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Final Flashcards

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1
Q

What does the chest do in pigeon chest?

A

Atrial or septum deficits

Severe asthma

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2
Q

What happens to the chest in barrel chest?

A

Inc in anterior posterior and medial lateral diameter

Diaphragm over stretched

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3
Q

What level of pleura does cystic fibrosis affect?

A

Visceral one covering the lungs

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4
Q

The upper lobes superifical markings are

A

1-6 ribs

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5
Q

The lower ribs superifical marking are

A

4-6 rib

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6
Q

What is pulmonary circulation?

A

Allows deoxygenated blood to lungs and oxygenated blood to heart

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7
Q

What is bronchial circulation?

A

Deliver nutrients, and blood to lungs itself

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8
Q

What is the phsyiological function of the pulmonary system?

A

Exchange of gas between blood and atmospheric gas

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9
Q

What is the dorsal respiratory group(drg)?

A

Controls quiet breathing
Stim diaphragm to inhale
Primary inspiratory neuron

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10
Q

What is the venteral respiratory group(vrg)?

A

Stimulates the drg

Responsible for inspiratory and expiratory

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11
Q

What is the pons pneumothorax center?

A

Inhibit inspiration

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12
Q

What is the pons apneumatix center role?

A

Promote rhythmic respiration

Connect to drg

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13
Q

What do centeral chemoreceptors sense?

A

CO2 levels in blood

Inc CO2 inc breathing

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14
Q

Ant do peripheral chemoreceptors sense?

A

Senses O2 in blood

Dec PO2 from aortic and carotid bodies, stim drg, inc respiration

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15
Q

What is the hypoxic drive?

A

Become a CO2 retainer
Overstim centeral chemoreceptors so shut off
Peripheral chemoreceptors take over
Shift from CO2 to O2

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16
Q

What is compliance?

A

Ease in which lungs can inflate and deflate during inspiration

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17
Q

What is ventilation?

A

Process in which air moves in and out

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18
Q

What is diffusion and what is it dependent on?

A

Passive tendency for molecules to move from high to low

Dependent on surface area, thickness, pressure, reactivity

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19
Q

What is perfusion and what is it dependent on?

A

Blood within pulmonary circulation

Dependent on gravity, r vent ejection, pulm vascular resistance

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20
Q

Which lung zone is not dependent on gravity?

A

One the apex

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21
Q

What lung zone is gravity dependent and receives constant blood flow?

A

Three the base

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22
Q

What type of patient is ventilation decreased in?

A

Pulmonary pt

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23
Q

What type of pt is perfusion decreased in?

A

Cardiac pt

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24
Q

What are the characteristics of peripheral stenosis?

