1
Q
evaluate pH of an ABG
A
7.35 (acidemia)-7.45 (alkalemia)
2
Q
evaluate CO2 of an ABG
A
35 (respiratory alkalosis) -45 (respiratory acidosis)
3
Q
evaluate HCO3 of an ABG
A
22 (metabolic acidosis) - 26 (metabolic alkalosis)
4
Q
Match the CO2 or HCO3 with the pH
A
one of them will be the same as pH
5
Q
is the PaO2 and O2 saturations normal
A
PAO2: 80-100
O2: 95-100
decrease hypoxemia
6
Q
list respiratory symptoms a person may have
A
- SOB
- chest pain/tightness
- dyspnea
-cough - pain
7
Q
signs a respiratory disorder patient may present with
A
- auscultation
- observation (appearance, breathing pattern)
- investigations (PFT, ABG)
8
Q
relevant findings a respiratory person may have
A
- Older age
- Medications
- Smoking history
- Main diagnosis of the patient
- Multi-morbidities
- Past intervention strategies
9
Q
list 4 CDV risk factors
A
- hypertension
- smoking
- obesity
- poor diet
- age
- diabetes
10
Q
CDV signs for a respiratory patient
A
- hypertension
- tachycardia or bradycardia
- irregular heart rhythm
- AF on ECG
- ST segment elevation in inferior leads
- elevated troponin
11
Q
list findings of an O2 movement impairment
A
- speaking in short sentences
- use of accessory muscles in upper chest breathing
- decreased breath sounds in mid and lower zones
12
Q
pathophysiology of O2 movement impairment COPD
A
- reduced alveolar surface area: decrease gas exchange
- leads to air trapping and hyperinflation: flat diaphragm
- poor basal ventilation
- upper chest breathing pattern and PLB posture
- kyphosis and barrel chest
13
Q
rationale for PLB
A
- creates back pressure during exhalation -> prevents airway collapse -> improves alveolar ventilation
- slows breathing rate and prolongs exhalation -> reduces dynamic hyperinflation -> decrease SOB
14
Q
rationale for forward lean position
A
- optimizes length tension of diaphragm
- fixes upper limb girdle
- may reduce work of breathing and improve oxygenation
15
Q
rationale of arm bracing on the table
A
- provides stability and optimizes breathing mechanics
- allows better engagement of accessory muscles and reduces overall energy expenditure during breathing
16
Q
what tools can be used to measure dyspnea
A
- VAS
- modified BORG scale
- QOL questionnaires
17
Q
rationale for PEP
A
Improves lung volumes
Temporarily increases FRC
Allows air to move behind secretions
PEP cycles should be followed by FET/HUFF/COUGH
18
Q
describe the relationship between CC and FRC
A
CC<FRC= normal
decreased FRC caused by: supine posture, obesity, age, GA, abdominal pain
increased CC caused by: age, smoking, pulmonary oedema
19
Q
what is closing capacity
A
volume in the lungs at which its smallest airways (respiratory bronchioles), collapse
20
Q
what techniques can help with O2 movement
A
specific positioning (affected lung uppermost)
positioning (sitting up, standing)
21
Q
what techniques can help with secretion movement problem
A
GAD/ mGAD
Huffing
ACBT
percussion, vibration,
PEP
22
Q
what age does CC > FRC
A
65
23
Q
AMI
A
blood flow to the heart is cut off due to a blockage in the coronary artery
24
Q
Bronchiectasis
A
irreversible dilation of the bronchi due to structural airway injury.
25
CF
caused my mutations to the CFTR gene. Causing abnormalities to salt and fluid clearance across the epithelium
26
Lobar pneumonia;
inflammatory exudate within the alveolar space
27
Pleural effusion;
excess fluid in the pleural space
28
Pneumothorax;
air in the pleural space between the visceral and parietal pleura
29
Chronic bronchitis;
expectoration (sputum) on most days for 3/12 for 2 years
30
emphysema
enlargement of air spaces and destruction of alveolar walls
31
bronchopneumonia
inflammation of the bronchi and lungs
32
ILD
lung disorder that produces similar inflammatory and fibrotic changes in the interstitum or intra-alveolar septa of the lung
33
pathology of emphysema
Thin atrophied airway walls, and loss of alveolar walls and capillary beds
34
pathology of chronic bronchitis
Mucous gland hypertrophy & goblet cell hyperplasia → ↑ mucus production.
