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CardioPulmoaryPT1 > Obstructive (can't get air OUT) Lung Dysfunction: Exam 2 > Flashcards

Obstructive (can't get air OUT) Lung Dysfunction: Exam 2 Flashcards

1
Q

OLD or

A

Obstructive Lung Disease!!!

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2
Q

What is Chronic Obstructive Pulmonary Disease

OLDs as a WHOLE?

A
  • Dis’s of airways, which produce obstruction of expiratory flow AND incomplete emptying of lungs
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3
Q

3 KEY components to Obstructive Lung Disease

A
  1. DECd diameter of airways
  2. Hyperinflation of alveoli
  3. INCd resistance to Airflow
    1. Air Trapping!!!
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4
Q

In Obstructive lung disease

Airflow obstruction can be related to 4 things:

A
  1. Retained or excessive secretions
  2. Inflammation of mucosal linings of airway walls
  3. Bronchial constriction:
    1. ​tone
    2. spasm
    3. size
    4. inflammation
  4. Weakening of support structure or alveoli
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5
Q

Obstructive Lung Diseases====>

A

CBABE

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6
Q

Obstructive Lung Diseases

CBABE

A
  • C: Cystic Fibrosis
  • B: (chronic) Bronchitis
  • A: Asthma
  • B: Bronchiectasis
  • E: Emphysema
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7
Q

Remember….there is a Difference b/w Chronic Obstructive Pulmonary Disease and just your “standard” COPD

What is the “Classic” COPD??

A
  • COPD== (chronic) Bronchitis + Emphysema TOGETHER!!!
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8
Q

Dx Imaging Tools for COPD:

4 Tools:

A
  1. Chest Xray
  2. PFT
  3. ABG
  4. CT scan
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9
Q

What is the Hallmark S/S for OBSTRUCTIVE LUNG DISEASE?

*Seen on Chest Xray*

A

Flattening of the Diaphragm

*Extra air in lungs pushes it DOWN

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10
Q

GOLD STANDARD TEST for OLD’s???

A

PFT

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11
Q

PFT Test of OLD’s

What are the components?

What does it determine?

A
  • As severity of lung obstruction INCs—-> LESS and LESS air can be exhaled in 1sec
    • ​this det’s our FEV1
  • MSK system
  • Diaphragm
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12
Q

ABG test and OLDs

A
  • MANY factors affect gas exchange
    • ​obstruction
    • hyperinflation
    • secretions
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13
Q

An abnormal ABG test w/ OLD

will show what?

A
  • PCO2
    • >CO2 (INCd)
  • PO2
    *
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14
Q

RV and OLDs

A

BIG INC in RV *****

BIG TLC

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15
Q

PFT Test

Normal vs. Obstructive

Break it down!!!

A
  • Normal: Example
    • ​FEV1= 3.0L
    • FVC (tot. air we breathe OUT)= 4.0L
    • FEV1/FVC= 75% (Nrml is .70)
  • Obstructive: example
    • ​FEV1= 1.0L (cant get air OUT)
    • FVC= 4.0L
    • FEV1/FVC= 25% (LOW bc cant get air OUT)
      • ​Obstructive Dis.=
      • **As FEV1/FVC shrinks==> MORE severe OLD***
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16
Q

FEV1/FVC

A

OLD!!!

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17
Q

COPD: MSK Component

What should you look @?

A

Flattening of the Diaphragm!!!!

