PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION

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CARDIORESPIRATORY DYSFUNCTION

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PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION

  1. 1. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 1 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION BY: Abdulrehman S. Mulla DATE: 03/21/2009 REVISION HISTORY REV. DESCRIPTION CN No. BY DATE 01 Initial Release PT0003 ASM 03/21/2009 Medicine: it’s a noble profession, it serves humanity 1
  2. 2. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 2 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. TABLE OF CONTENTS PAGE 1.0 CARDIORESPIRATORY PHYSICAL THERAPY:........................................................................................... 3 1.1 CARDIORESPIRATORY CONDITIONS: ........................................................................................... 3 2.0 ACUTE CARDIORESPIRATORY CONDITIONS:........................................................................................... 5 2.1 ATELECTASIS: .................................................................................................................................. 6 2.2 PNEUMONIA:..................................................................................................................................... 6 2.3 BRONCHIOLITIS/ALVEOLITIS: ......................................................................................................... 7 2.4 PNEUMOTHORAX:............................................................................................................................ 7 2.5 TUBERCULOSIS (TB):....................................................................................................................... 8 2.6 PULMONARY EMBOLI: ..................................................................................................................... 8 2.7 PLEURAL EFFUSION: ....................................................................................................................... 9 2.8 PNEUMOCYSTIS CARINII PNEUMONIA:......................................................................................... 9 3.0 ANGINA: ........................................................................................................................................................ 10 4.0 ADULT RESPIRATORY DISTRESS SYNDROME (ARDS): ........................................................................ 11 5.0 ASTHMA:....................................................................................................................................................... 12 6.0 BRONCHIECTASIS:...................................................................................................................................... 14 7.0 BRONCHITIS:................................................................................................................................................ 15 8.0 CONGESTIVE HEART FAILURE (CHF) AND PULMONARY EDEMA: ....................................................... 16 9.0 CYSTIC FIBROSIS (CF): .............................................................................................................................. 17 10.0 EMPHYSEMA:............................................................................................................................................... 18 11.0 HEART ATTACK (MYOCARDIAL INFARCTION - MI):................................................................................. 19 12.0 HYPERTENSION: ......................................................................................................................................... 20 13.0 PULMONARY FIBROSIS: ............................................................................................................................. 21 14.0 CARDIORESPIRATORY TREATMENTS: .................................................................................................... 22 14.1 CARDIOVASCULAR EXERCISES: ................................................................................................. 22 14.2 CHEST PHYSIOTHERAPY:............................................................................................................. 25 14.2.1 PERCUSSION OF CHEST: ................................................................................................ 25 A. PROCEDURE: .............................................................................................................. 25 B. AREAS OF PERCUSSION: .......................................................................................... 27 14.2.2 VIBRATIONS OF THE CHEST: .......................................................................................... 28 14.3 DEEP BREATHING EXERCISES AND COUGHING: ................................................................ 30 15.0 YOUR HEART: .............................................................................................................................................. 