Pulmonary System Flashcards
Ventilation
Ventilation: gas (O 2 & CO 2 ) transport into and out of
Respiration
gas exchange across the alveolar capillary and capillary
tissue interfaces.
Muscles of Inspiration
Principal: external intercostals, Diaphragm, internal intercostals
Accessory: SCM (elevates sternum), Scalenes (elevate upper ribs)
Muscles of Expiration
Quiet: passive recoil of lungs and rib cage
Active: Internal Intercostals, Abdominals
Ventilation/Perfusion (V/Q)
Patient History
- History: smoking, O2 therapy, toxins (asbestos), pneumonia, dyspnea, intubation
- Sleeping position
- Level of activity
Patient Hx Clinical Tip
Dyspnea also may be measured by counting the number of syllables a person can speak per breath
American Thoracic Society Dyspnea Scale
Physical Examination (Inspection)
- General appearance & level of alertness
- Ease of phonation
- Skin color
- Posture & chest shape
- Ventilatory or breathing pattern
- Presence of digital clubbing
- Presence of supplemental O 2 and other medical equipment
- Presence & location of surgical incisions
Observation of Breathin Pattern
- Assessment of rate (12 to 20 breath/minute)
- Depth
- Ratio of inspiration to expiration (1:2)
- Sequence of chest wall movement during inspiration & expiration
- Comfort
- Presence of accessory muscle use
- Symmetry
Apnea (Breathing Pattern)
- Lack of airflow to the lungs for >15 seconds
- Airway obstruction, cardiopulmonary arrest, narcotic overdose
Eupnea (Breathing Pattern)
- Normal Breathing
Biot’s respirations (Breathing Pattern)
- Constant increased rate & depth of respiration followed by periods of apnea of varying lengths
- Elevated intracranial pressure, meningitis, stroke
Bradypnea (Breathing Pattern)
- Ventilation rate <12 breaths per minute
- Use of sedatives, narcotics, or alcohol
Cheyne Stokes respirations (Breathing Pattern)
- Increasing depth of ventilation followed by a period of apnea
- Elevated ICP, CHF, narcotic overdose
Hyperpnea (Breathing Pattern)
- Increased depth of ventilation
- Activity, pulmonary infections, CHF
Hyperventilation (Breathing Pattern)
- Increased rate & depth of ventilation resulting in decreased Pco 2
- Anxiety, nervousness, metabolic acidosis
Hypoventilation (Breathing Pattern)
- Decreased rate & depth of ventilation resulting in increased Pco 2
- Sedation, neurologic depression of respiratory centers, metabolic alkalosis
Kussmaul respirations (Breathing Pattern)
- Increased regular rate & depth of ventilation
- Diabetic ketoacidosis, renal failure
Orthopnea (Breathing Pattern)
- Dyspnea that occurs in a flat supine position. Relief occurs w/ more upright sitting or standing
- Chronic lung disease, CHF
Paradoxical ventilation (Breathing Pattern)
- Inward abdominal or chest wall movement with inspiration and outward movement with expiration
- Diaphragm paralysis , ventilation muscle fatigue, chest wall trauma
Sighing respirations (Breathing Pattern)
- The presence of a sigh >2 3 times per minute
- Angina, anxiety, dyspnea
Tachypnea (Breathing Pattern)
- Ventilation rate >20 breaths per minute
- Acute respiratory distress, fever, pain, emotions, anemia
Paradoxical Breathing
- reverse movement of inspiration and expiration
Palpation (Physical Examination)
- Presence of fremitus during respirations.
- Presence, location, & reproducibility of pain, tenderness, or both.
- Skin temperature.
- Presence of bony abnormalities, rib fractures, or both.
- Chest expansion & symmetry.
- Presence of subcutaneous emphysema (PTX, central line complication, post thoracic surgery).
Mediate Percussion (Physical Examination)
- Resonant (over normal lung tissue)
- Tympanic (over gas bubbles in abdomen)
- Lung tissue –> emphysematous lungs or PTX
- Dull ((↑tissue density or lungs w/ ↓air).
- Lung tissue –> tumor or
- Flat (extreme dullness over very dense tissues, such as the thigh muscles).
Coughing (Physical Examination)
- Effectiveness (ability to clear secretions)
- Control (ability to start & stop coughs)
- Quality (wet, dry)
- Frequency
- Sputum production (color, quantity, odor, & consistency) (ex, hemoptysis)
Oximetry (Diagnostic Testing)
- Noninvasive method of determining (Sa O 2 ) through the measurement of (Sp O 2 ).
- Readings can be affected by:
- Poor circulation (cool digits)
- Movement of sensor cord
- Cleanliness of the sensors
- Nail polish
- Intense light
- Cardiac dysrhythmias
- Severe hypoxia
SaO2 & PaO2 Average Values
Arterial Blood (Diagnostic Testing)
- Examines acid base balance (pH), ventilation (Co2 levels), and oxygenation (O2 levels).
- Guides interventions, such as mechanical ventilation settings or breathing assist techniques.