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18
Q

COPD: MSK Component

Sequela #1:

Talks about EXPIRATION

A
  • Anatomically Barrel Shaped diaphragm—> ​
    • ​CLASSIC S/S—> ribs now angled out horiz.
  • Diaphragm pulled to flat pos.—>
  • Length-tension relationship changes—>
  • Exhalation now active or forced—->
    • ​remember should be passive
  • Leads to excessive fatigue + caloric use—->
    • ​using mm’s not norm. active
    • all energy goes to breathing
    • these people DO NOT eat
  • Excess abd. pressure==> urinary incontinence
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19
Q

COPD: MSK Component

Sequela #2:

Talks about INSPIRATION

A
  • Anatomically barrel-shaped diaphragm—>
  • Diaphragm pulled to flat pos.—–>
  • Altered length-tension relationship—->
  • Inspiration req’s accessory mm’s to overcome large RV+ poor functioning diaphragm—>
    • ​*still diff. to breathe IN bc fighting lg. RV
  • Hypertrophied acess. mm’s + functional shortening
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20
Q

What will Posture look like w/ OLD?

A

Forward Head

Rounded shoulders

Thoracic kyphosis

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21
Q

SIDE NOTE: What happens to the diaphragm w/ the MSK component of OLD?

A
  • Switches to Type II skeletal mm fibers
    • ​NEEDS SUGAR
    • takes leucine from quads and makes it into sugar
      • ​Glucose-Alanine Cycle***
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22
Q

32% pts w/ COPD have skeletal mm weakness

INCd prevalance directly related to severity of the disease

A

USUALLY LE MORE

*ESP the QUADS

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23
Q

Psychological impairments of COPD

3:

A
  1. Anxiety
  2. Depression
  3. Cognitive decline
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24
Q

S/S of OLD:

A
  1. Signs of lung hyperinflation
  2. Elevation of shoulder girdle
  3. Horizontal ribs
  4. Barrel-shaped thorax
  5. Low, flattened diaphragm
  6. Anxiety
  7. Cough w/ secretions
  8. Hypertrophy of SCM
  9. Forward posture ​
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25
Q

Adult COPD

What is this a combination of?

A

Emphysema

+

chronic Bronchitis

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26
Q

Adult COPD: Emphysema

what is it?

A

Condition of lung characterized by destruction of alveolar walls and enlargement of airspaces DISTALLY

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27
Q

Adult COPD: Emphysema

also enlargement of airspaces Distally:

what are these Distal airspaces?

A
  1. Bronchioles
  2. Alveolar ducts
  3. Alveoli
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28
Q

Emphysema think…….

A

Alveolar Destruction

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29
Q

MOST COMMON CAUSE OF EMPHYSEMA

A

Smoking

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30
Q

Emphysema

Distal airways enlarged

1. bronchioles

2. alveolar ducts

3. alveoli

*All 3 of these make up what?

A

Parenchyma

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31
Q

Adult COPD: Emphysema

Pathophys:

A

Inflammatory cells role

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32
Q

Disorders common in COPD:

Emphysema

Picture depiction

A
  • Enlargement and Destruction of alveolar walls
  • Walls of alveoli are torn and cannot be repaired
  • Alveoli fuse into large air spaces
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33
Q

Chronic Bronchitis think…..

A

Bronchiole inflammation

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34
Q

Adult COPD: Chronic Bronchitis

What MUST be present in order for it to be Chronic Bronchitis?

A

Presence of productive cough for 3 mos in each of 2 successive years

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35
Q

Adult COPD: Chronic Bronchitis

Pathophys:

A
  • Irritation leads to hypersecretion of mucus in LARGE airways and progresses to SMALLER airways hypersecretion
  • Hypertrophy of submucosal glands
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36
Q

Chronic Bronchitis

Explain role of Goblet Cells

A
  • Make mucus as a defense mechanism
    • ​EVENTUALLY…..mucus clogs everything up!!!
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37
Q

Disorders common in COPD

Chronic Bronchitis

What happens?

