Cardiopulmonary Conditions Worksheet Flashcards
Pulmonary physical therapy focuses on excercise intervetnions and manual techniques that enhance _________ and __________ ____________ to meet necessary and functional demands.
ventialtion
airway clearance
what are some warnings that may indicate there is a problem with a persons respiratory system?
- Chronic cough
- Shortness of Breath
- Chronic Mucus Production
A cough that you have had for a month or more.
This is an important early symptom.
Chronic cough
not being able to catch your breath even after exercise, or after little or no exertion. Labored or difficult breathing. The feeling that it is hard to breath in or out.
Shortness of Breath
Mucus, also called sputum or phlegm, is produced byt he airways. it is a defense response to infection or irriatants.
If mucus production has lasted a month. It can indicate lung disease.
Chronic Mucus Production
Noisy breathing is a sign that something unusual is blocking the lungs’ airways or making them too narrow.
what is the sound known as?
Wheezing
blood may be coming from lungs or upper resiratory tract.
coughing up blood
Unexplained chest pain that lasts for a month or more - especially if it gets worse when taking a breath in or coughing
Chronic chest pain
- 6 no exertion at all
- 7
- 8 extremely light
- 9 very light
- 10
- 11 light
- 12
- 13 Somewhat hard
- 14
- 15 Hard (heavy)
- 16
- 17 very hard
- 18
- 19 extremely hard
- 20 Maximal exertion
borg scale
or
PRE scale
3 General goals for cardiovascular and pulmonary physical therapy
- Prevent airway obstruction
- improve airway clearance
- improve endurance
what type of sputum
Typical causes: Normally present
Observation of Sputum: Clear/watery
Saliva
what type of sputum
Typical causes: pulmonary edema
Observation of Sputum:bubbly either white or pink colored
Frothy
what type of sputum
Typical causes: pulmonary conditions with no infection, eg. Asthma, chronic bronchitis
Observation of Sputum: White and opaque
Mucoid
what type of sputum
Typical causes: cystic fibrosis, pneumonia, bronchiectasis
Observation of Sputum: May have a slight yellow tinege and is slightly thicker thatn mucoid: may have a slight odor; cystic fibrosis sputum is often foul smelling due to infection
Mucopurulent
what type of sputum
Typical causes: pulmonary infections, ex pseudomonas, pneumococcus bacteria
Observation of Sputum: thick, yellow or green; may be rust colored due to presence of old blood or red due to presence of fresh blood; often has a bad odor
Purulent
what type of sputum
Typical causes: infections such as tuberculosis or bronchiectasis, pulmonary infarction, trauma causing damage to the lung, diorders of coagulation
Observation of Sputum: Blood spots in sputum or a lot of blood; old blood appears brown and fresh blood red
hemoptysis
what type of sputum
Typical causes: inhalation of smoke from cigarettes, fires or heroin use; inhalation of coal dust
Observation of Sputum: spots of black in the sputum
black sputum
This term is used to describe gas exchange within the body and can be categorized as either external or internal
respiration
the exchange of gas at the alveolar-capillary membrane and the pulmonary capillaries
external respiration
describes the exchange of gas between the pulmonary capillaries and the cells of the surrounding tissues
internal respiration
the mass exchange of air to and from the body during inspiration and expiration
ventilation
what are the main muscles of inspiration?
- Diaphragm
- scalenes
- parasternal intercostals
you are trying to discourage the use of your pt’s accessory muscles for quiet inspiration.
What muscles would you inhibit?
these muscles become extremely active with greater inspiratory effort which frequently occurs with strenuous physical activity.
- SCM
- upper traps
- pectoralis major
- pectoralis minor
- subclavius
what are the main muscles of EXpiration?
abdominals
what are the accessory muscles of EXpiration?
- pectoralis major
- quadrates lumborum because of its attachment on 12th rib
- possibly internal intercostals
the inspiratory capacity plus the functional residual capacity; the volume of air contained in the lungs at the end of a maximal inspiration; also equals vital capacity plus residual volume.
Vital capacity + residual volume
total lung capacity (TLC)
the lung volume representing the normal volume of air displaced between normal inspiration and expiration when extra effort is not applied.
Tidal Volume
The maximum volume that can be inhaled above the tidal volume
Inspiratory Reserve capacity
the amount of air Remains in the lungs after a maximal expiratory effort; cannot be exhaled
Residual volume
The maximum volume that can be inhaled
Inspiratory capacity
Volume left in the lungs at the end of a normal breath which is not normally part of the subdivisions
Functional residual capacity (FRV)
The maximum volume that can be inhaled and exhaled
Vital capacity–VC
Vital capacity–VC
the maximal amount of gas that can be exhaled from the resting end-expiratory level.
expiratory reserve volume
General appearance of the patient
LEVEL OF AWARENESS(level of consciousness):
alert, responsive, or cooperative vs. lethargic, disoriented or inattentive
what would the implications be?
Respiratory acidosis, hypercarbia (increased Pco2 level) or hypoxia (decreasedPO2 level) can alter level of consciousness
General appearance of the patient
BODY TYPE: normal, obese or cachectic
what would the implications be?
May reflect intolerance to exercise
General appearance of the patient
COLOR: cyanosis (bluish appearance)
what would the implications be?
Peripheral cyanosis may indicate low cardiac output; central cyanosis may indicate inadequate as exchange in the lungs
General appearance of the patient
FACIAL SIGNS OR EXPRESSIONS: focused or dilated pupils, nasalflaring, sweating or distressed appearance.
what would the implications be?
