1
Q
What are the two categories of pulmonary pathologies?
A
-Restrictive
-Obstructive
2
Q
True/False: Restrictive pulmonary pathologies make it difficult for air to leave the lungs
A
False (air cannot enter - atelectasis)
3
Q
Which category of pulmonary pathology makes it difficult for air to leave the lungs?
A
Obstructive
4
Q
Is supplemental oxygen considered a prescription drug?
A
Yes
-Requires prescription/physician (except for emergencies)
5
Q
What is needed first in order to titrate supplemental oxygen?
A
Can only change O2 level if MD provides the order
6
Q
True/False: Restrictive lung dysfunction is considered a disease
A
False (not necessarily)
-Result of a disease that restricts chest or lung expansion
7
Q
To understand restrictive lung dysfunction, what three aspects of pulmonary ventilation must be considered?
A
-Compliance of lung/chest wall
-Lung volumes/capacities
-Work of breathing
8
Q
True/False: Compliance is the inverse of stiffness
A
True
9
Q
How are lung volumes and capacities evaluated?
A
Using a pulmonary function test (spirometry)
10
Q
With restrictive lung dysfunction, is lung compliance decreased or increased?
A
Decreased (stiffer; difficult to expand)
-Patient will need to work harder to move air into lungs
11
Q
With restrictive lung dysfunction, the patient’s work of breathing is increased. How does this impact tidal volume and respiratory rate?
A
-RR = Increased
-Tidal volume = Decreased
12
Q
What is considered to be the primary inspiratory muscle?
A
Diaphragm
13
Q
What two muscles are considered to be accessory muscles of inspiration?
A
-Scalenes
-Sternocleidomastoid
14
Q
If restrictive lung dysfunction progresses, what may occur?
A
-Respiratory fatigue
+Respiratory failure
15
Q
What are signs of restrictive lung dysfunction?
A
-Tachypnea (increased RR)
-Hypoxemia (low O2 in blood)
-Reduced lung sounds (quieter - less airflow)
-Decreased lung volumes/capacities
-Greater susceptibility to carbon monoxide poisoning
-“Cor pulmonale”
16
Q
What are symptoms of restrictive lung dysfunction?
A
-Dyspnea (shortness of breath w/ rest or exercise)
-Irritating/nonproductive cough
-Emaciated appearance
17
Q
In someone with restrictive lung dysfunction, the work of breathing is increased how much?
A
Increased up to 12x (that of normal)
-Use caloric requirements comparable to running marathon 24 hrs./day
18
Q
What is the approach to treatment for an individual with restrictive lung dysfunction?
A
Disease-specific (aimed at treating underlying disease process)
19
Q
If the disease is more permanent (restrictive lung dysfunction), what additional measures are often considered?
A
Supportive measures
-Supplemental O2
-Antibiotics (infections)
-Nutritional support
20
Q
What are some of the major causes of restrictive lung dysfunction?
A
-Normal aging
-Atelectasis
-Pneumonia
-Acute respiratory distress syndrome (ARDS)
-Interstitial lung disease
-Idiopathic pulmonary fibrosis
-Sarcoidosis
-Autoimmune disorders (RA, lupus, scleroderma)
-Silicosis
-Asbestosis
-Lung carcinoma
-Pleural effusion
-Pulmonary edema (cardiogenic and non-cardiogenic)
-Pulmonary embolus
21
Q
The compliance of the pulmonary system starts to decrease at what age?
A
Age 20 (decreases by 20% over next 40 yrs.)
22
Q
Between ages 30-70, does vital capacity increase or decrease?
A
Decreases (by 25%)
23
Q
Do decreases in inspiratory muscle strength occur as a result of normal aging?
A
Yes
24
Q
In general, how is atelectasis defined?
A
“Incomplete expansion” of lung tissue (due to collapse)
-Leads to reduced or absent gas exchange
25
What conditions may cause atelectasis to occur?
-Pneumothorax (air in pleural space)
-Hydrothorax (fluid in pleural space)
-Tumors (obstructs airways/compresses)
26
Can the use of small tidal volumes cause atelectasis?
Yes (post-surgically; bed rest)
-Fail to fully expand the alveoli
+Result = Leads to gradual collapse
27
PT implications - What interventions does atelectasis usually respond well to?
-Deep breathing exercises (incentive spirometer)
-Coughing
28
True/False: Prevention of atelectasis should be a goal for all hospitalized patients
True
29
What is pneumonia and how does it usually transpire?
Inflammatory process of the lung parenchyma due to infection in lower respiratory tract (bacterial, viral, fungal)
30
What are the four types of pneumonia (how and where infection was acquired)?
