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Module 2 Flashcards

1
Q

Respiratory function:
where does oxygen come from and where does it go
…

A

blue blood /red blood (vein/artery)

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2
Q

Our heart sends blood that has circulated body to the lungs via?

blood is oxygenated in the lungs from the ?

oxygenated blood is then sent back to heart via ?

the … connection

A

pulmonary artery

oxygen filtered through alveoli

veins driven throughout the body

cardiac and respiratory connection

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3
Q

Oxygen levels in the blood:
measured with ?
measures the ? that is ?
normal oxygen saturation levels are approx.
pulse oximetry measurements can be ?
-a blood draw from an artery can be done to check ?

A

pulse oximetry (SpO2 -saturation of peripheral oxygen)

hemoglobin (a protein in the blood carries oxygen) saturated with oxygen in blood

93-100% (can vary)

inaccurate
-blood gasses (ABG-arterial blood gas0

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4
Q

What if body’s oxygen levels are low:
blood is not able to ?
body begins to try to ?

the respiratory rate ?

  • normal range is different for
  • check monitor to see
  • be on look out for ?

tachypnea -

begin to see ?

A

send enough oxygen to organs to maintain function

compensate

increases (Normal 12-20 breaths per minute)

  • infants/children
  • patient’s baseline
  • changes with intervention (swallowing)
  • rapid shallow ineffective breathing
  • cyanosis (see deoxygenated hemoglobin)
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5
Q 
Resp. rates in infants/children: 
newborn: 
infant: 
toddler: 
preschoolers 
school age 
adolescent
A 
30-60 breaths pm
30-60 
24-40
22-34
18-30
12-16
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6
Q

Supplemental oxygen:
want to give the least amount of ?
delivered in amount measured in ? or ?

conversion : one litre of flow per minute equals ?

about. .. is O2 content of room air
- if a patient is on 1 litre of oxygen per minute, the air contains ?

-if patient is on 4 litres of oxygen per minute, the air contains about ? oxygen

A

supplemental oxygen as possible
-litres or percent

  • 3-4% of room air
  • 21%

24%-25% oxygen
33% (21+2) -37% (21+16) oxygen

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7
Q 
Type of delivery method supplemental oxygen: 
-.. 
... mask 
-high flow 
non
-
-
intubation with
A 
nasal cannula (NC O2) 
oxygen mask (face or trach) 
nasal cannula 
non-re-breather mask 
-BiPAP 
CPAP
ventilation
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8
Q 
Respiratory Distress/Code Blue:
absent 
-significantly increased ? 
-patient may require a change in the ? potentially? 
patient may require ?
A

respiration

  • respiratory rate
  • respiratory support they are recieving/ increase in level of suppl. oxygen being provided
  • intubation or to be placed on ventilator
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9
Q 
Diseases of lungs: 
Chronic obstructive pulmonary disease
-
-
-
A

emphysema
chronic bronchitis
chronic damage from asthmatic bronchitis

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10
Q 
COPD: 
one of leading causes of 
lung disease that blocks? and leads to impaired ? 
no ? 
eventually, results in ?
A

death wordlwide
airflow /gas exchange of oxygen and carbon dioxide
cure
death

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11
Q

Impact on swallowing/phonation:
any abnormality in respiratory system can negatively ?
period of apnea during ?
voice production is powered by ?

A

impact swallowing or voice function
swallow (.5-3.5 seconds)
exhaled air

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12
Q 
Dysphagia in COPD: 
deficits with coordination of ? 
reduced tolerance for the ? 
generalized ? 
xerostomia: 
-.. breathing 
-... oxygen 
-respiratory ?

timing of respiration/swallow:

  • post-swallow ?
  • risk of ?
A

respiration and swallowing
-apneic event that occurs with swallow
fatigue/reduced endurance

mouth
supplemental
medications/breathing treatment

respiration/swallow

  • inspiration -especially on sequential sips
  • aspiration on inspiration immediately upon completion of swallow
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13
Q

pneumonia:
infection in
caused by?
there are more than?

A

one or both of lungs

  • bacteria, viruses or fungi
  • 30 diff. types of pneumonia
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14
Q

Pneumonia:
aspiration pneumonia: is only ?
-bacteria from material that has ?
often but not always occurs in ?

