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PTA - Intro to Rehab > PTA Acute Care - Pulmonary > Flashcards

PTA Acute Care - Pulmonary Flashcards

1
Q

medical treatment for Pneumoconiosis

A

cessation of exposure
nutrition
adequate ventilation
adequate oxygenation

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2
Q

medical treatments for Bronchiectasis

A 
oxygen
pulmonary hygiene
hydration - helps to loosen secretions
antibiotics/vaccines
surgical resection (for necrotized tissue)
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3
Q

prognosis, medical treatment and PT treatment for Tuberculosis

A

Prognosis - fine if you take you meds
Med. Treatment - antibiotics and steroids
PT treatment - treating for decreased endurance
(very contagious - use airborne precautions)

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4
Q

PT treatment for Pneumoconiosis

A

progressive exercise training to maximize remaining lung function

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5
Q

PT treatments for Bronchiectasis

A

breathing exercises
effective coughing
postural drainage with percussion and vibration
HEP of PD or ACBTexercise program

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6
Q

signs and symptoms for Bronchiectasis

A 
chronic coughing bouts
copious purulent (pus) sputum
pneumonia
hypoxemia (not enough O2)
decreased FEV; increased RV
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7
Q

signs and symptoms of Pneumoconiosis

A

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

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8
Q

signs and symptoms of viral pneumonia

A 
low grade fever
dyspnea
decreased appetite
persistent, non - productive cough
fatigue
muscle aches
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9
Q

What are characteristics of COPD?

A
  • 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
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10
Q

what are indications for breathing exercises?

A

post-op
atelectasis or lung infection
chronic respiratory disease

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11
Q

what are pathological changes in COPD?

A
  • airway narrowing
  • parenchymal (lung tissue) destruction
  • pulmonary vascular thickening
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12
Q

what are some impairments noted for COPD?

A

expiratory flow rates are decreased - FVC & FEV1 decreasedresidual volumes are increased

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13
Q

what are some pt interventions for idiopathic pulmonary fibrosis?

A

breathing exercises
inspiratory mm training
expiratory mm training

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14
Q

what are some reasons we use Pursed Lip Breathing?

A

Reduces dyspnea
Decreases respiratory rate
COPD; atelectasis; pneumonia
Keeps alveoli open so there is more gas exchange

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15
Q

what are some types of pneumonia?

A

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

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16
Q

what are sternal precautions?

A 
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
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17
Q

What are the different lobes of the lung?

A

Right - Upper, Middle, Lower

Left - Upper, Lower

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18
Q

What does surfactant do?

A

Reduces surface tension

is a chemical that keeps alveoli from collapsing

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19
Q

What comprises the lower respiratory tract?

A

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)

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20
Q

what is and why do we use paced breathing?

A

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

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21
Q

What is Bronchial Circulation?

A

actual arteries that supply lung tissue with blood

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22
Q

what is Bronchiectasis?

A

an abnormal dilation due to destruction of elastic/muscular components
caused by uncontrolled severe necrotizing infections and bronchial obstructionan obstructive lung disease

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23
Q

what is FEV1?

A

Forced expiratory volume in 1 second - Liter/sec

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24
Q

what is FVC?

A

Forced Vital Capacity - forced amount of air coming out of lungs

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25
Q

what is idiopathic pulmonary fibrosis?

A

a restrictive lung disease of unknown origin

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26
Q

what is PAD?

A

Peripheral Airway Disease -very acute
it is in the terminal and respiratory bronchi
is reversible

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27
Q

What is perfusion?

A

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

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28
Q

what is pneumoconiosis?

A

a restrictive lung disease caused by the inhalation of dust, often in mines.
Includes black lung disease, silicosis, asbestosis.

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29
Q

what is pneumonia and what causes it?

A

an inflammation of lung tissue

caused by a virus or bacteria infection in lower respiratory tract

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30
Q

What is Pulmonary Circulation?

A

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

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31
Q

what is restrictive lung disease?

A

expansion of lungs is limited
cannot get enough air into lungs
pft’s - all volumes and capacities are decreased
working to breathe markedly increases

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32
Q

What is the anatomic dead space?

A

What is not perfused out of the tidal volume (s/b 150 ml)

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33
Q

What is the Conducting zone?

A

Ventilation - The trachea, bronchi, terminal bronchioles

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34
Q

What is the function of the lower respiratory tract?

A

gas exchange

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35
Q

What is the importance of Breathing Pattern?

A

want max amount of alveolar ventilation with minimal amount of effort

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36
Q

How are scalene muscles innervated?

A

C3, C4-8

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37
Q

How are abdominal muscles innervated?

A

intercostals T7 - L1

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38
Q

How are intercostal muscles innervated?

A

thoracic nerve (T2 - T12)

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39
Q

what is the pathology of idiopathic pulmonary fibrosis?

A

Inflammatory process of alveolar walls
- Fibrotic and distorted walls
- Destroy capillary beds
Decreased lung compliance

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40
Q

What is the Respiratory zone?

A

Respiration - Alveoli

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41
Q

what is the SCM innervation?

