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Cardiopulmonary > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Goals of cardiovascular pulmonary PT

A
  • Prevent airway obstruction/ accumulation of secretions that interfere with normal respiration
  • Improve airway clearance, cough effectiveness, ventilation through mobilization and drainage of secretions
  • Improve endurance, general exercise tolerance
  • Reduce energy costs during respiration through breathing retraining
  • Prevent, correct postural deformities associated with pulmonary or extrapulmonary disorders
  • Maintain or improve chest mobility
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2
Q

Anatomy of the respiratory tract

A
  • trachea
  • 2 mainstem bronchi
  • 5 lobar bronchi (3 upper, middle, lower) on right; (2 upper and lower and a lingula on the left
  • 18 segmental bronchi
  • bronchioles
  • alveolar ducts and sacs
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3
Q

Primary ventilatory muscles

A 
Inspiration: 
•Diaphragm
•Scalenes
•Parasternals
Expiration: 
•none active during tidal (resting) expiration-passive recoil
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4
Q

Accessory ventilatory muscles

A 
Inspiration: 
• SCMs 
• upper traps
•pecs 
•possible external intercostals
Expiration:
• abdonminals
• pec major
•possibly internal intercostals
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5
Q

Compliance

A

distensibility of tissue- how easily the lungs inflate during respiration

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6
Q

Airway resistance

A

amount of resistance to flow of air- depends on: bifurction/ branching of airways, size of lumen- diameter may be decreased by mucus or edema.

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7
Q

Flow rates

A
  • measurements of amount of air moved in and out of airway over a period of time.ie. With COPD flow rate is decreased- takes longer than normal to exhale a specific volume of air
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8
Q

Total lung capacity

A

the total amount of air contained in the lunges after a maximal inspiration
•approx 6,000 mL

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9
Q

Tidal volume

A

the amount of air exchanged during a relaxed inspiration followed by a relaxed expiration (quiet/resting breathing)
•approx 500 mL

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10
Q

Residual volume

A

the amount of air left in the lungs after a max expiration
• approx 1500 mL
•RV increases with restrictive and obstructive pulmonary disease

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11
Q

Vital capacity

A

measured by max inspiration followed by max expiration
•approx 4500 mL
•decreases with age, restrictive and obstructive diseases, and is less in supine than erect sitting or standing

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12
Q

normal respiration rates for adults

A

12-20 breaths per minute

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13
Q

normal ratio of inspiration/expiration

A

at rest= 1:2
with activity= 1:1
*patient with COPD may have a ratio of 1:4 at rest- reflects this patient types difficulty with expiratory phase of breathing

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14
Q

ausculation- normal and adventitious

A

Normal: vesicular, bronchiol, bronchovesivular
Adventitious: crackles (rales), wheezes (rhonchi)

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15
Q

thin, frothy, and white consistency of cough production indicates…

A

pulmonary edema and heart failure

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16
Q

Restrictive lung diseases

A

Difficulty with INHALATION
Pulmonary causes:
•pneumonia
•TB
•asbestosis (a lung disease resulting from the inhalation of asbestos particles, marked by severe fibrosis and a high risk of mesothelioma- cancer of the pleura)
•atelectasis
•tumor
•pulmonary fibrosis
•pulmonary edema
•PE
•ARDS (adult or acute respiratory distress syndrome caused by fluid build up in the alveoli)
•bronchopulmonary dysplasia (Chronic lung disease of premature babies)
• advanced age
•pneumothorax (A collapsed lung. A pneumothorax occurs when air leaks into the space between the two pleural membranes surrounding each lung, space is called the pleural cavity)
•hemothorax (an accumulation of blood within the pleural cavity- space between the pleural membranes surrounding each lung)
Extrapulmonary causes:
• chest wall pain due to trauma or surgery
•chest wall stiffness due to disease- scleroderma (autoimmune disease- hardening of the skin), ankylosing spondylitis
•postural deformity- scoliosis, kyphosis
• Ventilatory muscle weakness- SCI, CP, MD, Parkinson disease
•pleural disease
• decreased diaphragmatic excursion due to ascites (fluid build up in the abdominal cavity) or obesity

