Additional Information
Book Details
Abstract
The latest edition of this must-have text book promises an evidence-based and practical approach covering the very latest in cardiorespiratory care.
The textbook covers a wide range of cardiorespiratory conditions and discusses treatment of patients in different clinical settings such as critical care, the ward area and out-patient departments. It begins with physiology and pathology and progresses into a detailed patient assessment section and a discussion of specific respiratory and cardiac conditions. The final section covers different groups of people who may require physiotherapy such as infants, children, and adults with specific conditions including a considered section on palliative care.
Critical thinking is facilitated by clinical reasoning boxes in the text, and problem-solving is aided by case studies at the end of each chapter. There are also relevant practice tips to enable transfer of learning into the clinical environment. The text is supported by over 280 line drawings and diagrams along with over 70 x-rays and photographs to further illustrate the points under discussion.
- Q & A case studies, with scans and x-rays
- Outcome measures for problems and diseases
- Boxes with learning and practice tips to encourage reflection
- Tables with definitions, normal values and comparisons
- Practical techniques described with precision
- Expanded cardiovascular section
- Updated practical details on physiotherapy techniques
- Extra chapters on surgical complications and interventions
- Comprehensive coverage of Critical Care procedures and rehabilitation
- Practicalities of the management of children and infants
Update on the evaluation of outcomes
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Evolve page | IFC1 | ||
| Hough's Cardiorespiratory Care | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Dedication | vi | ||
| Preface | vii | ||
| Acknowledgements | viii | ||
| Contributors List | ix | ||
| About the Author | x | ||
| I Physiology and pathology | 1 | ||
| 1 Physiological Basis of Clinical Practice | 1 | ||
| Outline | 1 | ||
| Learning Objectives | 1 | ||
| Defence | 1 | ||
| Nose | 2 | ||
| Oral Cavity | 2 | ||
| Pharynx | 2 | ||
| Airways | 2 | ||
| Cough | 3 | ||
| Other Defences | 4 | ||
| Control | 4 | ||
| Mechanics | 5 | ||
| The Respiratory Muscles | 5 | ||
| Inspiration | 5 | ||
| Expiration | 6 | ||
| Pressures | 6 | ||
| Resistance | 7 | ||
| Airflow resistance | 7 | ||
| Elastic resistance | 7 | ||
| Compliance | 8 | ||
| Work of Breathing | 9 | ||
| Inspiratory muscle fatigue | 9 | ||
| Inspiratory muscle weakness | 9 | ||
| Ventilation | 10 | ||
| Diffusion | 12 | ||
| Perfusion | 12 | ||
| Ventilation/Perfusion Ratio | 13 | ||
| Arterial Blood Gases | 14 | ||
| Oxygen Dissociation Curve | 15 | ||
| Upper flat portion of the curve | 15 | ||
| Steep portion of the curve | 15 | ||
| Shift of the curve | 15 | ||
| Hypoxaemia and Hypoxia | 15 | ||
| Hypoxaemia | 15 | ||
| Hypoxia | 16 | ||
| Effects of hypoxaemia and hypoxia | 16 | ||
| Hypercapnia | 16 | ||
| Interpretation | 17 | ||
| Other Indices of Oxygenation | 17 | ||
| Acid–Base Balance | 17 | ||
| Buffers | 18 | ||
| Regulation | 18 | ||
| Interpretation | 19 | ||
| The Oxygen Cascade | 19 | ||
| Variations | 21 | ||
| Effects of Obesity | 21 | ||
| Effects of Smoking | 22 | ||
| Effects of Stress | 23 | ||
| Effects of Sleep | 24 | ||
| Effects of Immobility | 24 | ||
| Turning, Sitting and Standing Up | 25 | ||
| Effects of Exercise | 25 | ||
| Case Study: Ms Ll | 26 | ||
| Relevant medical history | 26 | ||
| Subjective | 26 | ||
| Objective | 27 | ||
| Questions | 27 | ||
| Response to Case Study | 27 | ||
| Recommended Reading | 27 | ||
| 2 Assessment | 29 | ||
| Outline | 29 | ||
| Learning Objectives | 29 | ||
| Introduction | 29 | ||
| Background Information | 30 | ||
| Handover | 30 | ||
| Notes | 30 | ||
| Charts | 30 | ||
| Biochemistry | 32 | ||
| Urea and electrolytes | 32 | ||
| Albumin | 32 | ||
| Microbiology | 32 | ||
| Haematology | 32 | ||
| Cytology and histology | 33 | ||
| Arterial blood gases | 33 | ||
| Subjective Assessment | 33 | ||
| Patient History | 33 | ||
| Cardiorespiratory Symptoms | 34 | ||
| Breathlessness | 34 | ||
| Cough | 34 | ||
| Secretions | 35 | ||
| Wheeze | 35 | ||
| Other Symptoms | 35 | ||
| Activities of Daily Living | 36 | ||
| Observation | 37 | ||
| Breathing Pattern | 37 | ||
| General Appearance | 38 | ||
| Confusion | 38 | ||
| Respiratory rate | 39 | ||
| Chest shape | 39 | ||
| Colour | 40 | ||
| Hands | 40 | ||
| Oedema | 40 | ||
| Sputum | 40 | ||
| Palpation | 42 | ||
| Abdomen | 42 | ||
| Chest Expansion | 42 | ||
| Percussion Note | 42 | ||
| Hydration | 44 | ||
| Trachea | 44 | ||
| Capillary Refill Time | 44 | ||
| Tactile Vocal Fremitus | 44 | ||
