Pulmonary Quiz Flashcards
(143 cards)
1
Q
obstructive lung disease
A
chronic inflammation of the lungs causing obstruction in exhalation
2
Q
COPD
effect on lungs
A
chronic obstructive pulmonary disease
leads to deterioration of small airways
airflow obstruction can come from retaining secretions, inflammation of lining, bronchial constriction, weakened support structure, increased compliance of tissue
airways close prematurely and trap air, causing hyperinflation
3
Q
progression of COPD
A
causes mismatched perfusion at capillaries, results in hypoxemia and decreased O2 in arterial blood
progresses further to hypercapnia/increased CO2 in blood and contributing to pulmonary hypertension
4
Q
COPD prevalence
A
most common chronic respiratory disease
common cause of death
5
Q
COPD demographics
A
40+ y/o
slightly more women than men
smoking
low SES
unemployed/retired/disability
southwest/midwest
rural
poor air quality
6
Q
risk factors for COPD
A
occupational exposure
air pollution
age
cigarette smoking
childhood respiratory conditions
genetics
SOB w activity
7
Q
COPD clinical presentation
A
dyspnea worse w exertion
chronic cough
barrel chest
wheezing
reduced/absent breath sounds
retaining CO2
excess sputum coughed up
8
Q
COPD function testing (PFT)
A
spirometry measuring time-volume relationship in lung - test for delayed and incomplete emptying
forced expiratory volume
forced expiratory volume over 1 sec/forced expiratory capacity should be >75%
9
Q
Gold Staging of COPD
A
mild: FEV1 is 80% of normal, mild symptoms and SOB, chronic cough
mod: FEV1 is 50-80% of normal, chronic cough, sputum, dyspnea
severe: FEV1 is 30-50% of normal, chronic cough, sputum, dyspnea
very severe: FEV1 is less than 30% of normal, chronic cough, sputum, dyspnea, R HF, weight loss
10
Q
changes in lung values with COPD
A
all are elevated volume, total lung capacity is higher due to trapped air
same tidal volume amount but higher residual volume
11
Q
BODE Index
A
index for COPD severity
predicts hospitalization, survival
0-10 points
0-2 80% 4 year survival
3-4 67%
5-6 57%
7-10 18%
12
Q
Medical management of COPD includes
A
smoking cessation
pharm: mucolytics, bronchodilators, steroids
flu vaccine
pneumonia vaccine
treat any sleep disorders
pulmonary rehab and exercise training
surgery to remove damaged lung segments
13
Q
emphysema
A
lung condition where alveolar walls are destroyed and airspaces distal to terminal bronchioles are enlarged
end stage COPD
14
Q
causes of emphysema
A
smoking is main cause
also environmental toxins
15
Q
emphysema s/s
A
non productive dry cough or absent cough
not eating
NOT cyanotic
accessory muscle use
pursed lip breathing
lean forward
16
Q
chronic bronchitis
A
presence of chronic productive cough for 3 months in each of 2 successive years
mucus hyper secretion in large airways, progressing to smaller airways
hypertrophy of submucosal glands
crackling breath sounds
17
Q
emphysema vs chronic bronchitis
A
pink puffer vs blue blower
emphysema:
- accessory muscles for breathing
- pursed lip breathing
- absent cough
- leans forward to breathe
- dyspnea on exertion
chronic bronchitis:
- excess body fluid
- chronic cough
- SOB
- increased sputum
- cyanosis
18
Q
COPD thorax ROM
A
decreased excursion
muscles of ventilation become stretched and diaphragm unable to return to dome shape, flattening
accessory muscles required to breathe
19
Q
asthma s/s
A
wheezing, SOB, chest tightness, fatigue during exercise, poor athletic performance, avoid activity, coughing
cough worse at night and morning
20
Q
asthma mechanism
A
inflammatory response caused by trigger
narrowed airways/bronchospasm
increased secretions
resistance to airflow and trapping of exhalation
can lead to airway remodeling in uncontrolled asthma
21
Q
asthma risk factors
A
genetics
boys>girls
environmental
infections
allergens
obesity
22
Q
spirometry for asthma
A
provoke attack with bronchoconstrictor agent and measure
