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Acute Care > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

What are the general parts of pulmonary anatomy?

A
  • upper respirator tract
  • lower respiratory tract
  • alveoli
  • primary inspiratory muscles
  • primary expiratory muscles
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2
Q

What does the upper respiratory tract consist of?

A
  • nasal cavity
  • oral cavity
  • larynx
  • pharynx
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3
Q

What is the function of the upper respiratory tract?

A
  • warm, humidify, and filter inspired air

- mucocilliary escalator

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4
Q

What does the lower respiratory tract consist of?

A
  • trachea
  • bronchi
  • bronchioles
  • alveoli
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5
Q

What is the function of the lower respiratory tract?

A
  • houses immune cells

- complete pulmonary defense

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6
Q

What should be noted about the R mainstem bronchus?

A

it is more vertically aligned than the L and is more likely to be the site of aspiration

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7
Q

What is the function of alveoli?

A

primary site of gas exchange

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8
Q

Name the primary inspiratory muscles

A
  • diaphragm
  • external intercostals
  • accessory muscles (SCM, scalenes, pecs, traps)
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9
Q

Name the primary expiratory muscles

A
  • rectus abdominus
  • external obliques
  • internal obliques
  • internal intercostals
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10
Q

What are the parts and normal values of V/Q ratio

A

V - ventilation
Q - perfusion
Normal value: 0.8

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11
Q

What affects V/Q ratio?

A
  • concentration gradient
  • surface area
  • thickness of membrane
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12
Q

When does dead space occur?

A
  • decreased perfusion (Q)

- example: pulmonary embolism

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13
Q

When does shunting occur?

A
  • decreased ventilation (V)

- example: atelectasis, COPD, pneumothorax

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14
Q

What are the types of lung volumes?

A
  • VC: vital capacity
  • TV: tidal volume
  • IC: inspiratory capacity
  • ERV: expiratory reserve volume
  • RV: residual volume
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15
Q

Define vital capacity

A
  • the greatest volume of air that can be expelled from the lungs after taking the deepest possible breath
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16
Q

Define tidal volume

A
  • the amount of air that moves in or out of the lungs with each respiratory cycle (quiet breathing)
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17
Q

Define inspiratory capacity

A
  • the max volume of air that can be inspired after reaching the end of a normal, quiet expiration
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18
Q

Define expiratory reserve volume

A
  • the amount of extra air, above a normal breath, exhaled during a forceful breath out
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19
Q

Define residual volume

A

the volume of air remaining in the lungs after maximum forceful expiration

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20
Q

Name the types of breathing patterns (13)

A
  • apnea
  • biot’s respirations
  • bradypnea
  • cheyne-stokes respirations
  • hyperpnea
  • hyperventilation
  • hypoventilation
  • kussmaul respirations
  • orthopnea
  • paradoxic ventilation
  • sighing respirations
  • tachypnea
  • hoover’s sign
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21
Q

Define apnea and its causes

A 
- lack of airflow to the lungs for >15 seconds
Causes:
- airway obstruction
- cardiopulmonary arrest
- alterations to the respiratory center
- narcotic overdose
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22
Q

Define Biot’s respirations and its causes

A
  • constant increased rate and depth of respiration followed by periods of apnea of varying lengths
    Causes:
  • increased ICP
  • meningitis
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23
Q

Define bradypnea and its causes

A 
- ventilation rate <12 breaths per minute
Causes:
- sedatives
- narcotics
- alcohol
- neurologic or metabolic disorders
- excessive fatigue
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24
Q

Define Cheyne-Stokes respirations and its causes

A 
- increasing depth of ventilation followed by a period of apnea
Causes:
- increased ICP
- CHF
- narcotic overdose
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25
Q

Define hyperpnea and its causes

A 
- increased depth of ventilation
Causes:
- activity
- pulmonary infections
- CHF
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26
Q

Define hyperventilation and its causes

A 
- increased rate and depth of ventilation resulting in decreased PCO2
Causes:
- anxiety
- nervousness
- metabolic acidosis
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27
Q

Define hypoventilation and its causes

A
  • decreased rate and depth of ventilation resulting in increased PCO2
    Causes:
  • sedation/somnolence
  • neurologic depression of respiratory centers
  • overmedications
  • metabolic alkalosis
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28
Q

Define Kussmaul respirations and its causes

A
  • irregular rate and depth of respirations
    Causes:
  • diabetic ketoacidosis
  • renal failure
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29
Q

Define orthopnea and its causes

A
  • dyspnea that occurs in a flat supine position; relief occurs with more upright sitting or standing
    Causes:
  • chronic lung disease
  • CHF
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30
Q