| Auscultation | 44 | ||
| Technique | 44 | ||
| Breath Sounds | 45 | ||
| Added Sounds | 46 | ||
| Voice Sounds | 47 | ||
| Imaging | 47 | ||
| Systematic Analysis | 47 | ||
| Preliminary checks | 49 | ||
| Trachea | 49 | ||
| Heart | 49 | ||
| Hila | 50 | ||
| Diaphragm | 50 | ||
| Lung fields | 52 | ||
| Bones | 55 | ||
| Artefact | 55 | ||
| Lateral Film | 55 | ||
| Other Tests | 56 | ||
| Tomography | 56 | ||
| Magnetic resonance imaging | 56 | ||
| Fluoroscopy | 56 | ||
| Functional respiratory imaging | 56 | ||
| Respiratory Function Tests | 57 | ||
| Working Definitions | 58 | ||
| Airflow Obstruction | 61 | ||
| Peak flow | 61 | ||
| Spirometry | 61 | ||
| Measurements independent of effort | 62 | ||
| Lung Volumes | 62 | ||
| Respiratory Muscle Function | 63 | ||
| Other Tests | 65 | ||
| O2 and CO2 | 65 | ||
| Maximum oxygen consumption (V̇O2max) | 65 | ||
| Oxygen cost of breathing | 65 | ||
| Ventilation/perfusion distribution | 65 | ||
| Ultrasonography | 65 | ||
| Exhaled breath | 65 | ||
| Exercise tests | 65 | ||
| Case Study: Ms DT | 65 | ||
| Relevant medical history | 65 | ||
| Social history | 65 | ||
| Drug history | 66 | ||
| Subjective | 66 | ||
| Objective | 66 | ||
| Question | 66 | ||
| Response to Case Study | 66 | ||
| Recommended Reading | 66 | ||
| 3 Respiratory Disorders | 69 | ||
| Outline | 69 | ||
| Learning Objectives | 69 | ||
| Introduction | 69 | ||
| Chronic Obstructive Pulmonary Disease | 70 | ||
| Causes | 71 | ||
| Pathophysiology, Clinical Features and Comorbidities | 71 | ||
| Chronic bronchitis | 71 | ||
| Emphysema | 71 | ||
| Alpha1-antitrypsin deficiency | 73 | ||
| Chronic bronchitis and emphysema | 74 | ||
| Further comorbidities and clinical features | 74 | ||
| Tests | 76 | ||
| General Management | 76 | ||
| Drug Management | 77 | ||
| Surgical Management | 78 | ||
| Physiotherapy | 78 | ||
| Stable Disease | 78 | ||
| Exacerbation | 78 | ||
| End Stage Disease | 80 | ||
| Outcomes | 80 | ||
| Asthma | 80 | ||
| Causes | 81 | ||
| Pathophysiology | 82 | ||
| Classification and Clinical Features | 82 | ||
| Tests | 84 | ||
| General Management | 84 | ||
| Medical Management | 84 | ||
| Drugs for chronic asthma | 85 | ||
| Drugs for acute asthma | 85 | ||
| Physiotherapy | 86 | ||
| Breathing retraining | 86 | ||
| Exercise | 87 | ||
| Physical assistance for acute asthma | 87 | ||
| Outcomes | 87 | ||
| Bronchiectasis | 87 | ||
| Causes | 88 | ||
| Pathophysiology | 88 | ||
| Clinical Features | 89 | ||
| Tests | 89 | ||
| Medical Treatment | 91 | ||
| Physiotherapy | 91 | ||
| Cystic Fibrosis | 92 | ||
| Pathophysiology | 92 | ||
| Comorbidities | 92 | ||
| Clinical Features | 93 | ||
| Tests | 94 | ||
| General Management | 94 | ||
| Education | 95 | ||
| Oxygen therapy | 95 | ||
| Nutrition | 95 | ||
| Medication | 95 | ||
| Assisted ventilation | 95 | ||
| Surgery | 95 | ||
| Future therapies | 96 | ||
| Physiotherapy | 96 | ||
| Precautions | 98 | ||
| Outcomes | 98 | ||
| Primary Ciliary Dyskinesia | 98 | ||
| Inhaled Foreign Body | 99 | ||
| Interstitial Lung Disease | 100 | ||
| Pathophysiology and Comorbidities | 100 | ||
| Classification | 101 | ||
| Clinical Features | 102 | ||
| Tests | 103 | ||
| General Management | 103 | ||
| Physiotherapy | 103 | ||
| Pleural Disorders | 104 | ||
| Pleurisy | 104 | ||
| Pleural Effusion | 104 | ||
| Empyema | 106 | ||
| Pneumothorax | 106 | ||
| Types of pneumothorax | 106 | ||
| Treatment | 107 | ||
| Neuromuscular Disorders | 107 | ||
| Clinical Features and Monitoring | 107 | ||
| Classification | 109 | ||
| General Management | 111 | ||
| Management of Chronic Aspiration | 111 | ||
| Respiratory Physiotherapy | 112 | ||
| Skeletal Disorders | 113 | ||
| Kyphosis, Scoliosis and Kyphoscoliosis | 113 | ||
| Ankylosing Spondylitis | 113 | ||
| Pigeon Chest and Funnel Chest | 113 | ||
| Chest Infections | 113 | ||
| Respiratory Tract Infection | 113 | ||
| Pneumonia | 114 | ||
| Mini case study: Ms TP | 114 | ||
| Background | 114 | ||
| Subjective | 114 | ||
| Objective | 114 | ||
| Questions | 114 | ||
| Bronchopneumonia | 115 | ||
| Lobar pneumonia | 115 | ||
| Aspiration pneumonia | 115 | ||
| Pneumocystis jiroveci pneumonia | 116 | ||
| Legionella pneumonia | 117 | ||
| BOOP or COP | 117 | ||
| Hospital-acquired pneumonia | 117 | ||
| Response to mini case study | 117 | ||
| Pulmonary Tuberculosis (TB) | 117 | ||
| Aspergillosis | 117 | ||
| Abscess | 118 | ||
| Lung Cancer | 118 | ||
| Clinical Features | 119 | ||
| Classification | 119 | ||
| General Management | 121 | ||
| Physiotherapy | 121 | ||
| Complications | 121 | ||
| Outcomes | 121 | ||
| Cardiorespiratory Manifestations of Systemic Disease | 122 | ||
| HIV and AIDS | 122 | ||
| Sleep Apnoea | 122 | ||
| Kidney Disease | 124 | ||
| Liver Disease | 124 | ||