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17
Q

Pulmonary HTN

A

can be caused by a number of factors, all of which force the heart’s right side to work harder to pump blood to the lungs. The right chambers may enlarge as they struggle to function, and the blood is often forced backwards through the tricuspid valve

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18
Q

lobectomy

A

removal of a lobe of a lung- often for removal of CA

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19
Q

COPD chronic obstructive pulmonary disease

A
  • peripheral airway disease
  • chronic bronchitis (inflammation (swelling) and irritation of the bronchial tubes. The irritation of the tubes causes mucus to build up)
  • Emphysema (In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger often mucus filled air spaces called bullae- instead of many small ones)
  • asthma (marked by spasms in the bronchi of the lungs, causing difficulty in breathing. It usually results from an allergic reaction or other forms of hypersensitivity- airways narrow and swell and may produce extra mucus)
  • bronchiectasis (a condition where the bronchial tubes of your lungs are permanently damaged, widened, and thickened. These damaged air passages allow bacteria and mucus to build up and pool in your lungs- leading to frequent infection and general obstruction)
  • cystic fibrosis (hereditary disease that affects the lungs and digestive system. The body produces thick and sticky mucus that can clog the lungs and obstruct the pancreas)
  • bronchopulmonary dysplasia (Chronic lung disease of premature babies- lungs don’t develop normally)
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20
Q

Types of breathing:

A
  • diaphragmatic
  • segmental: lateral costal expansion and posterior basal expansion
  • pursed lip breathing- avoid forceful expiration- there should be no contraction of abdominals
  • Glossapharyngeal breathing: for high SCI or other neuromuscular disorders- usually ventilator dependent because of absent or incompetent innervation to diaphragm (gulping air)
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21
Q

Pulmonary A&P Dr.B

A

•Involuntarily controlled by brainstem. Voluntarily by cerebral cortex.

•Primary inspiratory muscles: 
Diaphragm
External intercostals
Internal intercostals
•Accessory: trap, SCM, scalenes, pectorals, serratus ant, lat dorsi
•Primary expiratory: 
Rectus abdominus
External oblique
Internal oblique. 
•Accessory exp: 
Latissimus dorsi
Tripod position allows for accessory muscles to be used more effectively
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22
Q

Respiratory flow chart

A

nose -> nasal cavities -> pharynx (adenoids & tonsils) -> larynx (epiglottis) -> trachea -> bronchi -> bronchioles -> alveoli -> lung capillaries

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23
Q

Gas exchange

A 
Occurs across the alveolar-capillary membrane. 
Factors involved: 	
Concentration gradient: 
Alveolar O2 100mmHg to capillary 40mmHg
Surface area of the A-C interface.
Thickness of membrane (phlegm)
Solubility of the gas
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24
Q

Ventilation/Perfusion

A
  • Close as possible to 1:1 is ideal
  • Air present and ready to exchange (V) and blood present and ready for exchange (Q)
  • Really is 0.8
  • V/Q depends on position
  • Dead space: perfusion is lacking
  • Shunt: ventilation is lacking
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25
Q

Obstructive disorders

A
  • Asthma
  • Chronic bronchitis
  • Emphysema
  • Cystic Fibrosis
  • Bronchiectasis
  • COPD: a combination of chronic bronchitis, emphysema, small airway obstruction.
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26
Q

COPD

A
  • Progressive airflow limitation caused by airway inflammation due to noxious particles/gases
  • Mucous membranes hyperplastic (narrow)
  • Cilia function decreases (hard to clear)
  • Chest wall flexibility decreases, no recoil
  • Elevated TLC, FRC, RV
  • Decreased IRV, VC, IC, ERV
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27
Q

COPD what can you do

A

What can you do?
•Teach patient positioning: upright or postural drainage
•Pursed lip breathing (tissue trick)
•Effective coughing with tactile cues
•Give rest breaks
•Use Borg scale
** don’t increase oxygen without permission**

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28
Q

Asthma: exacerbation

A

•S&S: Tachypnea, fatigue, anxiety, pursed lip breathing, active expiration, cyanosis, accessory muscle use
•if severe: both BP and pulse will decrease on inspiration
polyphonic wheezing on expiration>inspiration
diminished breath sounds