A

Purple or blue nail beds

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25
What is centeral stenosis characterized by?
Purple or blue lips
26
What causes metabolic acidosis?
``` Diabetic ketoacids Diarrhea Renal failure Shock Aspirin overdose Sepsis Latic acid ```
27
What are s and s of metabolic acidosis?
``` Bicarbonate deficit Hyperventilating H/A Dullness Deep respiration Stupor Coma Hyperkalemia Cardiac arrhythmia ```
28
What are the causes of respiratory acidosis?
Hypoventation
29
What are the s and s of respiration acidosis?
``` Hypercalemia Hypoventilation Visual disturbance Confusing Drowsy Coma Dec tendon reflex Hyper kalmia Ventricular fibrillation ```
30
What does the chest do during funnel chest?
Sternal depression | Dec anterior and posterior diameter
31
What are some causes for metabolic alkalosis?
Loss of gastric secretions Overdose of anti acids K wasting diuretics
32
What are signs and symptoms of metabolic alkalosis?
``` Bicarbonate excess Depressed respiration Mental confusion Numbness/ tingling Tetany Convulsion Hyperkalemia Cardiac arrhythmia ```
33
What are some causes of respiratory alkalosis?
``` Hyperventilation from Anxiety High altitude Pregnancy Fever Hypoxia Excessive tidal vol Initial stage of PE ```
34
What are the symptoms of respiratory alkalosis?
``` Light headed Numb and tingling Tetany Convulsions Hypo kalmia Cardiac arrhythmia ```
35
Inc in pH means __________ in PaO2
dec
36
Inc in PaO2 means________ pH
Dec
37
What is a normal pH?
7.35-7.45
38
What is an acidic pH?
Less than 7.35
39
What is a basic pH?
> 7.45
40
What is a normal PaO2?
35-45
41
What is an acidic PaO2?
>45
42
What is a basic PaO2?
Less than 35
43
What is a normal HCO3?
22-26
44
What is an acidic HCO3?
Less than 22
45
What is a basic HCO3?
>26
46
Rules of ABGs are
1. PH tells if acidic or basic 2. PH tells origin of disease if in PaO2 or HCO3 column 3. If it is compensated for. Look at parameter not assocsciated with PH, if that is in normal limits no compensation
47
How do you tell if there is s partial compensation in the ABG values?
If PaO2 or HCO3 are not compensated with pH is an acid or base
48
What is full compensation for ABG levels?
If pH is normal and other parameters are not Recalculate using pH of 7.4 If below 7.4= acidic If above 7.4= basic
49
What body system counteracts for a metabolic disorder?
Respiration
50
What body system compensates for a respiration disorder?
Kidneys
51
In an obstructive lung disease what can't the person do?
Get air out
52
In an restrictive lung disease what can't the person do?
Can't get air in
53
What is tidal volumE?
Amount of air normally inhaled and exhaled with each quiet breathe
54
What is inspiratory reserve volume?
Amount of air that can be taken into lungs in normal breath
55
What is expiratory volume?
Amount of air that can be let out of lungs after end expiration
56
What is residual volume?
Amount of air that remains in lungs at end max expiration
57
What does obstructive lung disease have an increase in?
Inspiratory reserve volume | Residual volume
58
What does restrictive lung disease have a decrease in?
Inspiratory reserve volume | Residual volume
59
What it total lung capacity?
Amount of air lungs contain at end of max inspiration | IRV, TV, ERV, RV
60
Is total Lung capacity inc or dec in pts with copd?
Inc
61
Is total Lung capacity inc or dec in pts with restrictive lung disease, ms disorders, pregnancy or obesity ?
Dec
62
What is vital capacity?
Max amount of gas that can be exhale following max inhalation TV, IRV, ERV
63
What is vital capacity deceased in?
``` Lung tissue Ms disorder Pregnancy Obesity Enlarged heart ```
64
What is inspiratory capacity?
Max air that can be inhaled after normal exhale | IRV, TV
65
What is functional residual capacity?
Max air remaining in lungs at the end of normal resting expiration ERV, RV
66
What does spirometery test?
TV ERV VC IC
67
What is max volume ventilation?
Measure max breathing Reflects strength and endurance of respiratory mm Pant into spirometer for 15 sec total volume expired
68
What is forced vital capacity?
Amount of air expelled during forceful exhalation from end of inspiration to end of expiration Dec in both restrictive and obstruction
69
What is FEC1?