| Sickle Cell Disease (SCD) | 124 | ||
| Gastro-oesophageal Reflux disease (GORD) | 125 | ||
| Diabetes Mellitus | 126 | ||
| Inflammatory Bowel Disease | 126 | ||
| Drug-Induced Cardiorespiratory Disease | 126 | ||
| Respiratory Failure | 127 | ||
| Case Study: Mr MB | 128 | ||
| Background | 128 | ||
| Subjective | 128 | ||
| Objective | 128 | ||
| Questions | 128 | ||
| Response to Case Study | 128 | ||
| Recommended Reading | 129 | ||
| 4 Cardiovascular Disorders | 133 | ||
| Outline | 133 | ||
| Learning Objectives | 133 | ||
| Introduction | 133 | ||
| Hypertension | 133 | ||
| Classification of Systemic Hypertension | 134 | ||
| Physiology | 134 | ||
| Pathophysiology of Systemic Hypertension | 134 | ||
| Clinical Features of Systemic Hypertension | 136 | ||
| Tests for Systemic Hypertension | 136 | ||
| Treatment of Systemic Hypertension | 136 | ||
| Lifestyle | 136 | ||
| Drugs | 136 | ||
| Heart Failure | 136 | ||
| Causes | 137 | ||
| Classification | 137 | ||
| Left ventricular failure | 137 | ||
| Right ventricular failure | 137 | ||
| Congestive cardiac failure | 138 | ||
| Pathophysiology | 138 | ||
| Clinical Features | 138 | ||
| Pulmonary oedema | 139 | ||
| Tests | 139 | ||
| Management | 140 | ||
| Coronary Heart Disease | 140 | ||
| Causes | 140 | ||
| Pathophysiology | 140 | ||
| Atherosclerosis | 140 | ||
| Myocardial ischaemia | 141 | ||
| Myocardial infarction | 141 | ||
| Classification and Clinical Features | 141 | ||
| Stable angina | 141 | ||
| Acute coronary syndrome | 141 | ||
| Tests | 141 | ||
| Prevention and Treatment | 142 | ||
| Drugs | 142 | ||
| Angioplasty | 142 | ||
| Surgery | 142 | ||
| Arrhythmias | 142 | ||
| Tests | 142 | ||
| Clinical Implications of Arrhythmias | 143 | ||
| Peripheral Arterial Disease | 144 | ||
| Causes | 144 | ||
| Clinical Features | 144 | ||
| Tests | 144 | ||
| Treatment | 144 | ||
| Aneurysms | 145 | ||
| Causes | 145 | ||
| Clinical Features | 145 | ||
| Complications | 145 | ||
| Tests | 145 | ||
| Treatment | 145 | ||
| Thromboembolism | 146 | ||
| Thrombosis | 146 | ||
| Pulmonary Embolism | 146 | ||
| Case Study: MS GF | 146 | ||
| Background | 146 | ||
| Nurse report | 146 | ||
| Subjective | 147 | ||
| Objective | 147 | ||
| Questions | 147 | ||
| Response to Case Study | 147 | ||
| Recommended Reading | 147 | ||
| 5 General Management | 149 | ||
| Outline | 149 | ||
| Learning Objectives | 149 | ||
| Oxygen Therapy | 149 | ||
| Indications and Limitations | 149 | ||
| Complications | 150 | ||
| Delivery Devices | 152 | ||
| Low-flow (variable performance) mask | 152 | ||
| High-flow (fixed performance) mask | 152 | ||
| Reservoir systems | 154 | ||
| Tusk mask | 154 | ||
| Nasal cannula | 154 | ||
| High-flow nasal cannula (Fig. 5.8) | 154 | ||
| Nasopharyngeal catheter | 156 | ||
| Transtracheal catheter | 156 | ||
| Head box | 157 | ||
| T-piece | 157 | ||
| Acute Oxygen Therapy | 157 | ||
| Patients with chronic obstructive pulmonary disease | 158 | ||
| Patients with other conditions | 159 | ||
| Home Oxygen | 159 | ||
| Long-term oxygen therapy | 159 | ||
| Ambulatory oxygen | 162 | ||
| Palliative oxygen therapy | 163 | ||
| Short-burst oxygen therapy | 163 | ||
| Hyperbaric Oxygen Therapy | 163 | ||
| Heliox | 163 | ||
| Nutrition | 163 | ||
| Causes of Poor Nutrition in Cardiorespiratory Patients | 164 | ||
| Effects of Poor Nutrition | 164 | ||
| Management | 164 | ||
| Respiratory Drugs | 166 | ||
| Drugs for Inflammation | 167 | ||
| Drugs for Bronchospasm | 167 | ||
| Drugs for Breathlessness | 169 | ||
| Drugs to Help Clear Secretions | 170 | ||
| Drugs for Smoking Cessation | 170 | ||
| Drugs for Infection | 170 | ||
| Drugs to Inhibit Coughing | 171 | ||
| Drugs to Improve Ventilation | 171 | ||
| Drugs to Improve Sleep | 171 | ||
| Delivery Devices | 171 | ||
| Inhalers (Fig. 5.15) | 171 | ||
| Small-volume nebulizers | 173 | ||
| Inhaler or nebulizer? | 174 | ||
| Bronchoscopy and Lavage | 175 | ||
| Case Study: Mr FJ | 175 | ||
| History of present complaint | 175 | ||
| Medication | 175 | ||
| Social history | 175 | ||
| Subjective | 175 | ||
| Objective | 175 | ||
| Questions | 176 | ||
| Response to Case Study | 176 | ||
| Recommended Reading | 177 | ||
| II Physiotherapy techniques | 179 | ||
| 6 Physiotherapy to Increase Lung Volume | 179 | ||
| Outline | 179 | ||
| Learning Objectives | 179 | ||
| Introduction to Cardiorespiratory Physiotherapy | 179 | ||
| What Is Loss of Lung Volume and Does It Matter? | 181 | ||
| Controlled Mobilization | 181 | ||
| Positioning | 182 | ||
| The Physiology of Positioning | 182 | ||
| Positioning for Lung Volume | 182 | ||
| Positioning for Gas Exchange | 184 | ||
| Breathing Exercises to Increase Lung Volume | 186 | ||
| Deep Breathing | 186 | ||
| End-Inspiratory Hold | 187 | ||
| Abdominal Breathing | 187 | ||
