Week 3- Pulmonary Conditions Flashcards
PART 1: ANATOMY
PART 1: ANATOMY
- What makes up the upper respiratory tract?
- What is its function?
- Nasal + oral cavity, pharynx, larynx
- Warms, humidifies, and filters inspired air (1st line of pulmonary immune defense)
- What makes up the lower respiratory tract?
- What is its function?
- Trachea, bronchi, bronchioles, and alveoli
- Immune cells (macrophages, neutrophils) complete pulmonary defense while also absorbing O2 and releasing CO2.
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.
- mainstem bronchus
- Right mainstem bronchus, it is aligned more vertically than left.
- Right, Left
- Trachea and bronchial tree
- Alveoli
The alveoli are the gas-exchanging organs and are affected by what (3) things?
- concentration gradient
- surface area
- thickness of membrane
- What is ventilation (V)?
- What is perfusion (Q)?
- Ventilation (V): Amount of air that is moving through the alveoli.
- Perfusion (Q): Pulmonary blood flow.
- What is a normal ventilation?
- What is a normal perfusion?
- Therefore, what is a normal V/Q ratio?
- V = 4L/min
- G = 5L/min
- V/Q = 0.8
V/Q Mismatch:
- What is dead space?
- What is shunt?
- Dead space = V is in excess of Q
- Shunt = Q is in excess of V
Do we see shunt or dead space with a pulmonary embolism? Why?
Dead space, blood flow is stopped, causing V to be higher than Q.
Do we see shunt or dead space with a alveolar collapse? Why?
Shunt, decreased alveolar function with normal perfusion.
What are the primary inspiratory muscles?
- Diaphragm
- External Intercostals
- *accessory muscles: SCM, scalenes, pecs, traps
What are the primary expiratory muscles?
- Rectus abdominus
- External/Internal Obliques
- Internal Intercostals
- ___ = 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.
- Tidal volume (TV)
- Inspiratory Reserve Volume (IRV)
- Expiratory Reserve Volume (ERV)
- Residual Volume (RV)
- ____ = 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.
- Vital capacity (VC)
- Inspiratory Capacity (IC)
- Functional Residual Capacity (FRC)
- Total Lung Capacity (TLC)
- What is apnea?
- What is orthopnea?
- What is bradypnea?
- What is tachypnea?
- What is hyperpnea?
- What is hyperventilation?
- What is hypoventilation?
- 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)
_______ respirations and _______-______ respirations are often associated with increased cranial pressure (ICP).
- Biot’s
- Cheyne-Stokes
_________ respirations are most often associated with diabetic ketoacidosis.
Kussmaul
In _________ ventilation, the diaphragm moves upwards when you inhale, and the lungs can’t expand as much preventing O2 inhalation.
Paradoxical
________ respirations is the presence of a sigh with breathing (2-3x/min)
Sighing
________ sign is most often associated with hyperinflation of the lungs.
Hoover’s
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.
- acid-base balance, ventilation, oxygenation
- acid-base
- What is PaO2?
- What is PaCO2?
- What is pH?
- What is HCO3?
- 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
______ is a percentage of the amount of hemoglobin sites filled with O2 molecules.
SaO2 (O2 saturation)
ABG Normal Values:
- PaO2?
- PaCO2?
- pH?
- HCO3?
- PaO2 = >80 mmHg
- PaCO2 = 35-45 mmHg
- pH = 7.35-7.45
- HCO3 = 22-26 mEq/liter
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.
- Air Trapping
- Bronchospasm
- Consolidation
- Hyperinflation
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.
- Hypoxemia
- Hypoxia
- Respiratory Distress
PART 2: RESPIRATORY PATHOLOGIES
PART 2: RESPIRATORY PATHOLOGIES
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?
- 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.
- 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?
- 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.
PART 3: PT EVALUATION OF PULMLONARY CONDITIONS
PART 3: PT EVALUATION OF PULMLONARY CONDITIONS
PT evaluation is base on patient _______, ________, and ___________. Also look at _________ side to side looking for normal breath sounds.
- history, inspection, and palpation
- auscultation
What are some things to look for with the patient history?
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
What are some things to look for during an inspection?
general appearance, easy of speaking, skin color, chest shape/posture, breathing patterns, digital clubbing, supplemental O2, surgical incisions
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)
cephalocaudal
Normal breath sounds are classified in what (3) ways?
- Bronchial
- Bronchovesicular
- Vesicular
What is the possible etiology of hearing bronchial sounds where vesicular sounds should be heard?
Fluid or secretion consolidation (airlessness) that could occur with pneumonia.
What is the possible etiology of decreased or diminished sound?
Hypoventilation, severe congestion, or emphysema
What is the possible etiology of absent sound?
pneumothorax or lung collapse
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.
- extrapulmonary
- voice
Describe the tests for the following:
- Whispered pectoriloquy
- Bronchophony
- Egophony
- 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.
Adventitious Breath Sounds:
- What are the 3 continuous sounds? Describe them.
- What is the 1 discontinuous sound? Describe it.
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
PT Evaluation:
- ______ ________ evaluates tissue densities within thoracic cage.
- How is it done?
-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
PT Evaluation:
A cough examination includes what (5) components?
- 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)
What are some common pulmonary pharmacologic medications?
- Glucocorticoids (inflammation)
- Antihistamines
- Bronchodilators
- Leukotriene modifiers
- Mast cell stabilizers
Nebulizer treatments optimally active __-__ minutes after administration.
15-20 minutes
PART 4: PT INTERVENTIONS
PART 4: PT INTERVENTIONS
Goals of PT Treatment of Pulmonary Conditions:
- Promoting independent _______ mobility
- Maximizing ____ exchange
- Increasing _______ capacity
- Increasing respiratory muscle ________
- Patient education about condition
- functional
- gas
- aerobic
- endurance
List some general intervention techniques for pulmonary patients.
- Breathing retraining exercises
- Secretion clearance techniques
- Positioning
- Functional activities
- Exercise
- Patient education
- Monitoring VS
The position of optimal physiological function is being ________ and _________.
upright and moving
Work on ___________ techniques and airway ________.
- breathing
- clearance
