Respiratory Diseases

Question 1

Cough

Answer 1

One of the most common indications of respiratory problems.

Basic protective system of explosive exhalation to attempt to rid the lungs and bronchial tree of foreign matter.

Productive cough is that in which sputum is produced.

Abnormal breath sounds that accompany a cough may indicate presence of secretions in the lungs (wheezing, rhonchi, crepitations, and crackles).

Question 2

Dyspnea

Answer 2

State of breathlessness, shortness of breath, and varies in intensity.

Orthopnea = stimulated by supine position.

Paroxysmal Nocturnal Dyspnea (PND) = causes patients to awaken at night.

Platypnea = occurs when sitting up from supine.

Trepopnea = unilateral dyspnea that occurs when patients lie on their side (usually unilateral lung pathology).

Question 3

Cyanosis

Answer 3

Refers to blue tinge of skin and is termed central or peripheral.

Central seen mainly in the mucous membranes of lips and tongue, when O2 saturation <80%.

Peripheral seen more with cardiac pathologies when heart is unable to maintain adequate peripheral circulation. Signs seen in fingers, nose, toes, and nail beds.

Question 4

Chest Pain

Answer 4

Results from several factors as a consequence of pulmonary pathology.

Pleuritic pain is caused by inflammation of the pleura. Is sharp and severe, and is worse in inspiration, particularly when coughing or deep breathing, due to stretching of the pleura.

Other causes of pain include Fx rib and some lung tumors.

Question 5

Chest Shape and Reduced Thoracic Mobility

Answer 5

Affects respiratory function.

Pectus Carinatum (pigeon chest) is seen in children with asthma because superior part of sternum is always elevated.

Barrel chest is characterized by thorax held in permanently inspiratory position with large spaces between ribs and subsequent ↑ in width and ant-post ⌀ of chest. May be seen in emphysema.

Kyphoscoliosis reduces ability of ribs to move and may restrict function of one lung more than the other. Increased kyphosis of Tx spine + forward head position is typical of COPD and ankylosing spondylitis (AS).

Both pulmonary and cardiac diseases produce clubbing of fingers and toes.

Question 6

Pulmonary Edema

Answer 6

Is a build-up of fluid in the lungs with accumulation of fluid in the alveoli and interstitial spaces which prevents gaseous exchange. Usually as a result of LV failure with pulmonary hypertension.

Causes many symptoms: dyspnea, cough, excessive sweating, and possibly reduced cognition (from lack of O2)

Question 7

Atelectasis

Answer 7

Condition in which either the whole or part of a lung collapses.

Occurs in premature infants because of lack of surfactant by immature lungs.

In adults, can occur when fluid collects within the pleura as a result of pleural inflammation or heart failure, or air in the pleural cavity causing a pneumothorax.

Question 8

Bronchiolitis

Answer 8

Inflammation of the bronchi resulting in production of secretions and inflammatory exudate in the lungs, causing productive cough.

Alveolitis is an inflammation of the alveoli. Often ocurrs in response to an allergen and may develop into chronic restrictive lung condition.

Question 9

Pneumothorax and Pleural Effusion

Answer 9

Pneumothorax is a life-threatening condition in which the lung collapses as a result of air entering the pleural cavity and changing the negative pressure that maintains the integrity of the lungs against the chest wall.

Pleural effusion is the result of fluid filling the pleural cavity.

Question 10

Lung Abscess

Answer 10

Localized cavity in the lung tissue, filled with pus and encapsulated by fibrous tissue.

Si and Sy: fever, pain, dyspnea, cough, hemoptysis (blood in the sputum from the trachea or lungs), and halitosis due to pusladen (infected) sputum.

PT intervention: facilitate drainage of pus from the lungs through postural drainage positioning without deep inspiration. Deep breathing exercises to facilitate coughing also beneficial.

Question 11

Chronic Bronchitis and Emphysema

Answer 11

Both fall under the category of COPD.

Chronic bronchitis is a chronic inflammation of the bronchial tree.

