Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonary Final > Obstructive > Flashcards

Obstructive Flashcards

1
Q

Obstructive Disease

A
  • An expiratory impairment
    • Expiratory volumes increase
      • May progress to decreased inspiratory volumes (only so much space in lungs)
    • difficulty getting rid of air
    • retained secretionw
    • inflammation of musosal lining of airway walls
    • bronchi constriction
    • weakening of support structure of airway walls
    • low flattended diaphragm
    • horizontal ribs
    • elevated shoulder girdle
    • barrel shaped thorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes

A

Increased resistance to airflow (i.e. lumen obstruction from various causes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

S/S

A

Tachypnea, dyspnea, decreased and/or adventitious breath sounds, chronic (potentially productive) cough, and characteristic musculoskeletal changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chronic Alveolar hypoxemia

A

Chronic alveolar hypoxemia → pulmonary vasoconstriction → pulmonary hypertension

•Manifested as cor pulmonale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Common pathologies

A
  • Asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease (COPD), bronchiectasis, and cystic fibrosis (CF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why might breath sounds be reduced in obstructive diseases given the pathology typically affects expiration?

A
  • air becomes trapped in lungs
  • inc residual and ERV
  • some portions may have to mcuh air in them at rest
  • so when inspire normal breath, might not be able to move air into lungs because might already be inflated with trapped air
  • would then hear “decreased” breath sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Obstructive Disease- CXR:

A
  • Hyperinflation (with flattened diaphragm)
  • Radiopacities(appear white) reveal regions with retained secretions

—Benefit of cough instruction?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Obstructive disease- PFTs:

A
  • Increased lung expiratory volumes
  • Decreased lung inspiratory volumes with worsening obstructive disease
  • Decreased (ratio < 75‐80%) FEV1 / FVC ratio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Asthma:

A
  • Hyperirritability of the tracheobronchial tree (can trap air from inc resistance)
    • Results in bronchospasm, inflammation of the bronchioles, and excess mucous secretion
    • Causes increased resistance to air flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Asthma- Precipitating factors

A
  • Respiratory infection
  • Irritants
  • Allergens
  • Stress and / or exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Asthma- Diagnostic findings

A
  • CXR consistent with hyperinflation with acute exacerbation; otherwise normal
  • PFTs consistent with obstructive disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Asthma- Hallmark S/S

A
  • Wheezing or diminished / absent breath sounds
  • Hyper‐resonant with mediate percussion (air trapping)
  • Prolonged expiratory phase
  • Increased use of accessory muscles
  • Dyspnea
  • Cough (with or without sputum)
  • Cyanosis
  • Retractions (intercostal spaces pulling in rather than out with chest wall)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Asthma- PT

A
  • Airway clearance
    • Bronchospasm considerations: cough versus huff
  • Breathing exercises
    • Primarily PLB and diaphragmatic
  • Activity / exercise
    • Tolerance
    • Ensure availability of rescue inhalers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Benefits of Exercise in Patients with Asthma

A
  • Aerobic training at moderate to high intensity
    • 20 minutes, 2 times/week, minimum of 4 weeks
    • Contraindicated during acute exacerbation
    • Include warm‐up to reduce risk of exercise induced bronchospasm
  • In the asthma population, exercise improves:
    • Quality of life
    • Cardiopulmonary fitness, but does not improve lung function
  • In the asthma population, exercise reduces:
    • Incidence of exacerbations
    • Reports of dyspnea and anxiety during activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chronic Bronchitis

A
  • Chronic inflammation and swelling of bronchial mucosa (scarring of mucus membrane)
    • Leads to hypersecretion of bronchial mucous given hyperplasia of mucous glands
    • Creates irreversible lung damage given scarring of mucous membranes
    • Results in dilation of alveoli

***Associated with recurrent productive cough for at least 3 consecutive months for 2 consecutive years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Chronic Bronchitis- Primary causes

A
  • Smoking
  • Repeat airway infections
  • Environmental and/or chemical irritants

***blue bloatter

17
Q

Chronic Bronchitis- Diagnostic findings

A
  • CXR consistent with mucous secretion; CXR not used diagnostically but rather to rule out other pathologies
  • PFTs consistent with obstructive disease
    • FEV1 < 65% of predicted value
    • FEV1 / FVC ratio < 70%
  • ABGs consistent with hypoxemia and hypercapnia
18
Q

Chronic Bronchitis: Hallmark Signs and Symptoms

A
  • Cyanosis and barrel chest deformity (“blue bloater”)
  • SOB
  • DOE
  • Orthopnea and PND
  • Crackles and wheezes
  • Tachypnea
  • Chronic productive cough
  • Peripheral edema (if progressed to R‐sided heart failure)
19
Q

