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Exam 2 Flashcards

1
Q

What are the most common obstructive lung diseases?

A

COPD
Asthma
CF

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2
Q

What are the parts of the upper airway?

A

Nose/mouth
Pharynx
Larynx

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3
Q

What are the parts of the lower airway?

A

Conducting airway

Respiratory unit

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4
Q

What is the function of the pharynx?

A

Digestive and respiratory

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5
Q

What is the function of the larynx?

A

Epiglottis and vocal cords

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6
Q

What is the path of the functioning airway?

A

Trachea to bronchiole

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7
Q

What are the components of the respiratory unit?

A

Alveolar ducts, sacs, and alveoli

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8
Q

What is the parenchyma?

A

Alveolar tissue

Describes any form of lung tissue including bronchioles, bronchi, BV, interstitium, and alveoli

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9
Q

What are the primary mm of inspiration?

A 
#1 diaphragm
#2 Intercostals
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10
Q

What are the accessory mm of inspiration?

A 
Pec major
Scalenes
SCM
UT
LS
Pec minor
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11
Q

What is the primary mm of exhalation?

A

Relaxation of inspiratory mm

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12
Q

What are the accessory mm of exhalation?

A

QL
Internal and external oblique
RA
TrA

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13
Q

Define Total Lung Capacity

A

All volumes together

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14
Q

What is vital capacity?

A

IRV + TV + ERV

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15
Q

Define residual volume?

A

Volume of air remaining in lungs that is not exhaled

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16
Q

Define tidal volume?

A

Amt of air inspired and expired during normal RESTING ventilation

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17
Q

Define inspiratory reserve volume

A

Volume of air that can be inspired when needed but kept in reserve

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18
Q

Define expiratory reserve volume

A

The volume of air that can be exhaled in excess of tidal volume

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19
Q

Define functional residual capacity

A

Volume of air that remain in the lungs at the end of tidal exhalation

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20
Q

What is inspiratory capacity?

A

TV + IRV

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21
Q

Define ventilation

A

Movement of air through the conducting airways

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22
Q

Define forced expiratory volume

A

Volume of air that can be forcefully exhaled during the first second of a forced vital capacity maneuver

Thought to reflect the status of the airways of the lungs 70% or more of FVC

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23
Q

Define max inspiratory pressure

A

Reflects the greatest static inspiratory effort that can be generated from residual volume

Reflects strength of inspiratory mm

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24
Q

Define max sustained inspiratory pressure

A

Test of inspiratory mm endurance

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25
Q

Define arterial oxygenation

A

Ability of the blood to carry oxygen

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26
Q

What is the value of partial pressure?

A

In room air

95-100 mmHg

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27
Q

Define hypoxemia

A

< 90 mmHg

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28
Q

Define hyperoxemia

A

> 100 mmHg

Over inflation, but not as common

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29
Q

When is supplemental O2 needed?

A

When <55-60 mmHg

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30
Q

What is the equivalent to PaO2 < 55 mmHg?

A

SaO2 < 88%

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31
Q

Define ventilation

A

Movement of air

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32
Q

Define respiration

A

Exchange of gases within the body

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33
Q

Define alveolar ventilation

A

Ability to remove CO2 from the pulmonary circulation and maintain pH

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34
Q

What does pH indicate?

A

Free floating H+ ions in the body

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35
Q

What is the normal body pH?

A

Between 7.35-7.45

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36
Q

What is the pH of respiratory acidosis?

A

pH <7.36

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37
Q

What is the pH of respiratory alkalosis?

A

pH > 7.44

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38
Q

What does decrease of pH do to the CO2 levels of the body?

A

Increases PaCO2

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39
Q

What does an increase of pH do to CO2 levels?

A

Decrease PaCO2

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40
Q

Define respiratory acidosis

A

AKA respiratory failure or ventilatory failure

When lungs cannot remove enough CO2 produced by the body.

Excess CO2 causes pH of blood and other bodily fluids decrease and cause it to be too acidic

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41
Q

Define respiratory alkalosis

A

When levels of CO2 and O2 are not balanced

As pH levels rise the CO2 levels will decrease

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42
Q

What are sx/sx of respiratory alkalosis?

A

Breathe too fast or too deep

CO2 levels drop too low and pH rises

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43
Q

Define hyperventilation

A

Underlying cause of respiratory alkalosis

AKA over-breathing

Breathes very deeply and rapidly

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44
Q

What affects the distribution of ventilation and perfusion?

A

Gravity

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45
Q

What position is best for ventilation?

A

Upright: more blood at base of blood and more air will be delivered to the base of the lung (Increase O2 exchange)

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46
Q

What receptors assist in adjusting the ventilatory cycle?

A

Baroreceptors
Chemoreceptors
Irritant receptors
Stretch receptors

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47
Q

What components of CNS alter ventilatory mm activation?

A

Cortex
Pons
Medulla
ANS

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48
Q

What does viscosity mean in terms of sputum?

A

Thickness

Greater the viscosity the more involvement of the system

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49
Q

What occurs in barrel chest of the thorax?

A

Enlargement due to decreased elastic recoil and hyperinflation

Increase of A-P diameter and kyphosis

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50
Q

What occurs during clubbing of fingers?

A

Widening of DIP jt = perfusion is impaired

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51
Q

What sx/sx are often seen in COPD?

A 
Pursed lip breathing
Hypertrophy
Use accessory mm
Cyanosis
Digital clubbing
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52
Q

What do normal tracheal and bronchial sounds sound like?

