cardio respiratory Flashcards

Question

paradoxical breathing

Answer 1

pattern in reveres, chest recoils on inspiration and expands with expiration

Answer 2

multiple fractires in multiple ribs creates a flail segment that gets sucked in during inspiration

Answer 3

normal is 1:2 obstructive is 1:3- hard time exhaling air, resistance restrictive is 1:1- can not take as much air in shallow fast breaths

Answer 4

may indicate air trapping and effor to rid lungs of air. obstructive disease

Answer 5

shallow- indicates restrictive disease, often compensated by increasing respiratory rate

Answer 6

pectus excavatum, sternum sunken restricts anterior lung expansion

Answer 7

pectus carinatum, sternum is forward retrictions in in medial lateral expansion

Answer 8

AP:lateral diameter is 1:1 indicates chronic hyper inflation and air trapping

Answer 9

blue tinge to lips and mucus membranes, indicates respiratory distress

Answer 10

low arterial blood O2

Answer 11

obvious in R sided heart failure, large vein in neck bulges visibly becuase of pressure. right heart pump can not keep up back up of blood evidendent in jugular vein

Answer 12

sign of righ sided heart failure, R side can t pump effectivley back up of blood in venous system, edmema most common in lower extremities becuase of gravity dependent positioniing.

Answer 13

indicates muscles not reciveing adequte O2-hypoxia

Answer 14

low o2 levels in tissues

Answer 15

forced expiration against a closed glottis, required to prevent retention, infection, atelectasis effective- strong with ability to clear productive/wet-things come up, vs non producrive or dry persistant- how often?

Answer 16

colour consitency volume odour

Answer 17

clear- salivia white-normal, may be associated with asthma yellow-mucopurlent, possible infection, chronic bronchitism cystic fibroisis, pnuemonia green-prolent, possible infection, emphysea, advanded pneumonia, bronchietasis, lung abcess brown flecks- carbon particples, smoker, smoke inhalation pink frothy- pulmonary edema frank blood-hemoptysis- Tb lung cancer pulmonary infarction

Answer 18

pulmonary edema

Answer 19

tuberculosis, lung cancer, pulmonary infarction

Answer 20

lots of thick mucpulent yellow mucus, copius amounts

Answer 21

1) chest wall expansion 2)diaphragmatic excursion 3) edema 4) pain and crepitus 5) traceal positioning 6) tactile fremitus

Answer 22

1) manual method- look for amount of movment and symmetry between sides, thumbs together-how far apart do they move with breath. assess upper(sternocostal), middle (vertebro costal) and lower (lateral costal) 2) circumferintial method- uses measuring tape to measure diffrence between full inlation and exhalation. measure at axilla, measure at 10th rib. 3 measurments-best of 3

Answer 23

1) hand placed on apex of belly during inspiration 2) measure diffence with tape measure apex of belly during inspiration 3) diaphragmatic percussions

Answer 24

pitting vs non pitting pitting pressure leaves an indent which persits indicates fluid retention that is gravity dependent,Right sided heart failure non pitting edema-chronic, lymphedema others: systemic pregnancy

Answer 25

this indicates oraganic or pain of musculoskeltal orgin

Answer 26

bubbles of air in subcutaneous tissue, sub cutaneous emphysema, air leak from chest tube, trauma, pneumothoracx requires medical attention ASAP

Answer 27

should sit between the SC joints, increase in pressure pushes contralateral decreae in pressure pulls ipsilateral

Answer 28

ulnar border of hand on chest as patient repeats 99, feeling for vibrations. increased sound transmission indicates more dense tissue (not air) pulmonary edema, consolidation, tumor decreased sound transmission =hyperinflation, emphysema, pneumothoracm pleural effusion, sound waves attenuate in less dense tissue like air and fluid.

Answer 29

purpose: determine density of underlying tissue, up to 5 cm in depth extended finger between ribs-tap firmly with other fingers 2-3 strikes resonat= normal tissue dull= nonareated lung tissue hyperresaonant= hyperinflated lung

Answer 30

patient sitting. max exhale and hold as physio percussates makes mark , max inhale and hold physio percussates makes mark normal distance between is 3-5 cm

Answer 31

art of listening to sounds porduced by the body, pt takes slow deep breaths though MOUTH when assesing, check for dizziness every 2-3 breaths normal lung sounds resonant abnormal dull indicates consolifation, plueral fluids, pulmonary edma, pneumonia, atlectasis, hyperesonant hyperinflation, COPD, acute asthma attack, penumothorax

Answer 32

RUL-apical (above clavicle) RUL-anterior (between clavicle and 4th rib anteriorly) RUL-posterior (between C7/T3, above spine of scapula-posteriorly) RML-lateral (mid axillary rib 5, stethoscope beneath orts bra inferiorly) RML- medial (anterior mid chest, beneath breast tissue between costal cartilages 4 and 6) RLL-anterior basal ( between ribs 6 and 8 in the mid clavicular area RLL-superior ( enclosed by T3 to T7 and medial scapular border) RLL-posterior basal (enclosed by T7 to T10 and mid scapular line) RLL- lateral basal ( enclosed by T7 to T10, mid scapular to posterior axillary line) medial basal- can not ausultate

Answer 33

LUL-apical posterior ( above clavicle anteriorly, posteriorly C7 to T3 above spine of scapula) LUL-anterior (between clavicle and 4th rib anteriorly) LUL-superior lingulus,(over 5th rib anterior lateral) LUL-inferior lingulus ( between costal cartilages 4 and 6 anterior mid chest) LLL-anterior medial basal LLL-superior ( posteriorly t3 to T7 and medial border of scap) LLL-posterior basal (T7 to T10 and medial to mid scapular line) LLL-lateral basal (T7 -t10 lateral to mid scapular line)

Answer 34

soft low pitched Inspiration to expiration 3:1 heard over peripheral lung tissue (not over trachea and bronchi) indicates normal lung

Answer 35

Mixture of branchial and vesicular inspiration to expiration 1:1 inspiration is soft and low pitched expiration is loud and high ptiched heard over main stem bronchi in 1st and 2nd intercostal spaces and posteriorly between scapular

Answer 36

loud high pitched hollow quality louder on exhalation inspiration:expiration 1:1 or 1:2 distinct pause between inspiration and expiration heard over trachea and manubrium

Answer 37

abnormal breath sound short explosive inspiratory or expiratory fine or course

Answer 38

air moving retained secretions cuaseing intermittent closing and opening of the airway, wet, insipration and/or expiration, can be in any area of the lung

Answer 39

sudden opening of collapsed alveoli, typically dry, inspiratory, typically in basal lung (area more proone to collapse) late inspiratory fine crackles

Answer 40

abnormal breath sound differnt pitches-high (bronchospasm), low ( secretions in upper airways) inspiratory(rare-severe obstructions) expiratory (most)

Answer 41

extrapulmonary sound long low pitcher leathery creaking produced by frictional resistance between layers, may be asociated with pain

Answer 42

loud musuical high constant pitch, audible from distance without stethoscope, most promminent during inspiration due to turbelent air flow -upper air way obstruction or narrowed air ways

Answer 43

a group of tests which help evaluate the mechanical functioning of the lungs, researched norm and predicted values are used for comparison, used for determination of presence of restrictive and obstructive diseases, determining severity of condition, determine response to bronchodilator treatment, as an out come measure for disease progresssion or effectiveness of treatment and medications.

