Unit 3 - Respiratory Diseases pt 1 - intro

Question 1

2 broad categories of chronic pulmonary diseases

Answer 1

1. obstructive

2. restrictive

Question 2

hypoxemia

Answer 2

reduced O2 content in the blood due to resp. alterations/disease.

Question 3

hypoxia

Answer 3

lack of O2 availability to the body’s tissues. may be due to hypoxemia or other non respiratory causes

Question 4

hypercapnia

Answer 4

increased CO2 content in the blood due to respiratory alterations/disease.

Question 5

pulmonary edema

Answer 5

fluid accumulation in the lung tissue. May be due to pulmonary disease, heart failure, and other systemic conditions.

Question 6

altered breathing patterns

Answer 6

• apneustic
• biots
• chyene-stokes
• hyper/hypoventilation
• kussmauls
• stridor
• wheezing

Question 7

eupnea

Answer 7

normal, unlabored breathing

Question 8

hyperventilation

Answer 8

increased alveolar ventilation, relative to metabolic demands (examples – “anxiety”, “panic attack”). Typically due to increased frequency of breaths, rather than increased depth of breathing. May result in a drop in PaCO2 (“hypocapnia”).

Question 9

hypoventilation

Answer 9

decreased ventilation, relative to metabolic demands. Shallow and/or infrequent breaths. May result in a rise in PaCO2 (“hypercapnia”). Examples – pneumonia, CPOD, drugs, neuromuscular disorders.

Question 10

apneustic

Answer 10

gasping inspiration followed by short or absent expiration. “Sleep Apnea”.

Question 11

biot’s

Answer 11

abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea

Question 12

cheyne-stokes

Answer 12

Repeated cycles of deep breathing followed by shallow breaths or cessation of breathing. Often seen with severe CHF.

Question 13

Kassmaul’s and characteristic of

Answer 13

abnormally deep and rapid respirations

*characteristic of diabetic coma

Question 14

stridor

Answer 14

high pitched sound created by an obstruction to airflow, especially an obstruction at the level of the trachea or larynx. (“upper airway obstruction”)

Question 15

wheezing

Answer 15

high pitched sounds created as air passes through narrowed tracheobronchial airways.
*asthma
deeper

Question 16

dry cough

Answer 16

Hypersensitive airways
Congestion
Tumor
Meds? – ACE inhibitors

Question 17

productive cough (3 kinds)

Answer 17

Purulent (pus) sputum indicates infection
Non-purulent sputum indicates non-specific irritation
Hemoptysis (coughing up blood) - “possible” pathologic condition

Question 18

dyspnea (what it is, hallmark feature of…., occurs…)

Answer 18

• **Hallmark feature of pulmonary disease
• shortness of breath
• Occurs secondary to inadequate ventilation and (lack of O2 in the circulating blood)
• Occurs mainly with diffuse, rather than localized disease

Question 19

orthopnea

Answer 19

dyspnea when lying down, secondary to fluid shifts and decreased efficiency of the respiratory muscles

Question 20

chest pain

Answer 20

Usually sub-sternal, or over the involved lung field
May mimic angina, including radiation to the neck or UE
Pleural irritation (“pleurisy”)may result in sharp pain that is reduced by lying on the affected side, thus limiting movement (“autosplinting”)

Question 21

Digital clubbing

Answer 21

A loss of the normal angle between the nail and nail-bed on the fingers and toes.

• caused by a chronic perfusion deficit secondary to pulmonary disease.
• May also occur with certain cardiac, liver, and GI disorders

Question 22

Cyanosis

Answer 22

bluish coloring of the skin and mucous membranes

occurs secondary to reduced O2 saturation or hemoglobin

Question 23

pulmonary changes with aging

Answer 23

• dec respiratory muscle strength and endurance
• dec in # of elastic fibers in the lung tissue
• dec in overall lung function (FVC, FEV1)
• inc chest-wall stiffness
• inc work of breathing (WOB)
• inc susceptibility to respiratory infections
• inc complications during anesthesia

Question 24

OT/PT implications with aging pulmonary changes

Answer 24

Expect reduced exercise capacities in older adults
Be aware of signs/symptoms of pulmonary disease, including abnormal breathing patterns
Monitor vitals at rest and during activity, including pulse oximetry if available
Educate on importance of regular aerobic exercise to reduce the age-related changes in cardiorespiratory function