A

Loud and tubular

High pitch noted during inspiration and expiration

Pause between inspiration and expiration

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53
Q

Define vesicular breath sounds

A

Normal, soft, low-pitched sounds heard primarily during inspiration

During EXPIRATION the soft sound diminishes and is only heard at the beginning

Rustling

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54
Q

Define adventitious breath sounds

A

Sounds heard using stethoscope with inspiration and/or expiration

Can be continuous/discontinuous

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55
Q

Define wheeze

A

High-pitched and vary duration

Usually heard during EXPIRATION, but can be present in inhalation

Sign of OBSTRUCTION

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56
Q

Define rhonchi

A

Low-pitched and occur with inspiration AND expiration associated with OBSTRUCTION w/ quality similar to snoring

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57
Q

Define stridor

A

High-pitch wheeze that occur with inspiration AND expiration

Indicates upper airway obstruction

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58
Q

Define crackle

A

Sound of “bubbles” or “pops”

Represents movement of fluid or secretions during inspiration (wet crackles) or occurs from sudden opening of closed airways (dry crackles)

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59
Q

What do diminished breath sounds indicate?

A

Severe congestion
Emphysema
Hypoventilation

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60
Q

What do absent breath sounds indicate?

A

Pneumothorax

Lung collapse

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61
Q

What does a chest x-ray indicate in the pulm system?

A

Detect presence of abnormal material

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62
Q

What does a ventilation perfusion scope indicate?

A

Matches ventilation pattern of lung to perfusion pattern to ID presence of PULM EMBOLI using radiographic dye

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63
Q

What does a fluoroscopy indicate?

A

Continuous X-ray beam to observe diaphragmatic excursion

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64
Q

What is normal PaO2 for infants?

A

75-80 mmHg

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65
Q

What is normal PaCO2 for infants?

A

34-54 mmHg

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66
Q

What is normal pH in infants?

A

7.26-7.41

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67
Q

What is normal tidal volume?

A

20 mL

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68
Q

What is the normal PaO2 level in adults?

A

80-100 mmHg

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69
Q

What is the normal PaCO2 for adults?

A

35-45 mmHg

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70
Q

What is the normal pH for an adult?

A

7.35-7.45

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71
Q

What is the normal tidal volume for an adult?

A

500 mL

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72
Q

What indicates the difference between respiratory and metabolic acidosis/alkalosis?

A

HCO3 = bicarbonate

Normally expelled by lungs

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73
Q

What defines an obstructive lung disease?

A

Airway obstruction that is worse in expiration

More force needed to expire a given volume of air or empty lungs slow

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74
Q

What is COPD a combination of?

A

Chronic bronchitis and emphysema

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75
Q

What is a major symptom of obstructive pulmonary disease?

A

Dyspnea and wheezing

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76
Q

What occurs to forced expiratory volume in COPD?

A

Decrease

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77
Q

What causes COPD?

A

Abnormal inflammatory response to noxious stimuli

Results in narrowing of airway and destruction of parenchyma

Damage leads to pronounced glands and goblet cells and hypertrophy that produce secretions that obstruct airways

Airways decreased during expiration

Leads to hypoxemia due to poor ventilation and perfusion and eventually hypercapnia (increase CO2 in arterial blood)

R ventricular hypertrophy and possible polycythemia (complication of advanced COPD)

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78
Q

What are examples of obstructive lung diseases?

A

Chronic bronchitis

Emphysema

COPD

Asthma

CF

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79
Q

What is the 4th leading cause of death in the world?

A

COPD

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80
Q

What characteristics are in stage 0 COPD?

A

Normal spirometry

Cough and sputum

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81
Q

What are the characteristics of stage 1 COPD?

A

Mild COPD

FEV1/FVC < 70%

FEV1 > 80% predicted

With or without symptoms

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82
Q

What are the characteristics of stage 2 COPD?

A

Mod COPD

FEV1/FVC < 70%

50% < FEV1 < 80% predicted

With or without symptoms

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83
Q

What are the characteristics of stage 3 COPD?

A

Severe COPD

FEV1/FVC < 70%

30% < FEV1 < 50% predicted

With or without symptoms

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84
Q

What are the characteristics of stage 4 COPD?

A

Very severe

FEV1/FVC < 70%

FEV1 < 30% predicted

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85
Q

What are the risk factors of COPD?

A

Hyperactivity of the airways

Overall lung growth

Genetics

Primary and secondary smoke

Occupational exposure

Indoor/outdoor pollutants

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86
Q

What is asthma?

A

More intermittent and acute than COPD

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87
Q

What factor differentiates asthma from COPD?

A

Reversible, but cannot be cured

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88
Q

How can asthma be categorized?

A

Chronic

Exercise induced

Childhood

Occupational

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89
Q

What is the pathological factor of asthma?

A

Inflammation resulting in hyperresponsiveness of the airways

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90
Q

What events occur in in an acute asthma attack?

A

Bronchiolar constriction, mucus hypersecretion, and inflammatory swelling

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91
Q

What are the clinical manifestations of asthma?

A

Periods of remission

Dyspnea

Often severe cough

Wheezing exhalation

Attacks can last 1-2 hrs and can last up to days or weeks

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92
Q

How is asthma managed?

A

Avoid triggers

Pt education

Acute attacks treated with corticosteroids and inhaled beta-agonists

Chronic management based on severity of asthma and regularly use of inhaled anti-inflammatory meds (IE. Corticosteroids, chromolyn sodium, leukotreine inhibitors)

Anti-inflammatory agents has long-term effects

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93
Q

What is a common side effect of asthma?

A

Increase HR

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94
Q

What is CF?

A

Affects excretory glands

Secretions thicken

Affect pulmonary, pancreatic, hepatic, sinus, and reproductive systems

Genetic disease

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95
Q

What is the pathophysiology of CF?

A

Impaired mucociliary transport by altered secretions = obstruction and hyperinflation

Sustained neutrophilic inflammation in response to infection

Obstruction reduces ventilation to alveolar units

Fibrotic changes to parenchyma

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96
Q

What are restrictive lung diseases?

A

Difficulty in expanding lungs and reduction of lung volume

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97
Q

What causes restrictive lung disease?