Chronic Bronchitis- PT

A
  • Airway clearance
  • Breathing exercises– Primarily PLB and diaphragmatic
  • Activity / exercise– Tolerance and Determine parameters of safety (HR & O2 sat)
20
Q

Hypoxic Drive- Obstructive disease Consideration

A
  • Consequence of retained CO2
  • Chronic hypercapnia blunts sensitivity of central chemoreceptors to detect changes in CO2
    • Body fails to naturally increase respiratory rate to eliminate CO2 excess central chemorecepors on overload)
    • Drive to increase respiratory rate therefore stimulated by peripheral chemoreceptor detection of hypoxemia
  • Impact of supplemental oxygen administration in setting of hronic hypercapnia
    • May improve hypoxemia
      • Without ongoing hypoxemia, body fails to increase respiratory rate to address hypercapnia (negative feedback loop: peripheral chemoreceptors detect sufficient oxygen and fail to stimulate spontaneous increase in respiratory rate or depth)
    • Often results in difficulty with supplemental oxygen weans
  • Common for SpO2goal to be ≥ 88%
21
Q

Emphysema

A
  • Destruction of elastic fibers surrounding the alveoli given deficiency of alpha 1‐antritrypsin
    • Decreased number of alveoli
    • Increased size of alveolar sac and ducts, thereby reducing elastic recoil
    • Overall reduced surface area for gas exchange

***dec elastic strength, lost structure and recoil

  • air trying to get out and pushes walls with it
  • over inflated (ribs and tissue change shape)
22
Q

Emphysema- Primary Causes

A
  • Genetic predisposition (hereditary alpha 1-antitrypsin deficiency)
  • Smoking
  • Environmental (occupational) exposures
23
Q

Emphysema- Diagnostic Findings

A
  • CXR consistent with hyperinflation (mucous not common)
  • PFTs consistent with decreased FEV1 and FEV1 / FVC ratio
  • ABGs consistent with slight hypoxemia
24
Q

Emphysema- Hallmark S/S

A
  • “Normal” coloration (“pink puffer”)
    • dont lack O2. Cant exhale. Pursed lips keeps airway open a little longer to get more air out
  • Tachypnea
  • Increased WOB with pronounced accessory muscle use
  • SOB
  • Significant DOE
  • Thin (no barrel chest deformity
  • Wheezes
  • Typically without a cough
25
Q

Emphysema- PT

A
  • Breathing exercises
    • Primarily PLB and diaphragmatic
  • Activity / exercise
    • Tolerance
    • Determine parameters of safety

***inc O2 might dec drive to breath

26
Q

COPD

A
  • Pathologic alveolar and airway changes resulting from inflammatory responses to noxious particles or gases
    • Partially reversible (treatable); preventable
  • Typically reflects components of both chronic bronchitis, emphysema, and asthma
    • Most commonly a manifestation of chronic bronchitis
  • Mucous production causes chronic and productive cough
  • Additional findings consistent with right‐sided heart failure
27
Q

Benefits of Pulmonary Rehabilitation in Individuals with COPD

A
  • In the COPD population, pulmonary rehabilitation improves:
    • Quality of life
    • Activity and maximal exercise tolerance –how?
      • Not through improved lung function but instead through improved skeletal muscle and heart function
  • In the COPD population, pulmonary rehabilitation reduces:
    • Frequency of hospitalizations
    • Reports of dyspnea
28
Q

Bronchiectasis

A
  • Results from a necrotizing infection that destroys the muscular wall and elastic components of the bronchus
    • Destroyed regions become fibrotic
    • Changes predispose individual to repeat infections
  • Results in irreversible dilation of the bronchi
    • Dilated bronchi accumulate mucous (mucopurulent sputum)
    • Mucous leads to bronchospasm
  • Antibiotic management has lessened incidence in general population
    • Most typically seen in individuals with CF
  • Airway clearance and exercise represent primary PT interventions
29
Q

Cystic Fibrosis

A
  • Genetic, autosomal recessive trait
    • Caucasian > non‐white
    • Equal gender distribution
    • Noncurable, but now with expanded treatment options and earlier detection
      • Diagnosed by sweat test, genetic testing, and stool sample
  • Impaired transport of chloride ion across membranes leading to hypersecretion of abnormally thick mucous
    • Creates mucous plugging and chronic respiratory infections
    • Greatest impact on small conducting airways which causes air trapping
30
Q

Cystic Fibrosis- Diagnostic findings

A
  • CXR consistent with hyperinflation and secretion retention
  • PFTs consistent with decreased VC, increased FRC, and decreased FEV1
31
Q

CF PT

A
  • Airway clearance
  • Breathing exercises
    • Primarily PLB and diaphragmatic
  • Activity / exercise
    • Tolerance
    • Posture education

Pulmonary Final (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions