Pulnary Pathology Flashcards
Tidal Volume
Normal quiet breathing, breath in breath out either 1 quiet expiration or one quiet inspiration. Normal healthy adult total volume is 500 mL.
IRV
Inspiratory resume volume
The amount of air breath in beyond tidal volume or VT . You breath in quietly then take a deep breath in .
Normal 2500ml
inspiratory capacity
VT +IRV
How much air can hold to breath air in
Both quiet resting breath and deep breath in
2500+500=3000
ERV
Expiratory Resume Volume
Breath in and out some air quietly at rest, then exhale or blow the rest of air out.1000ml
Residual Volume
After ERV or forced air out, still some air left or stays in the lung. How much air still in your lung. 1500ml
FRC
Functional Residual Capacity
Combine ERV +RV 2500
FRC : air left in lungs after normal exhalation
Vital Capacity
How much air I can breathe in and out quietly or Tidal Volume + ERV or forced amount of air +IRV or forced air volume
Basically everything except for residual volume
4000ml
Total volume
VT+IRV +ERV +Residual volume
5500ml
FEV1
Take a deep breath in or take max inspiration, how much can I expire or exhale (my expiration) in 1 sec.
How much air can they forcefully expire within 1 second.
Important for pts like COPD ,they tend to have lower FEV1, be their lungs are no longer elastic, harder for them to get the air out of the lungs.
3200ml
ABG
More accurately way to test How much oxygen somebody blood has.
Get arterial blood , put in arterial line or just take blood from artery.
PaO2
Partial pressure of oxygen
The concentration of the oxygen in the blood.
Basically how much oxygen in people’s blood
Range is 80 to 100.
If they less than 80 , hypoxemia, means low oxygen in their blood.
Hypoxia tissue
Over 100 is hyperoxemia
More oxygen in their blood
PaCo2
Partial pressure of Co2 40 is normal
Breath out co2
Lower than 35 is hypocapnia
More than 45 is hypercapnia
More than 50 is ventilatory failure
PH level
Effected by PaCo2 or HCO3
If too high or too low can affect nervous systems like seizures
Normal 7.4 (7.35-7.45)
Acidosis less than 7.35
Alkalosis over 7.45
HCO3
Bicarbonate , to help to buffer blood to maintain the PH balance.
Normal 24
PH Imbalance
Metabolic acidosis/alkalosis is related to bicarbonate being off.
Respiratory Acidosis increased CO2 too much CO2 in the body they cannot get rid of it
Sx :confusion AMS (altered mental status ）fatigue lethargic SOB cyanosis
Respiratory alkalosis
Decreased CO2
Sx tachypnea tachycardia hyperventilation dizziness seizures if severe
Pulse Oximetry SpO2 Considerations
Motion and weight bearing can affect reading
Location
3rd /4th finger>index finger >earlobe
Forehead probe best
Dirt fingernail polish blood can block sensor
Low perfusion or dysthymias = weak signal
Dyspnea
Breathlessness or SOB
Sensation of difficulty breathing
Difficult to quantitate
Not =o2 level
Could be a sign of pulmonary disease but not necessarily.
Not always related to patients oxygen saturation
Breathing requirements exceed capacity
Causes of Dyspnea
Anxiety( increase awareness of normal breathing)
Severe: tingling hands /feet, lightheaded, numbness around mouth
* increase work of breathing
Greater inspiratory pressure needs to be generated
Need more mms to help them breathing
* abnormality in ventilatory system
Dyspnea on Exertion
Definition: common complaint in cardiopulmonary dysfunction
Need to establish amount of activity that produces DOE
Dyspnea index: take a deep breath count to 15
Dyspnea Scale : +1 mild noticeable to the pt not the observer
+2 some difficulty noticeable to pts and observer
+3. Moderate but can continue
+4 severe cannot continue to activity
Paroxysmal nocturnal Dyspnea
Strong predictive value of CHF
Pt falls asleep laying down , 1-2 hours later wakes up with acute SOB, sits at EOB or opens window to breath fresh air.
Sitting up in bed doesn’t relieve it.
Excessive blood or fluid resting on your chest, u can’t breathe, drop the legs off the bed , some of fluid or edema will going down to the legs
COPD
Chronic obstructive pulmonary disease
Definition: common preventable treatment disease characterized by persistent airflow limitations that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.
It’s treatable not irreversible.
Chemicals smoke, including secondhand smoking.
