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DPT 629: Cardio > PT Exam and Assessment of the Pulmonary System > Flashcards

PT Exam and Assessment of the Pulmonary System Flashcards

1
Q

what are the elements of pt/client management

A

exam, eval, dx, prognosis, and intervention

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2
Q

what are the components of the examination?

A

pt hx, systems review, tests and measures

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3
Q

what is the purpose of the evaluation?

A

to evaluate data to make a clinical judgement

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4
Q

what is the purpose of the diagnosis?

A

to classify a pt w/in a specific practice pattern and indicates the primary dysfunctions

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5
Q

what is the purpose of the prognosis?

A

to determine the predicted level of optimal function

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6
Q

what is included in the pt/client hx?

A

info on their current symptoms and medical problems

PMH

initial info on impairments and functional limitations

other sources of info beyond the chart from the pt/family/nurses

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7
Q

what is the difference bw aerobic capacity and fatiguability?

A

aerobic activity is specific to exercise, fatiguability can be any level of exertion w/SOB

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8
Q

is dyspnea a function change or a description of a change in function?

A

a description of a change in function

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9
Q

what info is included in the medical chart review?

A

dx and date of event

symptoms

other medical problems and PMH

relevant social hx

meds

clinical lab data

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10
Q

the date of the event determines the ___

A

acuteness

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11
Q

what are the classic pulmonary symptoms?

A

SOB, dyspnea, increased work of breathing, sputum, wheezing, coughing

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12
Q

what is dyspnea?

A

SELF REPORTED difficulty breathing

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13
Q

what is SOB?

A

OBSERVABLE increased RR, shallow quick breathing

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14
Q

what is the normal range of pH?

A

7.35-7.45

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15
Q

if the pH is low (<7.35) is this acidosis or alkalosis?

A

acidosis

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16
Q

if the pH is high (>7.45) is this acidosis or alkalosis?

A

alkalosis

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17
Q

is PCO2 the respiratory or metabolic component of ABGs?

A

respiratory

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18
Q

is HCO3 the respiratory or metabolic component of ABGs?

A

metabolic

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19
Q

what is the key indicator of alveolar ventilation?

A

PaCO2

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20
Q

what is normal PaCO2?

A

40 mmHg

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21
Q

if PaCO2 is <40mmHg, what is this indicative of?

A

HYPERventilation

respiratory alkalosis

rapid shallow breathing

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22
Q

what are some s/s of hyperventilation?

A

rapid, shallow breathing

anxiety

irritability

respiratory alkalosis

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23
Q

if PaCO2 is >40mmHg, what is this indicative of?

A

HYPOventilation

respiratory acidosis

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24
Q

what is a key sign of hypoventilation?

A

drowsiness

loss of consciousness even

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25
Q

what is ventilatory failure?

A

PaCO2>50mmHg

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26
Q

if HCO3 is low, is this acidosis or alkalosis?

A

acidosis

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27
Q

if HCO3 is high, is this acidosis or alkalosis?

A

alkalosis

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28
Q

what can cause low HCO3?

A

increased production from ketoacidosis

failure to remove from kidney failure

medical condition

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29
Q

what can cause high HCO3?

A

overuse of antacids

vomiting

potassium wasting diuretics

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30
Q

if the pH is low, and PaCO2 is high, what is this?

A

respiratory acidosis

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31
Q

if the pH is low, and HCO3 is low, what is this?

A

metabolic acidosis

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32
Q

if the body is in respiratory alkalosis, what may the body do to create equilibrium?

A

create a metabolic acidosis

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33
Q

what is partial compensation in ABGs?

A

the pH remains out of range, CO2 and HCO3 are out of range

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34
Q

what is full compensation in ABGs?

A

the pH is in normal range, but PaCO2 and HCO3 are both out of range

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35
Q

what is normal PaCO2?

A

80-100 mmHg

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36
Q

what is SpO2?

A

% hemoglobin oxygenated

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37
Q

what are the S/S of hypoxemia?

A

headache, breathlessess, dyspnea, palpitations, angina, restlessness, tremors

if severe: impaired judgement, progressive loss of cognitive fxn, loss of consciousness

38
Q

what is O2 therapy?

A

the use of supplemental O2

39
Q

what things should be noted about O2 therapy?

A

use of O2 and the delivery method

amount of O2 delivered

correlate to ABGs

any other respiratory treatments

40
Q

t/f: supplemental O2 is registered as a drug by the FDA

A

true

41
Q

t/f: oxygen requires a physician order or prescription that is flexible

A

true

42
Q

an O2 prescription should specify ___ not ____

A

an SpO2 goal, amount O2

43
Q

why should O2 prescriptions be flexible?

A

to allow practitioners to adjust the dose according to pt presentation

44
Q

what is FiO2?

A

fraction of inspired O2

the fraction of O2 in the atmosphere

45
Q

what is normal FiO2?

A

0.21 or 21% (room air)

46
Q

does supplemental O2 increase or decrease FiO2?

A

increase

47
Q

what is the flow rate?

A

the amount of O2 delivered to the pt per minute

48
Q

what are the supplemental O2 delivery options from least to most potent?

A

nasal cannula (NC)

oxidizer

simple face mask

venturi face mask

non-rebreather mask

high flow nasal cannula

tracheostomy collar

49
Q

what is the nasal cannula delivery method of O2?

