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NPTE > Pulmonary System > Flashcards

Pulmonary System Flashcards

1
Q

Muscles of inspiration include:

A 
External intercostals - (slope forward and downward)
SCM
Scalenes
Serratus Ant
Pec minor
Pec major
Lat dorsi
Trapexzius
Erector spinae
Diaphragm
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2
Q

Muscles of Expiration

A

Rectus abdominis, TA, Internal/external obliques

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3
Q

The Diaphragm is innervated by what? Moves how in quiet sitting? Changes how between supine, sitting and sidelying? Changes in COPD?

A

Innervated by the Phrenic n C3-5
Moves 2/3 of an inch during quiet sitting but up to 2.5-4 inches with max ventilator effort.
In supine: the level of the diaphragm rises
In sitting/standing: the dome of the diaphragm is pulled down (gravity)
In sidelying - the uppermost side drops to a lower level and has less excursion.
In COPD - compromised expiration - hyperinflated lungs = flattening of the diaphragm

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4
Q

Respiratory rate for infants

A

30-45

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5
Q

RR for children

A

20-35

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6
Q

Bradypnea

A

<12

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7
Q

Tachypnea

A

> 20

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8
Q

Hyperpnea/Hypopnea

A

increased/decreased rate and depth of breathing

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9
Q

Auscultation: Vesicular sounds

A

Soft rustling all inspiration and the beginning of exp. Normal, unlabored breathing.

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10
Q

Auscultation: Vocal sounds

A

Loudest near the trachea and mainstem bronchi. Normal.

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11
Q

Auscultation: Bronchovesicular

A

Heard over 1st and 2nd intercostal spaces and interscapular region. Normal

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12
Q

Auscultation: Bronchial sounds

A

Hallow echoing all inspiration and expiration. Normally over the manubrium. Normal.

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13
Q

Auscultation: Apneuistic

A

Abnormal. Gasping inspiration

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14
Q

Auscultation: Biots

A

Irregular deep and shallow breaths, abrupt pauses. Ataxia.

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15
Q

Cheyne-stokes

A

Deep followed by shallow breaths

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16
Q

Kussmauls breathing

A

Distressing dyspnea - increased RR and depth, panting, air hunger

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17
Q

Lateral costal breathing

A

Ant flattening of chest with excessive flaring of lower ribs.

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18
Q

Paradoxical breathing

A

Part of the chest wall falls in during inspiration

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19
Q

Auscultation: Crackles

A

Rattling or bubbling due to excretions/ Atelectasis, fibrosis or pulmonary edema.

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20
Q

Auscultation: stertor

A

Snoring sound due to partial obstruction

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21
Q

Egophany

A

Abnormal transmission of vocal sounds, nasal or bleating.

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22
Q

Stridor

A

Shrill, harsh sound during inspiration in the presence of laryngeal obstruction

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23
Q

Dyspnea on exertion

A

classic sign of anemia

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24
Q

Proxysmal nocternal dyspnea

A

Sign of heart failure

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25
Q

Explain muscular activity during normal breathing

A

Inspiration: diaphragm contracts flattening the dome
Expiration: passive relaxation of inspiratory msucles and elastic recoil - diaphragm returns to normal

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26
Q

Rib cage excursion

A

Rib 2-4 pump handle - up and down supine for assessment. Increase chest dimension in AP direction
Rib 8-10 bucket handle flop up and down, sidelying for assessment. Increase chest dimension in lateral direction

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27
Q

Asthma

A

Reversible obstructive lung disease

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28
Q

Atelectasis

A

Collapse of normally expanded and aerated lung tissue

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29
Q

Bronciectasis

A

Dilated, inflamed and easily collapsible bronchi due to destruction of the muscle and decrease in elasticity

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30
Q

Bronchitis (acute)

A

Viral/bacteria. Inflammation of the bronchi

31
Q

Brochitis (chronic)

A

Inflammation of bronchi - lasts years. Caused by smoking. Also have COPD

32
Q

Cystic fibrosis

A

Disorder of ion transport in the exocrine glands - effects on hepatic, digestive, male reproductive and respiratory systems.

33
Q

Emphysema

A

Accumulation of air in the tissues. Part of COPD.

34
Q

Lofgren’s syndrome

A

A group of symptoms present at initial onset of sarcoidosis. Fever, arthritis, enlarged lymph nodes, rash.