Answer 44

trouble getting air out, leads to air trapping, lots of junk air and no room for new air increased airway resistance, narrowed air way leads to increased resisance to air out chronic bronchitis, emphysema, COPD, asthma, bronchiextasis increased lung capcities due to air trapping decreased flow rates FEV1, FEV1/FVC,

Answer 45

decreased ability to expand lungs and take air in, stiff chest/lung/ribcage, decreased strength to expand decreased compliance--> decreased negative pressure--> decreased air entry, colume of air in lung is reduced results in increased work of breathing increase RR that may lead to hyperventiliation (decreased PACO2) increased accesory muscle use increased pressure required to maintain lung expansion and ventilation increaed fatigue ( lots of energy for breathing, depleted O2 deconditioning)

Answer 46

the amount of air taken in or out during normal quiet breathing. about 500 mL in normal adult

Answer 47

diaphragm moves down on inspiration, the primiary muscle 70%. thoracic space increases and chest wall expands. intrapleural presure becomes more negative and draws air in. diaphragm is its lowest at the end of inspiration acccessory muscles: external intercostals, SCM, scalenes, pecs

Answer 48

expiration is a passive recoil of the lungs and rib cage. forced expiration/reduced elastic recoil requiers contraction of abdominal wall and internal intercostals. these muscles press the abdominnal organs upwards into the diaphragm reducing the volume of the thoracic cavity. inspiratory muscles are relaxed. throacic volme is decreased intrapleura pressure becomes less negative and forces air out.

Answer 49

maximum amount of air that can be inspired above tidal volume, Inspiratory capacity - tidal volume 2- 3L used during exertion or exercise

Answer 50

maximal exhalation after tidal volume expiration ( max expiration - tidal volume) 1L

Answer 51

the amount of air left in the lungs after maximal exhalation, cant exhale all the air cannot be measured by spirometry 1L

Answer 52

the volume of air in the lungs after a maximal inspiration residual volume, tidal volume, expiratory reserve volume and inspiratory reserve volume 4-6L

Answer 53

the maximum amount of air that can me exhaled after a maximal inhaltion expiratory reserve volume, Tidal volume and inspiratory reserve volume 3.8L females 4.8 L males

Answer 54

maximum amount of gas that can be inhaled from resting expiratory level tidal volume and inspiratory reserve volume

Answer 55

amount of air in the lungs after a normal breath out expiratory reserve volume and residual volume

Answer 56

volume of ventilated air that does not participate in gas exhange, ventilation with out perfusion 1. anatomical - volume of air that fills the conducting airways (nose trachea bronchi) where gas exhange is not possible because there is no alveoli 2. physiological dead space= antomical dead space plus alveolar dead space. neligible in healthy indiviudals. value increases in lung desease states

Answer 57

restrictive

Answer 58

obstructive

Answer 59

restrictive

Answer 60

obstructive

Answer 61

restrictive

Answer 62

restrictive

Answer 63

the total volume of air that can be exhaled after a maximal inhlation indpendent of time

Answer 64

maximum amount of air that can be expired in 1 second after maximal inhalation

Answer 65

% of of FEV that can be exhaled in 1 sec. 80% is normal in a restrictive disease both FEV1 and FVC decrease the ratio is normal or greater then normal <70% is obstructive disease becuase it indicates there is lots of resistance to getting air out, FEV1 reduces beucase hard time removing air.

Answer 66

normal: most of the air is exhaled in 1 sec, steady decline afterwards Obstructive: less air is exhaled then normal, takes longer to exhale air, graph scoops, increased scooping indicates increase severity of disease, longer horizontallly Restrictive: air is exhaled fast, less air to exhale, graph is shorter horizontally

Answer 67

normal or low

Answer 68

low, becuase of resistance to air getting out

Answer 69

<70% and is diagnositic

Answer 70

low, can not take as much air in therfore less to exhale

Answer 71

normal or low

Answer 72

normal to high

Answer 73

mesures the functioning of gas exchangefrom the lungs to the blood low: could be a problem with pulmonary or circulatory system eg// emphseyma, fibrosis, anemia high: problem with circulatory system-not pulmonary eg// polycythemia high RBC count viscous blood

Answer 74

nose clip, breath trhough tube attached to gage indicated when resipiratory muscle weakness is expected, when perscribing a inspiratory muscle trainer inspiration: pt' attempts a maximal inspiratory effort through blocked mouthpiece, reflex strength of inspiratory muscles expiration: patient attempts a maximal forced expiratory effort through blocked mouth piece after a full exhalation, reflex strength of patients expiratory muscles

Answer 75

a measure of the hydrogen ion concentration indicating acidity and alkalinity 7.35-7.45

Answer 76

35-45 mmHG controlled by ventilation

Answer 77

22-26 mEq/L

Answer 78

95-100% % of saturation of hemoglobin molecules with ocygen measured by pulse oximeter

Answer 79

80-100mmHg

Answer 80

test of arterial blood to measure blood gases and acidity assess effectiveness of gas exhange in diagnosis of acute respiratory conditions body tries to maintain homeostasis

Answer 81

increased PACO2 patient not breathing in fresh O2 and retaining CO2 respiratory acidosis

Answer 82

decreased PaCO2 patient breathing too much offloading excess Co2 repiratory alkalosis

Answer 83

metabolic acidosis

Answer 84

metabolic akalosis

Answer 85

mild 60-80mmHg moderate 40-60mmHg severe <40 mmHg

Answer 86

low Ph and high PaCo2

Answer 87

high Ph, low PaCo2

Answer 88

low HCO3-, low Ph

Answer 89

high Ph, high HCO3-

Answer 90

1. respiratory 2. metabolic

Answer 91

notmal ph but other components are abnormal

Answer 92

abnormal ph, one component HCO3- or PaCo2 is abnormal while the other is normal

Answer 93

ph is abnormal, PaCO2 and HCO3- are also abnormal

Answer 94

ratio of the amount of air reaching alveoli to the amount of blood reachingi the alveoli optimal =1 ventilation is the exhange of gases, movement of air in and out of the lugs perfusion- amount of blood that reaches the alveoli via the capillaries which enables the movment of O2 and CO2 across the alvelolar membrane and capillary membrane shunt- low VQ ratio , alveoli are perfused but ventilation fails to supplu the perfused region deadspace- hihg V/Q ratio, air is inhaled but unable to take part in gas exhange

Answer 95

smoking-inhibition of cilary motility airway irritation air pollution genetics-alpha-1 antirypsin definciency elastin breakdown, floppy lung infection- repeated/chronic aging due to increased compliance fo lungs allergy-asthma attacks

Answer 96

progressive airway obstruction that is not fully reversible associated with RHF Chronic bronchitis-small airway remodelling emphseyma-parenchyml destruction- destruction of air ways distal to terminal bronchi, destruction of interalveolar septa cuasing mergin of alveoli into larger air spaces

Answer 97

productive cough on most days for 3 months out of the year for 2 consectutive years (provided other conditions have been ruled out)

Answer 98

hypertrpphy and hyperpalsia of mucus glands and goblet cells- leading to an increase in mucus. decrease in cilia #'s cuasing secretion retention. chronic inflamatory changes in broncial walls, decreased gas exhange due to formation of misshapen and large aveloar sacs

Answer 99

chronic irritant exposure ( pollutnats, smoking) long term irritation of trachea/bronchi

