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Sharlene and MB's PT party > Pulmonary- acute, chronic obstructive, chronic restrictive, and bronchogenic carcinoma > Flashcards

Pulmonary- acute, chronic obstructive, chronic restrictive, and bronchogenic carcinoma Flashcards

1
Q

List of acute diseases

A
  • bacterial pneumonia
  • aspiration pneumonia
  • viral pneumonia
  • tuberculosis
  • pneumocystis pneumonia (PCP)
  • Severe Acute Respiratory Syndrome (SARS)
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2
Q

What is bacterial pneumonia

A
  • intra-alveolar bacterial infection
  • gram-positive bacteria is usually acquired in community
  • pneumococcal pneumonia (strepococcal) is most common type of gram-positive pneumonia
  • gram-negative bacteria usually develop in host w/ underlying , chronic debilitating conditions, severe acute illness, and recent antibiotic therapy
  • gram-negative infections result in early tissue necrosis and abscess formation
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3
Q

Pertinent physical findings for bacterial pneumonia

A
  • shaking chills
  • fever
  • chest pain if pleuritic involvement
  • cough becoming productive of purulent, blood-streaked or rusty sputum
  • decreased bronchial breath sounds and/0r crackles
  • tachypnea
  • increased WBC
  • hypoxemia, hypocapnea initially, hypercapnea w/ increasing severity
  • CXR confirmation of infiltrate
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4
Q

What is viral pneumonia

A

interstitial or intra-aveolar inflammatory process caused by viral agents
–such as influenza, herpes, measles, other viruses

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5
Q

Pertinent physical findings for viral pneumonia

A
  • recent Hx of upper respiratory infection
  • fever
  • chills
  • dry cough
  • headaches
  • decreased breath sounds or crackles
  • hypoxemia or hypercapnea
  • normal WBC
  • CXR confirmation of infiltrate
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6
Q

What is aspiration pneumonia

A
  • aspirated material causes an acute inflammatory reaction w/in lungs
  • usually found in pts. w/ impaired swallowing (dysphagia) , fixed neck extension, intoxication, impaired consciousness, neuromuscular disease, and recent anesthesia
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7
Q

Pertinent physical findings for aspiration pneumonia

A
  • s/s begin w/in hours after aspiration event
  • dyspnea
  • fever
  • cough may be dry at onset, progresses to putrid secretions
  • tacypnea
  • cyanosis
  • chest pain over involved area
  • wheezes and crackles w/ decreased breath sounds
  • hypoxemia or hypercapnea, in severe cases
  • WBC shows varying degrees of leukocytosis
  • CXR initially shows pneumonitis, chronic aspirations shows necrotizing pneumonia w/ cavitation
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8
Q

What is tuberculosis

A

infection spread by aerosolized droplets from an untreated infected host.
Incubation period: 2-10 weeks
Primary disease lasts 10 days- 2 weeks

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9
Q

What is post-primary (secondary) TB infection

A

reactivation of dormant tuberculosis bacillus, which can occur years after the primary infection

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10
Q

Medical treatment of TB

A
  • 2 weeks of antituberculin drugs renders host non-infectious
  • During infection: pt. must be isolated in negative pressure room. Anyone entering room must wear potective TB mask and use universal precautions. Pt. must do the same if they leave the room
  • medication is taken 3-12 months
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11
Q

TB and HIV

A

increased incidences of TB w/ HIV

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12
Q

Mild symptoms that may be initially ignored during primary TB

A

slight productive cough
mild fever
possible CXR changes consistent w/ primary disease

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13
Q

Pertinent physical findings for post-primary TB

A
  • fever
  • weight loss
  • hilar adenopathy- enlargement of lymph nodes at hilum
  • night sweat
  • crackles
  • hemoptysis (blood-streaked sputum)
  • WBC w/ increased lymphocytes
  • CXR shows upper lobe involvement w/ air densities, cavitation, pleural involvement, and parenchymal fibrosis
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14
Q

What is pneumocystis pneumonia

A
  • pulmonary infection caused by a fungus in immuno-compromised hosts
  • most often found in pts. following transplantation, neonates, or HIV
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15
Q

Pertinent physical findings for pneumocystis pneumonia

A
  • insidious progressive SOB
  • nonproductive cough
  • crackles
  • weakness
  • fever
  • chest X-ray showing interstitial infiltrates
  • CBC w/ no sign of infection
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16
Q

What is SARS

A
  • atypical respiratory illness caused by coronovirus

- initial outbreak in South China and spread through Asia to worldwide

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17
Q

Pertinent physical findings for SARS

A
  • high temp
  • dry cough
  • decreased WBC, platelets, and lymphocytes
  • increased liver function tests
  • abnormal CXR w/ boderline breath sounds changes
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18
Q

Chronic Obstructive Diseases: What is chronic obstructive pulmonary disease

A

a disease state characterized by airflow limitation that is not fully reversible. The air flow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gasses

