respiratory Flashcards

Question

Brochiectasis signs and symptoms

Answer 1

constant cough and infections, due to damaged cillia and unable to remove mucus. (can be as a result of other lung diseases) causinf fatigue, weightloss and shortness of breath

Answer 2

defined by it's symptoms - persistant cough\* inflammation of the brochi

Answer 3

structural changes to the **alveoli** where they are Overinflation of the air sacs is a result of a breakdown of the alveoli walls. It causes a decrease in respiratory function and breathlessness. Damage to the air sacs can't be fixed. It causes permanent holes in the lower lung tissue.

Answer 4

Breathing technique - then thorasic expansions on affected side - with a hold… then out (patient can do their own BT after demonstartion). They hold then sniff in which allows alveolar expansion. as you run through the cycle.

Answer 5

Atelectasis (at-uh-LEK-tuh-sis) is **a complete or partial collapse of the entire lung or area (lobe) of the lung**. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid

Answer 6

* No nail varnish, acrylics or gel nails * Fingers should be clean * Fingers should be warm * Avoid bright overhead light * Make sure the battery is working * If monitoring continuously, change the finger used regularly to avoid pressure damage

Answer 7

Lie the patient on the good lung so that the bad lung is able to drain and you’re able to access it and the good lung can compensate and improve ventilation.

Answer 8

Gentic condiion which causes excess sputum in the lungs and digesive system. identifyied by the heel prick test. signs and coughing and regular chest infections.

Answer 9

**Aetiology**: •CFTR: protein that transports chloride ions (Cl-) across cell membranes. Involved in production of sweat, digestive fluid and mucous (exocrine glandular system) **→** CF: dehydrated & thicken secretions due to imbalance between Cl- & water in/out of cell

Answer 10

•**Airway:** patent? self-ventilating? able to communicate?•**Breathing:** spontaneous, non-invasive, invasive?, respiratory rate (RR), use of diaphragm, accessory muscles, purse-lip breathing, prolonged expiration? wounds?, Intercostal drains? Auscultate and percuss.••**Circulation:** patient’s colour, HR, BP, raised JVP, fluid charts•**Disabilities:** level of consciousness•**Exposure:** other considerations – trauma / fracture / fall risk – mobility

Answer 11

Forced Expiratory technique - FET - ***1 level huff*** ## Footnote * Take a normal sized breath in. **Open the mouth to an O shape** or place breathing tube in the mouth•Breathe out with some force (not a lot of force) and good flow * The breath out is similar **to fogging up a mirro**r – use a tissue in front of the mouth to check technique - 3 levels are **Small**, **medium** and **large**

Answer 12

improves ventilation of the lungs and assist in the clearance of excess secretions. use bronchoddilators before use and the technique is generally taught in sitting.

Answer 13

The ACBT is taught in 3 stages. **Breathing control** (hand on diaphragm x5). **Thoracic expansion exercises** (holding ribcage x5 with a 2-3 second hold). **Forced expiratory huff** - small, medium and large (fogging up a mirror with an open glottis)

Answer 14

The cause is unknown for 50% of cases, but it has been linked to inflammatory **bowel disease**, rheumatoid arthritis, and in 29-50% of patients, **COPD**

Answer 15

due to 15% reduction in mucus clearance - physiotherapy and education are effective in the removal of consolidated secretions.

Answer 16

bronchodilators - steriods to help with an anti inflammatory response. check sputum isn't green otherwise it could be infection. Breathing techniques - Breathing exercise - TTE - hold and huff - helps clearence of secretions - percussions/shaking - through cycle

Answer 17

Positive Expiratory Pressure (PEP) Devices flutter and acapella - exhale agiast a fixed resistance - air gets behind the mucus, mucas moves from the lungs to the airway wall and holds the airways open for longer

Answer 18

**Asthma** is a relatively common condition that is characterised by at least **partially reversible** inflammation of the airways and reversible **airway obstruction due to airway hyperreactivity.** It can be acute, subacute or chronic[^[](https://www.physio-pedia.com/Asthma?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal#cite_note-:2-1)and/or [exercise induced](https://www.physio-pedia.com/Exercise_Induced_Asthma) or **by allergens (inflammatory response)**

Answer 19

**Short/long-acting beta 2-agonists** **bronchodilators** - relaxing diphragmatic breathing, deeper breathing, decreasing respiratory rate. Education - using spacers and medication correctly

