Path/Pharm Respiratory Notes

These notes are being provided to the Thursday Path/Pharm class in lieu of lecture. Although they are not a substitute for class/lecture hours, it is recognized that you will be spending much time in study with them. Because of this you will be receiving 3 hours of credit towards your hours total. Please notify me if there are any questions or comments.

Outline
501 Pathology
934 Pharmacology
Respiratory Pathologies

I. Anatomy and physiology of the structures of the respiratory system
A. Breathing is most easily observable vital sign
1. Holding breath – pain
2. shallow/rapid – anxiety
B. Effects of massage
1. Increases oxygenation
2. Decreased tension
3. Increased removal of wastes of metabolism
C. functions of respiratory system
1. Gas exchange (O2 intake and elimination of CO2)
2. Disruption build up of CO2 and cell death
3. Assists regulation of body’s pH (elimination CO2 – decreasing acidity)
4. Provides for sense of smell by containing olfactory receptors
5. Filters air
6. Produces sound
7. Eliminates water and heat in exhaled air
D. Mucous membranes – line resp. tract, start in nose and mouth, sinuses, throat, all the way down to smaller tubes in lungs
E. Air movement
1. Nasal cavity
2. Pharynx
a. nasopharynx
b. oropharynx
3. Larynx (voice box)
4. Trachea
a.. 16-20 incomplete rings of cartilage
b. semi rigid support to deep airway open
5. Primary bronchi (bronchus) – enter lungs
a. right is bigger, wider, straighter
b. usual location of aspirated object
6. Secondary bronchi
7. Tertiary bronchi
8. Bronchioles – subdivide 23 times
9. Alveoli
a. air sacs
b. elastic tissue
c. alveolar sac
d. surrounded by pulmonary capillaries
e. respiratory membrane – site of has exchange
f. blood from pulmonary capillaries into pulmonary veins to heart

II. Pulmonary ventilation – inspiration (inhalation) + expiration (exhalation)
A. controlled by resp. center in medulla oblongata and pons
B. can be voluntarily altered
C. mechanical process altering atmospheric air pressure
a. inspiration (active process)
1. Diaphragm contracts
2. External intercostals lift ribs
3. Alveoli fill w/air
b. exhalation (passive)
1. Diaphragm relaxes
2. Elastic recoil of alveoli pushes air out
D. Secondary muscles of respiration (accessory)
a. scalenes – lift ribs 1 and 2
b. sternocleidomastoid (SCM) lifts sternum and clavicle
c. pec. minor lifts ribs
d. Serratus posterior lifts ribs
e. abdominal muscles – push diaphragm upward
f. internal intercostals – depresses ribs

III. Specific homeostatic imbalances and the associated medications
A. Asthma – chronic, inflammatory disorder caused by airway sensitivity to various stimuli, airway obstruction
1. Triggers – allergens, emotional stress, aspirin, exercise, cold air, smoke
2. Smooth muscle spasm, excessive mucus is produced
3. Airway inflammation, edema, death of cells
4. Tx: inhaled muscle relaxants and bronchodilators
a. albuterol (Ventolin) pg 121
b. ipratropium bromide (Atrovent), w/albuterol (Combivent)
c. anhydrous theophylline (Theo-Dur) pg 119
d. meds stimulate sympathetic nervous system
5. Massage – as to tolerance
a. monitor for triggers
b. rescue inhalers within reach
c. side lying or semi reclining
d. work muscles of resp.
e. deep friction, kneading, deep gliding strokes
f. vibration and percussion to loosen mucus
B. Bronchitis – inflammation of bronchial mucosa, causes edema of bronchial tubes and production of extra mucus
1. acute – URI, productive cough, high fever (massage contra’d)
2. chronic – increased mucus, prod. Cough 3 mos of yr. for 2 successive years
a. cigarettes
b. mucous narrows airways
c. impairs cilliary action
d. increased risk of infection
e. same meds as asthma, and acetylcysteine (Mucomyst) pg. 124
i. act directly on mucus, to make it easier to eliminate
3. Massage
a. positioning
b. postural drainage – head lo0wer than rest of body
c. percussion and vibration for 5 mins
d. menthol based lubrication
e. muscles of respiration – deep friction, kneading, ischemic compression, deep gliding strokes
C. Coryza (common cold) – acute inflammation of mucous membrane of upper respiratory tract usually nose and throat caused by a virus
1. Coughing, sneezing, watery eyes, nasal congestion and discharge, sore throat, hoarseness, fever, chills
a. Decongestants pg. 125
i. pseudoephedrine (Sudafed) – side effects: nervousness, restlessness, and insomnia
b. Antihistamine
i. diphenhydramine – Benadryl pg. 181
ii. CNS depression – dizziness, lethargy
2. Massage – contra’d for 3 days after sx appear
a. as to tolerance after acute stage
b. exacerbates sx for short time but decreases recovery time

