Final exam info Flashcards
Describe medullary rhythmicity
Maintains basic rhythm
Describe the pneumotaxic area
Stimulates expiration
Keeps lungs from overfilling
Describe the apneustic area
Activates inspiration
Describe COPD
Chronic airflow obstruction
Minimally reversible
Describe emphysema
Enlargement and destruction of alveoli
Develops gradually from irritants like smoking
Describe the pathology of emphysema
Loss of elastic and gas exchange properties of the acini
Formation of bullae a blebs
What are some SS for emphysema
Dyspnea
Cough
use of accessory muscles, pursed lip breathing
Barrel chest, digital clubbing
Describe centrlobar emphysema
Involves respiratory bronchioles
Associated with smoking
Describe panlobar emphysema
all acini are affected
Associated with antitrypsin deficiency
Describe paraseptal emphysema
Involves alveoli along the peripheral septa and lung pleura
Associated with spontaneous pneumothorax
Describe irregular emphysema
Occurs around scars
Describe cystic fibrosis
Genetic disorder causing Cl ion transporters to become defected leading to increased secretions of bodily fluids
What are some medications used to treat CF
Oxygen
Antibiotics
Mucolytics
Bronchodilators
What surgery can be done for CF patients
Double lung transplant
What PT can be done for CF patients
Airway clearance techniques
Inspiratory muscle training
Aerobic and strength training
What is pneumothorax
Presence of gas in the pleural space
Causes lung to collapse on the affected side
What are some SS for pneumothorax
Acute dyspnea
Acute pleuritic chest pain
absent or diminished breath sounds
tracheal deviation
What are some treatments for Pneumothorax
Oxygen
Chest tube drainage
Incentive spirometry
Describe primary pneumothorax
No underlying cause
Seen in young, tall, thin men
Describe secondary pneumothorax
Associated with COPD, blebs, bullae
Describe traumatic pneumothorax
Gun shot wound
knife wound
Rib fracture
Describe tension pneumothorax
Air enters the plural space and cannot escape
Increasing pressure causes the lungs to collapse
Medical emergency
What is a pulmonary embolism
Floating thrombus that lodges in pulmonary artery
Often from a DVT
Passes through right heart to lodge in pulmonary circulation
Describe the pathology of a pulmonary embolism
Decreased pulmonary blood flow
Increased pulmonary vascular resistance
Death may occur rapidly
What are some SS of pulmonary embolism
Rapid onset of dyspnea
Pleuritic chest pain
anxiety, apprehension, restlessness
What are some treatments for pulmonary embolism
Prevention of DVT’s
Anticoagulant drugs
Thrombolytic drugs
Surgery
What are some general characteristics of restrictive lung diseases
Lung expansion is restricted
Difficulty getting air in
What are some general characteristics of obstructive lung pathologies
Weakening, narrowing, obstruction of airways
Difficulty getting air out
Air trapped in the lungs
What is acute respiratory distress syndrome
Acute onset of respiratory failure
PaO2 <60 mmHG
PaCo2 > 55 mmHG
Results from acute extensive lung inflation
Describe the pathophysiology of acute respiratory distress syndrome
Diffuse alveolar damage
Extensive inflammation
What are some treatments for acute respiratory distress syndrome
Ventilation in ICU
Corticosteroids to manage inflammation
Catecholamines to increase BP and CO
What is bronchiectasis
Permanent dilation and destruction of bronchi caused by destruction of elastic and muscular components of bronchial wall
What are some SS of bronchiectasis
Cough, small to large amounts of purulent sputum
Crackles, hemoptysis
What is asthma
Airways hypersensitive to various stimuli
Can be life threatening
Reversible
Describe the pathology of asthma
Inflammation, smooth muscle spasm, bronchoconstriction, excessive mucus production
What are some SS of asthma
Dyspnea Wheezing Chest tightness Cough Impaired PFT
What are some medical managements of asthma
Bronchodilators
Anti-inflammatories
Glucocorticosteroids
Leukotriene modifiers
What is chronic bronchitis
Chronic inflammation of the bronchial mucosa
Caused by smoking, pollutants, infections
Describe the pathology of chronic bronchitis
Inflammation
