Respiratory/pulmonary Flashcards
S&S of pulmonary disease
- chest pain
- clubbing
- couch (dry or wet)
- dyspnea
- cyanosis
Dyspnea
Subjective feeling of breathlessness
Orthopnea
Dyspnea felt in supine position
Cyanosis
Bluish color of skin and mucous membranes
- central: lips and tongue
- peripheral: nail beds
External presentation of pulmonary disease
- Barrel chest: thoracic cage permenantenly held in expanded inspiration position
- Kyphosis/scoliosis: restricts lung capacites
- Funnel chest
Upper respiratory tract infections
Infection localized to mucosa of the upper respiratory tract (nose, pharynx, larynx)
- common cold - sinusitis - laryngotracheobronchitits (croup) - influenza
Lower respiratory tract infections
Infection in lower respiratory tract (bronchi to lungs)
- bronchitis - pneumonia - tuberculosis
Pneumonia
Inflammation of the lung, caused by an infection or aspiration
- most common causes are bacteria, viruses, fungi
- lobar or bronchopneumonia
1. Early - active lung inflammation - productive cough - SOB and decreased chest excursion - decrease or absent lung sounds - chest pain - aches and fever
2. Later - decrease in inflammation/infection - cough - increased adventitious lung sounds (crackles)
Tuberculosis
An infection caused by mycobacterium tuberculosis
- bacteria usually attack the lungs, can also effect kidney, spine, and brain
- multidrug resistant form d/t incomplete course of meds
- airborn transission, oral droplets released from person with active infection
- droplets inhaled into lungs by another individual
S&S for TB
- anorexia
- malaise
- weight loss
- fatigue
- night sweats
- prolonged, productive cough
Treatment for TB
- Active TB:
- actively spreading in body. Treatment includes medication cocktail for at least 6 months
- PT is not usually indicated to treat active, full blown TB - Latent TB:
- person has inactive TB infection, but is not infectious, +TB skin test, chest x-ray, and sputum test
- cannot infect others
Respiratory volumes and capacities
Pulmonary volumes measure ventilators capacity = air moving in & out of the lungs with normal/forced inspiration/expiration
- volumes can change with disease processes so helps monitor pt’s response to treatment
Obstructive lung diseases
- causes obstruction (blockage) of airways
- total lung capacity may be normal, but time of maximal inhale or exhale is increased
- lung volumes are changed and skewed upwards
- later stages require supplemental oxygen
- chronic bronchitis, asthma, emphysema cystic fibrosis
COPD GOLD stages 1-4
- Mild, FEV1 80% or more of normal
- Moderate, FEV1 50-80% of normal
- Severe, FEV1 30-50% of normal
- Very severe, lower FEV1 than stage 3, or stage 3 + low blood oxygen levels
Bronchitis
Inflammation of mucous membranes of the bronchi
- causes a cough, SOB, and chest tightness
1. Acute 2. Chronic
Acute bronchitis
Cough with or without sputum
- often occurs during acute viral illness (cold or flu)
- 90% viral, 10% bacterial
- antibiotics and bronchodilators
Chronic bronchitis
Productive cough that lasts for 3 months, for 2 years in a row
- often develops due to recurrent injry to the airways caused by inhaled irritants
- secretions cause damage to small airways
- PT: airway clearance techniques, improve exercise tolerance, aerobic capacity, strength, and functional mobility
- strength training of respiratory mm
- training intensity of 60-85% VO2max, 3x/wk at least 15 minutes
Asthma (types and S&S)
- types: allergic, non-allergic, exercise induced, adult onset, aspirin induced
- S&S: nonproductive cough, expiratory wheezes, apprehension, sweating, tachycardia
Asthma
- reversible obstructive disease, consisting of inflammation and bronchospams
- stimuli can include allergens, exercise, extreme temps, air
- statue asthmaticus = medical emergency!
