FINAL EXAM - All Conditions of the Respiratory System Flashcards
nasal cavity Fn
sticky mucous membrane lining the nasal cavity traps dust particles, and tiny hairs called cilia help move them to the nose to be sneezed or blown out
sinuses Fn
these air-filled spaces along side the nose help make the skull lighter
pharynx fn
both food and air pass through the pharynx before reaching their appropriate destinations. the pharynx also plays a role in speech.
larynx
essential to human speech
traches fn
located just below the larynx, the trachea is the main airway to the lungs.
lungs Fn
together the lungs form on of the body’s largest organs. they’re responsible for providing oxygen to capillaries and exhaling co2
bronchi fn
for the trachea into each lung and create the network of intricate passages that supply the lungs with air
diaphragm fn
the diaphragm is the main respiratory muscle that contracts and relaxes to allow air into the lungs
normal Respiratory rate (RR)
12-15 minute
Heart Rate (P) (4)1. rate2. feel for how long3. if irregular count for how long4. if it’s low ask client what?
- 60-1002. feel for 15sec. x43. if irregular count for 1 min. 4. low rate - ask if client feels light headed
Metabolic Equivalent of task (MET)
amount of energy used by the body to perform a physical activity or daily task
at rest what is the average oxygen consumption MET?
1 MET
With more activity MET values
increase
tachycardia(3)1. what is the heart rate2. what is it not always?3. what do you ask the client?
- heart rate > 100 bpm2. not always pathological (side effect)3. Ask if they’re light headed/ dizzy and if they sit down does it go away
tachypnea (2)1. what is the RR2. What is a normal RR
respiratory rate > 20/minutenormal rate is 8-12/minute
wheeze
airway is constrictedcontinuous, coarse, whistling sound produced in the airways during breathing
If there is no sound when listening to lungs it means
air is not moving around; not good
rales
sounds like bubble wrap; avioli popping due to filled with secretions; clicking, rattling, or crackling noises that may be made by one or both lungs during inalation
Rhonchi
wheezing then cough and sound is gone; due to mucous moving around.coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways
Signs of CAP (3)
- tachycardia/tachypnea2. dullness to percussion with consolidation/effusion3. exam alone cannot confirm/exclude diagnosis
Symptoms of CAP (5)
- altered breath sounds/rales2. rigor/sweats3. fever/hypothermia4. dyspnea5. new cough (+/- sputum)
rigor
shaking chills
CAP prognosis
can take weeks to return to baseline functioning
Signs of Nosocomial pneumonia (HCAP) (2)
- altered breath sounds/rales2. dullness to percussion with effusion
Symptoms of HCAP (4)
- fever/hypothermia2. rigor/sweats3. dyspnea4. new cough (+/- sputum)
OT intervention recommendations (4)
- encourage coughing2. sitting/walking is good and can speed recovery3. walking prevents blood clots4. recovery can take several weeks
Atropy
tendency to be hypoallergic is the strongest identifiable factor
Atopic “triad” (3)
- wheeze2. eczema3. seasonal rhinitis
Asthma’s impact on structure of the respiratory system (4)
- narrowed airway (limited airflow)2. tightened muscles- constrict airway3. inflamed/thickened airway wall 4. mucus
Asthma symptoms (5)
- breathlessness2. cough3. wheeze prolonged expiration4. episodic/chronic symptoms of airway obstruction5. 1/3 of children have no wheeze
asthma general management (4)
- remove irritants2. peak flow measurements3. desensitization4. oxygen
Asthma pharmacological management (3)
- quick relief meds (beta 2 agonists - albuterol)2. long term control - steroid3. medication side effects-Tachycardia or increased RR
asthma OT activity recommendation (3)
- avoid triggers such as cold air2. control symptoms first before activity3. activities with short bursts are better tolerated to build up conditioning
emphysema clinical findings (8)
- exertional dyspnea (activity)2. cough is rare3. quiet lungs4. no peripheral edema5. thin; recent weight loss6. barrel chest7. pursed lips breathing8. hyperventilation
Emphysema CXR (5)
- decreased lung markings at apices2. flattened diaphragms3. hyperinflation4. parenchymal bullae and blebs - small thin appearing heart
bronchitis clinical findings (5)
- mild dyspnea2. chronic productive cough3. noisy lungs; rhonchi and wheeze4. peripheral edema5. overweight and cyanotic
bronchitis CXR (2)