Volume of air exhaled during the first second of FRC
70
What is normal FEc1?
83%
71
What is mild to moderate FEC1?
1-2 liters
72
What is severe FEC1?
Less than one liter
73
What is posteolateral thoractomy?
Resections | Descending thoracic aorta
74
What is the incision of the posteriolateral thoracotomy?
4 th thoracic vertebrae Scapula around inferior angle 5&6 th ICS
75
What are the mm involved in a posterolateral thoracotomy?
``` Serratus anterior ICS 5,6 Latts Rhomboids 5&6 rib broken ```
76
PT for posterolateral thoracotomy?
``` Premed Posture train Rib mob Prom AROM (I) UE Deep breathing Scapula winging ```
77
What is anterolateral thoracotomy used for?
Cardiac procedures Pulm restriction Esophageal procedure
78
What is the incision for the anterolateral thoracotomy?
Submammary 4-5 th ICS at midaxillary line
79
What are the mm used in anterolateral thoracotomy?
Pec major Serratus anterior ICS mm Costal arch
80
PT for anterolateral thoracotomy?
``` Premed Postural train Rib mob Prom (I) UE Deep breathing ```
81
What is a lateral thoractomy used for?
Pneumonorectomy Lobectomy Wedge restriction
82
What is the incision for lateral thoractomy?
Nipple line | Extend around inferior angle
83
What mm are used for lateral thoractomy?
Latts Serratus anterior ICS mm Rhomboid
84
PT for lateral thoractomy
``` Premed Posture train Prom AROM (I) UE Deep breath Rib mob Scap winging ```
85
What is a median sternomty used for?
Cardiac procedure
86
What is the incision of median sternomty?
Below xiphoid process | Sternal retractors used
87
What mm are used in median sternomty?
Pec major Rectus abdominis Rib 1-3 Costovertebra ligament
88
PT for median sternomty
``` Pre med Posture Rib mob Prom, Aaron, AROM (B) UE Deep breath Cardiac rehab ```
89
What is An axillary thoracotomy used for?
Belb resection | Symphatectomy
90
Where is the incision of an axillary thoracotomy ?
Ant axillary line to posterior axillary line at 2 ICS
91
What mm are used in an axillary thoracotomy ?
Pec major | 2 ICS
92
PT for axillary thoracotomy
Pre med Posture Prom, AROM, AAROM (I) UE Deep breath
93
What is a thorabdominal incision used for?
``` Diaphragm Esophagus Bilateral tract Right lobe of liver Spleen Kidney ```
94
What is the incision for thorabdominal incision?
8 or 9 ICS at posterior axillary line to midline ab
95
What are the mm of thorabdominal incision?
``` Latts Serratus anterior External oblique Recutus abdominal Costal arch ```
96
PT for thorabdominal incision
Premed Posture train Transfers Deep breathing
97
What is a lobectomy?
Entire lobe
98
What is a wedge resection?
Small localized lesion
99
What is a segmentectomy?
Bronchopulmary segment removed
100
What is a bilboectomy?
Removal of middle lobe along with upper or lower lobe
101
What is bronchoplasty/ sleeve resection?
Excision of lobe and part of main stem bronchus followed by anastomoses of lower lobe to prox bronchus
102
What is decortication?
Excision of painful pleura and residual clot and or organizing scar tissue after hemp thorax or emphysema
103
What is a pleursectomy?
Strip away and remove partial pleura from chest wall to open up pleura space and prevent reaccumulation of air and fluid
104
What is a tracheal resection?
Excision of portion of trachea with end to end anastomoses remaining trachea
105
What is a bullae?
Excision of dominant bullae in pt with significant emphysema with goal to allow expansion and recruit better functioning living tissue and dec intrathroacic lung volume
106
What is a metastectomy?
Excision of pulm metases and any other thoracic metastasis
107
What is an open lung biopsy?
Pulm tissue samples obtained through an expiratory thoractomy to diagnose pulmonary disease processes
108
Why administer supplemental oxygen?
Correct hypoxia from poor ventilation or impaired gas exchange
109
What percentage of oxygen is toxic?
60%
110
What does oxygen toxicity do to the body?
Airway inflams Inc alveolar permeability Dec ability to exchange gases
111
How liters is a portable cylinder and how many psi does it have?
620 L | 2200 psi
112
How many liters is a home, h, cylinder and how many psi does it have?
6900 L | 2200 psi
113
How many liters is a E cylinder and how heavy is and how does it last and how many liters per min?
