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S4- Acute Care > Week 3- Pulmonary Conditions > Flashcards

Week 3- Pulmonary Conditions Flashcards

1
Q

PART 1: ANATOMY

A

PART 1: ANATOMY

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2
Q
  • What makes up the upper respiratory tract?

- What is its function?

A
  • Nasal + oral cavity, pharynx, larynx

- Warms, humidifies, and filters inspired air (1st line of pulmonary immune defense)

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3
Q
  • What makes up the lower respiratory tract?

- What is its function?

A
  • Trachea, bronchi, bronchioles, and alveoli

- Immune cells (macrophages, neutrophils) complete pulmonary defense while also absorbing O2 and releasing CO2.

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4
Q

Lower Respiratory Tract:

  • The trachea divides into R and L _______ _______
  • Which side is the more likely site of aspiration and why?
  • ______ lung has upper, middle, and lower lobes. ______ lung has only upper and lower lobes.
  • ________ and _________ tree warm/moisten air.
  • _______ is the primary site of gas exchange.
A
  • mainstem bronchus
  • Right mainstem bronchus, it is aligned more vertically than left.
  • Right, Left
  • Trachea and bronchial tree
  • Alveoli
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5
Q

The alveoli are the gas-exchanging organs and are affected by what (3) things?

A
  • concentration gradient
  • surface area
  • thickness of membrane
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6
Q
  • What is ventilation (V)?

- What is perfusion (Q)?

A
  • Ventilation (V): Amount of air that is moving through the alveoli.
  • Perfusion (Q): Pulmonary blood flow.
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7
Q
  • What is a normal ventilation?
  • What is a normal perfusion?
  • Therefore, what is a normal V/Q ratio?
A
  • V = 4L/min
  • G = 5L/min
  • V/Q = 0.8
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8
Q

V/Q Mismatch:

  • What is dead space?
  • What is shunt?
A
  • Dead space = V is in excess of Q

- Shunt = Q is in excess of V

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9
Q

Do we see shunt or dead space with a pulmonary embolism? Why?

A

Dead space, blood flow is stopped, causing V to be higher than Q.

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10
Q

Do we see shunt or dead space with a alveolar collapse? Why?

A

Shunt, decreased alveolar function with normal perfusion.

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11
Q

What are the primary inspiratory muscles?

A
  • Diaphragm
  • External Intercostals
  • *accessory muscles: SCM, scalenes, pecs, traps
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12
Q

What are the primary expiratory muscles?

A
  • Rectus abdominus
  • External/Internal Obliques
  • Internal Intercostals
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13
Q
  • ___ = Volume that enters and leaves with each breath, from a normal quiet inspiration to a normal quiet expiration.
  • ____ = Extra volume that can be inspired above tidal volume, from normal quiet inspiration to maximum inspiration.
  • ____ = Extra volume that can be expired below tidal volume, from normal quiet expiration to maximum expiration.
  • ___ = Volume remaining after maximum expiration.
A
  • Tidal volume (TV)
  • Inspiratory Reserve Volume (IRV)
  • Expiratory Reserve Volume (ERV)
  • Residual Volume (RV)
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14
Q
  • ____ = Volume that can be exhaled after maximum inspiration (to maximum expiration).
  • ____ = Volume breathed in from quiet expiration to maximum inspiration.
  • ____ = Volume remaining after quiet expiration.
  • _____ = Volume of air in lungs after maximum inspiration.
A
  • Vital capacity (VC)
  • Inspiratory Capacity (IC)
  • Functional Residual Capacity (FRC)
  • Total Lung Capacity (TLC)
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15
Q
  • What is apnea?
  • What is orthopnea?
  • What is bradypnea?
  • What is tachypnea?
  • What is hyperpnea?
  • What is hyperventilation?
  • What is hypoventilation?
A
  • Apnea: Slowed or stopped breathing.
  • Orthopnea: Discomfort when breathing while lying down flat.
  • Bradypnea: Abnormally slow breathing rate.
  • Tachypnea: Abnormally rapid and often shallow breathing.
  • Hyperpnea: Breathing more deeply.
  • Hyperventilation: Rapid breathing with exhaling more than inhaling. (decreased CO2 in body)
  • Hypoventilation: Breathing that is too shallow or too slow to meet the needs of the body. (increased CO2 in body)
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16
Q

_______ respirations and _______-______ respirations are often associated with increased cranial pressure (ICP).

A
  • Biot’s

- Cheyne-Stokes

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17
Q

_________ respirations are most often associated with diabetic ketoacidosis.

A

Kussmaul

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18
Q

In _________ ventilation, the diaphragm moves upwards when you inhale, and the lungs can’t expand as much preventing O2 inhalation.