Answer 100

mucus I: obese and cyanotic blue bloater, mucus (white to green), commonly ass. with RHF (edema and jugular vein distension), hypoxeimia, dyspnea, chronic productive cough P: decreased tactile fremitus in areas of air trapping (pillowing) , increase tactilie fremitus in areas of consolidation, possible ankle edema (RHF) P: hyperresonate in areas of air trapping, dull in areas of consolidation A: decreased breath sounds in areas of little air movement trapped air, early inspiratory wet crackles-bronchi mucus, possible wheezing due to airway narrowing ABG: low PaO2, high PACO2 CXR: black in areas of trapping white in oslidations-haziness, cardiomelgaly (enlarged heart due to RHF)

Answer 101

airway wall increases due to inflammation and scarring= smaller airways, increase in mucous also decreases airway lumen, damage to cilia increases susceptibility to lung infection, incrase in airway smooth muscle contracton can cuase increase in bronchconstriciton,

Answer 102

enlargement of airway distal to the terminal bronchioles accompianed by destruction of their walls, air sacs rupture and enlarge (normal many small sacs,) fewer larger sacs. Centrilobar: affects respiartory bronchioles, males, rare among non smokers, found often with chronic bronchitis Panlobar: affects terminal and respiratory bronchioles. due to alpha antitrypsin defieciency (genetic) which inhibits elastase, lung is floppy decreased elastic recoil.

Answer 103

develops from obstruction to air flow during exhalation leading to hyperinflation-->destruction of alveloar walls--> decreased elastic recoil--> increased dead space, . decreased gas exhange(alveoli rupture daamage to capillaries and decreased SA).

Answer 104

smoking, pollution, alphaantitrypsin diefeincy

Answer 105

I: thin and wasted pink puffer, muscle atrophy, barrel chest, I:E ratio prolonged 1:3/long exhlaation, pursed lip breathing, increased respiratory muscle use, other signs of resp distress P: tactile fremitus decreases due to air trapping and pillowing affect chest wall expansion is decreased becuase lungs are already hyperinflated P: hyperesonat with precussion A: decrease breath sounds, may have dry crackles ABGs: decreased PaO2 normal or increased PACO2 CXR: increased balck area (air trapped), flattened diaphargm, flattened rib angles, narrow mediastinum (thin elongated heart)

Answer 106

decreased surface area for gas exhang elasticity of alveloar septa are compromised, air ways collapse early trapping inspired air hyperventilation-breathing at high lung volumes, diaphragm at a mechanical disadvantage

Answer 107

diffusion capcitiy studies Carbon monoxide spirometry

Answer 108

hyperinflation and gas exhange abnormalities -invcreased airway resistance, early airway collapse leads to to air trapping, short inspiratory muscles - poor gas exchange

Answer 109

1) bronchodialators for smooth muscle relaxation (ventilin/albuteral) helps to decrease air way resitance corticosterioids to decrease airway inflammation 2) oxygen is often used during exacerbations, during exercise or for long term use in very chronic individuals, goal is to admin the lowest amount of O2 needed to keep SPO2 around 88-92% 3) pursed lip breathing- slows air flow to create back pressure that stents airways open during exhalation- more CO2 is removed less air is trapped

Answer 110

chronic inflammatory condition of the airways characterized by hyper responsivemenss of the airways to various stimuli that result in airway narrowing often reversible with a bronchodialotor often cooccurs with allergies and eczema

Answer 111

decreased thresholds od airway smooth muscle reactivity leads to bronchospasm, bronchial wall edma and inflammationm and increased secretions narrow airways increase risistance both in and out

Answer 112

idiopathic, internal, localized immune drugs, exercise induced, inhaled irritants, respiratory infecions, stress, weather hypersensitovity usually adult onset

Answer 113

external: animals, dust, feathers, food, mold, polleen usually a specific trigger childhood onset

Answer 114

Pulmonary function tests improve post bronchodialtors Pt reports chest tightness and dyspnea I: increase in accesssory muscle use, other isgns of respirtory distress P: tactile fremitus decreases becuase of air trapping, chest wall excursion decreases due to to air trapping P: hyper resonant due to air trapping A: decreased breath sounds, possible WHEEEZING due to air way narrowing, possible crackles ABG: decreased PaO2, increased PaCO2 if severe and decreased Ph or respiratory acidosis

Answer 115

irriversible abnormal destruction and dialation of medium sinzed bronchi and bronchioles + increased serections resulting in airflow obstruction and secretion retention, commonly associated with chronic inflammation and infection within these airways extreme form of chronic broncitis

Answer 116

prevent triggers control attacks pharmalogically: bronchodilators and corticosteriods inhaled for exercised induced asthma: keep patient upright, use inhaler if prescribed, lean forward and teach pursed lip breathing

Answer 117

destruction of bronchial wall cuasing permenanent dialation of airways, ciliated walls are replaced by non ciliated mucus secreting cells, poolnig of secretion lead to reoccurent infections and may cuase atelectasis distal to obstruction ( may lead to restrictive findings, increased difficulty to expand)

Answer 118

post infection ( necortizing bacterial pneumonia, congential disorders ( cystic fibrosis, cillary defect, airway defects), bronchial obstruction (aspiration,Ca), other ( connective tissue diseases, systemic disorders, imunodefeicneis,idiopathic- increases in lifetime infection risk), tuberculosis

Answer 119

I: thin and fatigued, digital clubbing, increased accesory respiratory muscle use, other signs of respiratory distress, severe cough, increase in mucus foul smelling, purlent, may contain blood) P: decreased chest wall excursion due to airtrapping, tactile fremitus increaes over consolidation/mucus and decreases of areas with trapped air P: resonat over air trapping, dull over mucus obstructions A: decreased breath sounds, wheezing, coarse crackles CXR: dilated airways, dark fields of air trapping, flattened diaphragm, high resolutions CT for diagnosis

Answer 120

antibiotics, bronchodialaotors, regular secretion clearnace techniques

Answer 121

thickening of the interstium of the alveolar walls which porgresses to fibrosis or scarring creating stiff less compliant lugs

Answer 122

decreased lung comliance, increased elastic recoil, increased fibrolansts results in increased collagen leading to fibrosis or scaring, decreased diffusion capacity ( increases thickness of diffusion membrain)

Answer 123

idopathic, environmental exposure to inorganic dust/toxic gas and certain drugs, geneticm some connective tissue disorders (RA), conditions that can lead to inflamttion and scarring og lungs (pneumonia, TB, lung cancer)

Answer 124

wieght loss I: dsypnea, increase RR and shallow breaths, dry unproductive cough becuase of irritation, clubbing, cyanosis P: decreased chest expansion, increased tactile fremitus P: dull on precussion A: Auscultation late fine inspiratory crackles-popping open of alveoli ABG: low PAO2 (not enough in ) and PACO2 (becuase of hyperventilation CXR: small contracted lungs, raised diaphargm, diffuse reticular markings, high resolution CT more accurate on diagnosis

Answer 125

O2 therapy, pulmonary rehab, lung transplant,

Answer 126

a disease invovling granuloma (collections of inflammatory cells that form a lump) developmment in the lungs, skin , lymph nodes and other organs complicated pathology unknown cuase can present with restrictive or obstrucive signs

Answer 127

collapse of alveoli or lung tissue (sub segmental, segmental or lobar distribution)

Answer 128

poor ventilation post surgical/ansesthetic obstruction- blocks air from getting distal decreased nitrogen-naturally in air, helps keep alveoli open decreased surfactant - to much surface tension, requires more energy and force to open, invovled in infant respiratory distress syndrome (no surfactant) compression-tumor penumothroax hyperventilation- too fast to fully open hypoventilation-breath to shallow and not enough air to fully exapnd