620 L 15 lbs 5 hrs @ 2L/ min
114
How many liters is a Liquid oxygen and how heavy is and how does it last and how many liters per min?
860 L 10 lbs 8 hours @ 2L/ min
115
What is fraction of inspired air?
Inc by 4% every 1 L / min increase in oxygen flow rate
116
What is a nasal cannula's flow rate and FiO2?
1-6L | 24-44%
117
What type of humidification is needed for a nasal cannula with 1-4 L of O2?
None
118
What type of humidification is needed for a nasal cannula with 4-9 L of O2?
Simple
119
What type of humidification is needed for a nasal cannula with 10 L of O2?
Heated
120
What is the flow rate and FiO2 for a simple mask?
5-10 L | 35-55%
121
What is the flow rate and FiO2 for an aersol mask?
10-12 L | 35-100%
122
What is the flow rate and FiO2 for a Venturi mask?
4-10 L | 24-50%
123
How does a venturi mask work?
Provide greater air flow of gas to patient by brining room air into side port Negative pressure created in tubing allow pt to exhale
124
What is a non rebreather used for?
Altered level of consciousness Fill bag with oxygen, 100% Place on pt and squeeze nose clips
125
What is a oral pharyngeal (semi rigid tube) used for?
Maintain patency of air way by holding tongue back Stims gag reflex Semiconscious or unconscious
126
How to measure a Oral pharyngeal tube?
Side of mouth to side of ear
127
What is a nasal pharyngeal tube used for?
Soft rubber tube in one of nares Doesn't stim gag reflex Used in semiconscious and alert Used for suction ing
128
What is an oral endotracheal tube?
Airway obstruction Aspiration Secretions Respirator
129
What is a tracheostomy used for?
Airway protection Airway Maintenence Ectubation Long term use
130
Where is a tracheotomy surgically put?
3 red tracheal ring below vocal cords
131
What is a tracheostomy button?
Intermediate step between mechanical ventilation and spontaneous breathing Uses upper airways
132
What causes the use of positive pressure?
Barotrauma | Dmg to the lungs
133
How does positive pressure work?
Used in ICU Overcomes resistance of airways Inc intrathroacic pressure
134
How does negative pressure work?
Provides subatmospheric pressure Dec pressure around pt so air can go into pt No tracheostomy
135
What is completed mechanical ventilation mode?
Preset rate and pressure | Machine is doing all of the work
136
What is assist mode/ assist control mode?
Preset rate and pressure unless the pt triggers machine with negative inspiratory effect Machine delivers positive pressure breath at rest established by the pt Starting to wake up
137
What is intermittent mandatory ventilation mode?
Preset number from which pt may spontaneously breath Mandatory breath at preset rate regardless of pt effort Machine not work as hard if pt takes own breath
138
What is synchronized intermittent mandatory ventilation mode?
Mandatory breath is initiated by pt spontaneous inspiratory effect Pt take breath machine sometimes help
139
What is positive end expiratory phase (peep)?
Pressure supplied at end of expiation. | Higher the peep higher the acid base problems
140
What is continuous positive airway pressure (cpap)?
Elevate baseline pressure greater than atmospheric pressure to allow the patient to spontaneously breath
141
What is pressure supported ventilation( psv)?
Change in inspiratory phase of pt bc of spontaneous ventilators effect with present amount of pressure
142
What is BiLevel positive airway pressure ( BiPaP)?
Before ventilation for pt who might need to be incubated | Inc pressure for inspiration
143
Who does suction get performed on?
Any pt unable to clear secretions by coughing
144
Areas for suctioning include
Nasopharynx Oropharynx Trachebrochial tree
145
Indications for suctioing include
Abnormal breathing Significant hypoxemia Respiratory distress
146
What are complications of suctioning?
Drop pts low PaO2 following ten seconds of suctioning Hypoxemia or stim vagus n-> Bradycardia, PVC, hypotension Arrhythmia Diaphsresis Tissue trauma
147
What does the chest tube drain?
Blood fluid air from pleural space and mediastinum.
148
What does drainage from chest tube monitor?
Amount of drainage | Intrathroacic blood loss
149
How do you tell if a chest tube is draining air?
Tube inserted to 2 ICS mid clavicular line
150
How do you tell if a chest tube is draining for fluid?
