Obstructive (can't get air OUT) Lung Dysfunction: Exam 2 Flashcards
(118 cards)
1
Q
OLD or
A
Obstructive Lung Disease!!!
2
Q
What is Chronic Obstructive Pulmonary Disease
OLDs as a WHOLE?
A
- Dis’s of airways, which produce obstruction of expiratory flow AND incomplete emptying of lungs
3
Q
3 KEY components to Obstructive Lung Disease
A
- DECd diameter of airways
- Hyperinflation of alveoli
- INCd resistance to Airflow
- Air Trapping!!!
4
Q
In Obstructive lung disease
Airflow obstruction can be related to 4 things:
A
- Retained or excessive secretions
- Inflammation of mucosal linings of airway walls
-
Bronchial constriction:
- tone
- spasm
- size
- inflammation
- Weakening of support structure or alveoli
5
Q
Obstructive Lung Diseases====>
A
CBABE
6
Q
Obstructive Lung Diseases
CBABE
A
- C: Cystic Fibrosis
- B: (chronic) Bronchitis
- A: Asthma
- B: Bronchiectasis
- E: Emphysema
7
Q
Remember….there is a Difference b/w Chronic Obstructive Pulmonary Disease and just your “standard” COPD
What is the “Classic” COPD??
A
- COPD== (chronic) Bronchitis + Emphysema TOGETHER!!!
8
Q
Dx Imaging Tools for COPD:
4 Tools:
A
- Chest Xray
- PFT
- ABG
- CT scan
9
Q
What is the Hallmark S/S for OBSTRUCTIVE LUNG DISEASE?
*Seen on Chest Xray*
A
Flattening of the Diaphragm
*Extra air in lungs pushes it DOWN
10
Q
GOLD STANDARD TEST for OLD’s???
A
PFT
11
Q
PFT Test of OLD’s
What are the components?
What does it determine?
A
- As severity of lung obstruction INCs—-> LESS and LESS air can be exhaled in 1sec
- this det’s our FEV1
- MSK system
- Diaphragm
12
Q
ABG test and OLDs
A
- MANY factors affect gas exchange
- obstruction
- hyperinflation
- secretions
13
Q
An abnormal ABG test w/ OLD
will show what?
A
- PCO2
- >CO2 (INCd)
- PO2
*
14
Q
RV and OLDs
A
BIG INC in RV *****
BIG TLC
15
Q
PFT Test
Normal vs. Obstructive
Break it down!!!
A
-
Normal: Example
- FEV1= 3.0L
- FVC (tot. air we breathe OUT)= 4.0L
- FEV1/FVC= 75% (Nrml is .70)
-
Obstructive: example
- FEV1= 1.0L (cant get air OUT)
- FVC= 4.0L
-
FEV1/FVC= 25% (LOW bc cant get air OUT)
- Obstructive Dis.=
- **As FEV1/FVC shrinks==> MORE severe OLD***
16
Q
FEV1/FVC
A
OLD!!!
17
Q
COPD: MSK Component
What should you look @?
A
Flattening of the Diaphragm!!!!
18
Q
COPD: MSK Component
Sequela #1:
Talks about EXPIRATION
A
- Anatomically Barrel Shaped diaphragm—>
- CLASSIC S/S—> ribs now angled out horiz.
- Diaphragm pulled to flat pos.—>
- Length-tension relationship changes—>
- Exhalation now active or forced—->
- remember should be passive
- Leads to excessive fatigue + caloric use—->
- using mm’s not norm. active
- all energy goes to breathing
- these people DO NOT eat
- Excess abd. pressure==> urinary incontinence
19
Q
COPD: MSK Component
Sequela #2:
Talks about INSPIRATION
A
- Anatomically barrel-shaped diaphragm—>
- Diaphragm pulled to flat pos.—–>
- Altered length-tension relationship—->
-
Inspiration req’s accessory mm’s to overcome large RV+ poor functioning diaphragm—>
- *still diff. to breathe IN bc fighting lg. RV
- Hypertrophied acess. mm’s + functional shortening
20
Q
What will Posture look like w/ OLD?
