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Canadian Exam > CardioRespiratory > Flashcards

CardioRespiratory Flashcards

1
Q

What are the physical examinations?

A

inspection, palpation, percussion, auscultation

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2
Q

What 5 things should you inspect?

A

vital signs, mechanism of ventilation, thoracic shape, head/neck/extremities, speech/cough/sputum

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3
Q

What are the 4 vital signs?

A

HR, RR, BP, SPO2

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4
Q

How to take HR, and what to note

A

radial artery with index and middle finger. Ask patient to be quiet and count for 15 secs and multiply by 4. Note rate, rhythm, and strength of pulse

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5
Q

Different HR?

A

bradycardia: <60bpm, normal: 60-100bpm, tachycardia: >100bpm

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6
Q

Rhythms

A

normal: regular consistent pattern, irregular: irregular but consistent pattern (bigeminy, trigemini), irregularly irregular: irregular but inconsistent pattern (atrial fibrillation)

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7
Q

How to measure RR and the wording for too high, normal, and too low?

A

Do it without the patient knowing. Bradypnea (less than 12), eupnea (12-20), tachypnea (greater than 20)

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8
Q

Normal RR for an adult?

A

12-20

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9
Q

normal RR for adolescent?

A

16-20

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10
Q

normal RR for child

A

20-30

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11
Q

normal RR for toddler (2yr)

A

25-32

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12
Q

normal RR for infant (6month)

A

30-40

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13
Q

normal newborn RR

A

35-40

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14
Q

How to take blood pressure?

A

upright seated, left arm supported at heart level, palpate brachial artery and place cuff 1 inch above that. stethoscope under cuff and on pulse and ask patient to be quiet. inflate until pulse is gone then add an extra 20 mmHg, Deflate slowly. Systolic BP is first noise, diastolic is when gone.

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15
Q

BP values

A

hypotension : <90/60.
normal: 120/80
hypertension: >140/90
orthostatic hypotension (SBP drops by 20 from lying to upright)

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16
Q

Considerations for taking BP measurements

A

Ensure cuff size is approx 80% of arm
too large= underestimate BP
too small= overestimate BP

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17
Q

Locations for SPO2 reading

A

finger or ear lobe

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18
Q

Normal value for SPO2 and when to require supplemental O2

A

Normal is 95-100%, below 90% warrants further investigation.

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19
Q

What is the normal breathing pattern? Percentage diaphragmatic vs costal?

A

> 70% diaphragmatic and <30% costal. 0% shoulders

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20
Q

What are signs of distress or increased metabolic demand?

A

apical, paradoxical, flail chest, use of abs to actively expire

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21
Q

Ratio of inspiration: expiration in normal, obstructive and restrictive diseases

A

normal- 1:2
obstructive- 1:3(or more)
restrictive- 1:1

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22
Q

What are the threee areas of mechanisms of ventilation to be aware of?

A

breathing pattern, ratio of inspiration:expiration, and depth (normal v shallow)

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23
Q

What are 4 abnomral thoracic shapes that can affect mechanics of ventilation and V/Q matching?

A

funnel chest (pectus excavatum), pigeon chest (pectus carinatum), kyphoscoliosis, barrel chest (AP:lateral = 1:1)

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24
Q

What to look for in the head? (3)

A

colour, cyanosis, nasal flaring

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25
Q

What to look for in the neck? (2)

A

accessory muscle use, jugular venous distension

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26
Q

What to look for in the extremities? (5)

A

capillary refill, clubbing, colour, edema, muscle wasting

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27
Q

What is a clubbing sign in fingers?

A

Schamroth’s Sign. put index fingers together and if there is a gapping (or no diamond window) then clubbing is present. A clubbed finger has a >180 degree bend.

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28
Q

4 things to analyze with coughs?

A

effective (strength), productive, presistent (freq), wet or dry

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29
Q

Sputum characteristics (4)

A

quantity, colour, consistency, odour

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30
Q

what does clear sputum indicate?

A

saliva

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31
Q

what does white sputum indicate?

A

normal (perhaps asthma)

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32
Q

what does yellow sputum indicate?

A

mucopurulent: infected (chronic bronchitis, cystic fibrosis, pneumonia)

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33
Q

what does green sputum indicate?

A

purulent (emphysema, advanced pneumonia, bronchiectasis, lung abscess)

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34
Q

what does brown flecks sputum indicate?

