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Semester 5 PMCP Exam 2 > Restrictive and Other Pulm. Dysfunction > Flashcards

Restrictive and Other Pulm. Dysfunction Flashcards

1
Q

Restrictive DYSFUNCTION (or disorder) - not a disease!!! How do you define it

A

Disorder in which the lungs can’t fully expand

Lung volumes/capacities are dec.

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2
Q

With restrictive dysfunction it is hard to ___ ___ ___

A

get air in

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3
Q

Restrictive dysfunction results from what

A

Diseases
Trauma
Therapeutic interventions
Drugs

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4
Q

With restrictive dysfunction the work of breathing is

A

increased

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5
Q

What happens with pulmonary compliance with restrictive dysfunction

A

decreased due to chest wall and/or lung and their decreased ability to expand

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6
Q

What happens to the lung volumes and capacities with restrictive dysfunction

A

all dec

TV and IRV are the first to dec

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7
Q

How does one compensate for dec volumes and capacities with a restrictive dysfunction

A

breathe faster - is exhausting and can actually lead to mm wasting

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8
Q

6 classic signs of restrictive dysfunction

A 
Tachypnea
Hypoxemia
Dec breath sounds
Dec lung vol and capacities
Dec diffusing capacity
Cor pulmonale
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9
Q

What is tachypnea

A

inc RR

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10
Q

What is Cor pulmonale

A

R heart failure

in this case due to R heart working so much harder and also is getting some backflow

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11
Q

3 hallmark symptoms with restrictive dysfunction

A

Dyspnea
Dry non productive cough (typically)
Weight loss and mm wasting

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12
Q

T or F: a patient with a restrictive lung dysfunction will have inc use of accessory mm

A

TRUE

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13
Q

Disorders of the pleural space

A

Pleural effusion (includes pleural emphysema)
Pleurisy
Pneumothorax

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14
Q

Define pleural effusion

A

accumulation of fluid in the pleural space

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15
Q

What systems are invovled with pleural effusion

A

vascular and/or lymphatic

An underlying pathology exists

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16
Q

What is the fluid called in pleural effusion

A

Transudate or exudate

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17
Q

Describe transudate - what is it made of

A

straw color

low protein count

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18
Q

What causes fluid to be transudate (reason)

A

abnormal hydrostatic pressure

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19
Q

What are some causes of transudate fluid

A

CHF
Nephrotic syndrome
Cirrhosis
Pericardial disease

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20
Q

Describe exudate - what is it made of

A

darker

high protein count, cellular debris, WBCs

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21
Q

What causes fluid to be exudate (reason)

A

change in permeability OR a trauma

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22
Q

What are some causes of exudate fluid

A 
Trauma (Most common)
Malignancies
Pneumonias
Infection
Lupus, RA
Abdominal abscess
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23
Q

General symptoms for pleural effusion (both transudate and exudate)

A

Dyspnea
Nonspecific chest discomfort
Pleuritic (sharp) chest pain

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24
Q

General signs for pleural effusion (both transudate and exudate)

A

as fluid inc, the lung tissue can compress and could potentially collapse
Fluid acts like a space occupying lesion

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25
Q

Pleural effusion - what will you see on x-ray

A

blunting (opaque) at the costophrenic angle

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26
Q

Pleural effusion - what will happen when you auscultate

A

you will not hear anything over the fluid

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27
Q

Pleural effusion - what will happen to lung volumes

A

dec if the effusion is large enough

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28
Q

Pleural effusion - what will the cough be

A

dry, non productive

Fluid is outside of the lung

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29
Q

Pleural effusion exam findings

A

Dec chest wall mvmnt
Mediastinum shift if large (to contralateral side)
Might have pleural friction rub

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30
Q

If pt has significant right pleural effusion, the trachea will shift

A

left

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31
Q

Diagnosing a pleural effusion

A 
Chest radiograph (AP,PA,lateral decubitus) 
Thoracacentesis
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32
Q

Diagnosing a pleural effusion - AP/PA vs. lateral decubitus

A

Lateral will allow you to see a pleural effusion in the earlier stages

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33
Q

Diagnosing a pleural effusion - thoracacentesis

A

have them lean forward and stick a needle in to drain the fluid
Can be treatment or diagnostic

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34
Q

Pleurisy (Pleuritis) - define

A

inflammation of the pleura

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35
Q

Pleurisy (pleuritis) - which pleura is causing pain

A

parietal (visceral does NOT sense pain)

