PTA Acute Care - Pulmonary Flashcards
medical treatment for Pneumoconiosis
cessation of exposure
nutrition
adequate ventilation
adequate oxygenation
medical treatments for Bronchiectasis
oxygen pulmonary hygiene hydration - helps to loosen secretions antibiotics/vaccines surgical resection (for necrotized tissue)
prognosis, medical treatment and PT treatment for Tuberculosis
Prognosis - fine if you take you meds
Med. Treatment - antibiotics and steroids
PT treatment - treating for decreased endurance
(very contagious - use airborne precautions)
PT treatment for Pneumoconiosis
progressive exercise training to maximize remaining lung function
PT treatments for Bronchiectasis
breathing exercises
effective coughing
postural drainage with percussion and vibration
HEP of PD or ACBTexercise program
signs and symptoms for Bronchiectasis
chronic coughing bouts copious purulent (pus) sputum pneumonia hypoxemia (not enough O2) decreased FEV; increased RV
signs and symptoms of Pneumoconiosis
slight decrease in lung volumes/compliance
dyspnea
cough
black sputum
barrel chest
weight loss - due to not wanting to eat and “working” so hard to breath 24/7
signs and symptoms of viral pneumonia
low grade fever dyspnea decreased appetite persistent, non - productive cough fatigue muscle aches
What are characteristics of COPD?
- obstruction of airflow within airways
- more difficult exhaling air
- too much air may be retained in the lungs
- PFT (pulmonary function test) shows decreased in flow rates and increases in residual volume
what are indications for breathing exercises?
post-op
atelectasis or lung infection
chronic respiratory disease
what are pathological changes in COPD?
- airway narrowing
- parenchymal (lung tissue) destruction
- pulmonary vascular thickening
what are some impairments noted for COPD?
expiratory flow rates are decreased - FVC & FEV1 decreasedresidual volumes are increased
what are some pt interventions for idiopathic pulmonary fibrosis?
breathing exercises
inspiratory mm training
expiratory mm training
what are some reasons we use Pursed Lip Breathing?
Reduces dyspnea
Decreases respiratory rate
COPD; atelectasis; pneumonia
Keeps alveoli open so there is more gas exchange
what are some types of pneumonia?
Bronchopneumonia - inflammation through bronchial tree
Acute lobar pneumonia - inflammation of entire lobe of lung
Segmental pneumonia - localized to 1 or 2 segments of the lobe
what are sternal precautions?
do not put pressure on arms to support upper body do not lift anything over 10 lbs w/ arms avoid pushing or pulling anything do not allow others to pull on you avoid driving for 4-6 weeks precautions for 6-8 weeks
What are the different lobes of the lung?
Right - Upper, Middle, Lower
Left - Upper, Lower
What does surfactant do?
Reduces surface tension
is a chemical that keeps alveoli from collapsing
What comprises the lower respiratory tract?
Trachea - C shaped rings keep it from collapsing
Left and right bronchi -( right is more vertical, usually where aspiration occurs)
Bronchioles:
- terminal (where the lungs connect)
- respiratory - alveoli are connected to them
Alveoli - ducts and sacs (gas exchange occurs)
what is and why do we use paced breathing?
coordinating activity with breathing
- used to decrease work of breathing and dyspnea during activity
use this type of breathing with activity; then when patient needs to stop use Pursed lip breathing
What is Bronchial Circulation?
actual arteries that supply lung tissue with blood
what is Bronchiectasis?
an abnormal dilation due to destruction of elastic/muscular components
caused by uncontrolled severe necrotizing infections and bronchial obstructionan obstructive lung disease
what is FEV1?
Forced expiratory volume in 1 second - Liter/sec
what is FVC?
Forced Vital Capacity - forced amount of air coming out of lungs
what is idiopathic pulmonary fibrosis?
a restrictive lung disease of unknown origin
what is PAD?
Peripheral Airway Disease -very acute
it is in the terminal and respiratory bronchi
is reversible
What is perfusion?