Hypersecretion of mucus
Ciliary dysfunction
Bronchial hyperreactivity
What are some SS of chronic bronchitis
Dyspnea Use of accessory muscles Pursed lip breathing Digital clubbing Decreased breath sounds
What are some signs of distress during weaning
> 30 breaths per minute HTN Tachycardia Increased use of accessory muscles Agitation Respiratory acidosis
What are some indications for respiratory distress
Increased respiration rate Nasal flaring Intercostal and sternal restrictions Visible expression of distress increased use of neck and accessory muscles Paradoxical breathing
Describe the relationship between CPAP and BIPAP
BIPAP preferred over CPAP
CPAP is better for obstructive sleep apnea
Describe an aerosol mask
Used to give meds
Controls amount of air 10-12L/min
Describe a venturi mask
Draws air into the space with a narrowed orifice
Considered high flow
Describe a non rebreather mask
Allows for delivery of higher concentrations of oxygen
Patient must be able to breath unassisted
When might nasal cannulas not be suitable
During acute exacerbations of COPD
Define tachypenia
Greater than 30 breaths per minute
What are some SS associated with respiratory or metabolic acidosis
Mental status change
Hyperkalemia
What are some SS associated with respiratory or metabolic alkalosis
Neuromuscular excitability
Hypokalemia
What are some SS associated with acidosis or alkalosis from caused by metabolic reasons
GI disturbances
What are the normal lab values to look out for what they mean when they are abnormal when identifying metabolic and respiratory acidosis and alkalosis
PH - A (7.35-7.45) B
Co2 - B (35-45) A
Bicarbonate - A (22-26) B
How do you treat respiratory acidosis
Improve ventilation
Intermittent positive pressure breathing
Postural drainage
How do you treat respiratory alkalosis
Sedation
Voluntary breath control
Change mechanical ventilation
How do you treat metabolic acidosis
Treat cause of acid accumulation
Give bicarbonate
Give insulin
Dialysis
How do you treat metabolic alkalosis
replace fluid loss
Give K or Cl as needed
Stop suctioning
Give acid substance
Describe inspiratory muscle training
Strengthens the inspiratory muscles
Makes it easier for people to breathe
What diagnoses will benefit from inspiratory muscle training
Asthma
Bronchitis
Emphysema
COPD
Describe expiratory muscle training
patients forcefully expire into a device
Strengthens expiratory and submental musculature
What factors determine diffusion rate
Pressure gradient and solubility
What are normal lung PFT values
FEV1 = 4L
FVC = 5L
Fev1 / FVC = .75 - .8
What are PFT values for Obstructive lung disease
FEV1 = 1.8L
FVC = 3.4L
Fev1 / FVC =
What are PFT values for restrictive lung disease
Fev1 - reduced
FEV - reduced
Fev1/ Fev = > .80
How do you improve ventilation perfusion with patient positioning
Have the patient lay on the ipsilateral side
How do you progress patients in rehab
Increase reps / time then load / intensity
Describe some symptoms of left sided heartfailure
Dry cough
Fatigue
Pulmonary rales
Describe some symptoms of right sided heart failure
Dependent edema
Jugular distension
Increased right atrial pressure
Peripheral effects
Describe cor pulmonale
Pulmonary HTN secondary to pulmonary diseases
Can cause right ventricular hypertrophy and heart failure
What is TV
Tidal volume
Air moved at rest
What is IR
Inspiratory reserve
Max amount inhaled above tidal
What is ER
Max amount we can exhale below tidal
What is RV
Residual volume
Amount of air left in the lungs below, expiratory reserve
What is TLC
Total lung capacity
Combination of all 4 volumes
What is IC
Inspiratory capacity
Tidal and inspiratory reserve
What is FRC
Functional residual capacity
expiratory reserved and residual
What is VC
Vital capacity
Expiratory reserve, inspiratory reserve, tidal volume
What conditions would present with bronchophony
Pneumonia
Atelactasis
What are the contraindications for postural drainage
CHF Pulmonary edema Raised ICP Airway aspiration Unstable head or neck injury
What are the contraindications for percussion
Bleeding disorders Rib fractures Flail chest Osteoporosis Open wounds and surgery Pneumothorax Pregnancy