-Community acquired
-Hospital acquired (>48 hrs. after admission)
-Healthcare acquired
-Ventilator associated (>48-72 hrs. after endotracheal intubation)
31
With reference to pneumonia, what creates a restrictive effect within the lungs?
-Inflammation
-Secondary fluid buildup
32
What is the primary focus when it comes to treating pneumonia?
Drug therapy
33
If a patient is struggling with pneumonia-related secretions, what can PTs assist with?
-Postural drainage
-Percussion
-Vibration
-Assisted cough techniques (encouraging patient to cough)
34
What is acute respiratory distress syndrome?
Diffuse lung inflammatory process (impacts both children and adults)
-Result = Alveoli (air sacs) fill with fluid and collapse
35
What are common causes/triggers of ARDS?
-Sepsis
-Pneumonia
-Trauma
-COVID 19
36
What "stage" of ARDS follows with the removal of inflammatory and damaged cells and repair of alveolar epithelium?
Proliferative stage
37
If the proliferative stage is prolonged, what forms and causes long-term damage to the lungs?
-Scar tissue
-Fibrosis
38
What are the medical priorities when treating ARDS?
Treat the underlying cause
-Mechanical ventilation
-Prolonged prone positioning (under sedation)
39
For an individual with ARDS, how many hours at a time are they undergoing prone positioning treatment?
12-16 hrs. at a time
40
True/False: More abdominal compression on the thorax occurs when in the prone position
False (even distribution of alveoli)
41
PT implications - When should mobilization be initiated for someone with ARDS?
Early mobilization should occur as soon as possible (patient is medically stable)
-Can still be on ventilator
42
With ARDS, what needs to be closely monitored with physical activity/early mobilization?
SpO2 (frequent desaturation)
-Poor oxygen diffusion due to increased edema/fluid
43
What is characterized as a large group of lung disorders that eventually lead to problems with oxygen diffusion due to progressive scarring/fibrosis?
Interstitial lung disease
44
What are some examples of interstitial lung diseases?
-Idiopathic pulmonary fibrosis
-Sarcoidosis
-Autoimmune disorder (lupus, RA, scleroderma)
-Silicosis
-Asbestosis
45
Is idiopathic pulmonary fibrosis reversible?
No - irreversible and fatal
46
Idiopathic pulmonary fibrosis commonly occurs in what population?
Older adults
47
How is idiopathic pulmonary fibrosis characterized?
-Progressive fibrosis of pulmonary structures
-Worsening dyspnea (shortness of breath)
+Result = Death
48
Is the cause of sarcoidosis known?
No
49
What is sarcoidosis?
When clusters of immune cells (granulomas) develop in multiple body systems
-Lungs are most involved
50
True/False: The clinical presentation of sarcoidosis is highly variable
True
-Spontaneous resolution of granulomas
-Pulmonary scarring (long-term deficits)
51
When medical treatment of sarcoidosis is necessary, most patients improve with moderate doses of what?
Corticosteroids
52
What are three examples of autoimmune pulmonary disorders?
-Rheumatoid arthritis
-Lupus
-Scleroderma
53
True/False: 90% of lupus cases are in men
False
-Women (particularly Blacks)
54
What is silicosis and what causes it?
Chronic fibrotic lung disease
-Due to inhalation of silica
+Occupational related disease (mining, fracking, shipbuilding, etc.)
55
Is there a cure for silicosis?
No
-Physical training may be beneficial and improve overall quality of life (exercise capacity and dyspnea severity)
56
What is asbestosis caused by?
Inhalation of asbestos
-Occupational related disease (shipyard, railroad, manufacturing, aerospace materials, etc.)
57
Is there a cure for asbestosis?
No
58
A tumor that develops, enlarges and occupies space in the lungs is known as what?
A lung carcinoma
-Leads to secondary swelling/fluid build up
59
What is the prognosis for someone with lung carcinoma?
Poor prognosis (especially w/ metastatic spread)
60
Any excess fluid within the pleural space is characterized as what?
Pleural effusion (will limit lungs ability to expand)
61
What are some potential causes of pleural effusion?
-Inflammatory conditions that spread to pleural space (pneumonia, PE, TB)
-Cancer (decreased lymphatic clearance of pleural space)
-Congestive heart failure
62
How can congestive heart failure lead to pleural effusion?
-Blood is not pumped out of L ventricles (back up into pulmonary veins)
+Result = Raises pressure in vessels
-Increase in pressure forces fluid out and into pleural space
63
What is pulmonary edema?
