Pulmonary Quiz Flashcards
obstructive lung disease
chronic inflammation of the lungs causing obstruction in exhalation
COPD
effect on lungs
chronic obstructive pulmonary disease
leads to deterioration of small airways
airflow obstruction can come from retaining secretions, inflammation of lining, bronchial constriction, weakened support structure, increased compliance of tissue
airways close prematurely and trap air, causing hyperinflation
progression of COPD
causes mismatched perfusion at capillaries, results in hypoxemia and decreased O2 in arterial blood
progresses further to hypercapnia/increased CO2 in blood and contributing to pulmonary hypertension
COPD prevalence
most common chronic respiratory disease
common cause of death
COPD demographics
40+ y/o
slightly more women than men
smoking
low SES
unemployed/retired/disability
southwest/midwest
rural
poor air quality
risk factors for COPD
occupational exposure
air pollution
age
cigarette smoking
childhood respiratory conditions
genetics
SOB w activity
COPD clinical presentation
dyspnea worse w exertion
chronic cough
barrel chest
wheezing
reduced/absent breath sounds
retaining CO2
excess sputum coughed up
COPD function testing (PFT)
spirometry measuring time-volume relationship in lung - test for delayed and incomplete emptying
forced expiratory volume
forced expiratory volume over 1 sec/forced expiratory capacity should be >75%
Gold Staging of COPD
mild: FEV1 is 80% of normal, mild symptoms and SOB, chronic cough
mod: FEV1 is 50-80% of normal, chronic cough, sputum, dyspnea
severe: FEV1 is 30-50% of normal, chronic cough, sputum, dyspnea
very severe: FEV1 is less than 30% of normal, chronic cough, sputum, dyspnea, R HF, weight loss
changes in lung values with COPD
all are elevated volume, total lung capacity is higher due to trapped air
same tidal volume amount but higher residual volume
BODE Index
index for COPD severity
predicts hospitalization, survival
0-10 points
0-2 80% 4 year survival
3-4 67%
5-6 57%
7-10 18%
Medical management of COPD includes
smoking cessation
pharm: mucolytics, bronchodilators, steroids
flu vaccine
pneumonia vaccine
treat any sleep disorders
pulmonary rehab and exercise training
surgery to remove damaged lung segments
emphysema
lung condition where alveolar walls are destroyed and airspaces distal to terminal bronchioles are enlarged
end stage COPD
causes of emphysema
smoking is main cause
also environmental toxins
emphysema s/s
non productive dry cough or absent cough
not eating
NOT cyanotic
accessory muscle use
pursed lip breathing
lean forward
chronic bronchitis
presence of chronic productive cough for 3 months in each of 2 successive years
mucus hyper secretion in large airways, progressing to smaller airways
hypertrophy of submucosal glands
crackling breath sounds
emphysema vs chronic bronchitis
pink puffer vs blue blower
emphysema:
- accessory muscles for breathing
- pursed lip breathing
- absent cough
- leans forward to breathe
- dyspnea on exertion
chronic bronchitis:
- excess body fluid
- chronic cough
- SOB
- increased sputum
- cyanosis
COPD thorax ROM
decreased excursion
muscles of ventilation become stretched and diaphragm unable to return to dome shape, flattening
accessory muscles required to breathe
asthma s/s
wheezing, SOB, chest tightness, fatigue during exercise, poor athletic performance, avoid activity, coughing
cough worse at night and morning
asthma mechanism
inflammatory response caused by trigger
narrowed airways/bronchospasm
increased secretions
resistance to airflow and trapping of exhalation
can lead to airway remodeling in uncontrolled asthma
asthma risk factors
genetics
boys>girls
environmental
infections
allergens
obesity
spirometry for asthma
provoke attack with bronchoconstrictor agent and measure
compare measurement with bronchodilators
decreased FEV1 with increased RV and functional residual capacity
should be reversible with bronchodilators/inhaler
peak flow meter
measures expiration in one quick blast 1 second
compare to age or personal norms
asthma severity levels
intermittent: <2x week, not interfering with normal activities, spirometry above 80%
mild persistent: >2x week, nighttime symptoms 3-4x month, spirometry above 80% when not having an attack
mod persistent: daily symptoms and daily meds, nighttime symptoms >1x week, interferes with activity, abnormal spiromatry >60%
severe persistent: continuous symptoms day and night, severely limited activity, frequent attacks, spirometry <60%
asthma medical management
prevention: avoiding triggers/exposures
long term control with pharm: anti inflammatory, bronchodilators, combo
exercise within activity parameters that won’t trigger attack
asthma clinical presentation
altered breathing pattern
wheezing breath sounds
decreased breath sounds in attack
dyspnea on exertion
coughing at night/after infection
accessory muscle use
pursed lip breathing
postural changes
asthma prevention
lifestyle modification: diet, sleep, reduce irritant exposure, hydration, weight, activity, flu shot
reduce household: mold, pets, wash bedding, HEPA filters, sanitize fabrics
exercise induced asthma should warm up, hydrate, cover nose in cold
PT implications with COPD
clear secretions
control breathing w rest and activity
ambulate
endurance
strength
thoracic stretching
postural reeducation
PT implications with asthma
secretion clearing
controlled breathing
exercise and strength
thoracic stretching
postural reed
pt edu/HEP
start once medication regiment stable
how does aerobic exercise impact asthma?