A
Forward Head
Rounded shoulders
Thoracic kyphosis
21
Q
SIDE NOTE: What happens to the diaphragm w/ the MSK component of OLD?
A
- Switches to Type II skeletal mm fibers
- NEEDS SUGAR
- takes leucine from quads and makes it into sugar
- Glucose-Alanine Cycle***
22
Q
32% pts w/ COPD have skeletal mm weakness
INCd prevalance directly related to severity of the disease
A
USUALLY LE MORE
*ESP the QUADS
23
Q
Psychological impairments of COPD
3:
A
- Anxiety
- Depression
- Cognitive decline
24
Q
S/S of OLD:
A
- Signs of lung hyperinflation
- Elevation of shoulder girdle
- Horizontal ribs
- Barrel-shaped thorax
- Low, flattened diaphragm
- Anxiety
- Cough w/ secretions
- Hypertrophy of SCM
- Forward posture
25
Adult COPD
What is this a **combination of?**
Emphysema
+
chronic Bronchitis
26
Adult COPD: **Emphysema**
## Footnote
**what is it?**
Condition of lung characterized by **destruction of alveolar walls** and **enlargement of airspaces DISTALLY**
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Adult COPD: **Emphysema**
**also enlargement of airspaces Distally:**
**what are these Distal airspaces?**
1. Bronchioles
2. Alveolar ducts
3. Alveoli
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Emphysema think.......
**Alveolar Destruction**
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MOST COMMON CAUSE OF **EMPHYSEMA**
Smoking
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Emphysema
## Footnote
**Distal airways enlarged**
**1. bronchioles**
**2. alveolar ducts**
**3. alveoli**
**\*All 3 of these make up what?**
Parenchyma
31
Adult COPD: **Emphysema**
## Footnote
**Pathophys:**
**Inflammatory cells role**
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Disorders common in COPD:
## Footnote
**Emphysema**
**Picture depiction**
* **Enlargement** and **Destruction** of **alveolar walls**
* Walls of alveoli are **torn and cannot be repaired**
* Alveoli **fuse** into **large air spaces**
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Chronic Bronchitis think.....
Bronchiole inflammation
34
Adult COPD: **Chronic Bronchitis**
## Footnote
**What MUST be present in order for it to be Chronic Bronchitis?**
Presence of **productive cough** for **3 mos** in **each of 2 successive years**
35
Adult COPD: **Chronic Bronchitis**
## Footnote
**Pathophys:**
* **Irritation** leads to **hypersecretion of mucus** in LARGE airways and **progresses** to SMALLER airways **hypersecretion**
* **Hypertrophy** of **submucosal glands**
36
Chronic Bronchitis
## Footnote
**Explain role of Goblet Cells**
* Make mucus as a **defense mechanism**
* ****EVENTUALLY.....**mucus clogs everything up!!!**
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Disorders common in COPD
## Footnote
**Chronic Bronchitis**
**What happens?**
1. Air tubes **narrow** as a result of **swollen tissues** and **excess. mucus production**
2. **Enlarged submucosal gland**
3. **Inflammation** of **epithelium**
4. **Mucus accumulation**
5. **Hyperinflation** of **alveoli**
38
Decreased recoil in lungs
OR
loss of **elasticity in lungs**
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Adult COPD: **Emphysema + Chronic Bronchitis**
## Footnote
**The cascade of events:**
1. **Risk factors==** smoking (**most common)**, air pollution, noxious particles
2. causes **inflammation of lung**
3. **structural** changes and **narrowing** of **small airways** w/ **hypersecretion**
4. Destruction of **lung parenchyma, resp. bronchioles, alveoli===\>** Dec. **lung recoil (loss of elasticity)**
40
Adult COPD: **Emphysema + Chronic Bronchitis**
**Air TRAPPED in lungs (bad open/closing of Alveoli)**
**Explain the events:**
* Air **TRAPPED** in lungs
* **lose elastic recoil of lungs**
* **NOT good control** of open/closing of **alveoli**
* ****air becomes **TRAPPED w/ not enough time to get out!!!**
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Adult COPD: **Emphysema + Chronic Bronchitis**
## Footnote
**PFT**
PFT \<60%
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Adult COPD: Emphysema + Chronic Bronchitis
## Footnote
**ABG**
INCd **CO2**
43
Adult COPD: Emphysema + Chronic Bronchitis
## Footnote
**Auscultation?**
**LONG Exhalation phase**
**\*Cannot get air OUT!**
44
Adult COPD: Emphysema + Chronic Bronchitis
## Footnote
**Posture**
Forward head
Rounded shoulders
Kyphosis
45
Adult COPD: Emphysema + Chronic Bronchitis
## Footnote
**Strength**
Loss-- **ESP LE's**
**Do MMT, HHD,**
**Weakness-- esp. INSP mm strength**
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Adult COPD: Emphysema + Chronic Bronchitis
## Footnote
**Explain Em**_P_**hysema Dominant:**
**PINK PUFFERS**
* EmPhysema has a P, Pink Puffers has P!!!