Ciliary dysfunction → impaired clearance of mucus.
Chronic inflammation in small airways →
* Narrowing of lumen
* Cellular infiltrates (inflammatory cells),
* Oedema of airway walls.
35
pathology of pneumothorax
Loss of negative intrapleural pressure causes the lung to collapse inwards.
36
Pathology of pleural effusion
Fluid compresses the lung underneath and restricts expansion.
37
pathology of lobar pneumonia
Alveolar spaces are filled partially or completely with fluid and blood cells (infectious debris & exudate)
38
Pathology of CF
Defective CFTR protein causes impaired chloride secretion and increased sodium absorption.
Leads to dehydrated, thick mucus on epithelial surfaces.
Lungs' airway obstruction leads to infections, inflammation and bronchiectasis.
39
pathology of bronchiectasis
Loss of cilia, mucous gland hyperplasia, airway wall destruction, and permanent dilation of the bronchi
40
pathology of ILD
Inflammation and fibrosis develops in the interstitial and alveolar tissues.
This makes the lungs stiffer (↓ compliance) → harder to expand with each breath.
The alveolar–capillary membrane thickens, impairing diffusion of gases, especially oxygen.
41
pathology of bronchopneumonia
Alveolar spaces are filled partially or completely with fluid and blood cells (infectious debris & exudate)
42
pathology of AMI
- a plaque in the heart artery breaks open forming a thrombus
- this blocks O2 from reaching part of the heart muscle
- without O2 the muscle gets injured and starts to die (necrosis) starting in the inner layer and going out
- dead tissue is replaced by scar tissue
43
describe the differences in presentation between a person with angina vs myocardial infarction
ANGINA:
- Chest pain that's triggered by exercise and stress
- pain eases with rest
-temporary decreased blood flow
- no permanent heart damage
MYOCARDIAL INFACTION:
- chest pain is more severe and long-lasting
- pain doesn't go away
- leads to permanent damage (death of the heart muscle)
44
pathophysiology of emphysema
- There is a loss of elastic recoil in the lungs due to the destruction of alveolar walls
- Enlargement of air spaces decreases the surface area available for gas exchange
45
pathophysiology of chronic bronchitis
Smoking or irritation makes mucus glands bigger → too much mucus.
Cilia don’t clear mucus well → secretions build up → constant cough with sputum.
Inflammation narrows and swells airways → blocks airflow.
Long-term damage reduces lung stretch (elastic recoil) → gas trapping and trouble breathing.
46
pathophysiology of ILD
Inflammation & fibrosis → lung tissue thickens and stiffens.
↓ Elasticity → lungs can’t expand easily.
↓ Gas exchange → oxygen struggles to move into blood.
↑ Work of breathing → muscles work harder to draw air in.
If muscles tire → CO₂ builds up (secondary problem).
47
pathophysiology of pneumothorax
Air enters the pleural space (between lung + chest wall).
Negative pressure lost → can’t keep lung expanded.
Lung recoils (elastic tissue pulls inward).
Lung collapses → smaller lung volume.
↓ Gas exchange → less oxygen enters blood.
48
pleural effusion pathophys
Effusion= disruption or alteration to the pleural pressure and a lung compression underneath the effusion.