Answer 129

I: dyspnea, cyanosis, increased RR shallow breathing P:ipsilateral tracheal deveiation, decreased chest wall expansino on affected side, decreased tactile fremitus (no voice vibrations where air is not folded up tissue increased distance from chest wall open space does not transmit well) P: dull directly over compressed tisssue A: decreased or absent breath sounds, fine crackles ABG's: decrease PAO2 CXR: ipsilaeral shift of mediastinum to area of low pressure, increased density/whitness in area of atelectasis, elevated hemidiapahragm on side with atelectasis

Answer 130

remove obstruction: mobilize secretions, chest tube for pleural effusion positioning, mobility, breathing exercises

Answer 131

an acute lung injury which is characterized by respiratory distress, sever hypoxemua and increase permeability of the alveloar capilarry memebrane

Answer 132

increased capillary permiability due to injury leads to edema and inflammation in interstitual space and then into alveoli decreased surfacant production leading to increased surface tension and decreased lung compliance V/Q mismatch right to left shunt-blood passes through without picking up oxygen (arterial hypoxemia) rapid fbrosis later in disease progression-persistant even after ards clears up

Answer 133

shock any type sever pnemonia sever trauma sepsis aspiration post infection

Answer 134

I: severe dyspnea, often require mechanical ventilation with high PEEP- keep lungs inflated and avoid lung collapse, cyanosis, increase RR and shallow breath P: increased tactile fremitus due to fibrosis and edema P: dull precussion A: inspiratory crackles, diffuse wheezes ABG: severe decrease in PAO2, increase in PaCO2-hyperventilation CXR patchy infiltrate in periphery of lungs, white out

Answer 135

PEEP to keep airways open tackle underlying cuase prone position intubation and ventilator assist secretion clerance if needed

Answer 136

an abnormal collection of air in the pleural space leading to collpased lung

Answer 137

loss of negative pressure in the pleural sapce- cuases an expsnded rib cage and/or a collapsed lung, in large pneumothroax air can be reomved via chest tube

Answer 138

trauma to chest wall (puncture), complication of invasive procedure, idopathic, rupture of respiratory strucuture (bleb), complucation from mechanical ventilation, infection of the pleura can also led to rupture

Answer 139

develops suddenly dur to rupture in air containing structure, most common in young tall men primiary =bleb ruputure secondar to another disease

Answer 140

due to penetrating or non penetrating injury to chest wall

Answer 141

tear in the pleura that acts as a one way valve, air enters during inhalation but air does not leave during exhalation, medical emoergency-acute lif threatening situation

Answer 142

I: signs of respiratory distress, dyspnea, incerased resp rate, chest pain, dry cough due to irritation of pleural receptors P: air trapping in space leads to decreased tacitile fremitus P: resonant due to air A: decreased or absent air is not moving on xray will see blackened area around lung and flattented hemi-diaphragm, medistinum shift away from side of pneomothorac

Answer 143

multiple rib fractures with a free floating rib section on inspiration flail segment sucks in reducinng air entry on expiration pushes out ineffecient ventilation and poor oxygenation Tx pain control, airway clearance, oxygen, intubation and ventilation if needed

Answer 144

abnormal collection of fluid in the pleural + space increased production or decreased clearace of fluids Cuases: CHF, liver disease, kidney disease, CA, pneumonia, pulmonary emoblism, tuberculosis, trauma

Answer 145

increased permability of the pleural surface leading to increased fluid, protiens, WBC and immune cells into the plerual space, fluid cloudy, cuased by inflammtation infection or cancer

Answer 146

increased hydrostatic pressure in pleural cappilarries like in CHF, fluid is clear and has very few proteins

Answer 147

I: may have dyspnea-compressive atelctasis, increased RR, chest pain, dry cough due to irritation P: decresased tacitile frem over fluid increased ovver atlectasis, decreased chest wall exursion on side of effusion P: dull precussion auscultation: decreased/ absent breath sounds over effusion, may hear pleural friction rub decreased PaO2, PaCO2 white in areas with increased fluid on xray, contralateral tracheal shiftr

Answer 148

primary muscle of ventilaion innervated by the phrenic nerve C3/4/5 dependent on the intercostals and abdominal muscles- does not work well in isolation

Answer 149

innervated by T1-T12, act to stabilize the rib cage. internal intercostals active exhale, external intercostals a primiary muscle of inhalation

Answer 150

innervated by T6-L1, stabilize inferior border of rib cage, increase intratrhoacic pressure for strong and effective cough

Answer 151

errector spinae, pec +/-, serratus anterior, sclaesns, SCM, traps

Answer 152

systemic hereditary disease, abnormal Na/Cl ion pump (cl- excertion, Na absorption. of the exocrine glands, copious amounts of thick secretions/scarrion/cysts in effected glands most commonly manifests in kidneys, lungs, kideneys and intestines. ion transport dysfunction-increased electorylyte content in sweat. increasedd obstruction in ednocrine ducts by thick seceretions. increased secretion retention in the lungs leads to secretion retention, reoccurent infections, fibrosis, scaring, cystic dialations of the bronchi, malaabsorbtion of nutrients

Answer 153

autosomal recessisve gene that affects exocrine glands, diagnosed in child hood usually due to impaired growth and development (malabsorption), thick yellow secretions

Answer 154

Dx: genetic testing, chloride sweat test, obstructive lung disease I: low weight, possbile, osteoporsis from not absorbing nutrients, increased RR, barrel chest, clubbing, chronic productive cough, copious amounts of purulent or mucopurelent mucus CF may be obstructive. retrictive or mixed auscultation: decreased breath sounds, inspiratory and expiratory crackles, wheezing, x ray: thickened bronchial walls, opacities, consolidation

Answer 155

bronchodialtors, antibiotics for infections, o2 supplmentation PT: airway clearance (<5 years: aggresive bronchial clerance/ vibration/ presussion, 6+ years: accapella/flutter/PEP mask, active cylce of breathing, autogenic drainage), secretion removal 2-3 x per day!!! exercise: posture, strengh, endurance with O2 monitoring and avoidance of overexertion

Answer 156

an acute inflammation of the lungs assoiated with the alveolar filling with exudates--> consolidation, common complication and cuase of morbidity and mortality in hospitalized pateints

Answer 157

infectious agent ( virus or bacteria) or irritant that reaches the lungs and triggers an inflammatory reaction.

