Module 2 Flashcards
Respiratory function:
where does oxygen come from and where does it go
…
blue blood /red blood (vein/artery)
Our heart sends blood that has circulated body to the lungs via?
blood is oxygenated in the lungs from the ?
oxygenated blood is then sent back to heart via ?
the … connection
pulmonary artery
oxygen filtered through alveoli
veins driven throughout the body
cardiac and respiratory connection
Oxygen levels in the blood:
measured with ?
measures the ? that is ?
normal oxygen saturation levels are approx.
pulse oximetry measurements can be ?
-a blood draw from an artery can be done to check ?
pulse oximetry (SpO2 -saturation of peripheral oxygen)
hemoglobin (a protein in the blood carries oxygen) saturated with oxygen in blood
93-100% (can vary)
inaccurate
-blood gasses (ABG-arterial blood gas0
What if body’s oxygen levels are low:
blood is not able to ?
body begins to try to ?
the respiratory rate ?
- normal range is different for
- check monitor to see
- be on look out for ?
tachypnea -
begin to see ?
send enough oxygen to organs to maintain function
compensate
increases (Normal 12-20 breaths per minute)
- infants/children
- patient’s baseline
- changes with intervention (swallowing)
- rapid shallow ineffective breathing
- cyanosis (see deoxygenated hemoglobin)
Resp. rates in infants/children: newborn: infant: toddler: preschoolers school age adolescent
30-60 breaths pm 30-60 24-40 22-34 18-30 12-16
Supplemental oxygen:
want to give the least amount of ?
delivered in amount measured in ? or ?
conversion : one litre of flow per minute equals ?
about. .. is O2 content of room air
- if a patient is on 1 litre of oxygen per minute, the air contains ?
-if patient is on 4 litres of oxygen per minute, the air contains about ? oxygen
supplemental oxygen as possible
-litres or percent
- 3-4% of room air
- 21%
24%-25% oxygen
33% (21+2) -37% (21+16) oxygen
Type of delivery method supplemental oxygen: -.. ... mask -high flow non - - intubation with
nasal cannula (NC O2) oxygen mask (face or trach) nasal cannula non-re-breather mask -BiPAP CPAP ventilation
Respiratory Distress/Code Blue: absent -significantly increased ? -patient may require a change in the ? potentially? patient may require ?
respiration
- respiratory rate
- respiratory support they are recieving/ increase in level of suppl. oxygen being provided
- intubation or to be placed on ventilator
Diseases of lungs: Chronic obstructive pulmonary disease - - -
emphysema
chronic bronchitis
chronic damage from asthmatic bronchitis
COPD: one of leading causes of lung disease that blocks? and leads to impaired ? no ? eventually, results in ?
death wordlwide
airflow /gas exchange of oxygen and carbon dioxide
cure
death
Impact on swallowing/phonation:
any abnormality in respiratory system can negatively ?
period of apnea during ?
voice production is powered by ?
impact swallowing or voice function
swallow (.5-3.5 seconds)
exhaled air
Dysphagia in COPD: deficits with coordination of ? reduced tolerance for the ? generalized ? xerostomia: -.. breathing -... oxygen -respiratory ?
timing of respiration/swallow:
- post-swallow ?
- risk of ?
respiration and swallowing
-apneic event that occurs with swallow
fatigue/reduced endurance
mouth
supplemental
medications/breathing treatment
respiration/swallow
- inspiration -especially on sequential sips
- aspiration on inspiration immediately upon completion of swallow
pneumonia:
infection in
caused by?
there are more than?
one or both of lungs
- bacteria, viruses or fungi
- 30 diff. types of pneumonia
Pneumonia:
aspiration pneumonia: is only ?
-bacteria from material that has ?
often but not always occurs in ?
one type of pneumonia
- entered into lungs is cause
- right lower lobe of lung
Mainstem bronchi: right bronchus: -.. long -more in line with -enters lung opposite the orifice is -foreign bodies tend to enter the ? as it is in line with
left bronchus: ... long less in line with enters lung opposite to orifice is foreign bodies less likely to ?
