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Respiratory pathophys 2 Flashcards

1
Q

Restrictive Patterns of pulmonary disease examples

A

Pulmonary fibrosis
lung cancer
Extra pulmonary causes –> neurological and musculoskeletal

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2
Q

Restrictive pulmonary diseases

A

any condition that limits lung expansion

generally characterized by stiffening of lung parenchyma which prevents lung from fully expanding (low compliance)

PFTs will show decreased vital capacity, FEV1 will be the same

often associated w/occupations and inhalation

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3
Q

Clinical Presentation of restrictive lung diseases

A

varies according to cause
shallow, rapid breathing pattern = chronic hyperventilation
disease progression leads to hypoxemia and CO2 retention

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4
Q

Treatment goals/prognosis of restrictive lung disease

A

maintenance of adequate oxygenation
most conditions are not reversible and lead to ventilatory failure

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5
Q

Treatment guidelines for restrictive lung diseases

A

pts will desaturate quickly
pace activities, monitor dyspnea, SPO2, HR
ineffective cough–facilitation techniques
routine positioning

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6
Q

Synonyms of pulmonary fibrosis

A

diffuse interstitial pulmonary fibrosis, interstitial lung disease

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7
Q

Pulmonary Fibrosis

A

chronic irritation of lung tissue that leads to progressive scarring of lungs. Causes issues with the alveoli, progressively grow bigger

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8
Q

Etiology of pulmonary fibrosis

A

Idiopathic–> no identifiable cause
others are inhalation of harmful particles, autoimmune disorders, certain drugs

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9
Q

Treatment of Pulmonary Fibrosis

A

No cure, limited treatment
glucocorticoids, O2, pulmonary rehab

generally poor prognosis

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10
Q

Indications for O2 therapy

A

hypoxemia
oxygen desaturation w/exercise
increased work of breathing
increased myocardial work

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11
Q

Low flow O2

A

Not intended to meet total inspiratory needs of pt. when pt inspires, supplemental O2 is diluted w/RA. inspiratory flow, cannot accurately calculate the FiO2

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12
Q

High flow O2

A

everything the patient breathes come from the device. FiO2 is stable and unaffected by pts type of breathing

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13
Q

Definition of Minute ventilation

A

volume of air per unit time that moves into and out of the lungs

MV = RRxTV
MV is about 8L/min for normal adult

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14
Q

Low-flow O2 delivery systems

A

flow rates are low enough that patient can easily overcome with MV

nasal cannula, simple face mask, non-rebreather mask

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15
Q

Nasal cannula

A

flow rates 1-6L/min
most common method
at higher flow rates, dries nasal mucosa and can be uncomfortable
actual FiO2 depends pts MV and breathing pattern
24-40% FiO2

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16
Q

Face mask

A

flow rates 5-10 L/min
mouth and nose covered, mask has exhalation ports for CO2
35-55% FiO2

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17
Q

Non-rebreather mask

A

flow rates 10-15 L/min
1-way valve between mask and reservoir bag prevents inhalation of expired air
80-95% FiO2

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18
Q

High Flow O2 delivery systems

A

flow rates high enough that patient cannot overcome with MV, so FiO2 is stable

rebreather, venturi, high-flow nasal cannula

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19
Q

Venturi mask

A

flow rates >40 L/min

allows precise measurements of FiO2 delivered, which is
useful in persons with COPD where precise O2 delivery may be crucial

different sized ports change the FiO2 delivered
24-50% FiO2

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20
Q

High-flow nasal cannula

A

flow rates >60L/min, up to 100% FiO2

heated, and 100% humidified O2 through wide-bore nasal prong
decreases inflammation, maintains mucociliary function, improves clearance, reduces caloric expenditure

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21
Q

O2 delivery devices

A

O2 concentrators
Compressed gas cylinders

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22
Q

O2 concentrators

A

draw RA through series of filters to leave concentrated O2
most units deliver O2 flows .5-5L/min
can be transported