A

carbon particles (smoker, smoke inhalation)

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35
Q

what does pink (frothy) sputum indicate?

A

pulmonary edema

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36
Q

what does frank blood sputum indicate?

A

hemoptysis (tb, lung cancer, pulmonary infarction)

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37
Q

What are 6 things to palpate for during respiratory examination?

A

chest wall expansion, diaphragmatic excursion, edema, pain and crepitus, tracheal positioning, tactile fremitus

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38
Q

What are the two methods for assessing chest wall expansion?

A

manual method or circumferential method

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39
Q

what is the manual method for assessing chest wall expansion?

A

hands on and assessing for symmetry and amount of movements in 3 areas (upper lobes @ sterno-costal, middle lobes/ lingual @ verebro-costal, and lower lobes @lateral costal)

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40
Q

What is the circumferential method for assessing chest wall expansion?

A

using a measuring tape and comparing full inspiration vs full exhalation. Measure @ axilla or 10th rib. Take 3 measurements and record best 3.

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41
Q

What are the 3 methods for assessing diaphragmatic excursion?

A

Manual method, circumferential method, and diaphragmatic percussions

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42
Q

what is the manual method for assessing diaphragmatic excursion?

A

hand placed on the apex of belly during inspiration

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43
Q

what is the circumferential method for assessing diaphragmatic excursion?

A

place tape at level of apex of belly and instruct patient to first exhale and then maximally inhale

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44
Q

What are two things to assess with edema?

A

Pitting vs non-pitting and the level (how far up does it extend)

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45
Q

What are 4 possible conditions that may cause respiratory edema?

A

right-sided heart failure, pregnancy, lymphedema, systemic diseases

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46
Q

What would pain indicate when doing a respiratory examination?

A

palpation producing pain could aid in differentiating between angina due to an organic nature or musculoskeletal pain.

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47
Q

What is crepitus in the respiratory area and what does it indicate?

A

it is when air bubbles are trapped in the subcutaneous tissue and a crackling sensation can be palpated (known as subcutaneous emphysema).
Possibly caused by air leak from chest tube, trauma, pneumothorax

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48
Q

Where should the trachea be located?

A

between the sterno-costal joints

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49
Q

What would increase and decrease in lung volume or pressure do to tracheal positioning respectively?

A

increase volume/ pressure pushes mediastinum away (pneumothorax, pleural effusion, tumor/mass). Decrease volume/pressure shofts mediastinum ipsilateral (atelectasis, pleural fibrosis, pneumonectomy)

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50
Q

What is the mediastinum?

A

The mediastinum is an area found in the midline of the thoracic cavity , that is surrounded by the left and right pleural sacs. It is divided into the superior and inferior mediastinum, of which the latter is larger.

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51
Q

What is tactile fremitus? How do you perform it?

A

palpable vibration of the chest wall that results from the transmission of sound vibrations through the lung tissue to the chest wall. Therapists uses palm of hand to feel for vibrations from sound transmitted when a patient repeats loudly “99”

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52
Q

What does an increase in sound transmission mean when performing tactile fremitus?

A

more dense tissue (ie. pneumonia)

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53
Q

What does a decrease in sound transmission mean when performing tactile fremitus?

A

less dense tissue (ie. pleural effusion, pneumothorax)

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54
Q

What are the two types of percussion you can do?

A

diagnostic percussion and diaphragmatic percussion

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55
Q

what is the purpose diagnostic percussion?

A

to determine the density if the underlying tissue. Can detect abnormalities up to 5 cm in depth.

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56
Q

What tissues will alter ability to perform diagnostic?

A

SUBCUTANEOUS FAT

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57
Q

how do you perform diagnostic percussion?

A

place the finger of a hand with an extended DIP directly on the chest wall with firm pressure
Strike the DIP of the hand placed on the chest wall with the tip of the middle finger of the other
hand
Motion comes with quick snap of the wrist
Perform 2-3 strikes
Best performed on exposed skin (use proper draping)

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58
Q

What are the 3 percussion sounds you could hear?

A

resonant, dull, hyperresonant (tympanic)

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59
Q

What does resonant percussion sound mean?

A

normal aerated lung tissue (air:tissue ratio normal) over normal lung tissue

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60
Q

What does a dull percussion sound mean?

A

non-aerated lung tissue (air:tissue ratio below normal). could be atelectasis, pneumonia, over organs, tumor.

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61
Q

What does hyperresonant (tympanic) percussion sound mean?