A

Paradoxical

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19
Q

________ respirations is the presence of a sigh with breathing (2-3x/min)

A

Sighing

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20
Q

________ sign is most often associated with hyperinflation of the lungs.

A

Hoover’s

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21
Q

Arterial Blood Gases:

  • ABG analysis examines ____________ (pH), ________ (CO2levels), and __________ (O2levels).
  • Guides medical or therapy interventions, such as mechanical ventilation settings or breathing assist techniques.
  • Disturbances in _________ balance can be caused by pulmonary or metabolic dysfunction.
A
  • acid-base balance, ventilation, oxygenation

- acid-base

22
Q
  • What is PaO2?
  • What is PaCO2?
  • What is pH?
  • What is HCO3?
A
  • PaO2(PO2): Partial pressure of dissolved O2in plasma
  • PaCO2(PCO2): Partial pressure of dissolved CO2in plasma
  • pH: Degree of acidity or alkalinity in blood
  • HCO3: Level of bicarbonate in the blood
23
Q

______ is a percentage of the amount of hemoglobin sites filled with O2 molecules.

A

SaO2 (O2 saturation)

24
Q

ABG Normal Values:

  • PaO2?
  • PaCO2?
  • pH?
  • HCO3?
A
  • PaO2 = >80 mmHg
  • PaCO2 = 35-45 mmHg
  • pH = 7.35-7.45
  • HCO3 = 22-26 mEq/liter
25
Q

Respiratory Dysfunction Common Terminology:

  • ____ ________:Retention of gas in lung as a result of partial or complete airway obstruction.
  • __________:Smooth muscle contraction of the bronchi and bronchiole walls resulting in a narrowing of the airway lumen.
  • ___________:Transudate, exudate, or tissue replacing alveolar air.
  • __________:Overinflation of the lungs at resting volume as a result of air trapping.
A
  • Air Trapping
  • Bronchospasm
  • Consolidation
  • Hyperinflation
26
Q

Respiratory Dysfunction Common Terminology:

  • _________: A low level of oxygen in the blood, usually a PaO2 less than 60 to 80 mm Hg
  • ________: A low level of oxygen in the tissues available for cell metabolism.
  • _______ _______: The acute or insidious onset of dyspnea, respiratory muscle fatigue, abnormal respiratory pattern and rate, anxiety, and cyanosis related to inadequate gas exchange; the clinical presentation that usually precedes respiratory failure.
A
  • Hypoxemia
  • Hypoxia
  • Respiratory Distress
27
Q

PART 2: RESPIRATORY PATHOLOGIES

A

PART 2: RESPIRATORY PATHOLOGIES

28
Q

Acute Respiratory Distress Syndrome (ARDS):

  • What is it?
  • What are the 3 stages of ARDS?
  • Lengthy recovery with _____ mortality rate.
  • What are the pulmonary sequela?
  • What position are patients placed in if they have ARDS?
A
  • Acute inflammation of the lungs causing fluid buildup in the tiny, elastic air sacs (alveoli) in your lungs. (usually caused by sepsis)
  • exudative, proliferative, and fibrotic
  • high
  • No impairments to mild exertional dyspnea to mixed obstructive-restrictive abnormalities.
  • Prone positioning in the ICU to improve V/Q matching.
29
Q
  • What is pleural effusion?
  • What is pneumothorax?
  • What is hemothorax?
  • What is COPD?
  • What is cystic fibrosis?
  • What is atelectasis?
  • What is pneumonia?
  • What is pulmonary edema?
  • What is flail chest?
A
  • Pleural Effusion: Buildup of excess fluid between the layers of the pleura outside the lungs. (“water on the lungs”)
  • Pneumothorax: Air leaks into the space between the lungs and chest wall. Collapsed lung.
  • Hemothorax: Collection of blood in the space between the chest wall and the lung (the pleural cavity).
  • COPD: A group of lung diseases that block airflow and make it difficult to breathe. (Asthma, Emphysema, Chronic Bronchitis)
  • Cystic Fibrosis: Congenital disease that affects the cells that produce mucus, sweat, and digestive juices. It causes these fluids to become thick and sticky. They then plug up tubes, ducts, and passageways.
  • Atelectasis: Collapsed alveoli.
  • Pneumonia: Infection that inflames air sacs in one or both lungs, which may fill with fluid.
  • Pulmonary Edema: Excess fluid in lungs.
  • Flail Chest: Two or more contiguous rib fractures with two or more breaks per rib.
30
Q

PART 3: PT EVALUATION OF PULMLONARY CONDITIONS

A

PART 3: PT EVALUATION OF PULMLONARY CONDITIONS

31
Q

PT evaluation is base on patient _______, ________, and ___________. Also look at _________ side to side looking for normal breath sounds.