Obstruction to expiratory airflow
Irreversible
Primary causes: smoking and genetics
3rd leading cause of death
Comorbities: more than one illness at once
Chronic obstructive pulmonary disease
Definition
Ipads notes
COPD pathophysiology
Hyper-secretion of mucus
Mucus plugging: blocking airways
Along with that they get Edema of mucosal lining in their airways.
And Increased reactivity of airways . All of these will cause
Destruction of bronchioles ,and
Alveolar sac destruction where gas exchange happens. Along with that, we will also see
Elastic recoil destroyed which will cause hyperinflation of the lungs causes their diaphragm to be flattened . So it not allowing their diaphragm to have length and tension relationship, so their breathing not as efficient as before. We will see pts using accessory mms .
ventilation/perfusion mismatch, means they may be are getting air in , but their alveoli getting destroyed, so they are not getting gas exchange means they are not getting good perfusion. And they have hypoxemia (and hypercapnia).
Impairments Associated with COPD
Chronic lung hyperinflation
Barrel shaped chest and flattened diaphragm
Exhalation becomes forced ( increased intrabdominal pressure) put extra stress on their pelvic floor mm like coughing, COPD can have pelvic floor issues. affecting urine?
Use of accessory mms lead to postural deviations , rounded shoulders, forward head, increased thoracic kyphosis, all these things cause overstretched posterior shoulder girdle.
Change in mm composition- mm wasting and decreased exercise capacity and LE function. Skeletal mm weakness. Breathing issues also have strengths issues as well.
Depression and anxiety : can’t do things that used to do
Cognitive impairments
: decreased oxygen in the brain.
Emphysema
Enlargement and destruction of alveolar walls , walls of alveoli are torn and cannot be repaired. Alveoli fuse into large air spaces.
Alveolar enlargement and destruction
Decreased elasticity
Air trapping
Hyperinflation of lungs
Emphysema presentation pink buffers
They use accessory mms to breath, they do pursed lip breathing, they either have a minimum cough or no cough at all relative to our pts have bronchitis, they tend to lean forward to breath because they are using tripod position, as they progress, they will have Dyspnea on exertion. Pink puffers because of rosy skin, many pts tend to be thinner.
Chronic bronchitis. Blue bloaters
Increased mucus production and inflammation of tissues which block their airways.
Airways narrow which is going to obstruct airways.
How to diagnose of this?
They have to have productive cough to more than 3 months for 2 consecutive years.
Pts can have bronchitis and emphysema combined or bronchitis dominates or emphysema dominates.
Blue bloaters: excessive body fluid, chronic cough, SOB on exertion, increased sputum, cyanosis (late sign)
These pts tend to have higher CO2 level in their blood, mucus increases obstructions even harder to get air out, and excessive fluid often associated with right heart failure, and LE edema .
Airway obstruction
COPD Bronchitis Presentation Blue Bloaters
LE edema
Chronic edema
Excessive body fluid
Chronic cough
SOB
Increased sputum
Cyanosis
COPD Clinical presentation
DOE
Prolonged expiration , 4 times long trying to get out of that trapped air.
Increased A-P diameter
Hypertrophy of accessory mms
Flattened diaphragm
Abnormal gas exchange
(Decreased po2 or increased CO2)
Decreased FEV1
Increased volume on static PNFs
COPD Gold Classification
Stage 1 mild COPD , minimal SOB, may or may not have cough, lung function may seem normal, FEV1 is >=80%of normal
Stage2 moderate COPD, mod to severe SOB on exertion, cough or sputum, FEV1 is 50-69%of normal
Stage 3 : severe COPD, More severe SOB, may or may not have cough, decreased exercise capacity, fatigue present, quality of life impaired, FEV1 is 30-49% of normal
Stage 4: very severe COPD, severe SOB with exacerbation of Dyspnea, cough/sputum production, reduced quality of life, FEV1 <30%of normal.
Medical management of COPD
Best diagnostic test: Pulmonary Function Tests (spirometry)
Overall goals: improve O2 intake, decrease Co2
Goals
Relief symptoms
Reduce frequency of exacerbations
Reduce mortality
Prevent progression : stop smoking
prevent and treat complications
Improve exercise tolerance which is PT comes in
Enhance health status
Medications for COPD
*Oral or inhaled bronchodilator s like nebulizers (short or long acting) Dilates bronchioles
* anti- inflammatory agents : anything reduce your inflammation in your airways.
* antibiotics : not long term , but if they have mucus, they could get infected
* mucolytic expectorants: it’s a cough medicine to help you to cough so you can get mucus out ,thin out your mucus
* mast cell membranes stabilizers : control allergic disorders )cold induced bronchi spasm with cold
* antihistamine: allergy medication
* Acute exacerbation: corticosteroids : no more than 3 weeks in a time. Only short term use.