31 15.1 HOW DOES THE HEART WORK?.................................................................................................. 32 16.0 YOUR LUNGS: .............................................................................................................................................. 33 17.0 PREVENTING A HEART ATTACK: .............................................................................................................. 34 17.1 RISK FACTORS THAT YOU CAN CHANGE:.................................................................................. 34 17.2 RISK FACTORS THAT YOU CAN USUALLY CHANGE: ................................................................ 34 17.3 RISK FACTORS THAT YOU CANNOT CHANGE: .......................................................................... 34 18.0 SIGNS AND SYMPTOMS THAT YOU ARE HAVING A HEART ATTACK: ................................................. 36 19.0 TIPS FOR YOUR SHORTNESS OF BREATH: ............................................................................................ 37 Medicine: it’s a noble profession, it serves humanity 2
  3. 3. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 3 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 1.0 CARDIORESPIRATORY PHYSICAL THERAPY: There are many ways that physical therapists can help improve your health and quality of life if you have heart and/or lung diseases. Exercise makes your heart and lungs healthier. It helps your heart pump easier, your lungs exchange oxygen and carbon dioxide better, and it can help you achieve a healthier weight. You may think that because you have a heart or lung disease, you should stop doing many activities. You may be afraid that you will worsen your health problems. However, in order to make your heart and lungs healthy, exercise and activity is of greatest importance! Without exercise, your heart and lungs will only get worse. When you have a heart or lung disease, many aspects of exercise need to be adjusted. The type of exercises, the exercise environments, and the exercise routines you use need to be adjusted to suit your body's needs. Cardio respiratory physical therapists are experts about these diseases and the changes that need to be made to your exercise routine. Using their expertise, physical therapists can help educate you about the safest methods of exercise and health, and personalize an exercise program that will suit your needs, goals, and lifestyle. Cardiac rehabilitation (CR) is a comprehensive outpatient program of medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling designed to restore patients with heart disease to active, productive lives. The central component of CR is a prescribed regimen of physical exercises intended to improve functional work capacity and to increase the patient's confidence and well-being. The program consists of a series of supervised exercise sessions with continuous electrocardiograph monitoring (CEM). Clinically optimal results are obtained if these sessions are conducted two to three times per week over a 12 to 18-week period. There is no evidence that CR without EKG monitoring is a medically effective service or that it is ever medically necessary. It therefore always should be denied as not medically necessary. CR only can be performed in a specialized, freestanding physician directed clinic or in an outpatient hospital department. The goals of CR are:  To increase exercise tolerance  Reduce symptoms of chest pain and shortness of breath  Improve blood cholesterol levels  Decrease smoking  Improve psychosocial well-being  Reduce mortality 1.1 CARDIORESPIRATORY CONDITIONS: Acute Cardiorespiratory Conditions Congestive Heart Failure (CHF) Angina Cystic Fibrosis (CF) Adult Respiratory Distress Syndrome (ARDS) Emphysema Asthma Heart Attack (MI) Bronchiectasis Hypertension Bronchitis Pulmonary Fibrosis Medicine: it’s a noble profession, it serves humanity 3
  4. 4. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 4 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Medicine: it’s a noble profession, it serves humanity 4
  5. 5. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 5 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.0 ACUTE CARDIORESPIRATORY CONDITIONS: All of the following conditions make it very difficult to breathe. If you have any of these problems a physical therapist will work with you in the Intensive Care Unit or wherever you are in the hospital. They can help you increase the air going in and out of your lungs, increase the amount of phlegm you cough out of your lungs, and decrease of risk of developing other complications.  Atelectasis  Pneumonia  Bronchiolitis or Alveolitis  Pneumothorax  Tuberculosis  Pulmonary Emboli  Pleural Effusion  Pneumocystis Carinii Pneumonia Picture 1.0 is a brief review of the anatomy of the respiratory system. Pict. 1.0 Medicine: it’s a noble profession, it serves humanity 5