A

Disease of alveolar parenchyma and/or pleura
- Begin with chronic inflammation and thickening of alveoli and interstitium

Change in chest wall (fibrosis decreases expansion)

Alter NM apparatus of the thorax

Reduced pulmonary vascular bed eventually leading to hypoxemia

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98
Q

What is the clinical presentation of restrictive lung disease?

A

Dyspnea

Nonproductive cough

Weakness and early fatigue

Rapid, shallow breathing

Limited chest expansion

Crackles in lower lungs

Digital clubbing

Cyanosis

Dec VC, FRC, and TLC

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99
Q

What is an intra-alveolar bacterial infection?

A

Pneumoncoccal pneumonia is most common

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100
Q

What are the sx/sx of bacterial pneumonia?

A

Shaking chills

Fever

Chest pain if pleuritic involvement

Productive cough

Decrease breath sounds, crackles

Tachypnea

Increase WBC

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101
Q

What is viral pneumonia?

A

Inflammation of lungs caused by virus

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102
Q

What are examples of viral pneumonia?

A

Influenza

Cytomegalovirus

Herpes

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103
Q

What are sx/sx of viral pneumonia?

A

Hx of URI

Fever

Chills

Dry cough

HA

Decrease breath sounds/crackles

Hypoxemia and hypercapnea

Normal WBC

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104
Q

What is aspiration pneumonia?

A

Aspirated material that causes acute inflammatory rxn within the lungs

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105
Q

What are common causes of aspiration pneumonia?

A

Pt with impaired swallowing, intoxication, NM disease, impaired consciousness, or anesthesia

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106
Q

What are the sx/sx of aspiration pneumonia?

A

Dry cough

Dyspnea

Tachypnea

Tachycardia

Cyanosis

Wheezes, crackles, decreased breath sounds

Chest pain

Fever

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107
Q

How is TB spread?

A

Spread by droplets in the air

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108
Q

When is TB non-infectious?

A

2 weeks after being on meds

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109
Q

What are the precautions of working with someone who has TB?

A

Isolation in negative pressure room

PPE

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110
Q

What are the sx/sx of TB?

A

Fever

Wt loss

Cough

Enlarged lymph nodes

Night sweats

Crackles

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111
Q

What is pulmonary edema?

A

Excessive seepage of fluid from the pulmonary vascular system into interstitial space

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112
Q

What is cardiogenic pulmonary edema?

A

Increase pressure in pulm capillaries associated with L ventricular failure, aortic valvular disease, or mitral valve disease

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113
Q

What is non-cardiogenic pulmonary edema?

A

Results from increase permeability of alveolar membranes due to inhalation of toxic fumes or narcotic overdose

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114
Q

What are the sx/sx of pulmonary edema?

A

Crackles

Tachypnea

Dyspnea

Hypoxemia

Peripheral edema

Cough with pink frothy secretions

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115
Q

What is a pulmonary emboli?

A

Thrombus from veins that gets stuck in pulmonary circulation

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116
Q

What are the sx/sx of pulm emboli?

A

Recent DVT sx

Oral contraceptives

Sudden SOB

Tachycardia

Hypoxemia

Cyanosis

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117
Q

What is atelectasis?

A

Partial or complete collapsed or airless ALVEOLAR unit caused by HYPOVENTILATION secondary to pain during ventilatory cycle

Lack of gas exchange within alveoli, due to alveolar collapse or fluid consolidation

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118
Q

What are the sx/sx of atelectasis?

A

Decrease breath sounds

Dyspnea

Tachycardia

Increased temp

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119
Q

What is a possible complication of atelectasis?

A

Could result in collapse

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120
Q

What are Beta-2 agonists?

A

Mimic SNS

Given in inhaler form

“Rescue drug”

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121
Q

What are anticholinergics?

A

Inhibit PNS

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122
Q

What are side effects of anticholinergics?

A

Dry mouth and lack of sweating

SNS increase

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123
Q

What are anti-inflammatory agents for the pulmonary system?

A

Decrease mucosal edema

Decrease inflammation and reduce reactivity

IE. Steroids

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124
Q

What is a pneumonectomy?

A

Removal of lung

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125
Q

What is a lobectomy?

A

Removal of lobe

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126
Q

What is a segmental resection?

A

Removal of segment

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127
Q

What is an midsternotomy?

A

Sternum cut in half length wise then ribcage is retracted

Wired shut after surgery

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128
Q

What does PT work on with someone who had a midsternotomy?

A

UE ROM

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129
Q

What is a thoracotomy?

A

Incision follows the path of the 4th intercostal space

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130
Q

What does PT work on in a pt who had a thoracotomy?

A

Work on full ROM

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131
Q

What is the goal of post-op pulmonary surgery education?

A

Remove residual secretions

Improve aeration

Gradual increase of activity

Return to baseline pulmonary fxn

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132
Q

What should you watch for in a pulmonary post-op pt?

A

Fever

Increase WBC

Change in breath sounds

Abnormal x-ray

Decrease thorax expansion

SOB

Change in cough/sputum

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133
Q

What are the indications for chest PT?

A

Acute/chronic resp probs

Inability to expel pulm secretions

Ineffective cough

Increased secretions

Pneumonia

Atelectasis

Neuro impairments that cause swallowing difficulties

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134
Q

What are the goals of chest PT?

A

Mobilize secretions

Expel secretions

Improve breathing patterns

Improve ventilation t/o all lobes

Improve overall fxn

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135
Q

What are common guidelines for chest PT?

A

Tx should be prior to eating or at least 1 hr post-meal

Percuss and vibrate over each segment for at least 3-5 min

Cough after each segment that is treated

Allow for rest period after each segment is treated

Review breathing exercises in each drainage position

Tx should not exceed 45-60 min secondary to pt fatigue

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136
Q

What is the rib cage mobilization?

A

In prone or sitting

Use thenar eminence to slightly depress ribs

Start bottom up or top down

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137
Q

What should a percussion sound like?

