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CPT I > CPT I - EXAM 2 > Flashcards

CPT I - EXAM 2 Flashcards

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1
Q

What are the 3 primary functions of the ventilatory pump?

A
  1. Ventilation
  2. Airway clearance
  3. Gas exchange
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2
Q

SpO2 going down = decreased

A

respiration

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3
Q

Patient has trouble breathing which affects metabolic demand and increases…

A

MET level during activity

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4
Q

Metabolic demand = VO2 =

A

CO x (a-vO2)

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5
Q

TV

A

Tidal volume

Volume of air inspired or expired per breath

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6
Q

Normal TV?

A

600-500 mL

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7
Q

IRV

A

Inspiratory Reserve Volume

Volume of air from end of tidal inspiration to max inspiration

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8
Q

ERV

A

Expiratory Reserve Volume

Volume of air from end of tidal expiration to max expiration

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9
Q

TLC

A

Total Lung Capacity

Volume of air in the lungs at the end of max inspiration

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10
Q

Normal TLC?

A

6000-4200 mL

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11
Q

RV

A

Residual Volume

Volume of air in the lungs after max expiration

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12
Q

Normal RV?

A

1200-1000 mL (20-25% TLC)

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13
Q

VC

A

Vital Capacity

Volume of air from max inspiration to max expiration

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14
Q

IC

A

Inspiratory Capacity

Volume of air from tidal expiration to max inhalation

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15
Q

FRC

A

Functional Residual Capacity

Volume of air in the lungs after a tidal expiration

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16
Q

Normal FRC?

A

2400-1800 mL (40-50% TLC)

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17
Q

FVC

A

Forced Vital Capacity

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18
Q

FEV1

A

Forced Expiratory Volume in 1 second

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19
Q

Normal FEV1?

A

75-80% FVC

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20
Q

FEV1/FVC ratio

A

75-80%

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21
Q

FEF 25-75%

A

Forced Midexpiratory Flow

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22
Q

PEF

A

Peak Expiratory Flow

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23
Q

Normal PEF?

A

9-10 L/sec

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24
Q

Innervation of upper trap and SCM?

A

Spinal Accessory (CN XI)

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25
Q

Innervation of scalenes?

A

C4-C8

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26
Q

Innervation of abdominals?

A

T5-L1

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27
Q

What 3 dimensions are tested regarding respiratory muscle function?

A

Strength
Endurance
Tension-time index

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28
Q

How is respiratory muscle strength tested?

A

Maximal inspiratory pressure (-)

Maximal expiratory pressure (+)

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29
Q

How is respiratory muscle endurance tested?

A

Maximal voluntary ventilation (RR x TV)

Breathing endurance time

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30
Q

What does the tension-time index represent?

A

Work imposed on inspiratory muscles at any point in time

Function of how strong muscle is contracting and time it is contracting.

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31
Q

Body will manipulate breathing patterns to avoid… at expense of…

A

To avoid excessive workload (fatigue) at expense of gas exchange (efficiency).

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32
Q

What are the 3 things that influence ventilation?

A

Compliance
Elasticity
Airway resistance

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33
Q

In a healthy individual, WOB at rest is what percent VO2max?

A

< 5%

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34
Q

In a healthy individual at max exercise, MV/MVV =

A

80%

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35
Q

Effective and efficient inhalation requires…

A
  1. Low resistance to airflow
  2. Sufficient compliance in the lungs
  3. Sufficient compliance in the chest wall
  4. Adequate diaphragmatic excursion
  5. Adequate inspiratory neuromuscular function, strength, and endurance
  6. Ability to decrease physiologic dead space
  7. Pain free
  8. Adequate exhalation
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36
Q

Effective and efficient exhalation requires…

A
  1. Low resistance to airflow
  2. Elastic recoil of the lungs and chest wall
  3. Free of obstruction
  4. Adequate expiratory muscle function
  5. Pain free (for coughing, pulmonary hygiene)
  6. Adequate inhalation
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37
Q

Effective and efficient gas exchange requires…

A

Diffusion:

  1. Surface area
  2. Permeability
  3. Partial pressures
  4. Time
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38
Q

What is respiratory failure?