* **Much more frail**
* **skinny**
* **Not a lot of coughing**
* **\*\*\*Hypertrophy of Scalenes**
* **Scalene Triangle\*\*\*\*\*\*\***
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Adult COPD: Emphysema + Chronic Bronchitis
## Footnote
**Chronic Bronchitis dominant:**
**Blue Bloaters**
* **Bronchitis has a B, Blue Bloaters has a B!!!**
* **R. sided HF**
* **Congestion, fluid**
* **Peripheral edema bc backflow of fluid**
48
Adult COPD: Emphysema + Chronic Bronchitis
## Footnote
**GOLD Classification**
**Global Initiative for Obstructive Lung Disease**
**Stage I (mild)**
**FEV1 % predicted**
\>80
## Footnote
**\*remember FEV1/FVC will be**
49
**Adult COPD: Emphysema + Chronic Bronchitis**
**GOLD Classification**
**Global Initiative for Obstructive Lung Disease**
**Stage II (moderate)**
**FEV1 % predicted**
50 to 80
## Footnote
**\*FEV1/FVC**
50
**Adult COPD: Emphysema + Chronic Bronchitis**
**GOLD Classification**
**Global Initiative for Obstructive Lung Disease**
**Stage III (severe)**
**FEV1 % predicted**
30 to 50
## Footnote
**\*FEV1/FVC**
51
**Adult COPD: Emphysema + Chronic Bronchitis**
**GOLD Classification**
**Global Initiative for Obstructive Lung Disease**
**Stage IV (very severe)**
**FEV1 % predicted**
\<30
## Footnote
**\*FEV1/FVC**
52
BODE Index
## Footnote
**just remember....**
HIGHER score === WORSE
53
Adult COPD: **Emphysema + Chronic Bronchitis**
## Footnote
**Medical Management:**
* smoking cessation
* **Pharmacotherapy** for COPD
* **Influenca vaccine**
* Tx of **sleep disorders**
* **Pulm rehab + exercise**
* **Surgical excision** of bullae or **lung volume reduction surgery (LVRS)**
* **O2 therapy**
* **\*Remember---\>** over 21%==**Drug**
54
Adult COPD: **Emphysema and Bronchitis**
## Footnote
**Implications for PT Tx??**
* Secretion **clearance**
* **Controlled breathing:**
* ****@ rest
* w/ activity
* **Ambulation w/ RW (or least restrictive device)**
* ****Tripod breathing\*\*\*
* **Education** in **use of recovery** from **SOB pos's**
* **Endurance ex.**
* Strength training
* **Thoracic stretching**
* Posture re-ed.
55
Alpha1-Antitrypsin Deficiency
## Footnote
**What is this ?**
How you get **emphsyema w/out smoking!!!**
56
Alpha1-Antitrypsin Deficiency
GENETIC\*\*\*
**Imbalance b/w what???**
Production and Destruction of **inner wall of alveoli**
## Footnote
**\*leads to Emphysema @ an early age**
57
Alpha1-Antitrypsin Deficiency
Think what when you see this.......