Tube inserted in 4-5 ICS ant axillary line
151
What are some precautions for a chest tube?
Avoid side lying Don't kink the tube Medically cleared If knock over clamp Kelly clamps as close to body as possible then go get help
152
What is a flow incentive spirometer?
Two or more chambers that contain a ball
153
What is a volume incentive spirometer?
One chamber with a ball
154
What are spirometers used for?
``` Pre op training Prevent and reverse atelactasis Practice diaphragmatic breathing Replenish surfactant Inc strength and endurance ```
155
Spirometer procedure is
``` 6x for every hour pt is a wake Goal is 100 cc 3 reg breaths Slow breath in Keep in middle ```
156
What is the pulse ox cut off for acute respiratory?
88%
157
What is the pulse ox cut off for acute cardiac?
90-92%
158
Pack/year equation
Pack/day x # of years
159
If pack per year is greater than 70
Increase risk of emphysema
160
What does the general appearance of a pulmonary patient say?
Severity of disease Pt position Struggling to breath, nasal flare, pursed lip breathing, hypertrophied accessory mm
161
What does SoB at rest mean?
Medical emergency
162
What does dyspena on exertion mean?
Sob with exertion | Unrelated to arterial oxygen levels
163
What does Orthopena mean?
Dyspena in recumbent position
164
What does platypnea mean?
Onset of dyspena when supine to sit
165
What does tresopnea mean?
Dysnea in one lateral position but not other | Air ate in right lung better
166
What is functional dyspena?
Sob during rest not during exertion
167
What is pes excavatum?
dec lower sternum
168
What is pes coniatium?
Inc in upper sternum
169
What are the biomechanics of respiration?
``` Diaphragm contract Compress abdominal contents Inc intrathroacic pressure Lateral expansion of ribs Bucket handle Pump handle Inc thoracic pressure vertically and transversely dec intra thoracic pressure Facilitates inspiration and gas exchange ```
170
What is apnea?
Temporly halting breathing
171
What is kussmal breathing?
Inc rate and depth of breathing
172
Document any findings by describing
``` Anatomical landmarks Intensity Pitch Duration Location Character ```
173
What are bronchial sounds?
Normal sounds Loud high pitch Pause between Expir> inspir
174
What are vesicular breathing sound?
Normal Soft breezy No pause Inspir> expir
175
What does bronchial sounds that are heard somewhere that is not normal?
Lung consolidation Contegestion Atelactasis Fibrosis
176
What are crackle or rales?
Over diseased lungs Soft high pitch Discontinuous During inspiratory
177
What are crackles in early inspiration indicate
Bronchitis Emphysema Asthma
178
What do crackles in late inspiration indicate
Interstitial lung Pulmonary edema Pulmonary effusion
179
What are crackles caused by?
Bubbling through airway secretion
180
What are the characteristics of wheezing?
``` Over constructed airway High pitch Continuous Music Exhale ```
181
What does wheezing heard in expiration a sign of?
Bronchospams
182
What does wheezing heard in inspiration a sign of?
Severe obstruction
183
What are characteristics of pleural friction rub?
``` Discontinuous sounds Each breath Leather rubbing Non musical Low pitch ```
184
What does location of the pleural friction rub indicate?
Lateral lung indicating pleural effusion
185
When voice sounds are heard over normal parenchyma?
Low muffled pitch
186
What does normal bronchopy sound like?
Inaudible
187
What does abnormal bronchopy sound like?
Loud and clear Indicates tissue consolidation Pulm edema, tumor, pneumonia
188
What does normal egophony sound like?
Muffled
189
What does abnormal egonophy sound like?
Tissue consolidate | Pleural effusion
190
What does normal whisper pectinography sound like?
Inaudible
191
What does abnormal whisper pectinography sound like?
Ay is loud and clear | Small consolidation pulmonary edema and tumor
192
When a trachea is away from each other?
Pneumothorax | Effusion
193
What does it mean when the trachea is toward each other
atelactasis | Tumor
194
What is the dull sound heard in percussion?
Low amp Med to high pitch Short duration Heard over solid organs
195
Solid organ on the L 3-5 ICS?
Heart
196
Solid organ on the R 5-7 ICS?
Liver
197
What does tympanic sound of percussion indicate?
