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Acute Care > Pulmonary Rehab > Flashcards

Pulmonary Rehab Flashcards

1
Q

What makes up the Upper and Lower Respiratory tracts?

A
  1. Upper
    • Nasal + Oral cavity, larynx, pharynx
    • Warms, humidifies, filters inspired air (1st line of pulmonary immune defense)
    • Mucociliary escalator - lines conducting airways ( 2nd line of immune defense)
  2. Lower
    • Trachea, bronchi, bronchioles, and alveoli
    • Immune cells (macrophages neutrophils) complete pulmonary defense
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2
Q

which side of the lung is more likely to be a site of aspiration?

A

Right

mainstem bronchus is more aligned vertically

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3
Q

what is the V/Q ratio?

A

Ventilation/Perfusion

should be 0.8

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4
Q

Describe the associated terms for V/Q mismatch

A
  1. Dead space → V is in excess of Q often a result of a pulmonary embolism
  2. Shunt → Q is in excess of V, often a result of alveolar collapse or atelectasis
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5
Q

List various types of breathing patterns

A
  1. Apnea
  2. Orthopnea
  3. Bradypnea
  4. Tachypnea
  5. Hyperpnea
  6. Hyperventilation
  7. Hypoventilation
  8. Biot’s respiration
  9. Cheyne-Stokes respiration
  10. Kussmaul respiration
  11. Paradoxical ventilation
  12. Sighing respiration
  13. Hoover’s sign
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6
Q

what is hyperpnea and what diseases is it associated with?

A

increased depth of ventilation, associated w/CHF and pulmonary infections

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7
Q

what is Kussmaul respirations and what diseases are associted with it?

A

increased regular rate and depth of ventilation

associated with diabetic ketoacidosis and renal failure

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8
Q

what is paradoxical ventilation and what is it associated with?

A

inward abdominal or chest wall movement w/inspiration and outward movement with expiration

associated with diaphragm paralysis, ventilation muscle fatigue, chest wall trauma

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9
Q

what are sighing respirations and what are they associated with?

A

the presence of a sigh >2-3x/min

angina, anxiety, dyspnea

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10
Q

what are Biot’s respirations and what are they associated with?

A

constant increased rate and depth of respiration followed by periods of apnea of varying lengths

elevated ICP, meningitis

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11
Q

What are Cheyne-Stokes respirations and what are they associated with?

A

Increasing depth of ventilation followed by a period of apnea

elevated ICP, CHF, narcotic OD

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12
Q

what is Hoover’s sign and what is it associated with?

A

The inward motion of the lower rib cage during inhalation

flattened diaphragm often related to decompensated or irreversible hyperinflation of the lungs

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13
Q

what is an ABG analysis?

A

Arterial Blood Gases → examines acid-base balance (pH), ventilation (CO2 levels), and oxygenation (O2 levels)

  • guides med or therpay interventions, such as mechanical ventilation settings or breathing assist techniques
  • disturbances in acid-base balance can be caused by pulmonary or metabolic dysfunction
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14
Q

define related terms for arterial blood gasses

A
  1. PaO2 → partial pressure of dissolved O2 in plasma
  2. PaCO2 → partial pressure of dissolved CO2 in plasma
  3. pH → degree of acidity or alkalinity in blood
  4. HCO3 → level of bicarbonate in the blood
  5. Percentage of SaO2 → a % of the amount of hemoglobin sites filled/saturated w/O2
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15
Q

List normal values for Arterial Blood Gases

A
  1. PaO2 → greater than 80 mmHg
  2. PaCO2 → 35-45 mmHg
  3. pH → 7.35-7.45
  4. HCO3 → 22-26
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16
Q

List some common respiratory dysfunction terms

A
  1. Air trapping
  2. Bronchospasm
  3. Consolidation
  4. Hyperinflation
  5. Hypoxemia
  6. Hypoxia
  7. Respiratory distress
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17
Q

what is air trapping?

A

retention of gas in lungs as a result of partial or complete airway obstruction

18
Q

what is consolidation?

A

transudate, exudate, or tissue replacing alveolar air

19
Q

what is hyperinflation?

A

overinflation of the lungs at resting volume as a result of air trapping

20
Q

what is hypoxemia?

A

a low level of oxygen in the blood, usually a PaO2 less than 60-80 mmHg

21
Q

what is hypoxia?

A

a low level of oxygen in the tissues available for cell metabolism

22
Q

what is respiratory distress?

A

the acute or insidious onset of dyspnea, respiratory muscle fatigue, abnormal respiratory pattern and rate, anxiety, and cyanosis related to inadequate gas exchange, the clinical presentation that usually precedes respiratory failure

23
Q

List some pulmonary pathologies

A
  1. Acute Respiratory Distress Syndrome (ARDS)
  2. Pleural effusion
  3. Pneumothorax
  4. Hemothorax
  5. COPD
    • Asthma
    • Emphysema
    • Chronic Bronchitis
  6. Cystic fibrosis
  7. Atelectasis
  8. Pneumonia
  9. Pulmonary edema
  10. Flail chest
24
Q

Describe ARDS

A
  1. this is acute inflammation of the lungs
  2. associated w/many conditions
  3. lengthy recovery w/high mortality rate
  4. variable latent pulmonary sequale → from no impairments to mild exertional dyspnea to mixed obstructive-restrictive abnormalities
  5. Prone positioning in the ICU helps
25
Q

what are some conditions associated w/ARDS?