| Sniff | 187 | ||
| Neurophysiological Facilitation of Respiration | 187 | ||
| Rib Springing | 189 | ||
| Incentive Spirometry | 189 | ||
| Continuous Positive Airway Pressure (CPAP) | 191 | ||
| Effects and Indications | 191 | ||
| Complications | 192 | ||
| Contraindications and Precautions | 192 | ||
| Technique | 192 | ||
| Intermittent Positive Pressure Breathing (IPPB) | 193 | ||
| Indications | 193 | ||
| Effects | 194 | ||
| Complications | 194 | ||
| Contraindications and Precautions | 194 | ||
| Technique for the Bird | 194 | ||
| Problems | 195 | ||
| Outcomes | 195 | ||
| Case Study: MS MB | 196 | ||
| Social history | 196 | ||
| History of present complaint | 196 | ||
| Subjective | 196 | ||
| Objective | 196 | ||
| Questions | 196 | ||
| Response to Case Study | 197 | ||
| Recommended Reading | 197 | ||
| 7 Physiotherapy to Clear Secretions | 199 | ||
| Outline | 199 | ||
| Learning Objectives | 199 | ||
| Sputum in Perspective | 199 | ||
| Are Excess Secretions a Problem? | 199 | ||
| What is the Specific Problem? | 200 | ||
| Hydration and Humidification | 200 | ||
| Classification | 201 | ||
| Hydration | 201 | ||
| Hot water humidification | 201 | ||
| Cold water bubble humidification | 202 | ||
| Nebulized humidification | 203 | ||
| Heat–moisture exchange | 204 | ||
| Complications | 204 | ||
| Indications | 205 | ||
| Technique | 205 | ||
| Exercise | 205 | ||
| Breathing Techniques | 205 | ||
| Active Cycle of Breathing Techniques | 206 | ||
| Mechanism | 206 | ||
| Technique | 206 | ||
| Autogenic Drainage | 207 | ||
| Indications | 208 | ||
| Effects | 208 | ||
| Technique | 208 | ||
| Postural Drainage | 209 | ||
| Effects | 209 | ||
| Technique | 209 | ||
| Indications | 210 | ||
| Contraindications to Head-Down Postural Drainage | 210 | ||
| Precautions to Head-Down Postural Drainage | 210 | ||
| Manual Techniques | 210 | ||
| Effects | 210 | ||
| Technique | 210 | ||
| Contraindications | 211 | ||
| Precautions | 211 | ||
| Mechanical Aids | 211 | ||
| Positive Expiratory Pressure | 211 | ||
| Indications | 212 | ||
| Contraindications | 212 | ||
| Technique | 212 | ||
| Variations | 212 | ||
| Oscillatory Positive Expiratory Pressure | 214 | ||
| Bubble PEP | 214 | ||
| Flutter | 214 | ||
| Acapella | 214 | ||
| Shaker | 214 | ||
| Cornet | 214 | ||
| Lung Flute | 215 | ||
| Machines | 215 | ||
| High-frequency chest compressors | 215 | ||
| Intrapulmonary percussors | 215 | ||
| High-frequency oscillators | 216 | ||
| Intermittent positive pressure breathing | 216 | ||
| Hydroacoustic therapy | 216 | ||
| Cough | 216 | ||
| Cough Facilitation | 216 | ||
| Manually assisted cough | 217 | ||
| Mechanically assisted cough | 217 | ||
| Cough Control | 218 | ||
| Suction | 219 | ||
| Indications | 219 | ||
| Catheters | 219 | ||
| Complications | 220 | ||
| Contraindications | 220 | ||
| Precautions | 220 | ||
| Technique | 221 | ||
| Nasopharyngeal Airway | 222 | ||
| Minitracheostomy | 223 | ||
| Home Suction | 223 | ||
| Outcomes for Airway Clearance | 224 | ||
| Case Study: MS | 224 | ||
| Social history | 224 | ||
| Home management | 224 | ||
| Subjective | 224 | ||
| Objective | 224 | ||
| Questions | 225 | ||
| Response to Case Study | 225 | ||
| Recommended Reading | 226 | ||
| 8 Physiotherapy to Decrease the Work of Breathing | 227 | ||
| Outline | 227 | ||
| Learning Objectives | 227 | ||
| Introduction | 227 | ||
| Breathlessness | 228 | ||
| Causes | 228 | ||
| Physiology | 228 | ||
| Mechanical inputs | 229 | ||
| Cortical inputs | 230 | ||
| Chemical inputs | 231 | ||
| Effects on the Patient | 231 | ||
| Management | 231 | ||
| Handling Breathless People | 231 | ||
| Desensitization to Breathlessness | 232 | ||
| Fan | 233 | ||
| Positioning | 233 | ||
| Mechanical Input | 234 | ||
| Quality of Movement | 234 | ||
| Thoracic Mobility | 235 | ||
| Other Respiratory Problems | 235 | ||
| Loss of lung volume | 235 | ||
| Sputum retention | 235 | ||
| Sleep, Rest and Relaxation | 235 | ||
| Breathing Re-education | 236 | ||
| Preliminaries | 236 | ||
| Rhythmic Breathing | 237 | ||
| Abdominal Breathing | 237 | ||
| Square Breathing | 238 | ||
| Yoga Breathing | 238 | ||
| Prolonged Exhalation | 238 | ||
| Pursed Lips Breathing | 238 | ||
| Exercise and Pacing | 238 | ||
| Noninvasive Ventilation | 239 | ||
| Noninvasive Ventilation for Acute Disorders | 239 | ||
| Noninvasive Ventilation for Chronic Disorders | 239 | ||
| Criteria | 240 | ||
| Contraindications, Precautions and Complications | 240 | ||
| Mode of Action | 240 | ||
| Interface | 241 | ||
| Technique | 242 | ||
| Other Ventilators | 244 | ||
| Outcomes | 244 | ||
| Discharge From Physiotherapy | 245 | ||
| Case Study: Ms Ab | 245 | ||
| Relevant medical history | 245 | ||
| History of present complaint | 245 | ||
| Family history | 245 | ||