Signs of respiratory distress, fatigue or pulmonary or musculoskeletal pain.
General appearance of the patient
JUGULAR VEIN ENGORGEMENT: visualization of the jugular venous pulse with the pt supine and the head and neck on pillow at a 45* angle
what would the implications be?
Bilateral distension associated with congestive heart failure/right-sided heart failure
General appearance of the patient
HYPERTROPHY OF OR USE AT REST OF ACCESSORY MUSCLES OF VENTILATION: SCM, upper traps
what would the implications be?
Seen in pt with early chronic lung disease or weakness of the diaphragm
General appearance of the patient
SUPRACLAVICULAR OR INTERCOSTALS RETRACTIONS occurring with inspriation.
what would the implications be?
Seen in pts with labored breathing
General appearance of the patient
USE OF PURSED LIPS BREATHING (usually w/ EXpiration)
what would the implications be?
inidcates difficulty with exxpiration; often seen in pts with COPD
General appearance of the patient
CLUBBING OF DIGITS: loss of angle between the nail bed and DIP joint
what would the implications be?
May be linked to perfusion
General appearance of the patient
PERIPHERAL EDEMA
what would the implications be?
Signs of R ventricular failure or lymphatic disorder
Circumference of upper chest appears larger than that of the lower chest.
common in pts with COPD
Barrel Chest
The lower part of the sternum is depressed and the lower ribs flare out.
Pectus excavatum
The sternum is prominent and protrudes anteriorly.
pectus carinatum
what is the common posture or preferred positioning that a pt with respiratroy dysfunction assumes?
a pt who has difficulty breathing often leans forward on hands or forearms to stabilize and elevate the shoulder girdle to assist with inspriation.
what is the NORMAL ratio of inspiration to expiration is
1:2
Does the rate of inspriation and expiration change with activity? if so, what does the ration change to ?
Normal inspiration to expiration is 1:1 with activity
COPD has difficulty Xhaling
what is their ration at rest?
Mrs T says to know this
1:4
Distressed, labored breathing as the result of SOB
dyspnea
- Rapid, shallow breathing:
- decreased tidal volume but increased rate:
- associate with restrictive or obstructive lung disease
- use of accessory muscle of inspiration
tachypnea
slow rate with shallow or normal depth and regular rhythm: may be associated with drug overdose
bradypnea
deep, rapid respiration: increased tidal volume and increased rate of respiration: regular rhythm
Hyperventilation
difficulty breathing in the supine position
otrhopnea
Cessation of breathing in the expiratroy phase
Apnea
Cessation of breathing in the inspriatory phase
Apneusis
Cycles of gradually increasing tidal volumes followed by a series of gradually decreasing tidal volumes and then a period of apnea. This is sometimes seen in the pt with a severe head injury
Cheyne-Stokes
This sound during inspiration can be fine or coarse as a result of secretions moving in the airways or in closed airways that are rapidly reopening.
formally called rales
Crackles
usually heard during Xhalation and occasionally during Inhalation. It is a continuous high or low pitched sound or sometimes musical tones.
Wheezing
Normal breath sounds are classified in what 3 ways?
- vesicular
- bronchial
- bronchovesicular
The absence of air and collapse of an area of lung tissues in known as what?
atelectasis
Obstruction of airways can be caused by what things?
- fluids
- mucus
- bronchospasm
- compression from a tumor
Precautions to teaching an effective cough
- Never allow a pt to gasp in air
- avoid uncontrolled coughing spasms
- avoid forceful coughing pt-CVA or aneurysm
- errect or side-lying position
A cough may be productive or nonproductive in the presence of pathology. Secretions are checked for:
- Color (clear, yellow, green, blood-stained)
- Consistency (viscous, thin, frothy)
- Amount ( minimal to copious)
- Odor (no order or foul smelling)
what are the goals of breathing exercises and vetilatory muscle training.
- improve or redistribute ventilation
- increasethe effectiveness
- prevent post op complications
- improve, strenght, endurance,and coordination of ventilation
- Maintain and improve chest and thoracic spine mobility
- correct inefficient or abnormal breathing patters and decrease the work of breathing
- promote relax and releive stress
- teach the pt how to deal with episodes of dyspnea
- improve overall function
What is a semi-Fowler’s position?
head and trunk elevated approx 45*
What are the precautions when teaching breathing techniques?
- No forceful expiration(xhale without sound)
- no highly prolonged expiration
- accessory muscle should not be used
- only 3-4 inspiration/expirations to avoid hyperventilation
What is the difference between diaphragmatic breathing and pursed lip breathing?
- Diaphragmatic is for relaxation
- pursed lips is used to control emergency breathing
a strategy of breathing that involves lightly pursing the lips together during controlled exhalation.
what pt would most benefit from this breathing pattern?
Pursed lip breathing
COPD pts
placing a hand or pillow over a painful area or a place of surgical repair during coughing.
the theapist can do it if the pt cannot reach
Splinting
Manual techniques that may assist with postural drainage
- Vibration
- Percussion
- Shaking
What are the 6 relative contras for percussion?
- over fx, spinal fuse, osteoporotic bone
- over tumor area
- had pulmonary embolism
- pt had hemorrhage condition->low platelet count or receiving anticoagulation therapy
- unstable angina
- chest wall pain-> thoracic surgery or trauma
When applying any technique, preparation is key. Waht can you, as the PTA, do to prepare the pt prior to implementing postural drainage techniques?