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29
Q

Asthma: tx

A 
Remove of trigger
Bronchodilator
Corticosteriods
Supplemental oxygen
IV fluids
PT: pt should bring inhaler to tx, stop exertion if wheezing noted, triggers should be noted on the chart (cold/allergen)
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30
Q

Chronic Bronchitis

A
  • S&S: tripod breathing, barrel chest, anxiety, fatigue, ^RR, prolonged expiration, stocky build, dependent edema, “blue bloater”, cyanosis due to cor pulmonale, edema, ^HR, BP, ^Hbg, ^CO2
  • Rhonchi, diminished breath sounds, crackles, productive cough in morning, clear to purulent sputum
  • Xray: flat diaphragms, cardiomegaly (cor pulmonale)
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31
Q

Chronic bronchitis tx

A

Smoking cessation, bronchodilator, steroids, expectorant, O2, ventilation if severe
PT: airway clearance techniques, pulmonary rehab

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32
Q

Emphysema

A

•S&S: cachexia, accessory muscle use, fatigue, anxiety, “Pink puffer-tachypnea, pursed lips & flushed skin”, muscle atrophy, air trapping
Very diminished breath sounds, wheeze, crackles
• No cough
•Xray: bullae, heart appears smaller, flat diaphragms

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33
Q

Emphysema tx

A
  • Bronchodilators,
  • O2
  • Nutrition support
  • Pulmonary rehab.
  • Be on the look out for spontaneous pneumothorax as bullae can burst
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34
Q

Cystic fibrosis

A

•S&S: tachypnea, fatigue, accessory muscle use, barrel chest, cachexia, clubbing
^BP, HR, diminished breath sounds, rhonchi, crackles, chronic cough, thick green/red streaked sputum
•Xray: flat diaphragms, fibrosis, atelectasis, linear opacities, large R ventricle

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35
Q

Cystic fibrosis tx

A
  • Antibiotics, Bronchodilators, Mucolytics
  • O2
  • PT: Airway clearance techniques & aerobic exercise
  • nutritional support
  • Psychosocial
  • lung transplant
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36
Q

Airway clearance techniques

A
  • Breathing control
  • Thoracic expansion
  • Forced expiratory
  • Directed cough and huffing
  • Postural drainage
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37
Q

Breathing techniques

A
  • Diaphragmatic breathing
  • Inspiratory muscle training
  • Paced breathing and exhale effort
  • Pursed-lip breathing
  • Segmental breathing
  • Sustained maximal inhalation with incentive spirometer
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38
Q

Bronchiectasis (bronchial dilation)

A
  • S&S: tachypnea, fatigue, accessory muscle use, barrel chest, cachexia, clubbing, ^BP & HR, pleuritic pain
  • Crackles, diminished breath sounds, rhonchi
  • Sputum: purulent, odorous, may have hemoptysis
  • Xray: infiltrates, atelectasis, honeycomb
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39
Q

Bronchiectasis tx

A
  • Antibiotics, bronchodilators, corticosteroids, O2, IV fluid, nutritition, pain control, lung transplant
  • PT: bronchopulmonary hygiene
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40
Q

Pulmonary function testing

A
  • Tests inspiration & expiration volumes and speeds.
  • Determines obstructive vs restrictive
  • Determines progress of condition
  • Obstructive: reduced expiratory flows, retained air leads to d/c inspiration
  • Restrictive: reduced lung volumes, normal expiration.
41
Q

Restrictive lung diseases

A
  • Atelectasis
  • Pulmonary Embolism (PE)
  • Adult Respiratory Distress Syndrome (ARDS)
  • Pneumonia
  • Pulmonary fibrosis/ Interstitial lung disease
  • Pulmonary edema
42
Q

Atelectasis

A
  • Partial or total collapse of alveoli, lung segments or lobes.
  • Caused by: inactivity, pain with deep breathing (hint…surgery patients), diaphragm weakness (ICU and SCI patients), foreign body
  • PT:Incentive spirometer, deep breathing and coughing, OOB, ambulate
43
Q

PE

A
  • A clot within the arterial pulmonary circulation. (90% of the time from the lower extremity)
  • No blood flow beyond the clot. No gas exchange beyond the clot.
  • PT should be ceased until cleared by MD, very close monitoring upon resumption of activity.
  • Sx: Sudden dyspnea, chest pain, tachypnea, tachycardia, severity varies
44
Q