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19
Q

Chronic Obstructive Diseases: How many stages of COPD

A

4

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20
Q

Chronic Obstructive Diseases: COPD Stage 1 (mild)

A

FEV1/FVC <70%
FEV1 equal or less than 80% predicted
w/ or w/out chronic symptoms

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21
Q

Chronic Obstructive Diseases: COPD Stage 2 (moderate)

A

FEV1/FVC <70%

50%

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22
Q

Chronic Obstructive Diseases: COPD Stage 3 (severe)

A

FEV1/FVC <70%

30%

23
Q

Chronic Obstructive Diseases: COPD Stage 4 (very severe)

A

FEV1/FVC <70%
FEV1 < 30% predicted
FEV1 < 50% w/ chronic respiratory failure
Impaired quality of life
exacerbations of their disease may be life threatening

24
Q

Chronic Obstructive Diseases: Physical findings for COPD (severity of symptom increase as disease progresses

A
  • cough/sputum/hemoptysis
  • dyspnea on exertion
  • breath sounds decrease w/ adventitious sounds
  • increased RR
  • weight loss/ anorexia
  • increased AP diameter of chest wall
  • cyanosis
  • clubbing
  • postures to structurally elevate shoulder girdle
  • CXR shows hyperinflation, flattened diaphragm, hyperlucency
  • ABG changes changes of hypoxemia, hypercapnia
  • PFTs show decreased FEV1 and FVC, increased FRC and RV
25
Q

Chronic Obstructive Diseases: What is asthma

A
  • increased reactivity of the trachea and bronchi to various stimuli such as allergen, exercise, cold
  • reversible in nature
  • manifests by widespread narrowing of airways due to inflammation, smooth muscle constriction, and increased secretions
  • even during remission, some degree of airway restriction is present
26
Q

Chronic Obstructive Diseases: Physical findings for asthma

A
  • wheezing, crackles, decreased breath sounds
  • increased secretions
  • dyspnea
  • increased accessory muscle use
  • anxiety
  • tachycardia
  • tachypnea
  • hypoxemia
  • hypercapnea
  • cyanosis
  • PFTs show impaired flow rates
  • CXR shows hyperfluency and flattened diaphragms during exacerbation
27
Q

List of Chronic Obstructive Diseases

A 
COPD
asthma
cystic fibrosis
bronchiectasis
respiratory distress syndrome (RDS)
bronchopulmonary dysplasia
28
Q

Chronic Obstructive Diseases: what is cystic fibrosis

A
  • genetically inherited disease characterized by thickening secretions of all exocrine glands, lending to obstrction (eg., pancreatic, pulmonic, GI)
  • may present as obstructive, restrictive, or mixed
  • clinical signs: meconium ileus, frequent respiratory infections, inability to gain weight despite proper nutrition
  • diagnosis made w/ blood test for trypsinogen or positive sweat electrolyte test
29
Q

Chronic Obstructive Diseases: Physical findings for cystic fibrosis

A
  • onset early childhood
  • dyspnea, especially on exertion
  • productive cough
  • hypoxemia, hypercapnea
  • cyanosis
  • clubbing
  • use of accessory muscle ventilation
  • tachypnea
  • crackles. wheezes, decrease breath sounds
  • abnormal PFTS
  • CXR shows marked findings for bronchiectasis and or pneumonitis
30
Q

Chronic Obstructive Diseases: what is bronchiectasis

A
  • chronic congenital or acquired disease acquired characterized by abnormal dilation of the bronchi and excessive sputum production
31
Q

Chronic Obstructive Diseases: Physical findings for bronchiectasis

A
  • cough and large amounts of sputum
  • frequent secondary infections
  • hemoptysis
  • crackles, decreased breath sounds
  • cyanosis
  • clubbing
  • hypoxemia
  • dyspnea
  • CXR shows bronchial markings with interstitial changes.
32
Q

Chronic Obstructive Diseases: what is RDS

A
  • aveolar collapse in a premature infant resulting from lung immaturity, inadequate level of pulmonary surfactant
33
Q

Chronic Obstructive Diseases: Physical findings for RDS

A
  • respiratory distress
  • crackles
  • tachypnea
  • hypoxemia
  • cyanosis
  • accessory muscle use
  • expiratory grunting, flaring nares
  • CXR showsa classic granular pattern (ground glass) caused by distended terminal airways and aveolar collapse
34
Q

Chronic Obstructive Diseases: PT considerations for RDS

A

increased breathing effort caused by handling a premature infant must be carefully weighed against possible benefits of PT

35
Q

Chronic Obstructive Diseases: what is bronchopulmonary dysplasia

A
  • sequela of premature infants w/ RDS
  • results from high pressures of mechanical ventilation, high fractions of inspired O2, and/or infection
  • lungs show areas of immaturity and dysfunction due t hyperinflaton
36
Q

