Restrictive Flashcards
Restrictive Disease
- An inspiratory impairment
- May ultimately reduce all lung volumes, not just inspiratory volumes
- difficulty getting air in
Restrictive disease Causes
- Decreased compliance of lung or chest wall
- Reduced inspiratory effort (i.e. pain, weakness, etc.)
***dec expansion= dec air in
Restrictive disease Signs and symptoms
- Tachypnea, dyspnea, decreased breath sounds (primarly lower lobe), dry (nonproductive) cough, and emaciated appearance
Restrictive disease Interface with cardiac system
- Left sided heart failure → pulmonary symptoms
- Pulmonary symptoms → right sided heart failure
- Chronic alveolar hypoxemia → pulmonary vasoconstriction → pulmonary hypertension
- Manifested as cor pulmonale
***Rt ventricle working harder!
Common Restrictive pathologies
- Fibrotic diseases,
- sarcoidosis,
- acute respiratory distress syndrome (ARDS),
- pleural effusion,
- pulmonary edema,
- pneumonia,
- tuberculosis,
- sequelae secondary to musculoskeletal and neuromuscular conditions
Restrictive Disease-CXR
- CXR
- Radiopacities (appear white)
- Regions with retained secretions or flud (mucus in chest)
- Atelectatic segments (areas will collapse down)
- Radiopacities (appear white)
Restrictive disease PFTs
- Reduced lung volumes
- Reduced FVC
- Normal to increased (ratio > 80%)
- FEV1 / FVC ratio
Why might inspiratory crackles occur in a restrictive pathology in the absence of secretions?
- When actelectic segments open back up from being filled with air
Fibrotic Diseases
- Focal lung lesions representing progression of an inflammatory process to tissue fibrosis
- Destruction of alveolar capillary beds
- Irregular shape and size of alveolar spaces
- Decreased lung compliance (harder to inspire air)
Common Fibrotic pathologies
- Idiopathic pulmonary fibrosis (IPF): most common
- Asbestosis, silicosis, and interstitial lung disease
Fibrosis Causes (not for IPF)
- Cigarette smoking, viral infection, environmental pollutants, chronic aspiration, and genetic predisposition
Fibrosis Diagnostic findings
- CXR consistent with reticulonodular pattern (honeycombing)
- CT scan consistent with “ground glass” findings
- PFTs consistent with restrictive pathology
- ABGs consistent with decreased PaO2 with unchanged CO2 (difficulty getting in enough oxygen)
Fibrotic Diseases: Hallmark Signs and Symptoms
- Diminished breath sounds with potential for crackles
- DOE
- Progresses to SOB at rest
- Dry, non‐productive cough
- Weight loss (need to work harder to breath so more energy expenditure)
Fibrotic disease PT
- PHYSICAL THERAPY
- Breathing exercises
- Focus on inspiration
- Activity / exercise
- Breathing exercises
***aerobic activity (60-80%), interval training, UE/Le resistance training, long duration more favorable outcomes
Given a diagnosis of fibrotic disease, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
- lung ascutation (how much can be inspired)
- expansion of chest wall (will be decreased with less inhaled)
- posture
- endurance testing
Sarcoidosis
- Uniform, epithelioid, fibrotic granulomas within multiple organs
- Most common locations: lung and lymph nodes
- Pulmonary insufficiency results in death in 5‐7% of patients
Sarcoidosis Diagnostic findings
- CXR consistent with diffuse infiltrates in bilateral lung fields
- Honeycomb appearance as disease progresses
- PFTs consistent with restrictive pathology
- ABGs consistent with hypoxia as disease state progresses
- Bloodwork consistent with leukopenia, anemia, and increased erythrocyte sedimentation rate
Sarcoidosis: Hallmark Signs and Symptoms
- Diminished breath sounds with crackles in lower lobes (actelectic areas)
- Dyspnea of unknown onset
- Dry, non‐productive cough
- Malaise
- Fatigue
- Weight loss (working harder to breath)
Sarcoidosis
- PHYSICAL THERAPY
- Breathing exercises
- Focus on inspiration
- Activity / exercise
- Endurance
- Strengthening as needed
- Consider energy demands
- Breathing exercises
Given a diagnosis of sarcoidosis, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
- lung ascultation
- chest expansion
- endurance testing (objective measure)
- posture/facial expressions
Acute Respiratory Distress Syndrome (ARDS)
- Endothelial injury damaging the alveolar‐capillary membrane
- Increased membrane permeability (more fluid passing through)
- Pulmonary edema limiting oxygen exchange
- Decreased lung compliance (cant inspire air)
***alveoli full of edema so cant get oxygen to blood supply
- Prognosis often poor
ARDS Causes
- Sepsis, trauma, shock, multiorgan failure, drug overdose, infection, and inhaled noxious fumes
ARDS Diagnostic findings
- CXR consistent with wide spread infiltrates (“white out”)
- Actelectic and areas of fluid from inc mem permeability
- PFTs consistent with restrictive pathology
- ABGs consistent with decreased PaO2 that is not responsive to supplemental O2 and increased CO2
- Adding O2 but cant get into lungs from fluid
- C02 cant go across membrane in other direction
- VQ scan consistent with severe mismatch
ARDS: Hallmark Signs and Symptoms
- Diminished or absent breath sounds Crackles (if breath is able to move through edema)