49
lobar pneumonia pathophys
1. infection starts - organisms enter the alveoli and trigger inflammation
2. alveolar fills with consolidation
3. impaired gas exchange leading to hypoxemia
50
pathophys bronchopneumonia
1. bacterial spreads from the bronchi into the alveoli
2. the infection spreads in scattered patched across multiple lobes
3. alveoli fills with pus
4. airways become obstructed
5. creating a gas exchange deficiency
51
pathophys bronchiectasis
1. recurrent lung infections
2. repeated infections cause persistent inflammation of the bronchi
3. this destructs smooth muscle and elastic tissue in the bronchial walls
4. damaged cilia - mucus cant be cleared
5. gas exchange problems
52
pathophys CF
1. mutation in the CFTR gene
2. creates impairment in Cl and sodium movement
3. causes less water in secretions - mucus = sticky and thick
4. mucus blocks the airway leading to resp fail
53
pathophys AMI
1. rupture of atherosclerotic plaque
2. blood flow to the myocardium is reduced
3. O2 cant get to the heart muscle
4. cell death occurs (necrosis)
5. macrophages and neutrophils go to the site and remove the dead tissue
54
what forms part of the respiratory system anatomy - visceral structures
- upper respiratory tract
- conducting airways
- gas exchange areas
- mucociliary apparatus
55
what forms part of respiratory system structures - neurological
- medulla oblongata
- spinal cord, phrenic and intercostal nerves
56
structure of the respiratory system- musculoskeletal
ribs
muscles (diaphragm, intercostals)
57
what are 3 main functions of the respiratory system
1. gas exchange - swapping O2 and CO2
2. immunological defense: protecting the lungs from germs
3. biological (metabolic and developmental): helping with growth and certain chemical processes
58
what is gas exchange
- happens in the alveoli (tiny sacs in the lungs)
- O2 moves from the air -> into the blood
- CO2 moves from the blood out of the body when you exhale
59
what is immune defence
- mucus traps dust and germs
- cilia (tiny hairs) move mucus up and out of the airways
- immune cells in the lungs (like macrophages) destroy bacteria and viruses, keeping lungs clean and protect you from infections
60
what are the biological or metabolic roles of the lungs
- lungs help in growth and development
- produce and break down substances
- regulate the balance of chemicals
- filter small clots before blood goes to the body
61
what is hypoventilation
breathing too slowly or too shallowly -> not enough air reaches the alveoli causing increase in CO2 (hypercapnia) and decrease O2
62
what is shunt
blood passes from the right side of the heart to the left without getting oxygenated in the lungs
63
what is dead space
air that dosent take part in gas exchange
64
what is V/Q mismatch
imbalance between ventilation and blood flow in the lungs
HIGH V/Q: too much air not enough blood
LOW V/Q: too much blood not enough air
65
what is diffusion
movement of gases (O2 and CO2) across the alveolar capillary membrane
66
what is a symptom
a subjective/self reported feeling
cant be quantified by anyone else
67
symptoms of respiratory disease
- wheeze
- pain
- cough
- dyspnoea
- chest tightness
68
measurement tools for Dyspnea
- QOL questionnaires
- VAS scale
- modified BORG scale
69
what is a sign
- noticed by other people
- demonstrated physically
70
what is a relevant finding
something to consider which may influence hypothesis generation
- is often found in pt history
71
differentiate between localized and generalized O2 movement impairment
localized: specific lung affected (eg. atelectasis)
generalized: entire lung function reduced
72
is there an airflow limitation PFT
FEV1 or FVC <80%
73
Examples of obstructive disorders
COPD
ASTHMA
Bronchiectasis
CF
74
Examples of restrictive disorders
Pleural effusion
ILD
Dystrophy
Obesity
75
Is it Obstructive or Restrictive
FEV1/FVC <70%
FEV1/FVC >70% +TLC <80%
76
Classify the severity for obstructive PFT
mild: FEV1= 60-80% predicted
mod: FEV1= 40-59%
severe: FEV1 <40% predicted
77
classify the severity for restrictive PFT
mild: TLC 65-80% predicted
mod: TLC 50-65% predicted
severe: TLC <50% predicted
78
what is FRC
volume of air remaining in the lungs at the end of a normal, passive exhalation
79
aims of airway clearance
1. to open up airways to get air behind the mucus
2. loosen the secretions from the small airways
3. mobilize the secretions from more peripheral to central
4. Clear secretions from the central airways
80
what is lung compliance
The measure of how easily the lungs expand (distensibility of the lung tissue).