compare measurement with bronchodilators
decreased FEV1 with increased RV and functional residual capacity
should be reversible with bronchodilators/inhaler
23
Q
peak flow meter
A
measures expiration in one quick blast 1 second
compare to age or personal norms
24
Q
asthma severity levels
A
intermittent: <2x week, not interfering with normal activities, spirometry above 80%
mild persistent: >2x week, nighttime symptoms 3-4x month, spirometry above 80% when not having an attack
mod persistent: daily symptoms and daily meds, nighttime symptoms >1x week, interferes with activity, abnormal spiromatry >60%
severe persistent: continuous symptoms day and night, severely limited activity, frequent attacks, spirometry <60%
25
asthma medical management
prevention: avoiding triggers/exposures
long term control with pharm: anti inflammatory, bronchodilators, combo
exercise within activity parameters that won't trigger attack
26
asthma clinical presentation
altered breathing pattern
wheezing breath sounds
decreased breath sounds in attack
dyspnea on exertion
coughing at night/after infection
accessory muscle use
pursed lip breathing
postural changes
27
asthma prevention
lifestyle modification: diet, sleep, reduce irritant exposure, hydration, weight, activity, flu shot
reduce household: mold, pets, wash bedding, HEPA filters, sanitize fabrics
exercise induced asthma should warm up, hydrate, cover nose in cold
28
PT implications with COPD
clear secretions
control breathing w rest and activity
ambulate
endurance
strength
thoracic stretching
postural reeducation
29
PT implications with asthma
secretion clearing
controlled breathing
exercise and strength
thoracic stretching
postural reed
pt edu/HEP
start once medication regiment stable
30
how does aerobic exercise impact asthma?
controls symptoms and lung function but does not affect airway inflammation
decreased exacerbation
low intensity, 3-5x week
progressively increase as tolerated without aggravating
31
cystic fibrosis
genetic condition
life threatening
abnormal protein affects cells to produce thickened mucus and sweat which gets stuck, reducing function and causing infection
affects respiratory, digestive, reproductive
32
prevalence of cystic fibrosis
recessive gene, need two carrier parents
genetic testing/sweat test
33
CF medical management
control: lung infections, mucus clearance, nutritional status, pancreatic status
nutrient supplementation
increase in survival to 38
34
CF symptoms
persistent cough: productive with sputum
recurrent lung infections
nutrient malabsoprtion
vitamin deficiency
pancreatic insufficiency
muscle pain
reduced bone density
diabetes
pursed lip breathing
accessory muscle hypertrophy
abnormal breath sounds: crackle, wheeze
cyanosis
digital clubbing
35
s/s of acute CF exacerbation
increased cough, sputum production, temperature, respiratory rate, WBC count
decreased FEV1, appetite, weight, activity level
36
PT treatment of CF
secretion clearance
controlled breathing
exercise/strength
inspiratory muscle training
thoracic stretching
postural reed
pt education on infection control and home management
37
restrictive lung disease
less common than obstructive
caused by intrinsic impairment or extrinsic condition affected chest wall mobility, NM function, obesity
results in reduced lung expansion, lung volume
hard to get air into lungs bc they can't expand fully
38
FEV1/FVC ratio in RLD
cannot inhale as much but no issue exhaling
ratio will be normal or increased
in general all lung volumes are reduced
FEV1 and FVC are both decreased
39
s/s of restrictive lung disease
tachypnea
hypoxemia
fatigue
weight loss
decreased lung volumes
chronic dry cough
pulmonary HTN/signs of HF
40
interstitial lung disease types
exposure related: chemo/meds, environmental/dust/fumes/radiation
autoimmune: RA, lupus, scleroderma, polymyositis, dermatomyositis
idiopathic
41
interstitial lung disease is...
