratory function?
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Lumbar flex or thoracic kyphosis can limit caudal displacement of abdominal viscera, which blocks diaphragm descent.
Also need to be striaght up to allow rib elevation and chest expansion. Check in sitting and supine to see if patient is stuck or flexible |
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How do you manually assist on the upper chest?
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Stand behind patient with palm on sternum and ask pt to breathe normally.
You can give a quick stretch at end of exhalation down and in or provide resistant during inhalation Can apply pressure down and in during exhalation to assist or provide pulsations |
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How do you manually assist on the diaphragm?
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Palm 2 inches under xiphoid process
Ask pt to push into your hand for strengthening purpose Can assist with exhalation or cough No quick stretch |
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Air shift
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Breathe completely with diaphragm and then transfer air to chest without exhaling
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How to teach a pt. in a W/C to cough effectively
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Hook elbow around chair back with pillow in lap
Lift opposite arm up, whip it back down into pillow and cough as you punch yourself in the stomach |
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Accessory mm of respiration and function
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SCM - elevates sternum
SA, pec minor and major, serratus pos superio, levatores costorum - assist in rib elevation and depression |
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What motions do you have at C4 NL?
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Elevation (traps), DR and retraction (rhomboids), head/neck - need head/neck W/C drive
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What motions do you have @ C5 NL?
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Elevation and retraction very good (traps and rhomboids), partial deltoids, RC, biceps, SA
GH and ST joint still very unstable - dependent transfers |
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What motions do you have @ C6 NL?
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5/5 RC, deltoid, and biceps = much more stable GH and ST joints. Parital wrist EXT and radial deviation.
Also clavicular head pecs and partial lats |
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What motions do you have @ C7 NL?
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Scapula and shoulder very stable with stronger pecs, lats, wrist EXTs, with 3/5 triceps and wrist flexors
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What motions do you have @ C8 NL?
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Good all the way to hand - no intrinsics. you can make a fist at this level to get a higher sitting push-up
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Who will absolutely need some type of bracing for the wrist/hand?
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C4 and C5 injuries... C6 should be able to use the tenodesis grasp
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When do you no longer need to use tenodesis grasp?
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C8 and below.. b/c have wrist EXT and FLEX
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Significance of weak abdominals for respiration?
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Need them to support diaphragm in its resting position. Contract Abs ot push visera up into diaphagm
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How is the diaphragm important for phonation?
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Contracts ecc for 2/3 of expiration, which slows the flow of air from the lungs
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Fxt of intercostals
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Stabilize ribs to prevent ribs from being drawn downward during inhalation and elevates ribs during deep inspiration. Reduce AP and ML dimensions
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What type of posture would make you think pt has decrease mobility for the diaghragm to descend during respiration?
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Kyphotic psoture wiht post. pelvic tilt and descended stomachs.
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When should you use air shifts in your treatment?
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To train the upper chest if you are not seeing or hearing it (stethoscope)
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What trunk movts should be coupled inhalation/exhalation?
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Inhalation: Trunk EXT
Exhalation: Trunk FLEX |
