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CardioPulm > Pulmonary Exam 2 > Flashcards

Pulmonary Exam 2 Flashcards

1
Q

active cycle of breathing

A 
quiet breathing 2-3 cycles
3-4 thoracic expansions, hold 3 sec then sigh out
quiet breathing 2-3 cycles
repeat several times
follow with forced expiratory technique
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2
Q

forced expiratory technique

A

1-2 huffs followed by relaxed controlled diaphragmatic breathing

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3
Q

autogenic drainage

A

can’t usually teach to children
often used in chronic bronchitis and CF
three levels: unsticking (from ERV to 1/2 ERV), collecting (VT+1/2ERV), evacuating (from 1/2 ERV to insp. capacity)

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4
Q

positive expiratory pressure

A

exhale through resistance, keeps airways open and helps air get behind mucus
after 10 PEP exhalations, perform several huffs, followed by several coughs
repeat 4-6 times for 10-20 min total

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5
Q

Acapella and flutter

A

PEP + high frequency oscillations
works sort of like internal percussion
acapella can be done in any position
flutter valve frequency changes at different angles

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6
Q

assist control ventilation

A

no spontaneous breaths occur
predetermined number of machine breaths
pt can initiate additional breath at set tidal volume and flow rate

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7
Q

intermittent mandatory ventilation (IMV, SIMV)

A

provides predetermined breaths, but pt can initiate additional spontaneous (non mechanical) breaths, more as they get better
minute ventilation = spontaneous + mechanical breaths

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8
Q

control ventilation

A

machine totally controls ventilation

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9
Q

assist ventilation

A

patient initiates, but breath is mechanical

resp rate is determined by patient

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10
Q

PEEP

A

positive end expiratory pressure
lungs remain partially distended to prevent airway collapse and facilitate collateral ventilation
given with mechanical breath

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11
Q

CPAP

A

continuous positive airway pressure

like PEEP but with spontaneous breath

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12
Q

pressure support

A

used when weaning from ventilator
ventilator delivers set pressure when patient triggers it
not forcing any air in, just giving pressure to help with flow rate

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13
Q

dyspnea definition

A

subjective!

sensation of difficulty breathing

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14
Q

chronic bronchitis lung changes

A

mucus clogging airways

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15
Q

emphysema lung changes

A

destruction of alveolar walls or overly dilated alveoli leading to poor gas exchange

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16
Q

cor pulmonale

A

right heart failure due to pulmonary pathology

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17
Q

training in COPD

A

train diaphragm for strength - endurance is fine

train peripheral muscles for endurance, they have more atrophy than you would expect from just being sedentary

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18
Q

exercise with COPD

A

quicker to produce lactic acid
increased CO2
central chemoreceptors increase activity
hyper-respirate to blow off CO2

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19
Q

intrinsic asthma

A 
affects adults > kids
not allergic reaction
no family history
attacks don't respond to treatment
history of sinus infections
poor prognosis
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20
Q

extrinsic asthma

A

affects kids>adults, often grow out of it
usually family history
attacks related to antigen

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21
Q

bronchiectasis

A

permanent abnormal dilation and distortion of medium sized bronchi and bronchioles due to destruction of elastic and muscular components of bronchial walls
associated with cystic fibrosis and infections

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22
Q

BODE index

A 
predicts mortality in COPD
BMI
degree of obstruction (FEV1)
Dyspnea
Exercise capacity (6 min walk test)
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23
Q

cystic fibrosis

A

disorder of exocrine glands
abnormal secretions in resp tract, sweat glands, small intestine, pancreas, bile ducts
leads to frequent resp. infections and COPD