A

hyperinflated lung (air:tissue ratio above normal) (COPD, pneumothorax, over empty stomach)

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62
Q

How do you perform diaphragmatic excursion?

A

Performed with patient in sitting
Ensure patient knows how to use diaphragm (if not, educate)
Patient is asked to maximallyexhale and hold as therapist percusses down the same
side of the chest wall (posteriorly) Therapist makes a marking when a dull sound is
heard (diaphragm)
Patient is asked to maximally inhale and hold as therapist percusses down one side of
the chest wall (posteriorly) from the point of the last marking. Therapist makes a
marking when a dull sound is heard (diaphragm)
Normal-3-5cm difference. D E with hyperinflation +other conditions
Note: Diaphragm sits higher on Right than Left

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63
Q

what are the normal breathing sounds?

A

vesicular, bronchial, bronchovesicular.

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64
Q

what are the abnormal breath sounds?

A

crackles, wheezes, pleural friction rub, stridor?

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65
Q

What is a vesicular breath sound?

A

Soft and low-pitched
Heard over peripheral lungtissue (i.e. entire lung except for anterior
and posterior areas over trachea and main stem bronchi) Indicates normal lung.
I:E = 3:1

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66
Q

What is a bronchovesicular breath sound?

A

Mixture of bronchial and vesicular :E = 1:1

Inspiration is soft, low-pitched Exhalation is loud, high-pitched

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67
Q

What is a bronchial breath sound?

A

Loud, high-pitched, hollow quallty Louder on exhalation
I:E = 1:1 or 1:2
Distinct pause between I and E Heard over trachea and manubrium

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68
Q

What is a crackles (rales) breath sound?

A

short, explosive

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69
Q

What are the classifications of crackles?

A

timing: inspiratory vs expiratory
quality: coarse vs. fine
coarse: usually sputum/secretions
fine: usually fluid (ie. pulmonary edema), also heard in atelectasis and fibrosis.

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70
Q

what is a wheeze (rhonchi) breath sound?

A

musical, can be affected by coughing.

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71
Q

What are the classifications of wheezes?

A

pitch: high vs low
timing: inspiratory vs. expiratory
duration: short or long
notes: monophasic vs polyphonic

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72
Q

What is a pleural friction rub (extrapulmonary sound)?

A

Long, low-pitched, leathery creaking sound
Produced by frictional resistance between layers
Pain may be associated with a pleural friction rub.
May be confused with pericardial rub from heart. To differentiate ask patient to hold their
breath. If rub sound persists then it is a pericardial rub. If rub sound disappears, it is a pleural friction rub.

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73
Q

What is a stridor breathe sound?

A

Loud, musical, high-constant pitch
Audible from a distance without stethoscope
Most prominent during inspiration
Due to turbulent air flow (upper airway obstruction or narrowed airways)

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74
Q

What are the 3 voice sounds techniques?

A

egophony, whispered pectoriloquy, bronchophony

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75
Q

How do you perform egophony voice sounds test?

A

ask the patient to repeat “E” as you auscultate, if you hear “A” it is an indication of consolidation (mucous or lung tissue)

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76
Q

How do you perform whispered pectoriloquy voice sounds test?

A

whispered words change from muffled over normal lung tissue to clear(er) over areas of consolidation

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77
Q

How do you perform bronchophony voice sounds test?

A

increased intensity and clarity of vocal resonance indicated consolidation

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78
Q

What are the 4 categories of pulmonary function tests?

A

volume, capacity, flow, diffusion studies, respiratory muscle strength

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79
Q

What is tidal volume?

A

the volume of air inhaled or exhaled during a single breath in a resting state (normal quiet breathing)

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80
Q

What is inspiratory reserve volume (IRV)?

A

the max amount of air inhaled following a normal inspiration

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81
Q

What is expiratory reserve volume (ERV)?

A

the max amount of air that can exhaled after a normal exhalation

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82
Q

what is the residual volume?

A

the volume of air remaining in the lungs at the end of maximum expiration (can’t exhale it)

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83
Q

What does a decreased tidal volume indicate?

A

restrictive disease, lung cancer, atelectasis, msk impariment

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84
Q

What does increase residual volume indicate?

A

obstructive disease

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85
Q

what does decreased residual volume indicate?

A

restrictive disease, lung cancer, atelectasis, msk impairment

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86
Q

what does increased inspiratory reserve volume indicate?