81
MCC can be increased by
- Posture
- Exercise
- General anesthesia
82
MCC can be decreased by
- Age
- Sleep
- Injury
83
Rationale of Deep breathing exercises w inspiratory hold
Promotes alveolar expansion
Allows air to move via collateral channels (pores of Kohn, canals of Lambert, channels of Martin)
Increases alveolar stretch → stimulates surfactant production (by type II pneumocytes)
Surfactant ↓ surface tension → prevents alveolar collapse & ↑ compliance
Improves gas exchange & prevents atelectasis
84
Rationale for GAD/postural drainage
- uses gravity to assist movement/drainage of secretions from peripheral airways to central airways
- positions bronchus of the lung segment being drained uppermost
85
Original GAD position
- Head down tilt
**neonates, ventilated ICU pt who cant SOOB may benefit
86
precautions + contraindications to head tilt
- severe HT
- gastro-esophageal reflux
-recent eye surgery
87
precautions + contraindications to percussion/vibration/shaking
- subcutaneous emphysema
- burns, grafts or wounds
- # ribs
- acute pain
88
ACBT components
relaxed breathing
deep breathing with inspiratory hold
relaxed breathing
2 huffs
cough
89
rationale for OPEP
uses a vibratory pressure that my mocks the pressure and vibrations of secretions. Thins out secretions via creating a positive pressure to get air behind the secretions
90
What is equal pressure point
The pressure inside the airway wall is equal and opposite to the pressure outside the airway (intrapleural pressure)
91
dynamic compression
mouth ward of the EPP is the dynamic compression (airway narrowing) in the airway
92
Pneumonia respiratory signs and symptoms
- Cough +- sputum
- +-Chest wall pleuritic pain
- Changed POB
93
ABG, CXR, Auscultation findings for pneumonia
Reduced PaO2
CXR: opacity
Ausc: wheeze, crackles, bronchial breath sounds, decreased breath sounds
94
respiratory signs and symptoms for bronchiectasis
- dyspnoea
- cough with excessive sputum
95
Ausc, Spirometry for Bronchiectasis
Aus: variable (crackles and wheeze)
Spirometry: mixed pattern (obstructive and restrictive)
96
Respiratory signs and symptoms for restrictive disorders ABG, Auscultation and POB
ABG: decrease PaO2
Auscultation: decrease breath sounds
Changed POB: decrease TV, increase RR
97
what can cause changes to respiratory system compliance
1. lung compliance (elastic recoil, surfactant changes)
2. chest wall compliance (joints, ligaments, muscle changes)
98
Respiratory signs and symptoms of a pleural space disorder (pneumothorax, pleural effusion)
- changed POB
Auscultation: decrease breath sounds, bronchial breath sounds
ABG: decrease oxygenation
99
Respiratory signs and symptoms of ILD spirometry, POB, ABG, Auscultation
Spirometry: restrictive pattern
Changed POB: decrease TV, increase RR
Auscultation: decrease breath sounds
ABG: decrease oxygenation
- cough
- wheezing -> fine crackles
- chest pain
100
Explain restriction to inspiration
↓ Lung expansion → ↓ FVC & ↓ FEV₁ (ratio = normal or ↑)
↓ Tidal volume → ↑ RR (compensatory)
Prevents adequate air volume entering lungs
***affects respiratory pump- limits inspiration and lung volume expansion
101
Causes of restriction inspiration
Neurological injury/disease below brainstem
Weak respiratory muscles
Stiff or floppy chest wall
Pleural disorders (e.g., effusion, fibrosis)
Stiff lungs (e.g., pulmonary fibrosis, edema)
102
Obstruction to exhalation
↓ Airflow out of lungs due to narrowed airway lumen
Smaller lumen → ↑ airway resistance
Air trapping → ↓ expiratory flow rates (↓ FEV₁, ↓ FEV₁/FVC ratio)
103
causes of reduced airway lumen
Within the airway: mucus, foreign body, bronchoconstriction
In the airway wall: inflammation, edema, smooth muscle hypertrophy
Outside the airway (peribronchial): external compression (e.g., tumor, enlarged lymph nodes)
104
Causes of airway narrowing
1. narrowing of lumen
2. thickening of airway wall
3. reduced stability of airway wall
105
causes of airway narrowing
- In the airway lumen
- compression the airway
106
Consequences of obstruction to expiration
1. gas trapping
2. hyperinflation
3. respiratory muscle dysfunction
4. increase WOB
107
explain gas trapping
- Loss of elastic recoil
- Small airway narrowing
- Prolonged expiratory time
- Increased RV, FRC
108
explain hyperinflation
- increase TLC with gas trapping
- permanent change
109
explain Respiratory muscle dysfunction
- hyperinflation -> flattened diaphragm, angle of intercostals altered
- inefficient muscle contraction as no longer in length tension relationship
110
explain WOB
- breathing @ higher lung volumes increase the demands on the respiratory muscles
- increase O2 cost to breathe
- increased risk of fatigue
111
Respiratory signs and symptoms in COPD
- SOB
- Cough +- sputum
- Abnormal POB
- Hyperinflated lungs
- Decreased exercise tolerance
ABG: decrease PaO2, Increase PaCO2
Pulse ox: decrease SpO2
112
6 ways to examine CXR
1. Technical details
2. Quality of film
3. Extra-thoracic structures
4. Thoracic cage
5. Intra-thoracic
6. Attachments
113
What is a CT
radiography where Xrays are processed by a computer to form tomographic images and a 3D picture
114
Describe a silhouette sign
A radiological sign seen on a chest X-ray where the normal borders between thoracic structures (like the heart, aorta, or diaphragm) are lost due to adjacent lung pathology.