A

Ventilatory pump can’t meet demands at any time

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39
Q

What is Type I respiratory failure?

A

Primarily Hypoxic

Inadequate oxygen carrying capacity of blood.

< 80 PaO2 is abnormal
< 60 PaO2 is failure

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40
Q

What is Type II respiratory failure?

A

Primarily Hypercapnic

Low oxygen, high CO2

> 50 PaCO2 is failure
(normal is 35-45)

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41
Q

What is acute respiratory failure?

A

Sudden onset; may or may not be reversible; probably unstable

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42
Q

What is chronic respiratory failure?

A

Chronic state of altered gas exchange; CO2 levels gradually elevate and bodies become accustomed to it as long as O2 levels are ok.

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43
Q

What are the 2 main categories of pulmonary dysfunction?

A

Restrictive Lung Dysfunction (RLD)

Obstructive Lung Dysfunction (OLD)

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44
Q

What is the primary problem with RLD?

A

Compliance (lung inflation) - problem getting the air IN

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45
Q

How does fibrosis cause RLD?

A

Fibrotic tissue replaces normal tissue in the lungs or chest wall (inspiratory muscles). Fibrotic tissue is not extensible so lung volume is decreased.

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46
Q

What happens to lung volumes in RLD?

A

TV is preserved at the expense of ERV and IRV. This causes decreased volumes and capacities yet ratios stay normal.

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47
Q

Implications of less reserve in RLD?

A

Less ability to decrease physiologic dead space and perform more than rest activity.

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48
Q

Characteristics of RLD

A
  1. Decreased lung volumes/capacities
  2. Tachypnea
  3. Dyspnea, initially with exercise
  4. Decreased breath sounds (crackles)
  5. Increased WOB
  6. Non-productive cough
  7. Hypoxemia (V/Q mismatching)
  8. Emaciation
  9. Cor Pulmonale
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49
Q

Why does tachypnea occur in RLD?

A

Elevated RR to maintain ventilation

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50
Q

Why kind of breath sounds do you hear in RLD?

A

Decreased breath sounds

Crackles upon inhalation (opening airways)

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51
Q

VI =

A

VI = MV/MVV

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52
Q

What are the 2 reasons for increased WOB in RLD?

A
  1. Respiratory muscle required to contract harder

2. Overall MV greater (breathing faster - wasted ventilation; air going more to anatomical dead space)

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53
Q

Why is there a non-productive cough in RLD?

A

Can’t get the air in

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54
Q

Why is there emaciation in pulmonary disease?

A

Takes work to eat
Increased metabolism due to WOB
Inactivity (muscle wasting)

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55
Q

What is the connection between secretions and RLD?

A

Pathology generally not due to secretions, but possible to develop secretions secondary to pathology.

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56
Q

What is cor pulmonale?

A

Right-sided heart failure secondary to chronic pulmonary disease.

Hypoxemia occurs due to V/Q mismatch, ventilation decreases, vasocontriction increases to compensate, this increases after load which causes pulmonary HTN which increases workload on the right side of the heart and creates ventricular hypertrophy.

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57
Q

Hyaline membrane disease

A

RLD / Infant Respiratory Distress Syndrome

Premature infants - presence of immature surfactant; surfactant begins production at 26-28 weeks but not mature until 36 weeks

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58
Q

Bronchopulmonary Dysplasia

A

RLD

Chronic inflammation and fibrosis in premature babies that needed long-term breathing support and/or oxygen.

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59
Q

Idiopathic Pulmonary Fibrosis

A

RLD

Formation of excessive fibrous tissue, as in a reparative or reactive process.

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60
Q

What environmental factors can cause RLD?

A

Asbestos, silicone, coal mines, etc.

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61
Q

Pneumonia

A

RLD

Inflammatory process of the lungs that usually comes on mid to late in life. Unknown origin but suspected viral, genetic, or immunological causes. Inflammation leads to tissue destruction and scarring/fibrosis. High mortality rate within 3-5 years of dx.

