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Pulmonary exam Flashcards

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1
Q

What risk factor put a patient into the “very severe” category for COPD?

A
  • FEV<30%

- Or presence of chronic respiratory failure or right heart failure

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2
Q

What are the elastic factors of breathing?

A

lung compliance
chest wall compliance
compliance-ability of tissue to expand (change in volume/change in pressure), 1/elasticity

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3
Q

What are the non-elastic factors of breathing?

A

airway resistance
surface tension- surfactant
tissue elasticity-elastin/collagen, muscle properties/skeletal alignment

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4
Q

Work of breathing

A

the work of the respiratory muscles to overcome the elastic factors and resistance forces needed to expand the lungs and chest wall

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5
Q

Effect of decreased lung compliance on WOB

A

decreases work of breathing

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6
Q

Increasing airway resistance effect on WOB

A

increases work of breathing

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7
Q

Effect of breathing more rapidly and more deeply on WOB

A

-increases the work of breathing

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8
Q

Restrictive lung disease

A

lung diseases that cause REDUCED EXPANSION of lung and/or chest wall
-decreased respiratory compliance

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9
Q

Examples of restrictive lung disease

A

pneumonia, atelectasis, pleural effusion, IPF

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10
Q

pulmonary interstitial disease

A

chronic interstitial lung disease can be caused by known etiologic agents (drugs, toxins) OR
interstiitial pulmonary fibrosis, sarcoidosis, collagen vascular disease

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11
Q

What specific lung volumes are decreased with restrictive lung disease?

A

inspiratory reserve volume

residual volume

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12
Q

IPF (idiopathic pulmonary fibrosis) beginning symptoms

A

-alveolitis: accumulation of inflammatory cells in the interstium and alveolar spaces- immune and inflammatory cells

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13
Q

End-stage IPF characteristics

A

fibrotic lung with useless airspaces; characterized as cystic spaces separated by thick bands of connective tissue with inflammatory cells

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14
Q

Fick’s law- rate of diffusion

A

(area x (P1-P2) x diffusion constant)/thickness of membrane

-passive exchange of gas between lung and blood & blood and tissues/organs

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15
Q

2 classifications of pneumonia

A

Community-acquired pneumonia: contracted outside of hospital

Hospital acquired pneumonia

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16
Q

Areas of pneumonia infection in the lung

A
  • entire lobe
  • segment of lobe
  • alveoli contiguous to bronchi
  • interstitial tissue
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17
Q

Complications of pneumonia

A

-fever/chills/tachycardia /tachypnea
-sputum
-pleurisy (painful chest wall)
-abscess
pleural effusions/empyema

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18
Q

atelectasis

A

lung collapse due to loss of air volume- failure of lungs to inflate

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19
Q

pneumothorax

A

abnormal presence of air in the pleural cavity resulting in the collapse of the lung

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20
Q

2 types of pneumothorax

A

spontaneous: rupture of sub pleural blobs
traumatic: lung puncture/liine instertion, etc.

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21
Q

pleural effusion

A

excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs
- can impair breathing by collapsing underlying lung

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22
Q

pulmonary edema

A
  • fluid accumulation in the lungs
  • impairs gas exchange and may cause respiratory failure
  • DOE, pink frothy sputum
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23
Q

Causes of pulmonary edema

A
  1. failure of heart to remove fluid from lung circulation

2. injury to the lung parenchyma or pulmonary vasculature

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24
Q

COPD

A

-preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients. Airflow limitation not fully reversible. Usually progressive

