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Pulmonary System Flashcards

1
Q

Ventilation

A

Ventilation: gas (O 2 & CO 2 ) transport into and out of

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2
Q

Respiration

A

gas exchange across the alveolar capillary and capillary
tissue interfaces.

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3
Q

Muscles of Inspiration

A

Principal: external intercostals, Diaphragm, internal intercostals

Accessory: SCM (elevates sternum), Scalenes (elevate upper ribs)

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4
Q

Muscles of Expiration

A

Quiet: passive recoil of lungs and rib cage

Active: Internal Intercostals, Abdominals

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5
Q

Ventilation/Perfusion (V/Q)

A
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6
Q

Patient History

A
  • History: smoking, O2 therapy, toxins (asbestos), pneumonia, dyspnea, intubation
  • Sleeping position
  • Level of activity
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7
Q

Patient Hx Clinical Tip

A

Dyspnea also may be measured by counting the number of syllables a person can speak per breath

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8
Q

American Thoracic Society Dyspnea Scale

A
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9
Q

Physical Examination (Inspection)

A
  • General appearance & level of alertness
  • Ease of phonation
  • Skin color
  • Posture & chest shape
  • Ventilatory or breathing pattern
  • Presence of digital clubbing
  • Presence of supplemental O 2 and other medical equipment
  • Presence & location of surgical incisions
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10
Q

Observation of Breathin Pattern

A
  • Assessment of rate (12 to 20 breath/minute)
  • Depth
  • Ratio of inspiration to expiration (1:2)
  • Sequence of chest wall movement during inspiration & expiration
  • Comfort
  • Presence of accessory muscle use
  • Symmetry
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11
Q

Apnea (Breathing Pattern)

A
  • Lack of airflow to the lungs for >15 seconds
  • Airway obstruction, cardiopulmonary arrest, narcotic overdose
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12
Q

Eupnea (Breathing Pattern)

A
  • Normal Breathing
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13
Q

Biot’s respirations (Breathing Pattern)

A
  • Constant increased rate & depth of respiration followed by periods of apnea of varying lengths
  • Elevated intracranial pressure, meningitis, stroke
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14
Q

Bradypnea (Breathing Pattern)

A
  • Ventilation rate <12 breaths per minute
  • Use of sedatives, narcotics, or alcohol
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15
Q

Cheyne Stokes respirations (Breathing Pattern)

A
  • Increasing depth of ventilation followed by a period of apnea
  • Elevated ICP, CHF, narcotic overdose
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16
Q

Hyperpnea (Breathing Pattern)

A
  • Increased depth of ventilation
  • Activity, pulmonary infections, CHF
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17
Q

Hyperventilation (Breathing Pattern)

A
  • Increased rate & depth of ventilation resulting in decreased Pco 2
  • Anxiety, nervousness, metabolic acidosis
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18
Q

Hypoventilation (Breathing Pattern)

A
  • Decreased rate & depth of ventilation resulting in increased Pco 2
  • Sedation, neurologic depression of respiratory centers, metabolic alkalosis
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19
Q

Kussmaul respirations (Breathing Pattern)

A
  • Increased regular rate & depth of ventilation
  • Diabetic ketoacidosis, renal failure
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20
Q

Orthopnea (Breathing Pattern)

A
  • Dyspnea that occurs in a flat supine position. Relief occurs w/ more upright sitting or standing
  • Chronic lung disease, CHF
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21
Q

Paradoxical ventilation (Breathing Pattern)

A
  • Inward abdominal or chest wall movement with inspiration and outward movement with expiration
  • Diaphragm paralysis , ventilation muscle fatigue, chest wall trauma
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22
Q

Sighing respirations (Breathing Pattern)

A
  • The presence of a sigh >2 3 times per minute
  • Angina, anxiety, dyspnea
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23
Q

Tachypnea (Breathing Pattern)

A
  • Ventilation rate >20 breaths per minute
  • Acute respiratory distress, fever, pain, emotions, anemia
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24
Q