  6. 6. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 6 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.1 ATELECTASIS: This means that parts of your lungs have collapsed. An atelectasis as in Picture 2.0, can refer to a whole section (or quot;lobequot;) of your lung collapsing or it may just refer to a few alveoli collapsing. An atelectasis can be caused by a rib fracture, a bronchial plug of phlegm, of by very little air getting into the lungs because you are not breathing well. You will probably need chest physiotherapy to help you get out the phlegm and expand the collapsed part of your lung. Pict.2.0 2.2 PNEUMONIA: This is an infection in the lung as shown in Picture 3.0. It can be caused by bacteria or viruses or by swallowing your food quot;the wrong wayquot;. With infections, you will have pus in your lungs, just as you would if a skin wound was infected. You will have to cough this out of your lungs and will probably need chest physiotherapy to help you with this. Pict. 3.0 Medicine: it’s a noble profession, it serves humanity 6
  7. 7. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 7 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.3 BRONCHIOLITIS/ALVEOLITIS: This is a swelling of the bronchi or alveoli as shown in Picture 4.0. This swelling may be caused by an infection or a trauma to your lungs. Pict. 4.0 Pict. 4.0 2.4 PNEUMOTHORAX: A pneumothorax is air in-between the lungs and the chest wall as shown in Picture 5.0, where there should not be any air. This air can press on the lungs and cause them to collapse. A pneumothorax is usually caused by a trauma to the chest like a rib fracture but it can also happen spontaneously by the bursting of alveoli from the inside out. If you have a pneumothorax, you will have a lot of chest pain and shortness of breath. Pict. 5.0 Medicine: it’s a noble profession, it serves humanity 7
  8. 8. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 8 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.5 TUBERCULOSIS (TB): This is a lung infection caused by a certain type of bacteria as shown in Picture 6.0. An infected person with active TB spreads it through the air by breathing or coughing near you. This is a very serious infection and it needs to be treated immediately. It can ruin your lungs and affect many other organs in your body. The initial symptoms are very mild and therefore they may go unnoticed. These symptoms are a slight cough and a low-grade fever. Many people may be exposed to TB sometime in their life, and it never develops into the disease. These people are referred to as quot;carriersquot; and you cannot catch TB from these people. Regular check ups are important to make sure TB does not cause any damage. Pict. 6.0 2.6 PULMONARY EMBOLI: This is caused by a blood clot from somewhere in the body getting lodged into the lung's circulation as shown in Pict. 7.0. This blood clot blocks any other blood getting to and from the lungs. Since the heart sends and receives all of the body's blood to and from the lungs, a pulmonary embolism can cause death. Pict. 7.0 Medicine: it’s a noble profession, it serves humanity 8
  9. 9. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 9 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 2.7 PLEURAL EFFUSION: This means that there is more than the normal amount of fluid in-between the lungs and the chest wall as shown in Picture 8.0. This can press on the lungs and cause shortness of breath and even part of the lung to collapse. Pleural effusion can be caused by pneumonia, cancer, or congestive heart failure. Pict. 8.0 2.8 PNEUMOCYSTIS CARINII PNEUMONIA: This is an infection of the lung in people who have a weak immune system as shown in Picture 9.0. A weak immune system is found in babies, people following an organ transplant, or people infected with HIV. With infections, there will be pus in the lungs, just as when a skin wound is infected. These people will probably need chest physiotherapy to help get the pus out and increase breathing. The normal exchange of gases is interrupted by the build up of fluids. Pict. 9.0 Medicine: it’s a noble profession, it serves humanity 9
  10. 10. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 10 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 3.0 ANGINA: Angina is pain, tightness, or discomfort in the middle of your chest. Sometimes these symptoms can spread into your jaw and arms. Angina is caused by a decreased blood supply to your heart. This pain is often brought on by heavy activity or exercise, however emotional changes can also cause angina. The pain often leaves within 10 minutes if you lie down and rest. See Picture 10.0. Angina is often a warning sign for an upcoming heart attack, and therefore it is important to report this chest pain to your health care workers. If the pain does not go away following a 10- minute rest period, report it to your doctor immediately. If you have had angina, it does not mean that you are definitely going to have a heart attack. Physical therapists can help teach you how to increase the health of your heart and decrease your risks of having a heart attack. Exercise is always important to help your heart get healthier, but you should NEVER exercise through angina. It is important to have a physical therapist initially monitor you during exercise and activity, to make sure your heart reacts properly. Pict. 10.0 Medicine: it’s a noble profession, it serves humanity 10