Answer 20

Asthma is characterised by narrowing of the airway and is usually reversable and is an OBSTRUCTIVE lung condistion. The narrowing is caused by bronchconsstriction of the bronchial smooth muscle. Asthma attacks can be caused by pollen, allergens smoke and a rapid change if temperature. The inflammation in the airway can result in yellow mucus and mucus plugging

Answer 21

Onset in childhood, allergens, pollen, smoke respiratory tract infections and other inhaled irritants

Answer 22

Expiratiory wheeze is a sign of worsening airway obstruction, Accessory muscel use, breathlessness and chest tightness

Answer 23

Inhaled bronchodialators (long and short acting), corticosteriods, PEP therpy, ACBT and manual therapy.

Answer 24

Bronchiestasis is caused by lower respiratory tract infections, pneumonia, aspergillosis and can co-exist with other diseases such as COPD

Answer 25

Permanent dialation and distortion of the bronchioloes and damage to the cillia, this causes fibosis and reduces the elastic properties of the bronchial walls. Inflammatory process leads to chronic mucus production and infection (can affect lobes of whole lungs)

Answer 26

A productive cough with sputum, wheeze on auscultation. Exacerbations and crackles on auscultation are associated with SOB, clubbing is common and reduced exercises tolerance

Answer 27

pulmonary rehab, smoking cessation, antibiotics, clearence techniques in line with timing of nebuliser (techniques that increase hyperinflation to be avoided). ACBT +- PEP, manual therapy and postural drainage

Answer 28

The leading cause of COPD is smoking in the first world. Biomass fuel exposure (burning biofuels)

Answer 29

(Emphysema and bronchitis) The airway becomes inflamed, narrow and floppy which causes airtrapping, hyperinflation and airflow limitation.

Answer 30

SOB, fatigue, wheeze and sputum, use of accessory muscles, hypoxia and reduced exercise tolerance (Barrel shaped chest)

Answer 31

Smoking cessasstion, 02 therapy, pulmonary rehab, airway clearance techniques \*avoid any hyperinflation due to already barrel chest/air trapped.

Answer 32

Genetic gene mutation diagnosed by the heel prick at brith that affects the lungs, pancreas and digestive tract. CF reduces the secreetion of chloride and water by the airway cells which increases respiratory secretions and consolidated mucus.

Answer 33

Chronic and productive cough, reduced pancreatic function (poor nutritional status), breathlessness, reduced exercises tolerance and common respiratory infection and heamopysis, weight loss, change of sputum production

Answer 34

Airway cleatance techniques (OBSTRUCTIVE LUNG DISEASE), antibiotics, hypertonic saline ABCT, PEP, manual techniques and postural drainage

Answer 35

Avoid hyperinflation \* time nebulisors with physio treatement, antibiotics for infection and analgesia, manage breathlessness with breathless managment techniques.

Answer 36

Group of lung diseases that cause fibrosis of the lungs interstitium (space around the alveoli). It is irreversable and it can be idopathic or secondary to connective tissue disorder, inhaled substances, infection, drug or malignancy.

Answer 37

Repetitive injury to the alveoli epithelium, capillary endothelium and basal membrane causes an overreacted tissue repair cascade. This lays down fibrotic scar tissue which leads to restricted and impaired gas diffussion, over time the interstituim thickens leading to lung infection.

Answer 38

Dyspnoea (), non productive cough, and end expiratory crackles, you may alos see weight loss and fatigue, clubbing and cyanosis.

Answer 39

02 therapy, corticosteriods (prednisilone), reduce exertion, improve lung mechnics, pulmonary rehab, smoking cessation

Answer 40

Subject tolerance

Answer 41

Cardiovascular instability, wheeze, SOB, symptoms of hyperventilation, Coughing in rapid succession with increasing intensity,

Answer 42

Prolonged use of high dose steroids (bone weakness), unstable bone fractures, osteoporosis, osteopenia, wheezing, bronchial hypersensitivity, burns, Frank heamoptysis, low platelet count (clotting disorder), pulmonary embolus

Answer 43

Rigid thorax, increased bronchial construction, breathlessness, cardiovascular instability, pulmonary carcinoma paroxysm coughing