A
  1. Air tubes narrow as a result of swollen tissues and excess. mucus production
  2. Enlarged submucosal gland
  3. Inflammation of epithelium
  4. Mucus accumulation
  5. Hyperinflation of alveoli
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38
Q

Decreased recoil in lungs

OR

A

loss of elasticity in lungs

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39
Q

Adult COPD: Emphysema + Chronic Bronchitis

The cascade of events:

A
  1. Risk factors== smoking (most common), air pollution, noxious particles
  2. causes inflammation of lung
  3. structural changes and narrowing of small airways w/ hypersecretion
  4. Destruction of lung parenchyma, resp. bronchioles, alveoli===> Dec. lung recoil (loss of elasticity)
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40
Q

Adult COPD: Emphysema + Chronic Bronchitis

Air TRAPPED in lungs (bad open/closing of Alveoli)

Explain the events:

A
  • Air TRAPPED in lungs
    • lose elastic recoil of lungs
  • NOT good control of open/closing of alveoli
    • ​air becomes TRAPPED w/ not enough time to get out!!!
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41
Q

Adult COPD: Emphysema + Chronic Bronchitis

PFT

A

PFT <60%

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42
Q

Adult COPD: Emphysema + Chronic Bronchitis

ABG

A

INCd CO2

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43
Q

Adult COPD: Emphysema + Chronic Bronchitis

Auscultation?

A

LONG Exhalation phase

*Cannot get air OUT!

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44
Q

Adult COPD: Emphysema + Chronic Bronchitis

Posture

A

Forward head

Rounded shoulders

Kyphosis

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45
Q

Adult COPD: Emphysema + Chronic Bronchitis

Strength

A

Loss– ESP LE’s

Do MMT, HHD,

Weakness– esp. INSP mm strength

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46
Q

Adult COPD: Emphysema + Chronic Bronchitis

Explain EmPhysema Dominant:

A

PINK PUFFERS

  • EmPhysema has a P, Pink Puffers has P!!!
    • Much more frail
    • skinny
    • Not a lot of coughing
    • ***Hypertrophy of Scalenes
      • ​Scalene Triangle*******
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47
Q

Adult COPD: Emphysema + Chronic Bronchitis

Chronic Bronchitis dominant:

A

Blue Bloaters

  • Bronchitis has a B, Blue Bloaters has a B!!!
    • ​R. sided HF
    • Congestion, fluid
    • Peripheral edema bc backflow of fluid
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48
Q

Adult COPD: Emphysema + Chronic Bronchitis

GOLD Classification

Global Initiative for Obstructive Lung Disease

Stage I (mild)

FEV1 % predicted

A

>80

*remember FEV1/FVC will be

49
Q

Adult COPD: Emphysema + Chronic Bronchitis

GOLD Classification

Global Initiative for Obstructive Lung Disease

Stage II (moderate)

FEV1 % predicted

A

50 to 80

*FEV1/FVC

50
Q

Adult COPD: Emphysema + Chronic Bronchitis

GOLD Classification

Global Initiative for Obstructive Lung Disease

Stage III (severe)

FEV1 % predicted

A

30 to 50

*FEV1/FVC

51
Q

Adult COPD: Emphysema + Chronic Bronchitis

GOLD Classification

Global Initiative for Obstructive Lung Disease

Stage IV (very severe)

FEV1 % predicted

A

<30

*FEV1/FVC

52
Q

BODE Index

just remember….

A

HIGHER score === WORSE

53
Q

Adult COPD: Emphysema + Chronic Bronchitis

Medical Management:

A
  • smoking cessation
  • Pharmacotherapy for COPD
  • Influenca vaccine
  • Tx of sleep disorders
  • Pulm rehab + exercise
  • Surgical excision of bullae or lung volume reduction surgery (LVRS)
  • O2 therapy
    • ​*Remember—> over 21%==Drug
54
Q

Adult COPD: Emphysema and Bronchitis

Implications for PT Tx??

A
  • Secretion clearance
  • Controlled breathing:
    • ​@ rest
    • w/ activity
  • Ambulation w/ RW (or least restrictive device)
    • ​Tripod breathing***
  • Education in use of recovery from SOB pos’s
  • Endurance ex.
  • Strength training
  • Thoracic stretching
  • Posture re-ed.
55
Q

Alpha1-Antitrypsin Deficiency

What is this ?

