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Cardiorespiratory 1 > Pathologies > Flashcards

Pathologies Flashcards

1
Q

Define atelectasis

A

Complete or partial collapse of lung or lobe of lung

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2
Q

What happens to the alveoli in atelectasis?

What does this mean in terms of ventilation?

A

Become deflated or filled with fluid

There is no ventilation in these areas - gas exchange cannot occur

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3
Q

Physiological process leading to atelectasis

A

Not deep breathing due to post op pain –> secretion retention
Anaesthesia paralyses cilia during surgery
No mucociliary clearance of sputum
Leads to mucus plug
No ventilation to lung areas distal to plug, but perfusion maintained
No gas exchange
Lack of O2 and hypoxaemia

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4
Q

How does atelectasis occur in relation to functional residual capacity (FRC) and closing capacity (CC)?

A

FRC reduced during and filling surgery
When FRC becomes less than CC smaller airways close and stick together due to not enough air holding them open
Alveoli below this level don’t receive any new air
Closure of small distal airways leads to closure of large lung areas
Leads to lack of O2 and hypoxaemia

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5
Q

Clinical features of atelectasis

A 
SOB
Increased respiratory rate - rapid shallow breathing
Wheezing
Cough
Chest pain
Increased HR
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6
Q

Physiotherapy interventions for atelectasis

A

Postural drainage
Chest wall percussion/vibration
FET

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7
Q

Postoperative atelectasis occurs within how many hours post surgery?

A

72 hrs post general anaesthesia

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8
Q

What V/Q mismatch occurs in atelectasis? Why?

A

“shunt” mismatch - no ventilation distal to blockage of airway but perfusion maintained

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9
Q

Patients more at risk for post-op atelectasis

A 
Longer anaesthesia duration
Smoker
Chronic lung disease
Inadequate post-op pain medication
Poor pre-op pulmonary education
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10
Q

Complications of atelectasis

A

Type I respiratory failure
Lung infections from retained secretions - Pneumonia
Lung scarring

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11
Q

Values of PaO2 and PaCO2 respectively, in an atelectasis patient

A

Low PaO2 and normal PaCO2

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12
Q

What does COPD stand for?

A

Chronic Obstructive Pulmonary Disease

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13
Q

What 2 conditions cover COPD?

A

Chronic bronchitis and emphysema

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14
Q

Is COPD reversible?

A

No, it is a progressive disease

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15
Q

What clinical feature defines chronic bronchitis?

A

Cough and sputum expectoration for at least 3 months over 2 successive years

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16
Q

Symptoms of chronic bronchitis

A 
Chronic sputum production
Chronic cough
Wheeze
Dyspnoea/SOB at rest
Fatigue
Difficulty with ADLs and exercise 
Depression/anxiety
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17
Q

In chronic bronchitis, there is an overproduction of mucus due to what?

A

inflammation

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18
Q

Pathophysiology of chronic bronchitis

A
  • Inhalation of noxious particles > release of inflammatory mediators by epithelial cells > activation of macrophages & neutrophils > proteases released and protease/anti-protease imbalance > causes inflammation
  • Increased swelling and blood flow in bronchial mucous membranes
  • Increase size and number of goblet cells – hyperplasia > increased mucus production
  • Cilia damage and dysfunction > Diminished mucociliary escalator
  • Airflow limitation, reduced sputum clearance > further irritation, fibrotic changes and increased risk of infection
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19
Q

Emphysema is disease of…

A

the alveoli

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20
Q

Define emphysema

A

Enlargement of air spaces distal to the terminal bronchiole with destruction of their walls

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21
Q

What 2 things are destroyed in emphysema?

A

Alveolar septa and capillary bed

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22
Q

Main result of emphysema

A

gas trapping leading to hyperinflation

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23
Q

Pathophysiology of emphysema

A
  • Inhalation of noxious particles > release of inflammatory mediators by alveolar epithelial cells > activation of alveolar macrophages & neutrophils > proteases released and protease/anti-protease imbalance
  • Inflammation, degradation and destruction of alveolar walls and elastic fibres
  • Erosion of alveolar septa > enlarged airspaces (potential bullae formation) > decreased surface area
  • Loss of elastic recoil > collapse of respiratory bronchioles and small airways > gas trapping
  • Hyperinflation
24
Q

Symptoms of emphysema

A

Dyspnoea/SOB at rest
Fatigue
Difficulty with ADLs and exercise
Depression/anxiety

25
Q

What are the clinical features of COPD?