35
Q

Pancoast syndrome

A

Apical lung tumor. Pain in 8th cervical nerve trunk and 1st/2nd thoracic nerve. Weakness/atrophy of hand muscles

36
Q

Pneumonia

A

Inflammation affecting the parenchyma of the lungs

37
Q 
Obstructive lung diseases are characterised by... 
Xray findings:
Pulmonary function test findings:
Lung volumes:
Examples:
A

Airflow limitation associated with abnormal inflammation.
Decreased elastic recoil, dyspnea on exertion, cough, sputum, hemoptysis, hypoxemia, hypercapnia, decreased breath sounds, increased RR, weight loss, low diaphragm, pursed lip breathing, cyanosis, clubbing.
Xray: hyperinflation, flattened diaphragm, hyperlucency
PFT: decreased FEV and FVC, increased RV and FRV, Decreased FEV1/FVC.
Lung volumes: Decreased vital capacity, increased residual volume and functional residual capacity.
Eg; CF, COPD, Asthma, Bronchiectasis, Bronchopulmonary dysplasia, Emphysema.

38
Q 
Restrictive lung diseases are characterised by... 
Xray findings:
Pulmonary function test findings:
Lung volumes:
Examples:
A

Alterations in lung parenchyma and pleura. Difficulty expanding lungs caused by a reduction in lung volumes. Fibrotic changes.
Dyspnea, hypoxemia/hypercapnia, crackles, clubbing, cyanosis, shallow rapid breathing, reduced cough, Chest wall alterations.
Xray: reduced volumes, pleaural thickening, atelectasis.
PFT: reduced vital capacity, reduced FRC and TLC
Lung vol: Reduced VC, residual volume and FRC
Eg: AS, Scolisosis, TB, Pneumonia, Arthrogryposis, burns, Scleroderma, MS, MD, SCI, CVA

39
Q

Monitor FEV1/FVC ration before during and after exercise - when does exercise need to be slowed and when does it need to be stopped?

A

Decrease of 10% = Slowing Activity

Drop of 15-20% = cessation of ex

40
Q

Postural Drainage: Upper lobe Apical

A

Flat table, lean back 30 degrees on therapist, Clav-scap

41
Q

Postural Drainage: Upper lobe Post

A

Flat table - lean forward 30 degrees - upper back bilat

42
Q

Postural Drainage: Upper lobe Ant

A

Flat table - supine, pillow under knees. Clav-nipple

43
Q

Postural Drainage: Middle lobe (R)

A

Table elevated 16” (L) SL1/4 turn backward

44
Q

Postural Drainage: (L) Lingular

A

Table elevated 16” (R) SL1/4 turn backward

45
Q

Postural Drainage: (L)/(R) anterior basal

A

Table elevated 20” (L) or (R) Sidelying

46
Q

Postural Drainage: Lower lobes Lateral basal

A

Table elevated 20” prone 1/4 turn upward

47
Q

Postural Drainage: Lower lobes posterior basal

A

Table elevated 20” Pillow under hips, prone

48
Q

Postural Drainage: Lower lobes superior segment

A

Table flat prone with two pillows under hips

49
Q

Percussion indications and contraindications

A

Secretion clearance from tracheobronchial tree
Secretions, atelectasis, aspiration, mucous plugging
- C/I - pain increase, aneurysm precautions, hemoptysis, increased PTT, increased PT, decreased platelet count, anticoag medications, fractured ribs, flail chest, degen bone disease, bone ca

50
Q

Vibrations

A

Shaking throughout expiration.

Ind and C/I as above. 5-10 inhalations

51
Q

Endotracheal suctioning - Size and suction pressure of catheters.

A

failure of other airway clearance techniques. Catheter sizes Adult: 10, Older children 8fr and young children/infants 5-6. Set at 120mmhg suction.

52
Q

High frequency airway oscillation

A

Uses high frequency vibration to mobilise secretions.
Inhale slowly 75% full breath, lips sealed Hold 2-3 sec, exhale 3-4 seconds. Repeat 10 x 20 times. Cough/huff
C/I - ICP >20 Skull trauma, sinusitis, nose bleeds, nausea, middle ear pathology, pneumothroax.

