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3 Cardiopulmonary > Respiratory pathophys 2 > Flashcards

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
Q

PCO2 levels rise (called ______) with progressive COPD, especially pronounced in pts with predominant _____

A

hypercemia
bronchitis

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26
Q

How do the central chemoreceptors respond to hypercapnia? (short term)

A

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

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27
Q

How do the central chemoreceptors respond to hypercapnia? (long term)

A

pH is normal due to metabolic compensation, and receptors no longer respond to elevated PCO2

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28
Q

How do the peripheral carotid bodies respond to pH, PCO2, PO2?

A

pH and PCO2 = no response

PO2 = hypoxic drive to breathe

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29
Q

What could happened during an acute severe exacerbation of chronic bronchitis if FiO2 is increased dramatically?

A

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

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30
Q

Should O2 therapy be withheld from hypoxemic patients with COPD to avoid loss of hypoxic drive to breathe?

A

NO

administration of high flow O2 is associated with higher mortality

lower the concentration (88% to 92%)

31
Q

Should PTs increase the O2 flow rate when pts are mobilizing/exercising?

A

YES

monitor for S/S of hypoxemia (cyanosis, dyspnea, decreased coordination, decreased brain function)

pts desat quickly

32
Q

When adjusting O2 flow rate, make sure to…

A

monitor vitals at baseline and exercise
O2 has to be turned down after activity
post exercise vitals to check s/s of hypoxemia

33
Q

Pathogenesis of Pulmonary fibrosis

A

abnormal wound healing response
thickened alveolar walls and fibrosis shrinks affected lobes, decreases compliance

34
Q

Acute respiratory distress syndrome (ARDS)

A

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
Q

Pathogenesis of ARDS

A

increased vascular permeability allows fluid to seep into interstitial spaces, leads to edema

damage to alveolar epithelial cells inactivates surfactant, increases surface tension

36
Q

Clinical presentation of ARDs

A

labored breathing, tachypnea, intercostal retractions, crackles
hypoxemia

37
Q

Dx and Treatment of ARDS

A

Dx: history and PE, CXR

Treatment: intubation, postive pressure ventilation, diuretics, glucocorticoids, PRONING

38
Q

What does proning do?

A

improves respiratory mechanics
assists airway clearance
helps prevent ventilator induced lung injury

improves V/Q and increases PaO2

39
Q

Nutrition and COPD

A

experience unintended weight loss
tips: rest before meals, limit salt to limit edema, choose foods that are easy to chew

40
Q

General problems that should be identified in pulmonary pts

A

Decreased airway clearance
increased work of breathing
decreased ventilation
decreased exercise tolerance
decreased knowledge of disease process and compliance

41
Q

Decreased airway clearance

A

consolidation/infiltrates, sputum, crackles/sounds, mediate percussion is dull, ejophany

42
Q

Increased work of breathing

A

hypertrophy of accessory muscles, increased RR, dyspnea

43
Q

Decreased ventilation

A

hypoxemia, hypercapnia, decreased breath sounds, SPO2

44
Q

Decreased exercise tolerance

A

SPO2 drops, increased RPE, decreased H/H, dyspnea on exertion

45
Q

Pulmonary rehab

A

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
Q

Specific cardiopulmonary PT goals

A

Improve breathing pattern and effectiveness
improve airway clearance
improve exercise tolerance
improve pt awareness of cardiopulmonary problems and resolutions

47
Q

Improve breathing pattern and effectiveness

A

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
Q

Improve airway clearnace

A

improve hydration status
improve cough effectiveness

49
Q

Improve exercise tolerance

A

improve ADL tolerance
incorporate active and wellness activities

50
Q

Improve pt awareness of cardiopulm problems and resolutions

A

teach pt signs of increasing cardiopulm problems
help pt increase independence in managing self-care and personal wellness

51
Q

Techniques to alter pts breathing pattern

A

positioning
ventilatory strategies
manual strategies

52
Q

Which breathing pattern should you promote?

A

always promote symmetrical activation
any one that promotes oxygen uptake

53
Q

When should you help increase activation of diaphragm?

A

in early COPD

54
Q

When should you help decrease activation of accessory muscles?

A

all stages of COPD

55
Q

When should you help increase activation of accessory muscles?

A

SCI, decreased musle tone, decrease breath support

56
Q

To facilitate activation of diaphragm

A

posterior pelvic tilt
shoulder adduction IR

57
Q

To facilitate activation of respiratory accessory muscles

A

anterior pelvic tilt
shoulder abduction, ER

58
Q

Manual strategies to facilitate breathing

A

cueing
provide resistance during movement to prolong expiratory phase
interrupted airflow to prolong expiratory phase

59
Q

What are the impediments to airway clearance?

A

respiratory conditions that produce lots of secretions
pain and meds
neuro impairments
dysfunctional mucociliary escalator
endotracheal tube

60
Q

What is done during chest physical therapy?

A

postural drainage
percussion
vibration

61
Q

ALL positions are contraindicated for

A

Intracranial pressure, head injury, active hemorrhage, spinal surgery/injury, aged/confused pts., rib fracture

62
Q

Trendelenburg position is contraindicated for

A

high ICP, uncontrolled HTN, distended abdomen, esophageal surgery, radiation therapy, uncontrolled airway at risk for aspiration

63
Q

Reverse Trendelenburg is contraindicated for

A

hypotension or vasoactive medication

64
Q

Airway Clearance Techniques

A

Chest PT
active cycles of breathing (huff)
autogenic drainage (huff)
positive pressure devices
aerobic exercise

consider motivation, compliance, ability, expense, availability

65
Q

Active cycles of breathing

A

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
Q

Phases of active cycles of breathing

A

Control: gentle breathing
Thoracic expansion: loosen secretions by breathing above TV w/deep inspiration
Forced expiration: mobilize secretions by one or two huffs

67
Q

Autogenic drainage

A
  1. unstick secretions
  2. collect
  3. evacuate

cycle is repeated 3-4 times. encourage pt not to cough until done with cycles

68
Q

Positive pressure devices

A

used during exhalation to keep airways open and mobilize secretions

69
Q

Manual percussors

A

penumatic device that provides overall percussion
the vest
good results for pts with CF and neuromuscular weakness

70
Q

Why should individuals participate in aerobic exercise if they have a hard time breathing?

A
  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
Q

How can we best describe the benefits of exercise for the individual with respiratory disease?

A

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
Q

Considerations when walking

A

walk as often as possible
maintain controlled breathing and proper posture
start small 5-10 min, level ground

73
Q

Techniques to help relieve dyspnea

A

control breathing pattern
pursed lip breathing
alter posture
relaxation techniques

74
Q

PT interventions for outpatient pulmonary

A
  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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