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THER 231 FINAL > PULMONARY > Flashcards

PULMONARY Flashcards

1
Q

Gas exchange:

A

Occurs at the alveoli
* Deoxygenated blood ‘picks up’ oxygen and ‘drops off’ carbon dioxide

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2
Q
  • Tidal volume
A

volume of air inspired and expired during each respiratory cycle (at rest)

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3
Q
  • Inspiratory reserve volume:
A

max amount of air that can be inspired above tidal volume

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4
Q
  • Expiratory reserve volume:
A

max amount of air that can be expired after normal tidal volume

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5
Q
  • Residual volume:
A

that air that remains after max expiration

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6
Q
  • Vital Capacity:
A

amount of air the lungs can expel after being completely full
o Ie, the change in volume from completely full to completely emptied lungs
o tidal volume + inspiratory reserve + expiratory reserve

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7
Q
  • Total Lung Capacity:
A

full amount of air that can fit into the lungs, including the air that we do not exhale

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8
Q
  • Air entry
A

o Should be noticeable, should hear air coming in/out of the lungs
o Sometimes we hear ‘decreased air entry’
o This can be a lack of air getting into the lungs or, in the case of COPD, just not being able to hear it because there is already so much air in there

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9
Q
  • Crackles or Crepes
A

o If they are there, usually heard on inspiration
o Indicative of excessive secretions (ex: pneumonia)

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10
Q
  • Wheezes or Rhonchi
A

o Like a whistling sound, usually noticed on expiration
o Due to early airway closure (ex: emphysema, asthma)

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11
Q

o Sputum (definition, colours)

A

Red- nosebleed, malignancy/lung injury
Clear/White- allergies, viral infection
Green- bacterial infection
Brown- may indicate lung disease

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12
Q

o Restrictive:

A

Any respiratory condition where the patient is unable to take in a full, deep breath
o Interstitial lung disease, Sarcoidosis- tighten up lung tissue, Scleroderma, broken rib, scoliosis.

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13
Q

o Obstructive:

A

o Any respiratory condition where the patient has difficulty getting all the air out of their lungs: Asthma, COPD, Emphysema, Chronic Bronchitis, Cystic Fibrosis, Bronchiectasis

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14
Q

o COPD

A
  • Describes two diseases that affect the lungs
    o chronic bronchitis
    o emphysema
  • Causes progressive damage to the lungs
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15
Q
  • Bronchitis:
A

inflammation of the lining of the bronchi

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16
Q

o Emphysema

A

barrel chest
* Damage to the alveoli
o Inner walls weaken and rupture
* Clubbing of the fingers, from chronic hypoxia to nail beds
* Cyanosis: bluish colouring of the skin
o Peripheral (fingers, etc.)
o Central (lips, face, etc.)
o due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface

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17
Q

o Pneumonia:

A
  • Lung infection
  • Can involve one, or both, lungs
  • Caused by bacteria, viruses, or fungi
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18
Q

Pneumonia: Symptoms:

A
  • Productive cough
  • Fever
  • Sharp chest pain on inspiration
  • Abnormal sounds in the chest
  • Diagnosis is confirmed by a chest x-ray
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19
Q

Cystic Fibrosis:

A

Congenital disease
* Most common, fatal genetic disease affecting young Canadians
* Affects mainly the lungs and the digestive system
* Affects cells that make mucus, sweat and digestive fluids
o These fluids are thick in CF patients
Causes the blockage of ducts throughout the body

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20
Q

Asthma:

A

A chronic inflammatory disease of the airway, Causes narrowing of the airways, They are inflamed and constricted

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21
Q

Asthma symptoms:

A
  • Shortness of breath
  • Tightness in the chest
  • Coughing
  • Wheezing
  • Severity varies from person to person, or can vary from one episode to the next
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22
Q

Bronchodilators (Puffers):

A
  • Help open the bronchial tubes of the lungs
    o decreasing resistance and allowing more air to flow
  • Useful in obstructive Lung diseases
  • Either short-acting or long-acting
    o Short-acting medications provide quick or “rescue” relief from acute bronchoconstriction
    o Long-acting bronchodilators help to control and prevent symptoms
23
Q

Trach:

A

An incision is made into the trachea

24
Q

Suctioning:

A

Using a tube, with suction, to remove secretions from the lungs
Can be done through a tracheostomy tube, an endotracheal (ET) tube, or through the nose

25
Q

Oxygen: Short-Term use

A
  • Recovering from acute lung disorders (ex: pneumonia)
  • After surgery
26
Q

Oxygen: Long-term use

A

o People with chronic lung disorders in whom oxygen levels are consistently low
o Sleep apnea, or other disorders where oxygen levels dip

27
Q

Mechanical Ventilation:

A
  • A machine which ‘breathes for’ the patient
  • May be attached via a trach or an ET tube
  • Severe cases, where client cannot breathe for themselves:
28
Q

o Chest Physio: Used to treat chest congestion

A

o Prevent accumulation of secretions
o Remove secretions already accumulated
o Conditions Treated
o Respiratory diseases (Ex: Bronchiectasis, COPD, Pneumonia, Cystic fibrosis)
o Neuromuscular diseases (muscular dystrophy, cerebral palsy, spinal cord injury)

29
Q

o Percussion

A

o Cupping over the chest wall to shake secretions loose prior to coughing
o thick, sticky or retained secretions
o Often used in combination with active cycle breathing techniques or postural drainage
o Can be done manually or mechanically
o Performed with cupped hands (to trap air between the patient’s thorax and caregiver’s hand) and in an alternating, rhythmic manner