A

How you get emphsyema w/out smoking!!!

56
Q

Alpha1-Antitrypsin Deficiency

GENETIC***

Imbalance b/w what???

A

Production and Destruction of inner wall of alveoli

*leads to Emphysema @ an early age

57
Q

Alpha1-Antitrypsin Deficiency

Think what when you see this…….

A

Genetic cause for Early emphysema w/out smoking!!!

58
Q

When you see Bronchiectasis

Think….

A

PERMANENT Dilation of the Bronchia

59
Q

Dilation of the Bronchia

A

Bronchiectasis

60
Q

Bronchiectasis

Irreversible dilation WITH what???

A
  • Chronic inflammation AND infection
    • ​*actually more prone to infection
61
Q

Bronchiectasis

Varying lvls of ________

A

Varying lvls of distortion of conducting airways

thickening

herniation

dilation

62
Q

Bronchiectasis

Causes:

A
  1. Idiopathic—-do NOT know why
  2. Bronchial wall injury OR structural weak.
  3. Traction from adj. lung fibrosis
  4. Bronchial lumen obstruction
    1. from mucus/swelling
63
Q

Some Common Causes of Bronchiectasis

See chart!!!

A
  • MANY CAUSES
    • Post-infectious dis’s
    • Injury/inhalation accidents
      • ​chronic GERD***
    • Congenital abnormal mucociliary clearance
      • ​*systemic diseases*
    • Exaggerated immune resp. disorders
    • RLD’s
64
Q

Bronchiectasis

Sx’s

A
  • Cough w/ sputum production
    • ​SM to LG quants of purulent secretions (HALLMARK—REMEMBER THIS!!!)
  • Secretion
    • ​mucoid initially THEN
    • purulent in sub-acute to chronic phases
    • ​thick, yellow-green plugs
  • Sputum GREATEST in morning
  • Recurrent, chronic, recurring lung infections
  • Hemoptysis
    • blood in mucus
65
Q

When is sputum greatest w/ Bronchiectasis?

A

In the MORNING !!!

66
Q

Bronchiectasis

Physical Exam

How are they Dx this?

A
  • Chest Xray
  • CT Scans*********** REMEMBER THIS ONE!!!
  • PFTS
  • Sputum testing
  • ABGs
  • Auscultation
  • Posture
  • Mm imbalances
  • Eval of GERD *****
67
Q

GERD can be an underlying cause of…..

A

Bronchiectasis

68
Q

Signet Ring Signs

Think….

A

Bronchiectasis!!!

69
Q

Bronchiectasis

Medical Mgmt:

What are the goals of this disease?

A
  • Goal: reduce # of exacerbations and improve QoL
  • Mng underlying cond.
  • Mng acute exacerb’s
  • Long-term mgmt
  • Sx
70
Q

These 2 OLD’s have the POOREST Prognosis

A
  1. CF
  2. Bronchiectasis
71
Q

Bronchiectasis

Prognosis?

A

DEPENDS on:

underlying dis. or cond.

72
Q

Bronchiectasis

Implications for PT Tx?

A
  • Secretion clearance
  • Controlled breathing
    • ​pre/post exertion
  • ACBT
  • Strength training
  • Endurance training
73
Q

Cystic Fibrosis (CF) is a ________ disorder

A

Multisystem***

74
Q

CF is a multisystem disorder that affects organs w/ epithelial surfs,

Primarily:

A
  • Pulmonary
    • usually what is fatal
  • Pancreatic
  • Intestine
    • Hepatic digestive
  • Male repro.
75
Q

CF

Secondary organs it will affect:

A
  • Mucus stasis in conducting airways of:
    • ​lung
    • nasal sinuses
    • sweat glands
    • sm. intestine
    • pancreas
    • biliary system
  • *Basically…..mucus clogs up ALL tubes!!!
76
Q

CF will also show abnormal transport of:

A

Abnormal Salt and Water transport

77
Q

CF is the failure of airways to do what?