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62
Q

Adult Respiratory Distress Syndrome

A

RLD

Caused by acute lung injury causing hypoxemia and changes in permeability of alveolar tissue. Common source of injury is barotrauma or volume trauma from mechanical ventilation. Severe form of pulmonary edema.

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63
Q

Bronchogenic Carcinoma

A

RLD

Invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body.

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64
Q

Pleural Effusion

A

RLD

Fluid within the pleural space

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65
Q

Pulmonary edema.

A

RLD

Fluid buildup within the parenchyma

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66
Q

Pulmonary Emboli

A

RLD

Blockage of arterial pulmonary vasculature from embolic event. Usually occurs as result of DVT dislodging and migrating into pulmonary vasculature.

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67
Q

How does SCI or neural dysfunction cause RLD?

A

Restriction caused by a weakened and ineffective ventilatory pump from respiratory muscle dysfunction of neurologic origin.

Postural changes and alterations in muscle tone can affect breathing.

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68
Q

Musculoskeletal causes of RLD?

A

Abdominals (no diaphragmatic excursion), severe scoliosis, rib fracture, trauma.

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69
Q

What connective tissue disorders cause RLD? Why?

A

RA, lupus, etc. - affect the pleura and compliance of the chest wall.

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70
Q

Why do obesity and pregnancy cause RLD?

A

Diaphragm can’t expand properly.

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71
Q

Tension pneumothorax

A

RLD

Pneumothorax is abnormal collection or air or gas in pleural space. If amount of air increases markedly when a one-way valve is formed by an area of damaged tissue, this leads to tension pneumothorax, a medical emergency that can cause steadily worsening oxygen shortage and low blood pressure.

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72
Q

How do chemotherapy and radiation therapy cause RLD?

A

Thoracic stiffness

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73
Q

When a person develops SOB, what do they typically do?

A

Become inactive (think they are just deconditioned). This allows pulmonary disease to progress to serious levels.

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74
Q

What is the primary problem with OLD?

A

Problem getting the air out

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75
Q

What number leading cause of death is COPD? Why?

A

5th worldwide, projected 3rd by 2020.
3rd in US currently

Under diagnosed and managed.

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76
Q

OLD Characteristics

A 
Problem with exhalation
Increased RV (flattened diaphragm)
Increased dead space
Decreased flow rates
Decreased FEV1/FVC ratio
Increased mucous (not always)
Chronic productive cough
Hypoxia and hypercapnea
Barrel chested
Wheezing, dyspnea, increased WOB
Accessory muscle use
Pursed lip breathing
Tripod position
Postural changes
Nutritional imbalance
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77
Q

Increased residual volume means air is…

A

trapped in the lungs

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78
Q

Why is there increased dead space in OLD?

A

Physiologic dead space becomes fixed

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79
Q

Why is there a decrease in FEV1/FVC in OLD but not RLD?

A

In RLD, FEV1 decreases, but so does FVC. In OLD, only FEV1 decreases.

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80
Q

What does barrel chested mean?

A

Hyper-inflated; increased AP diameter; ribs more horizontal

81
Q

Why does a patient with OLD use pursed lip breathing?

A

Helps control and prolong exhalation; keeps airways open longer by increasing their pressure and therefore helps get more air out).

82
Q

Why does a patient with OLD use the tripod posture?

A

Seated, leaning forward with hands on knees - fixes upper extremities to reverse action the accessory breathing muscles.

Secondarily, it compresses abdominal contents and pushes diaphragm up into more dome shape.

83
Q

Chronic accessory muscle use leads to…

A

Orthopedic problems - FHP, scapular pain, etc.

84
Q

COPD =

A

Emphysema + chronic bronchitis

85
Q

What is chronic bronchitis?

A

Cough productive of sputum for 2-3 months for 2 consecutive years. Generally associated with smoking and not reversible.

86
Q

What 2 cells line airways?

A

Goblet cells - produce sputum

Ciliated cells - eat sputum

87
Q

What is the pathogenesis of chronic bronchitis?