115
Describe the loss of heart boarders for a silhouette sign
loss of L border= lingula
loss of R border= RML
Loss of diaphragm= lower lobe
116
Describe air bronchogram on a CXR
air filled bronchi are visible against surrounding opaque alveoli
when something other then air fills the alveoli
117
features of atelectasis/collapse/loss of volume on CXR
1. opacity due to loss of air
2. smaller lung due to loss of air in the lung overall
3. structures shift to areas of collapse
4. possible air bronchogram
5. silhouette sign depending where is effected
118
Consolidation on a CXR
- no loss of volume
- opacity: lung is solid cause air spaces are filled with fluid
- possible air bronchogram
- possible silhouette sign depending which part of the lungs effected
119
Hyperinflation on CXR
- increased lucency: lung contains more air
- increased volume: low flat diaphgram
-elongated heart
- possible bullae (thin walled air filled spaces within the lung)
120
Acute pulmonary oedema on CXR
- increased opacity -> bilateral, diffuse, batwing
*possible septal line
*cardiomegaly
*pleural effusion
121
Pleural effusion on CXR
- increased opacity
- blunting of the costophrenic angles
- may be unilateral or bilateral depending on cause
122
Pneumothorax on CXR
- area of increased lucency
- no lung markings
- lung edge visible
123
subcutaneous emphysema on a CXR
- increased blackness in soft tissue
124
What is angina
result of a reduction in blood supply to the myocardium
125
Acute coronary syndrome (ACS)
used to describe a range of conditions associated with sudden, reduced blood flow to the heart
126
What does ACS include
- unstable angina
- myocardial (permanent cell death) classified as:
1. ST-segment elevated (STEMI)
2. NON ST-segment elevated (NSTEMI)
127
Signs of MI
- pale moist skin
- hypotension
- fainting
- vomiting
-tachycardia
128
Symptoms of MI
- fatigue
- weakness
- SOB
- nausea
129
Symptoms of acute heart failure
- severe SOB
- weakness
- fatigue
- coughing up pink sputum
130
Signs of acute heart failure
CXR: acute pulmonary oedema
AUSC: fine crackles + wheeze all over chest
Vital signs: hypotension, sinus tachycardia
131
Signs and symptoms of PAD
- pain in one or more muscle groups
- diagnosis is via doppler US
- pain may be typical or atypical pain, or theres no pain
132
What is lung volume
Individual measurable amounts of air in the lungs (e.g., tidal volume, vital capacity, residual volume)
133
What is lung capacity
Two or more volumes added together (e.g., functional residual capacity (FRC), total lung capacity (TLC))
134
Consequences of reduced lung volumes
↓ gas movement (less O₂ into blood) → hypoxia
↑ lung stiffness (↓ compliance → ↑ respiratory load)
↓ deep breaths → ↓ cough effectiveness
Airway closure → ↓ mucociliary clearance
↑ risk of infection (e.g., post-op atelectasis)
135
How does general and local volume loss differ
GENERAL: decrease FRC, widespread stiffness -> general O2 problem
LOCAL: collapse or effusion -> local O2 problem
136
What happens if FRC is decreased
Alveoli close, decreases O2 diffusion, increase WOB
137
Signs of reduced lung volumes
↓ chest wall movement
↑ RR, accessory muscles
↓/absent breath sounds, fine crackles
↓ SpO₂, ↑ opacification on CXR
138
Rationale for inspiratory hold
Recruits collapsed alveoli through collateral ventilation
139
Why is deep breathing good
Bigger VT → ↑ surfactant → ↑ compliance + ↑ alveoli open (↑ FRC)
140
Why do rib # decrease lung volumes
Rib # → pain → shallow breathing → ↓ tidal volume
= ↓ stretch of alveoli → ↓ surfactant → atelectasis (local collapse)
141
When is specific positioning good
Used when ventilation is reduced in one lobe due to:
➡ Atelectasis
➡ Pleural effusion
➡ Rib fracture
142
How specific positioning works
- gravity stretches the lung region open
- moves up the compliance curve -> less stiff
- air preferentially flows there -> alveolar recruitment
- more surfactant produced -> alveoli stay open
143
Describe upright positioning
✅ Upright helps lungs expand
Gravity pulls the stomach down → diaphragm has more room to move