A

Hollow sound

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138
Q

How long should percussion be performed for?

A

3-5 min

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139
Q

What are the contraindications for percussion?

A

Over the spine, breastbone, stomach, and lower ribs

Over fx

Over spinal fusion site

Over osteoporotic bone

Unstable angina

Low platelet count

Anticoagulation therapy

Pulm emboli

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140
Q

What is the goal of postural drainage?

A

Clear mucus from the 5 lobes of the lungs into larger airways to be coughed out

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141
Q

What are the contraindications of postural drainage?

A

CHF

Significant pulm edema

Significant pneumothorax

Cardiac arrhythmia

Hx of recent MI

Unstable angina

Pulm embolism

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142
Q

How long should a session of postural drainage be?

A

20-40 min

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143
Q

What are common guidelines of postural drainage?

A

Do before meals or 1.5-2 hr after meal

Remove tight clothing prior to tx

Do not perform on bare skin

Therapist should remove rings and jewelry prior to tx

Watch body mechanics

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144
Q

What are parts of airway clearance techniques?

A

Cough and huff

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145
Q

How to perform a cough after postural drainage tx?

A

Ask pt to cough in upright position after each lung is tx

146
Q

What is a huff?

A

Effective for pt with collapsible airways (COPD), prevent high intrathoracic pressure which causes airway closure

Ask pt to deeply inhale and immediately, forcibly expel air by saying hah or huffing

Assisted cough

147
Q

What is the exercise prescription for the pulmonary patient?

A

PT perform exercise test

Monitor vitals

Work at 40-85% THR

Increase duration of time to 20 min, then increase intensity

Use RPE and/or THR during exercise to monitor performance

148
Q

What are the 3 layers of skin?

A

Epidermis
Dermis
Subcutaneous tissues

149
Q

What is the epidermis?

A

Outermost layer

No BV

150
Q

What is the dermis?

A

Inner layer of collagen and elastin

Contains lymphatics, BV, Nn, and Nn endings, sebaceous and sweat glands

151
Q

What is the subcutaneous tissue of the skin?

A

Innermost layer

Loose CT and fat

Insulates body

152
Q

What is an acute wound?

A

Can repair themselves in orderly and timely manner

153
Q

What is a chronic wound?

A

Cannot repair themselves

154
Q

What are the phases of wound healing?

A

Inflammation
Proliferation
Remodeling

155
Q

What occurs immediately when you get a wound?

A

Coagulation

156
Q

What occurs from days 0-10 days when you get a wound?

A

Inflammatory process

Platelets, neutrophils, and macrophages

157
Q

What occurs from days 3 to 21 when you get a wound?

A

Proliferative process

Macrophages, lymphocytes, fibroblasts, epithelial cells, and endothelial cells

158
Q

What occurs from days 7 days to 2 years?

A

Remodeling process

Fibroblasts

159
Q

What is the composition of a clot?

A

Fibrin mesh, platelets, and blood cells

160
Q

What is fibrin?

A

Clotting protein

161
Q

What occurs during the vascular stage of the inflammatory phase?

A

Hyperemia, edema, warmth, erythema, and discomfort

162
Q

What occurs during the exudate stage of the inflammatory phase?

A

Serous, purulent, fibrinous, and bleeding

Fluid passes into tissues to bring leukocytes for healing

163
Q

What occurs during the reparative stage of the inflammatory phase?

A

Injured cells are removed via phagocytosis

Damaged cells are replaced

164
Q

What occurs during epithelialization?

A

Cells at edge of wound flatten and change into collagen

New BV growth, creation of capillary buds, and formation of granulation tissue

165
Q

What is granulation tissue?

A

New CT and microscopic BV that form on the surface of a wound during the healing process

Typically tissue grows from the base of wound and fills it in

166
Q

What is wound contraction?

A

New tissue at wound edges

Modified fibroblasts

Generate strong contractile forces on the wound edges
- Myofibroblasts

167
Q

What replaces granulation tissue during the remodeling phase of healing?

A

Replaced by less vascular tissue

168
Q

What is the definition of an immature scar?

A

Disorganized collagen fibers

169
Q

What is the definition of mature scar?

A

Replacement to Type I collagen fibers

Organized parallel fibers

170
Q

What type of tissue fills deeper wounds?

A

Fibrous

171
Q

What is primary intention healing?

A

Wounds with min tissue loss OR smooth clean edges OR closed with sutures or staples OR superficial partial thickness wounds

Direct union

172
Q

What is the secondary intention of healing?

A

Healing WITHOUT superficial closure

Tissue loss or necrosis

Irregular margins

Diabetes, ischemia, and inflammatory disease

Granulation tissue fills the bed

Closure via contraction and scar formation

Indirect union

Fills in and heals from bottom up

173
Q

What is tertiary intention of healing?

A

AKA delayed primary intention healing

Wounds initially left open to address infection, edema, etc

Closed later by primary intention methods

174
Q

What type of wounds tend to be more acute?

A

Traumatic and surgical

175
Q

What type of wounds tend to be more chronic?

A

Venous
Arterial
Pressure
Dermatologic

176
Q

What does compression interfere with?

A

Blood supply
Leading to vascular insufficiency
Tissue anoxia
Cell death

177
Q

What are the major contributing factors to pressure ulcers?

A

Pressure

Friction

Shear

Moisture

178
Q

What are other contributing factors to pressure ulcers?

A 
Nutrition
Advanced age
Thinning skin
Decreased blood flow
Low BP
Psychosocial status
Smoking
Elevated body temp
Poor oxygen perfusion
179
Q

What classifies a stage I pressure ulcer?

A

Skin temp - warm or cool

Tissue consistency - firm or boggy

Sensation

Defined area of persistent redness`

180
Q

What classifies a stage II pressure ulcer?