A

Pathogen inhaled constantly over time
Hypersecretion of mucous
Hypertrophy of goblet cells encroach airway
Hyperplasia of goblet cells
Ciliated cells can’t handle increased sputum
Excessive mucous causes cough
Bacterial infection –> exacerbation –> inflammation –> lung deterioration
Interference with gas exchange
CO2 retention / hypoxemia
Cor pulmonale

88
Q

Constant mucous =

A

Chronic infection (bacteria thrive in mucous)

89
Q

Characteristics of emphysema?

A

Similar etiology to bronchitis (smoking)
Nothing to do with secretions
Caused by smoking or alpha-1 antitrypsin deficiency (genetic defect)
Inflammatory reaction
Enlarged airways: bullae (hyperinflated air sacs)
Pneumothorax

90
Q

People with emphysema produce secretions because…

A

They often have bronchitis as well

91
Q

Emphysema destroys alveolar sacs and causes loss of

A

Elastic recoil

92
Q

Characteristics of asthma

A

Reactive airways
Reversible obstruction
Stimulants: allergens, infection, exercise, stress (cold dry air)
Asthma attacks: SOB, wheezing, airway obstruction

93
Q

What are the 3 causes of airway inflammation?

A

Mucous production
Airway muscle tightening
Swollen bronchial membranes

94
Q

What is wheezing?

A

High-pitched sounds associated with air moving through a narrowed passageway.

95
Q

Median survival age of CF?

A

36.8 years

96
Q

What race are patients with CF?

A

94% are caucasion

97
Q

Characteristics of Cystic Fibrosis?

A

Genetic recessive exocrine disorder

Defective CFTR channel (Cystic Fibrosis Transmembrane Regulator) - affects hydration content of mucous: left with thick mucous that blocks airways & infection

DX by genetic testing or sweat test (elevated Cl-)

Progressive; cause of death is respiratory disorder.

98
Q

What is atelectasis?

A

Airway collapse

99
Q

What is bronchiectasis?

A

Abnormal dilated airways (breakdown and loss of elastic recoil)

100
Q

What is hemoptysis?

A

Coughing up blood (bleeding in airways)

101
Q

What are symptoms of CF exacerbation?

A 
Increased cough/sputum
Increased dyspnea
Fever
Weight loss
Fatigue
Decreased PFTs
Increased WBC count (infection)
Decreased exercise tolerance
102
Q

Secondary complications of CF?

A 
Pancreatic insufficiency
Infertility (males)
Depression (QOL)
Osteoporosis
CF-related diabetes
CF-related arthropathies and postural dysfunction
Nutritional compromise
103
Q

Pulmonary effects of aging

A

Decreased strength of respiratory muscles (RLD)

Decreased chest wall compliance (RLD)

Increased alveolar compliance (OLD)

Decreased pulmonary vasculature

104
Q

OLD/RLD: when is FEV1 reduced?

A

Both

105
Q

OLD/RLD: when does FEV1/FVC go down?

A

OLD

106
Q

FEF25-75 is a sign of

A

small airway disease

107
Q

OLD/RLD: when does RV/TLC increase?

A

OLD (trouble getting air out, volume stays in body).

108
Q

What does FEV1/FVC have to be in order to indicate COPD? What is then used to determine stage of COPD?

A

FEV1/FVC has to be < 70

FEV1 used to determine stage

109
Q

Concerns with ventilatory pump dysfunction

A 
Ventilation
Respiration
Protection
Impact on exercise and functional capacity
Impact on QOL
110
Q

Concerns with suspected ventilatory pump dysfunction

A 
Ability to maintain oxygenation
How much energy to breath
Handle metabolic cost of exercise in addition to metabolic cost of breathing
What is their ventilatory reserve
Can they keep airways clear
111
Q

Phase I of pulmonary rehab?

A

Acute stage: focus on airway clearance and pulmonary hygiene

112
Q

What phase are pulmonary patients usually in?

A

Usually in both with rehab focusing on one. Ex: acute patient (phase I): getting out of bed might be their aerobic exercise (phase II)

112
Q

Phase II of pulmonary rehab?

A

Aerobic training, strengthening

113
Q

If patient had pulmonary rehab, they should not…

A

have orthopedic rehab on the same day.

114
Q

Who are candidates for pulmonary rehab?