✅ Bigger breathing space (↑ FRC)
Better air left in lungs between breaths
✅ Best for when lungs are generally “small”
Post-op, ICU, or after anaesthetic → everything is a bit collapsed
✅ Better oxygen movement everywhere
Helps the whole lung get fresh air → prevents gas exchange issues
144
What is closing capacity
the point at which dependent small airways close during inspiration and expiration
145
When CC > FRC
small airways close during normal breathing
146
Techniques to increase lung volumes
- increase inspired volume: deep breathing exercises increases including breath holds
- increase FRC: upright positioning
- re-expand the localized area of loss of volume
147
Rationale of deep breathing exercises
- increase gas movement by increasing TV and FRC
- prevent possible secondary effects on secretion clearance
- prevent possible secondary effects on respiratory load
148
Pathy phys of deep breathing
increase amount of gas moving in and out of more alveoli
stretches type 2 alveolar cells
increase surfactant secretion
decreased surface tension (increases compliance)
alveoli stay open (increase FRC)
149
Pathophys inspiratory hold
Allows for gas to travel through collateral channels, opening up adjacent closed alveoli
150
Upright positioning (increasing FRC)
- increases FRC
-highest FRC is in standing, followed by upright sitting
- lowest FRC is head down tilt
151
Describe components of MCC
1. Mucus -> 2 layers, function as a mechanical, chemical and biological barrier
2. Cilia -> moves material caught in mucus towards pharynx
152
Describe 2 layers of mucus
1. Sol layer: thin and watery fluid that bathes the cilia
2. Gel layer elastic and viscous, moves towards the mouth
153
How can Mcc be increased
- posture
- exercise
- environment
154
How can MCC be decreased
- Sleep
- Increasing Age
- Disease/Injury
155
Conditions that lead to MCC impairments
increase volume of mucus: infection
increase size and number of secretroy cells: smoking, chronic bronchitis
decrease in depth of Sol layer: CF
where rheological properties are altered: CF, asthma
156
Components of a cough
1. Deep inspiration
2. breath hold against closed glottis
3. contraction of the expiratory muscles resulting in large increase in intrathoracic pressure
4. glottis opens and there's a rapid expulsion of air
157
What is 2 phase gas liquid flow
when gas passes through a liquid lined tube (like an airway), the liquid can be moved 2 ways
158
2 components of gas liquid flow
MIST: the liquid is carried as small droplets in the gas (associated with coughing )
ANNULAR: the surface of the liquid layer moves in waves
159
Describe monitoring for an intervention
- occurs during the intervention
- check everything is ok
- uses tools appropriate and available
- don't disrupt the intervention
160
Evaluation for a treatment
- occurs at the end of an intervention
- re-assesses to look for reversal of the signs and symptoms that told you the problem was present
- should be standardized and reproducible
- should be timely
161
Examples of monitoring a treatment
Questioning - pain (not scales), breathlessness
Obs- POB
Pulse ox- SpO2, HR
162
Examples of evaluation of a treatment for increased O2 generally
Ausc
Obvs (increased basal expansion, upper chest breathing pattern)
Pulse O2 (increase in SpO2)
CXR
163
Evaluation of improved cough effectivness treatment
Ausc: no crackles
Obvs: clears secretions
listen: sounds stronger
164
Longer term evaluation methods of treatment
- mobility: distance walked, ability to stair climb
- independent ADLs: can shower independently
165
Describe the complete clinical reasoning process:
Review patient signs & symptoms
Understand effects of medical management
Decide patient problems: Actual or Potential
Decide treatment goals/aims: Reversal, Symptom ↓ / Compensator, Prophylactic (prevention)
Use knowledge of treatments to select intervention
Implement + modify treatment
Assess treatment effectiveness
Repeat cycle based on reassessment
166
Discuss sequencing of interventions
Treat life-threatening problems first (e.g., O₂ movement failure)