A

obstructive disease

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87
Q

what does decreased inspiratory reserve volume indicate?

A

restrictive disease

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88
Q

what does decreased expiratory reserve volume indicate?

A

pleural effusion, pneumothorax, ascities

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89
Q

what are the four lung capacities?

A

total lung volume, vital capacity, inspiratory capacity, functional residual capacity

90
Q

Define total lung volume and what does it consist of?

A

the volume of gas in the lungs at the end of maximum inspiration.

TLC= VT+IRV+ERV+RV

91
Q

Define vital capacity and what does it consist of?

A

the maximum amount of gas that can be expired from the lungs following a maximum inspiration

92
Q

Define inspiratory capacity and what does it consist of?

A

the maximum amount of gas that can be inspired from the resting expiratory level

93
Q

Define functional residual capacity and what does it consist of?

A

the amount of gas remaining in the lungs at the resting expiratory level.

94
Q

Differential diagnosis of capacities regarding obstructive and restrictive lung disease?

A

decreased capacity= restrictive
increased capacity= obstructive

95
Q

What is forced vital capacity?

A

the total volume of air that can be expired after a maximal inhalation (independednt of time)

96
Q

What is forced expiratory volume

A

the maximum voume of air that can be expired from maximal inhalation in x seconds

97
Q

What is FEV1/FVC%?

A

the percent of FVC that can be expired in 1 second
<70% = obstructive disease

98
Q

Obstructive values: FVC, FEV1, and FEV1/FVC (%)?

A

FVC: normal or low
FEV1: low
FEV1/ FVC: low

99
Q

Restrictive values: FVC, FEV1, and FEV1/FVC (%)?

A

FVC: low
FEV1: normal or low
FEV1/ FVC: normal or high

100
Q

What are diffusion capacity of Carbon Monoxide (DLCO)?

A

tests which measure the functioning gas exchange from the lungs (alveoli) to the blood (pulmonary capillary bed)

101
Q

What are the problems associated with low DLCO?

A

could be a problem wth pulmonary or circulatory system (ex emphysema, fibrosis, anemia)

102
Q

What are the problems associated with high DLCO?

A

problem with circulatory, but not pulmonary.

103
Q

What are the two tests that assess respiratory muscle strength>

A

maximal inspiratory pressure (MIP)
maximal expiratory pressure (MEP)

104
Q

What is the maximal inspiratory pressure (MIP)?

A

patient attempts a maximal inspiratory effort through a blocked mouthpiece.
a patients MIP reflects the strength of the patient’s inspiratory muscles

105
Q

What is the maximal expiratory pressure (MEP)?

A

patient attempts a maximal forced expiratory effort through a blocked mouthpiece after a full inhalation
a patients MEP reflects the strength of the patient’s expiratory muscles

106
Q

Arterial Blood Gas test

A

a test used to measure amount of arterial gases (eg. oxygen, carbon dioxide) and acidity (pH) of arterial blood.

107
Q

pH

A

normal: 7.35-7.45
a measure of the hydrogen ion concentration in the blood which indicates the alkalinity or acidity of the blood

108
Q

PaCO2

A

normal: 35-45mmHg

109
Q

respiratory acidosis

A

low pH and high PaCO2.

patient hypOventilating leads to increase PaCO2 (>45 mmHg)

110
Q

respiratory alkalosis

A

high pH and low PaCO2.

patient hypERventilating leads to decrease PaCO2 (<35mmHg)

111
Q

HCO3

A

22-26 mEq/L

112
Q

metabolic alkalosis (HCO3)

A

high pH and high HCO3 (>26 mEq/L)

113
Q

metabolic acidosis (HCO3)

A

low pH and low HCO3 (< 22 mEq/L)

114
Q

PaO2

A

80-100 mmHg

115
Q

Mild, moderate, severe hypoxemia

A

mild- 60-80 mmHg
moderate- 40-60mmHg
severe- <40mmHg

116
Q

ABG compensation- uncompensated

A

the pH level is abnormal, with one component (PaCO3 or HCO3) abnormal and the other normal

117
Q

ABG compensation- partially compensated

A

the pH is abnormal, with the other compnent (PaCO3 or HCO3) also being abnormal

118
Q

ABG compensation- compensated

A

the pH is normal, the other component (PaCO3 or HCO3) also being normal

119
Q

Interpreting ABGs

A

1) is the pH acidotic, alkalotic, normal?
2) is the PaCO2 acidotic, alkalotic, normal?
3) is the HCO3 acidotic, alkalotic, normal?
4) is it compensated, partially compensated or uncompensated

120
Q

Obstructive lung disease

A

respiratory disorder(s) characterized by increased airway resistance and obstruction affecting expiratory airflow.