A 
Barrel chest due to hyperinflation
Accessory muscle use
Decreased breath sounds - course crackles if sputum present 
Reduced functional exercise capacity 
O2 desaturation during exercise
26
Q

Risk factors for COPD

A 
Cigarette smoking
Passive smoking
Occupational - dusts, fumes, chemicals
Outdoor air pollution
Genetic - eg. Alpha-1 antitrypsin deficiency
Low socio-economic status 
^risk with age 
^risk if female
27
Q

Why should you be cautious giving O2 to a COPD patient?

A

Decreases hypoxic drive to breath

28
Q

Is COPD more common in men or women?

A

Women

29
Q

Acute exacerbation of COPD defined by…

A

a sustained worsening of patients condition that is acute in onset

30
Q

What may occur in an acute exacerbation of COPD?

A

Change in baseline dyspnoea, cough, sputum production that is beyond normal day-to-day variability

31
Q

Physiotherapy interventions for COPD

A 
early mobilisation - prevent deconditioning 
sputum clearance 
control of dyspnoea 
self-management 
pulmonary rehab 
smoking cessation
32
Q

Describe the cycle of inactivity

A

feels breathless
fear of activity increasing breathlessness
avoids activities which increase breathlessness
less active
muscles become weaker
weak muscles use more oxygen and are less efficient
feeling breathless

33
Q

Describe the dyspnoea spiral

A 
Respiratory impairment
dyspnoea during moderate exercise 
avoidance of exercise 
physical deconditioning 
dyspnoea during mild exercise 
further avoidance of exercise 
further deconditioning 
dyspnoea during ADLs
34
Q

What does STEMI stand for?

A

ST elevation myocardial infarction

35
Q

Significant Ischaemia leads to…

A

significant necrosis of cardiac muscle

36
Q

What causes an MI?

A

prolonged or permanent occlusion of coronary arteries due to atherosclerosis

37
Q

What does CABG stand for?

A

Coronary artery bypass graft

38
Q

Pathophysiology of MI

A

• Atherosclerosis of coronary arteries
o Foam cells are too big and become trapped in intima – plaque builds up
o Plaque continues to grow
• Occlusion of one/more coronary arteries due to an unstable atherosclerotic plaque that ruptures
• Fatty plaque materials highly thrombogenic
• Leads to large thrombus in the coronary artery
• Reduced/complete loss of blood flow distal to the blockage
• Not sufficient O2
• Ischaemia leading to necrosis of cardiac muscle

39
Q

Modifiable risk factors for MI

A 
hypertension
smoking
obesity
sedentary lifestyle 
hypercholesterolemia 
poor oral health
alcohol
drug use
40
Q

Non-modifiable risk factors for MI

A 
Sex - more M>F
age
family history
male pattern baldness
previous MI
41
Q

Are women or men more at risk of an MI

A

men

42
Q

Purpose of CABG procedure

A

bypass atheromatous blockages in coronary arteries with harvested veins (long saphenous vein)
revascularise ischaemic myocardium

43
Q

Aims of CABG

A

restore blood flow to cardiac muscle
alleviate SOB and angina
improve exercise tolerance

44
Q

Post-op complications - cardiac surgery following STEMI

A 
infection - mediastinitis 
wound instability 
postoperative pulmonary complications (PPCs)
arrhythmias 
haemorrhage 
pain
reduced exercise capacity 
'Post-pump syndrome'
45
Q

Clinical presentation of STEMI

A 
intense pain - chest, left arm, left side neck
nausea/vomiting
sweating 
acute SOB
syncope/collapse
substernal heaviness
46
Q

Physiotherapy goals post STEMI

A 
reduce myocardial demand 
mobility
enhance QoL
increase CV fitness
reduced dyspnoea on exertion
assist return to employment
47
Q

Physio interventions post-cardiac surgery following STEMI

A 
Pre-op assessment and education 
cardiac rehab
early post-op mobilisation
wound supported FET and cough
LTEE
foot/ankle circulatory exercises
posture - thoracic extension needed
thoracic/shoulder mobility
48
Q

Examples of shoulder/thoracic exercises post cardiac surgery

A 
shoulder shrugs - elevation/depression
ball around body
theraband abductions/flexions
pendulum 
shoulder retraction
thoracic rotations - hands on hips, hands on head
49
Q

Drugs used in medical management post-cardiac surgery

A 
ACE inhibitors
Beta blockers
GNT spray 
Anticoagulants
Antiplatelets
Calcium channel blockers
50
Q

What are ACE inhibitors

A

vasodilators - lower BP

51
Q

What do beta blockers do?

A

lower BP and HR

52
Q

What is GNT spray?

A

vasodilator - reduces angina symptoms

53
Q

What do anticoagulants do?

A

inhibit thrombus formation

54
Q

What do anti platelets do?

A

inhibit thrombus formation

55
Q

What do calcium channel blockers do?

A

reduce myocardial contractility and propagation of electrical impulses

Cardiorespiratory 1 (4 decks)

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