A

Clear mucus normally

78
Q

WHO does CF affect?

A

Children

AND Young Adults

79
Q

Supplementary digestive enzymes taken w/ this disease

A

CF

80
Q

Normal airways vs. Airways w/ CF

A

NOTE: 2 things

  1. Bacterial infection
  2. Blood in mucus
81
Q

Cystic Fibrosis S/S

Pulmonary

A
  1. Persistent cough
  2. Productive cough/sputum production
  3. Persistent wheezing
  4. Fluctuating lung infiltrates/consolidations OR infections
  5. Wheezing w/ resp.
  6. INC’ing dyspnea
  7. Barrel-chested/horiz. rib align.
  8. Cyanosis/Clubbing—–> long term hypoxia
  9. Kyphosis
82
Q

CF S/S

Cardiac

A
  • End-stage dev. of R. Sided HF from Pulm HTN
83
Q

CF S/S

GI

A
  • Wt. loss–> Anorexia–> Failure to thrive
  • Malabsorption of nutrients in intest. tract
  • Maldigestion and fecal impaction in term. ileum
84
Q

Cystic Fibrosis S/S

Pancreatic

*think nutrition!!!

A
  • Pancreatic insuff.
  • Lg, freq, loose foul-smelling stool
  • Fat-soluble (A, D, E, K) vit. deficiency
    • encourage to eat MORE fat
  • Malnutrition/ inability to break down FATS and CHO
85
Q

CF S/S

GU

A
  • Male urogenital abnorms w/ sterility and infertility
    • ​tubes blocked up w/ mucus EVERYWHERE
86
Q

CF S/S

Musculoskeletal

A
  • myalgia
  • osteoporosis/penia
  • mm wasting
87
Q

WHO does CF Affect?

A
  • Caucasians
  • Equal gender prev.
  • >5% pop. carries single copy of genetic mutation
88
Q

CF

Pathophysiology

What is the CFTR Gene?

A

CF Transmembrane Conductance Regulator Protein

  • gene loc’d on chromosome 7 that creates abnorms in CFTR PRO
    • ​this CFTR PRO usually provides a channel by which Na+/Cl- can pass thru epithelial cells
  • SO…gene mutations cause lack of (or malformed) CFTR
89
Q

What is another good way to remember the CFTR PRO?

A

Where sodium goes, H2O follows!!!

Na + Cl live together

*w/ malformed CFTR PRO—> now mucus cannot get hydrated (to thin out)==> Thicccc mucus that cannot get coughed out!!!

90
Q

CF causes an impermeability of ______ to _______

A

Impermeability of Epithelial cells to Chloride

91
Q

One of the results of impermeability of epithelial cells to chloride results in:

Inc’d viscosity of the mucus glands normal lung secretions:

This now results in?

A
  • Inc’d viscosity of the mucus glands normal lung secretions: ​
    • Impaired cilia function
    • bronchial obstruction by lg mucus
    • Hyperinflation
    • atelectasis
      • ​collapsed alveoli
    • chronic infections
    • SEVERE: bronchiectasis and fibrosis
92
Q

2 other things that Impermeability of the epithelial cells to Chloride results in?

A
  1. Elevation of sodium chloride in sweat
  2. Inc’d viscosity of pancreatic enzymes secretion from the pancreas leading to pancreatic insufficiency
93
Q

CF

Phys. Exam

How are they Dx this?

A
  • Dx tests
    • New born screen==> CFTR mutation screen
    • Sweat test==> elevated chloride lvls
      • >/= 60 mEq/L
    • Radiographs
    • PFTs
    • ABGs
94
Q

CF

Medical Mgmt:

A
  • Guidelines CF Care
  • Goals==>
    • ​Control lung infection
    • Promote mucus clearance
    • Improve nutritional stat.
  • Look 4 pulm infections
  • Pancreatic stat. + nutritional supp.
95
Q

CF

Prognosis

A

DRAMATIC INC in median age survival

2015: was 40yo

96
Q

S/S acute pulm exacerbation

A

see chart

Everything you would expect BUT

inc’d temp is interesting—-low grade rise in temp

inc’d WBC–fighting something

DEC FEV1== typ. OLD

97
Q

How can we prevent CF?