30
Q
  • Dyspnea –
A

monitor oxygen sats, as percussion can cause temporary hypoxemia, Pain, Monitor changes in, mucus colour and consistency, breathing pattern and rate- SOB,

31
Q

Precautions percussion:

A

Avoid bony prominences (ex: vertebrae, spine of scapula), Not over rib fractures, Avoid floating ribs, Watch for redness – this is a result of slapping or not trapping enough air between the hands and the chest wall

32
Q

Contraindications percussion:

A
  • Subcutaneous emphysema
  • Recent epidural spinal infusion or spinal anesthesia
  • Recent skin grafts, or flaps, on the thorax
  • Burns, open wounds, and skin infections of the thorax
  • Recently placed transvenous pacemaker or subcutaneous pacemaker (particularly if mechanical devices are to be used)
  • Suspected pulmonary tuberculosis
  • Lung contusion
  • Bronchospasm
  • Osteomyelitis of the ribs
  • Osteoporosis
  • Coagulopathy
  • Complaint of chest-wall pain
33
Q

o Vibration

A
  • Hands are placed with the fingers in the direction of the ribs
  • On expiration, shake lightly as the ribs move in
34
Q

o Postural Drainage

A

Affected lobe goes on top

35
Q
  • Contra/in: postural drainage
A
  • Hemorrhage
  • Untreated acute conditions
  • Cardiovascular instability
  • Recent neurosurgery
  • Any condition that does not allow excess pressure in the head
36
Q

o PEP devices

A

positive expiratory pressure
* Increases resistance to expiratory airflow to promote mucus clearance
* Increase exhalation pressure
* Prevents airway closure
* Example: TheraPEP

37
Q
  • Oscillating (vibratory) PEP
A

o Combines high-frequency oscillations with PEP
o Provides exhalation resistance, like normal PEP
o Also create vibrations when a patient breathes out, to move mucus from the surface of the airways
o Example: Acapella

38
Q

Steps for PEP:

A

Step 1: Loosen mucus:
* Deep breath and hold 2-3 seconds
* Place mouthpiece in mouth while holding breath
* Exhale steadily 4-6 seconds or as long as possible
Step 2: Cough and bring up mucus:
* Remove mouthpiece from mouth
* Do 2 to 3 huff coughs
* Deep breath in
* 3 quick, forceful exhales (make a ha, ha, ha sound)
* Cough hard to bring up mucus
* Spit mucus out (do not swallow)
How long to do this?
* At least 5 times = 1 cycle
* May continue for 10-20 minutes, until sputum is cleared

39
Q

o Assisted cough

A

o For clients with a weak or absent cough, Ex: spinal cord injury
o Provide manual assistance to cough
o Enables client to clear secretions

40
Q

Contraindications: Assisted cough

A

Increased potential for aspiration (Ex: unconscious patient with unprotected airway)
* Acute abdominal pathology, abdominal aortic aneurysm, hiatus hernia, or pregnancy
* Bleeding
* Untreated pneumothorax
* Osteoporosis
* Flail chest

41
Q

Technique: Assisted cough

A

TECHNIQUE: Client uses signal to tell you that inspiration is complete, When the client signals, apply brief, firm pressure during expiration at the same time as the client attempts to cough, When the client is on ventilator, apply pressure at the end of inspiratory cycle

42
Q

o Pursed Lip

A

in through your nose, out through your mouth like you’re blowing out a birthday candle
o Population: COPD
o Anyone with an obstructive lung issue

43
Q

Rationale for pursed lip:

A

Pursed lip changes the positive end expiratory pressure (PEEP) which keeps airways open so that C02 can get out
* Increased PEEP can also hold open bronchioles (ex: in emphysema)

44
Q
  • Benefits: pursed lip
A

Improves ventilation
* Releases trapped air in the lungs
* Keeps the airways open longer to decrease the work of breathing
* Prolongs exhalation to slow the breathing rate
* Relieves shortness of breath
* General relaxation

45
Q

Rationale for braced breathing:

A
  • Bracing can allow increased use of accessory breathing muscles
    Benefits:
  • Relieves shortness of breath
  • Promotes relaxation
46
Q

o DB&C rationale

A
  • Deep breathing is better for lung health
  • After surgery, anesthetic has often resulted in shallower breathing
47
Q

Benefits DB&C

A
  • Bronchial hygiene
  • Decreased risk of complications
48
Q

o ACBT population:

A
  • Post-surgery
  • Increased sputum (acute or chronic)
  • SOB
  • Ventilated
49
Q

Rationale: ACBT

A

Calming breath can reduce an episode of shortness of breath
* Deep breaths help loosen secretions
* Huff helps clear secretions

49
Q

Benefits: ACBT

A
  1. Loosens and clears secretions from the lungs
  2. Reduces the risk of chest infections
  3. Improves ventilation in the lungs
  4. Improves the effectiveness of cough
50
Q

o Incentive Spirometer: pop

A
  • Usually post-operative
  • Patient’s with reduced inspiratory muscle strength/capacity
51
Q

Rationale: IS

A
  • Has a visual feedback system to show if you are using your inspiratory muscles
  • Encourages deeper breathing – has patients take a sustained maximal inspiration (SMI), which is a slow, deep inspiration from function residual capacity up to total lung capacity
52
Q

Benefits: IS

A

Prevents lung complications after surgery, bedrest, etc. (ex: atelectasis, infection)
* Visual feedback often means patient’s do a deeper breath than with deep breathing alone

53
Q

Technique: IS

A
  • Patient in a relaxed position
  • Create a tight seal around device with mouth
  • Inhale slowly, get the ball as high as you can, hold 5 seconds
  • Relax and exhale
  • Generally, try for 10 IS breaths per waking hour

THER 231 FINAL (4 decks)

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