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Cardiopulm > Test 3 > Flashcards

Test 3 Flashcards

1
Q

4 postural positions for relief of dyspnea

A
  1. professorial position- sitting leaning over table
  2. standing leaning forward on wheel chair
  3. standing with back against the wall
  4. sidelying on bed with an incline
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2
Q

When do we stop exercise:

A
  • drop in O2 sats 3.-5% or below 90%- desaturates
  • dyspnea index 2/4 or 5/10
  • angina, dizziness, pallor
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3
Q

objective rating of dyspnea level count to 15

A 
0 able to count to 15 easily
1 count to 15  with one breath 
2 count to 15 with 2 breaths
3 count to 15 with 3 breaths
4 Unable to count
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4
Q

objective rating of dyspnea 1-10 scale

A 
0- Nothing at all
1 very slight
2 slight
3 moderate
4 somewhat severe
5 severe
7 very severe
10 maximal
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5
Q

6 minute walk test norms

A

max distance in 6 minutes is the out come measure
- normal , healthy = 571 +/- 90 m

  • COPD avg 380 m
    • <200 m is predictive of unacceptable post- op outcomes of LVRS
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6
Q

aerobic Training for chronic pulmonary patients

A

1:1 ratio work: rest interval adding to 20 min

if less than 15-20 minute work capacity, increase frequency to 2-3 times/day

  • work towards 30-45 minutes
  • warmup/ work/cooldown
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7
Q

Peripheral Muscle atrophy of COPD and CHF patients

A

decreased number of Type I fibers, shift to higher percentage of Type II
– use more anaerobic glycolysis = Incr PaCO2

-slow adaptation to exercise, slow recovery

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8
Q

resistance training COPD and CHF

A 
light resistance
at least 6 reps x 3, build to 15 reps before increasing weight
-theraband, wrist weights, wand exercise
-RPE at 4-6/10 or 11-13/20
-2-3x/ week
- no isometric/static ex
- no Valsalva or breath holding
no bending from waist
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9
Q

Goals of respiratory medications

A

-Opening airways
- control inflammation
-secretion removal
-fighting infections
=improved oxygenation

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10
Q

bronchodilators

A

prevent or decrease air ways constriction caused by irritants
- used with anti-inflammatories

  • sTo produce bronchodilation: Beta adrenergic agonists, alpha adrenergic antagonists, cholinergic antagonists
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11
Q

bronchomotor tone

A
  • Balance between adrenergic and cholinergic influence
  • cAMP: Bronchodilation (sympathetic)
  • cGMP: Bronchoconstriction (parasympathetic)
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12
Q

corticosteroids

A

may assist in preventing airway inflammation sometimes caused by an immune reaction to irritant

  • administered by
  • inhalation, metered-dose inhaler (flovent)
  • oral, tablet (prednisone)
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13
Q

Side effect of long- term Use of respiratory medication

A 
immunosuppression
osteoporosis
GI upset
proximal muscle weakness
white patches in mouth or throat
Cushingoid symptoms
growth retardation
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14
Q

non-steroidal anti-inflammatories

A

nedocromil sodium

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15
Q

decongestants

A

decrease mucosal edema

  • alpha 1 agonists (vasoconstriction in mucosa)
  • cardiac irritability
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16
Q

antihistamines

A

act on CNS to decrease mucosal discharges

-drowsiness

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17
Q

antitussives

A
  • cough center in brain to increase firing threshold

- sedation

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18
Q

relaxation technique to minimize accessory muscles

A
  • thinker’s pose
  • max contract/relax
  • maximize diaphragmatic
  • posterior pelvic tilt
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19
Q

improve diaphragmatic breathing in lying

A
  1. breathe into my hands (rise/fall)
  2. Facilitate with scoop technique
    3 Inhibit accessories
    *sniffing
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20
Q

secretion removal clearance techniques

A

-aerobic exercise
-postural drainage
-percussion/vibration
- positive expiratory pressure- flutter valve
- active cycle breathing
facilitated cough

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21
Q

goals of airways clearance and secretion removal techniques

A
  • open airways
  • optimize lung/alveolar expansion
  • improve gas exchange
  • discharge criteria: when independent in secretion removal and clearance techniques
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22
Q

Postural drainage for upper lobe

  • apical segment
  • posterior segments
  • anterior segments
A

apical segments: sitting up 30 degrees back hit to of shoulders

posterior segments: sitting at edge of table hunched over pillow hit behind shoulder

anterior segment: laying down pillow under head and one under knees hit front of shoulder

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23
Q

Postural drainage for middle lobe and lingula

A

lingual: 15 decreased head down. sidelying and rotated back 1/4. hit front of mid-chest Left