A

Partial thickness skin loss

Involves epidermis AND dermis

Superficial - clinical abrasion, blister, or shallow crater

181
Q

What classifies a stage III pressure ulcer?

A

Full thickness

Damage or necrosis of subcutaneous tissue

Not through underlying fascia

Deep crater with or without undermining

182
Q

What is the difference between necrosis and gangrene?

A

Necrosis = tissue death
- More black or green

Gangrene = tissue death and specifically due to lack of blood supply

183
Q

What classifies a stage IV pressure ulcer?

A

Full-thickness

Extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structure

May involve tendon or jt capsule

184
Q

What are unstageable wounds?

A

Base of wound is covered with slough or eschar

Cannot visualize depth or color

Cannot be staged

185
Q

What is eschar?

A

Presents as dry, thick, leathery tissue that is often tan, brown, or black

186
Q

What is slough?

A

Characterized being yellow, tan, green, or brown in color and may be moist, loose, and stringy

187
Q

What indicates poor arterial flow?

A

Pain in calves while walking and at rest

Cool feeling to feet

Changes in color - dependent rubor or elevational pallor

Loss of hair (toes first)

Thickening of nails

188
Q

What is dependent rubor?

A

Have pallor when legs are elevated and when they sit up all of their blood flows to their feet (bright red)

189
Q

What are some characteristics of an arterial ulcer?

A

Regular shaped with well defined edges

Deep and pale

Unhealthy granulation

Min exudate

Often with dry eschar

Periwound skin blanched, shiny

Painful

190
Q

What are risk factor modifications of arterial ulcers?

A

Stop smoking, weight control, glucose, and lipid control

Protect extremities from injury

Exercise training for those with PAD - improve functional capacity, improve peripheral blood flow, and mm oxidative capacity

191
Q

What is the role of vein perforators?

A

Connect superficial veins to deep veins

192
Q

What is a venous pressure of someone in bed?

A

0 mmHg

193
Q

What is the venous pressure of someone standing?

A

90 mmHg

194
Q

What is the venous pressure of someone walking?

A

30-40 mmHg

195
Q

What is capillary HTN?

A

Venous HTN causes capillary walls to stretch, which create gaps between cells

196
Q

What are venous wounds?

A

Locate in gaiter area

Large wounds with irregular wound margins

Superficial, red granular wound base

Edema and exudate

Hemosiderin staining

Dermatitis

Lipdermatosclerosis

Palpable pulse

197
Q

Define gaiter area

A

Region of lower leg that would normally be covered by a sock

198
Q

Define lipodermatosclerosis

A

Changes in skin of lower legs

Forms panniculitis - inflammation of the layer of fat under skin

199
Q

What are the s/s of lipodermatosclerosis?

A

Pain

Hardening of skin

Change in skin color

Swelling

Tapering of legs above the ankles

200
Q

Define hemosiderin

A

Protein that stores iron and can accumulate under skin

May give bruise like coloring

201
Q

How to diagnosis venous wounds?

A

Clinical presentation

Venous doppler

Venous duplex scan

Biopsy`

202
Q

What do venous insufficiencies lead to?

A

Pressure ulcers

Begin to see pooling of blood = edema

203
Q

What is the main tx for venous insufficiencies?

A

Eliminate edema and COMPRESSION

204
Q

How do you apply compression stockings?

A

Distal to proximal

Ankle should be at 90-degrees AKA 0-degrees of neutral

205
Q

What is the purpose of compression stockings?

A

Get fluid back through the venous valves and they have to close

206
Q

What happens if there is too much pressure from stockings?

A

Restrict blood flow = necrosis and gangrene

207
Q

What is the pressure of about 1 layer of elastic tubes?

A

Approximately 8 mmHg

208
Q

What are short stretch wraps?

A

Low pressure at rest

High working pressure when mm expand during activity

209
Q

When are short stretch stretch wraps used?

A

During exercise

210
Q

What are the long stretch wraps?

A

Greatest resting pressure (60-70 mmHg)

Very elastic

Used for immobile patients

211
Q

What is a semi-rigid wrap?

A

AKA Unna Boot

35-40 mmHg

With Zinc Oxide

212
Q

What is zinc oxide used for?

A

No skin irritation and can help neutralize bacteria

213
Q

When do you use a Unna boot?

A

Used with those who have open wounds

214
Q

What are multi-layer wraps?

A

Most commonly used for venous stasis ulcers

Combo of elastic and inelastic

Mod to high resting pressure

215
Q

When do you use multi-layer wraps?

A

Immobile patients

216
Q

What compression pressure is used for the UE?

A

30-60 mmHg

217
Q

What compression pressure is used for the LE?

A

40-80 mmHg

218
Q

How do you treat an ulcer?

A

Control exudate

Clean and debride fibrin

Protect surrounding skin

Proper dressing

Active therapies if recurrent or slow to heal

219
Q

What increases the risk of PVD?

A

Diabetes (Type II)

220
Q

How do you examine diabetic foot ulcers?

A

Neurosensory function

Foot structure and appearance

Check shoes

Vascular status

Check callous; probe for ulcers

221
Q

What is sensory neuropathy?

A

Loss of peripheral sensation

Gradual loss of pain and temp sensation

Loss of protective sensation lending to ulcerations

222
Q

What is motor neuropathy?

A

Mm atrophy of pedal arch and metatarsal fat pad atrophy

Alter pressure points which can result in weak callous formation and rupture

223
Q

What is autonomic neuropathy?

A

Decrease in perspiration

Cracks and fissures of skin occur

224
Q

What are the Semmes Weinstein Monofilament Exam?

A

Used on 4-10 sites of the met heads and great toe

Place perpendicular to foot and add enough pressure

Lack of sensation indicates risk

Loss of protective sensation

225
Q

How to document Semmes Weinstein Monofilament Exams?

A

Percentage of loss

226
Q

What should blood glucose be to prevent diabetic ulcers?