A

Anyone with pulmonary issues or potential to develop pulmonary issues

115
Q

What is required for pulmonary rehab reimbursement?

A

Pulmonary diagnosis and documented functional limitations secondary to pulmonary issues

116
Q

What are the most common symptoms of pulmonary disease? Others?

A

Dyspnea
Fatigue

Others: cough, sputum, breathing pattern

116
Q

Definition of dyspnea

A

Perception of SOB (subjective experience)

117
Q

Acute dyspnea

A

Sudden onset of SOB, change in condition without explanation

118
Q

Chronic dyspnea

A

Predictable SOB at rest or with activity; can be explained and controlled

119
Q

Causes of dyspnea

A
  1. Increased ventilatory demand
  2. Dynamic airway compression (exhalation triggers receptors that cause perception)
  3. Hyperinflation (trigger receptors in lungs)
  4. Respiratory muscle dysfunction (weaker, work perceived as more intense)
120
Q

Baseline Dyspnea Index (BDI)

A

Measures dyspnea at particular point in time (baseline)

120
Q

Transitional Dyspnea Index (TDI)

A

Assesses changes in dyspnea (ex: at end of intervention)

121
Q

Both BDI and TDI look at:

A
  1. Functional impairment
  2. Magnitude of effort
  3. Magnitude of task
122
Q

What is the MMRC Dyspnea Scale?

A

Measures how dyspnea affects function

123
Q

What tests are used for exercise capacity?

A

Graded exercise tests
Six-minute walk test
Modified shuttle test
Step tests

124
Q

Which exercise capacity test is used as criteria for lung transplant?

A

6MWT

126
Q

What questionnaires are used for QOL?

A

Chronic Respiratory Disease Q
St. George’s Respiratory Q
Cystic Fibrosis Q

126
Q

What is the BODE index?

A 
B = body mass index (BMI)
O = degree of airflow obstruction (FEV1)
D = level of dyspnea (MMRC)
E = exercise capacity (6MWT)
127
Q

Exercise limitations in COPD

A

Ventilatory factors max out before cardiovascular system

May not maintain 98% SpO2 or blow off extra CO2

Deconditioning and pulmonary HTN: cardiovascular problems

Skeletal muscle dysfunction

Depression, motivation, comorbidities, orthopedic problems, diabetes

128
Q

Skeletal Dysfunction in COPD

A 
Direct inflammatory-mediator effects
Malnutrition
Blood-gas abnormalities (retain CO2)
Impaired O2 delivery from right heart failure
Electrolyte imbalance
Medications
Comorbidities
129
Q

Retaining CO2 makes blood more…

A

acidic which slows reactions down

130
Q

What are the 4 electrolytes?

A

K, Cl, Na, Ca

132
Q

Chronic steroids –> muscle…

A

wasting

132
Q

Why are patients with COPD losing aerobic capacity?

A

Peripheral muscle fibers shift from aerobic to anaerobic; patients constantly exercising in anaerobic condition which builds up CO2

134
Q

If exercise can’t change right-sided heart failure, fixed FEV1, etc., why have patient with COPD exercise?

A

Prevents progression and working on skeletal muscle for training effects that will improve aerobic capacity so SOB is less frequent, anaerobic threshold is pushed back, and QOL is improved.

135
Q

Patients can be a little SOB during exercise, but if they stay SOB afterward, that means…

A

they worked too hard

136
Q

Frequency and duration of aerobic exercise for pulmonary rehab?

A

Freq: 3-5x/week; lower if severe disease

Duration: 20-30 min; intermittent is best

137
Q

Target of aerobic exercise intensity?

A

SpO2 > 90%

Target: 60% max work rate

139
Q

How do you prevent exercise-induced asthma?

A

Pre-medicate
Avoid stimulants
Prolonged warmup

140
Q

Patients with asthma are usually on two types of…

A

bronchodilators

Long-acting: maintain level of drug
Short-acting: rescue inhaler

141
Q

What is burkholderia cepacia?

A

Bacteria in some CF patients - very hard to treat and needs to be isolated; associated with rapid decline in pulmonary function in patients with CF and poor outcomes for lung transplant.

