PULMONARY

Question 1

Gas exchange:

Answer 1

Occurs at the alveoli
* Deoxygenated blood ‘picks up’ oxygen and ‘drops off’ carbon dioxide

Question 2

• Tidal volume

Answer 2

volume of air inspired and expired during each respiratory cycle (at rest)

Question 3

• Inspiratory reserve volume:

Answer 3

max amount of air that can be inspired above tidal volume

Question 4

• Expiratory reserve volume:

Answer 4

max amount of air that can be expired after normal tidal volume

Question 5

• Residual volume:

Answer 5

that air that remains after max expiration

Question 6

• Vital Capacity:

Answer 6

amount of air the lungs can expel after being completely full
o Ie, the change in volume from completely full to completely emptied lungs
o tidal volume + inspiratory reserve + expiratory reserve

Question 7

• Total Lung Capacity:

Answer 7

full amount of air that can fit into the lungs, including the air that we do not exhale

Question 8

• Air entry

Answer 8

o Should be noticeable, should hear air coming in/out of the lungs
o Sometimes we hear ‘decreased air entry’
o This can be a lack of air getting into the lungs or, in the case of COPD, just not being able to hear it because there is already so much air in there

Question 9

• Crackles or Crepes

Answer 9

o If they are there, usually heard on inspiration
o Indicative of excessive secretions (ex: pneumonia)

Question 10

• Wheezes or Rhonchi

Answer 10

o Like a whistling sound, usually noticed on expiration
o Due to early airway closure (ex: emphysema, asthma)

Question 11

o Sputum (definition, colours)

Answer 11

Red- nosebleed, malignancy/lung injury
Clear/White- allergies, viral infection
Green- bacterial infection
Brown- may indicate lung disease

Question 12

o Restrictive:

Answer 12

Any respiratory condition where the patient is unable to take in a full, deep breath
o Interstitial lung disease, Sarcoidosis- tighten up lung tissue, Scleroderma, broken rib, scoliosis.

Question 13

o Obstructive:

Answer 13

o Any respiratory condition where the patient has difficulty getting all the air out of their lungs: Asthma, COPD, Emphysema, Chronic Bronchitis, Cystic Fibrosis, Bronchiectasis

Question 14

o COPD

Answer 14

• Describes two diseases that affect the lungs
  o chronic bronchitis
  o emphysema
• Causes progressive damage to the lungs

Question 15

• Bronchitis:

Answer 15

inflammation of the lining of the bronchi

Question 16

o Emphysema

Answer 16

barrel chest
* Damage to the alveoli
o Inner walls weaken and rupture
* Clubbing of the fingers, from chronic hypoxia to nail beds
* Cyanosis: bluish colouring of the skin
o Peripheral (fingers, etc.)
o Central (lips, face, etc.)
o due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface

Question 17

o Pneumonia:

Answer 17

• Lung infection
• Can involve one, or both, lungs
• Caused by bacteria, viruses, or fungi

Question 18

Pneumonia: Symptoms:

Answer 18

• Productive cough
• Fever
• Sharp chest pain on inspiration
• Abnormal sounds in the chest
• Diagnosis is confirmed by a chest x-ray

Question 19

Cystic Fibrosis:

Answer 19

Congenital disease
* Most common, fatal genetic disease affecting young Canadians
* Affects mainly the lungs and the digestive system
* Affects cells that make mucus, sweat and digestive fluids
o These fluids are thick in CF patients
Causes the blockage of ducts throughout the body

Question 20

Asthma:

Answer 20

A chronic inflammatory disease of the airway, Causes narrowing of the airways, They are inflamed and constricted

Question 21

Asthma symptoms:

Answer 21

• Shortness of breath
• Tightness in the chest
• Coughing
• Wheezing
• Severity varies from person to person, or can vary from one episode to the next

Question 22

Bronchodilators (Puffers):

Answer 22

• Help open the bronchial tubes of the lungs
  o decreasing resistance and allowing more air to flow
• Useful in obstructive Lung diseases
• Either short-acting or long-acting
  o Short-acting medications provide quick or “rescue” relief from acute bronchoconstriction
  o Long-acting bronchodilators help to control and prevent symptoms

Question 23

Trach:

Answer 23

An incision is made into the trachea

Question 24

Suctioning:

Answer 24

Using a tube, with suction, to remove secretions from the lungs
Can be done through a tracheostomy tube, an endotracheal (ET) tube, or through the nose

Question 25

Oxygen: Short-Term use

Answer 25

* Recovering from acute lung disorders (ex: pneumonia) * After surgery

Question 26

Oxygen: Long-term use

Answer 26

o People with chronic lung disorders in whom oxygen levels are consistently low o Sleep apnea, or other disorders where oxygen levels dip

Question 27

Mechanical Ventilation:

Answer 27

* A machine which ‘breathes for’ the patient * May be attached via a trach or an ET tube * Severe cases, where client cannot breathe for themselves:

Question 28

o Chest Physio: Used to treat chest congestion

Answer 28

o Prevent accumulation of secretions o Remove secretions already accumulated o Conditions Treated o Respiratory diseases (Ex: Bronchiectasis, COPD, Pneumonia, Cystic fibrosis) o Neuromuscular diseases (muscular dystrophy, cerebral palsy, spinal cord injury)

Question 29

o Percussion

Answer 29

o Cupping over the chest wall to shake secretions loose prior to coughing o thick, sticky or retained secretions o Often used in combination with active cycle breathing techniques or postural drainage o Can be done manually or mechanically o Performed with cupped hands (to trap air between the patient's thorax and caregiver's hand) and in an alternating, rhythmic manner