ARDS

A
  • Acute lung inflammation
  • S&S: dyspnea, AMS, ^RR, ^PA pressure, hypotension, decreased chest wall expansion, d/c breath sounds, crackles, wheeze.
  • Xray: pulmonary edema, patchy opacities, “ground glass”
  • Tx: vent, IV fluid, prone, glucocorticoids,
  • PT will start when pt is stable, 30% mortality
45
Q

Pneumonia

A

•Distal airway inflammation with alveolar exudate formation.
•May be one lobe or many.
Fever, increased WBC, dyspnea
•Resolution may take 6 weeks (prolonged in advanced age, smoking hx, poor nutrition, co-morbidities)

46
Q

Pulmonary fibrosis/interstitial lung disease (ILD)

A
  • Destruction of respiratory membranes in multi locations
  • 1st phase inflammatory, 2nd phase fibrotic
  • S&S: exertional dyspnea, non productive cough, dry crackles (Velcro sound),
  • Xray: diffuse, bilateral changes
47
Q

Pulmonary edema

A
  • Fluid moves from capillaries into alveoli.
  • S&S: tachypnea, orthopnea, anxiety, accessory muscle use, wet crackles at bases, may have wheeze.
  • Sputum frothy, white, clear, pink**
  • ^ Hilar vascular markings, ^cardiomegaly, fluffy opacity
  • Tx: diuretics, O2, hold PT until stable
48
Q

Red flag signs of acute pulmonary edema

A
  • Extreme dyspnea
  • Diaphoresis
  • Bubbly/wheezing/gasping breath sounds
  • Frothy or blood tinged sputum
  • Cyanosis
  • Rapid, irregular HR
  • Severe drop in BP
49
Q

Extrapulmonary restriction

A
  • Pleural effusion, •Hemothorax
  • Pneumothorax (PTX)
  • Flail chest (rib cage breaks and moves)
  • Empyema
  • Kyphoscoliosis, ankylosing spondylitis, RA
  • Obesity/pregnancy
50
Q

Plueral effusion/hemothorax

A
  • Fluid gathered between the lung tissue and the pleural sac.
  • Prevents full expansion
  • Hemothorax indicates this fluid is blood
  • Empyema indicates this fluid is purulent.
51
Q

Pneumothorax

A
  • Pneumothorax: Air gathers in the pleural cavity
  • Can be due to trauma, tension, bleb/bulla, central line insertion, thoracentesis, atelectasis.
  • S&S: tachypnea, pleural pain, d/c expansion, d/c breath sounds
52
Q

Thoracentesis and chest tube

A
  • Thoracentesis: surgical puncture to remove fluid from pleural space
  • Chest tube: tube placed in the intercostal space to remove fluid/air/blood from pleural space, drains to pleurovac container, or pleurax is drained intermittently. sutured in place
53
Q

tracheostomy

A

Surgical creation of opening into the trachea through the neck

54
Q

lung surgeries and PT

A

Lung surgeries tend to be quite painful for several days, especially when a chest tube is present. Plan for premedication, splinted coughing, don’t roll on to the incision or chest tube if possible, be very careful not to pull on the chest tube, gait belt may be contraindicated. Don’t knock over Pleurevac.

55
Q

ABG (arterial blood gas)

A
  • Blood sample from (radial) artery
  • Detects acid/base balance, how well body is removing
  • CO2 and bringing in O2
  • pH: 7.35-7.45
  • PaCO2: 35-45 mmHG
  • PaO2: 80-100 mmHG. •Hypoxemia: <80
  • HCO3: 22-26 mEq/L
  • SaO2: 95-98%
56
Q

Normal lung sounds

A

Depend on the area:
•Tracheal/bronchial: over the trachea or bronchi. Loud, inspiration shorter.
-heard over tubual structures, abnormal if over lung tissue
•Vesicular: breezy, inspiration longer
-Heard over lung tissue

57
Q

Abnormal lung sounds

A
  • Wheeze
  • Stridor (a high-pitched, wheezing sound caused by disrupted airflow)
  • Rhonchi (continuous low pitched, rattling lung sounds that often resemble snoring)
  • Crackles (fine, short, high-pitched, intermittently crackling sounds. The cause of crackles can be from air passing through fluid, pus or mucus)
  • Pleural friction rub
58
Q

Cheyne- Stokes respirations

A

a cycle of abnormal breathing that lasts between 30 seconds and 2 minutes, the patient’s breathing will become really deep and then gradually get very shallow and some may experience a period of apnea. This condition is associated with heart failure and stroke, as well as airway obstruction.