inflammatory process of alveolar wall that causes fibrotic scarring
progressive
many types
42
risk factors for pulmonary fibrosis
age
smoking
genetic predisposition
air pollution
viral infection
GERD
more common in men
43
s/s idiopathic pulmonary fibrosis
dry cough, weight loss, fatigue, digital clubbing, LE edema
44
Sarcoidosis
inflammatory autoimmune condition
multisystem
presence of tiny granulomas
lungs and lymph nodes
women more than men, 30-55 y/o
45
RA
chronic peripheral joint inflammation
results in progressive destruction of articular/periarticular structures
pleural involvement, pulmonary nodules/vasculitis, bronchiolitis, bronchogenic cancer
46
risk factors for interstitial lung disease
RA (esp severe)
smoker
age
male
47
clinical presentation of RA and interstitial lung disease
progressive dyspnea
non productive cough
cyanosis
warm/swollen joints
diminished breath sounds/rales
48
systemic lupus
multi system autoimmune disorder causing chronic inflammation of connective tissue
skin, joints, kidneys, lung, NS, heart
affect lungs: pleuritis and diaphragmatic weakness
49
clinical presentation of SLE -systemic lupus erythematosus
articular pain and swelling
OA
dyspnea
fatigue
cough
weight loss
raynaud's phenomenon
photosensitivity
fever
mouth ulcers
chest pain
hair loss
eye disease
kidney
anemia
50
scleroderma
autoimmune, idiopathic
progressive fibrosing in skin, blood vessels, esophagus, GI, lung, heart, kidneys, joints
appears as interstitial fibrosis
no cure, symptom management
51
s/s scleroderma
skin thickening/swell/tighten
enlarged blood vessels
calcium deposits on skin
HTN from kidney dysfx
heartburn
GI involvement
weight loss
decreased lung volume
raynaud's
dy cough
joint pain
52
polymyositis/dematomyositis
inflammatory autoimmune
progressive muscle weakness/skin changes
pulmonary characteristics:
aspiration pneumonia, neck muscle weakness, respiratory muscle weakness, elevated diaphragm
SOB, dry cough
53
SCI and pulmonary involvement
C3: vent dependent
C4: may need support
C5: may or may not need depending on zone of partial preservation
pts less likely to be able to cough or breathe fully, increased risk of infection
paradoxical breathing: belly expands and ribs depress or belly flattens and ribs expand
54
diaphragm paralysis impact on respiration
commonly from phrenic nerve
causes diaphragm to pull up and ribs in
results in alveolar hypoventilation/poor gas exchange
UL won't need treatment, teach compensation
BL needs vent support
55
ALS and pulmonary function
reduced due to weakness, secretions, infiltrates
decreased breath sounds, poor airway clearance, dyspnea w mild exertion
56
poliomyelitis and pulmonary function
reduced lung volume, rhonchi, weak cough, anxious, poor airway clearance, dyspnea, fatigue, poor endurance
57
Guillain Barre and pulmonary function
reduced lung volume, rhonchi/crackles, BL LE weakness, anxious, poor cough, poor clearance, reduced endurance/fatigue
58
Myasthenia Gravis and pulmonary function
chronic NM disease
progressive muscle weakness on exertion
reduced lung volumes, breath sounds, poor airway clearance, crackles/rhonchi
weakness, fatigue, dyspnea, weak cough
59
ankylosing spondylitis and pulmonary function
chronic inflammatory of spine, immobility of SI and vertebral joint, ligament ossification
arthritic
decreased chest wall compliance
60
kyphosis/scoliosis and pulmonary function
often idiopathic
angle of >120 degrees can affect chest movement and respiratory failure
61
pectus excavatum
funnel chest with sternal depression, could restrict lung volume
62
pectus carinatum
pigeon breast, associated with childhood asthma
63
obesity and pulmonary function
central fat deposits affecting breathing mechanics
restricted chest wall making expansion difficult
reduced volumes
shallow breathing
64
supportive therapies for RLD
supplemental O2
antibiotics for secondary infection
ventilation
prevention secretion accumulation
nutritional support
65
total lung capacity in restrictive lung disease
<80%
70-80 mild
60-70 mod
50-60 mod severe
<50 severe
66
