Wk 1 Flashcards
functions of the respiratory system
- gas exchange
- immunological
- biological
how does the immunological respiratory function protect the lungs from infection?
defense systems in both the airway and alveolus protect the lungs from infectionhy
hypoventilation definition
the state in which less air enters the alveoli, resulting in reduced O2 & increased CO2 levels in the blood
what can hypoventilation be due to?
breathing that is too shallow/ too slow, from a number of causes e.g. obesity, SC injury, NM diseases
is a shunt intrapulmonary or intracardiac?
both
what do both intrapulmonary / intracardiac forms of shunting reuslt in?
blood entering the left-sided circulation without an increase in O2 content
intra-cardiac shunting defintion
blood passing from right to left side of heart (e.g. via ventricular septal defect) without going through lungs to be oxygenated
what is a ‘dead space’
non gas-exchange areas
what areas are classified as ‘dead space’
conducting airways (trachea, bronchi, respiratory bronchioles)
V/Q mismatch when there is either:
- blood flow (Q) with reduced ventilation (V) –> low V/Q
- ventilation (V) with reduced blood flow (Q) –> high V/Q
shunt example
obstructed airway –> perfusion without ventilation
dead space example
obstructed blood vessel –> ventilation without perfusion (blood cant travel through but air can)
driving force for the exchange of gases between alveolar and capillary blood?
difference in partial pressure between the individual gases
2 main movements occurring in the respiratory system
- pump (NM-skeletal structures)
- lung (gas and secretion movement in the lungs)
Pump definition
to move air in and out of the lungwh
what does a ‘pump’ require?
neuro, musculo, and skeletal components to be intact e.g. SC, nerves, NMJ, muscles, bone, pleura
2 key functions within the lung:
- gas movement
- secretion movement
where does gas movement go
through the conducting airways to alveoli
where is the gas movement occurring?
between the alveolus and capillary
secretion movement occurs:
in the airways
Link between gas & secretion movement
if gas doesnt get into alveoli, clearance by gas flow will be ineffective
what happens if the airways are blocked / narrowed by secretions?
affects gas getting into alveoli (distribution of ventilation)
what can gas movement be divided into?
O2 and CO2 movement
what are the 2 components of secretion movement?
- MCC
- cough (back up clearance mechanism)
CO2 movement depends on…
the total volume of gas that moves in and out of the alveoli (Va) and is linked to the efficiency of the ‘pump’
what is O2 movement largely dependent on?
- alveolar surface area
- integrity of the interstitium
- pulmonary circulation
define respiratory load
what the muscles have to work against to:
1. move the chest wall (chest wall compliance)
2. move air through the airways (airway resistance)
3. expand the alveoli (lung compliance)
Is reduced O2 movement localised or generalised?
both
is reduced MCC mucus issues or cilia issues?
both
define symptom
new feeling, or a departure from normal feelings which is noticed by the patient
are symptoms subjective or objective ?
subjective
common symptoms of respiratory disease
- dyspnoea (breathlessness)
- wheeze/ chest tightness
- cough (+/- sputum, haemoptysis)
- pain
- constitutional symptoms
what measurement tools are used for dyspnoea
- self reporting scales e.g. VAS, BORG Dyspnoea scale
- questionnaires
what is the scale that validates cardiac disease?
New York Heart Association (NYHA)
which scale describes how dyspnoea affects ADLs
the MRC Breathlessness Scale
when does wheeze/ chest tightness occur?
when air moves through airways that are narrowed e.g. by mucus, spasm/ swelling
questions to ask the patient to determine the pattern of symptoms and triggers
- nocturnal?
- exercise induced? / things in atmosphere
- post viral infection?
what does a cough that is chronic, persistent, or distressing indicate?
bronchial irritation by excess secretions, chronic infection/ inflammation or airflow restriction
questions to determine cough characteristics
- frequency & pattern (aggs ? AM/PM)
- is it moist or dry
- is it productive / non-productive of sputum, blood
sign definition
something that can be demonstrated physically
- objective
- noticed by other people/ the therapist
what is pectus excavatum?
funnel chest
what is pectus carinatum?
pidgeon chest
how many dimensions do you observe the chest wall movement?
3
what are the dimensions of chest wall movement?
- AP
- Basolaterally
- inferior/ superior
breathing pattern
- observe muscle action
- diaphragmatic movement pattern
- are there accessory muscles being used in quiet breathing?
what do you observe with muscle recruitment with abnormalities of breathing pattern?
Muscle recruitment
- excessive / early recruitment of accessory muscles
- can be an appropriate strategy to deal with increased CVS demands of strenuous activity, or may be a sign of respiratory distress
what is paradoxical breathing patterns?
- abdominal, lower ribs or intercostal in-drawing
- sign of respiratory distress / chest wall abnormality
observable abnormalities of breathing pattern
- pursed lip breathing
- nasal flaring
- barrel chest
- accessory muscle use
- fatigue
- SOB
- lateral basal expansion
- paradoxical breathing
how does pursed lip breathing assist breathing?
- creates back pressure
- splints airways
- helps with gas exchange
what is the NORMAL ADULT RR?
12-16 breaths/min with insp:exp ratio approx 1:1.5/ 1:2
tachypnoea
too fast RR (>20 breaths/min)
bradypnoea
too slow RR (<10 breaths/ min)
apnoea / hypopnoea
period of absent respiration
where are normal breath sounds loudest?
over the trachea
where do normal breath sounds become softer and softer?
more peripherally
what can wheeze be?
polyphonic or monophonic
what must you define with wheeze?
in which phase of the respiratory cycle they occur (i.e. inspiratory / expiratory)
what are crackles characterised as?
coarse / fine
UPPER AIRWAY SOUNDS
characteristics of stridor
harsh, loud, louder in inspiration
what does stridor indicate?
acute upper airway narrowing (extra-thoracic)
what is the cause of pleural/ pericardial rub sounds?
inflamed pleural/ pericardial tissues may transmit a sound through the airways
haemoptysis define
presence of blood in the sputum from a bleeding source in the airway
what can haemoptysis range from?
very mild (streaking) to life threatening
when should you documented and reported?
always (haemoptysis of any volume)
what can bilateral ankle oedema indicate?
- cor pulmonale, right sided heart failure
- congestive heart failure
what is digital clubbing associated with?
some conditions where there is chronic hypoxia, such as lung cancer, CF
what are some validated QoL tools to use with patients with respiratory disease?
- St George’s Respiratory Questionnaire
- Chronic Respiratory Questionnaire
- Short Form 36
- COPD Assessment Test
- Cystic Fibrosis Quality of Life
what can the results of the QoL tools be used to do?
- assess disease progression
- set treatment goals
- outcome measure
red flags to Rx
- chest pain
- calf pain
- are they in respiratory distress?
- do they have stridor?
- paradoxical breathing?
- have they had any haemoptysis ?
- has there been any acute deterioration / change in their condition
what is a ‘relevant finding’?
some that you need to consider, which:
- may influence hypothesis generation and / or treatment choice/ implementation
- is often found in the patient’s history
- may or may not have a cause
examples of a relevant finding
- main diagnosis of the patient
- multimorbidities
- older age
- smoking history
- medications
- past intervention strategies (and their effect)
example of how signs and symptoms = relevant findings
new shortness of breath (symptom) –> reduced Oxygen saturations ( signs)
+
fatigue and increased SOB walking to bathroom (symptoms) –> opaque changes on CXR in Right middle lobe (signs)
= MEDICAL DIAGNOSIS OF PNEUMONIA (RF)
