Pneumonia/Restrictive Diseases

Question 1

What are the 4 general types of restrictive lung disease?

Answer 1

Primary lung: stiff, decreased compliance of parenchyma
-fibrosis

Pleural abnormality
-pleural effusion

Thoracic abnormality: decreased chest wall mobility
-kyphoscoliosis

Limited space for expansion
-obese, pregnant

Question 2

What is the pathology of pneumonia?

Answer 2

Inflammatory response of bronchioles/alveolar space to infectious agent

• excessive mucous in alveoli
• inflamed bronchiole

Falls under multiple categories of disorder:
obstructive (hard to get air in)
lung tissue diffusion(decreased from mucus)
compliance (decreased alveoli)
pleural space (fluid; severe leads to effusion)

Question 3

What sx/chart lab values are characteristic of pneumonia?

Answer 3

Sx:
SOB, productive cough, fever, chills

Chart:
High WBC
Increased temp
High HR/RR

Question 4

What are symptoms of chronic hypoxemia?

Answer 4

Cyanosis
Digital clubbing
Hypertension
Accessory muscle use

Question 5

What are pulmonary function test volumes for restrictive diseases?

Answer 5

Decreased:
TLC
VC
IC
RV (or normal)

All result in:
Impaired pulmonary function-> hypoventilation
Decreased gas exchange-> hypoxemic
Desaturation with activity

Question 6

What are normal auscultation results in pneumonia?

Answer 6

Crackles, bronchiole sounds over middle/lower lobes
Listen to cough/huff
Bronchophony= increased sound (from consolidation)
Mediate percusion= dull in affected area (should be resonant)
Increased tactile fremitus

Question 7

When do you stop assesing/treating based off of their SpO2 levels with 6MWT/treatment?

Answer 7

Perform 6MWT at baseline oxygen (air)

If

Question 8

What airways clearance techniques are best for respiratory problems?

Answer 8

Incentive Spireometor
Active airway clearance techniques
Coughing mechanics

Question 9

What are the goals of airway clearance?

Answer 9

Decrease obstruction from secretions
Increase ventilation
Increase gas exchange

Question 10

Who do you perform airway clearnace on?

Answer 10

Atelectasis, secretions:

• impaired cilliary motion
• decreased inflation
• decreased elasticity
• decreased chest wall mobility
• weak/fatigued respiratory muscles

Question 11

What are types of non-active clearing techniques

Answer 11

Post drain
percussion
increase frequency osculations
PEP devices

Question 12

When do you perform Active Airway Clearance?

Answer 12

30-1hr after meals
Premedicate
Bronchioldilator meds 20-30min before to help secretion removal
Antibiotics AFTER so don’t clear them out

Question 13

What is the first stage of AAC?

Answer 13

Breath Control

• gentle tidal with relaxed muscles
• prevents bronchospasm
• lasts long enough for pt to relax

Question 14

What is the second stage of AAC?

Answer 14

Thoracic Expansion Exercise

• deep inspiration helps loosen secretion
• air gets behind secretions to assist in mob
• can use I.S. for this part

Question 15

What is the last stage of AAC?

Answer 15

Forced Expiratory Technique

• huff moves secretions from small to large airways and then cough to get out
• important to cough only when secretions reach conducting zone (zone 6-7; terminal bronchioles and up)

Periph secretions: LONG quiet huff after MEDIUM inspiration
Large airway secretions: SHORT loud huff after DEEP inspiration

Question 16

What adjustments can you make in each stage of AAC depending on the condition?

Answer 16

Increase time in breathing control for patients with reactive airways/anxious (wheezes)

Increase time in TEE for patients with atelectasis to pop open alveoli

Increase time in FET for patients with sputum production