Answer 158

aspiration, contact trauma/chest tube), inhalation ( droplet), hematogenous (circulation). increased risk in infants and elederly, chronic caridac and respiratory disease, immunosuppressed patients

Answer 159

I: dyspnea, cyanosis, increased RR and shallow breath, cough, fever (high in bacterial, low inviral) P: tactile fremitus increases becuase of consolidation P: dull on precussion A: wet inspiratory crackles. bronchial and bronchialvesicular breath sounds decreased PaO2, decreased PaCO2

Answer 160

an infectious, systemic inflammatory disease that primarly affects the lungs and other organs mycobacteriiu tuberculosis (ariborne) most infections dont have symtpoms (latent, may lay dormant then reactivate when immune system weaknes (post primairy TB)

Answer 161

cough lasting greater then 2 weeks, early dry cough late wet cough ( mucus and blood), fevere, fatigue, night sweats, weightloss, swollen lymph nodes, brnochial breath sounds

Answer 162

TB skin test TB blood test Xray: indiltrates and cavitation sputum sample medical history -immunocompromised/ recent travel physical examination

Answer 163

medications 6-12 months prevent exposure to others: negative pressure room, universal precuastions and N95 respiratorr mask sesecretion clearnace/deep breathing/coughing

Answer 164

acute inflammation of the lungs in which some or all alveoli are filled wirh fluid or cells, often hopsital aquired, normally from airborne pathogens ( bacterial, fungal, viral, toxic), increased occurence in the immunocompromised, common in patients with swallowing disorders-aspiration productive cough/fever/fatgue/dyspnea/tachy cardia infection controll procedures/mobility/keep lungs clear/manage aspiration risk hob up 30 degrees

Answer 165

term used to decribe a spectrum of clinical presentations which results from impairments in the blood supply to the heart mysocarioal ischemia and myocardial infarction

Answer 166

insuffiencent blood flow to the myo cardium , typically presents with angina can be silent

Answer 167

fist over sternum--> angina

Answer 168

diffuse retrosternal pressure, heaviness, tightness of constriction in the chest cuased by reduced blood flow to the myocardium, clutch chest fist over sternum may radiate to the left jaw left arm and or upper back between sapula (visceral reffered pain) allviated often by rest and nitro

Answer 169

stable: preciptated by activities that increas myocardial oxygen demand (PA, sex, emotional stress,, cold ,meals, lying supine (venous return heart needs to contact harder) relived by rest or nitro. once demand in met angina disapears, predictable unstable: occurs at rest without any obvious preciptating factors or with minimal exertion- very ishcemic tissue can expereince angina anytime with little aggrevation, not releived by rest, may not be relived by nitro, requires immediate medical attento n as there is high risk for infarctionp, atherosclerosis

Answer 170

seated against the wall with knees bent up. pillows behind back and under knees to support.

Answer 171

death of cardiac tissue due to lack of blodd flow, cuased by sudden complete occulsion od one or more of the coronary artiereis. area of infarction is irreversible

Answer 172

symptoms: angina, anxiety, diaphroesis, sypneam dizziness fatigue, nausea ECG changes 1) signs of ischemia- ST segment depression and inverted t wave 2) small acute MI- no ST segment change, NSTEMI-non ST segment elevation MI, no ECG changes 3) large acute MI: st segment elevation STEMI and pathological q-wave Cardiac biomarkers: bloodwork--> troponin 1 an 11, myoglobin, creatine kinase-myocardial band

Answer 173

1) Surgery: percuaneous transluminal coronary angioplasty- stent placement, coronary artery bypass graft with donor vessels 2) medications beta blockers calcium channel blockers angiotensinogen receptor blocker supplmental oxygen nitrates -vasodialtor angio tensinogen converiting enzyme

Answer 174

improve exercise capacity iprove exercise effeiceincy-same work less cost imporve exercise tolerance-same work less signs and symptoms imporve qulity of life

Answer 175

arteriosclerosis-thickening, hardening and stiffening of arterial walls, loss of elasticity, restricts blod flow to tissues, common in smaller sized arteries atheriosclerosis-a form of arteriosclerosis, slow progressive condition, narrowing of srtiers due to a buikd up of plaque (cholestrol/lipids/Ca2+) gradual closure of lmen and prevention of blood flow down stream, rupture can result in blood clot formation local occulsion or further down stream thromboembolism weakening of artery wall and rupture medium to large sized arteries herat attack/stroke/ aprtic anerusym, peripheral vascualr disease

Answer 176

a comprehesnive exercise, education and lifestyle modification program designed to optimize physical psychological social and vocational functioning

Answer 177

indicators: dyspnea that interfers with lifestyle, reduced ability to perform exercise/ADL/selfcare SPO2 should not fall belw 88% BORG scale 5 and lower no abnormal cardiac signs no pain nausea dizziness headaches

Answer 178

I acute impatinet phase II subacute conditioning phase III intensive rehabiliation phase IV maintenance phase

Answer 179

begins in hospital setting prepare for discharge, monitior activity tolerance, support risk factor modification techniques, provide emotional support, biuild self effeicacy, education on s/s with aciviy and collaborate assess hemodynamic response to activity, I in functional mobility , monitoring vital signs before and after low level intensisty LEVEL 1: 1 MET, stable in ICU for 24hrs, bed rest gentle AROM upper and lower with breathing exercises LEVEL 2: 2 METS, sitting for meals, perform ADLS, walking in room and to bathroom few times per day LEVEL 3: ambulate up to 250 ft a few times a day LEVEL 4: 4 METS perform adls independently and ambulate up to 1000 ftfew times a day, climb 1 flight of stairs

Answer 180

begins after hospital discharge in outpatient setting conditioning exerises are doine with close cardiac monitoring

Answer 181

exercise in lare groups resistance training typically intiated in this phaseph

Answer 182

patient is encouraged to continue exercise training in a group setting or self monitored program

Answer 183

-self monitor intensity of activities (pulse, HR, RPE) awareness of S/S that suggest exercise intolereance

Answer 184

should be able to recognize symptoms and know how to respond call doctor, go to emeregency etc. written information should be provided

Answer 185

a syndrome charcterized by impairment in the hearts pump function. leading cuase of cardiac deaths in north america, most frequent cardiac diagnosis for hospital admissions, insuffient pump to meet metabolic demands of the body both at rest and during activity, m>F left sided failure, right sided failure/ cor pumonale , bivnetricular failure

Answer 186

L heart pump is failing- decreased stroke volume, increased L end systolic volume, increased pressure in L ventricle pressures increased L atrial pressure, increased pressure in the pulmonary viens, fluid movment from veins to intersitial space of the lung leading to pulmonary edema to compensate for decreased SV leads to increase in symapthetic activty to increase HR and maitaine arterial pressure. left ventircle does not relax completely-stiffenens, weak L ventricle, increased resistance downstream pulmonary edema, dyspnea, increased WOB, orthopnea, SOb when sleeping, pink frothy sputum, tachypnea, crackles on auscultation the myocardium may veucome fatigued an worsen failure. eventual decrease in CO decreasing arterial blood flow and decreased perfusion to kidneys--> renal failure. increased inactivity and bed rest leads to muscle wasting/myopathies osteoporosis. can be compensated by increased HR or uncompensated and worsening

Answer 187

failure of the R ventricle. decreased SV, increased end systoloic volume, back up of blood in RA and systemic venous system. systemic hypertension peripheral pitting edema, jv distension, ascites, kidney and brain issues becuase of decreased perfusion cor pulmonale- enlargement and failure of the right side of the heart due to chronic severe pulmonary hypertension. Right heart is working too hard to pump blood into pulmonary circulation

Answer 188

L: dyspnea, fatigue, weakness, pulmonary edema, paraoxysmal nocturnal dyspnea, orthopnea ( fluid all over lung in supinne affecting gas exahnge) R: dyspnea, fatigue, weakness, jugular vien distension, peripheral edmema, pitting edema, fluid weight gain, ascities - fluird in belly

Answer 189

positioning to reduce orthopnea relaxed breathing exercises supplmental oxygen graded increase in ambukation graded exercise cardiac rehabiliation program

Answer 190

abnormala acumlatation of fluid in the lungs (often due to LHF) fluid moves from high pressure pulmonary capillaries into intersitsial space and then into the alveolar space. P: increased capillary membrane permeability increased capillary hydrostatic pressure decreased capillary osmotic pressure lymphatic insuffiency