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36
Q

What is the parietal pleura innervated by

A

intercostal nerves

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37
Q

What are the causes of pleurisy (pleuritis)

A

Infection
Injury
Tumor
Complication of lung or other disease process

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38
Q

Clinical manifestations with pleurisy (pleuritis)

A 
Abrupt onset
Unilateral (lower and lateral pleura)
Fever and chills
Worse with deep breath, cough
Pleural rub can be heard
Tachypnea
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39
Q

Complications that can happen from pleurisy (pleuritis)

A 
Pleural effusion
Significant splinting
Dec chest mvmnt
Atelectasis 
Pleural adhesions
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40
Q

Treatment of pleurisy (pleuritis)

A

Self-limiting if no underlying pathology
Antibiotics and pain meds can be used
Encourage breathing as tolerated

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41
Q

What to be aware of in regards to pleurisy (pleuritis)

A

referal patterns can occur to the neck, trap, shoulder, or even lumbar

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42
Q

A therapist working with a patient with pleurisy in the acute care setting should

A

coordinate with other disciplines so that the patient isn’t getting everything at once - they need some uninterrupted bed rest

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43
Q

Define pneumothorax

A

accumulation of air within the pleural cavity leading to partial or complete collapse of the affected lung (atelectasis)

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44
Q

What happens to the pleura with a pneumothorax

A

parietal and visceral pleura become separated

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45
Q

What happens that causes the atelectasis from a pneumothorax

A

The negative pressure is lost and recoil of the lungs occurs

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46
Q

What are the types of pneumothorax

A

Spontaneous
Traumatic - open AND tension/closed
Hemothorax

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47
Q

Spontaneous pneumothorax is what

A

rupture of BLEBs what can happen with a cough or sneeze

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48
Q

Two types of spontaneous pneumothorax

A

Primary - genetic, males 20-40

Secondary - associated with underlying disease that makes the lung tissue weak

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49
Q

Two types of traumatic pneumothorax

A

Open

Traumatic/Closed

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50
Q

What is an open traumatic pneumothorax

A

Air enters the pleural cavity during inspiration and some is able to exist with expiration
Bad, but doesn’t progress as quickly since some air is getting out

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51
Q

What is a closed/tension pneumothorax

A

air enters the pleural cavity during inspiration but cannot escape so continues to build up with every inhale

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52
Q

What is a hemothorax

A

accumulation of blood within the pleural space usually due to trauma
Blood can fibrose and lead to fibropneumothorax

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53
Q

Events associated with what condition are considered an acute life threatening situation

A

Tension pneumothorax

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54
Q

Signs and Symptoms with pneumothorax

A 
Inc RR
Dyspnea
Pleural pain
Dec lung volume
Dec lung compliance
Impaired gas exchange (less SA for it to occur0
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55
Q

Exam findings with pneumothorax

A

Jugular vein distention
Dec or absent breath sound over area
Ches wall asymmetry
Mediastinum deviation to contralateral side

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56
Q

Treatment for pneumothorax

A

Ches tube to release air and alter pressure to return to normal

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57
Q

Parenchymal and pulmonary vasculature disorders

A 
Atelectasis
Pneumonitis
Pulmonary fibrosis
Pneumonia
Bronchiolitis obliterans
Pulmonary edema
Pulmonary embolism
58
Q

Define atelectasis

A

restrictive lunge dysfunction in which parts of the lung are unable to aerate - typically alveoli collapse

59
Q

Atelectasis is considered what -

A

A condition NOT a disease

60
Q

Types of atelectasis

A

Compressive
Obstructive (absorptive)
Post operative

61
Q

Compressive atelectasis - define

A

something pressing on the lung tissue that leads to collapse

62
Q

Obstructive (absorptive) atelectasis - define

A

Something plugs a bronchial or the airway and everything distal to the plug collapses
This is the most common

63
Q

Post operative atelectasis - define

A

from anesthesia or narcotics associated with surgery

64
Q

Clinical manifestation of large atelectasis includes what

A

Dec breath sound over area
Dyspnea
Cyanosis if large enough
Inc RR

65
Q

Primary intervention for preventing atelectasis post op

A

deep breathing

walking

66
Q

Pneumonitis define

A

inflammation of the lungs without the toxemia associated with pneumonia
Often is localized