thoracic trauma and restrictive lung dysfunction
blunt or penetrating
respiratory compromise with lung contusion, rib fracture, flail chest
cause shallow breathing, chest wall excursion, decreased lung expansion
67
flail chest
free floating rib segment from Fx
pain causes splinting, holding ribs in so can't take full breath
paradoxical breathing due to compromised motion
68
rib Fx and pulmonary function
often lower ribs
restrictions due to pain
shallow breathing to prevent thoracic expansion
hemothorax taking up space
fluid in lungs, fibrosis, scarring
69
pneumothorax and pulmonary function
air in pleural space collapsing lung
tracheal deviation away from affected lung
absent/decreased breath sounds
UL pain in chest, dyspnea, tachycardia
can be spontaneous or traumatic
70
atelectasis
alveoli collapse
common post op or RLD
treat w deep breathing to open alveoli
71
pleural effusion
fluid build up in space
limits lung expansion
caused by HF, pneumonia, neoplasm
71
transudative pleural effusion
elevated hydorstatic pressure in pleural capillaries
increased pressure causes more fluid being reabsorbed into pleural space
result of HF
72
exudative pleural effusion
increased permeability allows more fluid in pleural space
inflammatory neoplastic diseases cause
infection or tumor
73
s/s pleural effusion
diminished sounds over pleural effusion
dullness to percussion
decreased tactile fremitus
pleural friction rub
dyspnea
pleuritic chest pain
dry cough
74
pleural effusion treatment
target underlying cause
thoracocentesis
O2 supplemental
pain management
75
pleurisy
swelling/irritation between pleural layers
associated with effusion
76
s/s pleurisy
shapr/stabbing pain, worse w cough/breath, dyspnea, radiating, chest palpation shows sandpaper sensation, increased fremitus
77
Acute respiratory distress syndrome (ARDS)
widespread inflammatory condition
triggered by illness, trauma, complication of surgery
organ fills with fluid causing respiratory failure
dyspnea at rest, increased RR, cyanotic, anxiety
78
ARDS treatment
mechanical vent
treat cause
position in prone for oxygenation
79
pulmonary edema
excess fluid from pulmonary vascular system into interstitial areas and alveoli
cardiogenic, ARDS, lymphatic insufficiency
increases work of breathing w decreased lung compliance, reduced gas exchange
80
s/s pulmonary edema
respiratory distress, dyspnea worse in supine, paroxysmal noctural dyspnea, cyanotic, increased RR, labored breathing, pallor, diaphoresis, anxiety
decreased breath sounds, crackles, increased tactile fremitus, S3, LE edema
81
pulmonary edema treatment
supplemental O2, target cuase, bronchial hygiene for secretions
82
Pulmonary embolism risk
CHF, acute MI, CVA, obesity, lupus, immobilized, SCI, trauma, oral contraceptives, post op, prior history
83
PE incidence
1-2/1000
25% sudden death
10-30% die 1 mo later
30-50% have long term complications
33% have recurrence in 10 years
84
s/s PE
acute dyspnea/tachycardia, chest pain, cough w blood, tachypnea, weak, hypotensive, lightheaded, dizzy, syncope, anxiety
85
treat PE
prevent w exercise, meds
heparin to treat DVT
low risk pt test D dimer for blood clot breakdown
mod/hi risk straight to CT w contrast
86
pulmonary hypertension
high BP in lungs
damages lung blood vessels
87
pulmonary HTN s/s
JVD, irregular heart sounds, LE edema/abdomen
only able to work at low levels
88
pulmonary arterial hypertension
arteries narrow/stiffen
advanced resistance can form lesions and thrombus
cause R HF and death
89
pulmonary HTN from L sided HF
heart can't pump effectively, back up of blood from L side leads to increased pressure in the lungs
treat by managing heart failure
90
pulmonary HTN due to lung disease
chronic lung disease or hypoexmia like obstructive/restrictive/sleep apnea/altitude
arteries in lungs constrict so blood only goes to well ventilated areas of lungs
91
pulmonary HTN due to chronic blood clots
bpdy not able to dissolve blood clots in the lungs, causing scarring in arteries
this increases resistance and leads to pulmonary hypertension and R sided issues