A

one type of pneumonia

  • entered into lungs is cause
  • right lower lobe of lung
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15
Q 
Mainstem bronchi: 
right bronchus: 
-.. long 
-more in line with 
-enters lung opposite 
the orifice is 
-foreign bodies tend to enter the ? as it is in line with

left bronchus: 
... long 
less in line with 
enters lung opposite 
to orifice is 
foreign bodies less likely to ?
A
  1. 5 cm
    - trachea
    - t5
    - larger
    - right bronchus - inline with trachea
5 cm 
trachea 
T6
smaller 
enter left bronchus
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16
Q 
Aspiration pneumonia: 
clinical signs of aspiration
-low grade 
-changes in 
-change in *** may take up to ? 
not all aspiration is created ? 
-... aspiration 
-
-
-.. contents 
-... feeds
A

fever - may initially present approx. 30 minutes after aspiration event

  • lung sounds (no longer clear)
  • chest x-ray ( 24 hours to manifest depending on pt’s hydration status)

equal

  • prandial vs. postprandial aspiration
  • food
  • liquid
  • gastric contents
  • tube feeds
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17
Q

The heart circulation:
.. chambers
-2
-2

the atrium and ventricle are separated by

A

4 chambers

  • 2 upper (atria)
  • 2 lower (ventricles)

1 way valve

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18
Q

Right atrium
receives … that is returning back to heart from ?

blood is sent to the right atrium via the ?

pumps blood through the

A

used blood / tissues throughout body (blue-deoxygenated)

superior and inferior vena cava

tricuspid valve, to right ventricle

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19
Q

Right ventricle:
blood that is sent to the right ventricle from the right atrium is pumped to lungs via ?
-deoxygenated blood in an artery ??

A

pulmonary artery

yes

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20
Q

left atrium:
blood is returned to heart into the ? from the lungs via the ?
oxygenated blood in a vein?

A

left atrium/ pulmonary veins

yip

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21
Q

Left ventricle:
oxygenated blood is pumped out of the ? to provide all tissue with

the force generated is ?
systolic blood pressure: the amount of force generated on the ?

A

left ventricle / oxygen

120mm of Hg
-walls of arteries when heart beats

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22
Q 
Myocardial Infarction: 
also called 
interruption of ? due to ? 
can cause death of? leading to ? 
.. can result 
need for ? 
...
A

heart attack
blood flow to heart muscle itself/ blockage of blood flow to one or more of coronary arteries
muscle fibers / permanent damage to heart
abnormal heart rhythm
sten placement, angioplasty, coronary artery bypass graft
death

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23
Q 
Heart beat rhythm: 
controlled by ? sent along ? 
...
the pacemaker of the heart aka...
the rate that the electrical impulses are sent out from the SA node=
-when this is normal it is called 
can be seen on an ?
A

electrical messages/ tiny fibers located near top of right atrium and along back wall of heart

sinoatrial node (SA node) 
-coordinates heartbeat

rhythm
sinus rhythm
ECG

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24
Q 
Heart rhythm: 
normal sinus rhythm: 
abnormal heart rhythms 
atrial - most common to 
ventricular ?
ventricular ?
A

60-100 BMP for adults measured by electrocardiogram
atrial fibrillation (Afib) most common to arrhythmia
tachycardia (V-tach)
fibrillation (V-fib)

