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Exam 2 Flashcards

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1
Q

What are the most common obstructive lung diseases?

A

COPD
Asthma
CF

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2
Q

What are the parts of the upper airway?

A

Nose/mouth
Pharynx
Larynx

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3
Q

What are the parts of the lower airway?

A

Conducting airway

Respiratory unit

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4
Q

What is the function of the pharynx?

A

Digestive and respiratory

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5
Q

What is the function of the larynx?

A

Epiglottis and vocal cords

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6
Q

What is the path of the functioning airway?

A

Trachea to bronchiole

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7
Q

What are the components of the respiratory unit?

A

Alveolar ducts, sacs, and alveoli

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8
Q

What is the parenchyma?

A

Alveolar tissue

Describes any form of lung tissue including bronchioles, bronchi, BV, interstitium, and alveoli

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9
Q

What are the primary mm of inspiration?

A 
#1 diaphragm
#2 Intercostals
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10
Q

What are the accessory mm of inspiration?

A 
Pec major
Scalenes
SCM
UT
LS
Pec minor
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11
Q

What is the primary mm of exhalation?

A

Relaxation of inspiratory mm

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12
Q

What are the accessory mm of exhalation?

A

QL
Internal and external oblique
RA
TrA

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13
Q

Define Total Lung Capacity

A

All volumes together

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14
Q

What is vital capacity?

A

IRV + TV + ERV

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15
Q

Define residual volume?

A

Volume of air remaining in lungs that is not exhaled

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16
Q

Define tidal volume?

A

Amt of air inspired and expired during normal RESTING ventilation

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17
Q

Define inspiratory reserve volume

A

Volume of air that can be inspired when needed but kept in reserve

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18
Q

Define expiratory reserve volume

A

The volume of air that can be exhaled in excess of tidal volume

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19
Q

Define functional residual capacity

A

Volume of air that remain in the lungs at the end of tidal exhalation

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20
Q

What is inspiratory capacity?

A

TV + IRV

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21
Q

Define ventilation

A

Movement of air through the conducting airways

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22
Q

Define forced expiratory volume

A

Volume of air that can be forcefully exhaled during the first second of a forced vital capacity maneuver

Thought to reflect the status of the airways of the lungs 70% or more of FVC

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23
Q

Define max inspiratory pressure

A

Reflects the greatest static inspiratory effort that can be generated from residual volume