  11. 11. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 11 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 4.0 ADULT RESPIRATORY DISTRESS SYNDROME (ARDS): This is caused by pneumonia or by a direct trauma to the lungs. You are said to have ARDS when the pneumonia or trauma causes pulmonary edema or atelectasis to develop. The signs and symptoms of ARDS can take up to 48 hours after the injury to develop. See Picture 11.0. Physical therapists will see these people when they are in the ICU and as they improve in health and are transferred somewhere else in the hospital. Physical therapists can help these people breathe easier and get some of the mucous out of their lungs. Pict. 11.0. Medicine: it’s a noble profession, it serves humanity 11
  12. 12. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 12 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 5.0 ASTHMA: This lung disease is caused by a narrowing of the airways that lead in and out of the lungs. The narrowing can be caused by swelling of the airways or by muscles tightening around your airways. Either way, this narrowing of your airways makes it very hard for you to breathe. See Picture 12.0. & 13.0. There are many irritants that can cause your airways to narrow. The causes differ depending on the type of asthma you have; allergic or non-allergic asthma. Allergic asthma usually begins in people under the age of 35. If you have allergic asthma, here are some of the things that can irritate your asthma. Pict. 12.0. Medicine: it’s a noble profession, it serves humanity 12
  13. 13. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 13 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Pict. 13.0. Medicine: it’s a noble profession, it serves humanity 13
  14. 14. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 14 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 6.0 BRONCHIECTASIS: This is a lung disease caused by having many lung infections like pneumonia. The repeated infections cause damage to parts of the lungs. In bronchiectasis, the damage causes swelling and scarring of the lungs and this means that there is less area where oxygen and carbon dioxide can get in and out of the lungs. See Picture. 14.0 You have huge amounts of phlegm in your lungs and your cough cannot get all of the phlegm out. The phlegm sits in your lungs and makes a perfect environment for more infections to grow and damage your lungs further. It is a viscous circle. When your lungs are scarred, there are less working parts and therefore you feel short of breath. Phlegm sitting in your lungs makes it even harder to breathe. As your bronchiectasis progresses, you may need to be given oxygen to help you breathe. Pict. 14.0 Medicine: it’s a noble profession, it serves humanity 14
  15. 15. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 15 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 7.0 BRONCHITIS: This is a lung disease that causes a cough with a lot of thick phlegm. It lasts for at least three months during a two-year period. The phlegm can sit in the lungs for a while and make a perfect environment for infections to grow. See Picture 15.0 Pict. 15.0 Therefore, if you have bronchitis, you are at an increased risk of getting lung infections like pneumonia. A lot of phlegm sitting in the lungs also decreases the amount of air that can get in and out of the lungs. This makes you feel short of breath. You may not be able to walk very far or do your normal activities without finding it hard to breathe. As your bronchitis progresses, you may need to be given oxygen to help you breathe. Chronic bronchitis is caused by a long-term irritation of the lungs, the most common irritation coming from cigarette smoke. Other causes may be air pollution, certain working environments (coal mining, construction working with asbestos), and having many lung infections. Medicine: it’s a noble profession, it serves humanity 15
  16. 16. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 16 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 8.0 CONGESTIVE HEART FAILURE (CHF) AND PULMONARY EDEMA: CHF is usually caused by a heart attack or coronary artery disease (disease of the arteries of the heart). These diseases make it more difficult for the heart to pump blood. Because the heart is not pumping as well as it should, an increased amount of fluid and blood stays in your arms and legs and does not get pumped back to the heart. This causes quot;edemaquot;, a swelling or puffiness in the limbs. See Picture 16.0. Pict. 16.0 The heart pumps blood in and out of the lungs. If it is not pumping well, fluid can sit in the lungs causing what is called pulmonary edema. This means there is swelling/puffiness in the lungs. Pulmonary edema makes it very difficult to breathe and can cause lung infections such as pneumonia. If you have CHF, you are at risk of developing pulmonary edema. Pulmonary edema can also be caused by a lung injury such as a wound to the lungs or severe pneumonia. These injuries cause the lungs to swell, just like any injury can cause swelling Medicine: it’s a noble profession, it serves humanity 16