Define paradoxic ventilation and its causes

A 
- inward abdominal or chest wall movement with inspiration and outward movement with expiration
Causes:
- diaphragm paralysis
- ventilation muscle fatigue
- chest wall trauma
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31
Q

Define sighing respirations and its causes

A 
- the presence of a sigh 2-3x/minute
Causes:
- angina
- anxiety
- dyspnea
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32
Q

Define tachypnea and its causes

A 
- ventilation rate >20 breaths per minute
Causes:
- acute respiratory distress
- fever
- pain
- emotions
- anemia
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33
Q

Define Hoover’s sign and its causes

A
  • the inward motion of the lower rib cage during inhalation
    Causes:
  • flattened diaphragm
    –> often related to decompensated or irreversible hyperinflation of the lungs
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34
Q

What are the arterial blood gasses (ABGs)?

A
  • acid-base balance (pH)
  • ventilation (CO2)
  • oxygenation (O2)
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35
Q

What are ABGs used for?

A

to guide medical or therapeutic interventions such as mechanical ventilation settings or breathing assist techniques

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36
Q

What might disturbances in acid-base balance be caused by?

A
  • pulmonary dysfunction

- metabolic dysfunction

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37
Q

In what order are ABGs typically written?

A

pH / PaCO2 / PaO2 / HCO3

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38
Q

What is PaCO2?

A

partial pressure of dissolved CO2 in plasma

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39
Q

What is PaO2?

A

partial pressure of dissolved O2 in plasma

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40
Q

What is HCO3?

A

the level of bicarbonate in the blood

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41
Q

What is the difference between PaO2 and SaO2?

A
  • PaO2 is the partial pressure of dissolved O2 in plasma

- SaO2 is a percentage of the amount of hemoglobin sites filled(saturated) with O2 molecules

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42
Q

Define air trapping

A

retention of gas in the lung as a result of partial or complete airway obstruction

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43
Q

Define bronchospasm

A

smooth muscle contraction of the bronchi and bronchiole walls resulting in a narrowing of the airway lumen

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44
Q

Define consolidation

A

transudate, exudate, or tissue replacing alveolar air

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45
Q

Define hyperinflation

A

over-inflation of the lungs at resting volume as a result of air trapping

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46
Q

Define hypoxemia

A

a low level of oxygen in the blood

- PaO2 <60-80mmHg

47
Q

Define hypoxia

A

a low level of oxygen in the tissues available for cell metabolism

48
Q

Define respiratory distress

A

the acute or insidious onset of dyspnea, respiratory muscle fatigue, abnormal respiratory pattern and rate, anxiety, and cyanosis related to inadequate gas exchange

  • this clinical presentation usually precedes respiratory failure
49
Q

Define Acute Respiratory Distress Syndrome (ARDS)

A

acute inflammation of the lungs associated with

  • aspiration
  • drug toxicity
  • inhalation injury
  • pulmonary trauma
  • shock
  • systemic infection
  • multi organ failure
50
Q

Describe the sequelae and treatment for ARDS

A
  • variable latent pulmonary sequelae (none to mild exertional dyspnea to mixed obstructive-restrictive abnormalities)
  • prone positioning in ICU
  • -> facilitates improved aeration to dorsal lung segments, improves VQ matching, and secretion drainage
51
Q

Define pleural effusion and describe its causes and treatment

A 
- fluid in the pleural space (transudate or exudate) which can be unilateral or bilateral
Causes:
- compressive atelectasis
Treatment:
- fluid must be drained
52
Q

Define pneumothorax

A
  • air in the pleural space which can be open or closed
53
Q

What can pneumothorax cause? (VQ)

A

decreased ventilation = shunting

54
Q

Define hemothorax

A

blood in the pleural space

55
Q

Define cystic fibrosis

A

a genetic anomaly in which there is an issue with sodium channels that results in an excessive amount of fluid in the lungs (mild to severe cases)

56
Q

Define atelectasis and what it may cause

A
  • collapsed alveoli

- May cause decreased ventilation = shunting

57
Q

Define flail chest and what it may lead to

A
  • a case in which you have a double fracture of 3+ adjacent ribs which separates the chest from the rib cage
  • this leads to paradoxical breathing patterns and can lead to atelectasis if not treated quickly
58
Q

Define subcutaneous emphysema

A

bubbles popping under the skin from the presence of air in subcutaneous tissue

59
Q

Name the different breath sounds

A
  • bronchial breath sounds
  • bronchovesicular breath sounds
  • bronchial breath sounds in place of vesicular sounds
  • decreased/diminished breath sounds
  • absent breath sounds
  • extrapulmonary sounds
  • whispered pectriloquy
  • bronchophony
  • egophony
60
Q