The amount of blood available in the capillaries surrounding the lung tissue ( to pick up oxygen from alveoli)
OR: In physiology, perfusion is the process of a body delivering blood to a capillary bed
what is pneumoconiosis?
a restrictive lung disease caused by the inhalation of dust, often in mines.
Includes black lung disease, silicosis, asbestosis.
what is pneumonia and what causes it?
an inflammation of lung tissue
caused by a virus or bacteria infection in lower respiratory tract
What is Pulmonary Circulation?
Circulation of the blood when it comes from the heart, circulates through the lungs to pick up O2 and goes back to the heart to go out to the body
what is restrictive lung disease?
expansion of lungs is limited
cannot get enough air into lungs
pft’s - all volumes and capacities are decreased
working to breathe markedly increases
What is the anatomic dead space?
What is not perfused out of the tidal volume (s/b 150 ml)
What is the Conducting zone?
Ventilation - The trachea, bronchi, terminal bronchioles
What is the function of the lower respiratory tract?
gas exchange
What is the importance of Breathing Pattern?
want max amount of alveolar ventilation with minimal amount of effort
How are scalene muscles innervated?
C3, C4-8
How are abdominal muscles innervated?
intercostals T7 - L1
How are intercostal muscles innervated?
thoracic nerve (T2 - T12)
what is the pathology of idiopathic pulmonary fibrosis?
Inflammatory process of alveolar walls
- Fibrotic and distorted walls
- Destroy capillary beds
Decreased lung compliance
What is the Respiratory zone?
Respiration - Alveoli
what is the SCM innervation?
C1, 2 and 3 (Accessory nerve)
what is Tuberculosis?
terribly contagious bacterial infection
mycobacterium tuberculosis
can become Pott’s disease - if they have TB for a long time
what are ventilation dependent factors?
chest wall motion (chest surgery, broken rib, poor posture, osteoporosis)
position (more capillaries in base of lung)
weight of lung (too heavy, cannot expand - due to scar tissue, etc.)
pleural pressures - if you lose pleural pressure (too little) your lungs cannot expand
Where does ventilation occur?
in the conducting zone
Why do we do chest mobilizations?
to open up the chest
to improve posture which leads to improved ventilation
to combine UE and trunk movements with deep breathing exercises
Why do we do Segmental Expansion?
to increases diameter of lung segment
Can be done during PD, percussion & vibration (quick stretch or hand resistance to help expand a lobe of lung)
Why do we use a Flutter Device?
to elicit variable positive expiratory pressure
to elicit vibration in chest wall
why do we use diaphragmatic breathing?
to increase ventilation and promote basal lung expansion
do not use for COPD patients
Why do we use huffing?
If patient has coughing spasms
History of CVA or aneurysm
Incisions
Hurts pt to cough
why do we use pursed-lip breathing?
to relieve dyspnea in patients with COPD, pneumonia, atelectasis
to relieve periods of dyspnea
why do we use the incentive spirometer?
promotes lung expansion control breathing gets congestion out good for patients w/ CABG helps prevent pneumonia gives pt. good feedback
Where does gas exchange occur in the body?
The alveoli
What are forms of protection in the respiratory system?
Mucus glands - trap particles
Cilia - move particles out
What are the primary inspiratory muscles?
Diaphragm - The primary muscle of inspiration
Parasternals
Scalenes
How is diaphragm innervated?
The phrenic nerve
C3 - C5
What are the primary accessory muscles used in inspiration?
Sternocleidomastoid
Upper traps
Pectoralis major and minor
How do the accessory muscles work for inspiration?
Elevate the ribs
What are the primary muscles needed for expiration?
None!
What are the accessory expiratory muscles?
Abdominal muscles
Internal intercostals
Quadratus lumborum
Pectoralis major
What is the mediastinum?
The area between the lungs
Consists of the heart, veins, arteries, trachea, esophagus, and bronchi
Where does the diaphragm originate and insert?
Originates on all the ribs on the lower half of the rib cage and anterior portion of the spinal cord (sternal, costal and lumbar)
Inserts on itself (central tendon)
What is the pleura of the lungs and the layers?