treat by thromboendarterectomy surgery, medication
92
other conditions causing secondary pulmonary hypertension
sarcoidosis, sickle cell anemia, splenectomy, metabolic disorder
93
who qualifies for a lung transplant
progressive/terminal cardiopulm disease
limited life expectancy
many have emphysema, others include COPD, pulomnary fibrosis, CF, idiopathic pulmonary artery HTN, sarcoidosis
94
stats on lung transplant
80% surivive 1 year post
50% survive 5 years
80% have minimal activity limitations
95
evaluation for lung transplant
to get on donor list
need:
- social support
- compliance w medical regimen
- coping style
- caregiver stress
96
UNOS ranking
based on:
- tissue match
- blood type
- time on list
- immune status
- distance
97
lung transplant absolute contraindications
active malignancy in 2 years
abuse of alc, tobacco, narcotics
HIV infection
chest wall/spinal deformity
Hep B positive
Hep C positive w liver disease
limited ability to comply to med regimen
untreatable psych condition making unable to comply
absence of support system
98
relative contraindications to lung transplant
symptomatic osteoporosis
65+
limited functional status, poor rehab potential
morbid obesity
mechanical vent
resistant bacteria
unstable clinical condition
99
preop rehab for lung transplant
20 sessions 2-3 times week + home session
as high intensity as is possible
interval training
UE/LE
endurance and strength
inspiratory training
O2 supplementation while training
100
pt education pre op lung transplant
breathing strategies
lung function
pathophysio of disease
med use
bronchial hygiene
exercise benefits
energy conservation
nutrition
smoking cessation
sexuality
need for healthcare
101
restrictive dysfunction after lung transplant
long term complication
fibrosing of terminal bronchioles
s/s: dyspnea, reduced exercise tolerance, productive cough, decreased breath sounds, crackles, rales, pulmonary HTN
treat: prevent through immunosuppressants, intervene quickly w infections/rejection
102
post op of lung transplant
start rehab once pt is stable, usually 1-2 days after in ICU
protective isolation
train ineffective cough and mucus secretion by teaching positioning and hygiene
103
levels of pulmonary rehab progression
1-2 in hospital, may progress as fast or as slow as pt tolerates based on pre op status
3 is home or inpt rehab
4 is home
104
levels of pulmonary rehab: 1
breathing/relaxation techniques
exercise bed/seated
shoulder movement
trunk rotation
seated marching, bridge, knee extension
ankle pumps
standing pregait activities
seated in chair
105
levels of pulmonary rehab: 2
shoulder exercise
lunges
marching
mini squats
weight shifts
SLS
toe raises
ambulate in room, hall as tolerated
independent transfer to chair
106
levels of pulmonary rehab: 3
head/shoulder exercise w wrist weights
toe raises
dynamic balance
gait ambulating 10-15 min
cool down stretch LE
107
levels of pulmonary rehab: 4
level 3 exercise
progress ambulation to 20 min consistently
stationary cycle 10-20 min - mild resistance, 2-3 min warm up/cool down
108
alternatives to lung transplant if not a candidate
lung volume reduction
remove dead parts to improve thoracic distension and chest wall mechanics
non invasive BiPAP: biphasic airway pressure - mask delivering pressure for respiratory failure at night or flareup
109
pneumonia
inflammatory reaction in lungs from inhaling/aspirating bacteria
moist/warm lungs promotes growth in smaller distal tissue
110
process of pneumonia
pathogen inhlaed, travels to deep lungs, alveoli inflamed
fill w fluid, harder to fight rising infection count
consolidation/accumulation of fluid/pus impairs gas exchange
111
pneumonia risk factors
age
impaired immune system
multiple comorbidities
smoker
acute head/neck/chest trauma
severe illness
mech vent
trach/GI tube
nosocomial acquired infection
aspiration
112
community acquired pneumonia
person gets pneumonia from community :) so silly
113
hospital acquired pneumonia
nosocomial infection where pt acquires pneumonia from being in hospital/SNF
114
diagnosis of pneumonia
abnx lung sounds