Chronic Obstructive Diseases: Physical findings for bronchopulmonary dysplasia

A
  • hypoxemia, hypercapnia
  • crackles, wheezing, and/or decreased breath sounds
  • increased bronchial secretions
  • hyperinflation
  • frequent lower respiratory infections
  • delayed growth or development
  • cor pulmonale
  • CXR shows hyperinflation, low diaphragms, atelectasis, and/or cystic changes
37
Q

Chronic Obstructive Diseases: common physical findings in diseases listed in these cards

A
  • hypoxemia, hypercapnia
  • crackles, wheezing, and/or decreased breath sounds
  • dyspnea
  • cyanosis
  • sputum or secretions of some sort
  • tachypnea and CXR was also pretty common in the hysical findings

**list I made, not a list formally made in book

38
Q

Chronic Restrictive Disease: different etiologies

A

typified by difficulty expanding the lungs, causing a reduction in lung volumes

39
Q

Chronic Restrictive Disease: what is going on when there are alterations in the lung parenchyma and pleura

A

fibrotic changes w/in pulmonary parenchyma or pleura due to idiopathic pulmonary fibrosis, asbestosis, radiation pneumonitis, oxygen toxicity

40
Q

Chronic Restrictive Disease: pertinent physical findings when there are alterations in the lung parenchyma and pleura

A
  • dyspnea
  • hypoxemia, hypocapnea (hypercapnia appears with severity)
  • crackles
  • clubbing
  • cynaosis
  • PFTs reveal a reduction in VC, FRC, and TLC (the lung capacities)
  • CXR shows reduced lung volumes, diffuse interstitial filtrates, and/or pleural thickening
41
Q

Chronic Restrictive Disease: what is going on when there are alterations in the chest wall

A

restricted motion of bony thorax w/ diseases such as: -

  • ankylosing spondylitis
  • arthritis, scoliosis
  • pectus excavatum
  • arthrogryposis
  • integumentary changes of chest wall such as thoracic burns or scleroderma
42
Q

Chronic Restrictive Disease: pertinent physical findings when there are alterations in the chest wall

A
  • shallow rapid breathing
  • dyspnea
  • hypoxemia, hypocapnea (hypercapnia appears with severity)
  • crackles
  • clubbing
  • cynaosis
  • reduced cough effectiveness
  • PFTs reveal a reduction in VC, FRC, and TLC (the lung capacities)
  • CXR shows reduced lung volumes, atelectasis
43
Q

Chronic Restrictive Disease: what is going on when there are alterations in the neuromuscular apparatus

A

decreased muscular strength results in the an inability to expand the rib cage. Examples:

  • MS
  • MD
  • Parkinson’s
  • SCI
  • CVA
44
Q

Chronic Restrictive Disease: pertinent physical findings when there are alterations in the neuromuscular apparatus

A
  • dyspnea
    • hypoxemia, hypocapnea (hypercapnia appears with severity)
  • crackles
  • clubbing
  • cynaosis
  • decreased breath sounds
  • reduced cough effectiveness
  • -PFTs reveal a reduction in VC, FRC, and TLC (the lung capacities)
  • CXR shows reduced lung volumes, atelectasis
45
Q

What is Bronchogenic Carcinoma

A

a tumor that arises from the bronchial mucosa

46
Q

Bronchogenic Carcinoma: causal agents

A

smoking and occupational exposures, most frequently

47
Q

Bronchogenic Carcinoma: cell types

A
  • small cell carcinoma (oat cell)

- non-small cell carcinoma ( squamous cell, adenocarcinoma, and large cell undifferentiated)

48
Q

Bronchogenic Carcinoma: secondary changes due to the tumor

A

obstruction or compression of an airway, blood vessel, or nerve

49
Q

Bronchogenic Carcinoma: local metastases

A

pleura, chest wall, mediastinal structures

50
Q

Bronchogenic Carcinoma: common distant metastases

A

lymph nodes, liver, bone, brain, adrenals

51
Q

Bronchogenic Carcinoma: pertinent physical findings

A
  • unexplained weight loss
  • hemoptysis
  • dyspnea
  • weakness
  • fatigue
  • wheezing
  • pneumonia w/ productive cough cough due to airway compression
  • hoarseness w/ compression of the laryngeal nerve
  • atelectasis or bacterial pneumonia with non-productive cough due to airway obstructtion
52
Q

Bronchogenic Carcinoma: medical management

A
  • chemotherapy
  • radiation therapy
  • surgical resection if possible
53
Q

Bronchogenic Carcinoma: PT considerations

A
  • pneumonias that develop behind a completely obstructed bronchus cannot be cleared w/ PT techniques. Hold treatment until palliative therapy reduces tumor size and relieves bronchial obstruction
  • possible fractures from thoracic bone metastasis w/ chest compressive maneuvers and coughing
  • ecchymosis in pts. w/ low platelet counts
  • fatigue that restricts necessary activities

Sharlene and MB's PT party (35 decks)

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