The membranous covering
Visceral Pleura - over the lungs
Pleural Space between the 2 layers
Parietal Pleura is the layer between the pleural space and other organs
How does the cough reflex work?
Something stimulates the larnyx or trachea
- > It stimulates afferent nerve fibers to fire
- > Then you cough
Stimulated by sensory nn in larynx or trachea
Stimulated by afferent nn endings in lungs or pleura
What is the hilum of the lungs?
Where arteries and vessels enter the lung
What is the pulmonary circulation: arteries?
Pulmonary trunk
- > Left and right pulmonary artery
- > Lobular and intralobular arteries
- > Arterioles
- > Pulmonary capillaries
What are the mechanics of cough reflex?
- Short deep inspiration
- Closure of the glottis
- Forced expiratory effort
- Glottis opens
What is respiration?
When gas exchange occurs
Where does external respiration occur?
In the lungs (alveolar sacs) and blood
Where does internal respiration (gas exchange) occur?
From the capillaries to the organ or muscle it is going to
What does the upper respiratory tract consist of?
Nasal cavity - has hairs, helps humidify the air and helps w/ smell
Pharynx - where the voice box is (articulate speech) Larynx - cartilaginous; Adam’s apple
What are the upper respiratory tract functions
Warm airHumidify airFilter - nasal hair, mucus, cilia
How many segments are on each lung?
10 segments on the right
8 segments on left
What is ventilation?
The movement of air into and out of the lungs
What do type II cells produce?
They produce surfactant (Chemical that keeps alveoli from collapsing)
What does Pulmonary Perfusion depend on?
Gravity
Right ventricular stroke volume
Pulmonary vascular resistance
What is Fick’s law?
Oxygen particles like to go from high concentration to low concentration
Where does diffusion occur?
between the alveoli and the capillary membrane
Where where does the majority of oxygen get dissolved when it’s diffused?
RBC's = 97% Plasma = 3%
what are the normal pH levels?
7.35 - 7.45
< acidic
> basic
What is the normal PaCO2?
35–45
> 45 acidic
< 35 basic
What is normal HC03?
22–26
< 22 acidic
> 26 basic
What is the diffusion of carbon dioxide (carbon dioxide transport)?
Body tissue –> blood capillary–> blood capillary –> lung
Respiratory Acidosis or Alkalosis is compensated with what organ/system?
Kidneys/Metabolic
What is TV?
Tidal Volume - volume of air brought into lungs at rest (500ml)
What is IRV?
Inspiratory Reserve Volume - addition volume of air brought in (normal = 3000 ml)
What is ERV?
Expiratory Reserve Volume - Air you can exhale after a normal breath (normal = 1100 ml)
What is RV?
Residual Volume - amount of air that always stays in lungs (around 1200ml-1500ml)
What is Total Lung Capacity?
TLC= IRV + TV + ERV + RV How much air in your lungs at one time ( 5800ml)
What is Inspiratory Capacity?
IC = TV+ IRV
Maximum air you quietly breathe in (3500 ml)
What is the Functional Residual Capacity?
FRC = ERV + RV
How much air left in lung after a normal exhale(2300 ml)
What is Vital Capacity?
VC = IRV + TV + ERV
How much air you can move in and out of the lungs with forceful breathing ( 4600 ml)
What is normal vital capacity?
3.2 - 4.6 L. Normally 80% of TLC
3200 - 4600 mL
What are the main characteristics of COPD?
Airflow obstruction
Airway hyperreactivity
What are some impaired functional markers with COPD?