A

Less than 200 mg/dl

227
Q

Why is it important to maintain proper glucose?

A

Normal protein synthesis required for wound healing

228
Q

What are interventions to prevent wounds?

A

Support surface

Turning schedule

Max mobilizations

Protect heels

Manage moisture

Manage nutrition

Reduce/eliminate friction and shear

229
Q

How to perform a wound examination?

A

Temp

Measure girth

Sensation at wound and surrounding area

Signs of infection

Assess health of tissues surrounding wound

230
Q

Define halo of erythema

A

Abnormal redness of skin

231
Q

Define maceration

A

Softening of skin due to moisture

232
Q

Define trophic changes

A

Result from disruption of arterial blood supply

233
Q

What are examples of necrotic tissue?

A

Eschar

Gangrene

Hyperkeratosis (callus)

Slough

234
Q

What is a superficial wound?

A

Involves EPIDERMIS

235
Q

What is partial thickness wound?

A

Penetrates to DERMIS

IE. Blister

236
Q

What is full thickness wound?

A

Penetrate into SUBCUTANEOUS tissue

237
Q

What is deep full thickness wound?

A

Penetrate deeper than subcutaneous

IE. exposed tendon, mm, or bone

238
Q

Is wound staging the same as ulcer staging?

A

No

239
Q

What are examples of partial thickness wounds?

A

Abrasions

Skin tears

Blisters

Skin graft donor sites

240
Q

How do you measure a wound?

A

Longest axis = length

Perpendicular line = width

Clock or head to toe

  • Line closest to 12-6 = length
  • 3-9 = width
241
Q

What is cratering?

A

Extend deeper than we think

242
Q

What is tunneling?

A

Cratering that can be assessed proximally and distally

243
Q

What is undermining?

A

Tissue loss parallel to the skin surface

244
Q

What color can exudate be?

A

Yellow

Blue-green

Gray

Red

Bloody

245
Q

What is serous exudate?

A

Mostly clear or slightly yellow thin plasma that is slightly thicker than water

246
Q

What is serosanguinous?

A

Fluid with both serum and RBC (capillary damage)

247
Q

What is sanguinous exudate?

A

Bloody drainage, bright red and somewhat thick

248
Q

What is purulent exudate?

A

Milky in appearance

AKA pus

Almost always a sign of infection

249
Q

Define exudate

A

Liquefying necrotic tissue

250
Q

What are the goals of wound management?

A

Use asepsis

Protect of wound and surrounding tissue

  • Reduce strain
  • Protect mechanical stressors

Reduce pathogens

Promote healing

Reduce scar tissue formation

251
Q

What is autolytic debridement?

A

Dressings retain moisture

Phagocytic cells and natural enzymes work on necrotic tissue

252
Q

What is enzymatic debridement?

A

Topical, chemical debridement

253
Q

What is non-selective mechanical debridement?

A

May debride healthy tissue as well as necrotic

Wet to dry, wound irrigation, whirlpool

Not a lot of control on slough

254
Q

What is sharp mechanical debridement?

A

Use scalpel, scissors, or forceps to remove necrotic tissue

255
Q

Define pruritus

A

Itching skin

256
Q

Define urticaria

A

Smooth, red, elevated hives

257
Q

Define rash

A

Local redness and eruption on skin

258
Q

Define xeroderma

A

Dry skin

259
Q

What does red skin color change mean?

A

CO poisoning

260
Q

What does cyanotic tissue mean?

A

Decrease O2

261
Q

What does pallor skin mean?

A

Anemia

262
Q

What does brown skin mean?

A

Venous insufficiency

263
Q

What should you assess for in skin integrity?

A

Pruritus

Urticaria

Rash

Xeroderma

Edema

Change in nails

Change in skin pigmentation

Change in skin color

Change in skin temp

264
Q

How to intervene for skin integrity?

A

Client instruction

Infection control

Therapeutic exercise

Functional training

Dressings and topical agent

Electrotherapeutic modalities

Modalities

265
Q

What is the purpose of wound dressings?

A

Prevent contamination

Prevent infection to other sites

Prevent further injury

Apply pressure

Absorb drainage

Remove exudates and toxins

Assist in healing

266
Q

What is the purpose of wound bandages?

A

Keep dressing in place

Maintain barrier

Provide pressure to reduce edema

Provide stability and support

Hold splints in place

Assist dressing

267
Q

Define alginates

A

Absorb mod to large amt of exudate

Infected or non-infected

Packing into wound

Autolytic debridement

268
Q

What is the purpose of gauze?

A

Absorb min to max drainage

Packed into deeper wounds

Can be used on infected wounds

Can be impregnated

No autolytic debridement properties

IE. Wet to wet, wet to dry, and dry

269
Q

What is the purpose of foam dressing?

A

Stage II to III

May be used on infected wounds

Non-adherent

Absorb for mod drainage

Autolytic debridement

270
Q

What is the purpose of hydrocolloids?

A

Stage II and III

Absorb min drainage

Non-infected wounds

Self-adherent

Exudate forms gel-like substance within the impermeable barrier

Autolytic debridement

271
Q

What is the purpose of hydrogels?

A

Stage II or III

Used on dry wounds and absorb min absorption

Require second bandage

Hydrate wound

Autolytic debridement

272
Q

What is the purpose of transparent film?

A

Stage I or II

Non-infected

Wounds with min drainage

Autolytic debridement

Protect wounds

273
Q

What are silver dressings?

A

Antimicrobial

Use with infected wound and could be used for prophylaxis

274
Q

What is an iodine dressing?

A

Antimicrobial

Use with infected wound and could be used for prophylaxis

275
Q

What should be thought of when removing dressings?

A

Be aware of post-surgical precautions

Avoid damage to viable tissue

Be sensitive to pain and discomfort

Avoid skin tears

276
Q

What is the goal of moisture and occlusion?