  17. 17. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 17 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 9.0 CYSTIC FIBROSIS (CF): This is a genetic disorder that affects many glands in the body. The purposes of glands are to secrete fluid. There are glands in the lungs that protect the lungs by secreting phlegm. There are glands in the liver, pancreas, and intestines that help with digestion of foods. There are also glands in the skin that secrete sweat to lower your body temperature when you are hot. CF can cause problems with any of these glands. See Picture 17.0. Pict. 17.0. Symptoms of cystic fibrosis start to show at very young ages. If you have CF you may or may not have significant problems with your lungs. CF lung problems cause your lungs to make more than normal amounts of phlegm. The phlegm produced is also thicker than normal. Because of these changes, it is very hard for you to get all of the phlegm out of your lungs. This leads to pneumonias, bronchiectasis, and makes it very hard to breathe. Physical therapists can teach you and your family about CF and how to manage your disease. This is important to increase your health and improve your quality of life, and decrease your risk of developing complications. There are many manual techniques that your parent or caregiver can learn, and some special breathing exercises for you that can help get your phlegm out of your lungs. Just like any other child, it is important that you are active! However, some changes may have to be made so that you do not become too short of breath. A physical therapist can teach you how to make these changes. Medicine: it’s a noble profession, it serves humanity 17
  18. 18. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 18 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 10.0 EMPHYSEMA: This is a disease that causes swelling in certain areas of the lungs called alveoli. The alveoli are the tiny parts of the lungs that allow oxygen and carbon dioxide to get in and out of the body. When the alveoli swell, air cannot get into and out of the body as easily so this makes you short of breath. This swelling eventually leads to the death of the involved alveoli. As emphysema gets worse, more and more alveoli die and it gets extremely hard to breathe. See Picture 18.0. & 19.0 Pict. 18 Emphysema causes air to sit, trapped, in the lungs instead of being inhaled and exhaled. This trapped air causes your chest to get bigger and change shape. This change in shape also makes it harder for you to breathe. Pict.19 As your emphysema progresses, you may need to be given oxygen to help you breathe. You may develop infections in the lungs, which can further injure them. With more lung injuries, you may need more and more oxygen. If the lungs are injured too much, breathing is impossible. Medicine: it’s a noble profession, it serves humanity 18
  19. 19. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 19 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 11.0 HEART ATTACK (MYOCARDIAL INFARCTION - MI): Coronary artery disease (CAD) is the most common cause of heart attacks and one of the leading causes of death in the Western world. See Picture 20.0, 21.0, 22.0 & 23.0 What is CAD? CAD is atherosclerosis of the blood vessels that supply blood to the heart. Atherosclerosis is the medical term meaning that there is fat sticking to the inside of your blood vessels. Pict. 23 Pict. 21 Pict. 20 Pict. 22 The fat causes a narrowing of the blood vessels. This means that there is less room for the blood to travel, and therefore less blood gets to the places it needs to. Sometimes blood vessels can even completely close due to CAD, and no blood can get through. Blood vessels supply blood to the heart, just as they supply blood to every other organ in the body. If there is fat on the inside of these blood vessels than this is called CAD. Medicine: it’s a noble profession, it serves humanity 19
  20. 20. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 20 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 12.0 HYPERTENSION: Hypertension means high blood pressure. High blood pressure is an increased pressure in your blood vessels, and therefore there is less space for your blood to travel through. See Picture 24.0 & 25.0. It can be caused by many factors such as stress, high cholesterol, and inactivity. It is classified into mild, moderate, and severe hypertension. If you have mild, moderate, or severe hypertension, you have an increased risk of having a heart attack or a stroke. Pict. 24 It is important to keep hypertension under control by using medication prescribed by your doctor. You will also need to make some lifestyle changes, like eating better and exercising, to decrease your risks of having a heart attack or stroke. Pict. 25 Medicine: it’s a noble profession, it serves humanity 20