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25
``` Abnormal heart rhythms: atrial fibrillation (A-fib) -... heartbeat involving the ? the most common causes are ? can cause the formation of ? increases risk of ? ``` ``` ventricular fibrillation (V-fib) ... heartbeat - involving the the most ? causes include ? the heart cannot? leads to ? ```
irregular - atria abnormal heart rhythm -varied and sometimes unknown -formation of blood clots/ stroke risk irregular/ quivering - ventricles serious heart rhythm abnormality MI, sepsis, cardiomyopathy, inadequate blood flow to myocardium pump blood - leads to cardiac arrest
26
Heart valves: can fail to function by not? - - ``` causes of valve dysfunction include: - ... abnormalities .... -... disease ... cholesterol -.... abuse .... fever ``` abnormal valve function can result in bacteria can grow on? -this can result in ? dental cleanings:
opening and closing appropriately - regurgitation (leaking) - stenosis (narrowing) ``` congenital abnormalities age heart disease high cholesterol IV drug abuse rheumatic fever ``` heart failure and heart enlargement diseased heart valves - bacterial endocarditis - life threatening infection - antibiotic prophylaxis
27
``` Coronary arteries: nourish the ? attach to and ? ... disease narrowing of the ? due to ? ```
heart muscle (myocardium) itself -wrap around the surface of the heart coronary artery disease (CAD) coronary arteries / plaque build up results in lack of oxygen to the heart muscle itself
28
``` Dysphagia following CABG: etiology of dysphagia ? -neurological -impaired function of -laryngeal changes following ``` dysphagia symptoms are similar in patients who undergo?
likely varies changes (small brainstem infarct - not detected on MRI) recurrent laryngeal nerve intubation (ETT tube) thoracotomy for lung resection and lung transplant, as well
29
Congestive heart failure (CHF): scarring and weakening of the ? results in decreased ability of the heart to ? the blood then backs up and creates ? some of the blood's fluid component ? and results in?
myocardium (heart muscle) contract with enough force to push out needed volume of blood pressure in lungs and other organs where blood is coming from leaks through walls of small blood vessels/ swelling or edema of tissue
30
CHF: the liver and kidneys that filter blood cnanot organs receive less -the back pressure of blood in the heart itself causes the chambers of th eheart to ? ventricular muscle ? causing heart to ? the enlarged heart requires more ? and thus this results in ? heart rate ? what can also result
``` work efficiently oxygenated blood - dilate -thickens in attempt to compensate/ enlarge oxygen/ more damage increases to try to compensate abnormal heart rhythm ```
31
``` CHF patients can experience ? -patients often experience difficulty ? lungs fill with ? wet lungs and poor circulation allows for ? death by CHF results from ? ```
shortness of breath (SOB) - breathing in supine position because they need to be upright to help fluid drain from lungs - fluid (pulmonary edema) - growth of bacteria - can result in pneumonia - drowning in fluid
32
COVID: conditions due to COVID - - conditions due to treatment for COVID: - preexisting conditions that are exacerbated with acute illness: - -
pneumonia MI (due to blood clotting issues) intubation/ventilator support COPD CHF
33
What is Respiratory Muscle Strength Training: the process of building strength within ? inspiratory muscle strength training: - - expiratory muscle strength training: - - -
muscles and muscle groups that control respiration -diaphragm external intercostal muscles (raise ribs for inspiration) abdominals internal intercostal muscles (assist in rib depression for expiration) supralaryngeal (suprahyoid)
34
Addressing the common dys
dystussia dysphonia dysphagia dyspnea
35
What's the goal of RMST: increase the ? improve the function of ? through?
force generating capacity of inspiratory or expiratory muscles respiratory muscles/ specific though not task specific exercise
36
EMST intervention targets : - - -
voice (reduced glottic closure) swallowing function cough strength
37
``` cough: a mechanism that protects the pulmonary system by ? a cough is comprised of three steps: 1. 2. 3. ``` EMST- targets
generating expiratory flows to create a scrubbing action to remove material from airway inspiration closure of VFs (generates subglottic pressure) forced expiration cough strength
38
``` Inspiratory Muscle strength training: vocal cord ? impaired ? -.... cystic -ventilator .... ```
``` dysfunction true vocal fold movement (bilateral) resulting in airway issues (reduced subglottic space) -COPD -cystic fibrosis -weaning Myasthenia gravis ```
39
Why focus on respiratory muscles ? age related ? along with reductions in ? respiratory muscle strength decreases in elderly with ? lack of physical exercise accelerates ? reported that EMS is reduced more than ? -due to reductions in ?
loss of muscle strength, sacropenia / elastic recoil and chest wall compliance decreases intrathoracic airway pressure as well as expiratory flow rates and velocity muscle fiber atrophy by approx. 20% by age 70 reduction in respiratory muscle force generation inspiratory muscle strength -muscle fiber cross sectional area of expiratory muscles
40
How does training work? muscle overload: .. of either maxium expiratory pressure or maximum inspiratory pressure overall typically less intrathoracic intracranial pressure than produced during?
muscle overload high freq. high resistance 70-75% bowel movement
41
Measurement force of expiration or inspiration measured in ? displacement of ? notated
centimeters of water water cm H20
42
Pressure generation -safety when there is concern regarding safety consider other ? speech cough bowel movement
pressures generated 5-10 cm H20 100-200 200-300
43