A

Homeostasis

277
Q

What is pulsed lavage?

A

Irrigation with normal saline at selected level of pressure (4-15 psi)

278
Q

What precautions should be taken with pulsed lavage?

A

Insenate (lack of physcall sensation)

Anticoagulants

Uncontrolled pain

Exposed vessels

279
Q

What is a vacuum assisted closure?

A

AKA negative pressure wound therapy (NPWT)

Foam placed in wound

Wounds that cannot be closed by primary intention

280
Q

What are the advantages of vacuum assisted closure?

A

Controls edema

Increase blood flow

Control infection

281
Q

What are the contradictions of VAC?

A

> 30% non-viable

Wounds w/ malignancy

Exposed vessels

Untreated osteomyelitis

282
Q

What is the purpose of high voltage pulsed current (HVPC) for wounds?

A

Enhance healing

Monophasic direct current - stim angiogenesis and epithelial migration, decrease bacterial activity, and pain increase oxygen perfusion

283
Q

What is the purpose of UV C for wounds?

A

For chronic wounds, regardless of infection

284
Q

What are the contraindications of UV C?

A

Malignancy

Acute periwound dermatological concerns

Fever

HIV

Many systemic organ disease

Skin grafts

285
Q

What is the purpose of US for wounds?

A

Enhance inflammatory and proliferation phases

Enhance the strength and elasticity of scar tissue

Protocol varies

May treat over wound with hydrogel or transparent film and coupling gel

286
Q

What US parameters are typically used for wounds?

A

Low intensity

20% - pulsed duty cycle

287
Q

What is the purpose of hyperbaric oxygen for wound healing?

A

Reduce edema

Antibiotic effects

Stim synthesis of fibroblasts and collagen

288
Q

What is the purpose of diathermy for wound healing?

A

Thermal and nonthermal

Use radio waves

Use heat for superficial to deep tissue

Nonthermal influences at cellular level depending on settings and parameters

289
Q

Define ecchymosis

A

Discoloration of skin from bleeding under skin

290
Q

Define turgor

A

Skin elasticity

291
Q

Define dehiscence

A

Split or burst open of pod or wound

292
Q

Define hypertrophic scar

A

Excess collagen production leading to scar

Does not exceed beyond boundary of original wound

293
Q

Define keloid scar

A

Extends beyond the boundary of original wound

294
Q

Define normotrophic scar

A

Most desirable

Thin and flat

Occurs after superifical injury

295
Q

What is dermatitis?

A

Inflammation of skin

296
Q

What causes dermatitis?

A

Allergic

Reaction to sun

Unknown

297
Q

What are contraindications for dermatitis?

A

Some modalities

298
Q

What is the medical treatment for dermatitis?

A

Decrease inflammation

299
Q

What is the cause of bacterial infection?

A

Bacteria entering through abrasion

300
Q

Define impetigo

A

Infection caused by staph or strep

301
Q

Define cellulitis

A

Inflammation of cellular or CT in skin

302
Q

Define abscess

A

Cavity containing pus

303
Q

How are fungal infections spread?

A

Person to person

304
Q

What causes parasitic infections?

A

Animal and insect contact

305
Q

How are parasitic infections transmitted?

A

Person to person

306
Q

What is psoriasis?

A

Chronic disease of skin with erythematous plaques covered with silvery scale

307
Q

Where are common areas for psoriasis?

A

Ears, scalp, knees, elbows, and genitalia

308
Q

What is lupus?

A

Chronic progressive inflammatory disorder of CT

309
Q

What are characteristics of lupus?

A

Red rash (butterfly) with raised red scaly plaques

310
Q

What is scleroderma?

A

Disease of CT causing fibrosis of the skin and jt

311
Q

Define petechiae

A

Tiny red or purple spots on the skin that result from tiny hemorrhages within the dermal layer

312
Q

What are causes of burns?

A

Thermal, chemical, electrical, or radioactive agents

313
Q

What is zone of coagulation?

A

Area of greatest damage is closest to heat source

Cells irreversibly injured

Cell death

Full-thickness damage

314
Q

What is zone of stasis?

A

Involves vascular system

Cells are injured

May die without specialized tx usually within 24-48 hr

315
Q

What is zone of hyperemia?

A

Min cell injury

Cells should recover

Superficial thickness burn

316
Q

What is a first degree burn?

A

AKA superficial

Damage only EPIDERMIS

Characterized by:

  • Erythema
  • Slight edema
  • Tenderness
  • No blistering

Full healing in 3-7 days

317
Q

What is a second degree superficial thickness burn?

A

Superficial partial thickness

Epidermis and upper layers of dermis are damaged

Characterized by:

  • Blisters
  • Inflammation
  • Severe pain

Heals within 7-21 days

318
Q

What is a second degree deep partial-thickness burn?

A

Deep partial-thickness

Severe damage to epidermis and dermis

Characterized by:

  • Red or white appearance
  • Edema
  • Blistering
  • Severe pain
  • Or damage to Nn endings may result in mod pain

Heals from 21-28 days

319
Q

What is a third degree burn?

A

Full thickness

Complete destruction of epidermis, dermis, and subcutaneous - and may extend to tissue

Characterized by:

  • White, gray, or black appearance
  • Dry surface
  • Edema
  • Eschar
  • Little pain (nn endings burned off)

Removal of dead tissue and skin grafting necessary

High risk of infection

Scarring and wound contracture are common

320
Q

Define escharotomy

A

Emergency surgical procedure for circumferential burns

Incise burnt skin to release eschar

321
Q

Define split-thickness skin graft

A

Epidermis and upper layers of dermis from donor site

322
Q

What is a fourth degree burn?

A

AKA subdermal burn

Complete destruction of epidermis, dermis, and subcutaneous tissue; involve mm and bone

Extensive tissue damage with destruction of vascular system

Course unpredictable

Require extensive surgery/amputation

IE. electrical burn or prolonged flame contact

323
Q

What is important to do post-grafting?