  21. 21. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 21 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 13.0 PULMONARY FIBROSIS: This lung disease is often associated with certain jobs such as miners, welders, and construction workers. This is because inhaling dusts such as coal dusts and asbestos can cause pulmonary fibrosis. It can also be caused by genetics, meaning you were born with it. However, most commonly, pulmonary fibrosis develops without any known cause. See Picture 26.0 Pict.26 Pulmonary fibrosis is a disease where scar tissue develops in the lungs following many infections and swelling. The scar tissue causes the lungs to become more stiff than normal. This means that the lungs cannot expand like normal, and therefore less air can get in and out of the lungs. This makes it very hard to breathe. If inhaling dusts causes the fibrosis, the symptoms can sometimes be reversed by removing the worker from the harmful environment or by using protective masks. If the worker is exposed for a long period of time, the effects may be irreversible. Genetic fibrosis or fibrosis caused by unknown causes, cannot be reversed. Physical therapists can help teach you how to manage your disease and how you can decrease your risks of developing other complications. They can give you tips to help you breathe easier and increase your ability to perform your normal daily activities. Medicine: it’s a noble profession, it serves humanity 21
  22. 22. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 22 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 14.0 CARDIORESPIRATORY TREATMENTS:  Cardiovascular exercises  Chest physiotherapy  Coughing and deep breathing exercises 14.1 CARDIOVASCULAR EXERCISES:  Cardiovascular exercises are exercises that help to make your heart and lungs stronger and healthier. See Picture 27.0.  Your heart is a muscle, a lot like all the other muscles in your body. It pumps blood to and from your organs, joints, and everywhere else in your body. When you are sleeping or lying on the couch, it does not have to work very hard to pump the blood. When you stand up and move around it has to work harder to pump blood.  Since your heart is a muscle, it can be quot;out-of-shapequot; just like the rest of your body. If your heart is quot;out-of-shapequot; than it cannot pump the blood that it needs to, even when you are performing easy activities. Medicine: it’s a noble profession, it serves humanity 22
  23. 23. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 23 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Medicine: it’s a noble profession, it serves humanity 23
  24. 24. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 24 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Medicine: it’s a noble profession, it serves humanity 24
  25. 25. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 25 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 14.2 CHEST PHYSIOTHERAPY: quot;Percussionsquot; and quot;Vibrationsquot; are two hands-on physical therapy techniques used to help get phlegm out of your lungs. The physical therapist applies a force to your chest using their hands or a mechanical device. Both percussions and vibrations cause certain movements in your lungs that can dislodge the phlegm that is stuck in your airways. See Picture 28.0. Percussions loosen phlegm within your lungs and make it easier for you to cough it out. Percussions involve striking your chest, at different speeds, with cupped hands or a mechanical quot;percussorquot;. Each area of your lung that contains phlegm is percussed for the length of time needed to loosen it. This time varies depending on the lung disease or injury that you have. You will be moved into many different positions that help the percussions effectiveness. 14.2.1 PERCUSSION OF CHEST: To perform a percussion examination, strike the surface of the body. When this is done, various sounds can be heard. The sounds are different depending on the underlying structure of the body. There are two reasons to use percussion as an examination technique. First, percussion results in setting the chest wall and underlying tissues in motion. This produces sounds that can be heard. Second, percussion sounds can be divided into four recognizable notes. Train your ear to recognize the pitch and duration of these notes. The sound can indicate whether the underlying tissues are filled with air, filled with fluid, or solid. NOTE: Percussion will set tissues in motion only about five to seven centimeters into the chest, so the percussion examination technique is not a way to detect lesions that are very deep. Table of percussion notes A. PROCEDURE: In order to perform the percussion examination technique, strike the stationary finger of one hand with a flexed finger of the other hand. The technique, described here, can be practiced on any surface. Here are the key points: Firmly rest the first joint of the middle finger of one hand on the patient's chest, but don't let the rest of the hand touch the chest (figure). Hand and finger placement. Medicine: it’s a noble profession, it serves humanity 25
  26. 26. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 26 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Keep the fingers of the other hand flexed and the wrist loose (figure 2-7). Hand position. With the tip of the middle finger of the flexed hand, strike the first joint of the middle finger of the hand that is on the patient's chest (figure 2-8). Have the motion come from the wrist. Striking position. Withdraw the striking finger immediately to avoid damping the vibration. Strike once or twice, and then move your hands symmetrically to another part of the chest. Medicine: it’s a noble profession, it serves humanity 26