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25
3 subsets of disease comprising COPD
- chronic bronchitis - asthma - emphysema
26
pneumothorax
abnormal presence of air in the pleural cavity resulting in the collapse of the lung (spontaneous or due to injury_
27
hemothorax
abnormal presence of air in the blood
28
pleural effusion
excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs -impair breathing
29
pulmonary edema
fluid accumulation in the lungs - impairs gas exchange - may cause reap. failure - difficulty breathing, DOE
30
causes of pulmonary edema
1. failure of the heart to remove fluid from the lung circulation 2. injury to the lung parenchyma or pulmonary vasculature
31
causes of COPD
chronic bronchitis, emphysema, asthma
32
Brochiectasis/cystic fibrosis
obstructive diseases
33
COPD
Chronic obstructive pulmonary disease - preventable and treatable disease with some extra pulmonary effects - airflow limitation (not fully reversible) - airflow limitation progressive and associated with inflammatory responses of the lung
34
risk factors for COPD
- aging - cigarette smoke - occupational dust/chemicals - socioeconomic status - nutrition - infection - indoor/outdoor air pollution
35
what is the success of smoking cessation
<30%
36
Change in FEV1 decline in smokers
Increased rate of FEV1 decline | smoking cessation decreases rate of FEV1 decrease
37
more COPD deaths in men or women?
in past men, but women surpassed this rate in 2000
38
COPD effect of FEV1
decreased
39
COPD effect of FEV1 on FRC and RV
increased (hyperinflation)
40
What factors does airflow obstruction result from?
- anatomic airway narrowing (bronchoconstriction/inflammation) - loss of elastic recoil of the lung
41
chronic bronchitis
persistent cough with sputum production for at least 3 months in at least 2 consecutive years - smoking includes predisposition - progressive dyspnea on exertion - may progress to for pulmonale (right heart failure)
42
Emphysema
-permanent, destructive abnormal enlargement of the air spaces distal to the terminal bronchiole with destruction of the alveolar walls without obvious fibrosis
43
Characteristics of emphysema (FEV, gas exchange)
Decreased FEV 1/3 of lung function must be lost for clinical manifestations to appear Impaired gas exchange
44
clinical signs of emphysema
``` DOE, decreased ex. capacity hyperinflation/chest deformation hypertrophy of accessory breathing muscles wheezing clubbing of digits weight loss ```
45
Emphysema underlying action
pleural pressures become greater than alveolar pressures, the tubing will collapse
46
Bronchiectasis and cystic fibrosis
- disorders associated with mucus hyper secretion - localized irreversible dilation of bronchial tree - cough, fever,
47
Cystic fibrosis
- genetic alteration in chromosome 7 | - mucus hypersecretion and plugging combined with repeated infections leading to bronchiectasis and airway obstruction
48
Other organs impaired by CF
pancreas digestive tract musculoskeletal
49
***3 major factors of CF (bronchiectasis)
infection inflammation obstruction
50
etiology of bronchiectasis
- bronchial enlargement w obstruction | - results from multiple causes including PNA, tuberculosis, tumor, asthma, CF, kartagener syndrome
51
asthma
characterized by chronic airway inflammation and bronchospasm -history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time
52
Areas of systems review for pulmonary exam
- cardiovascular - integumentary - pulmonary - musculoskeletal - neuromuscular
53
5 components of pulmonary exam
inspection, palpation, percussion, auscultation, activity
54
tachypnea/bradypnea
tachypnea=>20 bpm | bradypnea=<10 bpm
55
kussmaul's breathing
consistent, very deep breathing pattern at a normal or increased rate -associated w severe metabolic acidosis- form of hyperventilation
56
cheyne stokes breathing
creschendo-decrescendo pattern in the depth of respirations with periods of apnea (HF, CVA, TBI)
57
phases of cough
irritation inspiration compression expulsion
58
things to check in sputum
color, amount, thickness, presence/odor
59
Situations when the trachea deviates towards the affected lung
atelectasis | fibrosis
60
Situations when the trachea deviates away from midline
pleural effusion tension pneumothorax (shifted contralateral)
61
tactile fremitus
palpable vibration produced during breathing caused by partial airway obstruction. Can be due to mucus, other secretions in airway, constriction, tumors
62
In which conditions is there increased tactile fremitus
- consolidation - large airway - pulmonary edema
63
decreased tactile fremitus
pneumothorax/pleural effustion
64