Emphysema is a disease of the alveoli. Prolonged CB can lead to emphysema.

Two types of physical appearance are associated with COPD:
> Type A or “pink puffer”
> Type B or “blue bloater”

Question 12

Chronic Bronchitis (definition)

Answer 12

Defined when a productive cough is present for at least 3 months of the year for 2 or more consecutive years.

Is an inflammation of the bronchi that produces excessive secretions that are expectorated.

Question 13

Chronic Bronchitis (Si and Sy)

Answer 13

Productive cough, dyspnea, and sensations of chest tightness. Swelling of LL may occur as a result of R heart failure, and patients may use the accessory muscles of respiration excessively.

Progression of the disease is gradual over years, resulting in reduced pulmonary function. Common complication is bronchiectasis, which involves permanent dilation of the bronchi and bronchioles. Constant inflammation of the walls of airways results in fibrosis of the walls of the bronchi and resultant dilation.

FEV1 is reduced to 70% or less of FVC.

Question 14

Chronic Bronchitis (PT intervention)

Answer 14

Breathing exercises, airway clearance techniques, and pulmonary hygiene consisting of positioning for postural drainage with percussion, vibration, and shaking of the chest and cough facilitation.

HEP and education of caregivers are extremely important.

Question 15

Emphysema (Si and Sy)

Answer 15

Typical barrel-shaped chest, hyperventilation and tachypnea in an attempt to ↑ O2 uptake, and use of accessory muscles of ventilation to try and ↑ volume of the chest.

In early stages patients may be short of breath only on exertion, but eventually they experience dyspnea at rest.

Patients don’t produce sputum or exhibit cough because there is no bronchial obstruction or inflammation.

FEV1 and FVC are not affected in these patients unless there is associated CB.

Question 16

Emphysema (PT intervention)

Answer 16

PT tests and measurements include vital-sign monitoring, pulse oximetry, pulmonary function testing for FVC and FEV1, measurements of chest excursion and breathing quality, assessment of cough, sputum and ability to expectorate sputum, postural assessment, manual muscle testing, endurance assessment, and functional and home activity assessment.

Interventions may include therapeutic exercise to ↑ endurance and strength, deep breathing exercises, and transfers and ambulation training with appropriate assistive devices.

Question 17

Chronic Bronchitis (clinical picture)

Answer 17

> Chronic productive cough.
Sputum clear/mucoid (purulent during infection).
Chest infections recurrent.
Cyanosis of lips and nails.
Overweight.
“Blue bloater” or Type B COPD appearance.
Associated with R heart failure and LL edema.
Bronchiectasis.
Rhonchi and wheezing.
Expiration phase of breathing longer.

Question 18

Emphysema (clinical picture)

Answer 18

> No bronchial obstruction so no cough/sputum.
Chest enlarged in full inspiration position (barrel chest).
Tachypnea due to reduced alveolar surface area for gaseous exchange.
“Pink puffer” of Type A COPD appearance.
Hyperventilation to ↑ O2 uptake.
Regular use of accessory muscles of ventilation.

Question 19

Asthma (definition)

Answer 19

Is an acute, reversible, inflammatory, obstructive pulmonary condition in which the bronchial system is acutely sensitive to external stimuli.

Question 20

Asthma (S and S)

Answer 20

Wheezing, coughing, and dyspnea.

During asthmatic episode cough is unproductive. As episode diminishes, plugs of sputum are expectorated.

Respiratory patterns have a prolonged expiratory phase and pulse is rapid.

FEV1 and FVC ↓↓ before and during episode, but return to normal when episode subsides.

Question 21

Asthma (PT intervention)

Answer 21

Tests and measures are the same as for COPD.

Postural awareness, breathing exercises to encourage chest excursion, relaxation training, and airway clearance techniques including postural drainage positioning, chest percussion, vibration, and shaking to facilitate removal of secretions.

Discharge program, HEP, and education are important.

Training of patients and care providers in the use of inhalers and nebulizer units.

Question 22

Pneumonia (definition)

Answer 22

Is a pulmonary disease involving inflammation of the alveoli and small bronchi. More common in people <2yo and >65yo.