  27. 27. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 27 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. B. AREAS OF PERCUSSION: Ideally, the patient should lie in the supine position (lying on the back, face upward) for percussion on the front of the chest. The patient should be sitting up for percussion on the back. If the patient is ill and unable to sit up, examine with the patient lying on the right or left side. Percuss the patient's anterior chest (figure 2-9). In a healthy patient, the entire upper chest is resonant except for the area of cardiac dullness. Percuss across the top of the body and work downward, symmetrically. Anterior percussion. Posterior percussion. Percuss the patient's posterior chest, symmetrically down the chest wall making a side to side comparison. Percussion over lung fields should reveal equal bilateral findings. Omit percussion over the shoulder blades. Measure the diaphragmatic excursion (movement of the diaphragm from a position of rest) by noting the difference between the levels of dullness when the person inhales fully and exhales fully. See figure above. The difference is normally about 5 or 6 cm. Diaphragmatic excursion. Medicine: it’s a noble profession, it serves humanity 27
  28. 28. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 28 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 14.2.2 VIBRATIONS OF THE CHEST: Involve the compression of the chest, at varying frequencies, while you are breathing out. Vibrations increase the movement of phlegm up and out of the smaller airways in your lungs. This is performed for varying lengths of time, depending on what disease or injury that you have. There are some injuries or illnesses that percussions and/or vibrations should not be used with or more damage could be caused. Physical therapists are knowledgeable about these risks and perform a full assessment before treatment in order to avoid any problems from occurring. Physical therapists also have other hands-on techniques that can increase the removal of phlegm. As well, they have hands-on techniques that help to:  Increase the amount of air that goes into your lungs  Increase the amount of air that goes out of your lungs  Increase the effectiveness of your cough Postural drainage is getting in positions that make it easier for mucus to drain. Chest physiotherapy is gently quot;clappingquot; parts of the body to remove mucus from the lungs. They are often used together in conditions such as cystic fibrosis or a spinal cord injury (SCI) to help loosen and remove mucus from the lungs. When mucus collects in your lungs, it increases your risk for lung infections, such as pneumonia. Following are general instructions for chest physiotherapy and postural drainage. Talk to your health professional about the positions you should use and how long how to do it.  Be sure your back is covered. Wear a shirt or blouse, or cover your back with a towel.  Hold each position for 5 minutes to help the mucus drain from your lungs.  For each position, your caregiver claps your back quickly and rhythmically. Your caregiver bends his or her hand at the knuckles to form a cup. The handprints in the above illustrations show where to clap.  When your caregiver claps, you should hear a hollow sound. If you hear a slapping, the hand is not cupped enough.  Do not clap over the spine. Morning is the best time to do postural drainage, because it helps clear mucus that has built up during the night. It may also be done just before bed to decrease nighttime coughing. Do not do it soon after a meal; this may increase the chance of vomiting. Pict. 28 Medicine: it’s a noble profession, it serves humanity 28
  29. 29. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 29 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Medicine: it’s a noble profession, it serves humanity 29
  30. 30. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 30 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 14.3 DEEP BREATHING EXERCISES AND COUGHING: People cough in order to get things out of their lungs or because there is an irritant in their throat. A cough is, therefore, protective. If you cannot cough effectively then you are at risk of developing lung infections. Some illnesses cause the phlegm made in your lungs to be abnormally thick. Other illnesses cause the lungs to make a huge amount of phlegm. In order to get out all the phlegm, your cough has to be very strong. See Picture 29.0 Many illnesses and open chest surgeries (like bypass surgery or removal of lung cancer) cause weakness in the muscles of the chest. This weakness means that your cough would be very weak and most likely you could not get the phlegm out of your lungs. This puts you at risk of developing lung infections. Pict. 29.0 Medicine: it’s a noble profession, it serves humanity 30
