Table Of Content

C P ARDIOVASCULAR AND ULMONARY P T HYSICAL HERAPY This page intentionally left blank 3251RiverportLane St.Louis,Missouri63043 CARDIOVASCULARANDPULMONARYPHYSICALTHERAPY,SECONDEDITION 978-0-7216-0646-0 Copyright#2010,1995bySaunders,animprintofElsevierInc. Allrightsreserved.Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans, electronicormechanical,includingphotocopy,recording,oranyinformationstorageandretrievalsystem, withoutpermissioninwritingfromthepublisher.PermissionsmaybesoughtdirectlyfromElsevier’sRights Department:phone:(þ1)2152393804(US)or(þ44)1865843830(UK);fax:(þ44)1865853333; e-mail:healthpermissions@elsevier.com.Youmayalsocompleteyourrequeston-lineviatheElsevierwebsite athttp://www.elsevier.com/permissions. Notice Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroaden ourknowledge,changesinpractice,treatmentanddrugtherapymaybecomenecessaryorappropriate. Readersareadvisedtocheckthemostcurrentinformationprovided(i)onproceduresfeaturedor(ii)bythe manufacturerofeachproducttobeadministered,toverifytherecommendeddoseorformula,themethod anddurationofadministration,andcontraindications.Itistheresponsibilityofthepractitioner,relyingontheir ownexperienceandknowledgeofthepatient,tomakediagnoses,todeterminedosagesandthebest treatmentforeachindividualpatient,andtotakeallappropriatesafetyprecautions.Tothefullestextentofthe law,neitherthePublishernortheAuthorassumesanyliabilityforanyinjuryand/ordamagetopersonsor propertyarisingoutoforrelatedtoanyuseofthematerialcontainedinthisbook. LibraryofCongressCataloging-in-PublicationData Watchie,Joanne. Cardiovascularandpulmonaryphysicaltherapy:aclinicalmanual/JoanneWatchie.--2nded. p.;cm. Rev.ed.of:Cardiopulmonaryphysicaltherapy/JoanneWatchie.c1995. Includesbibliographicalreferencesandindex. ISBN978-0-7216-0646-0(pbk.:alk.paper)1.Cardiopulmonarysystem--Diseases--Physicaltherapy--Handbooks, manuals,etc.I.Watchie,Joanne.Cardiopulmonaryphysicaltherapy.II.Title. [DNLM:1.CardiovascularDiseases--rehabilitation--Handbooks.2.LungDiseases--rehabilitation--Handbooks. 3.PhysicalTherapyModalities--Handbooks.WG39W324ca2010] RC702.W382010 616.1’2062--dc22 2009008630 VicePresidentandPublisher:LindaDuncan ExecutiveEditor:KathyFalk SeniorDevelopmentalEditor:MelissaKuster PublishingServicesManager:CatherineJackson ProjectManager:JenniferBoudreau DesignDirection:KarenPauls CoverDesigner:KarenPauls PrintedinUnitedStatesofAmerica Lastdigitistheprintnumber:9 8 7 6 5 4 3 2 1 This book is dedicated to all physical therapists who appreciate the importance of the pulmonary and cardiovascular systems in designing treatment plans that not only achieve the treatment goals they establish for their patients, but also return them to optimal health. This page intentionally left blank CONTRIBUTORS Jeffrey Rodrigues, PT, DPT, CCS Instructor of Clinical Physical Therapy Division of Biokinesiology and Physical Therapy University of Southern California Los Angeles, California Chapter7:Cardiovascular andPulmonaryPhysicalTherapy Treatment Robin J. Winn, PT, MS, PCS Head Physical Therapist Morgan Stanley Children’s Hospital of New York Presbyterian Hospital/Columbia University Medical Center Instructor in Clinical Rehabilitation Medicine (Physical Therapy) Columbia University College of Physicians and Surgeons Program in Physical Therapy New York, New York Chapter8:Pediatrics Joel D. Hubbard, PhD, MT (ASCP) Associate Professor Clinical Laboratory Science School of Allied Health Sciences Texas Tech University Lubbock, Texas Chapter9:Laboratory Medicine vii This page intentionally left blank PREFACE The first edition of Cardiopulmonary Physical Therapy: A Clinical Manual came about as the result of discussions within the Executive Committee of the Cardiopulmonary Section of the American Physical Therapy Association in 1988. At that time, several members expressed frustration over the amount of time and effort required to find appropriate materials to use in the orientation and instruction of staff and students who would rotate onto services that served patients with cardiopulmonary diseases or dysfunction. In addition, some members received frequent requests for reference materials and bibliographies from practicing physical therapists interested in developing more expertise in cardiopulmonary physical therapy. Cardiopulmonary Physical Therapy: A Clinical Manual was created to address these needs. Thefirsteditionofthebookservedasareadyreferenceforphysicaltherapistsandother care providerswhose patientshaveprimary orsecondary cardiovascularor pulmonarycon- ditions. Itwasdesignedtoprovidevaluableinformation quickly andconciselyforclinicians who require immediate understanding of a particular pathology, diagnostic test or proce- dure, therapeutic intervention, medication, or cardiopulmonary problem, as well as the important clinical implications of participation in exercise and rehabilitation activities. Theresponsetothebookhasbeenverypositive,andtheneedformorecurrentinforma- tion has prompted the publication of a second edition. The title change to Cardiovascular and Pulmonary Physical Therapy: A Clinical Manual reflects the inclusion of pathologies and clinical manifestations involving the vascular system among the conditions affecting patients served by this area of clinical practice. Like the first edition, this book is a quick and convenient resource, offering a clinical overview of a wide variety of diseases and disorders that affect the pulmonary and cardiovascular systems and the physical therapy management of patients with these conditions. It integrates information related to anatomy and physiology, diagnostic tests and relevant findings, significant pathophysiological features and clinical manifestations, and medical and surgical interventions, while offering important clinical implications for exercise and physicaltherapyinterventions.Crossreferences torelatedinformationfoundinotherchap- ters and bulleted lists make finding information quick and easy. Thiseditionincludesanintroductiontotheoxygentransportpathwayasitactuallyfunctions intheclinicalsettingandtheimplicationsofdefectsinthepathway.Updatedmaterialisprovided on diagnostic tests and procedures, therapeutic interventions, pharmacology, and laboratory valuesandprofilesusedinthemanagementofpatientswithcardiovascularandpulmonarydys- function.Therearemanynewandupdatedillustrations,includingdepictionsofthepathophysi- ology and associated clinical manifestations of obstructive and restrictive lung disease and systolicanddiastolicventriculardysfunction.Inaddition,informationonobesityanddiabetes hasbeenexpanded,andmaterial onmetabolicsyndromeandanthropometricmeasurements fordeterminingobesityandassociatedlevelofhealthriskhasbeenadded. Cardiovascular and Pulmonary Physical Therapy: A Clinical Manual is a unique and valuable resource for physical therapists practicing in all clinical settings, including acute ix