| Social history | 245 | ||
| Subjective | 245 | ||
| Objective | 245 | ||
| Questions | 245 | ||
| Response to Case Study | 245 | ||
| Recommended Reading | 246 | ||
| 9 Pulmonary Rehabilitation | 247 | ||
| Outline | 247 | ||
| Learning Objectives | 247 | ||
| Introduction | 247 | ||
| Effects | 247 | ||
| Participants | 249 | ||
| The Setup | 249 | ||
| Resources | 249 | ||
| Structure and timing | 250 | ||
| Assessment | 250 | ||
| Background Information | 250 | ||
| Subjective | 251 | ||
| Exercise Tests | 251 | ||
| Six-minute walk distance | 251 | ||
| Incremental shuttle walk test | 252 | ||
| Endurance shuttle test | 252 | ||
| Other tests | 252 | ||
| Education | 252 | ||
| Motivation | 253 | ||
| Understanding Reactions to the Disease | 254 | ||
| Exercise Training | 255 | ||
| Effects | 255 | ||
| Mechanism of Training | 255 | ||
| Safety | 256 | ||
| Technique | 256 | ||
| Preliminaries | 256 | ||
| Exercise prescription | 257 | ||
| Progression | 260 | ||
| Respiratory Muscle Training | 260 | ||
| Rationale | 260 | ||
| Effects | 260 | ||
| Indications and Precautions | 260 | ||
| Technique | 261 | ||
| Energy Conservation | 261 | ||
| Activities of Daily Living | 261 | ||
| Stress Reduction | 262 | ||
| Relaxation | 263 | ||
| Complementary therapies | 263 | ||
| Follow-Up | 263 | ||
| Outcomes | 264 | ||
| Case Study: Mr Eh | 265 | ||
| Background | 265 | ||
| Subjective | 265 | ||
| Objective | 266 | ||
| Questions | 266 | ||
| Response to Case Study | 266 | ||
| Recommended Reading | 266 | ||
| 10 Physiotherapy for People With Cardiovascular Disorders | 269 | ||
| Outline | 269 | ||
| Learning Objectives | 269 | ||
| Introduction | 269 | ||
| Physiotherapy for People With Heart Failure | 269 | ||
| Education | 270 | ||
| Exercise | 271 | ||
| Management of Patients With Acute Disease | 272 | ||
| Physiotherapy for People With Coronary Heart Disease – Overview | 272 | ||
| Physiotherapy for People With Peripheral Arterial Disease | 273 | ||
| Education | 273 | ||
| Exercise | 273 | ||
| Case Study: Mr BG | 274 | ||
| Background | 274 | ||
| Nurse report | 274 | ||
| Subjective | 274 | ||
| Objective | 274 | ||
| Questions | 274 | ||
| Response to Case Study | 274 | ||
| Recommended Reading | 274 | ||
| 11 Cardiac Rehabilitation | 277 | ||
| Outline | 277 | ||
| Learning Objectives | 277 | ||
| Introduction | 277 | ||
| Structure | 279 | ||
| Inpatient Period | 279 | ||
| Early Postdischarge Period | 279 | ||
| Intermediate Postdischarge Period | 279 | ||
| Long-Term Maintenance | 280 | ||
| Education | 280 | ||
| Exercise | 280 | ||
| Assessment | 281 | ||
| Safety | 281 | ||
| Procedure | 282 | ||
| Relaxation | 283 | ||
| Follow-Up | 283 | ||
| Outcomes | 284 | ||
| Exercise Capacity | 284 | ||
| Quality of Life | 284 | ||
| Case Study: Mr Te | 284 | ||
| Background | 284 | ||
| Nurse report | 284 | ||
| Subjective | 284 | ||
| Objective | 284 | ||
| Questions | 284 | ||
| Response to Case Study | 284 | ||
| Recommended Reading | 285 | ||
| III Surgery | 287 | ||
| 12 Complications | 287 | ||
| Outline | 287 | ||
| Learning Objectives | 287 | ||
| Introduction to Surgery | 287 | ||
| Cardiorespiratory Complications | 287 | ||
| Atelectasis | 287 | ||
| Hypoxaemia | 289 | ||
| Chest Infection | 289 | ||
| Haemodynamic Instability | 290 | ||
| Ventilatory Instability | 290 | ||
| Obstructive Sleep Apnoea | 290 | ||
| Thromboembolism | 290 | ||
| Other Complications | 290 | ||
| Case Study: Mr MF | 291 | ||
| From notes | 291 | ||
| Subjective | 292 | ||
| Objective | 292 | ||
| Questions | 292 | ||
| Response to Case Study | 292 | ||
| Recommended Reading | 293 | ||
| 13 Physiotherapy for Surgical Patients | 295 | ||
| Outline | 295 | ||
| Learning Objectives | 295 | ||
| Preoperative Physiotherapy | 295 | ||
| Preoperative Teamwork | 296 | ||
| Pain Management | 297 | ||
| Effects of Pain | 297 | ||
| Assessment | 298 | ||
| Handling Patients in Pain | 298 | ||
| Medication | 299 | ||
| Postoperative Physiotherapy | 300 | ||
| Mobility | 301 | ||
| Positioning | 301 | ||
| Breathing Exercises | 302 | ||
| Prevention of Deep Vein Thrombosis (DVT) | 303 | ||
| Discharge and Outcomes | 303 | ||
| Case Study: Mr MW | 303 | ||
| Social history | 303 | ||
| Subjective | 303 | ||
| Objective | 303 | ||
| Questions | 304 | ||
| Response to Case Study | 304 | ||
| Recommended Reading | 304 | ||
| 14 Modifications for Different Types of Surgery | 307 | ||
| Outline | 307 | ||
| Learning Objectives | 307 | ||
| Abdominal Surgery | 307 | ||
| Complications | 307 | ||
| Oxygen, Fluids and Nutrition | 308 | ||
| Physiotherapy | 308 | ||
| Lung Surgery | 309 | ||
| Procedures | 309 | ||
| Complications | 310 | ||
| Physiotherapy | 312 | ||
| Pleural Surgery | 313 | ||
| Chest Drains | 314 | ||
| Procedure | 314 | ||
| Mechanism | 314 | ||