142
Q

Definition of ventilatory movement strategies

A

Coordination of inhalation and exhalation with movement and exercise based on the fact that inhalation is an extension moment and exhalation is a flexion moment of the trunk.

144
Q

What are segmental breathing exercises?

A

Defined as utilization of manual or verbal biofeedback to enhance ventilation to particular area of the lung.

Indicated in individuals with dynamic asymmetrical breathing patterns.

144
Q

Purpose of ventilatory movement strategies?

A

Enhance ventilation

146
Q

What is primary determinant of airway clearance?

A

Ventilation

147
Q

What questionnaires are used for QOL?

A

Chronic Respiratory Disease Q
St. George’s Respiratory Q
Cystic Fibrosis Q

148
Q

What questionnaires are used for QOL?

A

Chronic Respiratory Disease Q
St. George’s Respiratory Q
Cystic Fibrosis Q

149
Q

What is the BODE index?

A 
B = body mass index (BMI)
O = degree of airflow obstruction (FEV1)
D = level of dyspnea (MMRC)
E = exercise capacity (6MWT)
150
Q

What is the BODE index?

A 
B = body mass index (BMI)
O = degree of airflow obstruction (FEV1)
D = level of dyspnea (MMRC)
E = exercise capacity (6MWT)
151
Q

Exercise limitations in COPD

A

Ventilatory factors max out before cardiovascular system

May not maintain 98% SpO2 or blow off extra CO2

Deconditioning and pulmonary HTN: cardiovascular problems

Skeletal muscle dysfunction

Depression, motivation, comorbidities, orthopedic problems, diabetes

152
Q

Skeletal Dysfunction in COPD

A 
Direct inflammatory-mediator effects
Malnutrition
Blood-gas abnormalities (retain CO2)
Impaired O2 delivery from right heart failure
Electrolyte imbalance
Medications
Comorbidities
153
Q

Retaining CO2 makes blood more…

A

acidic which slows reactions down

154
Q

What are the 4 electrolytes?

A

K, Cl, Na, Ca

155
Q

Chronic steroids –> muscle…

A

wasting

156
Q

Why are patients with COPD losing aerobic capacity?

A

Peripheral muscle fibers shift from aerobic to anaerobic; patients constantly exercising in anaerobic condition which builds up CO2

157
Q

If exercise can’t change right-sided heart failure, fixed FEV1, etc., why have patient with COPD exercise?

A

Prevents progression and working on skeletal muscle for training effects that will improve aerobic capacity so SOB is less frequent, anaerobic threshold is pushed back, and QOL is improved.

158
Q

Patients can be a little SOB during exercise, but if they stay SOB afterward, that means…

A

they worked too hard

159
Q

Frequency and duration of aerobic exercise for pulmonary rehab?

A

Freq: 3-5x/week; lower if severe disease

Duration: 20-30 min; intermittent is best

160
Q

Target of aerobic exercise intensity?

A

SpO2 > 90%

Target: 60% max work rate

161
Q

How do you prevent exercise-induced asthma?

A

Pre-medicate
Avoid stimulants
Prolonged warmup

162
Q

Patients with asthma are usually on two types of…

A

bronchodilators

Long-acting: maintain level of drug
Short-acting: rescue inhaler

163
Q

What is burkholderia cepacia?

A

Bacteria in some CF patients - very hard to treat and needs to be isolated; associated with rapid decline in pulmonary function in patients with CF and poor outcomes for lung transplant.

164
Q

Definition of ventilatory movement strategies

A

Coordination of inhalation and exhalation with movement and exercise based on the fact that inhalation is an extension moment and exhalation is a flexion moment of the trunk.

165
Q

Purpose of ventilatory movement strategies?

A

Enhance ventilation

166
Q

What are segmental breathing exercises?

A

Defined as utilization of manual or verbal biofeedback to enhance ventilation to particular area of the lung.

Indicated in individuals with dynamic asymmetrical breathing patterns.

167
Q

What is primary determinant of airway clearance?

A

Ventilation

168
Q

Pneumothorax

A

Air in pleural space

169
Q

Hemothorax

A

Blood/bleeding in pleural space

170
Q

What is the 6MWT?