59
Q

Kussmaul’s respirations

A

deep and rapid breathing pattern, a form of hyperventilation that is one of the body’s responses to excessive internal acidity. This breathing pattern commonly occurs with severe metabolic asidosis (experienced by those with DM) including keto acidosis as well with renal failure

60
Q

Biot’s respirations

A

clusters of rapid and shallow breathing, unlike Cheyne-Stokes this breathing abnormality wont come on gradually and there are no periods of deep breathing. This condition is caused by pressure on or damage to the brainstem due to CVA or problems such as meningitis.

61
Q

Hyperventilation

A

period of rapid and deep breathing, generally associated with extreme stress or panic attacks, but sometimes with a more serious underlying cause such as heart problems, COPD, and pulmonary infections

62
Q

Hypoventilation

A

period of slow and shallow breathing, associated with lung issues like cystic fibrosis and emphysema as well as metabolic alkalosis

63
Q

tracheal breath sounds

A
  • Normal

* loud and tubal, heard over proximal airways, such as the trachea and main stem.

64
Q

Bronchial breath sounds

A
  • Normal

* loud and tubal, heard over proximal airways, heard near the manubrium

65
Q

Vesicular breath sounds

A
  • Normal

* soft and rustling sound, heard over more distal lung areas (parenchyma)

66
Q

Wheezing breath sounds

A
  • Abnormal

* airway obstructions or retained secretion, heard during expiration

67
Q

Stridor breath sounds

A
  • Abnormal

* very high pitched wheezing occurring during inhalation, usually associated with an upper obstruction

68
Q

Rhonchi breath sounds

A
  • Abnormal

* low pitched sound (similar to snoring) caused by large obstructions, usually in the form of secretions

69
Q

Discontinuous breath sounds

A
  • abnormal
  • crackling and bubbling or popping sounds, usually indicates presence of fluid secretions or sudden opening and closure of airway
70
Q

breath sounds from fluid

A

such as pneumonia or pulmonary edema- the sound is wet

71
Q

breath sounds from atelectasis

A

sound is dry

72
Q

Resonant breath sounds

A

occurs over normal lung tissue

73
Q

Hyper-resonant lung sounds

A

occurs with emphysema or a pneumothorax

74
Q

Dull breath sounds

A

occurs with increased lung tissue density, or decreased air content

75
Q

TLC total lung capacity

A

the volume of air contained in the lungs after a maximal inspiration. Increase in this volume indicates an obstructive disorder, while a significant decrease indicates a restrictive disorder

76
Q

FEV forced expiratory volume

A

forced expiratory volume is the amount of air that can be expired within a certain time frame. A significant decrease in this volume indicates a restrictive disorder, while a decrease in FEV1/FVC indicates an obstructive disorder