- 5 cm
- trachea
- t5
- larger
- right bronchus - inline with trachea
5 cm trachea T6 smaller enter left bronchus
Aspiration pneumonia: clinical signs of aspiration -low grade -changes in -change in *** may take up to ?
not all aspiration is created ? -... aspiration - - -.. contents -... feeds
fever - may initially present approx. 30 minutes after aspiration event
- lung sounds (no longer clear)
- chest x-ray ( 24 hours to manifest depending on pt’s hydration status)
equal
- prandial vs. postprandial aspiration
- food
- liquid
- gastric contents
- tube feeds
The heart circulation:
.. chambers
-2
-2
the atrium and ventricle are separated by
4 chambers
- 2 upper (atria)
- 2 lower (ventricles)
1 way valve
Right atrium
receives … that is returning back to heart from ?
blood is sent to the right atrium via the ?
pumps blood through the
used blood / tissues throughout body (blue-deoxygenated)
superior and inferior vena cava
tricuspid valve, to right ventricle
Right ventricle:
blood that is sent to the right ventricle from the right atrium is pumped to lungs via ?
-deoxygenated blood in an artery ??
pulmonary artery
yes
left atrium:
blood is returned to heart into the ? from the lungs via the ?
oxygenated blood in a vein?
left atrium/ pulmonary veins
yip
Left ventricle:
oxygenated blood is pumped out of the ? to provide all tissue with
the force generated is ?
systolic blood pressure: the amount of force generated on the ?
left ventricle / oxygen
120mm of Hg
-walls of arteries when heart beats
Myocardial Infarction: also called interruption of ? due to ? can cause death of? leading to ? .. can result need for ? ...
heart attack
blood flow to heart muscle itself/ blockage of blood flow to one or more of coronary arteries
muscle fibers / permanent damage to heart
abnormal heart rhythm
sten placement, angioplasty, coronary artery bypass graft
death
Heart beat rhythm: controlled by ? sent along ? ... the pacemaker of the heart aka... the rate that the electrical impulses are sent out from the SA node= -when this is normal it is called can be seen on an ?
electrical messages/ tiny fibers located near top of right atrium and along back wall of heart
sinoatrial node (SA node) -coordinates heartbeat
rhythm
sinus rhythm
ECG
Heart rhythm: normal sinus rhythm: abnormal heart rhythms atrial - most common to ventricular ? ventricular ?
60-100 BMP for adults measured by electrocardiogram
atrial fibrillation (Afib) most common to arrhythmia
tachycardia (V-tach)
fibrillation (V-fib)
Abnormal heart rhythms: atrial fibrillation (A-fib) -... heartbeat involving the ? the most common causes are ? can cause the formation of ? increases risk of ?
ventricular fibrillation (V-fib) ... heartbeat - involving the the most ? causes include ? the heart cannot? leads to ?
irregular - atria
abnormal heart rhythm
-varied and sometimes unknown
-formation of blood clots/ stroke risk
irregular/ quivering - ventricles
serious heart rhythm abnormality
MI, sepsis, cardiomyopathy, inadequate blood flow to myocardium
pump blood - leads to cardiac arrest
Heart valves:
can fail to function by not?
-
-
causes of valve dysfunction include: - ... abnormalities .... -... disease ... cholesterol -.... abuse .... fever
abnormal valve function can result in
bacteria can grow on?
-this can result in ?
dental cleanings:
opening and closing appropriately
- regurgitation (leaking)
- stenosis (narrowing)
congenital abnormalities age heart disease high cholesterol IV drug abuse rheumatic fever
heart failure and heart enlargement
diseased heart valves
- bacterial endocarditis - life threatening infection
- antibiotic prophylaxis
Coronary arteries: nourish the ? attach to and ? ... disease narrowing of the ? due to ?
heart muscle (myocardium) itself
-wrap around the surface of the heart
coronary artery disease (CAD)
coronary arteries / plaque build up results in lack of oxygen to the heart muscle itself
Dysphagia following CABG: etiology of dysphagia ? -neurological -impaired function of -laryngeal changes following
dysphagia symptoms are similar in patients who undergo?
likely varies
changes (small brainstem infarct - not detected on MRI)
recurrent laryngeal nerve
intubation (ETT tube)
thoracotomy for lung resection and lung transplant, as well
Congestive heart failure (CHF):
scarring and weakening of the ? results in decreased ability of the heart to ?
the blood then backs up and creates ?
some of the blood’s fluid component ? and results in?