Reflects strength of inspiratory mm

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24
Q

Define max sustained inspiratory pressure

A

Test of inspiratory mm endurance

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25
Define arterial oxygenation
Ability of the blood to carry oxygen
26
What is the value of partial pressure?
In room air 95-100 mmHg
27
Define hypoxemia
< 90 mmHg
28
Define hyperoxemia
> 100 mmHg Over inflation, but not as common
29
When is supplemental O2 needed?
When <55-60 mmHg
30
What is the equivalent to PaO2 < 55 mmHg?
SaO2 < 88%
31
Define ventilation
Movement of air
32
Define respiration
Exchange of gases within the body
33
Define alveolar ventilation
Ability to remove CO2 from the pulmonary circulation and maintain pH
34
What does pH indicate?
Free floating H+ ions in the body
35
What is the normal body pH?
Between 7.35-7.45
36
What is the pH of respiratory acidosis?
pH <7.36
37
What is the pH of respiratory alkalosis?
pH > 7.44
38
What does decrease of pH do to the CO2 levels of the body?
Increases PaCO2
39
What does an increase of pH do to CO2 levels?
Decrease PaCO2
40
Define respiratory acidosis
AKA respiratory failure or ventilatory failure When lungs cannot remove enough CO2 produced by the body. Excess CO2 causes pH of blood and other bodily fluids decrease and cause it to be too acidic
41
Define respiratory alkalosis
When levels of CO2 and O2 are not balanced As pH levels rise the CO2 levels will decrease
42
What are sx/sx of respiratory alkalosis?
Breathe too fast or too deep CO2 levels drop too low and pH rises
43
Define hyperventilation
Underlying cause of respiratory alkalosis AKA over-breathing Breathes very deeply and rapidly
44
What affects the distribution of ventilation and perfusion?
Gravity
45
What position is best for ventilation?
Upright: more blood at base of blood and more air will be delivered to the base of the lung (Increase O2 exchange)
46
What receptors assist in adjusting the ventilatory cycle?
Baroreceptors Chemoreceptors Irritant receptors Stretch receptors
47
What components of CNS alter ventilatory mm activation?
Cortex Pons Medulla ANS
48
What does viscosity mean in terms of sputum?
Thickness Greater the viscosity the more involvement of the system
49
What occurs in barrel chest of the thorax?
Enlargement due to decreased elastic recoil and hyperinflation Increase of A-P diameter and kyphosis
50
What occurs during clubbing of fingers?
Widening of DIP jt = perfusion is impaired
51
What sx/sx are often seen in COPD?
``` Pursed lip breathing Hypertrophy Use accessory mm Cyanosis Digital clubbing ```
52
What do normal tracheal and bronchial sounds sound like?
Loud and tubular High pitch noted during inspiration and expiration Pause between inspiration and expiration
53
Define vesicular breath sounds
Normal, soft, low-pitched sounds heard primarily during inspiration During EXPIRATION the soft sound diminishes and is only heard at the beginning Rustling
54
Define adventitious breath sounds
Sounds heard using stethoscope with inspiration and/or expiration Can be continuous/discontinuous
55
Define wheeze
High-pitched and vary duration Usually heard during EXPIRATION, but can be present in inhalation Sign of OBSTRUCTION
56
Define rhonchi
Low-pitched and occur with inspiration AND expiration associated with OBSTRUCTION w/ quality similar to snoring
57
Define stridor
High-pitch wheeze that occur with inspiration AND expiration Indicates upper airway obstruction
58
Define crackle
Sound of "bubbles" or "pops" Represents movement of fluid or secretions during inspiration (wet crackles) or occurs from sudden opening of closed airways (dry crackles)
59
What do diminished breath sounds indicate?
Severe congestion Emphysema Hypoventilation
60
What do absent breath sounds indicate?
Pneumothorax Lung collapse
61
What does a chest x-ray indicate in the pulm system?
Detect presence of abnormal material
62
What does a ventilation perfusion scope indicate?
Matches ventilation pattern of lung to perfusion pattern to ID presence of PULM EMBOLI using radiographic dye
63
What does a fluoroscopy indicate?
Continuous X-ray beam to observe diaphragmatic excursion
64
What is normal PaO2 for infants?
75-80 mmHg
65
What is normal PaCO2 for infants?
34-54 mmHg
66
What is normal pH in infants?
7.26-7.41
67
What is normal tidal volume?
20 mL
68
What is the normal PaO2 level in adults?
80-100 mmHg
69
What is the normal PaCO2 for adults?
35-45 mmHg
70
What is the normal pH for an adult?
7.35-7.45
71
What is the normal tidal volume for an adult?
500 mL
72
What indicates the difference between respiratory and metabolic acidosis/alkalosis?
HCO3 = bicarbonate Normally expelled by lungs
73
What defines an obstructive lung disease?
Airway obstruction that is worse in expiration More force needed to expire a given volume of air or empty lungs slow
74
What is COPD a combination of?
Chronic bronchitis and emphysema
75
What is a major symptom of obstructive pulmonary disease?
Dyspnea and wheezing
76
What occurs to forced expiratory volume in COPD?
Decrease
77
What causes COPD?
Abnormal inflammatory response to noxious stimuli Results in narrowing of airway and destruction of parenchyma Damage leads to pronounced glands and goblet cells and hypertrophy that produce secretions that obstruct airways Airways decreased during expiration Leads to hypoxemia due to poor ventilation and perfusion and eventually hypercapnia (increase CO2 in arterial blood) R ventricular hypertrophy and possible polycythemia (complication of advanced COPD)
78
What are examples of obstructive lung diseases?
Chronic bronchitis Emphysema COPD Asthma CF
79
What is the 4th leading cause of death in the world?
COPD
80