A

6-minute walk test

Submax exercise used to indirectly measure an individual’s functional exercise capacity

171
Q

Step tests are commonly used as…

A

a measure of fitness; easy to do with limited equipment/space needed; constant load test (to metronome) so can repeat to note improvement

Requires coordination!

172
Q

Astrand-Rhyming protocol
3-minute step test
3-minute YMCA step test

Examples of…

A

methods to objectively measure activity tolerance in certain individuals; considered submax tests

173
Q

During an exercise test, what SpO2 level indicates that you should stop?

A

< 90%

174
Q

Problems with excessive secretions

A

Interference with ventilation
Interference with gas exchange
Increases WOB
Increases risk for infection

175
Q

How do excessive secretions interfere with gas exchange?

A

Limit alveolar ventilation

Directly interferes with transport of O2 and CO2

Decreases surface area available for gas exchange

176
Q

How do excessive secretions increase the risk for infection?

A

Can’t get bacteria out and it flourishes in the moisture.

177
Q

Goblet cells are most numerous in…

A

the larger and medium size airways

178
Q

Function of mucus?

A

Protective mechanism against pathogens

179
Q

Function of cilia?

A

Line the airways from trachea to terminal bronchioles - propel mucus to upper airways

180
Q

Need to have what percent of VC for adequate cough?

A

60%

181
Q

Need to have what percent of FEV1 for adequate cough?

A

60%

182
Q

Cough is a…. moment

A

flexion

183
Q

Value of the cough is only effective down to…

A

the sixth and seventh bronchial generation

Secretions below the seventh generation are harder to cough out; need secretions to get to the upper airways; collapse of upper airways will prevent secretions from being coughed out.

Healthy people could get lower airway secretions out with a lot of energy, but unhealthy patients cannot

184
Q

What are the stages of a cough?

A
  1. Effective inhalation
  2. Closure of the glottis
  3. Buildup of pressure
  4. Forceful exhalation
185
Q

Splinted cough

A

Used for post-op patients

Hold pillow or towel over wound, then take deep breath and cough

186
Q

What is the most important factor of mucus movement?

A

Ventilation - without airflow there can be no effective movement

187
Q

Why should a patient breathe slowly when using a nebulizer?

A

More deposition of particles throughout the lungs - fast breathing only allows medicine to reach upper airways

188
Q

3 avenues of collateral ventilation?

A

Pores of Kohn - interalveolar
Canals of Lambert - bronchoalveolar
Canals of Martin - interbronchiolar

189
Q

Equal Pressure Point

A

EPP - site at which pressure within the airway is equal to the pleural pressure and hence the pressure difference across the wall is zero

190
Q

With tidal volumes, the EPP is in…

As lung volumes decrease, the EPP is moved…

A

Tidal: proximal (large) airways
Decrease: peripheral (small) airways

191
Q

Determinants of mucociliary clearance

A 
Quantity of mucus
Viscosity of mucus
Airway aperture
Cilia beat frequency
External influences
VENTILATION
192
Q

How does smoking suppress ciliary function?

A

Numbs and paralyzes the cilia

193
Q

What is the danger of surgery regarding mucociliary clearance?

A

Anesthesia suppresses cilia function when mechanical ventilators increase mucus production

194
Q

Indications for pulmonary hygiene

A

Aid in mobilizing secretions to maximize ventilation and maintain clear airways

Individual with difficulty mobilizing secretions secondary to an elimination problem, ventilation problem, and/or mucus problem

Individuals at risk for secretion build up

195
Q

Goal of airway clearance

A 
Decrease airway obstruction
Enhance muco-ciliary clearance
Improve ventilation
Optimize gas exchange
Decrease risk for infection
Expedite recovery
Optimize cough
196
Q

Crackles are a good thing if…

A

it shows you are stimulating airways to open, but ultimately you want to get rid of them

197
Q

Initially you might want more sputum volume to know you’re getting it out, but…

A

over long-term, you want volume to decrease to indicate less production

198
Q

What are the primary methods to maintain pulmonary hygiene?

A

Exercise
Functional mobility

(stimulates deep breathing)

CPT I (4 decks)

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