Pulmonary and Cardiac Patients 2017 Flashcards
What type of chest is associated with COPD?
Barrel Chest
What are Obstructive pulmonary diseases?
– COPD – Asthma – Cystic Fibrosis
What are the Restrictive pulmonary diseases?
– Scoliosis – Inhaled toxins – pneumonia
labored breathing due to SOB
Dyspnea
Rapid shallow breathing
Tachypnea
Slow rate…may be with drug overdose
Bradypnea
Deep, rapid respiration
Hyperventilation
Difficulty breathing in supine
Orthopnea
Cessation of breathing in the expiratory phase
Apnea
Cessation of breathing in the inspiratory phase.
Apneusis
Cycles of gradually decreaseing tidal volumes and then a period of apnea. Seen with severe head injury.
Cheyne-Stokes
Volume of air inhaled or exhaled during each normal breath.
Tidal Volume (TV)
Maximal volume of air that can be inhaled over and above the inspired tidal volume
Inspiratory Reserve Volume (IRV)
Maximal volume of air that can be exhaled after exhaling a normal tidal breath.
Expiratory Reserve Volume (ERV)
Volume of air remaining in the lungs after a maximal exhalation.
RV
Maximal volume of air in the lungs at the end of a maximal inhalation.
Total Lung Capacity (TLC)- RV + TV + ERV + RV
Volume of air present in the lung at end-expiration during tidal breathing.
Functional Residual Capacity (FRC)- RV + ERV
Maximal volume of air that can be inhaled from the resting end-expiratory level.
Inspiratory Capacity (IC)- IRV + TV
Maximal volume of air that can be exhaled after a maximal inhalation.
Vital Capacity (VC)- IRV + TV + ERV
– Combo of chronic airway inflammation and remodeling that results in air trapping from hyperinflation. – Loss of the normal elastic recoil of the lungs. – Capillary beds thicken and eventually are destroyed. - Ventilation and perfusion in the capillary membrane are no longer matched. This results in hypoxemia. – The decreased oxygenation leads to hypercapnea or too much carbon dioxide in the blood.
Pathophysiology of COPD
COPD Clinical Presentation • Hx of cigarette smoking, chronic ______, expectoration and exertional ______. • The A-P diameter of the chest increases leading to a ______ chest. • As the chest changes shape, _______ excursion decreases. • The ______ flattens due to ________.
Coughing; DyspneaBarrel; ThoracicDiaphragm; Hyperinflation
With COPD, clinicians may hear?
– Expiratory wheeze – Crackles from secretions in the airways
With COPD, clinicians may see?
Digital Clubbing
With COPD, patients will have Lung volume changes such as _______ _______ and ______ _______ _______ are _______ due to air trapping. Also, the ______ is decreased.
Residual Volume (RV); Functional Risidual Capcity (FRC); increasedFEV1
With COPD, patients may have Arterial blood gases that show ________.
Hypoxemia
Finger Clubbing is explained by a variety of theories, including increased perfusion. Its association with _______ oxygen desaturation has been noted, but this is not an exclusive ________; clubbing has also been observed in nonpulmonary diseases such as ________ _______ and _______ disease.
Arterial; Phenomenon; Hepatic fibrosis; Crohn’s
What are two types of asthma?
- Allergic- Non Allergic *from other irritants
Within non allergic asthma, what are 4 irritants?
- Smoke- Fumes- Infections - Cold Air
• Common • Characterized by bronchospasm, wheezing, breathlessness and coughing with sputum production. • Diagnosis based on history.
Symptoms of Asthma
What is the pathophysiology of Asthma?
– Bronchospasm – Increased airflow resistance – Leads to hyperinflation
What is the clinical presentation of Asthma?
– Cough, dyspnea on exertion & wheezing. – Clinicians may hear crackles – Barrel-chest – Decreased expiratory flow rates (FEV) – Mild to moderate hypoxemia
What is a Chronic disease that affects the excretory glands of the body? What organs does it affect?
– Pulmonary Cystic Fibrosis:– Pancreatic – Hepatic – Sinus and – Reproductive
• Autosomal recessive trait. • Caucasians make up the majority of all cases • There is also defective transport of sodium, potassium and water leaves the mucus made by the excretory glands thickened and difficult to move.