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23
Q

Compressed gas cylinders

A

metal container filled with compressed gas held under high pressure
O2 cylinders available in range of sizes that determine the capacity for O2

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24
Q

Why would someone be on high-flow O2

A

high flow O2 delivery can provide the patient a consistent and known amount of O2 which might be important for pts with long-standing COPD

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25
PCO2 levels rise (called ______) with progressive COPD, especially pronounced in pts with predominant _____
hypercemia bronchitis
26
How do the central chemoreceptors respond to hypercapnia? (short term)
increase firing rate, stimulates neurons in rhythmicity center in the medulla, increased firing of descending motor via the phrenic nerve to the diaphragm, increased ventilation
27
How do the central chemoreceptors respond to hypercapnia? (long term)
pH is normal due to metabolic compensation, and receptors no longer respond to elevated PCO2
28
How do the peripheral carotid bodies respond to pH, PCO2, PO2?
pH and PCO2 = no response PO2 = hypoxic drive to breathe
29
What could happened during an acute severe exacerbation of chronic bronchitis if FiO2 is increased dramatically?
Carotid bodies now sense increased PaO2, decrease their input to rhythmicity center, essentially removing hypoxic drive to breathe ventilation decreases, leading to acute respiratory acidosis
30
Should O2 therapy be withheld from hypoxemic patients with COPD to avoid loss of hypoxic drive to breathe?
NO administration of high flow O2 is associated with higher mortality lower the concentration (88% to 92%)
31
Should PTs increase the O2 flow rate when pts are mobilizing/exercising?
YES monitor for S/S of hypoxemia (cyanosis, dyspnea, decreased coordination, decreased brain function) pts desat quickly
32
When adjusting O2 flow rate, make sure to...
monitor vitals at baseline and exercise O2 has to be turned down after activity post exercise vitals to check s/s of hypoxemia
33
Pathogenesis of Pulmonary fibrosis
abnormal wound healing response thickened alveolar walls and fibrosis shrinks affected lobes, decreases compliance
34
Acute respiratory distress syndrome (ARDS)
life-threatening form of acute respiratory failure characterized by inflammatory pulmonary edema, results in severe hypoxemia can be causes by shock, trauma, infection, lung contusion, pneumonia, near drowning, toxic inhalation
35
Pathogenesis of ARDS
increased vascular permeability allows fluid to seep into interstitial spaces, leads to edema damage to alveolar epithelial cells inactivates surfactant, increases surface tension
36
Clinical presentation of ARDs
labored breathing, tachypnea, intercostal retractions, crackles hypoxemia
37
Dx and Treatment of ARDS
Dx: history and PE, CXR Treatment: intubation, postive pressure ventilation, diuretics, glucocorticoids, PRONING
38
What does proning do?
improves respiratory mechanics assists airway clearance helps prevent ventilator induced lung injury improves V/Q and increases PaO2
39
Nutrition and COPD
experience unintended weight loss tips: rest before meals, limit salt to limit edema, choose foods that are easy to chew
40
General problems that should be identified in pulmonary pts
Decreased airway clearance increased work of breathing decreased ventilation decreased exercise tolerance decreased knowledge of disease process and compliance
41
Decreased airway clearance
consolidation/infiltrates, sputum, crackles/sounds, mediate percussion is dull, ejophany
42
Increased work of breathing
hypertrophy of accessory muscles, increased RR, dyspnea
43
Decreased ventilation
hypoxemia, hypercapnia, decreased breath sounds, SPO2
44
Decreased exercise tolerance
SPO2 drops, increased RPE, decreased H/H, dyspnea on exertion
45
Pulmonary rehab
part of a comprehensive treatment program for individuals w/pulmonary diseases includes medical management of disease, pt education, counseling, reconditioning general goal is to improve QOL through cardiopulmonary functions
46
Specific cardiopulmonary PT goals
Improve breathing pattern and effectiveness improve airway clearance improve exercise tolerance improve pt awareness of cardiopulmonary problems and resolutions
47
Improve breathing pattern and effectiveness