- increased interstitial markings at bases2. diaphragms not flattened
treatment options for COPD - increase in severity as you go down the list (7)
- no cure; once developed never goes away2. self-management education and smoking cessation3. bronchodilators4. inhaled corticosteroids5. pulmonary rehabilitation6. oxygen7. surgery
vital signs (7)
- temperature - T2. pulse - P3. respirations - R4. blood pressure - BP5. height - Ht6. weight - Wt7. pain
Alveoli
small air sacs that perform gas exchange
epiglottis
protects the lungs from foreign objects by covering the trachea during swallowing
tachycardia - define
heart is pumping too quickly or thready; impacts circulation
Due to the close relationship between the lungs and the heart; conditions that
impact one organ can cause impairment in the other
HTN
increase in the amount of force that is pushing against the walls of the arteries as the heart pumps blood
HTN is usually
asymptomatic; can go years unnoticed and untreated; but still causing damage to the heart, kidneys, and other body structures
Prehypertensive is considered between what 2 numbers?
120/80 and 139/89
HTN Preventions include (2)
- regular exercise2. eating a healthy diet
Treatment of HTN
- follow physician recommended health care plan2. adhering to exercise and healthy eating plans3. monitoring BP levels4. taking medications
atherosclerosis
condition where plaque made of cholesterol, fat, calcium, and other substances sticks to the inner lining of arteries; over time hardening and narrowing the opening of blood vessels, thus reducing the rate of oxygenated blood being delivered.
Causes of CAD(6)
smokingobesitydiabeteshigh cholesterolgeneticsage
Treatment of CAD
- healthy lifestyle choices2. medications3. surgical procedures
Surgical procedures for CAD include
- angioplasty 2. CABG3. Carotid endartrerectomy
Angioplasty
small mesh tube is inserted into the coronary artery to widen the opening, thus increasing the blood flow
CABG
artery or veins are harvested from the leg usually and then surgically attached to bypass the blocked arteries near the heart
Carotid Endarterectomy
surgery where the carotid artery in the neck is opened in order to remove some of the plaque that has formed thus allowing better blood flow to the brain
pneumonia
inflammation of the lung tissue caused by infection, usually from bacterial, viral, or fungal sources
Community-acquired pneumonia
exposure to the bacteria or virus in the community
Those at risk for hospital-acquired pneumonia (3)
- post surgery (especially abdominal or chest surgery)2. patients in intensive care unit3. patients with weakened immune system
Those at risk for aspiration pneumonia are
- TBI or CVA pts. that have impacted the swallowing sequence or gag reflexes2. when food or foreign substance enters the lungs and causes an infection
Early signs and symptoms of pneumonia are often confused with the
flu
Symptoms for pneumonia include (8)
- cough2. fever3. dyspnea4. sweating5. chills6. chest pain or tightness7. headache8. fatigue
diagnosing pneumonia(3)
listening to the chest for rales or rumblingchest xrayblood and mucus tests (less common)
Course of pneumonia
- signs of the flu2. severity of symptoms depend on the infecting organism3. caught early enough avoid hospitalization4. If hospitalized, usually 3-4days5. Older adults over 85 may have other health complications
if left untreated pneumonia can lead to
severe respiratory distress and even death b/c organs are no longer getting the O2 that they need and begin to fail
Prevention of pneumonia (2)
vaccinationflu shot
Standard treatment plan for pneumonia
- antibiotics2.. rest3. fluids
Cough is not totally stopped in pneumonia with medications because
it is an important mechanism for removing excess mucus from the airways
COPD is an overarching term that also includes (2)
emphysema and chronic bronchitis
Physically, a COPD lung is more
floppy and somewhat deflated or damaged
emphysema
the alveoli walls may become deflated or damaged which reduces the amount of gas exchange that can occur
chronic bronchitis
the bronchial tubes become inflamed and thickened making it difficult to breathe
Symptoms of COPD (4)
smoker’s cough (persistent mucus producer)wheezing or whistling while inhalingchest tightnessdyspnea with exertion
As COPD progresses other symptoms may include (2)
swollen ankles and feet lips and fingernails may be bluish due to decreased oxygen levels
What is the main test for lung Fn for those with COPD?