Middle lobe: down 15 degrees head down right arm up hit side of mid-chest. 1/4 rotate back

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24
Q

postural drainage Lower lobe

  • anterior basal segments
  • posterior basal segments
  • lateral basal segments
  • superior segment
A
  • anterior: 30 degrees head down. side lying hit bottom side chest
  • posterior 30 degrees head down, side lying bottom posterior chest. 1/4 turn forward
  • lateral 30 degrees head down, side lying hit bottom side chest 1/4 turn forward
  • superior segment laying flat prone: hit upper posterior chest
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25
Q

How long do you hold a postural drainage positions

A
  • postural drainage alone: 10 minutes each position
  • postural drainage combined with percussion or vibration: 3-5 minutes each position

vibration or shaking applied during expiratory phase only
- deep breath and cough/huff after each position

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26
Q

contraindication of vibration/percussion

A
  • osteoporosis
  • rib fx
  • anxiety
  • seizure disorder
  • tumor obstruction in airway
  • pulmonary edema caused by heart failure
  • recent spinal sx
  • active hemoptysis
  • hemodynamically unstable
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27
Q

4 phases of coughing

A

1 deep inspiration

  1. glottis closure
  2. increased intra-abdominal and intra-thoracic pressure
  3. glottis opens, forceful abdominal contraction and expulsion
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28
Q

why do forced expiratory maneuver

A

huffing

  • keeps glottis open, less forceful
  • use for patients prone to bronchospasm
  • mouth in “O”
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29
Q

active cycle of breathing

A
  • obstructive dysfunction
    1. breathing control: 5-10 sec of normal tidal volume
    2. 3-4 thoracic expansion exercises Big breaths
    —-full inspiration with relaxed expiration, can be combined with vibration, breath hold, or sniff
    3. full inspiration followed by 1-2 Huffs
    4 repeat
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30
Q

Flutter valve

A
  • provide back pressure to maintain airways open
  • oscillating pressure loosens secretions and move centrally
  • deep breath, hold 2-3 sec, exhale through device x10
  • deep breath, forceful exhalation through device
  • cough or huff
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31
Q

high frequency chest wall oscillation

A
  • treat all lobes at once in upright
  • progress through low, medium and high frequencies
  • each frequency 5-10 minutes
  • follow with cough
  • adv: independence, easy
  • disadv: expensive, cant target specific lobe
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32
Q

paraplegia T1-L1

A

Loss of abdominals

  • w/o support, abdominal viscera fall anterior and inferior
  • decreased diaphragm mechanical adv abd ability to increase intra-abdominal pressure

Loss of intercostals

  • decreased rib cage stability
  • decreased chest expansion

Paradoxical breathing

Lose ability to cough with forced expiration

33
Q

C5-C8 Quadriplegia

A

-Complete loss of expiratory muscle function, loss of intercostals

  • functioning diaphragm
  • weak accessory muscles
  • decreased anterior, lateral, and posterior chest expansion
  • paradoxical breathing
34
Q

C3-C4 quadriplegia

A

Varying degrees of weakness in diaphragm, scalenes
paradoxical breathing
impaired ability for speech

35
Q

C1-C2 quadriplegia

A
  • Only traps and SCM available
  • Superior-anterior upper chest expansion
  • mechanical ventilation usually necessary
36
Q

costophrenic assist in supine

A
  • hands at lower rib cage
  • quick stretch at end of expiration
  • Pt takes breath and holds at end of inspiration
  • ask pt to cough- compress air out as pt coughs
  • 2-3 coughs per breath
37
Q

costophrenic assist - sidelying

A
  • for asymmetrical weakness, specific lung segment pathology

- quick stretch to facilitate inspiration, pressure applied to assist with cough on expiration

38
Q

anterior chest assist

A
  • involves upper and lower chest: one arm across Pecs one parallel on lower ribs
  • pressure applied in direction
    • don’t use with cavus deformity
39
Q

Heimlich assist aka abdominal thrust

A
  • supine, sidelying, or sitting
  • heel of hand at level of naval
  • deep breath and hold
  • assist with cough : up and in under diaphragm
  • use as last resort
40
Q

suctioning

A
  • indicated for patients w/ artificial airways, excess pulmonary secretions, and inability to clear secretions from the airway
  • to facilitate removal of secretions and stimulate cough reflex
  • freq determined by amount of secretions produced
  • suction catheter can only reach to level of mainstem bronchi- postural drainage/percussion/vibration should be utilized to mobilize secretions centrally prior to suctioning
41
Q

complications of suctioning

A
  • hypoxemia
  • bradycardia or tachycardia
  • hypo or hyper tension
  • increased intracranial pressure
  • atelectasis
  • tracheal damage
  • infections
42
Q

signs of restrictive lung dysfunction

A 
tachypnea
hypoxemia
decreased Lung volume
decr breath sound
inspiratory crackles
nodules on Chest X-ray
pulmonary hypertension 
(cor pulmonale)
43
Q

symptoms of restrictive lung dysfunction

A

dry cough
SOB
weight loss
muscle wasting

44
Q

infant respiratory distress syndrome

A
  • prematurity <36 weeks
  • inadequate surfactant production
  • decreased compliance, incr work of breathing
  • pulmonary hemorrhage, pneumonia
  • ventilator - possible disruption of airways
  • survivors: bronchopulmonary dysplasia - if FIO2 >60 % for 5 days
45
Q