Question 23

Pneumonia (S and S)

Answer 23

> Fever
> Chills
> Productive cough with rusty, hemoptysis (blood), or mucopurulent (viscous and infected) sputum
> Dyspnea
> Tachypnea
> Rales

Question 24

Pneumonia (PT intervention)

Answer 24

Tests and measures are the same as for COPD.

Airways clearance techniques, and postural drainage.

Exercises for strength and endurance after recovery.

Question 25

Cystic Fibrosis (definition)

Answer 25

Hereditary disease of pancreas. Both parents must pass on the CF for the child to have CF. If only one passes it the child becomes a carrier.

Affects the transport of chlorine ions within the body, mainly affecting the functions of the pancreas and lungs.

Question 26

Cystic Fibrosis (Si and Sy)

Answer 26

> Pancreatic insufficiency → nonabsorption of nutrients → malnutrition.
Pulmonary infections with secretions that block airways.
Highly productive cough with purulent sputum.
Dyspnea.
Wheezing.
Failure to gain weight.
Diarrhea.
Fatigue.
High levels of Na content in sweat.

Question 27

Cystic Fibrosis (PT intervention)

Answer 27

Tests and measures are similar to other pulmonary diseases.

At least twice-daily postural drainage for their whole lives, teach postural drainage and airway clearance techniques (percussion, shaking, and vibrations), breathing techniques, cough facilitation to the family and patient.

Mobility of the shoulder girdle and thorax.

Program of physical exercises and general fitness with endurance and aerobic activity, together with postural awareness and relaxation techniques.

Question 28

Tuberculosis (definition)

Answer 28

TB is a type of bacterial lung disease, with similar effects to those of pneumonia.

Question 29

Tuberculosis (Si and Sy)

Answer 29

> Productive cough
General body symptoms: fatigue, weight loss, fever, chills, night sweats.

PT intervention not required.

Question 30

Lung cancer, Benign Lung Tumors, and Malignant Lung Tumors

Answer 30

Clinical picture:
> Dry cough
> Dyspnea
> Pain
> Hemoptysis
> Weight loss
> General feelings of fatigue

PT intervention:
> Postural drainage
> Vibrations (percussion is contraindicated)
> Aerobic activity, endurance exercises

Question 31

Pulmonary Infarction

Answer 31

Def: Condition in which areas of the lung tissue are deprived of O2.

PT intervention: Not required.

Question 32

Pneumoconioses

Answer 32

Def: Group of lung diseases caused by inhaling small particles from the air (asbestosis, coal-worker’s lung, and silicosis).

Si and Sy: Fibrosis of the lungs and dyspnea, predisposition to develop cancer.

PT intervention: Postural drainage and percussion, general endurance exercises, and mobility training.

Question 33

Sarcoidosis

Answer 33

Def: Inflammatory condition with granuloma formation in various organs including the lymphatic system and the lungs.

Si and Sy: many patients are asymptomatic, others develop dyspnea, fever, anorexia, skin ulcers, eye irritation, joint and muscle pain, HA, LL edema, cough, chest pain, and wheezing on ventilation.

PT intervention: Not required.

Question 34

Adult Respiratory Distress Syndrome (ARDS)

Answer 34

Def: Rapid lung failure as a result of many types of lung pathologies that lead to cardiopulmonary failure.

Si and Sy: shortness of breath ~24-72h after precipitating event (critical disease or infection, drowning incident, severe trauma), tachycardia, cyanosis, difficulty breathing, hyperventilation, and fatigue.

PT intervention: Patients recovering may require chest PT, exercise programs to ↑ strength and endurance, and mobility for ambulation and fx ADL.

Question 35

Bronchopulmonary Dysplasia in Pediatric Respiratory Distress Syndrome (BPD)

Answer 35

Def: Characterized by respiratory distress and a dependency on O2.

Si and Sy: Cyanosis of skin, tachypnea, and dyspnea.

PT intervention: Chest PT with percussion and postural drainage positioning.