A
  1. aspiration
  2. drug toxicity
  3. inhalation injury
  4. pulmonary trauama,
  5. shock
  6. systemic infections
  7. muli-organ failure
26
Q

how does prone positioning in the ICU assist with ARDS?

A

facilitates:

  1. improved aeration to dorsal lung segments
  2. improved V/Q mismatch
  3. secretion draining
27
Q

what makes up the PT physcial evaluation for pulmonary patients?

A
  1. Pt history
  2. Inspection
  3. Palpation
  4. Ascultation
  5. Mediate percussion
  6. Cough examination
28
Q

what specific things should be included in the pt history for pulmonary pts?

A
  1. smoking history
  2. amount of supplemental O2
  3. exposure to toxins
  4. hx of lung conditions
  5. hx of ventilatory assist
  6. episodes of dyspnea
  7. level of activity
  8. sputum production
  9. sleeping position
29
Q

what should be included in the inspection of a pulmonary pt?

A
  1. general apperance
  2. ease of speaking
  3. skin color
  4. chest shape/posture
  5. breathing patterns
  6. digital clubbing
  7. supplemental O2
  8. superfical incisions
30
Q

where should you palpate during a pulmonary exam and what things are you looking for?

A

palpate chest wall in cephalocuadal direction to examine the following:

  1. fremitus (vibration)
  2. pain, tenderness
  3. skin temperature
  4. bony abnormalities, fractures
  5. chest expansion and symmetry
  6. subcutaneous emphysema (bubbles popping under skin from presence of air in subQ tissue)
31
Q

List several possible sounds that may be heard during lung ascultations. What causes each?

A
  1. Bronchial (abnormal if heard in areas where vesicular sounds should be)
    • fluid or secretion consolidation that could occur w/pneumonia
  2. Decreased or diminished (less audible)
    • hypoventilation, severe congestion, or emphysema
  3. Absent
    • pneumothorax or lung collapse
32
Q

list several adventitious breath sounds that may be heard during lung ascultation

A
  1. extrapulmonary sounds
  2. voice sounds
  3. continous sounds
  4. discontinous sounds
33
Q

what are extrapulmonary sounds?

A

come from dysfunction outside of lung tissue

most common sound → pleural friction rub

34
Q

List and describe several types of voice sounds

A
  1. whispered pectoriloquy
    • pt whispers “1, 2, 3”.
      • for consolidation if phrases are clearly audible in distal lung field
      • for hyperinflation if the phrases are less audible in distal lung field
  2. bronchophony
    • pt repeats the phrase “99”
    • the results are similar to whispered pecotriloquy
  3. egophony
    • pt repeats the letter “e”
    • if the auscultation in the distal lung fields sound like “a”, then fluid in the air spaces or lung parenchyma is suspected
35
Q

list and describe continous sounds

A
  1. Wheeze → airway obstruction, more common on expiration
  2. Stridor → high-pitched wheeze, inspiration and expiration
  3. Rhonci → low-pitched from airway obstruction
36
Q

Name and describe a discontinuous sound

A

crackles → bubbling, popping sounds from fluid/secretions or sudden opening of closed airway

37
Q

what is mediate percussion? how do you perform it?

A

evalutates tissue densities within thoracic cage

  1. place palmar surface of index finger, middle finger, or both from one hand flatly against chest wall within intercostal spaces
  2. strike distal 1/3 of these fingers with tips of other fingers
  3. proceed cephalocaudal, side-to-side pattern
  4. sounds
    • resonant
    • hyperresonat
    • tympanic
    • dull
    • flat
38
Q

what components are included in a cough examination?

A
  1. effectiveness → ability to clear secretions
  2. control → ability to start and stop coughs
  3. quality → wet, dry, bronchospastic
  4. frequency → how often during the day/night cough occurs
  5. sputum production → color, quantity, odor, and consistency
39
Q

list several common pulmonary pharmacologic agents

A
  1. glucocorticoids
  2. antihistamines
  3. bronchodilators
  4. leukotriene modifiers
  5. mast cell stabilizers
40
Q

what are some goals for PT treatments for pulmonary pts?

A
  1. Promoting independent functional mobility
  2. max gas exchange
  3. increasing aerobic capacity
  4. increasing respiratory muscle endurance
  5. pt edu about condition
41
Q

list some general intervention techniques that may be used for pulmonary pts

A
  1. breathing retraining exercises
  2. secretion clearance techniques
  3. positioning
  4. functional activities
  5. exercise
  6. pt edu
  7. monitoring VS
42
Q

how can you work on breathing techniques?

A

PLB, incentive spirometer

increases tidal volume, coordinated w/movement

Acute Care (11 decks)

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