A
  • Genetic counseling
    • remember CFTR PRO
  • Screen for CF carrier status
98
Q

CF

Implications for PT Tx?

A
  • secretion clearance tech’s
  • controlled breathing ex’s
  • Exercise!!! Strength training!!!
  • Inspiratory mm training
  • Thoracic stretch ex’s
  • Postural re-ed***
99
Q

W/ Asthma

Greek word for what???

A

Panting

100
Q

MOST common OLD

A

Asthma

101
Q

is Asthma reversible??

A

YES!!!

102
Q

Asthma

What is it?

A

Reversible, Chronic inflamm. disorder of airways

103
Q

Asthma is the abnormal accumulation of???

6 things (think WBC’s)

A
  1. Eosinophils
  2. lymphocytes
  3. mast cells
    1. produce histamine
  4. macrophages
    1. eat/engulf antigens
  5. dendritic cells
  6. myofibroblasts
104
Q

Many causes for Asthma

A
  • genetic
  • Low/High birth wt
  • Prematurity
  • Maternal smoking
  • Paternal smoking in household
  • obesity
  • High intake of Salt***** INTERESTING!!!
  • Extremely sterile environments

***Asthma comes from Trigger

***Everyone has ability to develop asthma

105
Q

Triggers + Asthma?

A

viral/allergen

Exercise

inhalation cold air

106
Q

Disorders common in COPD:

Asthma

A

NOTE:

  • Edema of resp. mucosa and excess. mucus prod. obstruct airways
  • hyperinflation alveoli
107
Q

Asthma

Sx’s

A
  • Recurrent episodic OLD
  • Wheezing
  • chest tightness
  • SOB
108
Q

Asthma

Physical Exam:

A

Do ALL of this @ Baseline

  • Dx tests:
    • ​PFTs to eval current function AND any reversibility of airway obstruction AFTER bronchodilator admin’d
  • Look for special types asthma:
    • ​seasonal
    • ex-induced
    • asthmatic bronchitis
  • Allergy test
109
Q

Asthma

Medical Mgmt

If JUST asthma

A

START w/ Steroid, THEN shift to Bronchodilators

110
Q

Asthma

Medical Mgmt:

If COPD

A

START w/ Bronchodilator THEN steroids

111
Q

Asthma

Medical Mgmt

A
  • Emphasize long-term control
  • Obj. measures to assess function and monitor!
  • ID and Eliminate causes
  • Comprehensive pharmacological tx
  • therapeutic partnership
112
Q

Asthma

Prognosis

How many who have it as kids will have it as adults ?

A

50% who have childhood asthma continue to have sx’s in adulthood

113
Q

Asthma

Clinical Features BEFORE Tx

see chart

A

Step 1: Mild Intermittent

Step 2: Mild Persistent

Step 3: Moderate Persistent

Step 4: Severe Persistent

114
Q

when would you use a Peak-Flow meter for asthma?

A

During asthma attack

115
Q

Asthma

Implications for PT Tx

What do you need to remember about this????

A

Interventions SHOULD NOT begin until medication regime is established

116
Q

Interventions SHOULD NOT begin until medication regime is established w/________

A

Asthma !!!

117
Q

Asthma

Implications for PT Tx

A

DO NOT begin until medication regime established!!!

  • Secretion clearance
  • controlled breathing
  • exercise!! strength!!!
  • thoracic stretching
  • Postural re-ed
  • assist w/ prevention planning

***ASK: how long using rescue inhaler? do you NEED it? OR uneducated HOW to use it?

118
Q
A

CardioPulmoaryPT1 (12 decks)

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