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PT 571 Cardiopulmonary > 2.4 Pneumonia > Flashcards

2.4 Pneumonia Flashcards

1
Q

Restrictive Lung Disease

A

Lungs restricted from fully expanding w/ air

*Problems INSPIRING!

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2
Q

Reasons for RLD?

A

Primary lung disease w/ stiff non-compliant lung parenchyma, IPF
Pleural abnormalities, effusions
Thoracic abnormalities that restrict chest wall mobility, kyphoscoliosis
Morbid obesity, pregnancy

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3
Q

PNA

A

inflammatory response of bronchioles and alveolar spaces to an infective agent
*bacterial, fungal, or viral

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4
Q

Chart review: Indirect

A

Amount of supplemental oxygen support required?
Trending up or down?
Lab values: WBC specifically.
Vital signs: temp, HR, RR, SpO2

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5
Q

Subjective: Direct

A

Cough? color/consistency
SOB? activities/supplemental O2
Chest pain? SINS, aggs/eases, hx

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6
Q

Hypothesis of Key Impairments

A

Respiratory System:
- decreased aerobic capacity due to hypoventilation and reduced gas exchange at alveolar level
- difficulty w/ airway clearance
MS System:
- decreased LE strength/power due to reconditioning
- impaired dynamic balanced due to reconditioning and loss of strength

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7
Q

LOOK

A 
Visual of breathing
Laborious?
Signs of chronic hypoxemia
- cyanosis
- digital clubbing
- hypertrophied accessory musculature

Clues in room

  • tissues/suction tubing
  • sputum
  • VC w/ IS
  • pre/post
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8
Q

What is normal VC?

A

3.0-5.0L

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9
Q

Volume vs. Capacity

A

Capacity - 2 or more volumes added (ERV+IRV)

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10
Q

PFT’s involve

A

gender
height
age

mechanical function of the lungs
*compared to predicted value expected

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11
Q

RLD: reduced lung volumes

A

VC
IC
TLC
decreased or normal RV

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12
Q

PNA pt can become hypoxic. T/F

A

True

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13
Q

LISTEN

A

Pulmonary auscultation
- inspiratory crackles & bronchial sounds

Dynamic Airway Assessment: Cough & Huff

  • excessive coughing
  • huffing

Bronchophony
- increased sounds in consolidated area

Mediate percussion
- dull in areas of consolidated

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14
Q

FEEL

A

Chest Wall Mobility
- decreased pump handle

Tactile Fremitus
- increased remits in consolidated area

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15
Q

Hypothesis: decreased aerobic capacity

What treatment?

A
  • functional capacity in comity-dwelling adult
  • measures response to therapeutic interventions

*Assess baseline, stop if the pt desat to 85%!! (sharp decline)

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16
Q

When doing a test to check when a patient desats at what point do you stop even if they are asymptomatic?

A

85%!!

  • Have face mask nearby!
  • Do this only when closer to d/c or feels better!
  • If everything checks out, balance/strength/power.
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17
Q

For training what do you want the SpO2?

A

92%

18
Q

Respiratory Treatments

A

1st hypothesis - use interval training

2nd hypothesis - use IS, ACBT, effective cough mechanics

19
Q

GOALS of airway clearance

A
  • Reduce airway obstruction caused by secretions
  • Improve ventilation
  • Optimize gas exchange
20
Q

Who’s appropriate for airway clearance?

A 
Atelectasis
Difficulty mobilizing secretions
- impaired ciliary motion
- reduced lung inflation
- impaired lung elasticity
- impaired chest wall mobility and biomechanics
- weak or fatigued respiratory muscles
*Post-op pts!!
*Intubated
*General anesthesia
21
Q

ACBT: PT moving towards this!!

A
  • Patient actively participates
  • Promotes patient I/autonomy
Previous treatments used:
*Postural drainage
*Percussion
*Vibration & shaking
PEP devices
High frequency chest wall oscillation
22
Q

How long after a meal should ACBT performed?

A

30m - 1hr

23
Q

Inhaled bronchodilator meds should be used how long before secretion removal treatment?

A

20-30 mins at least

24
Q

Inhaled antibiotics should be scheduled AFTER ACBT. T/F

A

True!

25
Q

ACBT: 3 ventilatory phases

A

1) Breathing control
2) Thoracic expansion
3) Forced expiratory technique

26
Q

ACBT: Breathing control

Relaxed TV breathing

A
  • Gentle TV breathing w/ relaxed upper chest/shoulder
  • Prevent bronchospasm
  • Needs to last long enough for patient to relax
  • 10-30s

*Chair for good posture, can be minutes

27
Q

ACBT: Thoracic expansion
Deep breathing
TEE

A
  • Deep inspiration helps loosen secretions
  • Allows air to get behind the secretions an assist w/ mobilization

*IS, they already know how to use this

28
Q

ACBT: FET

Huffing

A
  • Huffing to move secretions form smaller/peripheral distal airways to larger/proximal/upper airways that can be expectorated with a cough
  • Cough only reaches the lung generations within the conducting zone from the respiratory zone!
  • Technique saves energy for functional activity!
  • Always follow with breathing control
  • If wheezing present then increase breathing control time
29
Q

How do we direct FET to specific areas of the lungs?

A
  • To mobilize secretions from peripheral airways, a LONG and QUIET huff after a MEDIUM-sized inspiration will be effective
  • To clear secretions that have reached the larger proximal airways (were in the distal and it’s otw out), a SHORT and LOUDER huff after a deep inspiration will be effective.
30
Q

When would you spend more time in the breathing control phase?

A

Reactive airways or appear anxious
Wheezes or become wheezy
Difficult diaphragmatic breathing, excessive accessory muscles

31
Q

When would you spend more time in the thoracic expansion phase?

A

Atelectasis
Post-op
Cardiac sx

32
Q

When would you spend more time in the FET phase?

A

Requires increased sputum expectoration
They have a productive cough
*PNA may not spend a lot of time here! UNLESS they have productive cough!

33
Q

Treatment Efficacy

A 
Pulmonary auscultation
Vital signs
IS vs. formal PFT
Modified BORG Dyspnea (resting vs. activity)
6MWT & supplemental O2
34
Q

Incentive Spirometer (IS), Sustained Maximum Inspiration (SMI)

A

visual/audio feedback that encourages slow, deep inspiration

  • treat & prevent atelectasis and PNA, post-op pts for high risk post-op complications
  • promotes alveolar expansion, gas exchange, thoracic expansion, promote improvement in overall oxygen transport and pulmonary function
35
Q

Position for IS?

A

Upright in bed, EOB, or chair

Shoulders neutral or slightly snap retracted, shin slightly up

36
Q

Thoracic expansion exercises (TEE)

A

Slowly breathe in as deep as possible
Keep indicator between arrows
Hold breath for 3-4s or as long as possible
Gently exhale and release the inspired air

37
Q

ACBT

A

Utilized to clear secretions and maximize ventilation of atelectatic lung segments

38
Q

Two TEE phase may e necessary to loosen secretions before FET can follow. T/F

A

True

39
Q

In pts w/ bronchospasm or unstable airways, breathing control phase may be long as 10-20s

A

True

40
Q

When can the ACBT treatment be concluded?

A

When huff from medium-sized inspiration through complete expiration is nonproductive and dry sounding for TWO cycles in a row.

PT 571 Cardiopulmonary (7 decks)

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