Answer 44

BC helps dyspnoea, TEE improves collateral ventilation to Improve aeration of alveoli to improve lung volume/compliance. FET- aid with expectation @ different lung volumes- percussion to help expel/ aid secretion removal

Answer 45

Bronchitis- increases goblet cells and mucus secretions and mucus glands. Air obstruction develops from repeated irritation of the airway, inflammation and fibrotic changes, bronchospasm

Answer 46

Parenchyma tissue destruction- permanent enlargement and loss of elasticity of the alveolar wall - neutrophils- destructive proteases & Collagenases break down elastin & collagen - causes loss of elastic recoil (floppy airway)

Answer 47

Sitting, Learning forward on a table or standing with their bum against a wall

Answer 48

Hand over diaphragm and focuses on thy rather than the accessory muscles (shortened position), reduces bronchospasm during the forced element of the FET - normal tidal volume breaths with upper chest and relaxed shoulders

Answer 49

Contraindications: patient tolerance/comfort: RR, HR, improve P02 & reduced use of accessory muscles

Answer 50

Chronic inflammation of the airway - airway obstruction and hypersensitivity of bronchial smooth muscle. Mast cells, neutrophils and macrophages cause inflammation- vasoconstriction/obstruction REVERSIBLE after treatment

Answer 51

Patient intolerance, ENT surgery, eye surgery, cardiac surgery, unstable spinal cord injury, central insult, anything that will increase intracranial pressure pnumonectomy

Answer 52

Hypertension, headache, recent seizure, gastric reflux, full stomach

Answer 53

LRTI- as inhal breach of lung defences muccocillary escalator, macrophages, inflammation responses of bronchioles, the alveoli fill and consolidate with bacteria blood and puss, may impair V/Q ratio

Answer 54

Persisting cough 3 months of the year, with increase in mucus secretion. Increase in goblet cells, sub-mucus glands, decrease number and length of cilia

Answer 55

Permanent dilation of the air space distal to the terminal bronchioles and destruction to the walls of these airways.

Answer 56

All ages but often starts in children, attacks of breathlessness and wheezing. Due to inflammation and irritation of the airway. Reducing airflow in/expiration (WHO 2004)

Answer 57

More common in children and boys 10% of children under 10! Most common cause of missing school. Remits after puberty but will come back later in life

Answer 58

Inflammatory exudate (pus) that leaks from blood vessels due to infection (inflammation, odema) into intra-alveolar space resulting in consolidation of the lobe parenchyma.

Answer 59

Congestion: neutrophils & bacteria intra-alveolar space, leaking of fluid (white blood cells/leukocytes) 24 hours. Vascular engorgement Red hepitization/ consolidation: 48-72 hours. Alveoli in the lobes dry, granular and cellular debris consolidates in the alveolar parenchyma. Neutrophil and fibrin break down creating more exudate fluid and macrophages form. Grey hepitization: 4-8 days - neutrophils, fibrin and red cells break down leading to more exudate - macrophages form. Recovery/resolution: 8-10 days: exudate (pus) is cleared by the macrophages cough will be used to clear sputum and lymphatic drainage.

Answer 60

Test Sputum/culture. CT scan or X-ray of lungs for light areas of consolidation. Streptococcus bacteria or fungal aspergillosis

Answer 61

Respiratory failure, Acute respiratory disease syndrome (ARDS), sepsis.

Answer 62

Regular vaccinations for flu etc, anything that will be boost the immune system. Good diet nutrition, not smoking, regular exercise.

Answer 63

Anything that will suppress the immune system. Smoking, diabetes, heart disease, long term steroid use, flu, HIV, heart failure.

Answer 64

-ACBT: BC - help with dyspnoea, Thoracic expiratory exercises - collateral ventilation channels to improve aeration of alveoli / improve lung compliance and volume; Forced Expiratory Techniques – aid with expectoration / @ different lung volume.-Percussions: aid secretion expectoration

Answer 65

Airflow limitation = increases mucus secretion, loss of elastic recoil in the lungs, airway collapse and trapping gas, airway inflammation and impair gaseous exchange V/Q mismatch. chronic inflammation, oxidative stress, protease/antiprotease imbalance

Answer 66

repeated irritation of the airway (smoking) causes increase in goblet cells, mucinous glands, chronic inflammation causes fibrotic changes and brochospasm (bronchoconstriction) hypercapnia and hypocemia and V/P ratio mismatch