A

C1, 2 and 3 (Accessory nerve)

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42
Q

what is Tuberculosis?

A

terribly contagious bacterial infection
mycobacterium tuberculosis
can become Pott’s disease - if they have TB for a long time

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43
Q

what are ventilation dependent factors?

A

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

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44
Q

Where does ventilation occur?

A

in the conducting zone

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45
Q

Why do we do chest mobilizations?

A

to open up the chest
to improve posture which leads to improved ventilation
to combine UE and trunk movements with deep breathing exercises

46
Q

Why do we do Segmental Expansion?

A

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)

47
Q

Why do we use a Flutter Device?

A

to elicit variable positive expiratory pressure

to elicit vibration in chest wall

48
Q

why do we use diaphragmatic breathing?

A

to increase ventilation and promote basal lung expansion

do not use for COPD patients

49
Q

Why do we use huffing?

A

If patient has coughing spasms
History of CVA or aneurysm
Incisions
Hurts pt to cough

50
Q

why do we use pursed-lip breathing?

A

to relieve dyspnea in patients with COPD, pneumonia, atelectasis
to relieve periods of dyspnea

51
Q

why do we use the incentive spirometer?

A 
promotes lung expansion
control breathing
gets congestion out
good for patients w/ CABG
helps prevent pneumonia
gives pt. good feedback
52
Q

Where does gas exchange occur in the body?

A

The alveoli

53
Q

What are forms of protection in the respiratory system?

A

Mucus glands - trap particles

Cilia - move particles out

54
Q

What are the primary inspiratory muscles?

A

Diaphragm - The primary muscle of inspiration
Parasternals
Scalenes

55
Q

How is diaphragm innervated?

A

The phrenic nerve

C3 - C5

56
Q

What are the primary accessory muscles used in inspiration?

A

Sternocleidomastoid
Upper traps
Pectoralis major and minor

57
Q

How do the accessory muscles work for inspiration?

A

Elevate the ribs

58
Q

What are the primary muscles needed for expiration?

A

None!

59
Q

What are the accessory expiratory muscles?

A

Abdominal muscles
Internal intercostals
Quadratus lumborum
Pectoralis major

60
Q

What is the mediastinum?

A

The area between the lungs

Consists of the heart, veins, arteries, trachea, esophagus, and bronchi

61
Q

Where does the diaphragm originate and insert?

A

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)

62
Q

What is the pleura of the lungs and the layers?

A

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

63
Q

How does the cough reflex work?

A

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

64
Q

What is the hilum of the lungs?

A

Where arteries and vessels enter the lung

65
Q

What is the pulmonary circulation: arteries?

A

Pulmonary trunk

  • > Left and right pulmonary artery
  • > Lobular and intralobular arteries
  • > Arterioles
  • > Pulmonary capillaries
66
Q

What are the mechanics of cough reflex?

A
  1. Short deep inspiration
  2. Closure of the glottis
  3. Forced expiratory effort
  4. Glottis opens
67
Q

What is respiration?

A

When gas exchange occurs

68
Q

Where does external respiration occur?

A

In the lungs (alveolar sacs) and blood

69
Q

Where does internal respiration (gas exchange) occur?

A

From the capillaries to the organ or muscle it is going to

70
Q

What does the upper respiratory tract consist of?

A

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

71
Q

What are the upper respiratory tract functions

A

Warm airHumidify airFilter - nasal hair, mucus, cilia

72
Q

How many segments are on each lung?

A

10 segments on the right

8 segments on left

73
Q

What is ventilation?

A

The movement of air into and out of the lungs

74
Q

What do type II cells produce?

A

They produce surfactant (Chemical that keeps alveoli from collapsing)

75
Q

What does Pulmonary Perfusion depend on?

A

Gravity
Right ventricular stroke volume
Pulmonary vascular resistance

76
Q

What is Fick’s law?

A

Oxygen particles like to go from high concentration to low concentration

77
Q

Where does diffusion occur?

A

between the alveoli and the capillary membrane

78
Q

Where where does the majority of oxygen get dissolved when it’s diffused?

A 
RBC's = 97%
Plasma = 3%
79
Q

what are the normal pH levels?

A

7.35 - 7.45
< acidic
> basic

80
Q

What is the normal PaCO2?

A

35–45
> 45 acidic
< 35 basic

81
Q

What is normal HC03?

A

22–26
< 22 acidic
> 26 basic

82
Q

What is the diffusion of carbon dioxide (carbon dioxide transport)?

A

Body tissue –> blood capillary–> blood capillary –> lung

83
Q

Respiratory Acidosis or Alkalosis is compensated with what organ/system?

A

Kidneys/Metabolic

84
Q

What is TV?

A

Tidal Volume - volume of air brought into lungs at rest (500ml)

85
Q

What is IRV?

A

Inspiratory Reserve Volume - addition volume of air brought in (normal = 3000 ml)

86
Q

What is ERV?

A

Expiratory Reserve Volume - Air you can exhale after a normal breath (normal = 1100 ml)

87
Q

What is RV?