Question 30

* Dyspnea –

Answer 30

monitor oxygen sats, as percussion can cause temporary hypoxemia, Pain, Monitor changes in, mucus colour and consistency, breathing pattern and rate- SOB,

Question 31

Precautions percussion:

Answer 31

Avoid bony prominences (ex: vertebrae, spine of scapula), Not over rib fractures, Avoid floating ribs, Watch for redness – this is a result of slapping or not trapping enough air between the hands and the chest wall

Question 32

Contraindications percussion:

Answer 32

* Subcutaneous emphysema * Recent epidural spinal infusion or spinal anesthesia * Recent skin grafts, or flaps, on the thorax * Burns, open wounds, and skin infections of the thorax * Recently placed transvenous pacemaker or subcutaneous pacemaker (particularly if mechanical devices are to be used) * Suspected pulmonary tuberculosis * Lung contusion * Bronchospasm * Osteomyelitis of the ribs * Osteoporosis * Coagulopathy * Complaint of chest-wall pain

Question 33

o Vibration

Answer 33

* Hands are placed with the fingers in the direction of the ribs * On expiration, shake lightly as the ribs move in

Question 34

o Postural Drainage

Answer 34

Affected lobe goes on top

Question 35

* Contra/in: postural drainage

Answer 35

* Hemorrhage * Untreated acute conditions * Cardiovascular instability * Recent neurosurgery * Any condition that does not allow excess pressure in the head

Question 36

o PEP devices

Answer 36

positive expiratory pressure * Increases resistance to expiratory airflow to promote mucus clearance * Increase exhalation pressure * Prevents airway closure * Example: TheraPEP

Question 37

* Oscillating (vibratory) PEP

Answer 37

o Combines high-frequency oscillations with PEP o Provides exhalation resistance, like normal PEP o Also create vibrations when a patient breathes out, to move mucus from the surface of the airways o Example: Acapella

Question 38

Steps for PEP:

Answer 38

Step 1: Loosen mucus: * Deep breath and hold 2-3 seconds * Place mouthpiece in mouth while holding breath * Exhale steadily 4-6 seconds or as long as possible Step 2: Cough and bring up mucus: * Remove mouthpiece from mouth * Do 2 to 3 huff coughs * Deep breath in * 3 quick, forceful exhales (make a ha, ha, ha sound) * Cough hard to bring up mucus * Spit mucus out (do not swallow) How long to do this? * At least 5 times = 1 cycle * May continue for 10-20 minutes, until sputum is cleared

Question 39

o Assisted cough

Answer 39

o For clients with a weak or absent cough, Ex: spinal cord injury o Provide manual assistance to cough o Enables client to clear secretions

Question 40

Contraindications: Assisted cough

Answer 40

Increased potential for aspiration (Ex: unconscious patient with unprotected airway) * Acute abdominal pathology, abdominal aortic aneurysm, hiatus hernia, or pregnancy * Bleeding * Untreated pneumothorax * Osteoporosis * Flail chest

Question 41

Technique: Assisted cough

Answer 41

TECHNIQUE: Client uses signal to tell you that inspiration is complete, When the client signals, apply brief, firm pressure during expiration at the same time as the client attempts to cough, When the client is on ventilator, apply pressure at the end of inspiratory cycle

Question 42

o Pursed Lip

Answer 42

in through your nose, out through your mouth like you’re blowing out a birthday candle o Population: COPD o Anyone with an obstructive lung issue

Question 43

Rationale for pursed lip:

Answer 43

Pursed lip changes the positive end expiratory pressure (PEEP) which keeps airways open so that C02 can get out * Increased PEEP can also hold open bronchioles (ex: in emphysema)

Question 44

* Benefits: pursed lip

Answer 44

Improves ventilation * Releases trapped air in the lungs * Keeps the airways open longer to decrease the work of breathing * Prolongs exhalation to slow the breathing rate * Relieves shortness of breath * General relaxation

Question 45

Rationale for braced breathing:

Answer 45

* Bracing can allow increased use of accessory breathing muscles Benefits: * Relieves shortness of breath * Promotes relaxation

Question 46

o DB&C rationale

Answer 46

* Deep breathing is better for lung health * After surgery, anesthetic has often resulted in shallower breathing

Question 47

Benefits DB&C

Answer 47

* Bronchial hygiene * Decreased risk of complications

Question 48

o ACBT population:

Answer 48

* Post-surgery * Increased sputum (acute or chronic) * SOB * Ventilated

Question 49

Rationale: ACBT

Answer 49

Calming breath can reduce an episode of shortness of breath * Deep breaths help loosen secretions * Huff helps clear secretions

Question 49

Benefits: ACBT

Answer 49

1. Loosens and clears secretions from the lungs 2. Reduces the risk of chest infections 3. Improves ventilation in the lungs 4. Improves the effectiveness of cough

Question 50

o Incentive Spirometer: pop

Answer 50

* Usually post-operative * Patient’s with reduced inspiratory muscle strength/capacity

Question 51

Rationale: IS

Answer 51

* Has a visual feedback system to show if you are using your inspiratory muscles * Encourages deeper breathing – has patients take a sustained maximal inspiration (SMI), which is a slow, deep inspiration from function residual capacity up to total lung capacity

Question 52

Benefits: IS

Answer 52

Prevents lung complications after surgery, bedrest, etc. (ex: atelectasis, infection) * Visual feedback often means patient’s do a deeper breath than with deep breathing alone

Question 53

Technique: IS

Answer 53

* Patient in a relaxed position * Create a tight seal around device with mouth * Inhale slowly, get the ball as high as you can, hold 5 seconds * Relax and exhale * Generally, try for 10 IS breaths per waking hour