77
Q

Asthma

A

Classification: obstructive

Observations: tachypnea, fatigue, and anxiety

Management: removal of causative agents, corticosteroids, bronchodilators

78
Q

Cystic fibrosis

A

Classification: obstructive

Observations: tachypnea, fatigue, digital clubbing, and barrel chest

Management: antibiotics, bronchodilators, nutritional support

79
Q

Emphysema

A

Classification: obstructive

Observations: wheezing, pink puffer, and cachexia

Management: bronchodilators, supplemental O2, nutritional support

80
Q

Chronic bronchitis

A

Classification: obstructive

Observations: blue bloater, tachypnea, barrel chest, fatigue

Management: supplemental O2, stop smoking, brochodilators

81
Q

Bronchiectasis

A

Classification: obstructive

Observations: accessory muscle use, fatigue, clubbing

Management: supplemental O2, antibiotics, bronchodilators

82
Q

Atelectasis

A

Classification: restrictive

Observations: dry or wet sputum, shallow breathing, tachypnea

Management: incentive spirometer, supplemental O2, functional mobilization

83
Q

Pneumonia

A

Classification: restrictive lung disease

Observations: fatigue, decreased chest wall expansion, crackles

Management: antibiotics, supplemental O2, bronchopulmonary hygiene

84
Q

Pulmonary edema

A

Classification: restrictive

Observations: tachypnea, orthopnea, accessory muscle use

Management: diuretics, supplemental O2, hemodynamic monitoring

85
Q

Adult respiratory syndrome

A

Classification: restrictive

Observations: labored breathing, altered mental status, tachypnea

Management: prone positioning, hemodynamic monitoring, mechanical ventilation

86
Q

PE

A

Classification: restrictive

Observations: rapid onset of chest pain, tachypnea, dysrhythmia

Management: anticoagulation, thrombolysis, hemodynamic stabilization

87
Q

side effect of pulmonary maintenance drugs, rescue drugs, antibiotics, supplemental O2

A

shaky hands, tachycardia, HA, vomitting, diarrhea, dizziness, abdominal cramping, rash, nasal inflammation, air trapped in the esophagus, tremors

88
Q

s/s of hyperthyroidism

A
  • tachycardia
  • Graves disease (autoimmune disorder that causes hyperthyroidism, or overactive thyroid. With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs)
  • increased perspiration
  • diarrhea, thirst, weight loss
89
Q

s/s of hypothyroidism

A
  • cold intolerance
  • nonpitting edema of the eyelids, hands, and feet
  • Hashimoto’s thyroditis (autoimmune disease that damages the thyroid gland. Hashimoto’s disease affects more women than men. It is the most common cause of hypothyroidism)
  • delayed DTR
  • dry and cool skin
90
Q

retained secretions…

A
  • Obstruct airways
  • Limit airflow
  • Cause VQ mismatch
  • Impair gas exchange
  • Increases risk of infection
  • Secretion clearance is the cornerstone of diseases of hypersecretion
91
Q

Goals of airway clearance

A
  • Improve ventilation
  • Facilitate secretion clearance
  • Manage dyspnea & discomfort
  • Increase cough effectiveness
92
Q

Principles of airway clearance: interdependence

A

deep inhalation expands direct and adjacent collapsed allveoli bringing air into obstructed airways

93
Q

Principles of airway clearance: collateral ventilation

A

channels bypass blocked airways using pressure from adjacent segments

94
Q

Principles of airway clearance: 3 seconds inspiratory hold

A

allows time for interdependence and collateral ventilation to occur

95
Q

Cough

A

•Coughing clears proximal 1/3 bronchial tree
- other techniques move secretions to this area to be cleared by coughing
•Effective cough requires:
- deep inhalation, 1.5x tidal volume to elicit elastic recoil
-closure of glottis, abdominal contraction, add 3 second hold for more effectiveness
- increased expiratory flow rate to shear secretions from bronchial walls
•Can cause bronchospasm

96
Q

Pharmacology

A
  • Bronchodilators: albuterol
  • Mucolytics: reduce viscosity
  • inhaled steroids
  • inhaled antibiotics
97
Q

postural drainage contraindications

A
  • intercranial pressure >20 mm Hg
  • head/neck injury
  • hemorrhage
  • recent spinal surgery
  • hemoptysis (coughing up of blood or blood-stained mucus)
  • surgical wound in area
  • empyema (a collection of pus in the pleural cavity)
  • bronchopleural fistula
  • pulmonary edema
  • confusion/anxiety
  • rib fx/CA
98
Q

Trendelenburg specifically contraindicated

A 
•uncontrolled HTN
• distended abdomen
•esophageal surgery
• lung CA with hemoptysis
• airway at risk for aspiration 
-tube feed
-recent meal
-unable to manage oral secretions
99
Q

postural draining positions

A
  • anterior apical segments: semi-fowlers
  • posterior apical segments: sitting up and leaning forward
  • anterior segments (upper lobes): supine
  • right posterior segments: prone with the right side propped up on a pillow so that it is superiorly positioned relative to the L (switch sides for L)
  • left posterior segment (upper lob): prone with upper body elevated
  • right middle lobe: trendelenburg with slight L rotation and right side propped up on pillow

Cardiopulmonary (4 decks)

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