conditions with tympanic percussion
pneumothorax/airtrapping
65
conditions with dull percussion
-consolidation (PNA), atelectasis, pleural effusion
66
normal tracheal breath sounds
loud/high pitched expiration longer than inspiration short pause between I and E
67
normal bronchovesicular BS
heard around sternum/between scapula | I and E are equal duration/loudness- no pause
68
Normal vesicular BS
- heard over majority of lung periphery | - inspiration louder and longer than expiration- very quiet
69
Wheezing
small airways= high pitch=sibilant rhonchi | large airways=low pitch=rhonchi
70
Crackles/rales
-bubbling/fizz- moist or dry -primarily heard on inspiration large airways= low pitch small airways= high pitch
71
diminished breath sounds
hyperinflation air, fluid, blood between lung and chest wall -airway blockage -obesity
72
pleural friction rub
- heard through respiratory cycle - creaking leather/rubbing balloon - pleural membrane inflammation
73
Absolute contraindications for airway clearance therapy
head and/or neck injury not yet stabilized | active hemorrhage with hemodynamic instability
74
other contraindications for airway clearance
``` bleeding abnormalitites recent pacemaker insertion burn/skin grafts to the chest pulmonary hemorrhage head injury hypoxia vomiting/aspiration ```
75
Amount of time for positioning
>/= 5 min
76
Ways to alter breathing through exercise/retraining
- change rate - change depth - change muscular pattern/breathing pattern
77
potential benefits of breathing exercise/retraining
- reduce work of breathing (decrease RR, increase tidal volume), decrease accessory muscle use - improve oxygenation and CO2 removal - remove/loosen secretions - maintain or improve thoracic mobility
78
types of breathing exercises
- diaphragmatic breathing - pursed lip breathing - deep breathing/incentive spirometry - segmental/lateral costal expansion
79
goals of oxygen therapy
- correct hypoxemia - decrease symptoms associated with hypoxemia - decrease workload on cardiopulmonary system
80
precautions of oxygen therapy
- oxygen toxicity - depression of ventilation - retniopathy of prematurity - absorption atelactasis - bacterial infection w humidifiers
81
The number one rehabilitative procedure
- LE aerobic training: helps patient become more functional and less short of breath - DOES NOT improve lung function: may feel better/walk further, but FEV1 will STAY THE SAME
82
What 3 main factors does lung disease impact?
ventilation (FEV1...) cardiac (decreased CO...) skeletal muscle (deconditioning...)
83
Types of exercise prescription for pulm. rehab
- aerobic - inspiratory muscle training - strength training - LE- treadmill - UE-UE ergometer - UE/LE isotonic
84
Intensity of exercise prescription
3-5 on borg | Initially 60% peak workload, goal of >80% peak workload
85
Time and frequency of ex. training
30-40 min continuously If >5 MET's , 3-5/wk 3-5 METs 1-2/day <3 MET- multiple/day
86
Benefits of plum. rehab
``` improved exercise capacity improved muscle strength reduced dyspnea improve QOL reduced readmission rates/length of stay in COPD ```
87
MRC breathlessness scale
Grade 1: not trouble by breathlessness except during strenuous activities Grade 5: too breathless to leave the house, or breathless when undressing
88
difference between MRC and Borg
Borg evaluates dypnea before during, after exercise, while the MRC scale is based on degrees of various physical activities that precipitate dypnea
89
In which conditions does chest wall excursion decrease?
Pneumothorax, pleural effusion, pneumonia, CF, COPD, IPF
90
In which conditions will tactile fremitus be decreased
pneumothorax, pleural effusion, COPD
91
In which conditions will tactile fremitus be increased?
penumonia, CF, bronchiectasis
92
Peripherally inserted central catheter
- intravenous access that can be used for a prolonged period of time: antibiotics, chemo, TPN - insterted peripherally and advanced to superior vena cava
93
Central venous catheter
- used for motoring in ICU (right trial pressure) - administration of meds/fluid - venous blood sampling - reduces number of venous punctures and allow for simultaneous administration of drugs
94
common problems w IV in PT
inflammation/pain due to infection accidental dislodgment infiltration clot formation
95
what do dysrhthmias result from?
altered conduction, automaticity or both
96
when is a pacemaker/defibrillator indicated?
dysrhythmia results in: hemodynamic instability, life threatening, symptomatic limitations
97
Indications for a defibrilator
v-fib or v-tach

Medical Conditions (3 decks)

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