| Management | 316 | ||
| IV Physiotherapy for specific groups of people | 337 | ||
| 15 Infants | 337 | ||
| Outline | 337 | ||
| Learning Objectives | 337 | ||
| Introduction | 337 | ||
| How the Neonatal Cardiorespiratory System Works | 337 | ||
| Prematurity | 337 | ||
| Care of the Family | 339 | ||
| Medical Conditions | 340 | ||
| Meconium Aspiration Syndrome | 340 | ||
| Persistent Pulmonary Hypertension of the Newborn | 340 | ||
| Intraventricular Haemorrhage | 340 | ||
| Pulmonary Haemorrhage | 340 | ||
| Respiratory Distress Syndrome | 340 | ||
| Chronic Lung Disease (CLD) of Prematurity | 341 | ||
| Bronchiolitis | 341 | ||
| Tracheobronchomalacia | 342 | ||
| Spinal Muscular Atrophy | 342 | ||
| Gastro-Oesophageal Reflux | 342 | ||
| Surgical Conditions | 342 | ||
| Congenital Heart Disease (CHD) | 342 | ||
| Congenital Diaphragmatic Hernia | 343 | ||
| Necrotizing Enterocolitis | 344 | ||
| Oesophageal Atresia With Tracheo-Oesophageal Fistula | 344 | ||
| Neonatal Intensive Care | 344 | ||
| Stress Management | 345 | ||
| Noise and light | 345 | ||
| Sleep | 345 | ||
| Pain | 346 | ||
| Support Systems | 347 | ||
| Humidification and temperature regulation | 347 | ||
| Oxygen therapy | 347 | ||
| Nutrition | 348 | ||
| Drugs | 348 | ||
| Continuous positive airway pressure (CPAP) | 348 | ||
| Noninvasive ventilation | 349 | ||
| Mechanical ventilation | 349 | ||
| Physiotherapy | 350 | ||
| Consent | 350 | ||
| Assessment | 350 | ||
| History | 351 | ||
| Subjective | 351 | ||
| Objective | 351 | ||
| Monitoring | 353 | ||
| Indications for Treatment | 353 | ||
| Contraindications | 353 | ||
| Precautions | 353 | ||
| Methods to Increase Lung Volume | 354 | ||
| Positioning | 354 | ||
| Hyperinflation | 354 | ||
| Methods to Reduce the Work of Breathing | 354 | ||
| Methods to Clear Secretions | 355 | ||
| Assisted autogenic drainage | 355 | ||
| Postural drainage | 355 | ||
| Percussion and vibrations | 355 | ||
| Mechanical insufflation–exsufflation | 356 | ||
| Suction | 356 | ||
| Nonbronchoscopic bronchoalveolar lavage (NBBAL) | 358 | ||
| Exercise and Rehabilitation | 360 | ||
| Case Study: Holly | 360 | ||
| Questions | 360 | ||
| Response to Case Study | 360 | ||
| Case Study: Jack | 361 | ||
| Observations | 361 | ||
| Auscultation | 361 | ||
| Questions | 361 | ||
| Response to Case Study | 361 | ||
| Recommended Reading | 362 | ||
| 16 Children | 365 | ||
| Outline | 365 | ||
| Learning Objectives | 365 | ||
| Introduction | 365 | ||
| Differences Between Children and Adults | 365 | ||
| Cardiorespiratory Conditions | 366 | ||
| Cystic Fibrosis | 366 | ||
| Asthma | 367 | ||
| Chest Infections | 368 | ||
| Croup | 368 | ||
| Epiglottitis | 369 | ||
| Pneumonia | 369 | ||
| Pertussis (whooping cough) | 369 | ||
| Paediatric Acute Respiratory Distress Syndrome (ARDS) | 369 | ||
| Inhaled Foreign Body | 369 | ||
| Hypertension | 370 | ||
| Conduction Disorders | 370 | ||
| Hyperventilation Syndrome | 370 | ||
| Conditions With Cardiorespiratory Complications | 370 | ||
| Gastro-oesophageal Reflux Disease | 370 | ||
| Neuromuscular Conditions | 370 | ||
| Trauma | 372 | ||
| Surgery | 372 | ||
| Preoperative Care | 372 | ||
| Postoperative Care | 373 | ||
| Paediatric Intensive Care Unit (PICU) | 373 | ||
| Pain Management | 373 | ||
| Oxygen Therapy | 374 | ||
| Respiratory Drugs | 374 | ||
| Continuous Positive Airway Pressure and Noninvasive Ventilation | 376 | ||
| Mechanical Ventilation | 377 | ||
| Extubation | 377 | ||
| Tracheostomy | 377 | ||
| Physiotherapy | 378 | ||
| Consent | 378 | ||
| Assessment | 378 | ||
| Subjective | 379 | ||
| Objective | 379 | ||
| Precautions | 379 | ||
| Methods to Increase Lung Volume | 380 | ||
| Methods to Reduce the Work of Breathing | 381 | ||
| Methods to Clear Secretions | 381 | ||
| Mucociliary clearance | 382 | ||
| Cough | 382 | ||
| Suction | 382 | ||
| Exercise and Rehabilitation | 383 | ||
| Transition | 384 | ||
| Palliative Care | 384 | ||
| Case Study: Mark | 385 | ||
| Questions | 385 | ||
| Response to Case Study | 385 | ||
| Case Study: Hannah | 386 | ||
| Questions | 386 | ||
| Response to Case Study | 386 | ||
| Recommended Reading | 387 | ||
| 17 Hyperventilation Syndrome | 391 | ||
| Outline | 391 | ||
| Learning Objectives | 391 | ||
| Introduction | 391 | ||
| Causes, Triggers and Effects | 392 | ||
| Pathophysiology | 395 | ||
| Clinical Features | 396 | ||
| Assessment | 397 | ||
| Subjective | 398 | ||
| Objective | 398 | ||
| Questionnaires | 398 | ||
| Tests | 399 | ||
| Education | 399 | ||
| Breathing Retraining | 401 | ||
| Awareness of Breathing | 401 | ||
| Nose Breathing | 401 | ||
| Relaxation | 401 | ||
| Abdominal Breathing | 402 | ||
| Reducing the Minute Volume | 402 | ||
| Variations | 403 | ||
| Management of Panic Attacks | 403 | ||