  31. 31. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 31 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 15.0 YOUR HEART: Your heart is a muscle. Just like any muscle in your body, your heart needs blood and oxygen in order to work. It can also get stronger and weaker depending on your fitness level. However, the heart is much more important than the rest of the muscles in your body. The heart's purpose is to pump blood around the body and supply your organs, joints, and muscles with oxygen. See Picture 29.0 & 30.0 Pict. 29 Pict. 30. Medicine: it’s a noble profession, it serves humanity 31
  32. 32. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 32 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 15.1 HOW DOES THE HEART WORK? The heart has four chambers. It has two quot;atriaquot; and two quot;ventriclesquot;, with one atrium and ventricle on the right and one atrium and ventricle on the left. Medicine: it’s a noble profession, it serves humanity 32
  33. 33. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 33 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 16.0 YOUR LUNGS:  Your lungs are the organs that allow you to breathe. In order for your lungs to be able to breathe air in and out, you need many working muscles. See picture 31.0  Your diaphragm is the major muscle of breathing. It sits below your lungs and just above your stomach and liver. When it contracts, it pushes down further into your abdomen to allow your lungs to expand and take up more room.  Muscles in-between your ribs and muscles in your neck are also very important muscles for breathing. When your diaphragm contracts, your ribs and neck muscles act to pull your ribs up and out. All of these muscles act together to give your lungs as much room as possible to expand and let air in.  As the diaphragm relaxes it pushes up and at the same time, the other muscles drop the ribs. In response, the lungs shrink and push air out. Pict. 31 Medicine: it’s a noble profession, it serves humanity 33
  34. 34. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 34 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 17.0 PREVENTING A HEART ATTACK: There are a variety of things that can increase your risk of having a heart attack. You can change most of these risk factors, and therefore decrease your chance of ever suffering from a heart attack. See Picture 32.0 17.1 RISK FACTORS THAT YOU CAN CHANGE:  Smoking and exposure to second hand smoke  High fat diets  Poor physical shape and inactivity  Excess weight for height and body type  Excessive alcohol use 17.2 RISK FACTORS THAT YOU CAN USUALLY CHANGE:  High blood pressure  High cholesterol level  Uncontrolled diabetes  Stress 17.3 RISK FACTORS THAT YOU CANNOT CHANGE:  Genetics –men generally have an increased risk of having a heart attack before the age between the ages of 40-60 however after this age women and men have an equal chance of having a heart attack  Increasing age  Ethnicity  Family History Medicine: it’s a noble profession, it serves humanity 34
  35. 35. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 35 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. Pict.33. Medicine: it’s a noble profession, it serves humanity 35
  36. 36. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 36 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 18.0 SIGNS AND SYMPTOMS THAT YOU ARE HAVING A HEART ATTACK:  Vague chest pain or a crushing, radiating chest pain  Heaviness, pressure, squeezing, fullness, burning or discomfort that begins in the centre of the chest and may spread to the neck, jaw and shoulders  Nausea and vomiting and/or indigestion  Shortness of breath, paleness, sweating or weakness  Feeling of anxiety, denial or fear Pict. 34.0 Medicine: it’s a noble profession, it serves humanity 36
  37. 37. PHYSICAL THERAPY PRINCIPALS & METHODS PTP&M:003 Revision: 01 Page: 37 of 37 PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTION NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time. 19.0 TIPS FOR YOUR SHORTNESS OF BREATH: When you are short of breath, here are 10 steps to follow: 1. Stop and rest in a chair. 2. Put your head and shoulders DOWN. 3. Breathe in through your mouth. 4. Blow out through your mouth. 5. Breathe in and out as fast as you need to. 6. Begin to blow out longer, purse your lips if you find it helps. 7. Begin to slow your breathing. 8. Begin to use your nose. 9. Begin deep breathing. 10. Stay in position for five more minutes. Medicine: it’s a noble profession, it serves humanity 37
  38. 38. Filename: PTPM003_PTM_of_Cardiorespiratory_dysfunction_Medic al_Journal Directory: C:UsersAnjumDocumentsShadab MullaMullsons Medical Journals Template: C:UsersAnjumAppDataRoamingMicrosoftTemplates Normal.dot Title: STATIONERY PRODUCTS GROUP Subject: Author: Jim Sergi Keywords: Comments: Creation Date: 3/22/2009 1:53 PM Change Number: 37 Last Saved On: 6/4/2009 9:25 PM Last Saved By: Abdulrehman S. Mulla Total Editing Time: 2,408 Minutes Last Printed On: 6/5/2009 2:10 AM As of Last Complete Printing Number of Pages: 37 Number of Words: 4,818 (approx.) Number of Characters: 27,463 (approx.)

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