A
  • history, inspection, and palpation

- auscultation

32
Q

What are some things to look for with the patient history?

A

smoking history, amount of supplemental O2, exposure to toxins, hx of lung conditions, hx of vent assist, episodes of dyspnea, level of activity, sputum production, sleeping position

33
Q

What are some things to look for during an inspection?

A

general appearance, easy of speaking, skin color, chest shape/posture, breathing patterns, digital clubbing, supplemental O2, surgical incisions

34
Q

We want to palpate chest wall in ___________ direction to examine the following:

  • Fremitus (vibration)
  • Pain, tenderness
  • Skin temperature
  • Bony abnormalities, fractures
  • Chest expansion and symmetry
  • Subcutaneous emphysema (bubbles popping under skin from presence of air in subQ tissue)
A

cephalocaudal

35
Q

Normal breath sounds are classified in what (3) ways?

A
  • Bronchial
  • Bronchovesicular
  • Vesicular
36
Q

What is the possible etiology of hearing bronchial sounds where vesicular sounds should be heard?

A

Fluid or secretion consolidation (airlessness) that could occur with pneumonia.

37
Q

What is the possible etiology of decreased or diminished sound?

A

Hypoventilation, severe congestion, or emphysema

38
Q

What is the possible etiology of absent sound?

A

pneumothorax or lung collapse

39
Q

Adventitious Breath Sounds:

  • _________ sounds are from dysfunction outside lung tissue. (most common is pleural friction rub)
  • Whispered pectoriloquy, bronchophony, and egophony are examples of ______ sounds.
A
  • extrapulmonary

- voice

40
Q

Describe the tests for the following:

  • Whispered pectoriloquy
  • Bronchophony
  • Egophony
A
  • Whispered pectoriloquy: patient whispers “one, two, three.” Positive for consolidation if phrases are clearly audible in distal lung fields. Positive for hyperinflation if the phrases are less audible in distal lung fields.
  • Bronchophony: Patient repeats the phrase “ninety-nine.” The results are similar to whispered pectoriloquy.
  • Egophony: Patient repeats the letter e. If the auscultation in the distal lung fields sound like a, then fluid in the air spaces or lung parenchyma is suspected.
41
Q

Adventitious Breath Sounds:

  • What are the 3 continuous sounds? Describe them.
  • What is the 1 discontinuous sound? Describe it.
A

Continuous sounds

  • Wheeze: airway obstruction, more common on expiration
  • Stridor: high-pitched wheeze, inspiration and expiration
  • Rhonchi: low-pitched from airway obstruction

Discontinuous sounds
-Crackles: bubbling, popping sounds from fluid/secretions or sudden opening of closed airway

42
Q

PT Evaluation:

  • ______ ________ evaluates tissue densities within thoracic cage.
  • How is it done?
A

-Mediate percussion

  • Place palmar surface of index finger, middle finger, or both from one hand flatly against chest wall within intercostal spaces
  • Strike distal 1/3 of these fingers with tips of other fingers
  • Proceed in cephalocaudal, side-to-side pattern
43
Q

PT Evaluation:

A cough examination includes what (5) components?

A
  • Effectiveness (ability to clear secretions)
  • Control (ability to start and stop coughs)
  • Quality (wet, dry, bronchospastic)
  • Frequency (how often during the day and night cough occurs)
  • Sputum production (color, quantity, odor, and consistency)
44
Q

What are some common pulmonary pharmacologic medications?

A
  • Glucocorticoids (inflammation)
  • Antihistamines
  • Bronchodilators
  • Leukotriene modifiers
  • Mast cell stabilizers
45
Q

Nebulizer treatments optimally active __-__ minutes after administration.

A

15-20 minutes

46
Q

PART 4: PT INTERVENTIONS

A

PART 4: PT INTERVENTIONS

47
Q

Goals of PT Treatment of Pulmonary Conditions:

  • Promoting independent _______ mobility
  • Maximizing ____ exchange
  • Increasing _______ capacity
  • Increasing respiratory muscle ________
  • Patient education about condition
A
  • functional
  • gas
  • aerobic
  • endurance
48
Q

List some general intervention techniques for pulmonary patients.

A
  • Breathing retraining exercises
  • Secretion clearance techniques
  • Positioning
  • Functional activities
  • Exercise
  • Patient education
  • Monitoring VS
49
Q

The position of optimal physiological function is being ________ and _________.

A

upright and moving

50
Q

Work on ___________ techniques and airway ________.

A
  • breathing

- clearance

S4- Acute Care (15 decks)

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