  • including chronic bronchitis, emphysema, asthma, bronchiectasis
121
Q

airway obstruction will lead to

A

decreased forced expiratory flow rates: FEV1, FEV1/FVC, FEF 25-75%, PEFR
increased air trappin (static volume): RV, TLC, FRC

122
Q

etiology of
Obstructive lung disease

A

smoking, air pollution, genetics (alpha-1 antitrypsin deficency), infection, aging, allergy

123
Q

Chronic Bronchitis

A

productive cough on most days for 3 months/year for 2 consecutive years (provided other conditions have been ruled out)

124
Q

Chronic Bronchitis: Pathophysiology

A
  • hypertrophy + hyperplasia of mucous glands and goblet cells (Increased mucus)
  • decreased number of cilia (secretion retention)
  • chronic inflammatory changes in bronchial walls
  • decreased gas exchange (d/t formation of misshapen and large alveolar sacs)
125
Q

Chronic Bronchitis: etiology

A

long term irritation of tracheobronchial tree (1. smoking, 2. pollution)

126
Q

Chronic Bronchitis: clinical presentation- inspection

A
  • obese and cyanotic “blue bloater”
  • mucus colour can be white, yellow, or green
  • possible increase JVP and ankle edema (CB commonly associated with RHF)
127
Q

Chronic Bronchitis: clinical presentation- palpation

A

tactile fremitus: decreased in areas of air trapping, increased in areas of secretion retention

128
Q

Chronic Bronchitis: clinical presentation- percussion

A

hyper-resonant over areas of air trapping, dull over areas of secretion retnetion

129
Q

Chronic Bronchitis: clinical presentation- auscultation

A

decreased BS, early inspiratory wet crackles, possible wheezing

130
Q

Chronic Bronchitis: clinical presentation- ABGs

A

large decreased PaO2, increased PaCO2

131
Q

Chronic Bronchitis: clinical presentation- CXR

A

cardiomegaly, white haziness

132
Q

Emphysema

A

enlargement of the airway distal to the terminal bronchioles, accompanied by destruction of their walls

133
Q

Types of emphysema and explain

A

centrilobar (more common)
- affects respiratory bronchioles
- M>f
- rare among non-smokers
- commonly found in patients with chronic bronchitis

Panlobar
- affects terminal and respiratory bronchioles
- due to alpha-antitrypsin deficiency

134
Q

Emphysema: pathophysiology

A
  • bullae may be found in these patients
  • develops from an obstruction of the air flow during expiration
  • leads to hyperventilation -> destruction of alveolar walls -> decreased elastic recoil, increased dead space, decreased gas exchange (alveloar walls rupture and alveolar capillaries are destroyed)
135
Q

Emphysema: etiology

A

smoking, pollution, alpha-antitrypsin deficency

136
Q

Emphysema: clinical presentation- inspection

A
  • thin and wasted “pink puffer”
  • barrel chest
  • I:E ratio prolonged (1:3 or longer exhalation)
  • pused lip breathing
  • increased accessory respiratory muscle use (30% diaphram, 70% accessory muscles)
  • other signs of respiratory distress (eg leaning over with hand on knees to unload thorax)
137
Q

Emphysema: clinical presentation- palpation

A
  • tactile fremitus: decreased
  • chest wall expansion: decreased
138
Q

Emphysema: clinical presentation- percussion

A

hyoer-resonant

139
Q

Emphysema: clinical presentation- ascultation

A
  • decreased BS, may have dry crackles
140
Q

Emphysema: clinical presentation- ABGs

A

decreased PaO2 (moderate hypoxemia), normal or increased PaCO2

141
Q

Emphysema: clinical presentation- CXR

A
  • increased black area ( hyperinflated + decreased lung tissue)
  • flattened diaphram (hyperinflated)
  • flattened ribs (no angles)
  • narrow mediastinum (thin elongated heart)
142
Q

Asthma

A

chronic inflammatory condition of the airways characterized by hyper-responsiveness of the airways (trachea and bronchi) to various stimuli which results in narrowing of the airways

143
Q

Asthma- pathophysiology (acute attack)

A
  • decreased threshold of airway smooth muscle reactivity
  • leads to bronchospasm, bronchial wall edema, and inflammation, and increased secretions within the lumen of the airways
  • narrow arways increase airway resistance (both in and out)
144
Q

Asthma- etiology

A

unknown

145
Q

What factors can trigger intrinsic asthma (idiopathic)?