Question 25

infectious and inflammatory diseases

Answer 25

Pneumonia
Pneumocystis Carinii
Lung Abscess
Pneumonitis
Acute Bronchitis
Pulmonary Tuberculosis

Question 26

pneumonia

Answer 26

acute lung tissue inflammation

“restrictive” pulmonary disease

Question 27

s/s pneumonia

Answer 27

chills / fever
elevated WBCs
respiratory distress
sputum changes
cloudy areas on chest x-ray

Question 28

pneumonia etiology

Answer 28

Virus:
*50% of All Types of pneumonia
A common complication of Influenza A, B, C
Adenoviruses (“common cause of upper respiratory infections”)

Bacterial:
Diplococcus pneumonia (pneumococcal) > 50% of bacterial cases
Klebsiella pneumonia (“Friedlander’s”) – alcoholism and poor nutrition seem to predispose to this type of pneumonia

Hypostasis (“lying in bed”)
Aspiration - passes and goes into lungs
Fungus

Question 29

lobar pneumonia (how long, what it produces, causes)

Answer 29

• Self-limiting, last 10 days
• Involves 1 entire lobe
• Produces an intra alveolar exudate (“thick protein and cellular rich fluid”)

common causes: Pneumococcus and Klebsiella
Consolidation of the Affected Lobe
Healthy Adults

Question 30

bronchopneumonia

Answer 30

Significant pleural effusion may result in atelectasis (“collapsed lung”)
Diffuse patchy consolidation pattern
Usually Bilateral
Occludes Small Airways

Longer Recovery; Permanent Damage
Elderly and Infants
May result in Pleurisy, Staph, and Strep

Question 31

Pneumocystis Carinii Pneumonia

Answer 31

• people who are immunosuppressed
• progressive, often fatal

ex) people with HIV, chemotherapy, organ transplant, Malnourishment

Question 32

lung abscess - def, risk factor and tx

Answer 32

• Accumulation of exudate in the lung
• Often a complication of a bacterial pneumonia

***risk factor: Aspiration associated alcoholism

Treatment = antibiotics and nutritional support

Question 33

pneumonitis and causes

Answer 33

Def- acute inflammation of lung tissue

Causes:
Usually caused by infections
Other causes:
Systemic Lupus Erythematosus (SLE)
Air-born irritants
Aspiration of gastric fluids
Obstructive form related to lung cancer
Interstitial pneumonitis related to AIDS

Question 34

acute bronchitis - cause, s/s, tx

Answer 34

Inflammation of bronchi and trachea
Self –limiting (usually 1-3 weeks)
Causes:
Viral infections
Exposure to chemical irritants, fumes, smoke
Symptoms:
Fever, cough, sore throat, laryngitis, chest pain, wheezing
Treatment:
Rest, humidity, hydration, good nutrition

Question 35

tuberculosis (TB)

Answer 35

highly contagious bacterial infection that can be spread via inhalation of droplets from another person
Once exposed, an individual may not actually manifest the disease for months or even years later. The TB may lie “dormant”.
Once active, the TB can lead to granuloma (“collection of immune cells”) formation in the lungs with resulting lung damage.
Early tx is critical to avoid permanent damage

Question 36

risk factors TB

Answer 36

Weakened immune system (HIV)
Poor nutrition
Crowded and unsanitary living conditions
Homelessness
Alcoholism
Healthcare worker
Migrant worker

Question 37

s/s TB

Answer 37

Cough (sometimes producing phlegm) 
Coughing up blood 
Excessive sweating, especially at night 
Fatigue 
Fever 
Unintentional weight loss
Other symptoms that may occur with this disease:
Breathing difficulty 
Chest pain 
Wheezing

Question 38

PT/OT implications for TB

Answer 38

“Negative pressure” isolation when in hospital.
Airborne infection signs should be posted on doors and doors should be kept closed.
Patients must wear mask when leaving room.
Healthcare workers/visitors should wear mask when entering room.
Gloves must be worn if handling infectious material.

Question 39

Tx TB

Answer 39

Consists of a combination of 4 different medications (isoniazid, rifampicin, pyrazinamide, and ethambutol) that when used together are very effective in curing TB. Treatment may last from 6-9 months.

Left untreated, TB is associated with a high mortality rate.