A

varying FiO2 by varying the flow rate

suitable for flow rates 0.25-6L/min

50
Q

what is the oxidizer delivery method of O2?

A

specialized nasal cannula w/an oxygen reservoir that provides greater FiO2 at lower flow rates

up to 12 L/min flow

up to FiO2 of .82/82%

51
Q

what is a simple face mask delivery of O2?

A

for pts who need flow >6-10 L/min

OR can be useful instead of NC for pts who mouth breathe

52
Q

what is the venturi face mask delivery of O2?

A

face mask that provides more specific FiO2 at a specified flow rate

varied orifice size to deliver specified FiO2

may have interchangeable inlets or may alter orifice size using a dial

tells the liters needed to reach a certain %

53
Q

what is humidification?

A

wetness that can added to O2 delivery methods bc O2 has a drying effect on mucus membranes

54
Q

the higher the O2, the ___ the need for humidification

A

higher

55
Q

what is a non-rebreather mask for O2 delivery?

A

delivery of higher FiO2 at lower flow rates by preventing rebreathing of CO2

FiO2 up to .90/90% (closest to 100% you can get w/o an invasive vent)

56
Q

what are some precautions to be aware of with a non-rebreather mask?

A

the mask must fit tightly to the face

the reservoir bag should remain 1/3 to 1/2 full w/inspiration

it is uncomfortable for pts

it is not for long term use

57
Q

what is a high flow nasal cannula for O2 delivery?

A

for flows >6L/min

can adjust to FiO2 and flow rate independently

FiO2 up to 1.0 or 100%

flows up to 60L/min

heated and humidified circuit

58
Q

what are some precautions to be aware of with a high flow nasal cannula?

A

it should fit tightly to the face and nostrils

you will likely need an aid to handle to device setup to mobilize pts

59
Q

what is a tracheostomy collar for O2 delivery?

A

for pts with an open tracheostomy to deliver O2 straight to it

60
Q

what is included in radiological studies of the medical chart?

A

chest radiographs, CT scans, MRIs, and scintigraphy

61
Q

t/f: the extent of a pt’s surgery predicts the activity performance impairments

A

true

62
Q

what are the incisions related to pulmonary surgery?

A

video-assisted thoracic surgery (VATS)

thoracotomy

sternotomy

clamshell

63
Q

what is a VATS incision?

A

small incision in the chest from scopes

64
Q

what is a thoracotomy incision?

A

extensive incision from the axilla back around the scapulae

tends to cause the most pain with mobility

65
Q

what is a sternotomy incision?

A

the typical incision for open heart surgery straight down the sternum

66
Q

what is a clamshell incision?

A

not commonly seen outside of lung transplant

lift up the chest to access the lungs

67
Q

what are the precautions post VATS?

A

typically none

68
Q

what are the precautions post-thoracotomy?

A

no lifting>10lbs on the ipsi side

69
Q

what are the precautions post-clamshell?

A

no lifting >10 lbs on the ipsi side

sternal precautions

70
Q

what are the PT considerations with VATS?

A

pain and guarding

71
Q

what are the PT considerations with thoracotomy?

A

pain and guarding

scar tissue if chronic

posture

72
Q

what are the PT considerations with clamshell incisions?

A

pain and guarding

scar tissue if chronic

posture

73
Q

where do chest tubes get placed?

A

in the pleural space or mediastenum

74
Q

what is the purpose of chest tubes?

A

to evacuate air or fluid

to prevent or correct lung collapse

75
Q

what are chest tubes connected to?

A

suction device or water seal

76
Q

check that what are intact b4 mobilizing with chest tubes?

A

sutures holding the tubes in place

77
Q

what are the PT implications of chest tubes?

A

pain

asking if suction needs to be maintained with mobilization

checking tubing b4 moving bed rails and recliner parts

maintaining the collector below the level of insertion to maintain gravity effects

avoid kinking tubes

avoid tipping collector

may have to wait for chest x-ray after removal before mobilizing

78
Q

what is obstructive disease?

A

can’t get air out

79
Q

what are the characteristics of obstructive disease PFTs?

A

decreased FEV1

decreased FEV1/FVC

normal FVC

less steep slope

80
Q

what does 65-80% predicted FEV1 mean?

A

mild obstruction

81
Q

what does 50-65% predicted FEV1 mean?

A

moderate obstruction

82
Q

what does <50% predicted FEV1 mean?

A

severe obstruction

83
Q

what is normal FEV1/FVC?

A

75%

84
Q

what is considered a significant change in FVC or FEV1 post bronchodilators?

A

12% increase

85
Q

what does a change post bronchodilators mean?

A

reversible obstruction

86
Q

what may complete return to normal after bronchodilators therapy indicate?

A

asthma

87
Q

what is restrictive disease?

A

can’t get air in

88
Q

what are the characteristics of restrictive disease PFTs?

A

decreased FEV1, FVC, TLC

normal FEV1/FVC (>80%)

89
Q

what does 65-80% predicted TLC mean?

A

mild restriction

90
Q

what does 50-65% predicted TLC mean?

A

moderate restriction

91
Q

what does <50% predicted TLC mean?

A

severe restriction

92
Q

what are the vital signs?

A

RR, temp, BP, HR, and pain

DPT 629: Cardio (11 decks)

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