What characteristics are in stage 0 COPD?
Normal spirometry Cough and sputum
81
What are the characteristics of stage 1 COPD?
Mild COPD FEV1/FVC < 70% FEV1 > 80% predicted With or without symptoms
82
What are the characteristics of stage 2 COPD?
Mod COPD FEV1/FVC < 70% 50% < FEV1 < 80% predicted With or without symptoms
83
What are the characteristics of stage 3 COPD?
Severe COPD FEV1/FVC < 70% 30% < FEV1 < 50% predicted With or without symptoms
84
What are the characteristics of stage 4 COPD?
Very severe FEV1/FVC < 70% FEV1 < 30% predicted
85
What are the risk factors of COPD?
Hyperactivity of the airways Overall lung growth Genetics Primary and secondary smoke Occupational exposure Indoor/outdoor pollutants
86
What is asthma?
More intermittent and acute than COPD
87
What factor differentiates asthma from COPD?
Reversible, but cannot be cured
88
How can asthma be categorized?
Chronic Exercise induced Childhood Occupational
89
What is the pathological factor of asthma?
Inflammation resulting in hyperresponsiveness of the airways
90
What events occur in in an acute asthma attack?
Bronchiolar constriction, mucus hypersecretion, and inflammatory swelling
91
What are the clinical manifestations of asthma?
Periods of remission Dyspnea Often severe cough Wheezing exhalation Attacks can last 1-2 hrs and can last up to days or weeks
92
How is asthma managed?
Avoid triggers Pt education Acute attacks treated with corticosteroids and inhaled beta-agonists Chronic management based on severity of asthma and regularly use of inhaled anti-inflammatory meds (IE. Corticosteroids, chromolyn sodium, leukotreine inhibitors) Anti-inflammatory agents has long-term effects
93
What is a common side effect of asthma?
Increase HR
94
What is CF?
Affects excretory glands Secretions thicken Affect pulmonary, pancreatic, hepatic, sinus, and reproductive systems Genetic disease
95
What is the pathophysiology of CF?
Impaired mucociliary transport by altered secretions = obstruction and hyperinflation Sustained neutrophilic inflammation in response to infection Obstruction reduces ventilation to alveolar units Fibrotic changes to parenchyma
96
What are restrictive lung diseases?
Difficulty in expanding lungs and reduction of lung volume
97
What causes restrictive lung disease?
Disease of alveolar parenchyma and/or pleura - Begin with chronic inflammation and thickening of alveoli and interstitium Change in chest wall (fibrosis decreases expansion) Alter NM apparatus of the thorax Reduced pulmonary vascular bed eventually leading to hypoxemia
98
What is the clinical presentation of restrictive lung disease?
Dyspnea Nonproductive cough Weakness and early fatigue Rapid, shallow breathing Limited chest expansion Crackles in lower lungs Digital clubbing Cyanosis Dec VC, FRC, and TLC
99
What is an intra-alveolar bacterial infection?
Pneumoncoccal pneumonia is most common
100
What are the sx/sx of bacterial pneumonia?
Shaking chills Fever Chest pain if pleuritic involvement Productive cough Decrease breath sounds, crackles Tachypnea Increase WBC
101
What is viral pneumonia?
Inflammation of lungs caused by virus
102
What are examples of viral pneumonia?
Influenza Cytomegalovirus Herpes
103
What are sx/sx of viral pneumonia?
Hx of URI Fever Chills Dry cough HA Decrease breath sounds/crackles Hypoxemia and hypercapnea Normal WBC
104
What is aspiration pneumonia?
Aspirated material that causes acute inflammatory rxn within the lungs
105
What are common causes of aspiration pneumonia?
Pt with impaired swallowing, intoxication, NM disease, impaired consciousness, or anesthesia
106
What are the sx/sx of aspiration pneumonia?
Dry cough Dyspnea Tachypnea Tachycardia Cyanosis Wheezes, crackles, decreased breath sounds Chest pain Fever
107
How is TB spread?
Spread by droplets in the air
108
When is TB non-infectious?
2 weeks after being on meds
109
What are the precautions of working with someone who has TB?
Isolation in negative pressure room PPE
110
What are the sx/sx of TB?
Fever Wt loss Cough Enlarged lymph nodes Night sweats Crackles
111
What is pulmonary edema?
Excessive seepage of fluid from the pulmonary vascular system into interstitial space
112
What is cardiogenic pulmonary edema?
Increase pressure in pulm capillaries associated with L ventricular failure, aortic valvular disease, or mitral valve disease
113
What is non-cardiogenic pulmonary edema?
Results from increase permeability of alveolar membranes due to inhalation of toxic fumes or narcotic overdose
114
What are the sx/sx of pulmonary edema?
Crackles Tachypnea Dyspnea Hypoxemia Peripheral edema Cough with pink frothy secretions
115
What is a pulmonary emboli?
Thrombus from veins that gets stuck in pulmonary circulation
116
What are the sx/sx of pulm emboli?
Recent DVT sx Oral contraceptives Sudden SOB Tachycardia Hypoxemia Cyanosis
117
What is atelectasis?
Partial or complete collapsed or airless ALVEOLAR unit caused by HYPOVENTILATION secondary to pain during ventilatory cycle Lack of gas exchange within alveoli, due to alveolar collapse or fluid consolidation
118
What are the sx/sx of atelectasis?
Decrease breath sounds Dyspnea Tachycardia Increased temp
119
What is a possible complication of atelectasis?
Could result in collapse
120
What are Beta-2 agonists?
Mimic SNS Given in inhaler form "Rescue drug"
121
What are anticholinergics?
Inhibit PNS
122
What are side effects of anticholinergics?
Dry mouth and lack of sweating SNS increase
123
What are anti-inflammatory agents for the pulmonary system?
Decrease mucosal edema Decrease inflammation and reduce reactivity IE. Steroids
124
What is a pneumonectomy?
Removal of lung
125
What is a lobectomy?
Removal of lobe
126
What is a segmental resection?