Describe bronchial breath sounds

A
  • a pause between inspiration and expiration

- inspiratory and expiratory phases are equal

61
Q

Describe bronchovesicular breath sounds

A
  • no pause between inspiration and expiration

- inspiration longer and louder than expiration

62
Q

Describe bronchial breath sounds in place of vesicular sounds

A
  • fluid or secretion consolidation that could occur with pneumonia
63
Q

Describe decreased/diminished breath sounds

A
  • hypoventilation
  • severe congestion
  • emphysema
64
Q

Describe absent breath sounds

A
  • pneumothorax

- lung collapse

65
Q

Describe extrapulmonary sounds

A
  • from dysfunction outside of lung tissue

- most common: pleural friction rub

66
Q

Describe whispered pectriloquy

A

patient whispers 1,2,3
+ Consolidation: phrases are clearly audible
+ Hyperinflation: phrases less audible in distal lung fields

67
Q

Describe bronchophony

A

patient repeats 99
+ Consolidation: phrases are clearly audible
+ Hyperinflation: phrases less audible in distal lung fields

68
Q

Describe egophony

A

patient repeats the letter ‘e’

+ fluid in air spaces: ‘e’ sounds like an ‘a’ in the distal lung fields

69
Q

Name the different types and subtypes of adventitious breath sounds

A 
Continuous breath sounds
- wheeze
- stridor
- rhonchi
Discontinuous breath sounds
- crackles
70
Q

Describe wheezing

A

caused by airway obstruction, more common with expiration

Continuous breath sound

71
Q

Describe stridor

A

a high-pitched wheeze on inspiration and expiration

Continuous breath sound

72
Q

Describe rhonchi

A

low-pitched, caused by airway obstruction

Continuous breath sound

73
Q

Describe crackles

A

bubbling and popping sounds from fluid/secretions or sudden opening of closed airway

Discontinuous breath sounds

74
Q

What is mediate percussion and why is it performed?

A
  • place palmar surface of index and middle fingers flatly against chest wall within intercostal spaces; strike the distal 1/3 of fingers with tips of other fingers; proceed in cephalocaudal, side to side pattern
  • evaluates tissue densities within the thoracic cage
75
Q

What are the different sounds heard from mediate percussion?

A
  • resonant
  • hyperresonant
  • tympanic
  • dull
  • flat
76
Q

What do resonant sounds indicate?

A

normal lung tissue

77
Q

What do hyperresonant sounds indicate?

A

tissue with emphysema or pneumothorax

78
Q

What do tympanic sounds indicate?

A

gas bubbles in the abdomen

79
Q

What do dull sounds indicate?

A

increased tissue density or decreased air

80
Q

What do flat sounds indicate?

A

dense tissue

sound like extreme dullness

81
Q

What are the different types of pulmonary pharmacologic agents?

A
  • glucocorticoids
  • antihistamines
  • bronchodilators
  • leukotriene modifiers
  • mast cell stabilizers
  • nebulizer treatments optimally active 15-20mins after administration
82
Q

Name the goals of PT treatment for pulmonary patients

A
  • promote independent functional mobility
  • maximize gas exchange
  • increase aerobic capacity
  • increase respiratory muscle endurance
  • patient education about condition
83
Q

Name general interventions for pulmonary PT

A
  • breathing retraining exercises
  • secretion clearance techniques
  • positioning
  • functional activities
  • exercise
  • patient education
  • monitoring VS
84
Q

Name some more specific interventions for pulmonary PT

A
  • improve endurance
  • improve strength
  • improve functional mobility
  • use positioning to promote hemodynamic stability
  • work on breathing techniques
  • airway clearance with effective coughing
  • energy conservation techniques
  • ROM to stimulate alveolar ventilation
  • postural drainage and manual techniques
  • suctioning
85
Q

What are appropriate outcome measures for pulmonary patients?

A
  • CPAx
  • 2MWT
  • 6MWT
  • AM-PAC 6 Clicks
  • DEMMI
  • FSS-ICU
86
Q

What is the purpose of mechanical ventilation?

A

to maintain homeostasis between gas concentrations of O2 and CO2

87
Q

When is mechanical ventilation indicated?

A
  • airway protection
  • cardiac arrest
  • management of ICP
  • airway obstruction
  • surgery/trauma
88
Q

What are the different values PTs need to know for mechanical ventilation?

A
  • FiO2
  • tidal volume
  • PEEP
  • O2 flow
  • RR
89
Q

What is FiO2?

A

fraction of inspired oxygen

- shown as %

90
Q

What is tidal volume?

A

normal amount of air ventilated at rest

- shown as mL

91
Q

What is PEEP?

