HW/Worksheets/Lab Flashcards
Right upper lobe drainage
Sitting up, reclined slightly
Right middle lobe drainage
elevate foot 30cm/12in
laying on left side
Right lower lobe drainage
elevate foot 50cm/20in
laying on left side
Left upper lobe, superior drainage
sitting with shoulders rounded, bent slightly over
Left upper lobe, inferior drainage
elevate foot 30cm/12 in
laying on right side
Left lobe drainage
elevate foot 50 cm/20in
lay on right side
Physical Exam of Pulmonary Pt
- Pt history
- Physical exam
- Inspection (especially around fingers, lips, respiratory pattern)
Tracheal, Bronchial Sounds
loud, tubular sounds
between scapulae or on trachea
Vesicular Sounds
soft, rustling sounds that are heard over more distal airways and lung parenchyma
CTA
clear to auscultation
Abnormal Breath sounds
heard outside their usual location or if they are quantitatively different from normal breath sounds or absent
Bronchial abnormal
fluid or secretion consolidation
Decreased or diminshed sounds
hypoventilation, severe congestion, emphysema, obesity
Absent sounds
pneumothorax
Adventitious sounds
wheeze
rhonchi
stridor
Crackles
bubbling or popping sounds that represent the presence of fluid or secretions, or sudden opening of a closed airway
discontinuous sounds
Wheeze
airway obstruction from bronchoconstriction or retained secretions
heard on expiration
Rhonchi
low pitched or snoring sounds that are continuous
large airway obstruction
Stridor
extremely high pitched wheeze that occurs with significant upper airway obstruction, present during both inspiration and expiration
medical emergency!
Extrapulmonary
dysfunction outside of the lung tissue
pleural friction rub
loud grating sound
both inspiration and expiration
Transmitted voice sounds
Whispered pectoriloquy (1, 2, 3)
bronchophony (99)
egophony (e to a)
Sounds from mediate percussion
Resonant = normal
hyerresonant, tympanic, dull, flat
Pulmonary Function Tests assess
- how much air volume can be moved in and out of lungs
- how fast the air in the lungs can be moved in and out
- how stiff are the lungs and chest wall
- diffusion characteristics of the membrane through which gas moves
- how the lungs respond to chest physical therapy
PFTs are used for
Screening for presence of obstructive or restrictive disease
evaluating pt prior to surgery
eval the pts condition for weaning from ventilator
progression of disease
effectiveness of intervention
FVC
Forced Vital capacity
volume of air which can be forcibly exhaled out of lungs
FEV1
forced expiratory volume in one second
volume of air which can be forcibly exhaled from lungs in one second
FEV1/FVC
FEV1 percent, ratio of FEV1 to FVC
only relevant if FEV1 and FVC are abnormal
PEFR
peak expiratory flow rate
max flow rate achieved during the forced vital capacity maneuver beginning after full inspiration and starting/ending with max expiration
shows if treatment is improving obstructive diseases
FEF
Forced expiratory flow
measure of how much air can be expired from the lungs
flow rate measurement
What does pursed lip breathing do?
releases air trapped in lungs
allows new air to enter lungs
slows breathing rate
relieves shortness of breath
causes relaxation
Diaphragmatic Breathing
helps you use diaphragm correctly
strengthen the diaphragm
decrease the work of breathing by slowing breathing rate
decrease O2 demand
use less effort and energy to breathe
Sleeping and PaO2
70 to 85 mmHg
Assuming the individual is laying on their side, blood flow will follow the path of gravity. Side-lying causes the blood to flow mainly to the lung on the side the individual is lying on. There will be little blood flow to the opposite lung. In this position, one lung is doing most of the perfusion and ventilation, because of the increased blood flow. PaO2 levels drop because you are using essentially one lung in contrast to two when you are sitting upright.
During normal breathing, which position allows the diaphragm to have the greatest excursion?
Having an individual in supine allows for the diaphragm to expand as much as possible.
During normal breathing, which position allows the largest change in lung volume to occur?
When an individual is sitting, the largest change in lung volume occurs.
What are the four main categories of the physical therapy examination of the patient with an
acute exacerbation of COPD
Observing breathing patterns
Strength and endurance testing of respiratory muscles
Auscultation of the lungs
Walk test while observing pulse oximetry levels
How does noninvasive positive pressure ventilation (NIPPV) such as BiPAP during exercise
training improve exercise duration and dyspnea?
NIPPV helps to push air into the lungs, or helps with the ventilation portion of breathing. This decreases the amount of work the respiratory muscles have to complete. Because the muscles aren’t working as hard, this decreases oxygen demand for the respiratory muscles, and helps them in turn to work more efficiently.
