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PTA 230 Final > 16. Pulmonary and Cardiac Patients > Flashcards

16. Pulmonary and Cardiac Patients Flashcards

1
Q

What type of chest is associated with COPD?

A

Barrel Chest

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2
Q

What are Obstructive pulmonary diseases?

A

– COPD
– Asthma
– Cystic Fibrosis

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3
Q

What are the Restrictive pulmonary diseases?

A

– Scoliosis

– Inhaled toxins
– pneumonia

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4
Q

labored breathing due to SOB

A

Dyspnea

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5
Q

Rapid shallow breathing

A

Tachypnea

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6
Q

Slow rate…may be with drug overdose

A

Bradypnea

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7
Q

Deep, rapid respiration

A

Hyperventilation

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8
Q

Difficulty breathing in supine

A

Orthopnea

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9
Q

Cessation of breathing in the expiratory phase

A

Apnea

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10
Q

Cessation of breathing in the inspiratory phase.

A

Apneusis

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11
Q

Cycles of gradually decreaseing tidal volumes and then a period of apnea. Seen with severe head injury.

A

Cheyne-Stokes

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12
Q

Volume of air inhaled or exhaled during each normal breath.

A

Tidal Volume (TV)

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13
Q

Maximal volume of air that can be inhaled over and above the inspired tidal volume

A

Inspiratory Reserve Volume (IRV)

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14
Q

Maximal volume of air that can be exhaled after exhaling a normal tidal breath.

A

Expiratory Reserve Volume (ERV)

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15
Q

Volume of air remaining in the lungs after a maximal exhalation.

A

RV

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16
Q

Maximal volume of air in the lungs at the end of a maximal inhalation.

A

Total Lung Capacity (TLC)

- RV + TV + ERV + RV

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17
Q

Volume of air present in the lung at end-expiration during tidal breathing.

A

Functional Residual Capacity (FRC)

- RV + ERV

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18
Q

Maximal volume of air that can be inhaled from the resting end-expiratory level.

A 
Inspiratory Capacity (IC)
- IRV + TV
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19
Q

Maximal volume of air that can be exhaled after a maximal inhalation.

A 
Vital Capacity (VC)
- IRV + TV + ERV
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20
Q

– Combo of chronic airway inflammation and remodeling that results in air trapping from hyperinflation.
– Loss of the normal elastic recoil of the lungs.
– Capillary beds thicken and eventually are destroyed.
- Ventilation and perfusion in the capillary membrane are no longer matched. This results in hypoxemia.
– The decreased oxygenation leads to hypercapnea or too much carbon dioxide in the blood.

A

Pathophysiology of COPD

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21
Q

COPD Clinical Presentation
• Hx of cigarette smoking, chronic ______, expectoration and exertional ______.
• The A-P diameter of the chest increases leading to a ______ chest.
• As the chest changes shape, _______
excursion decreases.
• The ______ flattens due to
________.

A

Coughing; Dyspnea
Barrel; Thoracic
Diaphragm; Hyperinflation

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22
Q

With COPD, clinicians may hear?

A

– Expiratory wheeze

– Crackles from secretions in the airways

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23
Q

With COPD, clinicians may see?

A

Digital Clubbing

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24
Q

With COPD, patients will have Lung volume changes such as _______ _______ and ______ _______ _______ are _______ due to air trapping. Also, the ______ is decreased.

A 
Residual Volume (RV); Functional Risidual Capcity (FRC); increased
FEV1
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25
Q

With COPD, patients may have Arterial blood gases that show ________.

A

Hypoxemia

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26
Q

Finger Clubbing is explained by a variety of theories, including increased perfusion. Its association with _______ oxygen desaturation has been noted, but this is not an exclusive
________; clubbing has also been observed in nonpulmonary diseases such as ________ _______ and
_______ disease.

A

Arterial; Phenomenon; Hepatic fibrosis; Crohn’s

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27
Q

What are two types of asthma?

