| Respiratory conditions are a very common | | | | normal then the doctors will prescribe oxygen at |
| presentation in community and hospital settings, | | | | a specific percentage such as 24 percent or 28 |
| with a wide variety of diagnoses being assessed | | | | percent via a venturi type administration device |
| and treated by physiotherapy. Conditions which | | | | which maintains a constant oxygen concentration |
| can present include pneumonia, chronic bronchitis, | | | | as variations in concentration would be damaging. |
| asthma, bronchiectasis, cystic fibrosis, | | | | Continuous gas delivery can dry the airways and |
| hyperventilation and chronic obstructive pulmonary | | | | the secretions, making treatments more difficult, |
| disease. Physiotherapists are trained to assess | | | | so oxygen should always be administered |
| respiratory conditions and manage, treat and | | | | humidified and heated to body temperature by |
| advise on them. Respiratory skills are an | | | | the appropriate gas delivery circuit. |
| important part of every physiotherapist's training | | | | The next clinical aspect for the physiotherapist to |
| and early work, if they have a job in an acute | | | | address is the air entry to the peripheral airways |
| area of practice. It is a difficult skill to learn and | | | | of the lungs. The airways can collapse or become |
| physiotherapists have a lot of responsibility for | | | | occluded by swelling or sputum, blocking air entry |
| managing acutely unwell patients in hospitals. | | | | and reducing the lungs' ability to maintain oxygen |
| The patient's notes and observation charts are | | | | concentrations. Physiotherapists initially use |
| first reviewed by the physiotherapist before going | | | | breathing exercises to attempt to re-inflate the |
| to see the patient, so as to be clear about the | | | | collapsed areas, instructing the patient to attempt |
| medical diagnosis, opinion and treatment. The | | | | to breathe deeply every hour or so. If this is not |
| blood test results will be important and the | | | | sufficient then intermittent positive pressure |
| physiotherapist should have a good understanding | | | | breathing may be attempted, using a pressure |
| of these. The physiotherapist will introduce | | | | device to deliver gas at varying pressures into |
| themselves to the patient and whilst questioning | | | | the lungs to re-inflate the desired areas passively. |
| the patient about their illness will be observing | | | | Sputum retention in the lungs occurs when the |
| their condition at the same time, looking for the | | | | patient is unable to expectorate the secretions |
| rate of respiration, hand, nose and lip colour, | | | | which are formed by infections and worsened by |
| oxygen or nebuliser treatments, the overall | | | | lying in bed in hospital. Active cycle of breathing is |
| wellness of the patient, their weight, the effort of | | | | a typical physiotherapy technique taught to |
| breathing they are making and if they are using | | | | patients, allowing them to move secretions from |
| arm and neck muscles to help breathing. | | | | peripheral airways to the central airways where |
| The observation gives the physiotherapist a lot of | | | | they can be removed by huffing or coughing. The |
| information very quickly about the patient's | | | | technique involves steadily increasing depth of |
| condition and what they need to concentrate on | | | | inspiration with longer expirations under slight |
| in the examination. They can then move on to | | | | pressure, avoiding the tendency to increase the |
| the objective examination, starting with assessing | | | | bronchospasm of the airways. Patients can |
| the lung expansion and air entry. By holding the | | | | become very good at practicing this technique, |
| chest on both sides, the physiotherapist can | | | | allowing them to self treat effectively. |
| assess how well the expansion is occurring and | | | | Physiotherapists can also apply manual techniques |
| whether it is symmetrical. Auscultation, listening to | | | | directly to the chest, using vibration or clapping to |
| the chest with a stethoscope, tells the examiner | | | | mechanically disturb the secretions and make |
| about how well the air is entering the lungs, | | | | coughing and expectoration more likely. Flutter |
| whether there is a blockage, collapse, consolidation | | | | devices are useful to mechanically disturb the |
| or wheeze. The results of this will determine any | | | | sputum as the patient breathes in the vibrating air, |
| further examination and the type of treatments | | | | again promoting coughing. Surgery to the thorax |
| suggested. | | | | or abdomen or fractured ribs can inhibit deep |
| The physiotherapist initially looks at the patient's | | | | breathing and coughing and physiotherapists will |
| oxygen concentration as the correct level is | | | | encourage patients to take regular pain control |
| critical for the patient's respiratory and overall | | | | medication and to support the wound or painful |
| status. If the blood oxygen saturations are below | | | | part whilst practicing their inspiration and huffing. |