53
Q

Paced breathing

A

Used for patients who become dyspneic during the performance of an activity or exercise.
Used to spread out the metabolic demands of an activity over time. Breath in at rest, breath out with first component of activity

54
Q

Inspiratory muscle trainer

A

Loads muscles of inspiration but breathing through graded apeture openings. Determine max inspiratory pressure and chose 30-50% of that to allow 10-15 minutes of training per session. Maintain usual tidal volume and respiratory rate.

55
Q

Common lung changes due to age

A

Chest wall stiffness - increased WOB
loss of lung elastic recoil
Changes in lung parenchyma incuding enlarged alveoli
Pulmonary blood vessels thicken
Declining TLV - RV increases, VC decreases, FEV decreases
Altered pulmonary gas echange - Pa02 at 20 = 90, paO2 at 70 = 75mmHg
Decline in gas exchange
Reduction in gag reflex
Prolonged recovery of respiratory illness

56
Q

Cuff pressure to prevent ventilator assisted pneumonia must be

A

25-35mmHG
Cuff pressure must be below tracheal mucosal capillary perfusion pressure. Too low and it will not prevent silent aspiration of pharyngeal secretions.

57
Q

What is the requirement for confirmation of asthma?

A

15% improvement post brochnodilator

58
Q

What is the DLCO

A

Diffusion capacity for carbon monoxide <60% poor lung cancer prognosis. >15% decline after 6 months - predictor of mortality.

59
Q

Respiratory acidosis

A

PH <7.35 and PCO2 >45
Hypoventilation
Confusion, stupor, coma

60
Q

Respiratory alkalosis

A

PH > 7.45 PCo2 <35
Hyperventilation
Hyper-reflexia
Dizziness, disorientation

61
Q

What are the 4 stages of pneumonia

A

Stage 1 - engorgement. A few days
Stage 2 - red hepatisation, alveoli, leukocytes present
Stage 3 - Grey hepatisation 4-8 days. Build up of dead bacteria and consolidation
Stage 4- Resolution

62
Q

Auscultation sounds - Hyperresonant

A

Very low pitch - emphysema

63
Q

Auscultation sounds - Flat tone

A

High pitch - over muscle mass

64
Q

Auscultation sounds - dull note

A

Low amplitude, med-high pitch, over consolidation

65
Q

What is Well’s clinical prediction rule for a DVT

A 
\+1 Cancer
\+1 paralysis/Cast
\+1 Recently bedridden
\+1 entire leg swelling
\+1 Calf swelling
\+1 localised tenderness
\+1 Collateral superficial vv. 
> 3 high prob
1-2 moderate prob
0 low probability
66
Q

Seek EMS if

A
  • VF
  • Asystole
  • SOB at rest
  • unstable angina not relieved by nitro x 3
  • Ventricular standstill + 3rd degree heart block
    VT - 3 or more PVCs
67
Q

Stop exercise if

A
  • Failure of SBP to rise or if it drops >10mmhG
  • SPB > 200 or DBP > 110
  • Hypotensive
  • change in cardiac rhythm
  • fatigue, discomfort or asks to stop
  • 2nd degree heart lock
  • VT - 3 more more PVCs no pwave
  • ST elevation >1mm
    Unstable angina
  • couplet/triplet
  • signs of poor perfucion
  • symptomatic CHF
  • Glucose >230 or <70
  • uncontrolled tachy or bradycardia
  • DVT
  • PTT >60sec
68
Q

What are the physiological differences between UE and LE ex

A

UE ex has 30% greater rise in sympathetic upregulation causing an increase in HR. Increased blood pressure due to lactate and muscle stress.
Same workload = more stressful to do isolated UE ex than isolated LE ex.

69
Q

What are the signs of pneumonia

A
  • reduced respiratory movement
  • dull note percussion (consolidation)
  • insp/exp course creps
  • no mediastinal shift
  • air bronchograms on radiography
70
Q

What causes same sided mediastinal shift?

A

Lung collapse

71
Q

What causes mediastinal shift to the opposite side?

A

Volume gain

72
Q

What is the difference between Reverse Trendelenberg and Semi-fowlers positions?

A
  • Reverse trendelenberg - bed head elevated

- semifowlers - head and trunk raised - breathing difficulties, cardiac and neurological NGT

73
Q

What two things can predict mortality in Lung disease?

A

Decline of DLCO (carbon monoxide diffusing capacity) 15% over 6 months
Desaturation to 88%

NPTE (19 decks)

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