Answer 191

high pressure (increased pulmonary capillary hydrostatic pressure), backflow of blodd in the system due to kideny/heartmuscle/valve damage leading to blodd accumlation in pulmonary capilliers which increases pressure LHF

Answer 192

low pressure, increased permeability of the pulmonary capilaries and alveolar endothelium due to truama or roxins ARDS

Answer 193

I: dyspnea, increased work of breathing, cyanoitc, orthopenea, cough with PINK FROTHY sputum Palpation: tactile fremitus normal to increaseed P: dull on precussion A: decreased breath sounds, fine inspiratory crackles/course crackles decreased PAO2 cadiomelgaly ( increased size of heart), enlarged pulmonary vessles, white fluffy/hazy airspace

Answer 194

a blood clot that has been lodged in a pulmonary artery, commonly associated with DVT in the lower estremities, life threatening

Answer 195

pulmonary embolus obstructs bloddflow to an area of the lung, if compltely blocked can lead to infarction and necrosis of lung tissue, very large can lead to increased pulmonary artery resitance and will increase the work load of the R ventricle leading to RHF

Answer 196

immobilization, secondary to increased coagulation, CHF, Hx od DVT, obestiy, pregnancy, stroke, trauma, varcoise veins

Answer 197

Acute onset of dyspnea, increased RR, chest pain, may have cough with bloddy sputu hemoptysis decreased PA O2, decreased PaCO2 , increased PH repiratory alkalosis infarcted area of lung apperars white diagnosed using CT or V/Q scan

Answer 198

anticoagulant medication, bed exercises, erarly mobilization, compression stockings- contraindicated in DVT

Answer 199

discontinue exercise and movilization untill further notice, notify nurse or sx, document, increase anticoagulant medication, thrombolytic medication- medications break down clot

Answer 200

refers to disorders of blood vessels of the body, primarly due to artherosclerosis, significant occulsion of vessels must occur before symptoms

Answer 201

s/s distal to occulsion leg pain-intermittent cluadication, coldness in limb, decrease pulses in limb, decreased mobility and fucntion of limb due to pain, possible numbness, pain palness with elevation-BUergers test, decreased heair growth, skiin break down, ulceration (arterial and venous insuffiency ulcers), gangrene in very severe cases-debride clean amputation, delayed healing, shiny/thin/hairless skin

Answer 202

pain or cramping that occurs in the buttocks or legs (primiarly calves) as a result of poor circulation to affected area pain increases with activity due to increased metabolic demands of the tissue and not enough blood flow to accomadate pain decreases with rest

Answer 203

progressive increase in aerobic exercise-may be painful but will stimulate colateral blood flow, education on risk factors and selfmanagment, self assessment of skin and education on skin care. walk into pain, rest untill symptoms decreased and continue

Answer 204

1) stenosis-failure of valves to open suffienctly and therby impeding flow foward 2) regurigitation- failure of valve to close, thus allows back flow during contraction tricuspid pulmonary bicuspid/mitral-stenosis secondary to rhumatic fever/calcification aortic-stenosis due to calcification (age, lipd accumlation)/ most common/ can cause LHF, insuffiency/regurgitationback flow can lead to pulmonary edema

Answer 205

before touching a patient before clean aseptic procedures after body fluid exposure or risk of after touching a patient adter touching patient surroundings at least 15 sec alcohol based hand rub must use soap and water if hands are visbly soiled

Answer 206

when contact with blood or body gluids may occur cahnge between pateints and sites be aware of touching self clothing and environment wash hands after removing gloves and when task is complete

Answer 207

if your clothing may get soliled wash hands after removing

Answer 208

for all couging patients, procedures whre spalshing may occur

Answer 209

sanitze, gown, mask, eye protection, gloveso

Answer 210

gloves, gown, snaitize, goggles, mask, sanitize

Answer 211

transmissionof organisms via skin to skin contact or indireect physical contact with infected environmental surface MRSA/VRE/ESBL/C-Diff/norovirus/ diarhea hand hygiene gloves gown if contact to patient or their enviro dedicated equiptment or disinfect before use with other patients hand hygine after

Answer 212

transimission of organisms through droplets generated from the respiratory tract. ie. coughing sneezing, talking or respiratory procedure travel short distances and settle on surfaces deposit on the nasal or oral mucus of new hosts mumps, rubella, pertusis, influenza, pneuomnia, meningitis, Acute resp illness hand hygine, patient wears mask outside the rooom, mask and eye protection within 2m of patient, hand hygine after encounter, clean and disinfect equpitment and surfaces

Answer 213

trnasmission of organissms which have become aerosolized and remain suspended in air, are inhaled by a suscpetible host, special ventilation systems are requried to control airborne transmission of icroorganisms TB/ shingles/ measles/ SARS/ Varcellia isolation room, negative pressure room, mask on patient outside room, fit tested N95 repiratora dn eye proteection for all health care workers only imune staff to have contact with patients with measkles or varcella

Answer 214

performed in order to remove an irreversibly damage area of the lung medain sternotomy/ throacotomy pneumonectomy-removal of a lung lobectomy- removal of a lobe segmetal resection- removal of a segment wedge resection- removal of a portion of a lung lung voume reduction surgery/bullectomy-removal of large emphysematous tissue

Answer 215

commonly performed for lung resections or to remove an irrversibly damage area of the lung posterior lateral throactomy is the most comon through 4th intercostal space chest tubes are replaced to evacute air and fluid from pleural space muscles incised: lats, SA, external intercostoals, internal intercostsalsm, traps, rhomboids can lye on chest tube as long as it is not kinked or pulled. important to change positions. pneumonectomy-avoid lying with surgical side up untill further ntoice- saline fluid sac-may comprimise.

Answer 216

deep breathing, supportive coughing manequvars, lines, scar managment, relaxation, bed mobility, positioning, transfers, early mobilizationpotential

Answer 217

aspiration, pain, phereic nerve impairment, atlectasis, ulcers, DVT

Answer 218

a thrombus/blood clot that forms in a deep vein of the body, most comon in the legs, may partially or completely block blodd flow can dislodge and travel to lungs/ heart or brain. venous stasis due to immobility post op can increase risk of DVT along wiht hypercoagulation and changes to blood vessel wall

Answer 219

leg painm tenderness, ankle edema, calf swelling, dialated veins, postive homans sign

Answer 220

early mobilization ankle pumps anticoagulants graded compression stockings

Answer 221

stop treatment wich may be contrainindcated untill further notice, alert surgeon/ doctor/nurse, document

Answer 222

often a median strenotomy a specialized type of surgery invovling the heart and the great vessesl, patient placed on extracorpal memebrane oxygenator or by pass machine due to interupted blood floww during procedure-takes over lung and heart function. CABG valve replacment heart transplant aortic anersym repair

Answer 223

strum takes 6- 8 weeks to heal 1. no pushing 2. no pulling 3. no lifting one arm above 90 degrees 4. no hand behind back (toilet, shirt tucking) 5. no driving 4 weeks 6. no lifting greater then 10 lbs " move within the tube", gently hug pillow to avoid arm use

Answer 224

improves breathing, chest mobility, secretino clearnace, assists in Gi function and bowel mobility, imporves conditioning and activity tolerance, allows increaed independence, improves mood, prevents aspiration/ thrombus/muscle atrophy/contractures/ pressure sores/ neropathy

Answer 225

negative pressure ventilation sucks air in by increasing space available eg// iron lung, not used as much anymore postive pressure ventiliation: pushes air in, air is forced in, used when inspiratory muscles are not working effectively or are becoming too fatigued.