Clinical Presentation of CO 2 Retention
- Altered mentalstatus
- Lethargy
- Drowsiness
- Coma
- Headache
- Tachycardia
- Hypertension
- Diaphoresis
- Tremor
- Redness of skin, sclera, or conjunctiva
Causes of Acid Base Imbalances
Interpretation of ABGs
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Chest X-Rays (Diagnostic Testing)
- Assist in the clinical diagnosis & monitor the progression or regression.
- Diagnosis cannot be made by CXR alone.
- CXRs sometimes lag behind significant clinical presentation.
Diagnostic Testing (others)
- Sputum Analysis
- Flexible Bronchoscopy
- Ventilation
- Perfusion Scan (rule out PE)
- Computed Tomographic Pulmonary Angiography
- Pulmonary Function Tests
Air Trapping
Common Terminology for Respiratory Dysfunction
Bronchospasm
Common Terminology for Respiratory Dysfunction
Contraction of the bronchi/bronchiole walls –> narrowing the airway
Consolidation
Common Terminology for Respiratory Dysfunction
Transudate, exudate , or tissue replacing alveolar air
Hyperinflation
Common Terminology for Respiratory Dysfunction
Overinflation of the lungs at resting volume due to air trapping
Hypoxemia
Common Terminology for Respiratory Dysfunction
Hypoxia
Common Terminology for Respiratory Dysfunction
Low level of O2 in the tissues available for cell metabolism
Respiratory Distress
Common Terminology for Respiratory Dysfunction
Acute or insidious onset of dyspnea, respiratory muscle fatigue, abnormal pattern & rate, anxiety, & cyanosis.
Health Conditions
Obstructive Pulmonary Conditions
- Asthma
- Chronic Bronchitis
- Emphysema
- Cystic Fibrosis
- Bronchiectasis
Restrictive Pulmonary Conditions
- Atelectasis (lung collapse)
- Pneumonia
- Pulmonary Edema
- ARDS
- PE
- Lung Contusion
Restrictive Extrapulmonary Conditions
- Pleural Effusion
- Pneumothorax
- Hemothorax
- Flail Chest
- Empyema
- Chest Wall Restrictions
Bronchoplasty (sleeve resection)
(Thoracic Procedures)
- Resection & reconnection of a bronchus ( e.g. bronchial carcinoma)
Lobectomy
(Thoracic Procedures)
- Resection of one or more lobes of the lung (isolated lesions)
Lung volume reduction
(Thoracic Procedures)
- Uni or bilateral removal of portion(s) of emphysematous lung parenchyma
Mediastinoscopy
(Thoracic Procedures)
- Endoscopic examination of the mediastinum (biopsy)
Pleurodesis
(Thoracic Procedures)
- Obliteration of the pleural space (persistent pleural effusions or PTX)
Pneumonectomy
(Thoracic Procedures)
Segmentectomy
(Thoracic Procedures)
- Removal of a segment of a lung (parenchymal lesion)
Thoracoscopy
(Thoracic Procedures)
- Examination through the chest wall (pleural fluid biopsy)
Tracheal resection & reconstruction
(Thoracic Procedures)
Tracheostomy
(Thoracic Procedures)
Wedge resection
- Removal of lung parenchyma without regard to segment divisions (peripheral parenchymal
Thoracentesis
(Thoracic Procedures)
PT Intervention (Goals)
- Promoting: independence in functional mobility
- Maximizing: gas exchange (by improving ventilation & airway clearance)
- Increasing: aerobic capacity, respiratory muscle endurance, and the patient’s knowledge of his or her condition
PT Intervention (General Techniques)
- Breathing retraining exercises
- Secretion clearance techniques
- Positioning
- Functional activity
- Exercise w/ vital sign monitoring
- Patient education
Dean’s Hierarchy
I. Mobilization & exercise
- To elicit an exercise stimulus that addresses various steps in the oxygen transport pathway.
Dean’s Hierarchy
II. Body positioning
- To elicit a gravitational stimulus that simulates being upright and moving as much as possible: active, active assisted, or passive
Dean’s Hierarchy
III. Breathing control maneuvers
- To augment alveolar ventilation , to facilitate mucociliary transport, and to stimulate coughing
Dean’s Hierarchy
- To facilitate mucociliary clearance w/ the least effect on dynamic airway compression and the fewest adverse cardiovascular effects
Dean’s Hierarchy
V. Relaxation & energy conservation interventions
- To minimize the work of breathing and of the heart and to minimize undue oxygen demand
Dean’s Hierarchy
VI. ROM exercises (cardiopulmonary indications)
- To stimulate alveolar ventilation & alter its distribution
Dean’s Hierarchy
VII. Postural drainage positioning
Dean’s Hierarchy
VIII. Manual techniques
Dean’s Hierarchy
IX. Suctioning
PT Intervention (Activity Progression)
- RPEor the dyspnea scale are better indicators of exercise intensity than HR
- Monitoring SpO2 can assist in determining the intensity of the activity
- Shorter, more frequent sessions are better than longer sessions
- Education on energy conservation & paced breathing enhances activity tolerance
- Schedule PT according to the pt’s other hospital activities
- Document the need & duration of seated or standing rest periods
- O2 may not be needed at rest , but may help during exercise
- Bronchopulmonaryhygiene before session may optimize activity tolerance
