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Pulmonary Final > Restrictive > Flashcards

Restrictive Flashcards

1
Q

Restrictive Disease

A
  • An inspiratory impairment
    • May ultimately reduce all lung volumes, not just inspiratory volumes
    • difficulty getting air in
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2
Q

Restrictive disease Causes

A
  • Decreased compliance of lung or chest wall
  • Reduced inspiratory effort (i.e. pain, weakness, etc.)

***dec expansion= dec air in

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3
Q

Restrictive disease Signs and symptoms

A
  • Tachypnea, dyspnea, decreased breath sounds (primarly lower lobe), dry (nonproductive) cough, and emaciated appearance
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4
Q

Restrictive disease Interface with cardiac system

A
  • 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!

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5
Q

Common Restrictive pathologies

A
  • Fibrotic diseases,
  • sarcoidosis,
  • acute respiratory distress syndrome (ARDS),
  • pleural effusion,
  • pulmonary edema,
  • pneumonia,
  • tuberculosis,
  • sequelae secondary to musculoskeletal and neuromuscular conditions
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6
Q

Restrictive Disease-CXR

A
  • CXR
    • Radiopacities (appear white)
      • Regions with retained secretions or flud (mucus in chest)
      • Atelectatic segments (areas will collapse down)
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7
Q

Restrictive disease PFTs

A
  • Reduced lung volumes
  • Reduced FVC
  • Normal to increased (ratio > 80%)
    • FEV1 / FVC ratio
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8
Q

Why might inspiratory crackles occur in a restrictive pathology in the absence of secretions?

A
  • When actelectic segments open back up from being filled with air
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9
Q

Fibrotic Diseases

A
  • 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)
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10
Q

Common Fibrotic pathologies

A
  • Idiopathic pulmonary fibrosis (IPF): most common
  • Asbestosis, silicosis, and interstitial lung disease
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11
Q

Fibrosis Causes (not for IPF)

A
  • Cigarette smoking, viral infection, environmental pollutants, chronic aspiration, and genetic predisposition
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12
Q

Fibrosis Diagnostic findings

A
  • 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)
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13
Q

Fibrotic Diseases: Hallmark Signs and Symptoms

A
  • 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)
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14
Q

Fibrotic disease PT

A
  • PHYSICAL THERAPY
    • Breathing exercises
      • Focus on inspiration
    • Activity / exercise

***aerobic activity (60-80%), interval training, UE/Le resistance training, long duration more favorable outcomes

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15
Q

Given a diagnosis of fibrotic disease, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?

A
  • lung ascutation (how much can be inspired)
  • expansion of chest wall (will be decreased with less inhaled)
  • posture
  • endurance testing
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16
Q

Sarcoidosis

A
  • Uniform, epithelioid, fibrotic granulomas within multiple organs
    • Most common locations: lung and lymph nodes
    • Pulmonary insufficiency results in death in 5‐7% of patients
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17
Q

Sarcoidosis Diagnostic findings

A
  • 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
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18
Q

Sarcoidosis: Hallmark Signs and Symptoms

A
  • 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)
19
Q

Sarcoidosis

A
  • PHYSICAL THERAPY
    • Breathing exercises
      • Focus on inspiration
    • Activity / exercise
      • Endurance
      • Strengthening as needed
      • Consider energy demands
20
Q

Given a diagnosis of sarcoidosis, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?

A
  • lung ascultation
  • chest expansion
  • endurance testing (objective measure)
  • posture/facial expressions
21
Q

Acute Respiratory Distress Syndrome (ARDS)

A
  • 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
22
Q

ARDS Causes

A
  • Sepsis, trauma, shock, multiorgan failure, drug overdose, infection, and inhaled noxious fumes
23
Q

ARDS Diagnostic findings

A
  • 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
24
Q

ARDS: Hallmark Signs and Symptoms

A
  • Diminished or absent breath sounds Crackles (if breath is able to move through edema)
  • Significant dyspnea
  • Tachypnea
  • Tachycardia
  • Hypotension
  • Impaired cognition
25
Q

ARDS PT

A
  • 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
26
Q

Given a diagnosis of ARDS, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?

A
  • 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
27
Q

Pleural Effusion

A
  • Fluid accumulation within the pleural space

***pathological condition not disease. Fluid not out properly.

28
Q

Pleural Effusion causes

A
  • Heart failure
  • Pulmonary embolism
  • Cirrhosis
  • Cancer
  • Kidney disease
29
Q

Pleural effusion Diagnostic findings

A
  • 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

30
Q

Pleural Effusion: Hallmark Signs and Symptoms

A
  • Diminished breath sounds over area with effusion
  • SOB
  • Dry, non‐productive cough
  • Orthopnea
  • Chest pain
31
Q

Pleural effusion PT

A
  • PHYSICAL THERAPY
    • Breathing exercises
      • Focus on inspiration
    • Activity / exercise
      • Endurance
      • Shoulder ROM in presence of chest tube
32
Q

Given a diagnosis of pleural effusion, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?

A
  • lung ascultation
  • chest expansion/symmetry (may be asymm on one side)
  • pulm edema
33
Q

Pneumonia

A
  • Inflammation of the parenchyma or alveoli following a lung infection
    • Increased mucous production
    • Decreased gas exchange
34
Q

Causes

A
  • Community‐acquired or hospital‐acquired
  • Inhalation of bacteria or virus
  • Aspiration of gastrointestinal contents
35
Q

Pneumonia Diagnostic findings

A
  • 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
36
Q

Pneumonia: Hallmark Signs and Symptoms

A
  • 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
37
Q

Pneumonia PT

A
  • 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
38
Q

Given a diagnosis of pneumonia, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?

A
  • lung ascultation to determine impaired segment
  • cough assessment- produced/ clear secretions?
  • expansion/symmetry–probably asymmetry
39
Q

Tuberculosis

A
  • 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
40
Q

Tuberculosis

A
  • 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
41
Q

Tuberculosis: Hallmark Signs and Symptoms

A
  • Crackles within apices
  • Frequent productive cough
  • Dull chest pain
  • Low grade fever
  • Weight loss with anorexia
  • Fatigue
  • Malaise
42
Q

Tuberculosis PT

A
  • 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)
43
Q

Sequelae Secondary to Musculoskeletal and Neuromuscular Conditions

A
  • 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

Pulmonary Final (6 decks)

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