myocardium (heart muscle) contract with enough force to push out needed volume of blood
pressure in lungs and other organs where blood is coming from
leaks through walls of small blood vessels/ swelling or edema of tissue
CHF:
the liver and kidneys that filter blood cnanot
organs receive less
-the back pressure of blood in the heart itself causes the chambers of th eheart to ?
ventricular muscle ? causing heart to ?
the enlarged heart requires more ? and thus this results in ?
heart rate ?
what can also result
work efficiently oxygenated blood - dilate -thickens in attempt to compensate/ enlarge oxygen/ more damage increases to try to compensate abnormal heart rhythm
CHF patients can experience ? -patients often experience difficulty ? lungs fill with ? wet lungs and poor circulation allows for ? death by CHF results from ?
shortness of breath (SOB)
- breathing in supine position because they need to be upright to help fluid drain from lungs
- fluid (pulmonary edema)
- growth of bacteria - can result in pneumonia
- drowning in fluid
COVID:
conditions due to COVID
-
-
-
pneumonia
MI (due to blood clotting issues)
intubation/ventilator support
COPD
CHF
What is Respiratory Muscle Strength Training:
the process of building strength within ?
inspiratory muscle strength training:
-
-
-
-
muscles and muscle groups that control respiration
-diaphragm
external intercostal muscles (raise ribs for inspiration)
abdominals
internal intercostal muscles (assist in rib depression for expiration)
supralaryngeal (suprahyoid)
Addressing the common dys
dystussia
dysphonia
dysphagia
dyspnea
What’s the goal of RMST:
increase the ?
improve the function of ? through?
force generating capacity of inspiratory or expiratory muscles
respiratory muscles/ specific though not task specific exercise
-
-
voice (reduced glottic closure)
swallowing function
cough strength
cough: a mechanism that protects the pulmonary system by ? a cough is comprised of three steps: 1. 2. 3.
EMST- targets
generating expiratory flows to create a scrubbing action to remove material from airway
inspiration
closure of VFs (generates subglottic pressure)
forced expiration
cough strength
Inspiratory Muscle strength training: vocal cord ? impaired ? -.... cystic -ventilator ....
dysfunction true vocal fold movement (bilateral) resulting in airway issues (reduced subglottic space) -COPD -cystic fibrosis -weaning Myasthenia gravis
Why focus on respiratory muscles ?
age related ? along with reductions in ?
respiratory muscle strength decreases in elderly with ?
lack of physical exercise accelerates ?
reported that EMS is reduced more than ?
-due to reductions in ?
loss of muscle strength, sacropenia / elastic recoil and chest wall compliance decreases intrathoracic airway pressure as well as expiratory flow rates and velocity
muscle fiber atrophy by approx. 20% by age 70
reduction in respiratory muscle force generation
inspiratory muscle strength
-muscle fiber cross sectional area of expiratory muscles
How does training work?
muscle overload:
.. of either maxium expiratory pressure or maximum inspiratory pressure
overall typically less intrathoracic intracranial pressure than produced during?
muscle overload
high freq. high resistance
70-75%
bowel movement
Measurement
force of expiration or inspiration measured in ?
displacement of ? notated
centimeters of water
water
cm H20
Pressure generation -safety
when there is concern regarding safety consider other ?
speech
cough
bowel movement
pressures generated
5-10 cm H20
100-200
200-300
Rehabilitative/restorative treatments: increase or maintain improve or maintain increase or decrease improve or maintain improve ...,...,... -adaptations -adaptation
muscle strength range of motion muscle tone maintain coordination of structures endurance
plasticity, plasticity, plasticity
- central adaptations
- peripheral adaptations
Skeletal muscle tissue: plasticity
performance ?
.. changes
…changes
performance (behavioural) changes
muscle changes
CNS changes
What changes?
neural changes:
peripheral -
central -
cortical -
-
level of motor unit
level of spinal cord or brainstem (sensory nerves)
cortical map area (synapses, etc)
muscular hypertrophy
fiber type changes
Neural changes:
neural changes occur … than muscular changes
endurance training results in increased ?
increased ?
cortical mapping adaptations in ?
earlier
increased blood flow and angiogenesis with motor cortex
muscle activation
sensory nerves, cortical thickness, and angiogenesis
Myogenic changes:
increase in ?
oxidative capacity refers to the muscles?
skeletal muscles are made of both ?
