Pulmonary Flashcards
What are the upper airways?
nose, mouth, pharynx, larynx
What are the lower airways?
trachea, terminal bronchioles (conducting airwyas, transport air, nil gas exchange)
respiratoy unit - resp bronchiles, alveolar ducts, alveolar sacs, alveoli (diffusion of gas)
What are primary and accessory muscles to inspiration?
Primary - diaphragm, external intercostals
accessory - scalenes, SCM, levator costarum, serratus, traps, pecs
What are expiratory muscles of ventilation?
used in exs or disease states
QL, internal intercostals, abs, triangularis sterni
What is normal HR?
60-100bpm
What is normal BP?
120-80
What is normal RR?
12-20
What is normal PaO2
80-100mmHg
What is normal PaCO2?
35-45 mmHg
What is normal pH?
73.5-7.45
What are crackles indicative of?
usually on inspiration
atelectasis, fibrosis, PE
What are wheezes indicative of?
during expiration
airway obstruction (asthma, COPD, foreign body aspiration)
What are normal hemoglobin levels?
12-16 g/dL
What is respiratory alkolosis and acidosis?
alkolosis - increased pH, decreased PaCO2, WNL HCO3; alveolar hyperventilation; dizziness, syncope, tingling, numbness
acidosis - decreased pH, increased PaCO2, NWL HCO3; alveolar hypoventilation; anxiety, restlessness, dyspnea, HA, confusion, coma
What is metabolic alkolosis and acidosis?
alkalosis - increased pH, increased HCO3, WNL PaCO2; bicarb ingestion, vomiting, duretics, steroids, adrenal disease; vauge symptoms of weakness, mental dullness
acidosis - decreased pH, decreased HCO3, WNL PaCO2; diabetic, lactic, prolonged diarrhea; secondary ventilation, nausea, lethary, coma
What is normal WBC count
4,000-11,000
What is normal hematocrit levels?
35-48%
What is the classification sclae GOLD for obstructive lung disease?
1 mild - 80% predicted, with/without chronic symptoms; unaware of lung function
2 moderate - 50-80%, SOB on exertion
3 severe - 30-50%, decreased exs capacity, exacerbations, heaps of SOB
4 very severe -
What are the Graded Exs Test termination criteria?
maximal SOB cardiac ischemia symptoms of fatigue incrase of diastolic pressure of 20, systolic hypertension >250, decrease in blood pressure with increasing workloads leg pain total fatigue signs of insufficient CO reaching ventilatory max
What are the types of pneumonia?
bacterial - intra-alveolar bacterial infection. gram positive (community) and gram negative
viral - interstitial or intra-alveolar inflammatory process caused by viral agents
aspiration pneumonia
What are physical findings of COPD?
cough sputum dyspnea on exertion decreased breath sounds increased RR wt loss/ anorexia increased AP diameter of chest wall cyanosis clubbing postures to elevate shoulder girdle CXR showing hyperinflamtion, flattened diaphragm, hyperlucency hypoxemia, hypercapnea increased FRC and RV decreased FEV1, FVC
What is asthma?
obstructive disease
reversible in nature
reactivity of trachea and bronch to various stimuli (allergens, exs, cold)
widespread narrowing of ariways due to inflammation
smooth muscle constriction, increased secretions
What are physical findings of asthma?
wheezing, crackels, decreased breath dounds increased secretion dyspnea increased accessory muscle use anxiety tachycardia hypoxemia hypocapnea, then hypercapnea cyanosis impaired flow rates CXR hyperlucency and flattened diaphragm
What is cystic fibrosis?
geneticlaly inherited disease characterised by thickening of secretions of all exocrine glands
What is bronchiectasis?
chronic congenital or acquired disease characterised by abnormal dilation of bronchi and excessive sputum production
What is resp distress syndrome/ RDS?
alveolar collapse in premature infant
*PT consideration: increased breathing effort casued by handling premature infant must be carefully weighed against possible benefits of PT
What is bronchopulmonary dysplasia?
obstructive pulmonary disease, often a sequela of premature infants with resp distress syndrome
Results from high pressures of mechanical vent, high fractions of inspired O2 and/or infection
What types of restrictive pulmonary diseases are there?
due to alterations in lung parenchyma and pleura - fibrotic changes
due to alterations in chest wall - restricted bony throax; ankylosing spond, scoliosis, arthritis, pectus excavatum, arthrogryposis, skin changes due to burns or scleroderma
due to neuromuscular apparatus - decreased muscle strength results in inability to expand ribs; MS, MD, PD, SCI, CVA
What postural drainage position do you use for upper lobes (apical segment)?
Pt sitting, leaning back 30degrees
PT clpas of apices
What postural drainage position do you use for upper lobes posterior seg?
leans forward over pillo 30 degrees
PT claps over upper back
What postural drainage position do you use for upper lobes anterior?
supine pillow under knees, PT claps between clavicle and nipple
What postural drainage position do you use for right middle lobe?
foot of table elevated 16in
patient head down on left side rotates 1/4 bakcward, knees flexed
PT claps over right nipple area
What postural drainage position do you use for left upper lobe lingular seg?
foot of table elevated 16 in
patients head down on right side and rotates 1/4 turn bakcward
PT claps over left nipple area
What postural drainage position do you use for lower lobe ant basal seg?
foot of table elevated 20 in
lie on side, head down, pillow under knees
PT claps over lower ribs
What postural drainage position do you use for lower lobes lateral basal seg?
foot of table elevated 20 in
lie on abdo, head down, then rotate 1/4 turn upward
PT claps over uppermost portion of lower ribs
What postural drainage position do you use for for lower lobes posterior basal seg?
foot of table elevated 20 in
prone, head down, pillow under hips
PT clasp over lower ribs close to spine on each side
What postural drainage position do you use for lower lobes superior seg?
table flat
prone, two pillows under hips
PT claps over middle back at tip of scap on either side of spine