Answer 226

1.severe hypventilation, hypoxia, hypoxemia ( apnea, acute hypercarbia, PaCO2 < 50 mm Hg with sup o2, respiratory rate greater then 30 bpm, vital capcity less then 10 litres/ minute, inpiratory force < 25 cm H2 O 2. central depression- decreased LOC, ansetheia or sedation, head injury, drug overdose 3. decreas wirk of breathing and respiratory muscle fatigue 4. poor pulmonary hygeine- secretion clearnace

Answer 227

barotruama-alveolar rupture volotruama- alveolar over distension ventilator aquried pneumonia- micro aspiration of gastric or oral secretions diaphargm atrophy due to disue, causes difficulty with weaning hemodynamic compromise- over inflation compression of great vessesl decreased venous return therefore decreased cardiac output

Answer 228

mandatory- intiated and controlled and ended by ventilator Assisted- intiated by patient but controlled and ended by ventilator spontaneous-intiated, controlled and ended by patient but volume and pressure deleivered is based on patient demand

Answer 229

continuous mandatory ventilation assist control ventilation synchronized intermittent mandatory ventilation

Answer 230

CPAP- continuous postive airway pressure

Answer 231

tidala volume and preset respiratory rate deliverd by the ventilator, ventilator provides total support. when people can not breath at all on their owm, completely sedated, possibly no diaphragm innervation ( High SCI)

Answer 232

tidal volume and minimal number of mandatory breaths per minute delivered by ventilator- will deliver a minimum minute ventilation. patient is able to intiate inspiration but still reiveces preset tidal voume if patient does not intiate within a specific time period the ventilator will deliver a breath to maintian the resp rate

Answer 233

preset mandatory tiral volume and respiratory rate delivered by ventilator, patient is able to breath spontenously between ventilator breaths spontaneous patient intiated breathas are synchronized with ventilator breaths

Answer 234

patients spontaneous breaths are augmented with predetermined level of positive pressure delivered throughout the entire repiratory cycle. keeps airways open continuously in patients who can breath on their own but who require assitance in keeping airways unobstructed. commonly used as a weaning modes for those who are intubated or attempt to postpone intubation. sleep apnea, neuromucular diseases, acute/chronic resp failure, children with actue resp failure

Answer 235

a positive pressure is applied to the lung at the end of expiratory phase of ventilation, helps to keep alveoli open during expiration and reduces pulmonary shunting complications: increase in dead space, decreased cardiac output, ventilator associated pneumonia, increased risk of barotrauma high lelvels can cause excessive alveolar distension or pulmonary baro truama

Answer 236

patient intiated breaths are augmented by the ventilator to maintain a constand preset inspiratoroy pressure, patiente intiates all breaths and controls respiratory rate and inspiratory time. helps to decrease the work of breathing

Answer 237

the process of decreasing mechanical ventilation, a spontaneous breathing trial while being closely monitored is typicaly performed to assess readiness to begin weaning process.

Answer 238

no!! administterd by a physician also known as a stress test to complete exhaustion graded bruce protocol may use metabolic cart for direct VO2 measure

Answer 239

Ax risk for adverse reactions to exercise prescreen patients s to identofy whether patient is at risk of adverse respone to exercise screen for those who may require further assessment prior to starting an exercise program hx, physical examination, lab tests, ris stratification, test selection

Answer 240

1. known cardio/metabolic/ or pulmonary disease = high risk ( CVD, stroke. diabetes, renal, copd, asthma, Cf, intistial lung disease) 2. have s/s of cardio/metabolic or pulmonary disease= moderate risk (angina, dizzy, syncope, orhtopneam nocturnal dysna, perpipheral edema, palatiation, hihg HR, intermittent claudication, heart mumor, faitgue, SOB 3. number of risk factors, <2 =low risk, > or = 2 is moderate risk (age, family hx, smoking, lacohol, sedentary, obestity, HTn, predibetes, dislipedema)

Answer 241

do not require medical screen prior to exercise program, do not require exercise testingm

Answer 242

do not rieuiwre medical screeen for light to mod xercise but should be screened before vigourus exercise. do not require exercise testing

Answer 243

require medical screen. requie maximal exercise test with MD supervision

Answer 244

1. age men above 45 and women above 55 2. family Hx: sudden death, MI or coronary revascularization before 55 in father/brother or before 65 in mother or sister 3. PA level: not engaging in at least 30 min 3 x per week 4. obesity: high BMI > 30. high waist circumference male > 102, female> 88 high 5. pre diabetes: had tests looking into sugars, any history of diabetes 6. dyslipedimia: on statins, ldl> 130, HDL<40 , total serum> 200 7. HTNsystolic greater then 140, diastolic greater then 90 8. stress pshycosocial- high 9. smoker: current, quit within last 6 months, second hadn exposure 10. alcohol consumption: male > 14 / week, female> 9/week 11. diet:

Answer 245

1) diagnostic: work capcity ,movement edurance, onset of s/s, endurance, effect of medicationm evualate progress 2) prognostic-determine liklehood of adverse events, determine surgical risk 3)prescription- what medications might be needed, what exercise programing is appropriate

Answer 246

may be administered by a PT- not to complete exhasution, are evualative, used as a measure of endurance or exercise capacity, can be used to predict VO2 max 6MWT, modifide Bruce protocol

Answer 247

fatigue, SOB, wheezing, poor perfusion: cyanosis/pallar/ lightheaded/confused/ataxia/ cold clammy/ nausea, angina, claudicatin/leg cramps, drop in SBP below resting or greater then 10 mmHG with increasing work rate, SBP > 250 DBP> 115, failure of HR to increase with increasing intensity, noticeable change in heart rhythm, requests to stop, failure of exercise equiptment

Answer 248

optimize gas exhange at all levels, which will imporve patients condition, decrease thier symptoms and optimize their function.

Answer 249

often the first step in any treatment procedure, optimal gas exhange dependes on ventilation and perfusion. Perfusion however is dependednt on gravity. shunting-good perfusion but poor ventilation/blood passes without gas exhange. dead space-ventilation good but no gas exhange due to no perfusion. in unilateral lung diseases place the good lung down. bilateral lung disease lie in prone (ARDS) "proning". pneumonectomy- removeal of lung DO NOT LIE WITH AFFECTED SIDE UP.

Answer 250

places muscles in mechanically advantageous position, allows postural muscles to relax to decrease energy expenditure. often a variation of the tripod positioing

Answer 251

GOAL: increased ventilation, prevent atelectasis, decrease WOB, assist with secretion removoal used: post op, resp failure and chronic diseases deep breaths contraindiacted in overinflated individuals (COPD- can breath with diapragm but not deeply). teaches technique: patient to use diaphagm for breath and decrease use of accessory muscles. belly breathing. diaphragmatice breathing is more energy effient. long slow breaths. additionally promotes relaxation. hands on bellly to guide. 3- 4 breaths a cycle 10 reps per hour -can add 3- 5 sec breath hold to prevnet atlectasis and increae perfusion time

Answer 252

take breath in through nose and exhale through pursed lips, smell the roses and blow out the candle, exhale should be 3x as long as inhale, creates positive back pressure that stents airways open for longer, increases effeceincy of lung emptying, helps control and reduce resp rate, improve gas exage and promote relaxation COPD!!