Removal of segment
127
What is an midsternotomy?
Sternum cut in half length wise then ribcage is retracted Wired shut after surgery
128
What does PT work on with someone who had a midsternotomy?
UE ROM
129
What is a thoracotomy?
Incision follows the path of the 4th intercostal space
130
What does PT work on in a pt who had a thoracotomy?
Work on full ROM
131
What is the goal of post-op pulmonary surgery education?
Remove residual secretions Improve aeration Gradual increase of activity Return to baseline pulmonary fxn
132
What should you watch for in a pulmonary post-op pt?
Fever Increase WBC Change in breath sounds Abnormal x-ray Decrease thorax expansion SOB Change in cough/sputum
133
What are the indications for chest PT?
Acute/chronic resp probs Inability to expel pulm secretions Ineffective cough Increased secretions Pneumonia Atelectasis Neuro impairments that cause swallowing difficulties
134
What are the goals of chest PT?
Mobilize secretions Expel secretions Improve breathing patterns Improve ventilation t/o all lobes Improve overall fxn
135
What are common guidelines for chest PT?
Tx should be prior to eating or at least 1 hr post-meal Percuss and vibrate over each segment for at least 3-5 min Cough after each segment that is treated Allow for rest period after each segment is treated Review breathing exercises in each drainage position Tx should not exceed 45-60 min secondary to pt fatigue
136
What is the rib cage mobilization?
In prone or sitting Use thenar eminence to slightly depress ribs Start bottom up or top down
137
What should a percussion sound like?
Hollow sound
138
How long should percussion be performed for?
3-5 min
139
What are the contraindications for percussion?
Over the spine, breastbone, stomach, and lower ribs Over fx Over spinal fusion site Over osteoporotic bone Unstable angina Low platelet count Anticoagulation therapy Pulm emboli
140
What is the goal of postural drainage?
Clear mucus from the 5 lobes of the lungs into larger airways to be coughed out
141
What are the contraindications of postural drainage?
CHF Significant pulm edema Significant pneumothorax Cardiac arrhythmia Hx of recent MI Unstable angina Pulm embolism
142
How long should a session of postural drainage be?
20-40 min
143
What are common guidelines of postural drainage?
Do before meals or 1.5-2 hr after meal Remove tight clothing prior to tx Do not perform on bare skin Therapist should remove rings and jewelry prior to tx Watch body mechanics
144
What are parts of airway clearance techniques?
Cough and huff
145
How to perform a cough after postural drainage tx?
Ask pt to cough in upright position after each lung is tx
146
What is a huff?
Effective for pt with collapsible airways (COPD), prevent high intrathoracic pressure which causes airway closure Ask pt to deeply inhale and immediately, forcibly expel air by saying hah or huffing Assisted cough
147
What is the exercise prescription for the pulmonary patient?
PT perform exercise test Monitor vitals Work at 40-85% THR Increase duration of time to 20 min, then increase intensity Use RPE and/or THR during exercise to monitor performance
148
What are the 3 layers of skin?
Epidermis Dermis Subcutaneous tissues
149
What is the epidermis?
Outermost layer No BV
150
What is the dermis?
Inner layer of collagen and elastin Contains lymphatics, BV, Nn, and Nn endings, sebaceous and sweat glands
151
What is the subcutaneous tissue of the skin?
Innermost layer Loose CT and fat Insulates body
152
What is an acute wound?
Can repair themselves in orderly and timely manner
153
What is a chronic wound?
Cannot repair themselves
154
What are the phases of wound healing?
Inflammation Proliferation Remodeling
155
What occurs immediately when you get a wound?
Coagulation
156
What occurs from days 0-10 days when you get a wound?
Inflammatory process Platelets, neutrophils, and macrophages
157
What occurs from days 3 to 21 when you get a wound?
Proliferative process Macrophages, lymphocytes, fibroblasts, epithelial cells, and endothelial cells
158
What occurs from days 7 days to 2 years?
Remodeling process Fibroblasts
159
What is the composition of a clot?
Fibrin mesh, platelets, and blood cells
160
What is fibrin?
Clotting protein
161
What occurs during the vascular stage of the inflammatory phase?
Hyperemia, edema, warmth, erythema, and discomfort
162
What occurs during the exudate stage of the inflammatory phase?
Serous, purulent, fibrinous, and bleeding Fluid passes into tissues to bring leukocytes for healing
163
What occurs during the reparative stage of the inflammatory phase?
Injured cells are removed via phagocytosis Damaged cells are replaced
164
What occurs during epithelialization?
Cells at edge of wound flatten and change into collagen New BV growth, creation of capillary buds, and formation of granulation tissue
165
What is granulation tissue?
New CT and microscopic BV that form on the surface of a wound during the healing process Typically tissue grows from the base of wound and fills it in
166
What is wound contraction?
New tissue at wound edges Modified fibroblasts Generate strong contractile forces on the wound edges - Myofibroblasts
167
What replaces granulation tissue during the remodeling phase of healing?
Replaced by less vascular tissue
168
What is the definition of an immature scar?
Disorganized collagen fibers
169
What is the definition of mature scar?
Replacement to Type I collagen fibers Organized parallel fibers
170
What type of tissue fills deeper wounds?
Fibrous
171
What is primary intention healing?
Wounds with min tissue loss OR smooth clean edges OR closed with sutures or staples OR superficial partial thickness wounds Direct union