67
Q

Pneumonitis is often caused by

A

environmental exposure to organic material

68
Q

Pneumonitis signs and symptoms

A

difficulty breathing accompanied by cough

often complain of fatigue

69
Q

tx for pneumonitis

A

encourage rest
avoid the allergen
Sometimes will be given corticosteroid or antibiotic if there is an underlying infection

70
Q

Pneumonitis can lead to

A

pulmonary fibrosis

71
Q

Pulmonary fibrosis - define

A

inflammatory process involves alveolar wall and progresses to distortion of the lung

72
Q

components of pulmonary fibrosis

A

inflammatory process

scarring or fibrotic process

73
Q

Which component happens first with pulmonary fibrosis

A

inflammatory process first and then leads to the scarring

74
Q

Causes of pulmonary fibrosis

A

Idiopathic
Viral
Genetic
Immune system disorders

75
Q

Signs of pulmonary fibrosis

A

Dec TLC, VC, FRC, RV
Hypoxemia
End inspiratory dry rales (adventitious sounds)

76
Q

Symptoms with pulmonary fibrosis

A 
Cough - non productive
Weight loss
Fatigue
Dyspnea 
Dec ex tolerance
77
Q

Tx for pulmonary fibrosis

A

Corticosteroids and/or cytotoxic drugs
Supportive measures
Lung transplant

78
Q

Define pneumonia

A

inflammatory process of the lung

79
Q

Classifications of pneumonia

A

By pathogen
By anatomic location
By the cause
Or can be a combination

80
Q

Risk Factors of pneumonia

A

1 Lower pt resistance to agents in URT maybe due to smoking, chronic bronchitis, resp infection, sinusitis, poorly controlled DM, malnutrition, existing illness
2 Inactivity/immobility

81
Q

Diagnosis of pneumonia is based on

A

clinical presentation
chest radiographs
blood culture
sputum cultures

82
Q

Bacterial pneumonia - most common cause

A

Strep

83
Q

Bacterial pneumonia - signs

A

Tachypnea
Crackles
Fluid

84
Q

Symptoms with bacterial pneumonia

A 
High fever
Chills
Dyspnea
Tachypnea
Productive cough!
85
Q

Viral pneumonia - most common cause

A

adenovirus

Influenza

86
Q

Viral pneumonia - signs

A

Insidious onset
Diffuse infiltrates
Hypoxemia

87
Q

Viral pneumonia - symptoms

A 
low to mod temp
Myalgia
Dyspnea
Tachypnea
Nonproductive cough!
88
Q

Fungal pneumonia - cause

A

Opportunistic infection (immune system is already weak from something else)

89
Q

Fungal pneumonia - signs

A

bilateral diffuse or interstitial alveolar infiltrates

90
Q

Funal pneumonia - symptoms

A 
Fever
Dyspnea
Cough
Chest pain
Malaise
Fatigue
Weight loss
Night sweats
91
Q

Bronchopneumonia - cause

A

VIRAL

92
Q

Lobar pneumonia - cause

A

BACTERIAL

93
Q

Aspiration pneumonia - cause

A

inhale foreign object

Common in those with dysphagia and neuro pop

94
Q

Symptms with aspiration pneumonia

A

Dyspnea
Wheezing
Fatigue
Green or bloody sputum

95
Q

Hypostatic pneumonia - cause

A

immobility

96
Q

Community acquired pneumonia - cause

A

viral but can turn into bacterial

97
Q

Nosocomial pneumonia (HAP) - cause

A

opportunistic - after hospital for 48 hours

98
Q

Bacterial pneumonia - tx

A

Antibiotics

3 Ps - percussion, position change, postural drainage

99
Q

Viral pneumonia - tx

A

Supportive

Anti virals

100
Q

Fungal pneumonia - tx

A

corticosteroids

antifungals

101
Q

Bronchopneumonia - tx

A

VIRAL!