Answer 253

lifting wieghts for inspiration, aim is to increase strength and endurance of respiratory muscles uses an inspiratory muscle trainer/ incentive spiraometer with alterable resistance in cm/H2O strength: 2-4 x per week 60-80% 8-12 reps 1-3 sets endurance: 4-6x per week, 40-85> 15 min or as tolerated

Answer 254

localized breathing towards a segement of lung that requires greater expansion or ventilation. uses tactile cues to increase expansion to specific areas

Answer 255

mx inspiration sustained for 3-5 sec-breath hold prevents atectasis and increases perfusion time. incentive spiratormeter uses a device to measure flow or volume volume: inhale deeply with constant flow kekeeping flow within prescribed ranges flow: keep ball up and level when inhaling may be used post up to prevent atlectasis or airway closure provides visual feed back provides incentive or goal for patient which may imporve patient compliance inflating lungs to prevent atelectasis

Answer 256

stacking little breaths on top of one anthoer untill maximal capcity is reached followed by relaxed exhale used when a single deep breath is too pain full or there is weakness in the inspiratory muscles

Answer 257

patient is placed in a position that allows draingage of secretions from bronchial airways via gravity position is maintained for 5- 10 min or longer if tolerated face and SpO2 should be monitiored s/s of intolerance: increased SOB, anxiety, dizziness, hpertension, bronchospasm. positions can be modified

Answer 258

-inceased ICP > 20 mmHG -head and neck injury-spinal instability -active hemmorrhage with hemodynamic instability -recent spinal surgery or acute spinal injury -active hemoptysis -empyema -bronchial pleural fistula - pulmonary edema associated with heart failure - large pleural effusion -elder, confused or anxious patients -rib fratures -surgical woulnd or healing tissues -pumonary emobolism -untreted pnsumothroax

Answer 259

-patients who increased ICP needs to be avoidied (TBI, etc) -uncontrolled hypertension -distended abdomene -espophageal X -recent gross hemoptysis related to lung carcinoma - uncontroled airway at risk of aspiration

Answer 260

secretion mobiliation technique, to loosen and dislodge secretions precussion: hand in cupped position over specific lung segmet, thin towel or gown should cover area, hollow sound, rhytmic, avoid bony promineces, faace and SpO2 should be monitored, vibrations: only on exhale!!, enhance mucocillary transport, strech of resp muscles, course large amplitude low frequency, fine low amplitude high frequency generally better tolerated, mechanical vibraition and percussion machines avaialble use secretion clearnce techniques post check skin before and after

Answer 261

sever osteoporosis -rib fracture - pulmonary embolus -pneumothorax -anticoagulation therapy -malignancy -burns, skin grafts - open wounds - increased ICP - suncutaneous emphysems -GI bleedding

Answer 262

positive expiratory flow device- hand held devices that create back pressure to splint airways while exhaling through device. this back presure allows air to pass through interalveolar connections with rpessure to dislodge or move mucus. can be used with aerosoled medications. performed > 15 min 2- 3 x per day

Answer 263

10-20 cm H2O, more commonly used, equal effectivness to high pressuer but with less risk

Answer 264

50-150 cm H2O, PEP mask is used, less used then low presure becuase of risk of pneumothorax

Answer 265

theraPEP, thershold PEP smooth flow, creates back pressure similarly to pursed lip breathing

Answer 266

accapella, flutter- position dependent ball end up increases presure ball end down decreases pressure, cornet, quake, bubbe PEP (kids) provides accelrated expiratory flow rates and interupts airflow through oscilation/vibration of airways which loosens secretions and helps move them centrally

Answer 267

helps to clear broncial secretions using three ventilatory phases breathing controlled, thoracic expansion, forced expiration techniques repeated cycles: 1. breathi controled 20 -30 secs, 2. 3-4 deep thoracic expansions to loose secretions can be accompanied by vibrations/precussions/ breath holds . 3. forced expirations 1- 2 huffs to mobilize or a cough to expell perfomred 10 min /segment, or 3- 4 cycles/ untill secretions are cleared -can be done in postural drainage positions or sitting -independent

Answer 268

varying expiratory flow at various lung volumes to help mobilize secretions from peripheral airways into central airways to be expelled through hiffin gor coughing. 3 phases 1.unstick- exhale to low volumes will mobilize mcus- 5- 6 reps with 3 sec hold on exhale 2.collect- breathing at mid lung volumes 5-6 reps with 3 sec hold on exhalation. taking slightly deeper breaths then normal and exhaling normally 3.evacuate- breathing into larger volumes 5 -6 reps with 3 sec hold. may perform huff or cough to expell at the end. -breath through nose diapharmatically 30-45 min session per day But time consuming, concentration, cognitive capacity, prpropception, skilled PT, active participation

Answer 269

a procedure used to remove secretions through insertion of a cathetor via nasopharynx, oropharync, artifical airway. to reovme secretions or stimulate a cough when patient is unable to do so independently when there is visible secretions, ausultations of cracles, tactile fremitus detects, SOB, increased work of breathing, suspected aspiration, hypoxemia, hypercapnia, chest radiographs - assess outcome after procedure through method that indicated necessity -a controlled act that requires adequte training, can be delegated

Answer 270

severe O2 deaturations, increased ICP, hemoptysis, malignant arhythmia, huperinflation post CABG/head injury nasopharnxy: nasal bleeding, croup, basal skull fracture, actue head/facial injury, CSF leak, nasal stenosis, nasal pathology

Answer 271

infecton, mucosal truama, hypocia/hypoxemia, heymodynamic instability, laryngo/broncho spasm, atelectasis, pnemothroax, increased ICP, pain, anxeity

Answer 272

infection control measures (sterile/ wash hands, PPE), hyper oxygenation before can decrease desat, hyperinflation to decrease increase in ICP, limit suction time to 10 - 15 sec per pass, medication and sedation prior to limit pain and anxiety

Answer 273

forced expiratory technique with an open glottis that may assist to mobilizze and clear secretions from airways -fog up window mid to low lung volumes helps to clear peripheral airways huff from high lung vlumes for clearing procimal airways huffing perferred to coughing in obstructive lung diseases to decrease air way collapse (cough pressure can collapase small airways better tolerated in those with coughing pain or weak cough, fatigue due to coughing

Answer 274

abdominal thrust, j stroke, quick presure up and in during cough or thoracic asssit through rib cage helps incrase expiratory flow, indicated in those with neuro or muscular weakness or lots of secretions contraindicated in those with GERD and recent abdominal surgery, preganancy, abdomina aneruisym, fragile rib cage, elevated ICP, post surgical, thorax spine truama

Answer 275

in parapelegics, deep breath with thrust foward with cough, sudden torso flexion to increase effectiveness

Answer 276

chest compression followed by over pressure at end expration thought to deepedn subsequnet inspiration usually only a few reps performed

Answer 277

gas exhange failure arterial hypoxemia-low blood O2, no increase in CO2 due to: pneumonia, ARDS, obstructive lung disease, pulmonary embolism

Answer 278

ventilation issue too much CO2 in the blood eads to decreased O2 in the blood depression of resp center by drugs/ acute upper or lower airway obstruction, weak impaired respiratory muscles

Answer 279

deep vien thrombosis risk: venous stasis/damage, hypercoagubility, turama, sx, pregancy obestiy, cancer, smoking, genetics S/S dull ache, tightness/pain in calf, tenderness on plpation, fever, pain with dorsifelxion-HOMANS sign doppler ultrasonagraphy anticoagulants heperin-acute immediate response, warfarin long term no mobilizaton is halted untill anticoagulation is acheived. prevent ankle pumps