Etiology of Cystic Fibrosis
The pathophysiology of Cystic Fibrosis is…• The altered viscous secretions in the lung result in ______ and ________. • This impairs the function of the ________ transport system. • Partial or complete obstruction of the airways reduces ________ to the ______ ______. • ________ and ______ within the lungs are not matched and leads to _______ changes.
Obstruction; HyperinflationMucociliaryVentilation; Alveolar unitsVentilation; perfusion; fibrotic
Diagnosis of Cystic Fibrosis:– From a _____ _____ of the disease – Repeated respiratory infections from ________ aureus or ________ aeruginosa. – Failure to thrive. – A ______ concentration of greater than or equal to ___ mEq/L found in the _____ of children is a positive test for the diagnosis of CF.
Family historyStaphylococcus; PseudomonasChloride; 60; sweat
Clinical Presentation Cystic Fibrosis:– Failure to thrive from ___ dysfunction. – _______ from pancreatic dysfunction, – OR frequent respiratory infections • Barrel chest & increased _______ • Cyanosis • Digital clubbing • Pulmonary function tests show – Decrease FEV1, PEF, FVC – Increased RV and ____ • Hypoxemia/_______
G.I.DiabetesKyphosis FRChypercapnea (more CO2)
__________________:• Course and Prognosis – 70% of all cases are diagnosed before ________. – Survival rates continue to increase • Treatment involves the removal of the abnormally ______ ______ and prompt treatment of pulmonary infections. • Also needs good diet, exercise and replacement ________ enzymes.
Cystic Fibrosis:1 year.Thick; SecretionsPancreatic
A group of diseases that result in difficulty expanding the lungs and a reduction in lung volumes.
Restrictive Lung Disease
Restrictive Lung Disease:– From lung parenchyma and/or pleura – Changes in the ______ ______– Alteration in the neuromuscular apparatus of the ______.
Chest wallThorax
What is the most common idiopathic Restrictive Lung Disease?
Pulmonary Fibrosis (thought to be immunological)
• From – Radiation therapy – Inorganic dust – Inhalation of noxious gases – Oxygen toxicity – Asbestos exposure
Etiology of Restrictive Lung Diseases
__________ _________ ___________: Pathophysiology • Disease often begins with parenchymal changes with inflammation and a thickening of the alveoli and interstitium. • As the disease progresses, the distal air spaces become fibrosed and resistant to expansion. • Lung volumes ______. ***
Restrictive Lung Disease Reduced
_________ __________ _________:Clinical Presentation • Dyspnea with activity • a non-productive cough • Signs include – Rapid, shallow breathing with ________ chest expansion – Inspiratory crackles – Digital clubbing – Cyanosis – __________ VC, FRC, RV and TLC – Blood gases show hypoxemia and hypocapnea. – ________ may significantly lower oxygenation***
Restrictive Lung Disease LimitedDecreasedExercise
Restrictive Lung Disease:Physical Therapy Management • The person with pulmonary dysfunction often _______ _______ that result in the uncomfortable sensation of dyspnea. A slow but steady ________ in these patient’s functional activities follows, resulting in progressive aerobic ________. • The intended outcome is to interrupt this downward spiraling of physical ability by improving ________ performance and decreasing ________.
Avoids activities; decrease; deconditioningExercise; Dyspnea
Review Question:Why do these patient with Edema?
Inadequate blood flow from heart and lungs causes blood and fluids to back up into other areas of body.
When a pump fails which side does the fluids build up?
Right sided failure: Peripheral Edema (Body), JVDExample: COPD, Asthma, CF (Obstructive)Left sided failure: Pulmonary Edema Example: Primarily CHF start,
What is known as a sign of right ventricular failure or lymphatic dysfunction.
Peripheral Edema
What is the head position to examine Jugular Vein Distention (JVD)?
45 degrees (Patient head turned away from therapist)
When checking JVD, a bilateral distention infers _______ _______ ______. A unilateral problem usually means that there is a ______ problem.
Congestive Heart FailureLocal
How does the the left side of the heart work when ventricle enlarged (abnormal) and when normal? What condition and symptoms can happen abnormally?
Abnormal: Decreases ejection fractionSx: CHF - SOB and CoughNormal: 55-75%- Systemic and Brain Blood Supply
The most primary and common CABG procedure is _____ to _____. What does the later effect?