D. Influenza (Flu) – acute viral infection of resp. tract caused by a virus
1. 3 day incubation lasts 3-10 days
2. Inflamed nasal mucosa and pharynx, fever, chills, headache, muscle aches and pains
3. Massage contra’d

E. Pneumonia – inflammation of alveoli d/t infection or other pathology (aspiration)
1. Alveoli fill w/fluid and exudates
2. Most common infectious cause of death in US
a. elderly, infants, immunocomprimised, smokers
b. “old man’s friend”
c. Expectorants pg 122
i. guaifenesin (Robitussin) – thin mucus for easier coughing, also smoothes respiratory tract
ii. Often combined with codeine
d. Antiussives pg 123
i. benzonaatate (Tessalon) – suppresses non productive cough
3. Massage contra if acute
a. obtain clearance
b. percussion and vibration of rib cage
c. primary and secondary muscles
d. stretching, joint mobilizations and massage on extrems to prevent atrophy
F. Sinusitis – inflammation of paranasal sinuses
1. Infection, change in environment, structural defect of nose
2. Swelling obstructs sinus openings
3. Local tenderness, pain, headaches, fever
4. Massage contra if fever
a. general massage
b. prone position and face cradle can increase sinus congestion
c. local moist heat
d. ischemic compression to frontal and sphenoidal sinuses
e. steam inhalation

IV. Other terminology
A. COPD – chronic obstructive pulmonary disease
1. asthma, bronchitis, emphysyma
B. Cystic Fibrosis – genetic disorder, over production of secretions of exocrine glands esp. pancreas and lining f respiratory system
1. full body massage
2. postural drainage
C. Pleurisy – inflammation of plural membrane

Thursday Path/Pharm May 24

Answer the following in your own words:

(Each are worth 8.3 points)

1. What is the path of a blood cell through all three circulatory systems (systemic, pulmonary, coronary)?

2. What are the functions of the Lymphatic system?

3. The death of cardiac tissue is termed what?

4. What modifications to the massage are you going to make because your patient has a recent (less than six months) history of the pathology mentioned in #3?

5. How does massage effect blood pressure?

6.A patient with DVT would most likely be receiving what medication for this pathology?

7. How would the medication in #6 effect the massage you are about to give?

The hospice for which you do pro bono work has received a new patient. Randy, a 45 year old African American is diagnosed with AIDS, hypertension, and diabetes type II. As a member of his care team you will be providing massage therapy 3 times a week, according to the order from his Certified Nurse Practitioner. Due to Randy’s “Comfort care only” care plan all medications were discontinued accept his narcotics, his insulin, and a diuretic as needed. He exhibits symptoms of Kaposi’s sarcoma, and high blood glucose. Randy is alert and communicative, but presents with the debility of the terminally ill.

Regarding the scenario above answer the following:
8. What types of techniques will you be using with Randy?

9. Randy's last dose of morphine was 4 hours ago, how does this fact change your treatment?

10. Would you provide hydrotherapy to Randy? Why or why not?

11. Randy is unable to remember his last glucose level. What do you do?

12. Because of Randy's HIV status, what precautions do you need to take?

Reminder

When you are going to be absent, please contact ME. Whether you call, text, or leave me a message I don't care. All of you received my phone number(s) and email at the beginning of the term. Please note (and as you were told on the first day of the term), if I am not notified of your absence you will not be able to sit for the exam you missed and any work you have due that day will receive a zero. Bummer.

All you need to do is call.

val.

Coming attrations...

Muscles 301
The fun continues as we look at the Intrinsic muscles of the hand this week. Speaking of fun, did you people know that there are earthworms in your hands? Yup. I'll prove it this Monday/Tuesday.
I've received a few calls about the worksheet due this week. Numbers 1-3 are not trick questions. As you answer, watch your wrists, hands and fingers while writing. I ask such questions because I want you to be able to use the info. It's good that all of you know the origin of the Extensor Carpi Radialis. But your client/patient doesn't. I haven't had anyone come in and say, "Val, I believe my Abductor Policis Longus is causing me problems." But they do say "My hand and wrist hurts when I put down my beer"(or whatever).Plus, the boards are going to ask you questions like numbers 1-3. But never fear, that is why we are here. Keep the calls coming. I love proving to you that you knew this information the whole time.

Pathology/Pharmacology 501/934
As you could probably tell, the nervous system is my favorite system in the body. I find it amazing that we are walking around with a buit in computer and internet. It's also amazing what massage can do for this enormously complex system. Massage can promote relaxation; promote the mind/body connection; stimulate and/or soothe the nerves. How cool.
This week we will be dealing with the Endocrine system. That's right; hormones. (no dirty jokes this time, I sorta promise) I will give a gold star to whomever can tell me the "Grandma of the two systems in charge of homeostasis"....

As for me I'm gonna go have an adult beverage and some pizza while listening to my favorite '80's hair metal bands. Have a good week.
val.