Condition where fluid builds up in the lungs (specifically air sacs - alveoli) and surrounding tissue
-Result = Breathing is hard
64
What are the two main types of pulmonary edema?
-Cardiogenic
-Non cardiogenic
65
What causes cardiogenic pulmonary edema?
Heart failure (problems with the heart)
66
What causes non-cardiogenic pulmonary edema?
Wide variety of causes (not related to heart)
-Direct injury to lung
-Inhalation injury (smoke)
-Pulmonary contusion
-Massive release of stress hormones following TBI
67
Medical treatment - Cardiogenic pulmonary edema
Aims to decrease cardiac preload and maintain oxygenation
-Venodilators (reduces venous return)
-Diuretics (decreases fluid/sodium in body)
-Supplemental O2
-Positive inotropes (improve myocardial contractility)
-ACE inhibitors (lowers BP; reduces afterload)
68
PT implications - Cardiogenic pulmonary edema
-Know potential side effects to medication groups
-Patients may not tolerate supine activities (increases venous return)
-Know orders for supplemental O2
-Closely monitor SpO2 w/ activity
69
True/False: Pulmonary embolism is the most common acute pulmonary problem among hospitalized patients
True
70
Can pulmonary embolisms be "clinically silent?"
Yes (some will go unnoticed)
71
What are the classic triad of symptoms present in 20% of patients with a pulmonary embolism?
-Dyspnea (rest or exertion)
-Hemoptysis (coughing up blood)
-Pleuritic chest pain (stabbing - worse w/ breathing or coughing)
72
In >95% of cases, pulmonary emboli are initially formed where?
Lower extremities
73
The highest risk of DVT formation is commonly seen in what patients?
Highest risk in orthopedic patients
-80% after hip or knee surgery
74
What are some examples of obstructive pulmonary diseases?
-COPD
-Asthma
-Cystic fibrosis
-Bronchiectasis
75
What are the two main features of COPD?
-Emphysema
-Bronchitis
76
What is emphysema?
Involves damage to the alveoli (air sacs) in the lungs
-As air becomes trapped = Alveoli become enlarged
77
What is bronchitis?
Impacts the bronchial tubes (inflammation)
-Result:
+Excess secretions
+Persistent cough
78
With bronchitis, the combination of what two things creates obstructed airflow?
-Inflammation
-Mucus
79
With reference to the features of COPD, what is the net result?
Reduced airflow out of the airways
-Eventual hyperinflation of lungs
-Poor gas exchange
80
What causes COPD?
-Inhalation (cigarette smoke)
-Genetic susceptibility (less surfactant; weaker alveoli)
81
True/False: With COPD, the lungs' ability for elastic recoil increases
False (diminishes)
-Result = Leads to lung hyperinflation
82
Do lung volumes/capacities increase or decrease in the presence of an obstructive lung disease?
Increase
83
Do lung volumes/capacities increase or decrease in the presence of restrictive lung dysfunction?
Decrease
84
What are the structural changes commonly observed in someone with COPD?
-Elevation of the shoulder girdle
-Horizontal ribs
-Barrel shaped thorax (decreases ribs ability to move; difficulty breathing)
-Low, flattened diaphragms
85
Lung function in COPD - Destruction of distal airways results in what?
Reduced gas exchange (decreased oxygenation)
86
What are the clinical implications of a flattened diaphragm?
Changes the length-tension relationship of the muscle
-Result = Weaker contraction (affects ability to perform passive exhalation)
87
True/False: A flattened diaphragm can ultimately lead to pelvic floor dysfunction and urinary incontinence
True (increase in intraabdominal pressure)
88
Is the ability to inhale also affected in an individual with COPD?
Yes (recruitment of accessory muscles)
-Sternocleidomastoid
-Upper trapezius
-Scalenes
-Pectoral muscles
89
What are postural deviation commonly observed in an individual with COPD?
Due to hypertrophy of accessory muscles of inspiration
-Forward head
-Rounded shoulders
-Thoracic kyphosis
90
What is tripoding in COPD?
When a person leans forward (with hands resting on their knees or a surface)
-Result = Breathing is easier
91
How is muscle composition impacted by COPD?
Muscle composition will gradually shift (skeletal; respiratory)
-Type I to Type II (reduced physical activity, hypoxia, inflammation)
92
Overall, changes in muscle composition due to COPD often result in what?
-Poorer exercise capacity
-Decreased LE functioning
93
What are the psychological/cognitive changes that may occur with COPD?