spirometry
Course of COPD
- breathing becomes more difficult and less O2 get to the body2. heart becomes enlarged due to strain3. BP increases4. Cognitive deficits due to lack of O25. Organ failure6. Death
Medical management of COPD includes
- Oxygen2. Inhaled medications3. oral medications4. Lung reduction surgery or replacement.
What are the first two things an OT practitioner should determine?
1.determine the occupational needs of the client 2.determine the effects of their symptoms on occupational performance
Common symptoms that impact occupational performance in cardiopulmonary disorders
- dyspnea2. fatigue3. depression4. difficulty focusing5. anxiety6. light-headed
Dyspnea’s impact on occupational performance
may need frequent breaks and may need chairs placed in various positions around their house to provide a place to sit
Fatigues impact on occupational performance
may need to have tasks broken down into smaller parts and to do them over a longer period of time. Work simplification and energy conservation
Depressions impact on occupational performance
encouragement to participate, support in successes, and empathy
Difficulty focusing and it’s impact on occupational performance
visual reminders and verbal cues. Processing time may be lengthened, so a slower pace may be helpful when problem-solving more complex tasks.
Anxiety’s impact on occupational performance
more time, encouragement, and pleasant distractions can help them move forward with the small day-to-day tasks. May become a larger issue that keeps clients from doing what they need to do.
Light-headedness: impact on occupational performance
allow the client to sit whenever possible to complete a task. have seats close and encourage them to stand near a stable counter or table, or use a grab bar is standing is needed.
It is important for OT’s to consider how precautions impact a clients
ability to safely complete all areas of occupations
Common Precautions for Cardiopulmonary disorders(6)
- No heavy lifting2. heart rate less than or equal to 110 beats/minute3. O2 at all times4. Maintain low-salt diet5. Record daily weight6. Follow recommended oral and inhaled medication schedule7. No activities at a MET rate of higher than 6
No heavy lifting - impact on occupational performance
any task that would require lifting would need to be modified or completed by someone else. lifting precautions also limit wheelchair self-propulsion as this too, puts too much strain on the upper body
heart rate less than or equal to 110 beats/minute - impact on occupational performance
clients will need to be taught to take their own heart rate and be reminded to take it if more exertion is attempted. Written cues may be needed for reminders.
O2 at all times - impact on occupational performance
Clients will need to be connected to an oxygen source; tank and long hose must be manipulated to ensure safety with mobility
Maintain low-salt diet - impact on occupational performance
Clients may need to modify cooking habits and seasoning habits and to explore alternatives
Record daily weight - impact on occupational performance
CHF clients may need a scale with large numbers and system setup for recording their daily weight. Scale may need to be in a place where client can hold on to something stable while stepping on and off.
Follow recommended oral and inhaled medication schedule - impact on occupational performance
Visual reminders and environmental set up may be needed. Dedicated site when doing breathing treatments help.
No activities at a MET rate of higher than 6 - impact on occupational performance
Clients will have limited tasks that they can complete until this precaution is lifted. Higher met values may not be permitted for many weeks.
