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PTA 230 Reloaded > Pulmonary and Cardiac Patients 2017 > Flashcards

Pulmonary and Cardiac Patients 2017 Flashcards

1
Q

What type of chest is associated with COPD?

A

Barrel Chest

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2
Q

What are Obstructive pulmonary diseases?

A

– COPD – Asthma – Cystic Fibrosis

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3
Q

What are the Restrictive pulmonary diseases?

A

– Scoliosis – Inhaled toxins – pneumonia

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4
Q

labored breathing due to SOB

A

Dyspnea

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5
Q

Rapid shallow breathing

A

Tachypnea

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6
Q

Slow rate…may be with drug overdose

A

Bradypnea

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7
Q

Deep, rapid respiration

A

Hyperventilation

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8
Q

Difficulty breathing in supine

A

Orthopnea

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9
Q

Cessation of breathing in the expiratory phase

A

Apnea

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10
Q

Cessation of breathing in the inspiratory phase.

A

Apneusis

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11
Q

Cycles of gradually decreaseing tidal volumes and then a period of apnea. Seen with severe head injury.

A

Cheyne-Stokes

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12
Q

Volume of air inhaled or exhaled during each normal breath.

A

Tidal Volume (TV)

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13
Q

Maximal volume of air that can be inhaled over and above the inspired tidal volume

A

Inspiratory Reserve Volume (IRV)

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14
Q

Maximal volume of air that can be exhaled after exhaling a normal tidal breath.

A

Expiratory Reserve Volume (ERV)

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15
Q

Volume of air remaining in the lungs after a maximal exhalation.

A

RV

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16
Q

Maximal volume of air in the lungs at the end of a maximal inhalation.

A

Total Lung Capacity (TLC)- RV + TV + ERV + RV

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17
Q

Volume of air present in the lung at end-expiration during tidal breathing.

A

Functional Residual Capacity (FRC)- RV + ERV

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18
Q

Maximal volume of air that can be inhaled from the resting end-expiratory level.

A

Inspiratory Capacity (IC)- IRV + TV

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19
Q

Maximal volume of air that can be exhaled after a maximal inhalation.

A

Vital Capacity (VC)- IRV + TV + ERV

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20
Q

– 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.

A

Pathophysiology of COPD

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21
Q

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 ________.

A

Coughing; DyspneaBarrel; ThoracicDiaphragm; Hyperinflation

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22
Q

With COPD, clinicians may hear?

A

– Expiratory wheeze – Crackles from secretions in the airways

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23
Q

With COPD, clinicians may see?

A

Digital Clubbing

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24
Q

With COPD, patients will have Lung volume changes such as _______ _______ and ______ _______ _______ are _______ due to air trapping. Also, the ______ is decreased.

A

Residual Volume (RV); Functional Risidual Capcity (FRC); increasedFEV1

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25
Q

With COPD, patients may have Arterial blood gases that show ________.

A

Hypoxemia

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26
Q

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.

A

Arterial; Phenomenon; Hepatic fibrosis; Crohn’s

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27
Q

What are two types of asthma?

A
  • Allergic- Non Allergic *from other irritants
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28
Q

Within non allergic asthma, what are 4 irritants?

A
  • Smoke- Fumes- Infections - Cold Air
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29
Q

• Common • Characterized by bronchospasm, wheezing, breathlessness and coughing with sputum production. • Diagnosis based on history.

A

Symptoms of Asthma

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30
Q

What is the pathophysiology of Asthma?

A

– Bronchospasm – Increased airflow resistance – Leads to hyperinflation

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31
Q

What is the clinical presentation of Asthma?

A

– Cough, dyspnea on exertion & wheezing. – Clinicians may hear crackles – Barrel-chest – Decreased expiratory flow rates (FEV) – Mild to moderate hypoxemia

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32
Q

What is a Chronic disease that affects the excretory glands of the body? What organs does it affect?

A

– Pulmonary Cystic Fibrosis:– Pancreatic – Hepatic – Sinus and – Reproductive

33
Q

• 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.

A

Etiology of Cystic Fibrosis

34
Q

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.

A

Obstruction; HyperinflationMucociliaryVentilation; Alveolar unitsVentilation; perfusion; fibrotic

35
Q

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.

A

Family historyStaphylococcus; PseudomonasChloride; 60; sweat

36
Q

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/_______

A

G.I.DiabetesKyphosis FRChypercapnea (more CO2)

37
Q

__________________:• 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.

A

Cystic Fibrosis:1 year.Thick; SecretionsPancreatic

38
Q

A group of diseases that result in difficulty expanding the lungs and a reduction in lung volumes.

A

Restrictive Lung Disease

39
Q

Restrictive Lung Disease:– From lung parenchyma and/or pleura – Changes in the ______ ______– Alteration in the neuromuscular apparatus of the ______.

A

Chest wallThorax

40
Q

What is the most common idiopathic Restrictive Lung Disease?

A

Pulmonary Fibrosis (thought to be immunological)

41
Q

• From – Radiation therapy – Inorganic dust – Inhalation of noxious gases – Oxygen toxicity – Asbestos exposure

A

Etiology of Restrictive Lung Diseases

42
Q

__________ _________ ___________: 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 ______. ***

A

Restrictive Lung Disease Reduced

43
Q

_________ __________ _________: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***

A

Restrictive Lung Disease LimitedDecreasedExercise

44
Q

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 ________.