Aging changes in chest wall and lung tissue

A

wall- decr strength of respiratory muscles, decr compliance

lung tissue : loss of elastic tissue in alveoli, increased physiologic dead space

46
Q

aging overall results

A
  • incr work of breathing
  • incr respiratory muscle fatigue
  • decreased vital capacity by 25% between age 30 and 70
47
Q

interstitial pulmonary fibrosis

A

Idiopathic - autoimmune, viral, genetic

alveolar walls- inflamed, turn to scar tissue

  • – decr compliance
    • decr volumes
  • – decr surface area for gas exchange

increased work of breathing

48
Q

treatment for interstitial pulmonary fibrosis

A

corticosteroids, pulmonary rehab, lung transplantation

49
Q

chest radiograph of idiopathic pulmonary fibrosis

A
  • elevated diaphragm
50
Q

occupational lung disease

A
  • coal workers pneumoconiosis - 10-12 yearh hx of coal dust
  • silicosis- silicon dioxide
  • asbestosis- contruction, mining
  • SSx: dyspnic, chronic infections, chronic cough

-treatment: nutrition, stop smoking, exercise, treat infections

51
Q

sarcoidosis

A
  • Black women 20-40 y.o unknown cause
  • granulomas: spleen, liver, lymph nodes, lungs, subcutaneous skin
  • heart: pericarditis, arrhythmias
  • nervous system: meningitis, encephalitis
52
Q

bronchiolitis Obliterans

A
  • major infection, necrosis of epithelium, fibrosis
  • – Reaction in small airways (respiratory bronchioles)
  • –medical treatment: corticosteroids
53
Q

Pneumonia

symptoms

A

bacterial, viral, fungal: destruction of cilia and mucosal surface, inflammation

  • symptoms: fever, productive cough,pleuritic pain
54
Q

Pneumonia results
medical Rx
PT Rx:

A

results: edema,hemorrhage, pus in alveoli
Medical Rx: antibiotics, nutrition, hydration
PT Rx: postural drainage, airway clearance, assisted coughing

55
Q

ARDS- adult respiratory distress syndrome

  • cause
  • result
A

Cause:

  • trauma, aspiration, drowning
  • shock, sepsis
  • oxygen toxicity

Result:

  • increased permeability of alveolar capillary membrane
  • fluid proteins into interstitial space, and alveoli
  • 30-63% mortality
  • subacute phase- chronic restrictive Lung disease
  • CXR: diffuse , fluffy infiltrate

-PT Rx: position changes if any until subacute

56
Q

Cancers of respiration

A

4 kinds

  • 80-90% from tabacco use
  • prognosis : 1 year survival 50%
  • medical treatment : - radiation, chemotherapy
  • sx, laser therapy

PT: pre and post surgery

57
Q

radiation Pneumonitis

A

fibrosis, inflammation

- up to 6 months after treatment

58
Q

Pleural effusion - pleurisy

A
  • collection of fluid in pleural space
  • CHF, abdominal abscess, cirrohosis, pneumonia, TB, cancer

-caused by backup of fluid moving from parietal to visceral pleura

symptoms- pleuritic pain- dry cough

  • medical RX: chest tube
  • Pt RX: help to re-inflate compressed alveoli
59
Q

pulmonary edema- space occupying

A

left ventricular failure

- RX: medication

60
Q

pulmonary embolism

A
  • blood clots- LE
  • ventilation/perfusion mismatch
  • high risk for orthopedic patient

symptoms: acute dyspnea, pain

Medical RX: medication to dissolve clot

PTs: preventive exercise, no RX when acute

61
Q

Neuromuscular Causes of Restrictive Dysfunction

A

SCI, hemiplegia, muscular dystrophies, ALS, Guillian Barre

  • decr chest wall compliance due to paralysis
  • if no intercostals, decr chest expansion, hypoventilation
  • if no abdominals,no cough, prone to chest infections
  • excess diaphragmatic fatigue- headache, lack of concentration
62
Q

