Obstructive and Restrictive Lung Disease

Question 1

obstructive lung disease characterized by…

Answer 1

airflow obstruction
increased airway resistance
often effects expiratory flow rate

Question 2

restrictive lung disease characterized by…

Answer 2

reduced lung compliance
reduced thoracic compliance
often affects inspiratory volume

Question 3

obstructive lung diseases

Answer 3

chronic bronchitis
emphysema
bornchiectasis (asthma)

Question 4

restrictive lung diseases

Answer 4

interstitial lung disease

idiopathic pulmonary fibrosis (IPF)

Question 5

what is the primary risk factor for COPD

Answer 5

smoking

obstructive is the 3rd leading cause of death in the US

Question 6

COPD radiograph characteristics

Answer 6

flattened diaphragm
hyperinflated lungs due to air trapping
enlarged hart with enlarged right ventricle
barrel chest

Question 7

obstructive lung disease: potential consequences

Answer 7

destruction of lung tissue resulting in emphysema
inflammation of the airways
pulmonary hypertension
hypoxemia
dysrhythmias
sleep disorders
repeated infections
build up of secretions
polycythemia
adaptation to chronically low O2
sluggish blood flow
right HF
resistance to air flow - increased work of breathing
normal or increased lung capacity

Question 8

chronic bornchitis

-Dx

Answer 8

greater than 3 months of productive cough most days in at least 2 consecutive years

Question 9

chronic bornchitis

-causes

Answer 9

irritation of the bronchial tree
-risk factor: smoking or exposure to smoke
genetics
exposure to particles
-enviornmental hazards
-occupational dust
-indoor air pollution
-outdoor air pollution
-respiratory infections
-apha 1 antitrypsin disorder

Question 10

S/S of obstructive lung disease

Answer 10

secretion production
reduced cilia action leading to build up of secretions and bacteria
repeated infection, pneumonia
hypoxemia < 90% SaO2 or < 55 mmHg PaO2
hypercapnea
chronic cough
poor exercise tolerance
increased work of breathing
finger clubbing

Question 11

emphysema - end stage COPD

-definition

Answer 11

abnormal, permanent increased size of air spaces distal to terminal bronchioles by the destruction of alveolar walls

Question 12

emphysema - end stage COPD

-consequences

Answer 12

alveolar destruction
over-inflation of the lungs
lungs cannot empty (expiration)
emphysematous bullae
chronic hypoxia and hypercapnea

Question 13

emphysema - end stage COPD

-surgical Rx

Answer 13

potential for lung reduction surgery

Question 14

restrictive lung disease

• what happens?
• causes

Answer 14

decreased expansion of the lung
decreased total lung capacity
hypoxemia
examples
-disease of pleura (pneumothorax)
-disease of chest wall (kyphoscoliosis, obesity)
-extrapulmonary mass restricting expansion of lungs

Question 15

restrictive lung disease

-due to?

Answer 15

stiffening of the lung tissue preventing expansion
structural limitations preventing lung inflation
-ex.: ankylosing spondylosis, kyphoscoliosis, obesity
interstitial lung disease (ILD)
pleural abnormalities “trapped lung”
mass
systemic lupus erythematosus (SLE)
pneumothorax
connective tissue disease - scleroderma
radiation therapy
idiopathic pulmonary fibrosis (IPF)

Question 16

medical treatments for lung diseases

Answer 16

steroids
antibiotics
oxygen
inhalers
assisted ventilation
lung transplant
lung reduction surgery

Question 17

medical treatments for lung diseases

-why use steroids

Answer 17

usually for presence of inflammation

Question 18

medical treatments for lung diseases

-why use antibiotics

Answer 18

for presence of infection

Question 19

medical treatments for lung diseases

-why use oxygen

Answer 19

to treat hypoxemia

Question 20

medical treatments for lung diseases

-why use inhalers

Answer 20

for bronchospasm

Question 21

medical treatments for lung diseases

-types of assisted ventilation

Answer 21

invasive

non-invasive

Question 22

PT assessment of lung disease includes

Answer 22

O2 need at rest
O2 need for activity
blood gases Pa O2, Pa CO2, pH
auscultation
RR
breathing patterns
endurance
perceived exertion
timing of rest breaks
time to return to baseline HR and RR
safe exertion levels
O2 saturation
O2 requirements as evidenced by O2 saturation
gait safety
prior level of function, prior O2 use
education needs, such as not tripping on O2 cords
need for lifestyle changes
psychosocial influences affecting potential outcomes

Question 23

precaution for working with patients with COPD

Answer 23

people with chronic lung disease may have chronic hypoxeia
-a certain level of hypoxemia is required to trigger inspiration
-over-oxygenating these patients may decrease their inspiratory drive
target O2sat is lower than usual: 88-92%
time to return to steady state may be prolonged
few or no symptoms at low O2 saturations - Low O2 saturation will overtax the heart and results in cell death and maybe actual death

Question 24

COPD alert

Answer 24

ILD (interstitial lung disease) and O2 desaturation
monitor with a pulse oximeter from the start if you have a patient with a diagnosis of ILD
be prepared to see O2 saturation drop like a rock with minimal activity
always have access to a full O2 tank
ambu-bag

Question 25

lung disease PT treatments

Answer 25

breathing control - diaphragmatic, PLB
pacing skills/work simplification
endurance training
strengthening
education e.g. O2 management, fatigue scale
confidence building
carrefully include those with
-older age
-hypercapnia
-severe impairment
patient's own goals

Question 26

goal-setting examples

Answer 26

Pt will complete supine to sit with minimal assistance of 1 person with RPE < 7 using energy conservation techniques within 2 weeks
Pt will demonstrate ability to ambulate on a level surface 1000’ with rollator walker for 6 min O2 saturation > 88% with contact guard of 1 person within 4 weeks
Pt will tolerate 20 consecutive minutes of (specify) at RPE 6-8 independently within 4 weeks
Pt will be able to ambulate 100 ft with a cane with PRE of 7 with an O2 saturation of 90% or above