A
  • Allergic

- Non Allergic *from other irritants

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28
Q

Within non allergic asthma, what are 4 irritants?

A
  • Smoke
  • Fumes
  • Infections
  • Cold Air
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29
Q
  • Common
  • Characterized by bronchospasm, wheezing, breathlessness and coughing with sputum production.
  • Diagnosis based on history.
A

Symptoms of Asthma

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30
Q

What is the pathophysiology of Asthma?

A

– Bronchospasm

– Increased airflow resistance
– Leads to hyperinflation

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31
Q

What is the clinical presentation of Asthma?

A

– Cough, dyspnea on exertion & wheezing.
– Clinicians may hear crackles
– Barrel-chest
– Decreased expiratory flow rates (FEV)
– Mild to moderate hypoxemia

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32
Q

What is a Chronic disease that affects the excretory
glands of the body? What organs does it affect?

A 
– Pulmonary 
Cystic Fibrosis:
– Pancreatic 
– Hepatic 
– Sinus and 
– Reproductive
33
Q

• Autosomal recessive trait.
• Caucasians make up the majority of all cases
• There is also defective transport of sodium, potassium and water leaves the mucus made by the excretory glands thickened and difficult to move.

A

Etiology of Cystic Fibrosis

34
Q

The pathophysiology of Cystic Fibrosis is…
• The altered viscous secretions in the lung result in ______ and ________.
• This impairs the function of the ________ transport system.
• Partial or complete obstruction of the
airways reduces ________ to the ______ ______.
• ________ and ______ within the lungs are not matched and leads to _______ changes.

A

Obstruction; Hyperinflation
Mucociliary
Ventilation; Alveolar units
Ventilation; perfusion; fibrotic

35
Q

Diagnosis of Cystic Fibrosis:
– From a _____ _____ of the disease
– Repeated respiratory infections from
________ aureus or ________ aeruginosa.
– Failure to thrive.
– A ______ concentration of greater than or equal to ___ mEq/L found in the _____ of children is a positive test for the diagnosis of CF.

A

Family history
Staphylococcus; Pseudomonas
Chloride; 60; sweat

36
Q

Clinical Presentation Cystic Fibrosis:
– Failure to thrive from ___ dysfunction.
– _______ from pancreatic dysfunction,
– OR frequent respiratory infections
• Barrel chest & increased _______
• Cyanosis
• Digital clubbing
• Pulmonary function tests show
– Decrease FEV1, PEF, FVC
– Increased RV and ____
• Hypoxemia/_______

A 
G.I.
Diabetes
Kyphosis 
FRC
hypercapnea (more CO2)
37
Q

__________________:
• Course and Prognosis
– 70% of all cases are diagnosed before ________.
– Survival rates continue to increase
• Treatment involves the removal of the
abnormally ______ ______ and prompt
treatment of pulmonary infections.
• Also needs good diet, exercise and
replacement ________ enzymes.

A

Cystic Fibrosis:
1 year.
Thick; Secretions
Pancreatic

38
Q

A group of diseases that result in difficulty
expanding the lungs and a reduction in lung volumes.

A

Restrictive Lung Disease

39
Q

Restrictive Lung Disease:
– From lung parenchyma and/or pleura
– Changes in the ______ ______
– Alteration in the neuromuscular apparatus of the ______.

A

Chest wall

Thorax

40
Q

What is the most common idiopathic Restrictive Lung Disease?

A

Pulmonary Fibrosis (thought to be immunological)

41
Q 
• From 
– Radiation therapy 
– Inorganic dust 
– Inhalation of noxious gases 
– Oxygen toxicity 
– Asbestos exposure
A

Etiology of Restrictive Lung Diseases

42
Q

__________ _________ ___________:
Pathophysiology
• Disease often begins with parenchymal
changes with inflammation and a
thickening of the alveoli and interstitium.
• As the disease progresses, the distal air
spaces become fibrosed and resistant to
expansion.
• Lung volumes ______. ***

A

Restrictive Lung Disease

Reduced

43
Q 
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_:
Clinical Presentation 
• Dyspnea with activity 
• a non-productive cough 
• Signs include 
– Rapid, shallow breathing with \_\_\_\_\_\_\_\_ chest expansion 
– Inspiratory crackles 
– Digital clubbing 
– Cyanosis 
– \_\_\_\_\_\_\_\_\_\_ VC, FRC, RV and TLC 
– Blood gases show hypoxemia and hypocapnea. 
– \_\_\_\_\_\_\_\_ may significantly lower oxygenation***
A

Restrictive Lung Disease
Limited
Decreased
Exercise

44
Q

Restrictive Lung Disease:
Physical Therapy Management
• The person with pulmonary dysfunction often _______ _______ that result in the uncomfortable sensation of dyspnea. A slow but steady ________ in these patient’s functional activities follows, resulting in progressive aerobic ________.
• The intended outcome is to interrupt this downward spiraling of physical ability by improving ________ performance and decreasing ________.

A

Avoids activities; decrease; deconditioning

Exercise; Dyspnea

45
Q

Review Question:

Why do these patient with Edema?

A

Inadequate blood flow from heart and lungs causes blood and fluids to back up into other areas of body.

46
Q

When a pump fails which side does the
fluids build up?

A

Right sided failure: Peripheral Edema (Body), JVD
Example: COPD, Asthma, CF (Obstructive)

Left sided failure: Pulmonary Edema
Example: Primarily CHF start,

47
Q

What is known as a sign of right ventricular failure or lymphatic dysfunction.

A

Peripheral Edema

48
Q

What is the head position to examine Jugular Vein Distention (JVD)?

A

45 degrees (Patient head turned away from therapist)

49
Q

When checking JVD, a bilateral distention infers _______ _______ ______. A unilateral problem usually means that there is a ______ problem.

A

Congestive Heart Failure

Local

50
Q

How does the the left side of the heart work when ventricle enlarged (abnormal) and when normal? What condition and symptoms can happen abnormally?

A

Abnormal: Decreases ejection fraction
Sx: CHF - SOB and Cough

Normal: 55-75%
- Systemic and Brain Blood Supply

51
Q

The most primary and common CABG procedure is _____ to _____. What does the later effect?

A

LIMA (Left Internal Mammary Artery); LAD (Left Anterior Descending)
- Left Ventricle (LV) and Cardiac Output (CO)

52
Q

Surgery is indicated for Myocardial Ischemia especially in an event greater than _____.
Indicators:
– CK-MB
– Chest, left shoudler, indigestion
– NTG (acute) under the tough and ER is indicated
– EKG changes after: reversed T-Wave and ST segment depression

A

20 minutes

53
Q

When dealing with cough, what primary characteristics should we examine?

A 
- Productive vs. Non-productive 
– Color 
– Consistency 
– Amount 
– Odor
54
Q

When dealing with cough…
• Small amounts of clear or white secretions are ______.
• Copious clear secretions are common with _____.
• Yellow green and purulent secretions with a strong odor indicate ______.
• Blood-streaked secretions indicate ______ in the lungs.
• Frothy white secretions are associated with ______ ______ and _____ _____.

A 
Normal
Bronchitis
Infection
Hemorrhage
Pulmonary Edema; Heart Failure
55
Q

• Treadmill or stationary bicycle
• Gradually increase the intensity until the point of limitation.
• Monitor vital signs throughout the testing.
Are used in _____ _____ _____.

A

Exercise Tolerance Testing (Phase 2 - Outpatient: S/p MI)

56
Q

What are the 4 variables of an Exercise Prescription?

A
  • Mode
  • Intensity
  • Duration
  • Frequency
57
Q

What are some examples of mode within the 4 variables of exercise prescription?