**Genetic cause for Early emphysema w/out smoking!!!**
58
When you see **Bronchiectasis**
**Think....**
PERMANENT **Dilation of the Bronchia**
59
Dilation of the Bronchia
Bronchiectasis
60
Bronchiectasis
## Footnote
**Irreversible dilation WITH what???**
* **Chronic inflammation AND infection**
* **\***actually more **prone to infection**
61
Bronchiectasis
## Footnote
**Varying lvls of \_\_\_\_\_\_\_\_**
Varying lvls of **distortion of conducting airways**
**thickening**
**herniation**
**dilation**
62
Bronchiectasis
## Footnote
**Causes:**
1. Idiopathic----do NOT know why
2. **Bronchial wall** injury OR **structural weak.**
3. **Traction** from **adj. lung fibrosis**
4. **Bronchial lumen** obstruction
1. from **mucus/swelling**
63
Some **Common Causes** of **Bronchiectasis**
## Footnote
**See chart!!!**
* MANY CAUSES
* **Post-infectious dis's**
* **Injury/inhalation accidents**
* **chronic GERD\*\*\***
* **Congenital abnormal mucociliary clearance**
* **\*systemic diseases\***
* **Exaggerated immune resp. disorders**
* **RLD's**
64
Bronchiectasis
## Footnote
**Sx's**
* **Cough** w/ **sputum production**
* SM to LG quants of **purulent secretions (HALLMARK---REMEMBER THIS!!!)**
* **Secretion**
* ******mucoid** initially THEN
* **purulent** in **sub-acute to chronic phases**
* **thick, yellow-green** plugs
* Sputum GREATEST in **morning**
* Recurrent, chronic, recurring **lung infections**
* **_Hemo_**ptysis
* **blood in mucus**
65
When is sputum greatest w/ **Bronchiectasis?**
In the **MORNING !!!**
66
Bronchiectasis
## Footnote
**Physical Exam**
**How are they Dx this?**
* Chest Xray
* **CT Scans\*\*\*\*\*\*\*\*\*\*\* REMEMBER THIS ONE!!!**
* PFTS
* **Sputum testing**
* ABGs
* Auscultation
* **Posture**
* Mm imbalances
* Eval of **GERD \*\*\*\*\***
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GERD can be an underlying cause of.....
Bronchiectasis
68
**Signet Ring Signs**
**Think....**
Bronchiectasis!!!
69
Bronchiectasis
## Footnote
**Medical Mgmt:**
**What are the goals of this disease?**
* Goal: **reduce # of exacerbations and improve QoL**
* Mng **underlying cond.**
* Mng **acute exacerb's**
* **Long-term mgmt**
* Sx
70
These 2 OLD's have the **POOREST** **Prognosis**
1. CF
2. Bronchiectasis
71
Bronchiectasis
## Footnote
**Prognosis?**
DEPENDS on:
**underlying dis. or cond.**
72
Bronchiectasis
## Footnote
**Implications for PT Tx?**
* **Secretion** clearance
* **Controlled breathing**
* pre/post exertion
* ACBT
* **Strength** training
* **Endurance** training
73
Cystic Fibrosis (CF) is a ________ disorder
Multisystem\*\*\*
74
CF is a **multisystem disorder** that affects **organs** w/ **epithelial surfs,**
## Footnote
**Primarily:**
* Pulmonary
* **usually what is fatal**
* Pancreatic
* Intestine
* **Hepatic digestive**
* Male repro.
75
CF
## Footnote
**Secondary organs it will affect:**
* **Mucus stasis** in **conducting airways of:**
* ****lung
* nasal sinuses
* sweat glands
* sm. intestine
* pancreas
* biliary system
* \***Basically.....mucus clogs up ALL tubes!!!**
76
CF will also show **abnormal transport of:**
Abnormal **Salt and Water** transport
77
CF is the **failure of airways to do what?**
Clear mucus normally
78
WHO does CF affect?