LIMA (Left Internal Mammary Artery); LAD (Left Anterior Descending)- Left Ventricle (LV) and Cardiac Output (CO)
Surgery is indicated for Myocardial Ischemia especially in an event greater than _____.Indicators: – CK-MB– Chest, left shoudler, indigestion – NTG (acute) under the tough and ER is indicated – EKG changes after: reversed T-Wave and ST segment depression
20 minutes
When dealing with cough, what primary characteristics should we examine?
- Productive vs. Non-productive – Color – Consistency – Amount – Odor
When dealing with cough…• Small amounts of clear or white secretions are ______. • Copious clear secretions are common with _____. • Yellow green and purulent secretions with a strong odor indicate ______. • Blood-streaked secretions indicate ______ in the lungs. • Frothy white secretions are associated with ______ ______ and _____ _____.
NormalBronchitisInfectionHemorrhagePulmonary Edema; Heart Failure
• Treadmill or stationary bicycle • Gradually increase the intensity until the point of limitation. • Monitor vital signs throughout the testing.Are used in _____ _____ _____.
Exercise Tolerance Testing (Phase 2 - Outpatient: S/p MI)
What are the 4 variables of an Exercise Prescription?
- Mode- Intensity- Duration- Frequency
What are some examples of mode within the 4 variables of exercise prescription?
Walking, jogging, cycling, UE exercise (ergometer, free weights) * Patients do best if both modes are combines.
What is intensity within the 4 variables of exercise prescription?
- Mild (40 – 60% of max VO2) - Mod (>60% of max VO2) *Based off of BORG Scale 0-10
What is duration within the 4 variables of exercise prescription?
- 20 – 30 minutes at desired intensity
What is the frequency within the 4 variables of exercise prescription?
3 – 5 sessions per week
What do you do if a patient can only walk 3 min?
- Take breaks- Continue until 20-30min is reached
How do you use the Rating of Perceived Dyspnea? What do you ask the patient?*Just like BORG • 3 = moderate SOB • 6 = between severe and very severe • A rating of 3 = 50% of VO2 max • A rating of 6 = 80% of VO2 max
Ask on a scale 0-10 how much shortness of breath that they feel.
Exercises Lungs
Inspiratory muscle trainers
• Exhale through device X 10. • Then, 2 large exhalations through device. • Followed by a huff or cough. • Repeated until lungs are clear.
Oral Airway Oscillation Devices
How is a patient progressed with exercise?
When 20 minutes of continuous activity can be accomplished, an increase in exercise duration or intensity can be proposed.
Used to clear secretions. Vest with air channels
High-Frequency Chest Compression Devices
What are the 6 Secretion Removal Techniques practiced with patients.
• Postural draining • Percussion • Vibration • Shaking • Airway Clearance • Active Cycles of Breathing
Which lobe is being treated in postural drainage techniques with the patient sitting with forward/backward leans or Fowler’s position?
Upper Lobes
Which lobe is being treated in postural drainage techniques with the patient Head down, foot elevated 16”, congested lobe on top?
Middle Lobe
Which lobe is being treated in postural drainage techniques with the patient Head down, foot elevated 20”, congested lobe on top?
Lower Lobes
Percussion; ______ minutes over each lung segment.
3-5 min
Shaking/Vibrating: ______ deep breaths with shaking on exhalation
5-7
What are the Airway clearance procedures? What is best for Obstructive patients?
- Coughing- Huffing “Kah, Kah, Kah” (better for Obstructive Diseased patients)
What home exercise program can be taught to actively move secretions for to bronchi for coughing?
Active Cycle of Breathing
Active Cycle of Breathing• Begins with a few minutes of the breathing control phase = relaxed, diaphragmatic tidal volume breathing. • Then _______ deep breaths with a hold at the end of inhalation for __ seconds, followed by passive exhalation. • Then return to controlled breathing. • Should move secretions to bronchi for coughing.
3-4; 3
______ ______ Pressure: • _____ devices. This is exhalation against pressure. • Treatment last __to __minutes. • Session is complete when all secretions are cleared. * As affective as drainage percussion/shaking
Positive Expiratory PressurePEP10-20
Breathing Exercises:• _______breathing can prevent airway collapse. • Diaphragmatic training does not have evidence to support use. Strengthen _______ ________.
Pursed-LipAccessory Muscles
What type of breathing is Unique to Patient with SCI or ALS?
• Glossopharyngeal Breathing • Gulping of air: commonly called “frog breathing” * This can be used for short periods of time for patients with high Cervical injury or during mechanical emergencies