crackles on inspiration
blood test
xray
sputum culture
CT/ABG/bronchoscopy/thoracentesis
115
lobar pneumonia
bacterial
affects a lobe of the lung
at risk: post op, weakened immune system
more common form
more serious
symptoms: high fever, increased HR/RR/cyanosis/confusion
116
viral pneumonia
commonly caused by flu or RSV
not as serious, faster recovery
117
fungal pneumonia
common in those w chronic condition or weakened immune systems
118
aspiration pneumonia
caused by dysphagia, NG/trach, trauma, poor mental status, poor oral hygiene
obstruction or chemical
119
aspiration pneumonia: airway obstruction
obstructed area due to aspiration
decreased breath sounds over area
120
aspiration pneumonia: chemical pneumonitis
inhale toxic substance
aspirate GI contents
contributes to acute lung injury/inflam/infection
rapid progression causing atelectasis/edema
121
complications of pneumonia
pleural effusion
bacteremia - bacteria in the bloodstream
septic shock
lung abscess
respiratory failure
kidney failure
heart failure
122
pneumonia treatment
prevention
vaccination
reduce risk of aspiration with positioning recumbant
dental hygiene
early mobilization
drug therapy
supplemental O2
mech vent
postural drainage
123
pneumonia clinical presentation
fever
productive cough
elevated WBC
positive sputum
fatigue
weight loss
sweating
chills
severe: dyspnea, tachypnea, tachycardia, hypoxemia, O2 desat, confusion
124
PT exam findings
fremitus, dullness to percussion over consolidated area
SOB
exercise limitation
weak proximal UE
limited endurance
125
pneumonia PT interventions
ACT
pursed lip breathing
coughing techniques
IMT
exercise to enhance QOL and improve function
126
TB
bacterial infection in the lungs, curable and preventable but most deadly disease in the world
1/3rd infected
higher rism w HIV
spread through airborne droplets
127
active TB
contagious, symptomatic, active infection
128
latent Tb
TB bacteria in the body that is nto making you sick
asymptomatic, not contagious
+ TB skin text, negative chest xray/sputum
129
diagnose TB
TB skin test
blood test
chest xray
biopsy
bronchoscopy
thoracentesis
spirometry
V/Q scan
130
pathophys of TB
incubation 2-12 days
disease lasts 10 days-2 weeks
give meds for 3-12 months to reduce risk of secondary infection
not contagious after 2 weeks on medication
131
TB precautions
negative pressure room
TB mask/N95
universal precautions
for pt to leave room where N95
132
TB clinical prsentation
cough lasting longer than 3 weeks
pain in the chest
coughing blood/sputum
weakness/fatigue
weight loss
no appetite
fever/chills/night sweats
133
TB damage to lung
acute inflammatory response
structural changes, damage due to complications
chronic complications can develop imapiring pulmonary function
also cause long term joint damage, liver/kidney problems, bone/brain/lymph infection
134
TB prevention
diagnose latent - complete all medications to reduce chance of active infection
limit contact w active infection
vaccination
TB screening
135
lung cancer screening
high risk screen w scan:
current smokers or those who quit in last 15 years
counsel to quit smoking
30 pack year smoking history
explain risks and benefits of scan
136
risk factors for lung cancer
smoking
radon exposure
environmental exposure
pulmonary fibrosis
genetics
presence of HIV
alcohol
137
lung cancer treatment
surgery: remove tumor in early stages
radiation: targte all types
chemo: effect depends on type
138
diagnose lung cancer
often incidental finding of nodule or mass
CT scan first, then repeat to monitor size, shape, location, appearance
139
non-small cell bronchogenic carcinoma
most common type in US, 90%
slower growing
140
adenocarcinoma
common form of non small cell lung cancer found in outer lungs in mucus glands
symptoms: cough, hoarse, weight loss, weakness
141
small cell lung cancer
less common than all non small cell types
142
pancoast tumor
rare, 3-5%
symptoms: shoulder pain
often small cell
superior sulcus tumor in apex of either upper lung and surrounding tissues: muscle, bone, vertebrae, sympathetic NS