Children
AND Young Adults
79
Supplementary digestive enzymes taken w/ this disease
CF
80
Normal airways vs. Airways w/ **CF**
NOTE: 2 things
1. Bacterial infection
2. Blood in mucus
81
Cystic Fibrosis S/S
## Footnote
**Pulmonary**
1. Persistent **cough**
2. **Productive** cough/**sputum** production
3. Persistent **wheezing**
4. Fluctuating **lung infiltrates/consolidations** OR **infections**
5. **Wheezing w/ resp.**
6. INC'ing **dyspnea**
7. **Barrel-chested/horiz. rib align.**
8. Cyanosis/Clubbing-----\> **long term hypoxia**
9. Kyphosis
82
CF S/S
## Footnote
**Cardiac**
* End-stage dev. of **R. Sided HF** from **Pulm HTN**
83
CF S/S
## Footnote
**GI**
* Wt. loss--\> Anorexia--\> **Failure to thrive**
* **Malabsorption** of **nutrients** in **intest. tract**
* **Maldigestion** and **fecal impaction** in **term. ileum**
84
Cystic Fibrosis S/S
## Footnote
**Pancreatic**
**\*think nutrition!!!**
* Pancreatic **insuff.**
* Lg, freq, **loose foul-smelling stool**
* **Fat-soluble** (A, D, E, K) vit. deficiency
* **encourage to eat MORE fat**
* **Malnutrition**/ inability to break down FATS and CHO
85
CF S/S
## Footnote
**GU**
* Male urogenital abnorms w/ **sterility and infertility**
* **tubes blocked up w/ mucus EVERYWHERE**
86
CF S/S
## Footnote
**Musculoskeletal**
* myalgia
* osteoporosis/penia
* mm wasting
87
WHO does **CF** Affect?
* Caucasians
* **Equal gender prev.**
* \>5% pop. carries **single copy** of **genetic mutation**
88
CF
**Pathophysiology**
**What is the CFTR Gene?**
CF Transmembrane Conductance Regulator Protein
* gene loc'd on **chromosome 7** that creates **abnorms in CFTR PRO**
* this CFTR PRO **usually** provides a **channel by which Na+/Cl- can pass thru epithelial cells**
* SO...**gene mutations cause lack of (or malformed) CFTR**
89
What is another good way to remember the **CFTR PRO?**
Where **sodium goes, H2O follows!!!**
**Na + Cl live together**
**\*w/ malformed CFTR PRO---\>** now mucus cannot get **hydrated (to thin out)==\> Thicccc mucus that cannot get coughed out!!!**
90
CF causes an **impermeability of ______ to \_\_\_\_\_\_\_**
Impermeability of **Epithelial cells** to **Chloride**
91
One of the results of **impermeability of epithelial cells to chloride results in:**
Inc'd **viscosity of the mucus glands _normal lung secretions:_**
**This now results in?**
* Inc'd **viscosity of the mucus glands _normal lung secretions:_**
* Impaired **cilia** function
* **bronchial obstruction** by **lg mucus**
* **Hyper**inflation
* **atelectasis**
* ****collapsed alveoli
* **chronic** infections
* **SEVERE: bronchiectasis and fibrosis**
92
2 other things that **Impermeability of the epithelial cells to Chloride results in?**
1. Elevation of **sodium chloride** in **sweat**
2. Inc'd viscosity of **pancreatic enzymes secretion** from the **pancreas** leading to **pancreatic insufficiency**
93
CF
## Footnote
**Phys. Exam**
**How are they Dx this?**
* Dx tests
* **New born screen==\> CFTR mutation screen**
* **Sweat test==\>** elevated **chloride lvls**
* \>/= 60 mEq/L
* Radiographs
* PFTs
* ABGs
94
CF
## Footnote
**Medical Mgmt:**
* Guidelines CF Care
* **Goals==\>**
* ****Control **lung infection**
* Promote **mucus clearance**
* Improve **nutritional stat.**
* Look 4 **pulm infections**
* **Pancreatic stat. + nutritional supp.**
95
CF
**Prognosis**
DRAMATIC INC in **median age survival**
**2015: was 40yo**
96
S/S acute pulm exacerbation
see chart
Everything you would expect BUT
**inc'd temp is interesting----low grade rise in temp**
**inc'd WBC--fighting something**
**DEC FEV1== typ. OLD**
97
How can we **prevent CF?**
* Genetic counseling
* remember **CFTR PRO**
* **Screen for CF carrier status**
98
CF
## Footnote
**Implications for PT Tx?**
* **secretion clearance** tech's
* **controlled breathing** ex's
* Exercise!!! Strength training!!!
