PT Exam and Assessment of the Pulmonary System Flashcards
what are the elements of pt/client management
exam, eval, dx, prognosis, and intervention
what are the components of the examination?
pt hx, systems review, tests and measures
what is the purpose of the evaluation?
to evaluate data to make a clinical judgement
what is the purpose of the diagnosis?
to classify a pt w/in a specific practice pattern and indicates the primary dysfunctions
what is the purpose of the prognosis?
to determine the predicted level of optimal function
what is included in the pt/client hx?
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
what is the difference bw aerobic capacity and fatiguability?
aerobic activity is specific to exercise, fatiguability can be any level of exertion w/SOB
is dyspnea a function change or a description of a change in function?
a description of a change in function
what info is included in the medical chart review?
dx and date of event
symptoms
other medical problems and PMH
relevant social hx
meds
clinical lab data
the date of the event determines the ___
acuteness
what are the classic pulmonary symptoms?
SOB, dyspnea, increased work of breathing, sputum, wheezing, coughing
what is dyspnea?
SELF REPORTED difficulty breathing
what is SOB?
OBSERVABLE increased RR, shallow quick breathing
what is the normal range of pH?
7.35-7.45
if the pH is low (<7.35) is this acidosis or alkalosis?
acidosis
if the pH is high (>7.45) is this acidosis or alkalosis?
alkalosis
is PCO2 the respiratory or metabolic component of ABGs?
respiratory
is HCO3 the respiratory or metabolic component of ABGs?
metabolic
what is the key indicator of alveolar ventilation?
PaCO2
what is normal PaCO2?
40 mmHg
if PaCO2 is <40mmHg, what is this indicative of?
HYPERventilation
respiratory alkalosis
rapid shallow breathing
what are some s/s of hyperventilation?
rapid, shallow breathing
anxiety
irritability
respiratory alkalosis
if PaCO2 is >40mmHg, what is this indicative of?
HYPOventilation
respiratory acidosis
what is a key sign of hypoventilation?
drowsiness
loss of consciousness even
what is ventilatory failure?
PaCO2>50mmHg
if HCO3 is low, is this acidosis or alkalosis?
acidosis
if HCO3 is high, is this acidosis or alkalosis?
alkalosis
what can cause low HCO3?
increased production from ketoacidosis
failure to remove from kidney failure
medical condition
what can cause high HCO3?
overuse of antacids
vomiting
potassium wasting diuretics
if the pH is low, and PaCO2 is high, what is this?
respiratory acidosis
if the pH is low, and HCO3 is low, what is this?
metabolic acidosis
if the body is in respiratory alkalosis, what may the body do to create equilibrium?
create a metabolic acidosis
what is partial compensation in ABGs?
the pH remains out of range, CO2 and HCO3 are out of range
what is full compensation in ABGs?
the pH is in normal range, but PaCO2 and HCO3 are both out of range
what is normal PaCO2?
80-100 mmHg
what is SpO2?
% hemoglobin oxygenated
what are the S/S of hypoxemia?
headache, breathlessess, dyspnea, palpitations, angina, restlessness, tremors
if severe: impaired judgement, progressive loss of cognitive fxn, loss of consciousness
what is O2 therapy?
the use of supplemental O2
what things should be noted about O2 therapy?
use of O2 and the delivery method
amount of O2 delivered
correlate to ABGs
any other respiratory treatments
t/f: supplemental O2 is registered as a drug by the FDA
true
t/f: oxygen requires a physician order or prescription that is flexible
true
an O2 prescription should specify ___ not ____
an SpO2 goal, amount O2
why should O2 prescriptions be flexible?
to allow practitioners to adjust the dose according to pt presentation
what is FiO2?
fraction of inspired O2
the fraction of O2 in the atmosphere
what is normal FiO2?
0.21 or 21% (room air)
does supplemental O2 increase or decrease FiO2?
increase
what is the flow rate?
the amount of O2 delivered to the pt per minute
what are the supplemental O2 delivery options from least to most potent?
nasal cannula (NC)
oxidizer
simple face mask
venturi face mask
non-rebreather mask
high flow nasal cannula
tracheostomy collar
what is the nasal cannula delivery method of O2?
varying FiO2 by varying the flow rate
suitable for flow rates 0.25-6L/min
what is the oxidizer delivery method of O2?
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%
what is a simple face mask delivery of O2?
for pts who need flow >6-10 L/min
OR can be useful instead of NC for pts who mouth breathe
what is the venturi face mask delivery of O2?
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 %
what is humidification?
wetness that can added to O2 delivery methods bc O2 has a drying effect on mucus membranes
the higher the O2, the ___ the need for humidification
higher
what is a non-rebreather mask for O2 delivery?
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)
what are some precautions to be aware of with a non-rebreather mask?
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
what is a high flow nasal cannula for O2 delivery?
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
what are some precautions to be aware of with a high flow nasal cannula?
it should fit tightly to the face and nostrils
you will likely need an aid to handle to device setup to mobilize pts
what is a tracheostomy collar for O2 delivery?
for pts with an open tracheostomy to deliver O2 straight to it
what is included in radiological studies of the medical chart?
chest radiographs, CT scans, MRIs, and scintigraphy
t/f: the extent of a pt’s surgery predicts the activity performance impairments
true
what are the incisions related to pulmonary surgery?
video-assisted thoracic surgery (VATS)
thoracotomy
sternotomy
clamshell
what is a VATS incision?
small incision in the chest from scopes
what is a thoracotomy incision?
extensive incision from the axilla back around the scapulae
tends to cause the most pain with mobility
what is a sternotomy incision?
the typical incision for open heart surgery straight down the sternum
what is a clamshell incision?
not commonly seen outside of lung transplant
lift up the chest to access the lungs
what are the precautions post VATS?
typically none
what are the precautions post-thoracotomy?
no lifting>10lbs on the ipsi side
what are the precautions post-clamshell?
no lifting >10 lbs on the ipsi side
sternal precautions
what are the PT considerations with VATS?
pain and guarding
what are the PT considerations with thoracotomy?
pain and guarding
scar tissue if chronic
posture
what are the PT considerations with clamshell incisions?
pain and guarding
scar tissue if chronic
posture
where do chest tubes get placed?
in the pleural space or mediastenum
what is the purpose of chest tubes?
to evacuate air or fluid
to prevent or correct lung collapse
what are chest tubes connected to?
suction device or water seal
check that what are intact b4 mobilizing with chest tubes?
sutures holding the tubes in place
what are the PT implications of chest tubes?
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
what is obstructive disease?
can’t get air out
what are the characteristics of obstructive disease PFTs?
decreased FEV1
decreased FEV1/FVC
normal FVC
less steep slope
what does 65-80% predicted FEV1 mean?
mild obstruction
what does 50-65% predicted FEV1 mean?
moderate obstruction
what does <50% predicted FEV1 mean?
severe obstruction
what is normal FEV1/FVC?
75%
what is considered a significant change in FVC or FEV1 post bronchodilators?
12% increase
what does a change post bronchodilators mean?
reversible obstruction
what may complete return to normal after bronchodilators therapy indicate?
asthma
what is restrictive disease?
can’t get air in
what are the characteristics of restrictive disease PFTs?
decreased FEV1, FVC, TLC
normal FEV1/FVC (>80%)
what does 65-80% predicted TLC mean?
mild restriction
what does 50-65% predicted TLC mean?
moderate restriction
what does <50% predicted TLC mean?
severe restriction
what are the vital signs?
RR, temp, BP, HR, and pain