controls symptoms and lung function but does not affect airway inflammation
decreased exacerbation
low intensity, 3-5x week
progressively increase as tolerated without aggravating
cystic fibrosis
genetic condition
life threatening
abnormal protein affects cells to produce thickened mucus and sweat which gets stuck, reducing function and causing infection
affects respiratory, digestive, reproductive
prevalence of cystic fibrosis
recessive gene, need two carrier parents
genetic testing/sweat test
CF medical management
control: lung infections, mucus clearance, nutritional status, pancreatic status
nutrient supplementation
increase in survival to 38
CF symptoms
persistent cough: productive with sputum
recurrent lung infections
nutrient malabsoprtion
vitamin deficiency
pancreatic insufficiency
muscle pain
reduced bone density
diabetes
pursed lip breathing
accessory muscle hypertrophy
abnormal breath sounds: crackle, wheeze
cyanosis
digital clubbing
s/s of acute CF exacerbation
increased cough, sputum production, temperature, respiratory rate, WBC count
decreased FEV1, appetite, weight, activity level
PT treatment of CF
secretion clearance
controlled breathing
exercise/strength
inspiratory muscle training
thoracic stretching
postural reed
pt education on infection control and home management
restrictive lung disease
less common than obstructive
caused by intrinsic impairment or extrinsic condition affected chest wall mobility, NM function, obesity
results in reduced lung expansion, lung volume
hard to get air into lungs bc they can’t expand fully
FEV1/FVC ratio in RLD
cannot inhale as much but no issue exhaling
ratio will be normal or increased
in general all lung volumes are reduced
FEV1 and FVC are both decreased
s/s of restrictive lung disease
tachypnea
hypoxemia
fatigue
weight loss
decreased lung volumes
chronic dry cough
pulmonary HTN/signs of HF
interstitial lung disease types
exposure related: chemo/meds, environmental/dust/fumes/radiation
autoimmune: RA, lupus, scleroderma, polymyositis, dermatomyositis
idiopathic
interstitial lung disease is…
inflammatory process of alveolar wall that causes fibrotic scarring
progressive
many types
risk factors for pulmonary fibrosis
age
smoking
genetic predisposition
air pollution
viral infection
GERD
more common in men
s/s idiopathic pulmonary fibrosis
dry cough, weight loss, fatigue, digital clubbing, LE edema
Sarcoidosis
inflammatory autoimmune condition
multisystem
presence of tiny granulomas
lungs and lymph nodes
women more than men, 30-55 y/o
RA
chronic peripheral joint inflammation
results in progressive destruction of articular/periarticular structures
pleural involvement, pulmonary nodules/vasculitis, bronchiolitis, bronchogenic cancer
risk factors for interstitial lung disease
RA (esp severe)
smoker
age
male
clinical presentation of RA and interstitial lung disease
progressive dyspnea
non productive cough
cyanosis
warm/swollen joints
diminished breath sounds/rales
systemic lupus
multi system autoimmune disorder causing chronic inflammation of connective tissue
skin, joints, kidneys, lung, NS, heart
affect lungs: pleuritis and diaphragmatic weakness
clinical presentation of SLE -systemic lupus erythematosus
articular pain and swelling
OA
dyspnea
fatigue
cough
weight loss
raynaud’s phenomenon
photosensitivity
fever
mouth ulcers
chest pain
hair loss
eye disease
kidney
anemia
scleroderma
autoimmune, idiopathic
progressive fibrosing in skin, blood vessels, esophagus, GI, lung, heart, kidneys, joints
appears as interstitial fibrosis
no cure, symptom management
s/s scleroderma
skin thickening/swell/tighten
enlarged blood vessels
calcium deposits on skin
HTN from kidney dysfx
heartburn
GI involvement
weight loss
decreased lung volume
raynaud’s
dy cough
joint pain
polymyositis/dematomyositis
inflammatory autoimmune
progressive muscle weakness/skin changes
pulmonary characteristics:
aspiration pneumonia, neck muscle weakness, respiratory muscle weakness, elevated diaphragm
SOB, dry cough
SCI and pulmonary involvement
C3: vent dependent
C4: may need support
C5: may or may not need depending on zone of partial preservation
pts less likely to be able to cough or breathe fully, increased risk of infection
paradoxical breathing: belly expands and ribs depress or belly flattens and ribs expand
diaphragm paralysis impact on respiration
commonly from phrenic nerve
causes diaphragm to pull up and ribs in
results in alveolar hypoventilation/poor gas exchange
UL won’t need treatment, teach compensation
BL needs vent support
ALS and pulmonary function
reduced due to weakness, secretions, infiltrates
decreased breath sounds, poor airway clearance, dyspnea w mild exertion
poliomyelitis and pulmonary function
reduced lung volume, rhonchi, weak cough, anxious, poor airway clearance, dyspnea, fatigue, poor endurance
Guillain Barre and pulmonary function
reduced lung volume, rhonchi/crackles, BL LE weakness, anxious, poor cough, poor clearance, reduced endurance/fatigue