172
What is the secondary intention of healing?
Healing WITHOUT superficial closure Tissue loss or necrosis Irregular margins Diabetes, ischemia, and inflammatory disease Granulation tissue fills the bed Closure via contraction and scar formation Indirect union Fills in and heals from bottom up
173
What is tertiary intention of healing?
AKA delayed primary intention healing Wounds initially left open to address infection, edema, etc Closed later by primary intention methods
174
What type of wounds tend to be more acute?
Traumatic and surgical
175
What type of wounds tend to be more chronic?
Venous Arterial Pressure Dermatologic
176
What does compression interfere with?
Blood supply Leading to vascular insufficiency Tissue anoxia Cell death
177
What are the major contributing factors to pressure ulcers?
Pressure Friction Shear Moisture
178
What are other contributing factors to pressure ulcers?
``` Nutrition Advanced age Thinning skin Decreased blood flow Low BP Psychosocial status Smoking Elevated body temp Poor oxygen perfusion ```
179
What classifies a stage I pressure ulcer?
Skin temp - warm or cool Tissue consistency - firm or boggy Sensation Defined area of persistent redness`
180
What classifies a stage II pressure ulcer?
Partial thickness skin loss Involves epidermis AND dermis Superficial - clinical abrasion, blister, or shallow crater
181
What classifies a stage III pressure ulcer?
Full thickness Damage or necrosis of subcutaneous tissue Not through underlying fascia Deep crater with or without undermining
182
What is the difference between necrosis and gangrene?
Necrosis = tissue death - More black or green Gangrene = tissue death and specifically due to lack of blood supply
183
What classifies a stage IV pressure ulcer?
Full-thickness Extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structure May involve tendon or jt capsule
184
What are unstageable wounds?
Base of wound is covered with slough or eschar Cannot visualize depth or color Cannot be staged
185
What is eschar?
Presents as dry, thick, leathery tissue that is often tan, brown, or black
186
What is slough?
Characterized being yellow, tan, green, or brown in color and may be moist, loose, and stringy
187
What indicates poor arterial flow?
Pain in calves while walking and at rest Cool feeling to feet Changes in color - dependent rubor or elevational pallor Loss of hair (toes first) Thickening of nails
188
What is dependent rubor?
Have pallor when legs are elevated and when they sit up all of their blood flows to their feet (bright red)
189
What are some characteristics of an arterial ulcer?
Regular shaped with well defined edges Deep and pale Unhealthy granulation Min exudate Often with dry eschar Periwound skin blanched, shiny Painful
190
What are risk factor modifications of arterial ulcers?
Stop smoking, weight control, glucose, and lipid control Protect extremities from injury Exercise training for those with PAD - improve functional capacity, improve peripheral blood flow, and mm oxidative capacity
191
What is the role of vein perforators?
Connect superficial veins to deep veins
192
What is a venous pressure of someone in bed?
0 mmHg
193
What is the venous pressure of someone standing?
90 mmHg
194
What is the venous pressure of someone walking?
30-40 mmHg
195
What is capillary HTN?
Venous HTN causes capillary walls to stretch, which create gaps between cells
196
What are venous wounds?
Locate in gaiter area Large wounds with irregular wound margins Superficial, red granular wound base Edema and exudate Hemosiderin staining Dermatitis Lipdermatosclerosis Palpable pulse
197
Define gaiter area
Region of lower leg that would normally be covered by a sock
198
Define lipodermatosclerosis
Changes in skin of lower legs Forms panniculitis - inflammation of the layer of fat under skin
199
What are the s/s of lipodermatosclerosis?
Pain Hardening of skin Change in skin color Swelling Tapering of legs above the ankles
200
Define hemosiderin
Protein that stores iron and can accumulate under skin May give bruise like coloring
201
How to diagnosis venous wounds?
Clinical presentation Venous doppler Venous duplex scan Biopsy`
202
What do venous insufficiencies lead to?
Pressure ulcers Begin to see pooling of blood = edema
203
What is the main tx for venous insufficiencies?
Eliminate edema and COMPRESSION
204
How do you apply compression stockings?
Distal to proximal Ankle should be at 90-degrees AKA 0-degrees of neutral
205
What is the purpose of compression stockings?
Get fluid back through the venous valves and they have to close
206
What happens if there is too much pressure from stockings?
Restrict blood flow = necrosis and gangrene
207
What is the pressure of about 1 layer of elastic tubes?
Approximately 8 mmHg
208
What are short stretch wraps?
Low pressure at rest High working pressure when mm expand during activity
209
When are short stretch stretch wraps used?
During exercise
210
What are the long stretch wraps?
Greatest resting pressure (60-70 mmHg) Very elastic Used for immobile patients
211
What is a semi-rigid wrap?
AKA Unna Boot 35-40 mmHg With Zinc Oxide
212
What is zinc oxide used for?
No skin irritation and can help neutralize bacteria
213
When do you use a Unna boot?
Used with those who have open wounds
214
What are multi-layer wraps?
Most commonly used for venous stasis ulcers Combo of elastic and inelastic Mod to high resting pressure
215
When do you use multi-layer wraps?
Immobile patients
216
What compression pressure is used for the UE?
30-60 mmHg
217
What compression pressure is used for the LE?
40-80 mmHg
218
How do you treat an ulcer?
Control exudate Clean and debride fibrin Protect surrounding skin Proper dressing Active therapies if recurrent or slow to heal