A

-drugs eg aspirin
- exercise-induced asthma (EIA)
- inhaled irritants eg smoke, pollution, chemicals
- repiratoru infectins eg common cold
- stress (emotions)
- weather eg humidity, cold air

146
Q

What factors can trigger extrinsic asthma (allergic)?

A
  • animals
  • dust
  • feathers
  • food
  • mold
  • pollen
147
Q

Clinical presentation (during attack only) of asthma?

A

PFT pre and post bronchodilators shows significant improvements
reports of “chest tightness” and dyspnea

148
Q

Asthma: clinical presentation- inspection

A

increased accessory respiratory muscle use
other signs of respiratory distress

149
Q

Asthma: clinical presentation- palpation

A

tactile fremitus: decreased
chest wall excursion : decreased (d/t air trapping)

150
Q

Asthma: clinical presentation- percussion

A

hyper-resonant

151
Q

Asthma: clinical presentation- auscultation

A

decreased BS, wheezing, possible crackles

152
Q

Asthma: clinical presentation- ABGs

A

decreased PaO2, increased PaCO2 in severe cases, decreased pH (respiratory acidosis)

153
Q

Bronchiectasis

A
  • irreversible, abnormal dilation of medium-sized bronchi and bronchioles resulting in airflow.
  • commonly associated with chronic inflammation and infection within these airways
  • considered an extreme form of chronic bronchitis
154
Q

Bronchiectasis- Pathophysiology

A
  • destruction of bronchial wall causing permanent dilation of airways
  • ciliated walls replaced by non-ciliated, mucus-secreting cells
  • pooling of infected secretions leading to recurrent infections
  • may cause atelectasis distal to obstruction
155
Q

Bronchiectasis- Etiology

A
  • post infection (most common: necrotizing bacterial pneumonia)
  • congenital disorder (eg cystic fibrosis, cilary defect, airway defects)
  • bronchial obstruction (eg aspiration, cancer)
  • other (eg. connective tissue diseases, systemic disorders, immunodeficiencies, idiopathic).
156
Q

Bronchiectasis: clinical presentation- inspection

A
  • thin and fatigued
  • clubbing
  • increased accessory respiratory muscle use
  • other signs of respiratory distress
  • severe cough
  • increased ++ mucus (foul-smelling, purulent, may contain blood)
157
Q

Bronchiectasis: clinical presentation- palpation

A
  • tactile fremitus: depends on specific lung changes present
  • chest wall excursion : decreased (d/t air trapping)
158
Q

Bronchiectasis: clinical presentation- percussion

A

depends on specific lung changes present

159
Q

Bronchiectasis: clinical presentation- CXR

A
  • dilated airways (seen in varicose or cystic type)
  • dark lung fields in areas of trapping
  • flattened diaphragm
  • may or may not see areas of consolidation or atelectasis
  • high resolution CT is more commonly used to help diagnose bronchiectasis.
160
Q

Restrictive lung diseases

A
  • parenchymal diseases
  • pleural diseases
  • chest wall diseases
  • neuromuscular disorders
161
Q

Explain what restrictive lung disease is?

A

diseases that restrict the lung from expanding fully.
decrease in compliance -> decrease negative pressure -> decreased air entry

162
Q

What are parachymal diseases?

A

interstitial pulmonary fibrosis
sarcoidosis
atelectasis
ARDs

163
Q

What is interstitial pulmonary fibrosis?

A

thickening of the interstitium of the avelolar walls which progress to fibrosis or scarring

164
Q

Interstitial pulmonary fibrosis- pathophyiology

A

decreased lung compliance
increased elastic recoil
increased fibroblasys results in increased collagen leading to fibrosis or scarring
decreased diffusion capacity

165
Q

Interstitial pulmonary fibrosis- etiology

A

idiopathic (most common)
enviromental exposure to inorganic dust, toxic gases, and certain drugs
there may be genetic factor
some connective tissue disorders are disorders are associated with IPF eg RA

166
Q

Interstitial pulmonary fibrosis: clinical presentation- inspection

A

-dyspnea
-increased RR and shallow breathing (tachypneic breathing)
- dry unproducitve cough
- clubbing
- cyanosis
- decreased chest expansion