- Significant dyspnea
- Tachypnea
- Tachycardia
- Hypotension
- Impaired cognition
ARDS PT
- PHYSICAL THERAPY
- Breathing exercises
- Dependent upon vent settings and patient’s ability to initiate breath
- Activity / exercises
- Coordinate with ventilator management and weaning
- Determine safe parameters
- Breathing exercises
Given a diagnosis of ARDS, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
- lung ascultation
- chest wall symmetry/expansion
- endurance testing
- on vent, might not use traditional endurance tests
- ex sit on bed with assistance
- posture/facial expression
Pleural Effusion
- Fluid accumulation within the pleural space
***pathological condition not disease. Fluid not out properly.
Pleural Effusion causes
- Heart failure
- Pulmonary embolism
- Cirrhosis
- Cancer
- Kidney disease
Pleural effusion Diagnostic findings
- CXR consistent with opacities
- Begins in bases and may spread throughout the entire lung (large effusions)
- PFTs may be normal
- Decreased lung volumes with larger effusions
- Thoracoscopy to visualize pleura
***fluid in pleural spaces not lungs/adjacent to lung bases
Pleural Effusion: Hallmark Signs and Symptoms
- Diminished breath sounds over area with effusion
- SOB
- Dry, non‐productive cough
- Orthopnea
- Chest pain
Pleural effusion PT
- PHYSICAL THERAPY
- Breathing exercises
- Focus on inspiration
- Activity / exercise
- Endurance
- Shoulder ROM in presence of chest tube
- Breathing exercises
Given a diagnosis of pleural effusion, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
- lung ascultation
- chest expansion/symmetry (may be asymm on one side)
- pulm edema
Pneumonia
- Inflammation of the parenchyma or alveoli following a lung infection
- Increased mucous production
- Decreased gas exchange
Causes
- Community‐acquired or hospital‐acquired
- Inhalation of bacteria or virus
- Aspiration of gastrointestinal contents
Pneumonia Diagnostic findings
- CXR consistent with infiltrates in affected lung segments (white)
- PFTs may be normal
- In severe cases, will be consistent with restrictive pathology
- Lab work consistent with increased WBCs
- Sputum culture to determine type of infection
Pneumonia: Hallmark Signs and Symptoms
- Diminished breath sounds with crackles in affected lung segments
- Productive cough
- Rusty or green‐colored sputum
- Purulent sputum
- Dyspnea
- Fever and chills
- Sharp pleuritic chest pain
- Tachypnea
- Decreased chest expansion on affected side
- Fatigue
- Generalized aches
Pneumonia PT
- PHYSICAL THERAPY
- Airway clearance
- Cough
- Determine need for other mucous‐clearing interventions
- Breathing exercises
- Focus on inspiration
- Activity / exercise
- Activity‐based interventions in the setting of functional decline
- HYDRATION/ANTIBIOTICS
- Airway clearance
Given a diagnosis of pneumonia, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
- lung ascultation to determine impaired segment
- cough assessment- produced/ clear secretions?
- expansion/symmetry–probably asymmetry
Tuberculosis
- Infection caused by mycobacterium tuberculosis
- Can present as a primary infection or as a reactivation of a prior infection
- Within developed countries, the majority of new infections occur within the immunosuppressed, incarcerated, elderly, malnourished, or immigrants from less‐developed countries
Tuberculosis
- Diagnostic findings
- CXR consistent with infiltrates within the apices
- Sputum culture for definitive diagnosis
- History consistent with contact with infected person
- PPD unable to distinguish between active or prior disease
Tuberculosis: Hallmark Signs and Symptoms
- Crackles within apices
- Frequent productive cough
- Dull chest pain
- Low grade fever
- Weight loss with anorexia
- Fatigue
- Malaise
Tuberculosis PT
- PHYSICAL THERAPY
- Airway clearance
- Cough (need to clear mucus)
- Breathing exercise
- Focus on inspiration
- Segmental breathing if indicated
- Activity / exercise
- Activity‐based interventions in the setting of functional decline
- Impact of airborne precautions (might need to do testing in room)
- Airway clearance
Sequelae Secondary to Musculoskeletal and Neuromuscular Conditions
- Conditions which impact the shape, strength, or flexibility of the chest wall and / or muscles of respiration can impact the pulmonary system
- Decreased compliance
-
Common pathologies
- Kyphoscoliosis
- Ankylosing spondylitis
- Traumatic injury to the chest wall
- SCI
- ALS
- Muscular dystrophy
- Myasthenia gravis
- Guillain‐Barre
- Poliomyelitis and post polio
