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INTRODUCTION

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Examination of the pulmonary system requires optimal use of auditory, observational, tactile, auscultatory, and medical information. A significant part of this chapter will focus on the actual physical therapy examination process. Perturbation of initial examination findings with auditory, positional, or tactile maneuvers may yield information that could (1) direct further examination techniques, (2) direct treatment techniques, and (3) provide important prognostic information. The following section will review each of the examination techniques and the application of specific maneuvers that may help to direct and predict the effects of these techniques. A review of medical information and the specific tests and measures providing the most clinically useful information will also be presented.1-5 Much of this information and the approach used to examine a patient with pulmonary disease are outlined in Box 9-1. This information can be documented in the initial patient note presented in Appendix 1 of this chapter.

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BOX 9-1 A Suggested Examination Approach to the Patient Designed to Determine the Disablement of Pulmonary Disorders and Direct and Predict Physical Therapy: a Patient Case Example

  1. Why are you here today?*

  2. Have you been diagnosed with a pulmonary disorder in the past?

  3. Have you had any special tests to examine your lungs like pulmonary function tests?

  4. Do you experience shortness of breath at rest, only with activity/exercise, or both at rest and with activity/exercise?

  5. If you become short of breath during activity or exercise, could you please describe the type of activity or exercise that produces your shortness of breath?

  6. Can you describe your shortness of breath? Can you help me understand your shortness of breath by pointing to your level of shortness of breath using this 10-point scale or by marking this Visual Analog Scale?

  7. Can I place this finger probe on your index finger to obtain an oxygen saturation measurement?

  8. Can I listen to your lungs with my stethoscope?

  9. Could I place one of my hands on your stomach and one hand on your upper chest to determine how you breathe?

  10. Could I place my hands on the lowermost ribs on each side of your chest to determine how you breathe?

  11. Could I place my hands on your back to determine how you breathe?

  12. Could I wrap my tape measure around your chest at several different sites to determine how you breathe?

  13. Now that I understand some very basic information about the manner in which you breathe, could you please breathe in the manner I instruct you via sounds I make, pressure from my hands, methods I show to you, or different body positions? I will occasionally place my hands on your chest and wrap my tape measure around your chest to determine how you breathe during these simple tests, and I will ask you to identify your level of shortness of breath using the 10-point scale or Visual Analog Scale—Is this OK with you?

  14. Could I measure the strength of your breathing muscles by ...

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