* time therapy , let pts take medication 20min before therapy, watch vitals, pts may feel increased HR increase palpations
Spiriva: 呼吸系统新药 is a bronchodilator that relaxes mms in the airways and increases air flow in the lungs. Prevent bronco spasm in adults with COPD.
Albuterol:舒喘宁 is used to prevent and treat difficulty breathing,wheezing,SOB,coughing and chest tightness caused by COPD or asthma.
Prednisone: prescription drugs, a corticosteroid medication, works on the immune system to help relieve swelling,redness, itching and allergic reactions.
Xopenex via nebulizer: bronchodilator that relaxes mms in the airways and increases air flow to the lungs.
Vasotec: treat HTN CHF kidney problems caused by diabetes.
Dyazide: used for HTN and edema , prescription drugs
Prognosis for patients with COPD
FEV lower, higher chance mortality and morbidity
One indicator is quad strength, can’t getting up to stand, walking, reduced functional capacity,then continue to do even less.
Mm wasting
BODE index
Body mass index
Obstructive defect FEV1
Dyspnea level
Exercise tolerance (6 min walk distance)
Time Walk as far as you can go in 6 minutes see how many times you stops. Objective measurement of function capacity.
PT for COPD
Airway clearance techniques : do this after bronchodilator treatment,it’s gonna open up airways, easier to move secretions.
Dyspnea relief : do some breathing treatments, paced breathing, into your nose, out to your mouth, slowly breathing down. Decrease anxiety sometimes. We don’t want them to hold their breath, we want to use pursed breathing.
Endurance training
Strength training : esp quads and arms, controlled breathing when they are doing arm work, they used to do use their arms a lot but not anymore they need to do arm strengthening as well.
Posture : alternating their posture to breath better. Like tripod position, putting arms on their legs.
Putting diaphragm into a better position to work. Like lean forward to put diaphragm into a better position.
Energy conservation/pacing : conserve your energy and pacing to maintain functional whatever I’m doing. Breaking up tasks that could take a long time. Space things out to save energy.
Balance training : their quad’s gonna be weak , tend to lean forward, forward rounded posture affect balance. Diabetes like standing,
Asthma
Another obstructive disease, this one we call it episodic, episodes of bronchospasm which is gonna limit their normal lung function in between these episodes of spasms where it’s gonna cause wheezing, chest tightness and coughing , airway not open even at normal lung function time. Narrowing airway.
Cough lingers much longer,increase sensitivity to their airways , it can be cold, exercise,which causes inflammation of airways. Also require bronchodilator before exercise.
PT : may be not the first thing to do. help pts mobilize secretions, airway clearance, control breathing exercise training.
Edema of respiratory mucosa and excessive mucus production obstruct airways.
Cystic Fibrosis
Most common life threatening genetic traits (Caucasians)
It can affect indifferent ways:pulmonary, intestines or pancreas.
Pulmonary : chronic airway obstruction/inflammation, thick sceretions, recurrent bacterial infections.
Both parents have to carry the recessive genes so the child would have the chance to get cystic fibrosis.
Intestines: thick mucus that body produces interferes with absorption of nutrients, so their malnourishment or low weight.
Pancreas insufficiency which affects GI function and growth.
Their life expectancy is shortened,it’s about 37, sometimes they may get lung transplant, sweat more salt, sweat test? They can develop into infection? Easily pass… stay apart from people have CF.
PT: Airway clearance techniques 3-4 x /day
These people also do airway clearance at home, they get diagnosed at young age their parents taught them to do this at young age. Use percussion techniques like tapping on them to help move secretions. Therapy vast Vibrates? They wear it for 10 to 15 min , 3 or 4 x/day to vibrate to mimic that same percussion technique to help loosening those secretions.
Exercise:strengthening/endurance, thoracic stretching and postural re-ed.
Restrictive lung dysfunction
Sx
Classic signs
Atelectasis
Portion of lung collapsed
Decreased lung expansion/hypoventilation, alveoli are collapsed.
Increase Inspiratory volume: use incentive spirometer or PEP
Prevent atelectasis is important!
PT: do PT before they get atelectasis to prevent it
Coughing
Deep breathing
Early mobility
Frequent position changes
Prevention!
Pneumonia
Inflammation of lung parenchyma, often begins with infection.includes alveoli.Often begins with infection, influenza, upper/lower respiratory infection.
CAP: community acquired pneumonia
HAP: hospital acquired pneumonia (pt at hospital because of other diseases then they got pneumonia)
Primary pneumonia: pt is sick and treated for
Secondary pneumonia: pt at hospital then they got pneumonia.