COPD
a condition in which airflow blockages that create breathing-related problems: includes emphysema and /ore chronic bronchitis
emphysema
a type of COPD characterized by permanent damage to the alveoli in the lungs, resulting in shortness of breath and difficulty exhaling
chronic bronchitis
tpre of copd characterized by the inflammation and eventual scarring of the lining of the bronchial tubes producing thick mucus and restricting airflow
Chronic bronchitis is diagnosed when a person has a
mucus-producing cough most day of the month, 3 months of a year for two successive years without other underlying disease to explain the cough
Tests for COPD include (4)
- lung Fn test using spirometry2. CT scans3. Chest Xrays4. arterial blood gas level tests
Most common cause of COPD is
cigarette smoke
COPD is caused by long term exposure to
inhalation of lung irritants
Lung irritants include (5)
- first-hand smoking2. second-hand smokeAnd long term inhalation of3. Dust4. air pollution5. Chemical fumes
Alpha-1 antitrypsin (AAT) deficiency
a condition in which the body produces a low level of lung-protective protein
People with AAT deficiency have an increased risk of developing
COPD
There are 4 stages of COPD
- I - Mild2. II- Moderate3. III - Severe4. IV - Very Severe
Initially patients may attribute COPD symptoms to (3)
- having a cold2. ageing3. being physically out of shape
Initial symptoms of COPD (4)
- persistent cough or a cough that produces large amounts of mucus2. dyspnea, particularly during and after physical activity3. wheezing4. chest tightness
Symptoms of COPD with disease progression(7)
- edema in the ankles, feet, or legs2. weight loss and muscle atrophy3. decreased endurance, fatigue4. bluish-colored lips and/or fingernails5. severe and constant dyspnea that inhibits even talking6. Rapid heartbeat7. Decreased alertness
individuals with COPD contract (3)
- cold 2.flu 3. other illnesses frequently
Clients with COPD experience a decrease in (2)
- occupational performance and participation2. quality of life and self-efficacy
Most COPD clients develop a comorbid diagnosis of
depression
Other comorbid diagnosis with COPD are (3)
- hypertension2. high cholesterol3. osteoporosis
What drugs are commonly prescribed for COPD?
- Bronchodilators2. anti-inflammatory drugs3. antibiotics (to combat contraction of illnesses)
oxygen therapy as an intervention for COPD
physician or respiratory therapist will work with a client to determine the best form of supplemental oxygen containers, liquid oxygen containers, and oxygen concentrators
Types of lung surgery as an intervention for COPD
- lung transplants2. Lung volume reduction (removes damaged portions to increase ventilation ability)3. removal of damaged or diseased alveoli
Occupational Therapy interventions for pulmonary conditions are done separately or as part of a pulmonary rehab team and include the following (8)
- teaching energy conservation techniques2. retraining in ADLs3. UE strength and ROM training4. Educating client and family members about the risk factors of respiratory conditions and measures to be taken to remain healthy and functional5. Lifestyle modification6. environmental assessment7. Medication management8. Recommendations of support groups and resources within the community
OT interventions has been shown to increase (4) for patients with Pulmonary conditions
- physical Fn2. Quality of life3. independence and efficiency in ADL/IADLs4. decrease dyspnea in clients with COPD
OT for COPD also can result in improvements in
- Social Fning 2. overall physical health3. psychological health
Teaching energy conservation techniques are used to (Pulmonary Conditions)
minimize respiratory exertion; may include environmental adaptions, breathing techniques and so forth
Retraining in ADLs may include (Pulmonary Conditions)
grading activities to optimize participation without causing excessive strain; using assistive devices if necessary
UE strength and ROM training may be necessary because (Pulmonary conditions)
clients with these conditions often use their shoulder girdle muscles to assist in inhalation, maintaining strength in these muscles is necessary
An example of lifestyle modification is
identifying new or alternate occupations that allow client to participate satisfactorily without exacerbating the pulmonary condition
Diagnosis and management of pulmonary disorders may include (4)
- Administering pulmonary function tests2. Arterial blood gas analysis3. Chest X-rays 4. Chemical or microbiological tests
Adenoid/o
Adenoids
Adenoidectomy
Excision of adenoids
Laryng/o
Larynx
Laryngoscope
Instrument for examining the larynx
Nas/o
Nose
Rhin/o
Nose
Rhinorrhea
Discharge of the noseAka runny nose
Pharyng/o
Pharynx (throat)
Pharyngospasm
Spasm of the muscles of the pharynx
Tonsill/o
Tonsils
Trache/o
Trachea -windpipe
Tracheotomy
Incision of the trachea
Alveol/o
Alveolus; air sac
Alveolar
Pertaining to the alveolus
Bronch/o
Bronchus - Plural bronchi
Bronchoscopy
Endoscopic procedure that examines The interior bronchi using a bronchoscope.