-Anxiety
-Depression
-Memory loss
-Impaired attention
-Impaired language/orientation
94
Is there a cure for COPD?
No
-Goals = Improved health status
+Slow disease progression
+Symptom relief
95
Pharmacological management - COPD
-Bronchodilators (open airways)
-Anti inflammatory medications (reduce inflammation)
-Antibiotics (lung infections)
96
PT implications - COPD
-Controlled breathing techniques
-Secretion clearance
-Endurance/strength training
-Progressive ambulation
-Postural re-education
-Monitoring SpO2 (use of O2 w/ activity)
97
A chronic inflammatory disorder of the airways is commonly known as what?
Asthma
98
The inflammation associated with asthma causes recurrent episodes of what?
Associated w/ variable airflow obstruction (reverse spontaneously or w/ treatment)
-Wheezing
-Dyspnea
-Chest tightness
-Coughing
99
True/False: With reference to asthma, episodes of acute inflammation result from viral or allergen exposure
True
100
What happens to the airways during a severe asthma attack?
Narrowing of all airways
-Result = Markedly decreased maximal expiratory (and inspiratory) flow
101
What happens to the airways as a result of repeated/chronic asthma attacks?
Airways are "remodeled"
-Result = Thickening in airway walls
102
List the "special" types of asthma
-Seasonal (high levels of certain allergens)
-Exercise induced bronchospasm
-Drug induced (NSAIDs)
-Cough variant (only presents w/ cough)
-Asthmatic bronchitis (features of both diseases)
103
What is the main goal when treating asthma?
Long-term control of symptoms
104
PT implications - Asthma
-Interventions can begin if the patient's symptoms are well controlled w/ medication
-Use bronchodilator medication 30 min. before exercise
105
A combination of what interventions may be beneficial for someone with asthma?
-Controlled breathing
-Exercise (strength training)
106
What is cystic fibrosis?
A life-threatening, genetic, multisystem disorder (affect children/young adults)
-Leads to the production of thick, sticky mucus (clogs various organs - epithelial surfaces)
107
For someone with cystic fibrosis, failure to clear thick secretions from the lungs leads to what?
Recurrent infections
108
What are the early symptoms associated with cystic fibrosis?
Early
-Cough (associated w/ lower respiratory tract infections)
+Progresses = Cough becomes productive (gagging/vomiting)
109
What are the symptoms associated with cystic fibrosis (moderate to severe pulmonary involvement)?
-Lung hyperinflation
-Barrel chest
-Thoracic kyphosis
-Hypertrophy of accessory muscles
110
What is the approach to pharmacological management for individuals with cystic fibrosis?
-Antibiotics (recurrent pulmonary infections)
-Mucus thinners
-Nutrition (digestive health)
111
True/False: 90% of individuals will die from pulmonary complications related to cystic fibrosis
True
112
PT implications - Cystic fibrosis
-Secretion clearance
+Coughing
+Percussion/vibration/shaking
+Chest wall oscillations
-Controlled breathing exercises (episodes of dyspnea)
-Exercise/strengthening
-Postural re education
113
What is bronchiectasis?
Represents an anatomic abnormality (rather than single disease)
-Irreversible dilation of one or more bronchi (w/ chronic inflammation and infection)
114
What causes bronchiectasis?
-Bronchial wall injury (severe/recurrent infections)
-Traction from adjacent lung fibrosis (pull/distort airways)
-Bronchial lumen obstruction (tumors; foreign objects)
115
What are the symptoms associated with bronchiectasis?
-Chronic cough (w/ sputum)
-History of recurrent lung infections
-Hemoptysis (coughing up blood)
116
Medical management - Bronchiectasis
Address underlying condition = Improve overall quality of life
-Reduce number of exacerbations
-Antibiotics (new infections)
-Bronchodilators
117
PT implications - Bronchiectasis
-Secretion clearance techniques
-Controlled breathing (if dyspnea is present)
-Exercise (strength/endurance)
118
For someone with bronchiectasis, when should secretion clearance techniques be deferred?
If blood-streaked sputum or coughing is present (urge patient to call physician in the case of new infection)
Cardiopulmonary Eval
flashcards
Decks in class (9)
# Cards
-
Introduction - A&P Review87
-
Cardiovascular Pathophysiology87
-
Pulmonary Pathophysiology118
-
Cardiopulmonary Diagnostic Tests/Procedures110
-
Cardiopulmonary Physical Exam - Part 1103
-
Cardiopulmonary Assessment - Part 22
-
Cardiovascular Medications82
-
Pulmonary Medications49
-
Electrocardiography (ECG) - Part 187
