Restrictive And Transplant Flashcards
what are the traumatic causes of restrictive lung dysfunction?
- blunt trauma (MVA or falls)
- penetrating trauma (gunshot or stabbing)
- rib fractures (ribs 5-9 less protected)
-pneumothorax (air or gas in pleural space causes collapse of lung tissue= tracheal deviation away from affected side with absent breath sounds) - spontaneous pneumothorax (abrupt onset of ipsilateral pleuritic chest pain, dyspnea, increased work of breathing, tachycardia, diminished or absent breath sounds)
list the pleural causes of RLD
atelectasis, pleural effusion, pleuritis “pleurisy”
Define the types of atelectasis
- collapsed lung: alveoli collapse or do not expand properly
- compression: lung becomes compressed by pleural fluid
- obstruction: air is obstructed into alveoli distal to an obstructed bronchus
what is the clinical presentation of atelectasis
dyspnea, shallow breathing, dry or productive cough, decreased breath sounds, hypoxia, tachypnea, crackles or wheezing, decreased tactile fremitus, low grade fever
what is the treatment for atelectasis? what is the overall goal?
- incentive spirometry, supplemental O2, movement
- get airways open and perform effective cough
what is pleural effusion? what does it limit? what are the causes?
- the abnormal fluid buildup in the pleural space (between visceral and parietal pleura)
- the abnormal accumulation of fluid limits lung expansion
- commonly caused by HF, pneumonia, malignant neoplasm
what are the types of pleural effusion?
- Transudative: elevated hydrostatic pressures in pleural capillaries, more fluid moves into the pleural space than can be reabsorbed; excess fluid creates pleural effusion as a result of HF
- exudative: increased permeability allows fluid to move into pleural space; inflammatory or neoplastic disease is the most common reason for this type
what is the clinical presentation of patients with pleural effusion?
- breath sounds will be diminished over area of pleural effusion, dullness to percussion and decreased tactile fremitus, pleural friction rub if inflamed
what are common symptoms of pleural effusion
mainly asymptomatic, dyspnea, pleuritic chest pain with inflammation, dry, nonproductive cough
what is pleuritis?
-swelling or irritation between the two pleural layers creating friction often associated with an effusion
what are symptoms of pleuritis?
sharp or stabbing pleuritic pain that worsens with a cough or deep breath, dyspnea, pain radiating to shoulder and back
what is the clinical presentation of pleuritis
sandpaper rubbing over the affected area and increased fremitus
what is acute respiratory distress syndrome?
a widespread inflammatory condition affecting lung tissue that is a MEDICAL EMERGENCY
what are the cardiovascular causes of RLD?
pulmonary edema, pulmonary embolism, pulmonary HTN
what is pulmonary edema? what are the 2 categories?
how does pulmonary edema lead to RLD?
-Excessive fluid moving from pulmonary vascular system into the parenchyma (usually the interstitial areas then alveoli)
- cardiogenic due to HF; L sided HF results in fluid backing up into pulmonary veins, increasing pressure in pulmonary circulation, increased fluid build up into interstitial area and alveoli
- non-cardiogenic from lymphatic insufficiency
- work of breathing increases, lung compliance decreased, gas exchange disrupted which leads to RLD
what are symptoms of pulmonary edema?
respiratory distress, dyspnea (worse in supine), paroxysmal nocturnal dyspnea, cyanotic, increased RR, labored breathing, pallor, diaphoresis, anxiety
what would be exam findings for pulmonary edema? What is the treatment for pulmonary edema?
- exam: decreased breath sounds, crackles, increased tactile fremitus, S3, LE edema
- treatment: supplemental O2, control underlying condition, bronchial hygiene to aid in secretion clearance
who is at risk of pulmonary embolism?
CHF, acute MI, CVA >40 yo, obesity, lupus, immobilized, SCI, trauma, oral contraceptives, post op orthopedic surgery, prior DVT
what is the common cause of pulmonary embolism?