* **Inspiratory mm** training
* **Thoracic stretch** ex's
* **Postural re-ed\*\*\***
99
W/ Asthma
## Footnote
**Greek word for what???**
Panting
100
MOST common OLD
Asthma
101
is Asthma reversible??
YES!!!
102
Asthma
## Footnote
**What is it?**
**Reversible**, **Chronic** inflamm. disorder of **airways**
103
Asthma is the **abnormal accumulation of???**
## Footnote
**6 things (think WBC's)**
1. Eosinophils
2. lymphocytes
3. mast cells
1. **produce histamine**
4. macrophages
1. eat/engulf antigens
5. dendritic cells
6. myofibroblasts
104
**Many causes for Asthma**
* genetic
* Low/High birth wt
* **Prematurity**
* Maternal **smoking**
* Paternal **smoking in household**
* obesity
* **High intake of Salt\*\*\*\*\* INTERESTING!!!**
* Extremely **sterile** environments
\*\*\*Asthma comes from **Trigger**
**\*\*\*Everyone** has ability to develop asthma
105
Triggers + Asthma?
**viral/allergen**
Exercise
inhalation **cold air**
106
Disorders common in COPD:
## Footnote
**Asthma**
NOTE:
* Edema of **resp. mucosa** and excess. mucus prod. **obstruct airways**
* **hyperinflation alveoli**
107
Asthma
## Footnote
**Sx's**
* **Recurrent** **episodic OLD**
* Wheezing
* chest tightness
* SOB
108
Asthma
## Footnote
**Physical Exam:**
Do ALL of this @ **Baseline**
* **Dx tests:**
* **PFTs** to eval **current function** AND any **reversibility** of **airway obstruction** AFTER **bronchodilator admin'd**
* **Look for special types asthma:**
* ****seasonal
* ex-induced
* **asthmatic bronchitis**
* Allergy test
109
Asthma
## Footnote
**Medical Mgmt**
**If JUST asthma**
START w/ **Steroid,** THEN **shift to Bronchodilators**
110
Asthma
**Medical Mgmt:**
**If COPD**
START w/ **Bronchodilator THEN steroids**
111
Asthma
## Footnote
**Medical Mgmt**
* Emphasize **long-term control**
* **Obj. measures** to assess **function** and monitor!
* **ID** and **Eliminate** causes
* Comprehensive **pharmacological tx**
* therapeutic partnership
112
Asthma
## Footnote
**Prognosis**
**How many who have it as kids will have it as adults ?**
50% who have childhood asthma continue to have sx's in adulthood
113
Asthma
## Footnote
**Clinical Features BEFORE Tx**
**see chart**
Step 1: Mild Intermittent
Step 2: Mild Persistent
Step 3: Moderate Persistent
Step 4: Severe Persistent
114
when would you use a **Peak-Flow meter for asthma?**
**_During_** asthma attack
115
Asthma
## Footnote
**Implications for PT Tx**
**What do you need to remember about this????**
Interventions **SHOULD** **NOT begin _until medication regime is established_**
116
Interventions SHOULD NOT begin until medication regime is established w/\_\_\_\_\_\_\_\_
Asthma !!!
117
Asthma
## Footnote
**Implications for PT Tx**
DO NOT begin until medication regime established!!!
* Secretion clearance
* controlled breathing
* exercise!! strength!!!
* thoracic stretching
* Postural re-ed
* **assist w/ prevention planning**
**\*\*\*ASK: how long using rescue inhaler? do you NEED it? OR uneducated HOW to use it?**
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