167
Q

Interstitial pulmonary fibrosis: clinical presentation- palpation

A

tactile fremitus: increased

168
Q

Interstitial pulmonary fibrosis: clinical presentation- percussion

A

dull

169
Q

Interstitial pulmonary fibrosis: clinical presentation- auscultation

A

late fine inspiratory crackles

170
Q

Interstitial pulmonary fibrosis: clinical presentation- ABGs

A

decreased PaCO2 and PaCO2

171
Q

Interstitial pulmonary fibrosis: clinical presentation- CXR

A

small contracted lungs
raised diaphram
diffuse reticular markings (mainly in lower lobes)
High resolution CT is more commonly used to help assess the severity of IPF.

172
Q

What is sarcoidosis?

A

a disease involving granuloma development in the lungs, skin, lymph nodes and other organs

173
Q

What is Atelectasis?

A

Collapse of alveoli or lung tissue
- can be sub-segmental, segmental or lobar distribution

174
Q

What is the Pathology/ etiology of atelectasis?

A
  • obstruction (eg. mucus plug, tumor, foreing body)
  • decreased nitrogen
  • decreased surfactant (increased surface tension)
  • compression
  • hyperventilation
  • hypoventilation
175
Q

Clinical presentation of ATELECTASIS:
Inspection
palpation
percussion
auscultation
ABGS
CXR

A

Inspection
- dyspnea, cyanosis, increased RR and shallow breathing (tachypneic breathing)

palpation
- tactile fremitus and chest wall expansion (on effected side) decreased

percussion
- dull directly over compressed tissue

auscultation
- decreased BS or absent, fine inspiratory crackles

ABGS
- decreased PaO2

CXR
- ipsilateral shift of mediastinum, increased density in area of atelectasis, elevated hemi-diaphram (tenting)

176
Q

order of doning PPE

A

sanitize, gown, mask, eye protection, gloves

177
Q

order of doffing PPE

A

gloves, gown, sanitize, goggles, mask, sanitize

178
Q

contact precaution

A

MRSA, VRE, ESBL, C-Diff, Norovirus, uncontained drainage/ diarrhea

179
Q

droplet precautions

A

mumps
rubella
pertussis (whooping contact)
influenza (droplet and contact)
pheumonia (droplet and contact)
meningitis
acute respiratory illness

180
Q

airbornne precautions

A

TB
Disseminated shingles
measles
severe acute respiratory syndrome
varicella

181
Q

pneumonectomy

A

removal of a lung

182
Q

lobectomy

A

removal of a lung lobe

183
Q

segmental resection

A

removal of a segment of a lobe

184
Q

wedge resection

A

removal of a portion of a lung

185
Q

lung volume reduction surgery or bullectomy

A

removal of large emphysematous tissue

186
Q

Thoracotomy- where? Muscles incissed? Postioning?

A

4th intercostal space
lats, SA, ext/int intercostals, traps, rhomboids
can techincally lie on either side, if pneumonectomy then dont lie on surgical side. Just ensure no kink in tube and not poisitioned about incicions site

187
Q

Thoracotomy- education

A

deep breathing
supportie coughing
line education
scar managment
relaxation
bed mobility
positioning
transfers
early mobilization

188
Q

possible complications of pulmonary surgery

A

aspiration, increase pain, phrenic nerve impairment, actelectasis, ulcers, DVT

189
Q

DVT- S&S

A

leg pain
tenderness
ankle edema
calf swelling
dilated veins
positive Homan’s sign

190
Q

DVT- prevention? What to do if suspected?

A

early mob
ankle pumps
anti-coagulants
graduated compression stockings

if suspected, stop movement

191
Q

sternal incisions (cardiac surgery) healing timeline

A

6-8 weeks to heal

192
Q

sternal incisions (cardiac surgery)- UL limitations

A
  • no pushing
  • no pulling
  • no lifting one arm above 90 deg
  • no hand behind back
  • no driving for 4 weeks
  • no lifiting >10 lbs
193
Q

Explain Mechanical Ventilation

A

machine to assist mvmt of air
negative or positive pressure (only positive used commonly)
invasive (endotrachotube or tracheostomy)
non-invasive (nasal mask, complete face mask)

194
Q

When is mechanical venitaltion used?