A

Walking, jogging, cycling, UE exercise (ergometer, free weights)
* Patients do best if both modes are combines.

58
Q

What is intensity within the 4 variables of exercise prescription?

A
  • Mild (40 – 60% of max VO2)
  • Mod (>60% of max VO2)
  • Based off of BORG Scale 0-10
59
Q

What is duration within the 4 variables of exercise prescription?

A
  • 20 – 30 minutes at desired intensity
60
Q

What is the frequency within the 4 variables of exercise prescription?

A

3 – 5 sessions per week

61
Q

What do you do if a patient can only walk 3 min?

A
  • Take breaks

- Continue until 20-30min is reached

62
Q

How do you use the Rating of Perceived Dyspnea? What do you ask the patient?
*Just like BORG
• 3 = moderate SOB
• 6 = between severe and very severe
• A rating of 3 = 50% of VO2 max
• A rating of 6 = 80% of VO2 max

A

Ask on a scale 0-10 how much shortness of breath that they feel.

63
Q

Exercises Lungs

A

Inspiratory muscle trainers

64
Q
  • Exhale through device X 10.
  • Then, 2 large exhalations through
    device.
  • Followed by a huff or cough.
  • Repeated until lungs are clear.
A

Oral Airway Oscillation Devices

65
Q

How is a patient progressed with exercise?

A

When 20 minutes of continuous activity can be accomplished, an increase in exercise duration or intensity can be proposed.

66
Q

Used to clear secretions. Vest with air channels

A

High-Frequency Chest Compression Devices

67
Q

What are the 6 Secretion Removal Techniques practiced with patients.

A
  • Postural draining
  • Percussion
  • Vibration
  • Shaking
  • Airway Clearance
  • Active Cycles of Breathing
68
Q

Which lobe is being treated in postural drainage techniques with the patient sitting with forward/backward leans or Fowler’s position?

A

Upper Lobes

69
Q

Which lobe is being treated in postural drainage techniques with the patient Head down, foot elevated 16”, congested lobe on top?

A

Middle Lobe

70
Q

Which lobe is being treated in postural drainage techniques with the patient Head down, foot elevated 20”, congested lobe on top?

A

Lower Lobes

71
Q

Percussion; ______ minutes over each lung segment.

A

3-5 min

72
Q

Shaking/Vibrating: ______ deep breaths with shaking on exhalation

A

5-7

73
Q

What are the Airway clearance procedures? What is best for Obstructive patients?

A
  • Coughing

- Huffing “Kah, Kah, Kah” (better for Obstructive Diseased patients)

74
Q

What home exercise program can be taught to actively move secretions for to bronchi for coughing?

A

Active Cycle of Breathing

75
Q

Active Cycle of Breathing
• Begins with a few minutes of the breathing control phase = relaxed, diaphragmatic tidal volume breathing.
• Then _______ deep breaths with a hold at the end of inhalation for __ seconds, followed by passive exhalation.
• Then return to controlled breathing.
• Should move secretions to bronchi for coughing.

A

3-4; 3

76
Q

______ ______ Pressure:
• _____ devices. This is exhalation against pressure.
• Treatment last __to __minutes.
• Session is complete when all secretions are cleared.
* As affective as drainage percussion/shaking

A

Positive Expiratory Pressure
PEP
10-20

77
Q 
Breathing Exercises:
• \_\_\_\_\_\_\_breathing can prevent airway collapse. 
• Diaphragmatic training does not have 
evidence to support use. Strengthen 
\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_.
A

Pursed-Lip

Accessory Muscles

78
Q

What type of breathing is Unique to Patient with SCI or
ALS?

A

• Glossopharyngeal Breathing
• Gulping of air: commonly called “frog breathing”
* This can be used for short periods of time for patients with high Cervical injury or during mechanical emergencies

PTA 230 Final (8 decks)

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