Bronchoscope is inserted 2 ways
- Transnasally2. Through the mouth
Bronchoscopy’s are performed to (4)
- Remove obstructions2. Obtain a biopsy specimen3. Observed directly for pathological changes4. In children, remove foreign objects that have been inhaled
What are the two reasons that are most common for adults to get a bronchoscopy?
- Obtain samples of suspicious lesions a.k.a. biopsy2. Culturing specific areas in the lung
Bronchi/o
Bronchus (plural, bronchi)
Bronchiol/o
Bronchioles
Bronchiolitis
Inflammation of the bronchioles
Phren/o
Diaphragm
Phrenalgia
Pain in the diaphragm
Pleur/o
Pleura
Pleurodynia
Pain in the pleura
Pneum/o
Air; lung
Pneumomelanosis
Abnormal blackening of the lung tissue
Pneumon/o
Air, lung
Pulmonary
Pertaining to the lungs or the respiratory system
pulmon/o
lung
thorac/o
chest
thoracopathy
any disease of the thoracic organs or tissue
aer/o
air
aerophagia
excessive swallowing of air, usually an unconscious process associated with anxiety, resulting in abdominal distention or belching; these are often interpreted by the patient as signs of a physical disorder.
cyan/o
blue
cyanosisWhat is it? What causes it?What is it associated with?
physical sign causing bluish discoloration of the skin and mucous membranes; caused by a lack of oxygen in the blood; associated with cold temperatures, heart failure, lung diseases, and smothering
muc/o
mucus
mucoid
resembling mucus
myc/o
fungus
mycosis
abnormal condition caused by fungus
orth/o
straight
orthopnea
dyspnea that is relieved when in an upright position
py/o
pus
pyothorax
pus in the pleural cavity
a-
without, not
brady-
slow
dys-
bad; painful; difficult
eu-
good, normal
tachy-
rapid
friction rub
dry, grating sound heard with a stethoscope during ausculation (listening for sounds within the body)
stridor
high-pitched, musical sound made on inspiration; caused by an obstruction in the trachea or larynx
acidosis
excessive acidity of blood as a result of blood as a result of an accumulation of acids or an excessive loss of bicarbonate caused by abnormally high levels of CO2 in the body
Acute respiratory distress syndrome(ARDS) What is it?What causes it?
Life-threatening buildup of fluid in the alveoli caused by vomit in the lungs (aspiration), and hailing chemicals, pneumonia, septic shock, or trauma
ARDS prevents
Enough oxygen from passing into the bloodstream
Anosmia
Absence or decrease in the sense of smell
Anoxia
Total absence of O2 and body tissues;
Anoxia is caused by
Lack of O2 in inhaled air or by obstruction that prevents 02 from reaching the lungs
Asphyxia
Condition of insufficient intake of oxygen as a result of choking, toxic gases, electric shock, drugs, drowning, smoke or trauma
AtelectasisWhat is it? How is it caused?
Collapse of lung tissue, which prevents the respiratory exchange of oxygen and carbon dioxide and it’s caused by various conditions including obstruction of foreign bodies, excessive secretions, or pressure on them on from a tumor
Coryza
Acute inflammation of the nasal passages accompanied by profuse nasal discharge; also called a cold
Croup
Acute respiratory syndrome that occurs primarily in children and infants and is characterized by laryngeal obstruction and spasm, barking cough, and stridor
Cystic fibrosis (CF)
Genetic disease that is one of the most common types of chronic lung disease in children and young adults and causes thick, sticky mucus to build up in the lungs and digestive tract, possibly resulting in early death
Epistaxis
Hemorrhage from the nose; also known as nose red
Hypercapnia
Greater than normal amounts of carbon dioxide in the blood
Hypoxemia
Deficiency of oxygen in body tissues; usually a sign of respiratory impairment
Influenza
Acute, contagious respiratory infection characterized by sudden onset of fever, chills, headache, and muscle pain
Otitis media (OM) What is it? What’s the cause?What is the symptom?How is it treated?