Trauma affecting restrive disease

A
  • blunt trauma/ contusions of lung
  • rib fractures
  • hemothorax
  • ARDS
63
Q

Pneumothorax

A
  • Open: air goes in and out
  • closed: air goes in. collapsed lung, mediastinum to opposite side
  • Medical RX: Chest tube
64
Q

post-surgery patients

A

Incisional pain

  • Increased RR
  • decr tidal volume
  • decr cough

effects of anesthesia
- cilia

PT treatment

  • deep breathing, chest expansion
  • airway clearance
65
Q

Sign on Physicla exam of restrictive disease

A
  • decr lung volume, PaO2, CXR with small lung fields and nodules, FEV1/FVC
  • —–restrictive disease: normal or incr 0.8-0.9
  • rapid shallow breathing
  • gradual, unintended weight loss
  • incr resting HR
  • lung auscultation- diminished breath sounds and inspiratory crackles
  • chest mobility- decreased
  • strength/ ROM - neck/shld/overall strength

-aerobic capacity- decr

66
Q

Inspiratory Muscle training pFlex

A

begin as tolerated (?5 min) without increased dyspnea or drop in O2 squat
–Incr to 15-30 minutes , 2-3 times/day, 6-7 days/week

Incr resistance when able to complete 2x 15-30 min sessions/day

67
Q

Inspiratory or expiratory Muscle Trainer

A

inspiratory

  • Begin 20-40 % of MIP, 515 minutes, 2-3x/day
  • – Incr to 15-30 min, 2-3x/day
  • – then increase to 40-60% of MIP based on tolerance

expiratory

  • Begin 5-10% or MEP, 5-15 min, 2-3x/day
  • —-Incr to 10-15% of MEP based on tolerance
68
Q

incentive spirometer

A

To incr volume

  • post surgerypatients, immobile patients
  • – to reopen airways, improve oxygenation
  • – incr surfactant production
  • – 10 breaths/ hour

-ALso used to maintain and incr inspiratory muscle strength and endurance

69
Q

Intervention to increase chest wall mobility and lung volumes: positions for success
-neck/trunk
arm position
-Pelvic position

A

neck and trunk: trunk extension fasciliates insp, trunk flexion faciliatates exp

arm: external roation facilitates insp, internal rotation facilitates exp
pelvic: post tilt facilitates exhalation, ant tilt facilitates insp

70
Q

combining breathing with exercise

A

inspiration- head up, eyes up, arms up and out PNF

expiration- head down, eyes down, arms down and in

butterfly technique - hands behind head : insp and expi

  • Bilateral shld flex with insp
  • shld Abd
  • horizontal ABd
71
Q

Lateral costal expansion- bilateral

A
  • lower ribs
  • “breathe into my hands”
  • add quick stretch at end of expiration for fasciliation if inspiration
72
Q

lateral costal expansion- unilateral

A
  • lie on one side of thorax and expand opposite side
  • combine with pillow or towel roll for additional stretch
  • inhibits “good” side
  • add quick stretch for faciliation
73
Q

facilitation of thoracic mobility

- horizontal towel roll stretch

A
  • for kyphotic, rounded shoulders posture
  • place towel roll at peak of kyphosis
  • combine with UE movement- shld flexion, anterior chest wall stretch
74
Q

facilitation of thoracic mobility:

- vertical towel roll stretch

A
  • for rounded shoulders, anterior chest tightness
  • place towel roll vertically along spine
  • combine with UE movement - butterfly ABd/ ER
75
Q

Facilitate Thoracic mobility

Lateral costal stretch

A
  • stabilize lower ribs
  • side bend toward stabilized ribs - expands contralateral side
  • combine with deep breathing
76
Q

trunk rotation stretch

A
  • stabilize lower ribs

- roatte upper trunk toward stabilization- expans contralateral side

77
Q

Beta adrenergics selective vs. nonselective

A

Beta 1- increase HR, contractility
B2 Bronchiole smooth muscle -
- selective Ventolin, alupent, serevent (long acting)

epinephrine- drug of choice for acute bronchospasm- nonselective

Isoproterenol, propranolol- hypertension, cardiac, Beta 1 and 2 blockers

78
Q

rib mobilization

A
  • start low on rib cage, paraspinals, just lateral to spine
  • inspiration- slight trunk roation off the bal
  • expiration- rotation on to the ball
  • move ball up thorax, then opposite side
79
Q

anticholinergic and Alpha blockers

A

block cholinergic receptors

  • atropine
  • atrovent
  • inhaler, nebulizer
  • side effectd: dizziness, headache. nausea

Block alpha receptor response

  • phentolamine- SE hypotension
  • catapress and Aldomet- SE drowziness

Cardiopulm (4 decks)

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