A

Discontinue ROM for up to 5 days

Immobilize jt with splints

324
Q

What is a critically burned area?

A

10% of body with 3rd degree burn AND 30% or more with 2nd degree

325
Q

What are moderate burned areas?

A

Less than 10% with 3rd degree burns and 19-30% with second degree burns

326
Q

What are minor burned areas?

A

Less than 2% with 3rd degree burns and 15% with 2nd degree burns

327
Q

What are complications of burns?

A

Infection - leading cause of death

Shock

Pulm complications - smoke inhalation

Metabolic complications - increase metabolic activity results in wt loss and decreased energy

Cardiac complications - fluid and plasma loss results in decreased CO

Heterotopic ossification

328
Q

Define heterotopic ossifications

A

Abnormal bone growth in the non-skeletal tissues

329
Q

What is common burn wound care?

A

Remove charred clothing

Wound cleansing

Topical meds

Occlusive dressings

Maintain airway

Monitor blood gases

Pain relief

Infection prevention

Fluid replacement

Surgery

330
Q

What is silver sulfadiazine?

A

Prophylactic agent

331
Q

What is the role of PT in burn wound care with infection control?

A

Hydrotherapy - debridement, dressing and removal, ROM exercises, and anti-infection control agents

Sharp debridement - excision of eschar

Autolytic dressing/enzymes to remove eschar

Topical agents and antimicrobial ointments - directly to burn, impregnate into gauze, and cover with bandage

332
Q

What is the role of PT in preventing or reducing complications of immobilization of burns?

A

Exercise to promote deep breathing and amb

Positioning

Edema

AROM/PROM

Massage

Strengthen

ADLS

Pain management

333
Q

What are common contracture risks of the neck?

A

Flex

334
Q

What are common contracture risks of the anterior chest and shoulder?

A

ADD and IR

335
Q

What are the contracture risks of the elbow?

A

Flex and pronation

336
Q

What are the contracture risks of the hand?

A

Claw hand and flex

337
Q

What are the contracture risks of the hip?

A

Flex and ADD

338
Q

What are the contracture risks of the knee?

A

Flex

339
Q

What are the contracture risks of the ankle?

A

PF

340
Q

What are hypertrophic scars?

A

Thick, raised scar within boundaries of the initial burn or wound

Red, raised, and firm

341
Q

What is a keloid scar?

A

Thick, raised scar that extends outside boundaries of original burn or wound

Red, raised, and firm in appearance

342
Q

What is the function of compression garments of burns?

A

Help reduce swelling

Decrease hypertrophic scarring

Sustained compression: 15-35 mmHg

343
Q

When should a PT auscultate breath sounds?

A

To determine if pt needs mechanical suctioning

344
Q

When should improvement in physical tasks and ADLs occur in a pt with a chronic pulmonary condition?

A

4-8 wk

345
Q

A decrease in what blood cells increase risk of infection?

A

WBC

346
Q

How long should compression garments be worn per day?

A

~23 hr/day

347
Q

What is the purpose of active cycle breathing?

A

Improve breathing control and remove secretions

348
Q

How to perform active cycle of breathing?

A

Seated

Pt breaths normal for 5-10 sec

Deep inspiration and relax expiration 3-4 times

Pt breaths normal for 5-10 sec

Deep inspiration and relax expiration 3-4 times

Forced expiratory technique - instruct pt to turn head and huff on exhalation

349
Q

What is normal ABI?

A

Greater than or equal to 1

350
Q

What is the ABI of min arterial disease?

A

0.9-1.0

351
Q

What is the ABI of significant arterial disease?

A

0.5-0.89

352
Q

What is the ABI of severe arterial disease?

A

Less than 0.5

353
Q

What segments are targeted in upper lobe in chest percussion?

A

Apical segment

Posterior segment

Anterior segment

354
Q

What is the position of pt to target apical segment?

A

Bed/table flat

Pt leans on pillow at 30-degree angle against therapist

Perform percussion - b/t clavicle and top of scap

355
Q

What is the position of pt to target posterior segment of upper lobe?

A

Bed/table flat

Pt leans over folded pillow at 30-degree angle

Perform percussion - upper back

356
Q

What is the position of pt to target anterior segment of upper lobe?

A

Bed/table flat

Pt lies on back with pillow under knees

Perform percussion - b/t clavicle and nipple

357
Q

What is the position of pt to target right middle lobe?

A

Foot of table elevated by 16 in

Pt head to left side and rotate to turn backward by 1/4. Pillow behind from shoulder to hip. Knees flexed

Perform percussion - over right nipple area
- Females = fingers toward the under portion of breast tissue

358
Q

What is the position of pt to target Singular segment of left upper lobe?

A

Foot of table elevated by 16 in

Pt head to right side and rotate to turn backward by 1/4. Pillow behind from shoulder to hip. Knees flexed

Perform percussion - over left nipple area
- Females = fingers toward the under portion of breast tissue

359
Q

What is the position of pt to target anterior basal segment of lower lobes?

A

Foot of table elevated 20 in

Pt lies on side, head down, pillow b/t knees, arm above head

Perform percussion - over lower ribs

360
Q

What is the position of pt to target lateral basal segments of lower lobes?

A

Foot of table elevated 20 in

Pt lies on abs, head down, rotate 1/4 turn upward, upper leg on pillow

Perform percussion - over lower ribs

361
Q

What is the position of pt to target posterior basal segments of lower lobes?

A

Foot of table elevated 20 in

Pt lies on abs, head down, pillow under hips

Percussion - over lower ribs close to spine

362
Q

What is the position of pt to target superior segments of lower lobes?

A

Bed/table flat

Pt lies on abs with 2 pillows under hips

Percussion - over middle of back at tip of scap on either side of spine

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