A

Residual Volume - amount of air that always stays in lungs (around 1200ml-1500ml)

88
Q

What is Total Lung Capacity?

A

TLC= IRV + TV + ERV + RV How much air in your lungs at one time ( 5800ml)

89
Q

What is Inspiratory Capacity?

A

IC = TV+ IRV

Maximum air you quietly breathe in (3500 ml)

90
Q

What is the Functional Residual Capacity?

A

FRC = ERV + RV

How much air left in lung after a normal exhale(2300 ml)

91
Q

What is Vital Capacity?

A

VC = IRV + TV + ERV

How much air you can move in and out of the lungs with forceful breathing ( 4600 ml)

92
Q

What is normal vital capacity?

A

3.2 - 4.6 L. Normally 80% of TLC

3200 - 4600 mL

93
Q

What are the main characteristics of COPD?

A

Airflow obstruction

Airway hyperreactivity

94
Q

What are some impaired functional markers with COPD?

A

expiratory flow rates (FEV1, FVC) - decreased

residual volumes - increased

95
Q

signs and symptoms of bacterial pneumonia

A 
Fever
Headache
Malaise
Cough (purulent or bloody)
Pleuritic chest pain
Nausea and vomiting
Myalgias
96
Q

etilogy of Chronic Bronchitis

A
  1. Chronic irritation: smoking air pollution; occupational exposure
  2. Heredity
97
Q

etiology of Emphysema

A
  1. Smoking, air pollution
  2. Hereditary: dec. alpha I antitrypsin
  3. Secondary to chronic bronchitis
98
Q

etiology of Asthma

A
  1. Allergens
  2. Exercise
  3. Infection
  4. Occupational, drug stress
  5. Emotional stress
99
Q

etiology of Cystic Fibrosis

A
  1. Recessively inherited genetic disorder

2. CF gene on chromosome 7

100
Q

pathological changes in Chronic Bronchitis

A
  1. Bronchial wall mucous gland hypertrophy
  2. Inc secretions> airway obstruction and infection
  3. Small airway walls become thickened
  4. Repeated infections> fibrosis & contractures of bronchioles> kinking and air trapping
  5. Secondary emphysema
101
Q

pathological changes in Emphysema

A
  1. Chronic inflammation > loss of supporting structure of lung and dec elastic recoil
  2. Unstable distal airways> increase resistance to expiration
  3. Distress> forced expiration
  4. Shutdown and air trapping
  5. Hyperinflation leading to overinflated alveoli
  6. Overstretched and weak diaphragm
  7. Increased infections
  8. Respiratory failure due to respiratory mm fatigue or failure o fthe lungs to exchange gas
102
Q

pathological changes in Asthma

A
  1. Irritant causing increased reactivity in airways
  2. Increased bronchoconstriction
  3. Narrowing of airways due to bronchospasm; mucous membrane edema; viscid mucous plugging
103
Q

pathological changes in Cystic Fibrosis

A
  1. Exocrine glands (mucous) – viscous secretions> obstruction of airways> bacterial infections
  2. Hypersecretion of mucous in small and larger airways; damage to muco-ciliary clearance
  3. Impaired pulmonary fuction
104
Q

signs and symptoms of Chronic Bronchitis

A
  1. Chronic productive cough
  2. Am expectoration of the secretions that accumulate at night
  3. Recurrent infections
  4. Overwt with cyanotic cast to lips and nails: “Blue Bloaters”
  5. Increased breath sounds; coarse crackles; and low pitch wheezes
105
Q

signs and symptoms of Emphysems

A
  1. SOB-rapid, shallow breathing
  2. Cough; scant sputum production
  3. Barrel chest
  4. Accessory mm hypertrophy
  5. Supportive postures; rounded shoulders
  6. Frequent infections
  7. Distant breath sounds due to hyperinflation
  8. Cyanosis and clubbing
  9. Often thin with rosy skin tones: “Pink Puffer”
106
Q

signs and symptoms of Asthma

A

Episodes of:

  1. Cough
  2. Dyspnea
  3. Wheezing
  4. Inability to expel air completely
107
Q

signs and symptoms of Cystic Fibrosis

A
  1. Increased sputum production
  2. Salty sputum and sweat
  3. Increased RR (work)
  4. Digital clubbing; often barrel chest
  5. Recurrent paroxysmal cough
  6. Frequent infection
  7. Pancreas, liver, GI tract, reproductive organ involvement (fatty stool; intestinal obstruction)
  8. Small for age
    Flattened diaphragm; air trapping; atelectasis; fibrosis; dev of bronchiectasis
108
Q

primary differences between Obstructive and Restrictive diseases/disorders

A

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

109
Q

how and when to use PEP

A

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.

110
Q

how and when to use Functional Training

A

Functional training with environmental and task modifications

i. For everyone
ii. To improve independence and therefore quality of life

111
Q

how and when to use Arm and Trunk Mobility Exercises

A

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

112
Q

how and when to use Strength and Endurance programs

A

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

PTA - Intro to Rehab (12 decks)

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