102
Q

Lobar pneumonia - tx

A

BACTERIAL
Antibiotics
3 Ps

103
Q

Aspiration pneumonia - tx

A

deep breathing
cough
mobility

104
Q

Hypostatic pneumonia - tx

A

depends on if viral or bacterial

Supportive

105
Q

Community acquired pneumonia - tx

A

Usually meds, rest fluids, maybe pain med

106
Q

Nosocornial (HAP) pneumonia - tx

A

depends on fending organism
Oxygen
Supportive

107
Q

Chronic aspiration most often causes recurrent bouts of pneumonia in which lobe

A

Right! - more vertical

108
Q

Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) - define

A

Bronchioles and alveoli become inflamed and plugged with connective tissue

109
Q

BOOP is usually from what

A

necrosis of respiratory epithelium in bronchioles
Fluid and debris cause alveolar pulmonary edema
Can lead to atelectasis

110
Q

BOOP - cause

A 
Peds - viral usually
Adults - toxic fumes
Can be viral or bacterial
CT disease
Organ transplant
Idiopathic
111
Q

BOOP - signs

A

Dec or norm lung volumes
Hypoxemia
Rales and wheezing
Tachycardia

112
Q

Symptoms - BOOP

A 
coughing
dyspnea
Inc RR
Cyanosis 
Chronic infections
113
Q

Tx - BOOP

A

Supportive measures
Peds - postural drainage or suction
Adult - corticosteroids

114
Q

Tuberculosis - define

A

Disease caused by mycobacterium tuberculosis

115
Q

Tuberculosis - includes

A

two conditions
Latent
Active

116
Q

Latent TB -

A

You have the infection and it can present itself later

117
Q

Active TB -

A

Active bacteria and is multiplying

118
Q

TB can impact

A

LUNGS first and mainly

but also brain, kidneys, spine, hear, liver

119
Q

TB - process of it

A

Bacteria replicate in alveoli
Inflammatory response
Fibrosis and calcification
Cavitation and scarring

120
Q

If you auscultate over TB lung what will you hear

A

absent or dec

121
Q

Symptoms of TB

A 
Bad cough for 3 weeks or longer
Pain in chest
Cough blood or sputum
Weakness
No appetite
Weight loss
Chills/fever
Sweating at night
122
Q

Tx of TB

A

Antibiotics 6-9 months
Prevention
Incubation 2-12 weeks

123
Q

If untreated TB - what is mortality rate

A

80% - usually from heart failure

124
Q

Pulmonary edema - define

A

Excessive fluid in the interstitial tissue then in the alveoli and alveolar sac

125
Q

Causes of pulmonary edema

A

Inc hyprostatic press
Inc alv cap permeability
Lymphatic obstruction
Dec serum and albumin

126
Q

The increase in pulmonary capillary hydrostatic pressure with pulmonary edema is caused by

A

Left ventricular failure

127
Q

Signs of pulmonary edema

A

Dec lung volume
Pleural effusion is common
Dec breath sounds
Maybe bronchospasm or wheezing

128
Q

Symptoms of pulmonary edema

A 
Restless, anxiety
Labored breathing
Cyanotic
Tachypnea
Productive cough
129
Q

Tx for pulmonary edema

A

Prevention!
Dec preload
Maintain oxygenation of tissue
Dec Na intake

130
Q

Adult Resp. Distress Syndrome (ARDS) known as

A

Noncardiogenic pulmonary edema, shock lung, acute lung injury

131
Q

ARDs caused by

A

lung injury

Trauma, aspiration, drug associated, inhaled toxins, shock…

132
Q

ARDs mortality rate

A

HIGH! it is a critical illness

133
Q

ARDs causes what to happrn

A

inc in permeability of pulmonary membrane
alveoli become fluid filled
atelectasis occurs

134
Q

ARDs- signs

A

dec FRC, VC, TV
Wet crackles, wheezing
Tachycardic and arrhythmias
Dec breath sounds over fluid areas

135
Q

ARDs - symptoms

A

Restless, anxious
Dyspnea at rest
Maybe impaired mental status
Cyanotic

136
Q

Pulmonary emboli - define

A

blood clot lodged in a pulmonary artery obstructing blood supply to lung parenchyma

137
Q

Pulmonary emboli - complication of what

A

venous thrombosis - most often from leg

138
Q

Common cause of sudden death in hospital is what

A

pulmonary emboli

139
Q

Risk factors with pulmonary emboli

A

Blood stasis - immobility
Enothelial injury
Hypercoaguable states
Obesity, smoking, HTN, infection, previous hx

140
Q

Signs pulmonary emboli

A

Dec lung volume
Dec breath sounds
Tachycardia

141
Q

Symptoms pulmonary emboli

A

Dyspnea
Pleuritic ches pain
Apprehension
Persistent cough

142
Q

Tx pulmonary emboli

A

Prevention
Thrombolytics
Filter in vena cava
Thombectomy/embolectomy

Semester 5 PMCP Exam 2 (6 decks)

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