Pulmonary Rehab Flashcards
What makes up the Upper and Lower Respiratory tracts?
- 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)
- Lower
- Trachea, bronchi, bronchioles, and alveoli
- Immune cells (macrophages neutrophils) complete pulmonary defense
which side of the lung is more likely to be a site of aspiration?
Right
mainstem bronchus is more aligned vertically
what is the V/Q ratio?
Ventilation/Perfusion
should be 0.8
Describe the associated terms for V/Q mismatch
- Dead space → V is in excess of Q often a result of a pulmonary embolism
- Shunt → Q is in excess of V, often a result of alveolar collapse or atelectasis
List various types of breathing patterns
- Apnea
- Orthopnea
- Bradypnea
- Tachypnea
- Hyperpnea
- Hyperventilation
- Hypoventilation
- Biot’s respiration
- Cheyne-Stokes respiration
- Kussmaul respiration
- Paradoxical ventilation
- Sighing respiration
- Hoover’s sign
what is hyperpnea and what diseases is it associated with?
increased depth of ventilation, associated w/CHF and pulmonary infections
what is Kussmaul respirations and what diseases are associted with it?
increased regular rate and depth of ventilation
associated with diabetic ketoacidosis and renal failure
what is paradoxical ventilation and what is it associated with?
inward abdominal or chest wall movement w/inspiration and outward movement with expiration
associated with diaphragm paralysis, ventilation muscle fatigue, chest wall trauma
what are sighing respirations and what are they associated with?
the presence of a sigh >2-3x/min
angina, anxiety, dyspnea
what are Biot’s respirations and what are they associated with?
constant increased rate and depth of respiration followed by periods of apnea of varying lengths
elevated ICP, meningitis
What are Cheyne-Stokes respirations and what are they associated with?
Increasing depth of ventilation followed by a period of apnea
elevated ICP, CHF, narcotic OD
what is Hoover’s sign and what is it associated with?
The inward motion of the lower rib cage during inhalation
flattened diaphragm often related to decompensated or irreversible hyperinflation of the lungs
what is an ABG analysis?
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
define related terms for arterial blood gasses
- PaO2 → partial pressure of dissolved O2 in plasma
- PaCO2 → partial pressure of dissolved CO2 in plasma
- pH → degree of acidity or alkalinity in blood
- HCO3 → level of bicarbonate in the blood
- Percentage of SaO2 → a % of the amount of hemoglobin sites filled/saturated w/O2
List normal values for Arterial Blood Gases
- PaO2 → greater than 80 mmHg
- PaCO2 → 35-45 mmHg
- pH → 7.35-7.45
- HCO3 → 22-26
List some common respiratory dysfunction terms
- Air trapping
- Bronchospasm
- Consolidation
- Hyperinflation
- Hypoxemia
- Hypoxia
- Respiratory distress
what is air trapping?
retention of gas in lungs as a result of partial or complete airway obstruction
what is consolidation?
transudate, exudate, or tissue replacing alveolar air
what is hyperinflation?
overinflation of the lungs at resting volume as a result of air trapping
what is hypoxemia?
a low level of oxygen in the blood, usually a PaO2 less than 60-80 mmHg
what is hypoxia?
a low level of oxygen in the tissues available for cell metabolism
what is respiratory distress?
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
List some pulmonary pathologies
- Acute Respiratory Distress Syndrome (ARDS)
- Pleural effusion
- Pneumothorax
- Hemothorax
- COPD
- Asthma
- Emphysema
- Chronic Bronchitis
- Cystic fibrosis
- Atelectasis
- Pneumonia
- Pulmonary edema
- Flail chest
Describe ARDS
- this is acute inflammation of the lungs
- associated w/many conditions
- lengthy recovery w/high mortality rate
- variable latent pulmonary sequale → from no impairments to mild exertional dyspnea to mixed obstructive-restrictive abnormalities
- Prone positioning in the ICU helps
what are some conditions associated w/ARDS?
- aspiration
- drug toxicity
- inhalation injury
- pulmonary trauama,
- shock
- systemic infections
- muli-organ failure
how does prone positioning in the ICU assist with ARDS?
facilitates:
- improved aeration to dorsal lung segments
- improved V/Q mismatch
- secretion draining
what makes up the PT physcial evaluation for pulmonary patients?
- Pt history
- Inspection
- Palpation
- Ascultation
- Mediate percussion
- Cough examination
what specific things should be included in the pt history for pulmonary pts?
- smoking history
- amount of supplemental O2
- exposure to toxins
- hx of lung conditions
- hx of ventilatory assist
- episodes of dyspnea
- level of activity
- sputum production
- sleeping position
what should be included in the inspection of a pulmonary pt?
- general apperance
- ease of speaking
- skin color
- chest shape/posture
- breathing patterns
- digital clubbing
- supplemental O2
- superfical incisions
where should you palpate during a pulmonary exam and what things are you looking for?
palpate chest wall in cephalocuadal direction to examine the following:
- fremitus (vibration)
- pain, tenderness
- skin temperature
- bony abnormalities, fractures
- chest expansion and symmetry
- subcutaneous emphysema (bubbles popping under skin from presence of air in subQ tissue)
List several possible sounds that may be heard during lung ascultations. What causes each?
- Bronchial (abnormal if heard in areas where vesicular sounds should be)
- fluid or secretion consolidation that could occur w/pneumonia
- Decreased or diminished (less audible)
- hypoventilation, severe congestion, or emphysema
- Absent
- pneumothorax or lung collapse
list several adventitious breath sounds that may be heard during lung ascultation
- extrapulmonary sounds
- voice sounds
- continous sounds
- discontinous sounds
what are extrapulmonary sounds?
come from dysfunction outside of lung tissue
most common sound → pleural friction rub
List and describe several types of voice sounds
- 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
- bronchophony
- pt repeats the phrase “99”
- the results are similar to whispered pecotriloquy
- 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
list and describe continous sounds
- Wheeze → airway obstruction, more common on expiration
- Stridor → high-pitched wheeze, inspiration and expiration
- Rhonci → low-pitched from airway obstruction
Name and describe a discontinuous sound
crackles → bubbling, popping sounds from fluid/secretions or sudden opening of closed airway
what is mediate percussion? how do you perform it?
evalutates tissue densities within thoracic cage
- place palmar surface of index finger, middle finger, or both from one hand flatly against chest wall within intercostal spaces
- strike distal 1/3 of these fingers with tips of other fingers
- proceed cephalocaudal, side-to-side pattern
- sounds
- resonant
- hyperresonat
- tympanic
- dull
- flat
what components are included in a cough examination?
- effectiveness → ability to clear secretions
- control → ability to start and stop coughs
- quality → wet, dry, bronchospastic
- frequency → how often during the day/night cough occurs
- sputum production → color, quantity, odor, and consistency
list several common pulmonary pharmacologic agents
- glucocorticoids
- antihistamines
- bronchodilators
- leukotriene modifiers
- mast cell stabilizers
what are some goals for PT treatments for pulmonary pts?
- Promoting independent functional mobility
- max gas exchange
- increasing aerobic capacity
- increasing respiratory muscle endurance
- pt edu about condition
list some general intervention techniques that may be used for pulmonary pts
- breathing retraining exercises
- secretion clearance techniques
- positioning
- functional activities
- exercise
- pt edu
- monitoring VS
how can you work on breathing techniques?
PLB, incentive spirometer
increases tidal volume, coordinated w/movement