A

Avoids activities; decrease; deconditioningExercise; Dyspnea

45
Q

Review Question:Why do these patient with Edema?

A

Inadequate blood flow from heart and lungs causes blood and fluids to back up into other areas of body.

46
Q

When a pump fails which side does the fluids build up?

A

Right sided failure: Peripheral Edema (Body), JVDExample: COPD, Asthma, CF (Obstructive)Left sided failure: Pulmonary Edema Example: Primarily CHF start,

47
Q

What is known as a sign of right ventricular failure or lymphatic dysfunction.

A

Peripheral Edema

48
Q

What is the head position to examine Jugular Vein Distention (JVD)?

A

45 degrees (Patient head turned away from therapist)

49
Q

When checking JVD, a bilateral distention infers _______ _______ ______. A unilateral problem usually means that there is a ______ problem.

A

Congestive Heart FailureLocal

50
Q

How does the the left side of the heart work when ventricle enlarged (abnormal) and when normal? What condition and symptoms can happen abnormally?

A

Abnormal: Decreases ejection fractionSx: CHF - SOB and CoughNormal: 55-75%- Systemic and Brain Blood Supply

51
Q

The most primary and common CABG procedure is _____ to _____. What does the later effect?

A

LIMA (Left Internal Mammary Artery); LAD (Left Anterior Descending)- Left Ventricle (LV) and Cardiac Output (CO)

52
Q

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

A

20 minutes

53
Q

When dealing with cough, what primary characteristics should we examine?

A
  • Productive vs. Non-productive – Color – Consistency – Amount – Odor
54
Q

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 _____ _____.

A

NormalBronchitisInfectionHemorrhagePulmonary Edema; Heart Failure

55
Q

• Treadmill or stationary bicycle • Gradually increase the intensity until the point of limitation. • Monitor vital signs throughout the testing.Are used in _____ _____ _____.

A

Exercise Tolerance Testing (Phase 2 - Outpatient: S/p MI)

56
Q

What are the 4 variables of an Exercise Prescription?

A
  • Mode- Intensity- Duration- Frequency
57
Q

What are some examples of mode within the 4 variables of exercise prescription?

A

Walking, jogging, cycling, UE exercise (ergometer, free weights) * Patients do best if both modes are combines.

58
Q

What is intensity within the 4 variables of exercise prescription?

A
  • Mild (40 – 60% of max VO2) - Mod (>60% of max VO2) *Based off of BORG Scale 0-10
59
Q

What is duration within the 4 variables of exercise prescription?

A
  • 20 – 30 minutes at desired intensity
60
Q

What is the frequency within the 4 variables of exercise prescription?

A

3 – 5 sessions per week

61
Q

What do you do if a patient can only walk 3 min?

A
  • Take breaks- Continue until 20-30min is reached
62
Q

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

A

Ask on a scale 0-10 how much shortness of breath that they feel.

63
Q

Exercises Lungs

A

Inspiratory muscle trainers

64
Q

• Exhale through device X 10. • Then, 2 large exhalations through device. • Followed by a huff or cough. • Repeated until lungs are clear.

A

Oral Airway Oscillation Devices

65
Q

How is a patient progressed with exercise?

A

When 20 minutes of continuous activity can be accomplished, an increase in exercise duration or intensity can be proposed.

66
Q

Used to clear secretions. Vest with air channels

A

High-Frequency Chest Compression Devices

67
Q

What are the 6 Secretion Removal Techniques practiced with patients.

A

• Postural draining • Percussion • Vibration • Shaking • Airway Clearance • Active Cycles of Breathing

68
Q

Which lobe is being treated in postural drainage techniques with the patient sitting with forward/backward leans or Fowler’s position?

A

Upper Lobes

69
Q

Which lobe is being treated in postural drainage techniques with the patient Head down, foot elevated 16”, congested lobe on top?

A

Middle Lobe

70
Q

Which lobe is being treated in postural drainage techniques with the patient Head down, foot elevated 20”, congested lobe on top?

A

Lower Lobes

71
Q

Percussion; ______ minutes over each lung segment.

A

3-5 min

72
Q

Shaking/Vibrating: ______ deep breaths with shaking on exhalation

A

5-7

73
Q

What are the Airway clearance procedures? What is best for Obstructive patients?

A
  • Coughing- Huffing “Kah, Kah, Kah” (better for Obstructive Diseased patients)
74
Q

What home exercise program can be taught to actively move secretions for to bronchi for coughing?

A

Active Cycle of Breathing

75
Q

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.

A

3-4; 3

76
Q

______ ______ 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

A

Positive Expiratory PressurePEP10-20

77
Q

Breathing Exercises:• _______breathing can prevent airway collapse. • Diaphragmatic training does not have evidence to support use. Strengthen _______ ________.

A

Pursed-LipAccessory Muscles

78
Q

What type of breathing is Unique to Patient with SCI or ALS?

A

• 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

PTA 230 Reloaded (16 decks)

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