Paradoxical Breathing

A
  • reverse movement of inspiration and expiration
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25
Palpation (Physical Examination)
* Presence of fremitus during respirations. * Presence, location, & reproducibility of pain, tenderness, or both. * Skin temperature. * Presence of bony abnormalities, rib fractures, or both. * Chest expansion & symmetry. * Presence of subcutaneous emphysema (PTX, central line complication, post thoracic surgery).
26
Mediate Percussion (Physical Examination)
* Resonant (over normal lung tissue) * Tympanic (over gas bubbles in abdomen) * Lung tissue --\> emphysematous lungs or PTX * Dull ((↑tissue density or lungs w/ ↓air). * Lung tissue --\> tumor or * Flat (extreme dullness over very dense tissues, such as the thigh muscles).
27
Coughing (Physical Examination)
* Effectiveness (ability to clear secretions) * Control (ability to start & stop coughs) * Quality (wet, dry) * Frequency * Sputum production (color, quantity, odor, & consistency) (ex, hemoptysis)
28
Oximetry (Diagnostic Testing)
* Noninvasive method of determining (Sa O 2 ) through the measurement of (Sp O 2 ). * Readings can be affected by: * Poor circulation (cool digits) * Movement of sensor cord * Cleanliness of the sensors * Nail polish * Intense light * Cardiac dysrhythmias * Severe hypoxia
29
SaO2 & PaO2 Average Values
30
Arterial Blood (Diagnostic Testing)
* Examines acid base balance (pH), ventilation (Co2 levels), and oxygenation (O2 levels). * Guides interventions, such as mechanical ventilation settings or breathing assist techniques.
31
Clinical Presentation of CO 2 Retention
* Altered mentalstatus * Lethargy * Drowsiness * Coma * Headache * Tachycardia * Hypertension * Diaphoresis * Tremor * Redness of skin, sclera, or conjunctiva
32
Causes of Acid Base Imbalances
33
Interpretation of ABGs
34
Respiratory Acidosis
35
Respiratory Alkalosis
36
Metabolic Acidosis
37
Metabolic Alkalosis
38
Chest X-Rays (Diagnostic Testing)
* Assist in the clinical diagnosis & monitor the progression or regression. * Diagnosis cannot be made by CXR alone. * CXRs sometimes lag behind significant clinical presentation.
39
Diagnostic Testing (others)
* Sputum Analysis * Flexible Bronchoscopy * Ventilation * Perfusion Scan (rule out PE) * Computed Tomographic Pulmonary Angiography * Pulmonary Function Tests
40
Air Trapping Common Terminology for Respiratory Dysfunction
41
Bronchospasm Common Terminology for Respiratory Dysfunction
Contraction of the bronchi/bronchiole walls --\> narrowing the airway
42
Consolidation Common Terminology for Respiratory Dysfunction
Transudate, exudate , or tissue replacing alveolar air
43
Hyperinflation Common Terminology for Respiratory Dysfunction
Overinflation of the lungs at resting volume due to air trapping
44
Hypoxemia Common Terminology for Respiratory Dysfunction
45
Hypoxia Common Terminology for Respiratory Dysfunction
Low level of O2 in the tissues available for cell metabolism
46
Respiratory Distress Common Terminology for Respiratory Dysfunction
Acute or insidious onset of dyspnea, respiratory muscle fatigue, abnormal pattern & rate, anxiety, & cyanosis.
47
Health Conditions
48
Obstructive Pulmonary Conditions
* Asthma * Chronic Bronchitis * Emphysema * Cystic Fibrosis * Bronchiectasis
49
Restrictive Pulmonary Conditions
* Atelectasis (lung collapse) * Pneumonia * Pulmonary Edema * ARDS * PE * Lung Contusion
50
Restrictive Extrapulmonary Conditions
* Pleural Effusion * Pneumothorax * Hemothorax * Flail Chest * Empyema * Chest Wall Restrictions
51
Bronchoplasty (sleeve resection) | (Thoracic Procedures)
* Resection & reconnection of a bronchus ( e.g. bronchial carcinoma)
52
Lobectomy | (Thoracic Procedures)
* Resection of one or more lobes of the lung (isolated lesions)
53
Lung volume reduction | (Thoracic Procedures)
* Uni or bilateral removal of portion(s) of emphysematous lung parenchyma
54
Mediastinoscopy | (Thoracic Procedures)
* Endoscopic examination of the mediastinum (biopsy)
55
Pleurodesis | (Thoracic Procedures)
* Obliteration of the pleural space (persistent pleural effusions or PTX)
56
Pneumonectomy | (Thoracic Procedures)
57
Segmentectomy | (Thoracic Procedures)
* Removal of a segment of a lung (parenchymal lesion)
58
Thoracoscopy | (Thoracic Procedures)
* Examination through the chest wall (pleural fluid biopsy)
59
Tracheal resection & reconstruction | (Thoracic Procedures)
60
Tracheostomy | (Thoracic Procedures)
61
Wedge resection
* Removal of lung parenchyma without regard to segment divisions (peripheral parenchymal
62
Thoracentesis | (Thoracic Procedures)
63
PT Intervention (Goals)
* **Promoting**: independence in functional mobility * **Maximizing**: gas exchange (by improving ventilation & airway clearance) * **Increasing**: aerobic capacity, respiratory muscle endurance, and the patient's knowledge of his or her condition
64
PT Intervention (General Techniques)
* Breathing retraining exercises * Secretion clearance techniques * Positioning * Functional activity * Exercise w/ vital sign monitoring * Patient education
65
Dean's Hierarchy I. Mobilization & exercise
* To elicit an exercise stimulus that addresses various steps in the oxygen transport pathway.
66
Dean's Hierarchy II. Body positioning
* To elicit a gravitational stimulus that simulates being upright and moving as much as possible: active, active assisted, or passive
67
Dean's Hierarchy III. Breathing control maneuvers
* To augment alveolar ventilation , to facilitate mucociliary transport, and to stimulate coughing
68
Dean's Hierarchy
* To facilitate mucociliary clearance w/ the least effect on dynamic airway compression and the fewest adverse cardiovascular effects
69
Dean's Hierarchy V. Relaxation & energy conservation interventions
* To minimize the work of breathing and of the heart and to minimize undue oxygen demand
70
Dean's Hierarchy VI. ROM exercises (cardiopulmonary indications)
* To stimulate alveolar ventilation & alter its distribution
71
Dean's Hierarchy VII. Postural drainage positioning
72
Dean's Hierarchy VIII. Manual techniques
73
Dean's Hierarchy IX. Suctioning
74
PT Intervention (Activity Progression)
* RPEor the dyspnea scale are better indicators of exercise intensity than HR * Monitoring SpO2 can assist in determining the intensity of the activity * Shorter, more frequent sessions are better than longer sessions * Education on energy conservation & paced breathing enhances activity tolerance * Schedule PT according to the pt’s other hospital activities * Document the need & duration of seated or standing rest periods * O2 may not be needed at rest , but may help during exercise * Bronchopulmonaryhygiene before session may optimize activity tolerance

Acute Care (7 decks)

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