Answer 67

parenchyma tissue destruction permanent enlargement and loss of elasticity of the alveolar walls (increased compliance = negative). **Inflammatory mediators and response** of **cytokines, neutrophils and macrophages.** neutrophils release destructive **proteases that break down elastin** and collagen causing a floppy airway (loss of elastic recoil)

Answer 68

reduces the risk of bronchospasm during the huff element during the forced expiratory technique, normal tidal volume in the upper chest with relaxed shoulders and the patient. Emphasis use of the diaphragm rather than accessory inspiratory muscles

Answer 69

To reduce energy requirements so patient can focus on manage their SOB, provide mechanical advantage for the work of accessory muscles and diaphragm, to control their breathing and try to relax.

Answer 70

Patient’s comfort – RR & HR – Improve SPO2 – reduced use of accessory muscle

Answer 71

**Chronic inflammatory, reversible airway obstruction due to hypersensitive smooth muscle.** Insult cold air, pollen etc, inflammatory response - **t cells, mast cells, neutrophils, macrophages**, causes bronchospasm (**bronchoconstriction**). causes wheezing, chest tightness, coughing and is reversible with bronchodilators

Answer 72

**subject tolerance**, **cerebral oedema**, **cardiovascular instability**, undrained **pneumothorax**, hiatus hernia, **ENT surgery**, eye surgery, **anything that increases intercranial pressure**, unstable spinal cord injury, **cardiac/gastric surgery**, bronchial plural fistula

Answer 73

**hypertension**, **headache**, recent **seizure**. **gastro-reflux**, full stomach **(eaten with 1.5 hours)**, abdominal distension

Answer 74

**LRTI** - bacteria/fungi/virus breach the body's defences and reach the lung parenchyma in alveloi/brocnhi. The inflammatory response of the macrophages fill the alveoli with exudate, consolidating the alveoli with pus. **Congestion** -neutrophils, vascular engorgement bacteria/virus/fungi **consolidation ‘red hepatization’** red cells, neutrophils and fibrin, filling the consolidation of the alveolar parenchyma. **Grey hepatization**: red cells disintegrate due to neutrophils and fibrin and turn grey. **Resolution**: the exudate (pus) is digested by enzyme activity (macrophages) sputum is released by cough or lymph drainage.

Answer 75

**subject tolerance**, prolonged steroid use, **osteoporosis**/osteopenia, unstable **spine fractures**, rib **fractures**, coughing up blood, thoracic **burns a**nd loss of skin integrity, wheeze or **bronchial sensitivity, pulmonary embolus**

Answer 76

breathlessness, bronchial constriction, non compliant rigid thorax, coughing , cardiovascular instability,

Answer 77

used in sitting - inspiration through the nose, slow deep breath, hold for 3-5 seconds, breath out at twice the normal speed until max oscillations is achieved, 4-8 reps. can be used with a cough or FET and BC in a cycle.

Answer 78

**Positive Expiratory Pressure increases resistance to airflow** (increase positive pressure). promotes mucus clearance and prevents airway closure by **increasing collateral ventilation**. A **flutter device** combines high frequency airflow with positive expiratory pressure. vibration helps move mucus from the surface of the airway.

Answer 79

•**ACBT:** **BC - reduce WOB, TEE - collateral ventilation channels to improve aeration of alveoli / improve lung compliance and volume; FET – aid with expectoration / @ different lung volume** ## Footnote •**Manual Techniques: Aid to mobilise tenacious sputum from airway**

Answer 80

**Amount of sputum expectorated – reduced signs respiratory distress – improve SpO2**

Answer 81

-**ACBT: BC – helps with dyspnoeic patients, breathing using least effort; FET – aid with expectoration / @ different lung volume. (1-2 huffs at different pressures)**

Answer 82

-**Pursed-lip breathing: helps to keep airway open longer during expiration in an attempt to avoid collapsing with the consequent air trapping inside the lungs. Helps to slow down the breathing.** ## Footnote Assess on patients with hyperinflation – remember that in people with emphysema the elastic recoil of the lung is affected (they do not need more air in!)

Answer 83

1in 100 people in the UK

Answer 84

Infection -inflammation- impaired mucocillary clearance - bacterial consolidation - destruction of airway - infection