219
What increases the risk of PVD?
Diabetes (Type II)
220
How do you examine diabetic foot ulcers?
Neurosensory function Foot structure and appearance Check shoes Vascular status Check callous; probe for ulcers
221
What is sensory neuropathy?
Loss of peripheral sensation Gradual loss of pain and temp sensation Loss of protective sensation lending to ulcerations
222
What is motor neuropathy?
Mm atrophy of pedal arch and metatarsal fat pad atrophy Alter pressure points which can result in weak callous formation and rupture
223
What is autonomic neuropathy?
Decrease in perspiration Cracks and fissures of skin occur
224
What are the Semmes Weinstein Monofilament Exam?
Used on 4-10 sites of the met heads and great toe Place perpendicular to foot and add enough pressure Lack of sensation indicates risk Loss of protective sensation
225
How to document Semmes Weinstein Monofilament Exams?
Percentage of loss
226
What should blood glucose be to prevent diabetic ulcers?
Less than 200 mg/dl
227
Why is it important to maintain proper glucose?
Normal protein synthesis required for wound healing
228
What are interventions to prevent wounds?
Support surface Turning schedule Max mobilizations Protect heels Manage moisture Manage nutrition Reduce/eliminate friction and shear
229
How to perform a wound examination?
Temp Measure girth Sensation at wound and surrounding area Signs of infection Assess health of tissues surrounding wound
230
Define halo of erythema
Abnormal redness of skin
231
Define maceration
Softening of skin due to moisture
232
Define trophic changes
Result from disruption of arterial blood supply
233
What are examples of necrotic tissue?
Eschar Gangrene Hyperkeratosis (callus) Slough
234
What is a superficial wound?
Involves EPIDERMIS
235
What is partial thickness wound?
Penetrates to DERMIS IE. Blister
236
What is full thickness wound?
Penetrate into SUBCUTANEOUS tissue
237
What is deep full thickness wound?
Penetrate deeper than subcutaneous IE. exposed tendon, mm, or bone
238
Is wound staging the same as ulcer staging?
No
239
What are examples of partial thickness wounds?
Abrasions Skin tears Blisters Skin graft donor sites
240
How do you measure a wound?
Longest axis = length Perpendicular line = width Clock or head to toe - Line closest to 12-6 = length - 3-9 = width
241
What is cratering?
Extend deeper than we think
242
What is tunneling?
Cratering that can be assessed proximally and distally
243
What is undermining?
Tissue loss parallel to the skin surface
244
What color can exudate be?
Yellow Blue-green Gray Red Bloody
245
What is serous exudate?
Mostly clear or slightly yellow thin plasma that is slightly thicker than water
246
What is serosanguinous?
Fluid with both serum and RBC (capillary damage)
247
What is sanguinous exudate?
Bloody drainage, bright red and somewhat thick
248
What is purulent exudate?
Milky in appearance AKA pus Almost always a sign of infection
249
Define exudate
Liquefying necrotic tissue
250
What are the goals of wound management?
Use asepsis Protect of wound and surrounding tissue - Reduce strain - Protect mechanical stressors Reduce pathogens Promote healing Reduce scar tissue formation
251
What is autolytic debridement?
Dressings retain moisture Phagocytic cells and natural enzymes work on necrotic tissue
252
What is enzymatic debridement?
Topical, chemical debridement
253
What is non-selective mechanical debridement?
May debride healthy tissue as well as necrotic Wet to dry, wound irrigation, whirlpool Not a lot of control on slough
254
What is sharp mechanical debridement?
Use scalpel, scissors, or forceps to remove necrotic tissue
255
Define pruritus
Itching skin
256
Define urticaria
Smooth, red, elevated hives
257
Define rash
Local redness and eruption on skin
258
Define xeroderma
Dry skin
259
What does red skin color change mean?
CO poisoning
260
What does cyanotic tissue mean?
Decrease O2
261
What does pallor skin mean?
Anemia
262
What does brown skin mean?
Venous insufficiency
263
What should you assess for in skin integrity?
Pruritus Urticaria Rash Xeroderma Edema Change in nails Change in skin pigmentation Change in skin color Change in skin temp
264
How to intervene for skin integrity?
Client instruction Infection control Therapeutic exercise Functional training Dressings and topical agent Electrotherapeutic modalities Modalities
265
What is the purpose of wound dressings?
Prevent contamination Prevent infection to other sites Prevent further injury Apply pressure Absorb drainage Remove exudates and toxins Assist in healing
266
What is the purpose of wound bandages?
Keep dressing in place Maintain barrier Provide pressure to reduce edema Provide stability and support Hold splints in place Assist dressing
267
Define alginates
Absorb mod to large amt of exudate Infected or non-infected Packing into wound Autolytic debridement
268
What is the purpose of gauze?
Absorb min to max drainage Packed into deeper wounds Can be used on infected wounds Can be impregnated No autolytic debridement properties IE. Wet to wet, wet to dry, and dry
269
What is the purpose of foam dressing?
Stage II to III May be used on infected wounds Non-adherent Absorb for mod drainage Autolytic debridement
270
What is the purpose of hydrocolloids?
Stage II and III Absorb min drainage Non-infected wounds Self-adherent Exudate forms gel-like substance within the impermeable barrier Autolytic debridement
271
What is the purpose of hydrogels?
Stage II or III Used on dry wounds and absorb min absorption Require second bandage Hydrate wound Autolytic debridement
272
What is the purpose of transparent film?
Stage I or II Non-infected Wounds with min drainage Autolytic debridement Protect wounds
