common pulmonary disorders Flashcards
What are four acute pulmonary conditions?
atelectasis, pneumonia, pulmonary edema, acute respiratory distress syndrome
What are some causes of atelectasis?
Blockage of airway, compression (pneumothorax) post-anesthetic
What are three ways atelectasis may present?
poor gas exchange, low SpO2
diminished breath sounds over area of atelectasis
possible fever, opacity on chest film
What are the aims of PT in atelectasis treatment?
deep breathing
positioning
mobilization
airway clearance if needed
What is acute inflammation of the lung called?
pneumonia
How does pneumonia present?
cough pleuritic pain rapid shallow breathing fever malaise tachycardia diminished breath sounds transmitted vocalization opacity on chest film
What PT goals in pneumonia treatment?
Improve gas exchange with breathing and positioning
Minimize effects of inactivity
Airway clearance if indicated
Symptoms of a small pulmonary embolism are often unrecognized, but can accumulate and include clogging of the pulmonary capillary bed which leads to pulmonary hypertension. True or False?
True
What are the symptoms of a medium-sized pulmonary embolism?
pleuritic pain with dyspnea, slight fever, tachycardia
What are symptoms of a massive pulmonary embolism?
sudden hemodynamic collapse w/shock pallor chest pain loss of consciousness rapid and weak pulse hypotension
What are two causes of pulmonary edema?
increased capillary hydrostatic pressure
increased capillary permeability
What is the major symptom of pulmonary edema?
Dyspnea, cough (dry of frothy)
What dyspnea when supine called?
orthopnea
What is the rapid onset of dyspnea at night called?
paroxysmal nocturnal dyspnea
What is the PT focus in treating pulmonary edema?
Combat the effects of inactivity
What can cause acute respiratory distress syndrome?
end result of a variety of insults (trauma, aspiration, sepsis, shock)
part of multiple organ failure
What are symptoms of acute respiratory distress syndrome?
Severe hemorraghic pulmonary edema
loss of surfactant decrease lung compliance
alveolar collapse
What are the PT implications for acute respiratory distress syndrome?
severe hypoxemia
high mortality
What are three types of obstructive disease?
Chronic Obstructive Pulmonary Disease (COPD)
Asthma
Cystic Fibrosis
What are causes of obstruction in the airway?
Excessive secretions
Thickened airway due to inflammation or hypertrophy
Loss of radial traction which leads to airway collapse
What impact does airway obstruction have on resistance to airflow and what does this mean for pressure in the lungs?
Obstruction increases resistance to airflow
So greater pressure gradient needed to drive airflow which increases the work of breathing.
What is FEV1?
The amount of air that can be exhaled in 1 sec
What is the FEV1/FVC ratio indicate?
The % of lung size that can be exhaled out in 1 sec
What is the clinical presentation of COPD?
Increasing SOB, Weight loss Chronic cough poor exercise tolerance Chest hyperinflation decreased breath sounds Exacerbations=acute change in dyspnea, cough, sputem, usually due to infection
What are non-modifiable risk factors for COPD?
genetic
increasing age
male
history of infections
What is the genetic deficiency that can cause emphysema?
alpha-1 antitrypsin deficiency
What are modifiable risk factors for COPD?
tobacco smoke
exposure to occupational dusts, indoor and outdoor air pollution
How is a pack year measured?
pack years=# of packs per day *years smoked
In emphysema, what are the two causes of the enlargement of air spaces distal to the terminal bronchiole with destruction of their walls?
loss of elastin in lung parenchyma
damaged capillary bed
What is the result of the enlargement of air spaces distal to the terminal bronchiole w destruction of their walls?
Air is trapped in the lungs
Hyperinflation
What is chronic bronchitis?
Excessive mucus production in the bronchial tree sufficient to cause excessive expectoration of sputem
What is the clinical presentation of chronic bronchitis?
persistent cough w excessive sputum
fluid retention= course crackles
severe hypoxemia
What are the PT goals for treatment of COPD?
Breathing and position
Exercise training to maintain functional capacity
Energy conservation techniques
Airway clearance
Increased responsiveness of airways leads to episodes of bronchoconstriction and inflammation is called?
Asthma
What are three physiological processes that occur in cystic fibrosis?
diminished ciliary function
excessive secretions, mucus plugging
chronic infections=bronchiectasis/destruction of lung tissue
What are three physical presentations of cystic fibrosis?
productive cough
decreased exercise tolerance
chronic hypoxemia (finger clubbing)
What are the three aspects of PT focus for cystic fibrosis?
regular and vigorous airway clearancel
exercise training to improve strength and endurance
posture training to maximize ventilation
Which do obstructive diseases affect more: expiration or inspiration?
expiration
What are the three categories of restrictive disease?
diseases of the pleura
diseases of the chest wall
neuromuscular disorders
What are two examples of diseases of the pleura?
pneumothorax
hemothorax
What are three examples of diseases of the chest wall?
scoliosis
kyphosis
ankylosing spondylitis
What are two causes of pulmonary hypertension?
increased left atrial pressure due to mitral stenosis or heart failure
increased pulmonary vascular resistance
What is the clinical presentation of acute respiratory failure?
Increasing dyspnea, cyanosis, arrhythmia, light-headedness, loss of consciousness
What is the clinical presentation of chronic respiratory failure?
poor arterial blood gasses
cyanosis
fatigue
What is the PT focus for respiratory failure?
breathing
positioning
max ventilation
What happens in the lungs during emphysema to cause hyperinflation?
- Decrease of elastic recoil
- End stage exhale requires an active contraction
- Destruction of airway support leads to airway collapse
- Air is trapped in lungs which causes hyperinflation
What happens to the mechanical advantage due to hyperinflation and the flattening of the diaphragm?
decreases
increases work of breathing
Is pulmonary fibrosis restrictive or obstruction?
restrictive
What is pulmonary fibrosis?
Thickening of interstitium and alveolar wall
What happens to lung compliance in pulmonary fibrosis?
decreases
increase muscular effort required for ventilation
increases work of breathing
Why is gas exchange impaired in restrictive disease?
ventilation-perfusion mismatched