Prioritise gas movement → secretion movement → activity
Reassess and alter sequence as patient condition changes
Consider fatigue, pain, timing around medical procedures
167
List goals of intervention
Impairment level
1.Improve gas movement: ↑ O₂ movement, ↓ CO₂ retention
2.Improve secretion movement (MCC + cough)
Activity limitation
1.Improve mobility, exercise tolerance, ADLs
Participation restriction
1.Improve return to work, school, sport, community activitie
168
Treatment sequencing
1. decide on the optimal order
2. target the biggest impact
3. target the worst problem
4. fix one problem that will help another problem
169
FRC is reduced in
- supine position
- anesthesia
- obesity
170
Why huffing is better then coughing
huff produces less compression than coughing, therefore less risk of airway collapse/closure
171
What does crackles on auscultation represent
fluid popping open of collapsed small airways/alveoli
172
when is fine crackles heard
at the end of inspiration
173
cause of fine crackles
small airway/alveolar popping open
174
Diseases where you hear fine crackles
- pulmonary fibrosis
- ILD
- early pulmonary oedema
- atelectasis
175
When do you hear coarse crackles
throughout inspiration, sometimes expiration
176
what diseases do you hear coarse crackles
COPD
bronchiectasis
pneumonia (with mucus)
later pulmonary oedema
177
CDV symptoms
- palpations
- dizziness
- chest discomfort
- SOB
178
effect of auscultation on gas movement
impaired -> alveoli collapse -> harder to get fresh gas to gas exchange
179
Reasons someone might have thoracic surgery
- Pleural disorders
- Rib cage
- Lung parenchyma disorders
- throat cancer
180
Reasons for cardiac surgery
- Valve repair/replacement
- Coronary bypass grafting
- Repair of congenital defects
181
Describe how an underwater seal drain functions & physiotherapy precautions
- ICC drains air (apical) or fluid/blood (basal) from pleural space
- water seal prevents air returning into pleura
- Helps restore negative pressure -> re-expands the lungs
182
Physio precautions to UWSD
- avoid pulling on tube
- always keep tube upright
- clamp only is ordered
- mobilise with device below the chest
183
How can thoracic surgery be performed
- Open thoracotomy (large thoracic incision)
- Video assisted thorascopic surgery
184
Describe the different types of thoracic surgeries
* Lung parenchyma surgeries — wedge resection, segmentectomy/lobectomy, pneumonectomy, LVRS, lung transplant
* Pleural surgeries — pleurodesis, pleurectomy, decortication
* Rib cage surgeries — pectus/ sternum repairs
* Esophageal/mediastinal surgeries — oesophagectomy, thymectomy, hiatus hernia repair, pulmonary thromboendarterectomy
185
List common thoracic surgeries
- lung parenchyma
- pleural
- rib cage
- esophageal
186
Types of cardiac surgery
- Open: with cardiopulmonary bypass, or off pump coronary artery bypass (OPCAB)
- Minimally invasive: minimally invasive direct coronary artery bypass (MIDCAB), transcatheter valve implantation
187
Describe effects of cardiopulmonary bypass (CPB) on the respiratory system
CPB causes:
- inflammatory response -> decreas gas exchange
- Red cell damage -> decrease O2 transport
- Platlet/clotting issues
- Hypothermia effects
- Left lower lobe atelectasis
188
Complications for post operative complications of cardiopulmonary bypass
- Pleural effusion
- Decrease PaO2
- Infection/LLL collapse
- Pneumothorax
189
List different types of post-operative drips, drains and attachments
- IV access (fluids, electrolytes, meds)
- Epidural/ PCA analgesia
- Wound drains
- Nasogastric tube
- Indwelling catheter
- Oxygen therapy
- Stoma bag
190
Whats the purpose of wound drains
- remove fluid/air and prevent infection and support healing
191
What reduces O2 movement post operatively
- Anesthesia
- pain limiting deep breaths
- positioning decreases FRC
- pleural disruption
192
Why does secretion clearance reduce post op
- poor cough pain
- decrease MCC from anaesthesia and immobility
movement science
flashcards
Decks in class (5)
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