A

severe hypoventialtion, hypoxia, hypoexemia
central depression
decrease WOB and respiratory muscle fatigue
poor pulmonary hygiene (clearance)

195
Q

Complications of mechanication ventialtion

A

barotrauma (alveolar rupture)
volutrauma (alveolar distension)
ventilator acquired pneumonia (VAP)
diaphragm atrophy
hemodynamic compromise

196
Q

Types of mechanical ventilation

A

mandatory (total control)
- continous mandatory venilation; invasive

assisted
- assisted control ventialtion; invasive

spontaneous
- synchronized intermittent mandatory ventilation; invasive
- continuous positive airway pressure; non-invasive or invasive

197
Q

What are the two ventilators adjucts

A

PEEP (positive end expiratory pressure)- helps give an end boost to keep alveli open

PSV (pressure support ventilation)- helps with inspriation

198
Q

How to assess weaning?

A

spontaneous breathign trail

199
Q

Why is pre-exercise screening important?

A

identifies whether a patient is at risk of exercise

200
Q

What type of exercise testing can we do as PTs?

A

submaximal testing
- 6 minute walk test
predictive submaximal exercise test
- treadmill tests (modified Bruce protocol)
- cycle ergonometer test

201
Q

FITT Principle: Frequency

A

3-5 times a week

202
Q

FITT Principle: Intensity

A

level of difficulty,

standard intensity ranges 60-85%
high risk ranges 50-75%

could be through a number of ways.

203
Q

How do you calculate target HR

A

max HR (220-age)

Target HR= HR max x % intensity desired (using Borg Scale)

204
Q

What is Borg Scale?

A

Original is 6-20 ( because multiply number by 10 and will result in you HR)

Modified is 0-10 and not as easy to do

205
Q

FITT Principle: Time

A

30-60 for moderate (150 min/week)
20-60 for vogorous (75 min/week)

206
Q

FITT Principle: Type

A

Should be anything aerobic or resitant training

207
Q

FITT Principle: Saftey concerns

A

upper body for those with BP issues should be avoided

208
Q

Cardioresp Intervention

A

Positioning
breathing exercise
airway clearance techniques
forced expiratory techniques
exercises

209
Q

Positioning for V/Q matching

A

unilateral- good lung down
bilateral- prone
pneumonectomy- do not lie with affected side up
ARDS- lie in prone “proning”

210
Q

Position for COPD Dyspnea

A

any position that offloads the ES.

standing against wall, on knees
standing, leaning on table
sitting leaning elbows on table
sitting leaning on table

211
Q

Breathing exercises

A

deep diaphramic breathing
pursed lip breathing for COPD
Inspiratory muscle training
segmental breathing
sustained maximal inspiration

212
Q

airway clearance

A

postural drainage
percussion
vibration
PEP devices
Independent breathing techniques
suctioning

213
Q

postural drainage contra-indications

A

ICP> 200 mmHg
Spinal instability/ surgery/ injury
active hemoptysis
empyema
bronchopleural fistula
pulmonary edema b/c of HF
large pleural effusion
elderly, confused or anxious person
initial rib fractures
surgical wound or healing tissue (initially)
PE
untreated pneumothorax

214
Q

Postural drainage contra-indications for those in Trendelenburg position?

A

ICP increased
uncontrolled hypertension
distended abdomen
esophageal surgery or GERD
recent gross hemoptysis related to recent lung carcinoma
uncontrolled airway at risk for aspiration

215
Q

contraindications for Percussions and Vibrations?

A

severe osteoporosis
rib fracture
pulmonary embolus
pneumothorax
anticoagulation therapy
malignancy
burns/ skin grafts
open wounds
Increased ICP
subcutaneous emphysema
GI bleeding

216
Q

Suction Contraidications

A

severe decrease O2 saturation (<92%)
increased ICP
hemoptysis
malignant arrhythmia
hyperinflation post-CABG and head injury

217
Q

Potential Complications of Suction

A

infection mucosal (tracheal and bronchial) trauma
hypoxia/hypoxemia
hemodynamic instability
laryngospasm/ bronchospasm
altelectasis
pneumothorax
increased ICP
pain
anxiety

218
Q

Ways to limit complications with suctioning

A

infection control measures
hyperoxygenation
hyperinflation
limit suction time (no > 10-15 secs) and time b/w (30 secs)
medication and sedation prior to procedure

219
Q

Four stages of coughing

A

inspiration
glottal closure
compression
expulsion

220
Q
A

Canadian Exam (56 decks)

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