| Progression and Integration | 404 | ||
| Outcomes | 405 | ||
| Case Study: Ms SJ | 405 | ||
| Relevant medical history | 405 | ||
| History of present complaint | 406 | ||
| Social history | 406 | ||
| Subjective | 406 | ||
| Objective | 406 | ||
| Questions | 406 | ||
| Response to Case Study | 406 | ||
| Outcomes: sequence | 407 | ||
| Recommended Reading | 407 | ||
| 18 Elderly People With Cardiorespiratory Disease | 409 | ||
| Outline | 409 | ||
| Learning Objectives | 409 | ||
| Normal Effects of Ageing | 409 | ||
| Preventable Effects of Ageing | 410 | ||
| Needs of Older People | 412 | ||
| Specific Environments | 413 | ||
| Outcomes | 414 | ||
| Case Study: Mr MM | 414 | ||
| Social history | 415 | ||
| Subjective | 415 | ||
| Objective | 415 | ||
| Questions | 415 | ||
| Response to Case Study | 415 | ||
| Recommended Reading | 416 | ||
| 19 Palliative Respiratory Physiotherapy | 417 | ||
| Outline | 417 | ||
| Learning Objectives | 417 | ||
| Introduction | 417 | ||
| Reactions of Patients | 418 | ||
| Reactions of Relatives | 419 | ||
| Reactions of Staff | 419 | ||
| Where to Die? | 419 | ||
| Communicating With Dying People | 420 | ||
| Management of Symptoms | 421 | ||
| Breathlessness | 421 | ||
| Fatigue | 423 | ||
| Weakness | 423 | ||
| Immobility | 423 | ||
| Cough | 423 | ||
| Difficulty Swallowing | 423 | ||
| Dehydration and Thirst | 424 | ||
| Stridor | 424 | ||
| Depression | 424 | ||
| Anxiety | 424 | ||
| Discomfort | 424 | ||
| Pain | 425 | ||
| Intractable Hiccups | 425 | ||
| Nausea or Vomiting | 425 | ||
| Agitation | 425 | ||
| Delirium | 425 | ||
| Insomnia | 425 | ||
| Secretions and the Death Rattle | 426 | ||
| Terminal Restlessness | 426 | ||
| Deathbed Phenomena | 426 | ||
| On Dying Well | 426 | ||
| Outcomes | 426 | ||
| Case Study: Ms Iu | 427 | ||
| Social history | 427 | ||
| Subjective | 427 | ||
| Objective | 427 | ||
| Questions | 427 | ||
| Response to Case Study | 427 | ||
| Recommended Reading | 428 | ||
| V Critical care | 431 | ||
| 20 Critical Care, Support and Monitoring | 431 | ||
| Outline | 431 | ||
| Learning Objectives | 431 | ||
| Introduction | 431 | ||
| Environment | 432 | ||
| Effects on the Patient | 432 | ||
| Effects on Relatives | 436 | ||
| Effects on Staff | 436 | ||
| Patients’ Rights | 437 | ||
| Consent | 437 | ||
| Moral rights | 437 | ||
| End-of-life decisions | 437 | ||
| Infection Control | 438 | ||
| Teamwork | 438 | ||
| Mechanical Ventilation | 438 | ||
| Indications | 439 | ||
| Airway | 439 | ||
| The Breath Cycle | 440 | ||
| Trigger: start of the breath | 440 | ||
| Control: delivery of the breath | 441 | ||
| Cycle: end of the breath | 442 | ||
| Modes of Ventilation | 442 | ||
| Controlled mandatory ventilation (CMV) | 442 | ||
| Assist-control | 442 | ||
| Intermittent mandatory ventilation (IMV) | 442 | ||
| Synchronized intermittent mandatory ventilation (SIMV) | 443 | ||
| Pressure support ventilation (PSV) | 443 | ||
| Proportional assist ventilation | 443 | ||
| Assist mode | 443 | ||
| Neurally adjusted ventilatory assist (NAVA) | 443 | ||
| Bilevel positive airway pressure (BiPAP) | 443 | ||
| Biphasic positive airway pressure (BIPAP) | 444 | ||
| Airway pressure release ventilation (APRV) | 444 | ||
| Continuous positive airway pressure (CPAP) | 445 | ||
| Mandatory minute ventilation | 445 | ||
| Variable ventilation | 445 | ||
| Strategies of Ventilation | 445 | ||
| Inverse-ratio ventilation | 445 | ||
| Lung protective ventilation | 446 | ||
| Settings | 446 | ||
| Complications | 447 | ||
| Impaired cardiac output | 447 | ||
| Barotrauma | 447 | ||
| Ventilator-induced lung injury | 448 | ||
| Gastro-oesophageal reflux | 449 | ||
| Weakness and muscle damage | 449 | ||
| Perfusion gradient | 449 | ||
| Ventilation gradient | 449 | ||
| Atelectasis | 449 | ||
| Increased dead space | 449 | ||
| Ventilation/perfusion (V̇A/Q̇) mismatch | 449 | ||
| Discomfort | 449 | ||
| Breathlessness | 450 | ||
| Gut and kidney dysfunction | 450 | ||
| Excess secretions and sputum retention | 450 | ||
| Intrinsic PEEP | 450 | ||
| Positive End-Expiratory Pressure (PEEP) | 451 | ||
| Benefits | 451 | ||
| Complications | 451 | ||
| Best PEEP | 452 | ||
| Precautions | 452 | ||
| High-Frequency Ventilation | 452 | ||
| Mechanism | 453 | ||
| Advantages | 453 | ||
| Disadvantages | 453 | ||
| Indications | 453 | ||
| Physiotherapy | 453 | ||
| Weaning | 453 | ||
| Intermittent Reduction in Ventilatory Support | 454 | ||
| Spontaneous Breathing Trial (SBT) | 455 | ||
| Extubation | 456 | ||
| Decannulation of Tracheostomy | 457 | ||
| Support Systems | 457 | ||
| Oxygen | 457 | ||
| Fluids | 457 | ||
| Nutrition | 458 | ||
| Causes of malnutrition | 458 | ||
| Effects of malnutrition | 458 | ||
| Management | 459 | ||
| Critical Care Drugs | 459 | ||
