Hypertension and COPD

Question 1

Describe normal and abnormal breath sounds, such as crackes and wheezes.

Answer 1

• normal breath sounds: tracheobronchial (trachea), bronchovesicular (carina, mainstem) and vesicular (all lung fields)
• crackles (fine- inspiration vs coarse-expiration), discontinuous sounds, rice krispies or dry leaves
• wheezes (low pitched vs high pitched), continuous sounds, more commonly heard on expiration but can be both, snoring or high pitched whistle

Question 2

With COPD, dysfunctional cilia make clearing secretions difficult if not impossible. What generation is it necessary to clear secretions to make respiration easier?

Answer 2

The 6th generation.

Question 3

What do MIP and MEP measure?

Answer 3

Maximum ventilatory muscle strength.

Question 4

What 3 measures are important in telling if there is a gas exchange problem?

Answer 4

1) SpO2
2) PaO2
3) PaCO2

Question 5

With a cardiovascular pump dysfunction, there usually abnormal vital signs and/or changes such as a flat response to activity. People can also experience decreases in HR and BP with increased workload. What are other lab measure that can identify dysfunction?

Answer 5

EF normal
>1-2 mm ST elevations or depressions
Angina
Onset of ventricular extopy with > workload (>7 PVCs per minute)

Question 6

24-48 hours of bedrest can lead to deconditioning, though the normal person wouldn’t notice because they have enough functional reserve. What other sign signal deconditioning?

Answer 6

Exaggerated vitals: > than expected increase in HR, BP, RR, RPE, DOE with workload.

Question 7

What are the signs of peripheral ischemia?

Answer 7

Claudication with ambulation
ABI < 0.5

Question 8

Describe four pathological types of ventilation: adeventitious sounds, purse lip breathing, collateral ventilation and effect, non-productive coughing.

Answer 8

ADVENTITIOUS SOUNDS
-added sounds not natural to the lung
-crackles, pleural friction, etc.

PURSE LIP BREATHING
-in through the nose, out through the mouth
-increased expiratory pressure allowing more time for gas exchange to occur

COLLATERAL VENTILATION
-When neighboring alveoli help facilitate gas exchange
-happens when there is an obstruction

EFFECTIVE, NON-PRODUCTIVE COUGH
-no airway clearance problem
-he can get things out, but there is nothing there

Question 9

On a resting EKG, what are ST depression indicative of?

Answer 9

Ischemia and angina.

Question 10

What is %MVV? What is RER?

Answer 10

%MVV
-maximal voluntary ventilation
-max in and out breath test

RER
-respirator exchange ratio
-CO2/O2, <1 at rest, diet dependent (0.8)
-increases to about 1 with activity due to increased CO2 production
-1.2-1.5 is max exercise test

Question 11

What are the most important impairments in a patient with emphysema, and what are you going to treat (based on patient in deck)?

Answer 11

IMPAIRMENTS
-Endurance (decreased VO2)
-Posture (from exam)
-Ventilatory pump (increased A/P diameter)
-Decreased muscle strength
-Gas exchange problem (decreased SpO2)
-CV pump problem (ST depression)

TOP IMPAIRMENTS TO TREAT
-muscular strength (most economical change), benefitting:
-CV Pump
-Vent Pump
-Gas exchange