- often a complication of DVT (thrombus travels from systemic vein to pulmonary circulation)(thrombus most commonly from leg)
what are the symptoms of pulmonary embolism? what are the treatments for PE?
- symptoms: acute dyspnea or tachypnea, chest pain, cough with hemoptysis, tachycardic and weak, hypotensive, lightheaded, dizzy, syncope, anxiety
-treatment: prevention of DVT with exercise and medication, heparin therapy
what is the primary management and acute management of pulmonary embolism?
- primary: prevention through use of compression stockings, intermittent pneumatic compression, early mobilization, anticoagulants, IVC filter
-acute: thrombolytic therapy (heparin)+ pulmonary embolectomy
what is pulmonary hypertension?
- high BP in the lungs causes the lungs to become damaged, stiff, and narrow requiring the R side of the heart to work harder
Describe pulmonary HTN due to L sided heart disease
- systolic or diastolic dysfunction means that the heart muscles can squeeze or relax effectively
- L side of the heart cannot keep up with blood returning from the lungs which leads to backup of blood raising pressure in the lungs
Describe pulmonary HTN due to lung disease
- arteries in the lungs will tighten so that blood can only go to well ventilated areas of the lungs
describe pulmonary HTN due to chronic blood clots in the lungs
- the body is unable to dissolve blood clots in the lung which leads to scarring within the artery increasing resistance making the R side of the heart work harder
what are the indications for lung transplant?
COPD, idiopathic pulmonary fibrosis, CF, idiopathic pulmonary arterial HTN, sarcoidosis
What are preoperative pulmonary rehabilitation recommendations?
- minimum of 20 sessions 3x/wk or 2x/wk plus one home session
- HIT when possible
- interval training when possible
- UE and LE
- combine endurance and strength training
- inspiratory training as adjunctive therapy
- oxygen supplementation for HIT
what is a common dysfunction following lung transplant? what are the symptoms? what is the clinical presentation? what is the treatment?
- restrictive dysfunction: bronchiolitis obliterans syndrome (BOS) is a major long term complication of transplantation which leads to fibrosing of terminal bronchioles
- symptoms include dyspnea, limited exercise tolerance, productive cough with sputum
- clinical presentation: decreased breath sounds, crackles and rales, pulmonary htn
-treatment: maintenance with immunosuppression regimen, quick interventions for infections
what are initial PT management goals post of lung transplantation?
- rehab begins once the patient is stable (usually 1 day post op in ICU)
- goals are bronchial hygiene, positioning, enhance cough effort, and improve mobility
what are level 1 activities to perform for inpatient physical therapy after lung transplantation
- breathing and relaxation techniques
- exercises 15-20 reps supine or seated
- follow sternal precautions
- seated marches
- bridges
- ankle pumps
-pregait activities (minisquats, weight shifting, single leg stance) - up in chair atleast 30-60 minutes
what are level 2 activities to perform for inpatient physical therapy after lung transplantation
-exercises (15-20 reps in standing)
- follow sternal precautions
- lunges
- marching in place
-minisquats, weight shifting, single leg stance
- toe raises
- ambulate in room or in the hall
-seated up in a chair
what are level 3 activities to perform for inpatient physical therapy after lung transplantation
- 15 to 20 repetitions in standing
-head and shoulder exercises with progression to wrist weights
-toe raises with progression to single leg - dynamic balance
- 10-15 mins continuous ambulation
- stair stepping
- cool down stretching
what happens when you are not a candidate for lung transplant?
- lung volume reduction surgery (20-30% volume of each lung removed) to improve thoracic distention and chest wall mechanics
- common for severe COPD, emphysema
- non-invasive ventilation or BiPAP is a mask that delivers positive airway pressure during inhalation and exhalation
- commonly used for severe COPD (at night to aid in sleep quality) and respiratory failure