A

positive end expiratory pressure

- shown as cmH2O

92
Q

What is O2 Flow?

A

how fast the oxygen is flowing

- shown as L/min

93
Q

What is RR?

A

respiration rate

- shown as breaths/min

94
Q

Name the types of mechanical ventilation (11)

A
  • invasive mechanical ventilation
  • non-invasive mechanical ventilation
  • tracheostomy
  • volume control (VC)
  • pressure control (PC)
  • assist control (AC)
  • pressure regulated volume control (PRVC)
  • synchronous intermittent mandatory ventilation (SIMV)
  • pressure support ventilation (PSV)
  • volume support (VS)
  • CPAP
95
Q

What is invasive mechanical ventilation and what does it consist of?

A
  • intubation of artificial ariway into trachea
  • endotracheal tube
  • nasotracheal tube
  • tracheostomy
96
Q

What is non-invasive mechanical ventilation? What is key about it?

A
  • BiPAP or CPAP

- KEY: the last step before intubation

97
Q

When is a tracheostomy indicated?

A
  • when a patient is unable to be weaned from the ventilator
  • difficulty intubating patient (severe morbid obesity)
  • airway blocked or obstructed (tumor, traumatic injury)
98
Q

What is VC and what are its characteristics and indications?

A
  • preset tidal volume delivered at a set respiratory rate
    Indication:
  • pt with no spontaneous breathing
    Characteristics:
  • peak pressure can vary depending on pts lung compliance and resistance
99
Q

What is PC and what are its characteristics and indications?

A

a predetermined amount of pressure at a set rate
Indication:
- pt with no spontaneous breathing
Characteristics:
- ventilator determines inspiratory time
- PEEP used to increase arterial O2 and improve lung compliance

100
Q

What is AC and what are its characteristics and indications?

A 
delivers a specific amount of tidal volume
Indications:
- pt can initiate breaths
Characteristics:
- forces air into lungs
- pt or vent initiates breaths
- high level of respiratory support
101
Q

What is PRVC and what are its characteristics and indications?

A

combines PC and VC ventilation
- a preset tidal volume is delivered at a set rate but with the lowest possible pressure
Indications:
- prevent barotrauma

102
Q

What is SIMV and what are its characteristics and indications?

A

allows pts to breathe in between each machine assisted breath and delivers a certain number of breaths in coordination with respiratory effort of pt
Indications:
- pts with some but not sufficient breathing
- weaning
Characteristics:
- increased work of breathing

103
Q

What is PSV and what are its characteristics and indications?

A

a small, specific amount of pressure occurs on inspiration
Indications:
- pt can initiate all breaths
Characteristics:
- ventilator assists pt with spontaneous breaths
- pt regulates RR and TV

104
Q

What is VS and what are its characteristics and indications?

A 
tidal volume and PEEP are set
Indications:
- pt can initiate all breathing
Characteristics:
- vent delivers support in proportion to pt's inspiratory effort and target volume
105
Q

What is CPAP and what are its characteristics and indications?

A

continuous pressure is maintained in the airways to prevent collapse
Indications:
- pt regulates all other respiratory functions

106
Q

What medications are used with mechanical ventilation?

A
  • propofol
  • precedex
  • fentanyl
107
Q

What are causes of red alarms with mechanical ventilation?

A
  • apnea
  • disconnection
  • high pressure
108
Q

What are causes of yellow alarms with mechanical ventilation?

A
  • low tidal volume
  • high respiratory rate
  • low minute ventilation
  • low inspiratory pressure
109
Q

What does weaning off mechanical ventilation mean?

A
  • a process of decreasing or discontinuing mechanical ventilation
  • a condition that led to ventilation support needs to be resolved
110
Q

What factors should be considered during weaning?

A
  • respiratory demand and ability of NM system to cope with O2 demand
  • oxygenation
  • cardiovascular performance
  • psychological factors
  • adequate rest and nutrition
111
Q

What are signs of distress during weaning?

A
  • tachypnea (>30 breaths/min)
  • decreased pH (<7.25-7.30 with increased PaCO2)
  • paradoxical breathing patterns
  • O2 Saturation <90%
  • HR change of >20bpm
  • BP change > 20mmHg
  • agitation
  • panic
  • diaphoresis
  • cyanosis
  • angina
  • arrhythmia
112
Q

What are contraindications to PT for mechanical ventilation?

A
  • comatose
  • unresponsive
  • does not follow commands
  • severe agitation/combativeness
  • PEEP >10cmH2O
  • FiO2 > 0.6 or 60%
  • uncontrolled active bleeding
113
Q

What are complications of mechanical ventilation?

A
  • skin breakdown
  • joint contractures
  • deconditioning

Acute Care (11 decks)

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