High pitch Medium duration Indicates hollow organs
198
What hollow organ is around L 6 ICS?
Stomach
199
What does resonant sound indicate during percussion?
High pitch Short duration Indicate normal air filled organs
200
What normal air filled organ is around L 6 ICS?
Stomach empty
201
What does hyperesonant sound in percussion mean?
Low pitch Prolonged duration Indicates emphysema
202
What does a flat sound in a percussion test indicate?
High pitch Short duration Indicate mm mass
203
If a dull sound is found where resonant is expects is
Fluid gathering
204
If a tympanic sound is found where resonant is expects is
Air
205
What does upright position do to FRC?
Inc all
206
What does supine position do to FRC?
Dec
207
What does the supine position do to cardiovascular change?
Centeral shift to blood volume from extremities Inc pre load and after load Make L CHF worse
208
What does the side lying position do to the pulm system?
Chest wall lose motion on lobe side down Gain ap motion Dependent diaphragm at advantage Inc lung volumes
209
What does the side lying position do to the cardiac system?
On right side inc hr, Bp, co | On left side inc bp, dec hr, co
210
What does the trendelenberg position do to the pulm system?
Inc o2 transportation and gas exchange Dec dyspena Rest accessory mm
211
What does the trendelenberg position do to the cardiac system?
Inc hr, bp | Dec co
212
What are contraindications of the trendelenberg position?
``` Inc ICP Uncontrolled hypertension Distended ab Esophageal Hemoptyais related to lung carcinoma Uncontrolled airway risk for aspiration ```
213
What does the prone position do to the pulm system?
Inc tidal vol Inc compliance Inc secretions
214
What does the prone position do to the cardiac system?
Inc o2 Inc hr Inc bp
215
What is the goal of airway techniques?
Reduce airway obstruction Improve mucocillsry clearance Ventilation Optimize gas exchange
216
Indications for air way clearance techniques?
``` Cf bronchiectasis Atelactasis/ pleural effusion Respiratory mm weak Mechanical ventilation Neonate respiration distress syndrome Asthma ```
217
What type of technique is postural drainage?
Passive
218
Contraindications for Postural drainage?
``` ICP Fractured ribs Acute bleeds Anticoagulants Pe Orthopedic issues ```
219
What is the postural drainage treatment?
Determine lobe that needs to be treated by auscultation position for 5-10 min
220
What is percussion used foR?
Mobilize secretions
221
Know what areas to percussion
``` Dec chest wall mobility Dec expansion Abnl breathing Eval of percussion X-ray ```
222
Tan color
Normal
223
Yellow Color
Bronchial
224
Green color
Infection
225
Brown color
Bronchiectasis
226
Bronze Color
Cf
227
Blood Color
Tb
228
What is the goal of vibration?
Move mucus prox to improve gas exchange
229
What's in stage one inhale?
Spontaneous Position of trunk should be extended Look up at the ceiling
230
What is stage two of close glottis?
Hold breath at peak inhale Increase intrathoracic pressure Cough or huff Look at ceiling hold hold hold
231
What is the third stage- ab and intercostals contraction?
Inc intra thoracic pressure Trunk flexion Look at floor
232
What is the fourth stage open glottis?
Pt gag Hold breath Stuck in expulsion If get stuck move into extension
233
What is pump cough?
Asthma or et | 3 short huffs, 3 easy coughs
234
What is costophrenic assist breathing?
At exhale Performed on costophrenic angle Push up and in Add quick stretch
235
What is the heimlich ab thrust ?
Sci pt Exhale Above umbilicus Push up and in
236
What is anterior chest compression?
Sci pt copd Exhale PT arm on ant chest Below clavicle, costophrenic border
237
What is counter relation?
``` Neuro and restrictive pt Inhale and exhale Side lye bad side up Bottom hand- iliac crest Top hand spine of scap Push into ext rot as inhale Pull back as exhale ```
238
What is prone on elbow?
Sci c4 below Inhale extension look at ceiling Exhale flexion look at floor
239
What is long sit?
Sci Inhale extension look at ceiling Exhale flexion look Down and stretch toward toes
240
What is short sit?
W/c Inhale extension look at ceiling Exhale flexor move into child's pose

Cardiopulmonary (2 decks)

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