decrease RR and increase TV (increasing MV) decrease work of breathing improve chest wall mobility improve coordination of breathing improve functional activities and SOB/DOE
48
Improve airway clearnace
improve hydration status improve cough effectiveness
49
Improve exercise tolerance
improve ADL tolerance incorporate active and wellness activities
50
Improve pt awareness of cardiopulm problems and resolutions
teach pt signs of increasing cardiopulm problems help pt increase independence in managing self-care and personal wellness
51
Techniques to alter pts breathing pattern
positioning ventilatory strategies manual strategies
52
Which breathing pattern should you promote?
always promote symmetrical activation any one that promotes oxygen uptake
53
When should you help increase activation of diaphragm?
in early COPD
54
When should you help decrease activation of accessory muscles?
all stages of COPD
55
When should you help increase activation of accessory muscles?
SCI, decreased musle tone, decrease breath support
56
To facilitate activation of diaphragm
posterior pelvic tilt shoulder adduction IR
57
To facilitate activation of respiratory accessory muscles
anterior pelvic tilt shoulder abduction, ER
58
Manual strategies to facilitate breathing
cueing provide resistance during movement to prolong expiratory phase interrupted airflow to prolong expiratory phase
59
What are the impediments to airway clearance?
respiratory conditions that produce lots of secretions pain and meds neuro impairments dysfunctional mucociliary escalator endotracheal tube
60
What is done during chest physical therapy?
postural drainage percussion vibration
61
ALL positions are contraindicated for
Intracranial pressure, head injury, active hemorrhage, spinal surgery/injury, aged/confused pts., rib fracture
62
Trendelenburg position is contraindicated for
high ICP, uncontrolled HTN, distended abdomen, esophageal surgery, radiation therapy, uncontrolled airway at risk for aspiration
63
Reverse Trendelenburg is contraindicated for
hypotension or vasoactive medication
64
Airway Clearance Techniques
Chest PT active cycles of breathing (huff) autogenic drainage (huff) positive pressure devices aerobic exercise consider motivation, compliance, ability, expense, availability
65
Active cycles of breathing
get air distal to the secretions gentle technique that uses changes in lung volume to ventilate different areas of the lung repeated cycles of 3 ventilatory phases (breathing control, thoracic expansion, forced expiration)
66
Phases of active cycles of breathing
Control: gentle breathing Thoracic expansion: loosen secretions by breathing above TV w/deep inspiration Forced expiration: mobilize secretions by one or two huffs
67
Autogenic drainage
1. unstick secretions 2. collect 3. evacuate cycle is repeated 3-4 times. encourage pt not to cough until done with cycles
68
Positive pressure devices
used during exhalation to keep airways open and mobilize secretions
69
Manual percussors
penumatic device that provides overall percussion the vest good results for pts with CF and neuromuscular weakness
70
Why should individuals participate in aerobic exercise if they have a hard time breathing?
1. increases transpulmonary pressure, opens airways and increases ventilation (ACT) 2. increases mucociliary transport (ACT) 3. increase mobility of chest wall 4. general strength training 5. respiratory muscle training
71
How can we best describe the benefits of exercise for the individual with respiratory disease?
Ex helps prevent this classic downward spiral helps you to become more efficient, muscles eventually require less oxygen increases circulation, decreases resting HR and BP
72
Considerations when walking
walk as often as possible maintain controlled breathing and proper posture start small 5-10 min, level ground
73
Techniques to help relieve dyspnea
control breathing pattern pursed lip breathing alter posture relaxation techniques
74
PT interventions for outpatient pulmonary
1. assess readiness to quit smoking 2. position to promote optimal o2 uptake 3. teach effective breathing patterns 4. prescribe aerobic exercise program 5. prescribe resistance ex program 6. teach energy conservation 7. teach relaxation strategies 8. supplemental O2

3 Cardiopulmonary (9 decks)

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