-slow:
-fast:
all muscles have a ?
RMST stimulates ?
oxidative capacity in trained muscles
-maximal capacity to use oxygen in micrometers of O2 per gram per hour
slow twitch or fast twitch muscle fibres
-slow to contract but very resistant to fatigue (posture)
-fast to contract with great force, but prone to fatigue (cough)
combination, depending on function
fast twitch resulting muscular enlargement or hypertrophy
Studies that show the effects of EMST on ?
stroke MS ALS PD sedentary elderly Head and neck cancer
EMST and swallow:
activation of ?
this may result in changes in the activation of ?
associated with ?
submental swallow muscles with EMST device
sensory system which triggers swallowing
significant decrease in the penetration or aspiration during sequential swallow tasks
wet swallow: EMST
dry swallow: EMST
25%
75%
CVA:
aspiration pneumonia most common cause of death
acute: subacute: PNA #1 cause of ? Associated with ? both cough and swallow impairments? EMST hypothesised to improve ?
post CVA
40-80%
11-25%
readmission up to 5 years
worse overall outcomes
common post CVA
strength and coordination of expiratory and submittal musculature
EMST impact on swallowing function:
evaluated with?
feasibility study to determine swallowing-related patterns of palatal and pharyngeal muscle activity can be detected during EMST
swallowing related muscle activity during EMST:
increased ?
-… activity
-… activity
submental EMG patterns:
activity was ? however, may have corresponded with ? further ?
high resolution manometry and electromyography
EMG activity with increased expiratory load
- palatal activity
- pharyngeal activity
detected/ mouth posturing and prep for task (meg influenced by jaw movement, tongue protrusion, posturing)/ study needed
EMST
… device
calibrated ?
load is set at ?
targets ?
pressure-threshold device
one way, spring-loaded valve
75% of MEP
muscles of expiration
EMST - low threshold device
threshold PEP ?
threshold range
positive pressure device
5-20 cm
training program EMST 5 sets of in ? how many days a week increase device threshold level by ? as tolerated
5 breaths (25)
-in one sitting, once per day
5/7 days a week
1/4 turn after each week of training
Application for patients following total laryngectomy:
..management
loss of ?
can we improve the ?
secretion management
filtration, humidification of inhaled air
the pump ?
Inspiratory muscle strength training:
the PCA is the principle ?
there is a temporal relationship between the ?
activation of the diaphragm has a ? stimulation of the diaphragm activates
abductor of the vocal cords
inspiratory phase of the respiratory cycle and PCA activation
synergistic effect - stimulation of the diaphragm activates the antagonist muscles
COVID-19
IMST use after ?
inspiratory muscle training for recovered COVID-19 patients after
conclusion:
a 2-week IMT improves ?
IMT program should be encouraged in? specifically with
ventilator weaning
weaning from mechanical ventilation
pulmonary functions, dyspnea, functional performance, and QOL in recovered intensive care unit
COVID-19 management protocol, specifically with ICU patients
Determining the device setting:
formal measurement of
EMST
-maximum
IMST
maximum
Maximum expiratory pressure (MEP)
inspiratory pressure (MIP)
What if I don’t have a manometer to determine MEP and or /MIP
... for setting the device -not too -not too -start at a ? have patient increase by back off by
low tech easy difficult low setting/blow into device 1 turn until unable to activate valve 1 turn
-
-
both
aspire
the breather
powerlung
expiratory and inspiratory training
contraindications for RMST:
COPD:
mild to moderate cases: keep device setting at ?
close ?
HTN?
…
possibly ?
ALWAYS discuss ?
50% of maximum pressure
monitoring
uncontrolled
hernia
post-operative patients (lung resection)
RMST with physician prior to intiiating use
RMST is NOT a one size fits all
adjustments may include: .... for patient -more adjust more training on
more ? of caregiver
clinician judgment re:
combination with ?
more/less intensive training for patient days with therapist mouthpiece weeks use of device itself
involvement and training of caregiver
EMST versus IMST versus both
compensatory or other restorative behavioural swallow therapeutic technique
How long to complete training: The rule of ?
detraining:
skeletal muscle will?
however respiratory muscle gains remain ?
neuroplasticity
use it or lose it
return to pre-training levels within 1 month of exercise cessation
significantly higher than pre-training levels up to 8 weeks after training cessation