| Cardiovascular drugs | 459 | ||
| Diuretics. | 459 | ||
| Inotropes. | 459 | ||
| Vasodilators. | 460 | ||
| Vasoconstrictors. | 460 | ||
| Beta-blockers. | 460 | ||
| Pulmonary vasodilators. | 460 | ||
| Sedatives | 460 | ||
| Analgesics | 461 | ||
| Muscle relaxants | 461 | ||
| Inhaled drugs | 461 | ||
| Advanced Life Support | 462 | ||
| Advanced cardiac support | 462 | ||
| Advanced pulmonary support | 463 | ||
| Advanced cardiopulmonary support | 464 | ||
| Monitoring | 465 | ||
| Ventilator Waveforms | 465 | ||
| Gas Exchange | 465 | ||
| Haemodynamic Monitoring | 467 | ||
| Fluid status | 467 | ||
| Blood pressure | 467 | ||
| Cardiac output (CO) | 467 | ||
| Central venous pressure (CVP) | 467 | ||
| Pulmonary artery wedge pressure (PAWP) | 468 | ||
| Electrocardiography (ECG) | 469 | ||
| Tissue Oxygenation | 471 | ||
| Mixed venous oxygenation () | 471 | ||
| Central venous oxygenation (ScvO2) | 472 | ||
| Cerebral oximetry | 472 | ||
| Case Study: Mr FA | 472 | ||
| Relevant medical history | 472 | ||
| On examination | 472 | ||
| Questions | 472 | ||
| Response to Case Study | 473 | ||
| Recommended Reading | 474 | ||
| 21 Physiotherapy for Critically Ill Patients | 477 | ||
| Outline | 477 | ||
| Learning Objectives | 477 | ||
| Introduction | 477 | ||
| Assessment | 478 | ||
| Notes and Charts | 478 | ||
| The Patient | 479 | ||
| Monitors | 479 | ||
| Ventilator | 480 | ||
| Imaging | 481 | ||
| Handling People Who Are Critically Ill | 481 | ||
| Minimizing Oxygen Consumption | 482 | ||
| Preliminaries | 482 | ||
| Orientation | 482 | ||
| Sleep and rest | 485 | ||
| Family | 485 | ||
| Communication | 485 | ||
| Helplessness | 485 | ||
| Touch | 486 | ||
| Handling Unconscious or Paralysed People | 486 | ||
| Turning | 486 | ||
| Pressure Area Care | 487 | ||
| Techniques to Increase Lung Volume | 487 | ||
| Positioning | 487 | ||
| Deep Breathing on the Ventilator | 488 | ||
| Manual Hyperinflation | 488 | ||
| Terminology | 488 | ||
| Effects | 488 | ||
| Complications | 488 | ||
| Equipment | 489 | ||
| Technique | 489 | ||
| Pressures | 491 | ||
| Contraindications | 491 | ||
| Precautions and modifications | 492 | ||
| Ventilator Hyperinflation or Recruitment Manoeuvre | 492 | ||
| Techniques to Clear Secretions | 494 | ||
| Humidification | 494 | ||
| Postural Drainage | 495 | ||
| Manual Techniques | 496 | ||
| Flow Bias | 496 | ||
| Manual and Ventilator Hyperinflation | 496 | ||
| Mechanical Aids | 496 | ||
| Suction | 496 | ||
| Complications | 497 | ||
| Catheters | 497 | ||
| Preliminaries | 497 | ||
| Technique for closed-circuit suction | 498 | ||
| Modifications for open suction | 498 | ||
| Reducing hypoxaemia | 498 | ||
| Saline instillation | 498 | ||
| Exercise and Rehabilitation | 500 | ||
| Passive Exercise | 501 | ||
| Active Exercise | 501 | ||
| Mobilization | 502 | ||
| End of Treatment Session | 505 | ||
| Transfer From the Intensive Care Unit | 506 | ||
| Follow-Up | 506 | ||
| Physiotherapy Outcomes | 507 | ||
| Recognition and Management of Emergencies | 507 | ||
| Cardiac Arrest | 507 | ||
| Anticipation | 507 | ||
| VI Does it work? | 555 | ||
| 23 Evaluation of Cardiorespiratory Physiotherapy | 555 | ||
| Outline | 555 | ||
| Learning Objectives | 555 | ||
| Introduction | 555 | ||
| Definitions | 556 | ||
| Research | 556 | ||
| Literature Appraisal | 557 | ||
| Examples | 558 | ||
| Example 1. | 558 | ||
| Example 2. | 558 | ||
| Example 3. | 558 | ||
| Example 4. | 558 | ||
| Example 5. | 558 | ||
| Example 6. | 558 | ||
| Example 7. | 559 | ||
| Standards | 559 | ||
| Outcomes | 559 | ||
| Subjective Measurement | 560 | ||
| Objective Measurement | 560 | ||
| Successes Folder | 560 | ||
| Cost Effectiveness | 560 | ||
| The Audit Cycle | 562 | ||
| Education and Continuing Education | 563 | ||
| Needs of Students and Junior Staff | 563 | ||
| Competencies for On-Calls and Weekends | 564 | ||
| Clinical Reasoning – Learnt or Taught? | 565 | ||
| Case Study: Mr FF | 565 | ||
| History of present complaint | 565 | ||
| Subjective | 565 | ||
| Phase 1 questions (Fig. 23.5A) | 565 | ||
| Response to Case Study Phase 1 | 565 | ||
| What happened | 565 | ||
| Management and progress | 565 | ||
| Phase 2 questions | 567 | ||
| Response to Case Study Phase 2 | 567 | ||
| Outcome | 567 | ||
| Recommended Reading | 567 | ||
| Glossary of Abbreviations, Definitions, Symbols and Values | 569 | ||
| Index | 579 | ||
| A | 579 | ||
| B | 581 | ||
| C | 582 | ||
| D | 586 | ||
| E | 586 | ||
| F | 587 | ||
| G | 588 | ||
| H | 588 | ||
| I | 590 | ||
| J | 591 | ||
| K | 591 | ||
| L | 591 | ||
| M | 592 | ||
| N | 593 | ||
| O | 594 | ||
| P | 594 | ||
| Q | 597 | ||
| R | 597 | ||
| S | 598 | ||
| T | 600 | ||
| U | 601 | ||
| V | 601 | ||
| W | 602 | ||
| Y | 602 | ||
| Z | 602 | ||
| References | e1 |