expiratory flow rates (FEV1, FVC) - decreased
residual volumes - increased
signs and symptoms of bacterial pneumonia
Fever Headache Malaise Cough (purulent or bloody) Pleuritic chest pain Nausea and vomiting Myalgias
etilogy of Chronic Bronchitis
- Chronic irritation: smoking air pollution; occupational exposure
- Heredity
etiology of Emphysema
- Smoking, air pollution
- Hereditary: dec. alpha I antitrypsin
- Secondary to chronic bronchitis
etiology of Asthma
- Allergens
- Exercise
- Infection
- Occupational, drug stress
- Emotional stress
etiology of Cystic Fibrosis
- Recessively inherited genetic disorder
2. CF gene on chromosome 7
pathological changes in Chronic Bronchitis
- Bronchial wall mucous gland hypertrophy
- Inc secretions> airway obstruction and infection
- Small airway walls become thickened
- Repeated infections> fibrosis & contractures of bronchioles> kinking and air trapping
- Secondary emphysema
pathological changes in Emphysema
- Chronic inflammation > loss of supporting structure of lung and dec elastic recoil
- Unstable distal airways> increase resistance to expiration
- Distress> forced expiration
- Shutdown and air trapping
- Hyperinflation leading to overinflated alveoli
- Overstretched and weak diaphragm
- Increased infections
- Respiratory failure due to respiratory mm fatigue or failure o fthe lungs to exchange gas
pathological changes in Asthma
- Irritant causing increased reactivity in airways
- Increased bronchoconstriction
- Narrowing of airways due to bronchospasm; mucous membrane edema; viscid mucous plugging
pathological changes in Cystic Fibrosis
- Exocrine glands (mucous) – viscous secretions> obstruction of airways> bacterial infections
- Hypersecretion of mucous in small and larger airways; damage to muco-ciliary clearance
- Impaired pulmonary fuction
signs and symptoms of Chronic Bronchitis
- Chronic productive cough
- Am expectoration of the secretions that accumulate at night
- Recurrent infections
- Overwt with cyanotic cast to lips and nails: “Blue Bloaters”
- Increased breath sounds; coarse crackles; and low pitch wheezes
signs and symptoms of Emphysems
- SOB-rapid, shallow breathing
- Cough; scant sputum production
- Barrel chest
- Accessory mm hypertrophy
- Supportive postures; rounded shoulders
- Frequent infections
- Distant breath sounds due to hyperinflation
- Cyanosis and clubbing
- Often thin with rosy skin tones: “Pink Puffer”
signs and symptoms of Asthma
Episodes of:
- Cough
- Dyspnea
- Wheezing
- Inability to expel air completely
signs and symptoms of Cystic Fibrosis
- Increased sputum production
- Salty sputum and sweat
- Increased RR (work)
- Digital clubbing; often barrel chest
- Recurrent paroxysmal cough
- Frequent infection
- Pancreas, liver, GI tract, reproductive organ involvement (fatty stool; intestinal obstruction)
- Small for age
Flattened diaphragm; air trapping; atelectasis; fibrosis; dev of bronchiectasis
primary differences between Obstructive and Restrictive diseases/disorders
a. Obstructive diseases have obstruction of airflow within the airways; restrictive disease limit expansion of the lungs or parts of it.
b. In obstructive, it sis more difficult exhaling the air; in restrictive, not enough air gets in
c. In obstructive: too much air may be retained in the lungs; in restrictive: not enough air gets in
d. PFTs in obstructive show decreases in flow rates and increased residual volume; in resistive disease all lung volumes and capacities are decreased
how and when to use PEP
j. Positive Expiratory Pressure Mask (PEP) (emphysema; pneumonia; atelectasis)
i. PEP = a mask and one way valve resistor that provides a steady pre-set positive expiratory pressure during expiration
ii. Acts to hold airways open during expiration, preventing premature airway closure and therefore, reducing gas trapping in lungs
iii. Shown to be very effective in enhancing airway secretion clearance, improving lung volumes and expiratory flow in patients with cystic fibrosis, improving oxygenation and exercise tolerance, and can prevent airway collapse.
how and when to use Functional Training
Functional training with environmental and task modifications
i. For everyone
ii. To improve independence and therefore quality of life
how and when to use Arm and Trunk Mobility Exercises
Arm and trunk mobility exercises: everyone
i. To coordinate upper extremity exercise with movement
ii. To increase mobility of the thorax, shoulders
iii. These two are thought to increase ventilation and mobilize secretions
how and when to use Strength and Endurance programs
i. Strength and Endurance programs: everyone
i. Important for all patients to help slow down the progression of their disease process and improve overall function of the patient and their overall