Caused by Bacteria vital fungal and aspiration
Aspiration: inhaling foreign objects, liquid or food, aspiration often seen with pts have neuromuscular issues , their swallowing mms not working properly.
Pulmonary embolism
DVT
Emergency!
Blood clot elsewhere in the body, often times in the leg, Blood clot can break off and move into the pulmonary artery, pulmonary arteries Carries the blood from your heart to your lungs to get oxygenated, so if there is a clot that blocking , then the blood is not gonna get to your lungs to get oxygenated. This can be life threatening.
Sx: SOB chest pain, sense of impending doom. Can be fatal , 30% of patients will die within a few hours if it’s left untreated.
Pleural Effusion
Pulmonary edema
Pneumothorax
Hemothorax
Increased pleural fluid that can occur as a result of pneumonia.
Increased fluid within lung often is caused from a cardiac disease.
Free air in pleural space- penetrating wound.
Blood in pleural space
Bronchogenic carcinoma
Sx.
Unexpected weight loss
Hemoptysis
Dyspnea
Weakness fatigue
Hoarseness
Tx. Chemo Radiation surgery
Lung cancer start from lungs, people can also have lung mets, metastasis to the lungs. If pts have these Sx but not been ill, definitely red flags.
PT: treating impairments, if they did surgery, we can do some breathing exercise, otherwise, chemo, radiation, surgery as well . Might do some strengthening ex as well, helping with functional activities.
ALI /ARDS
Acute respiratory distress syndrome
Fatal complications
Injury to alveolar- capillary membrane, inflammation +edema: not be able to get that gas exchange
Early Sx: increased RR with shallow rapid breathing
PT: prone position and residual impairments of survivors: whatever residual impairments like decreased strength, or whatever functional training they need.
Sepsis, body wide , trauma, they have had multiple bone fractures, burns, drowning or major surgery.
Can progress very rapidly, esp in sepsis, to cause multi organ failure.
In order to treat this , they would need to address the sepsis.ultimately, sedated with ventilators.
Idiopathic pulmonary fibrosis
Interstital lung disease
Chronic progressive
Irreversible
Progressive worsening of Dyspnea
Epithelial surfaces in lung are damaged causing scarring in lungs
Poor prognosis 2-3 years
Idiopathic: no known cause
Most common and most deadly interstitial lung disease
Turberculosis
Airborne bacteria infection
Lesions ~necrosis-granulomas
Sx Fever night sweat, weight loss,cough hemoptysis. Crackles
They have lesions that develop in their lungs, these lesions become necrotic areas, which then enclosed with a fibrous tissue, which create granulomas. These pts usually not require PT, TB is extremely contagious, some of the places can be passed very easily, like jails prisons homeless shelters.
Wear N95
Bronchopulmonary Dysplasia
Result of RDS
Alveoli didn’t develop normal surfactants
High pressures ( mechanical ventilation)
Frequent lower respiratory infection
Delayed growth and development
Bronchopulmonary dysplasia result of RDS, premature babies can get, these babies have to be mechanically ventilated when they were born because their lungs are not fully developed and those high pressure causes damage.
Cause lung stiffness, these babies frequently have lower respiratory infections.
Even in the childhood, they could have delayed growth and development.
Other causes of restrictive pulmonary disease
Neuromuscular
Musculoskeletal
Surgery
Obesity
Rib fractures
Sleep Apnea
Sx loud snoring, gasping, choking
Daytime fatigue
Large tonsils and body fat
Decreased weight
Stop smoking drinking
Sidelying
Wear CPAP
Continuous positive airway pressure
Non-Invasive ventilation
Pt must be able to breathe spontaneously
CPAP: provides end expiratory pressure to keep soft palate open
BiPAP: provides Inspiratory and expiratory pressure ( may be different amount)
STOPBANG
Snore
Tired during day
Observed to stop breathing
Pressure HTN
BMI >35
Age >50
Neck size >17 16
Gender =male
Measurements used in the hospitals a surgery to see if pts have sleep apnea or at risk of sleep apnea.
People who have sleep apnea tend to have 2 times higher risks to get pulmonary complications, 2 times higher to suffer from post cardiac complications, like heart attack, death, stroke, low blood pressure p having surgery.
Chest tube
Reservior suction on the wall
Portable suction wheelchair
Keep the reservior below the level of chest tube prevent getting back flow into the pts
Lab tools
All the treatment
Pulmonary interventions
Breathing exercises
Mobilize secretions/ Airway clearance
Case study