Asthma and exercise
- mild or well control asthma, no limitations
- avoid environmental triggers with chronic or sever asthma
- acture asthma, limit ex until symptoms subside
Emphysema
- degenerative obstructive disease of alveoli
- primary cause: smoking
- enzymes produced during inflammation process destroy alveoli which decreas function as a gas exchange unit
- pt overinflate lungs to increase volume for gas exchange and leads to barrel chest
- dry cough
- obstruction from trapped/retained air
Cystic fibrosis
- congenital disorder of exocrine glands
- defect is on chromosome 7
- sodium and chloride disorder
- thicker mucus secretions
- salty sweet
- mucolytics (meds)
Restrictive lung disease
- restriction (reduced stretch) of thoracic cavity and alveoli
- restric inspiration, reduce pulmonary volumes and capacities
- inflammation or fibrosis (scarring) of lung tissue due to exposure to asbestos, coal, or silicon dust can restrict alveoli
- mm weakness (Guillian-barre ALS)
- bony deformities of chest wall (kyphosis, scoliosis)
- atelectasis, pneumonia, P edema, pneumothorax
- all lung volumes are smaller
Pulmonary edema
Fluid collecting in the alveoli and interstitial area
- fluid reduces amount of oxygen diffusing into the blood which interferes with lung expansion and reduces oxygenation of blood
- congestive heart failure may lead to a shift of fluid out of the capillaries and into the alveoli
- meds: O2 and diuretics
Pulmonary edema (Etiology and S&S)
- Etiology: may result from many primary conditions
- CHF - kidney disease - liver disease - inflammation in the lungs - blocked lymphatic drainage - S&S
- cough - crackles - sputum is frothy - labored breathing - hypoxemia increases - cyanosis drainage
Lung sounds pic
Pic
Pulmonary embolism
Artery in lung blocked, usually from LE blood clot
- life threatening
- S&S: sudden onset of SOB; pain worsens with deep breathing, coughing,eating, bending; coughing up blood; wheezing; LE edema; rapid pulse; lightheaded ness
- tx: anticoagulants, surgery, compression stockings, fluids
Pneumothorax
Air in the pleural cavity (the space around the lungs)
- collapsed lung
- buildup of air puts pressure on the lung, so it cannot expand normally
- etiology: chest trauma, spontaneous, activities (diving, smoking, high altitude)
- S&S: dyspnea, chest pain, cough, reduced breath sounds, unequal chest movements, hypoxia, increased HR, low blood pressure
- tx: chest tube placed between ribs in space around the lungs to help drain the air and allow lung to reexpand
- likely to reoccur if tall, skinny, smoking, have 2+ previously
ABG
Arterial blood gas tests acidity and oxygen and carbon dioxide levels in the arterial blood
- checks levels of bicarbonate and pH
- checks how well the lungs are moving oxygen into the blood and removing CO2
ABG measures
- PaO2 = partial pressure of oxygen: pressure of oxygen dissolved in blood
- PaCO2
- HCO3: bicarbonate: a chemical (buffer) keeps the pH of blood from becoming too acidic or too basic (plays a role in diabetic ketoacidosis)
_pH
- usually 7.35 - 7.45 in blood
- 7+ basic, 7- acidic
- PaO2 80-100mmHg
- PaCO2 35-45mmHa
Pulse oximeter
Used to measure the oxygen saturation of blood
- normal values 96-100%
- readings may not be reliable during activity
Chest x-ray
Helpful in evaluation of tumors/infections like pneumonia or tuberculosis
Spirometry
Based on max forced exhalation FEV1 volume exhaled in 1 sec
Postural drainage
Using gravity in various positions to facilitate flow of secretions from various parts of the lung into the bronchi, trachea, and throat so that they can be cleared and expelled from the lungs more easily
Percussion and vibration
In addition to gravity, we add external forces to speed up the flow of mucus
Phases of effective cough pic
Pic
Treatments for asthma and emphysema
- postural awareness
- breathing exercises
- airway clearance techniques (asthma only)
- strengthening and endurance exercises for respiratory and accessory mm
Breathing patterns
- normal respiratory rate: 12-20 bpm
- trachypnea: 24+ bpm
- bradypnea: 10- bpm
- apnea: absence of breathing
- cheyne strokes: irregular breathing pattern; deep breaths followed by periods of apnea
Cystic fibrosis evidence based practice
- active cycle of breathing techniques along with aerobic training helps to enhance the aerobic performance, thoracic mobility and improves physical fitness in children with CF