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24
Q

treatment for cystic fibrosis

A 
*bronchial hygiene*
exercise
meds
nutrition
lung or heart/lung transplant
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25
pulmonary fibrosis
inflammatory process in alveolar wall scarring or fibrotic process leading to "honeycomb lung" restrictive lung disease - lungs don't expand well presents similar to emphysema will eventually need lung transplant
26
pneumonia sounds
decreased breath sounds, dull percussion, possible increased fremitis, end inspiratory crackles
27
bacterial vs viral pneumonia
bacterial get chills, high fever, productive cough, pleural pain viral get only mod fever, non productive cough, muscle pain
28
pneumonia treatment
airway clearance techniques antibiotics if bacterial hydration isolation
29
pleural effusion
accumulation of fluid in pleural space transudate: low protein count exudate: high protein count treatment: treat underlying cause, chest tube to drain, pleurodesis (irritation to pleura to get it to attach to what it should and should stop fluid buildup)
30
pulmonary embolism high risk groups
post op orthopedic surgery anyone on prolonged bedrest cancer
31
symptoms of small PE
tachycardia, breathlessness
32
atelectasis causes
lack of upright position and movement breathing at low lung volumes most pts post op will have some degree - so good to encourage deep breathing
33
central mechanism of atelectasis
dec volume dec CNS drive poor inspiratory pressure and volume
34
external mechanisms of atelectasis
kyphoscoliosis, respiratory muscle weakness, phrenic nerve problem, pleural effusion
35
bronchial wall mechanism of atelectasis
hypertrophy of smooth muscle and mucous glands
36
internal mechanism of atelectasis
excess mucous in airway
37
intervention for atelectasis
``` prevention by deep breathing, coughing, segmental breathing mobilization: move out of supine! breathing control coughing airway clearance ```
38
respiratory distress syndrome cause
``` inadequate surfactant production when born premie increased work of breathing V/Q mismatch collapsed alveoli will have dec pH ```
39
signs and symptoms of respiratory distress
``` expiratory grunting crackles dec breath sounds bradycardia hemorrhage in lung, brain, ventricles rapid and labored breathing nasal flaring cyanotic dec volume and strength of crying ```
40
treatment for respiratory distress
surfactant replacement
41
hypoxemic respiratory failure
most common | PaO2
42
hypercapnic respiratory failure
``` PaCO2 >50mmHg hypoxemia common on room air pH depends on duration (bicarb level) common with asthma, COPD can be acute or chronic, how fast it develops ```
43
end inspiratory crackles suggest
restrictive disease
44
how does restrictive disease lead to fast breathing?
``` inc anerobic enzymes you burn carbs rather than fat increase lactic acid dec pH inc CO2 inc firing of central chemoreceptors inc breathing ```
45
flail chest
at least 2 ribs broken in 2 places each
46
pneumothorax
air in pleural space, lung collapse
47
tension pneumothorax
can get air in through chest wall, but then a flap closes and the air can't get back out - really bad
48
most common pulmonary meds
anticholinergic agents beta agonists glucocorticoids
49
bronchodilators
excite cAMP pathway: beta adrenergics, anticholinergics | inhibit cAMP: methyxanthines
50
anti-inflammatory agents
mast cell stabilizers - blocks antigens corticosteroids phophodiesterase-4 inhibitors
51
anticholinergic effect
inhibit cGMP to decrease bronchoconstriction superior to beta agonist for COPD also decreases secretions, but thicker
52
rescue inhaler contents
short acting beta2 agonist = brochodilation | albuterol, bitolterol
53
prophylactic bronchodilation
long acting beta 2 agonist along with anti-inflammatory
54
implications for PT after lung transplant
lack of cough reflex - remind them decreased secretion clearance - airway clearance techniques important V/Q imbalance deep breathing important
55
frequency of incentive spirometer use
5-6 times/hour awake | hold for a few seconds to encourage collateral ventilation
56
precautions/contraindications for percussion
asthma, fracture, flail chest, low platelets, osteoporosis
57
important training effect seen in 6 min walk test
25-35 m
58
pulmonary rehab exercise prescription
dyspnea rating of 3~=50% VO2max | 4-5 on Borg scale
59
Borg scale of perceived breathlessness
0-10, limit exercise to 5
60
Levels of dyspnea
0-4, judged by how many breaths needed to count to 15 (2=2 breaths needed), with 4 being unable to speak or count. Should not be >2 with exercise, not >1 with functional activities
61
Dyspnea Scale for subjective rating
1-mild, not noticeable to observer 2-mild, noticeable to observer 3-moderate, but can continue 4-severe, cannot continue
62
unique s/s of CO2 retention
flushed skin, diaphoresis but hypoxemia more common, if pt is tachycardic and headache, probably hypoxic

CardioPulm (3 decks)

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