273
What are silver dressings?
Antimicrobial Use with infected wound and could be used for prophylaxis
274
What is an iodine dressing?
Antimicrobial Use with infected wound and could be used for prophylaxis
275
What should be thought of when removing dressings?
Be aware of post-surgical precautions Avoid damage to viable tissue Be sensitive to pain and discomfort Avoid skin tears
276
What is the goal of moisture and occlusion?
Homeostasis
277
What is pulsed lavage?
Irrigation with normal saline at selected level of pressure (4-15 psi)
278
What precautions should be taken with pulsed lavage?
Insenate (lack of physcall sensation) Anticoagulants Uncontrolled pain Exposed vessels
279
What is a vacuum assisted closure?
AKA negative pressure wound therapy (NPWT) Foam placed in wound Wounds that cannot be closed by primary intention
280
What are the advantages of vacuum assisted closure?
Controls edema Increase blood flow Control infection
281
What are the contradictions of VAC?
>30% non-viable Wounds w/ malignancy Exposed vessels Untreated osteomyelitis
282
What is the purpose of high voltage pulsed current (HVPC) for wounds?
Enhance healing Monophasic direct current - stim angiogenesis and epithelial migration, decrease bacterial activity, and pain increase oxygen perfusion
283
What is the purpose of UV C for wounds?
For chronic wounds, regardless of infection
284
What are the contraindications of UV C?
Malignancy Acute periwound dermatological concerns Fever HIV Many systemic organ disease Skin grafts
285
What is the purpose of US for wounds?
Enhance inflammatory and proliferation phases Enhance the strength and elasticity of scar tissue Protocol varies May treat over wound with hydrogel or transparent film and coupling gel
286
What US parameters are typically used for wounds?
Low intensity 20% - pulsed duty cycle
287
What is the purpose of hyperbaric oxygen for wound healing?
Reduce edema Antibiotic effects Stim synthesis of fibroblasts and collagen
288
What is the purpose of diathermy for wound healing?
Thermal and nonthermal Use radio waves Use heat for superficial to deep tissue Nonthermal influences at cellular level depending on settings and parameters
289
Define ecchymosis
Discoloration of skin from bleeding under skin
290
Define turgor
Skin elasticity
291
Define dehiscence
Split or burst open of pod or wound
292
Define hypertrophic scar
Excess collagen production leading to scar Does not exceed beyond boundary of original wound
293
Define keloid scar
Extends beyond the boundary of original wound
294
Define normotrophic scar
Most desirable Thin and flat Occurs after superifical injury
295
What is dermatitis?
Inflammation of skin
296
What causes dermatitis?
Allergic Reaction to sun Unknown
297
What are contraindications for dermatitis?
Some modalities
298
What is the medical treatment for dermatitis?
Decrease inflammation
299
What is the cause of bacterial infection?
Bacteria entering through abrasion
300
Define impetigo
Infection caused by staph or strep
301
Define cellulitis
Inflammation of cellular or CT in skin
302
Define abscess
Cavity containing pus
303
How are fungal infections spread?
Person to person
304
What causes parasitic infections?
Animal and insect contact
305
How are parasitic infections transmitted?
Person to person
306
What is psoriasis?
Chronic disease of skin with erythematous plaques covered with silvery scale
307
Where are common areas for psoriasis?
Ears, scalp, knees, elbows, and genitalia
308
What is lupus?
Chronic progressive inflammatory disorder of CT
309
What are characteristics of lupus?
Red rash (butterfly) with raised red scaly plaques
310
What is scleroderma?
Disease of CT causing fibrosis of the skin and jt
311
Define petechiae
Tiny red or purple spots on the skin that result from tiny hemorrhages within the dermal layer
312
What are causes of burns?
Thermal, chemical, electrical, or radioactive agents
313
What is zone of coagulation?
Area of greatest damage is closest to heat source Cells irreversibly injured Cell death Full-thickness damage
314
What is zone of stasis?
Involves vascular system Cells are injured May die without specialized tx usually within 24-48 hr
315
What is zone of hyperemia?
Min cell injury Cells should recover Superficial thickness burn
316
What is a first degree burn?
AKA superficial Damage only EPIDERMIS Characterized by: - Erythema - Slight edema - Tenderness - No blistering Full healing in 3-7 days
317
What is a second degree superficial thickness burn?
Superficial partial thickness Epidermis and upper layers of dermis are damaged Characterized by: - Blisters - Inflammation - Severe pain Heals within 7-21 days
318
What is a second degree deep partial-thickness burn?
Deep partial-thickness Severe damage to epidermis and dermis Characterized by: - Red or white appearance - Edema - Blistering - Severe pain - Or damage to Nn endings may result in mod pain Heals from 21-28 days
319
What is a third degree burn?
Full thickness Complete destruction of epidermis, dermis, and subcutaneous - and may extend to tissue Characterized by: - White, gray, or black appearance - Dry surface - Edema - Eschar - Little pain (nn endings burned off) Removal of dead tissue and skin grafting necessary High risk of infection Scarring and wound contracture are common
320
Define escharotomy
Emergency surgical procedure for circumferential burns Incise burnt skin to release eschar
321
Define split-thickness skin graft
Epidermis and upper layers of dermis from donor site
322
What is a fourth degree burn?