Inflammation of the middle ear, commonly the result of an URI with symptoms of otodynia; may be treated with myringotomy or tympanostomy tubes
Exudative
OM with the presence of fluid, such as pus or serum
Pertussis
Acute infectious disease characterized by a “whoop”-sounding cough; also called whooping cough
Pleurisy
Inflammation of the pleural membrane characterized by a stabbing pain that is intensified by deep breathing or coughing
Pneumothorax
Collection of air or gas in the pleural cavity, causing the complete or partial collapse of a lung
SIDS
Completely unexpected and unexplained death of an apparently well, or virtually well, infant; aka crib death
Arterial blood gases (ABGs)
Group of tests that measure the oxygen ad co2 concentration in an arterial blood sample
Mantoux test
Intradermal test to determine recent or past exposure to tuberculosis (TB)
Polysomnography (PSG)What is it?What does it evaluate?
Sleep study test monitored by a technician while the patient sleeps; used to evaluate physical factors affecting sleep, such as heart rate and activity, breathing, eye and muscle movements, snoring, kicking during sleep, and sleep cycles and stages
Pulmonary function tests (PFTs)
Various tests used to determine the capacity of the lungs to exchange O2 and CO2 efficiently
Spirometry What is it? What is it used for?What is it used to assess?
Common lung function test that measures and records volume and rate of inhaled and exhaled air.Used to assess pulmonary function by means of a spirometer.Assess obstructive lung disease especially asthma and COPD
Cardiopulmonary resuscitation (CPR)
Basic emergency procedure for life-support, consisting of artificial respiration and manual external cardiac massage
Endotracheal intubation
Procedure in which an airway catheter is inserted through the mouth or nose into the trachea just above the bronchi in patients who are unable to breathe on their own; also used to administer oxygen, medication, or anesthesia
Postural drainage
Use of body positioning to assist in the removal of secretions from specific lobes of the lung, bronchi, or lung cavities
Thoracic entasis
Use of a needle to collect pleural fluid for laboratory analysis or to remove excess pleural fluid or air from the pleural space. Aka thorax entrails
Tracheostomy
Incision into the trachea (tracheotomy) and creation of a permanent opening through which a tracheostomy tube is inserted to keep the opening patent.
Bronchodilators
Dilate constricted airways by relaxing muscle spasms in the bronchial tubes through oral administration or inhalation via a metered-dose inhaler (MDI)
corticosteroids
suppress the inflammatory reaction that causes swelling and narrowing of the bronchi
expectorants
improve the ability to cough up mucus from the respiratory tract
metered-dose
device that enables the patient to self-administer a specific amount of medication into the lungs through inhalation
nebulized mist treatment (NMT)
method of administering medication directly into the lungs using a device (nebulizer) that produces a fine spray; also called aerosol therapy
apnea
temporary cessation of breathing
sleep apneaWhat is it?What can it cause?
sudden cessation of breathing during sleep that can result in hpoxia and lead to cognitive impariment, hypertension, and arrhythmias.
obstructive sleep apnea (OSA)What is it?Signs/symptoms?
physical obstruction in the upper airways; usually marked by recurrent sleep interruptions, choking and gasping spells on awakening, and drowsiness caused by loss of normal sleep.
Continuous positive airway pressure (CPAP)
gentle ventilator support used to keep the airways open
An example of a physical obstruction in OSA is
enlarged tonsils
If OSA is left untreated it can cause(3)
- central sleep apnea2. pulmonary failure3. cardiac abnormalities
3 major disorders included in COPD
- asthma2. chronic bronchitis3. emphysema
In COPD air reaches the alveoli in the lungs during inhalation but
it is not fully exhaled.
Predisposing factors of COPD are (4)
- smoking2. prolonged exposure to polluted air3. respiratory infections4. allergies
Medications used to alleviate the symptoms of COPD (2)
- bronchodilators2. corticosteroids
Distended bronchioles and alveoli are associated with
emphysema
Inflamed airways and excessive mucus are associated with
chronic bronchitis
narrowed bronchial tubes and swollen mucous membranes are associated with
asthma
uvulopalatopharyngoplasty (UPP)
removal of excess tissue in the throat to make the airway wider.