``` Rehabilitative/restorative treatments: increase or maintain improve or maintain increase or decrease improve or maintain improve ...,...,... -adaptations -adaptation ```
``` muscle strength range of motion muscle tone maintain coordination of structures endurance ``` plasticity, plasticity, plasticity - central adaptations - peripheral adaptations
44
Skeletal muscle tissue: plasticity performance ? .. changes ...changes
performance (behavioural) changes muscle changes CNS changes
45
What changes? neural changes: peripheral - central - cortical - myogenic changes: - -
level of motor unit level of spinal cord or brainstem (sensory nerves) cortical map area (synapses, etc) muscular hypertrophy fiber type changes
46
Neural changes: neural changes occur ... than muscular changes endurance training results in increased ? increased ? cortical mapping adaptations in ?
earlier increased blood flow and angiogenesis with motor cortex muscle activation sensory nerves, cortical thickness, and angiogenesis
47
Myogenic changes: increase in ? oxidative capacity refers to the muscles? skeletal muscles are made of both ? -slow: -fast: all muscles have a ? RMST stimulates ?
oxidative capacity in trained muscles -maximal capacity to use oxygen in micrometers of O2 per gram per hour slow twitch or fast twitch muscle fibres -slow to contract but very resistant to fatigue (posture) -fast to contract with great force, but prone to fatigue (cough) combination, depending on function fast twitch resulting muscular enlargement or hypertrophy
48
Studies that show the effects of EMST on ?
``` stroke MS ALS PD sedentary elderly Head and neck cancer ```
49
EMST and swallow: activation of ? this may result in changes in the activation of ? associated with ?
submental swallow muscles with EMST device sensory system which triggers swallowing significant decrease in the penetration or aspiration during sequential swallow tasks
50
wet swallow: EMST dry swallow: EMST
25% 75%
51
CVA: aspiration pneumonia most common cause of death ``` acute: subacute: PNA #1 cause of ? Associated with ? both cough and swallow impairments? EMST hypothesised to improve ? ```
post CVA 40-80% 11-25% readmission up to 5 years worse overall outcomes common post CVA strength and coordination of expiratory and submittal musculature
52
EMST impact on swallowing function: evaluated with? feasibility study to determine swallowing-related patterns of palatal and pharyngeal muscle activity can be detected during EMST swallowing related muscle activity during EMST: increased ? -... activity -... activity submental EMG patterns: activity was ? however, may have corresponded with ? further ?
high resolution manometry and electromyography EMG activity with increased expiratory load - palatal activity - pharyngeal activity detected/ mouth posturing and prep for task (meg influenced by jaw movement, tongue protrusion, posturing)/ study needed
53
EMST ... device calibrated ? load is set at ? targets ?
pressure-threshold device one way, spring-loaded valve 75% of MEP muscles of expiration
54
EMST - low threshold device threshold PEP ? threshold range
positive pressure device | 5-20 cm
55
``` training program EMST 5 sets of in ? how many days a week increase device threshold level by ? as tolerated ```
5 breaths (25) -in one sitting, once per day 5/7 days a week 1/4 turn after each week of training
56
Application for patients following total laryngectomy: ..management loss of ? can we improve the ?
secretion management filtration, humidification of inhaled air the pump ?
57
Inspiratory muscle strength training: the PCA is the principle ? there is a temporal relationship between the ? activation of the diaphragm has a ? stimulation of the diaphragm activates
abductor of the vocal cords inspiratory phase of the respiratory cycle and PCA activation synergistic effect - stimulation of the diaphragm activates the antagonist muscles
58
COVID-19 IMST use after ? inspiratory muscle training for recovered COVID-19 patients after conclusion: a 2-week IMT improves ? IMT program should be encouraged in? specifically with
ventilator weaning weaning from mechanical ventilation pulmonary functions, dyspnea, functional performance, and QOL in recovered intensive care unit COVID-19 management protocol, specifically with ICU patients
59
Determining the device setting: formal measurement of EMST -maximum IMST maximum
Maximum expiratory pressure (MEP) inspiratory pressure (MIP)
60
What if I don't have a manometer to determine MEP and or /MIP ``` ... for setting the device -not too -not too -start at a ? have patient increase by back off by ```
``` low tech easy difficult low setting/blow into device 1 turn until unable to activate valve 1 turn ```
61
EMST devices - - - both
aspire the breather powerlung expiratory and inspiratory training
62
contraindications for RMST: COPD: mild to moderate cases: keep device setting at ? close ? HTN? ... possibly ? ALWAYS discuss ?
50% of maximum pressure monitoring uncontrolled hernia post-operative patients (lung resection) RMST with physician prior to intiiating use
63
RMST is NOT a one size fits all ``` adjustments may include: .... for patient -more adjust more training on ``` more ? of caregiver clinician judgment re: combination with ?
``` more/less intensive training for patient days with therapist mouthpiece weeks use of device itself ``` involvement and training of caregiver EMST versus IMST versus both compensatory or other restorative behavioural swallow therapeutic technique
64
How long to complete training: The rule of ? detraining: skeletal muscle will? however respiratory muscle gains remain ?
neuroplasticity use it or lose it return to pre-training levels within 1 month of exercise cessation significantly higher than pre-training levels up to 8 weeks after training cessation

Medical SLP (11 decks)

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