AKA subdermal burn Complete destruction of epidermis, dermis, and subcutaneous tissue; involve mm and bone Extensive tissue damage with destruction of vascular system Course unpredictable Require extensive surgery/amputation IE. electrical burn or prolonged flame contact
323
What is important to do post-grafting?
Discontinue ROM for up to 5 days Immobilize jt with splints
324
What is a critically burned area?
10% of body with 3rd degree burn AND 30% or more with 2nd degree
325
What are moderate burned areas?
Less than 10% with 3rd degree burns and 19-30% with second degree burns
326
What are minor burned areas?
Less than 2% with 3rd degree burns and 15% with 2nd degree burns
327
What are complications of burns?
Infection - leading cause of death Shock Pulm complications - smoke inhalation Metabolic complications - increase metabolic activity results in wt loss and decreased energy Cardiac complications - fluid and plasma loss results in decreased CO Heterotopic ossification
328
Define heterotopic ossifications
Abnormal bone growth in the non-skeletal tissues
329
What is common burn wound care?
Remove charred clothing Wound cleansing Topical meds Occlusive dressings Maintain airway Monitor blood gases Pain relief Infection prevention Fluid replacement Surgery
330
What is silver sulfadiazine?
Prophylactic agent
331
What is the role of PT in burn wound care with infection control?
Hydrotherapy - debridement, dressing and removal, ROM exercises, and anti-infection control agents Sharp debridement - excision of eschar Autolytic dressing/enzymes to remove eschar Topical agents and antimicrobial ointments - directly to burn, impregnate into gauze, and cover with bandage
332
What is the role of PT in preventing or reducing complications of immobilization of burns?
Exercise to promote deep breathing and amb Positioning Edema AROM/PROM Massage Strengthen ADLS Pain management
333
What are common contracture risks of the neck?
Flex
334
What are common contracture risks of the anterior chest and shoulder?
ADD and IR
335
What are the contracture risks of the elbow?
Flex and pronation
336
What are the contracture risks of the hand?
Claw hand and flex
337
What are the contracture risks of the hip?
Flex and ADD
338
What are the contracture risks of the knee?
Flex
339
What are the contracture risks of the ankle?
PF
340
What are hypertrophic scars?
Thick, raised scar within boundaries of the initial burn or wound Red, raised, and firm
341
What is a keloid scar?
Thick, raised scar that extends outside boundaries of original burn or wound Red, raised, and firm in appearance
342
What is the function of compression garments of burns?
Help reduce swelling Decrease hypertrophic scarring Sustained compression: 15-35 mmHg
343
When should a PT auscultate breath sounds?
To determine if pt needs mechanical suctioning
344
When should improvement in physical tasks and ADLs occur in a pt with a chronic pulmonary condition?
4-8 wk
345
A decrease in what blood cells increase risk of infection?
WBC
346
How long should compression garments be worn per day?
~23 hr/day
347
What is the purpose of active cycle breathing?
Improve breathing control and remove secretions
348
How to perform active cycle of breathing?
Seated Pt breaths normal for 5-10 sec Deep inspiration and relax expiration 3-4 times Pt breaths normal for 5-10 sec Deep inspiration and relax expiration 3-4 times Forced expiratory technique - instruct pt to turn head and huff on exhalation
349
What is normal ABI?
Greater than or equal to 1
350
What is the ABI of min arterial disease?
0.9-1.0
351
What is the ABI of significant arterial disease?
0.5-0.89
352
What is the ABI of severe arterial disease?
Less than 0.5
353
What segments are targeted in upper lobe in chest percussion?
Apical segment Posterior segment Anterior segment
354
What is the position of pt to target apical segment?
Bed/table flat Pt leans on pillow at 30-degree angle against therapist Perform percussion - b/t clavicle and top of scap
355
What is the position of pt to target posterior segment of upper lobe?
Bed/table flat Pt leans over folded pillow at 30-degree angle Perform percussion - upper back
356
What is the position of pt to target anterior segment of upper lobe?
Bed/table flat Pt lies on back with pillow under knees Perform percussion - b/t clavicle and nipple
357
What is the position of pt to target right middle lobe?
Foot of table elevated by 16 in Pt head to left side and rotate to turn backward by 1/4. Pillow behind from shoulder to hip. Knees flexed Perform percussion - over right nipple area - Females = fingers toward the under portion of breast tissue
358
What is the position of pt to target Singular segment of left upper lobe?
Foot of table elevated by 16 in Pt head to right side and rotate to turn backward by 1/4. Pillow behind from shoulder to hip. Knees flexed Perform percussion - over left nipple area - Females = fingers toward the under portion of breast tissue
359
What is the position of pt to target anterior basal segment of lower lobes?
Foot of table elevated 20 in Pt lies on side, head down, pillow b/t knees, arm above head Perform percussion - over lower ribs
360
What is the position of pt to target lateral basal segments of lower lobes?
Foot of table elevated 20 in Pt lies on abs, head down, rotate 1/4 turn upward, upper leg on pillow Perform percussion - over lower ribs
361
What is the position of pt to target posterior basal segments of lower lobes?
Foot of table elevated 20 in Pt lies on abs, head down, pillow under hips Percussion - over lower ribs close to spine
362
What is the position of pt to target superior segments of lower lobes?
Bed/table flat Pt lies on abs with 2 pillows under hips Percussion - over middle of back at tip of scap on either side of spine

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