Restrictive Flashcards
(43 cards)
1
Q
Restrictive Disease
A
- An inspiratory impairment
- May ultimately reduce all lung volumes, not just inspiratory volumes
- difficulty getting air in
2
Q
Restrictive disease Causes
A
- Decreased compliance of lung or chest wall
- Reduced inspiratory effort (i.e. pain, weakness, etc.)
***dec expansion= dec air in
3
Q
Restrictive disease Signs and symptoms
A
- Tachypnea, dyspnea, decreased breath sounds (primarly lower lobe), dry (nonproductive) cough, and emaciated appearance
4
Q
Restrictive disease Interface with cardiac system
A
- Left sided heart failure → pulmonary symptoms
- Pulmonary symptoms → right sided heart failure
- Chronic alveolar hypoxemia → pulmonary vasoconstriction → pulmonary hypertension
- Manifested as cor pulmonale
***Rt ventricle working harder!
5
Q
Common Restrictive pathologies
A
- Fibrotic diseases,
- sarcoidosis,
- acute respiratory distress syndrome (ARDS),
- pleural effusion,
- pulmonary edema,
- pneumonia,
- tuberculosis,
- sequelae secondary to musculoskeletal and neuromuscular conditions
6
Q
Restrictive Disease-CXR
A
- CXR
- Radiopacities (appear white)
- Regions with retained secretions or flud (mucus in chest)
- Atelectatic segments (areas will collapse down)
- Radiopacities (appear white)
7
Q
Restrictive disease PFTs
A
- Reduced lung volumes
- Reduced FVC
- Normal to increased (ratio > 80%)
- FEV1 / FVC ratio
8
Q
Why might inspiratory crackles occur in a restrictive pathology in the absence of secretions?
A
- When actelectic segments open back up from being filled with air
9
Q
Fibrotic Diseases
A
- Focal lung lesions representing progression of an inflammatory process to tissue fibrosis
- Destruction of alveolar capillary beds
- Irregular shape and size of alveolar spaces
- Decreased lung compliance (harder to inspire air)
10
Q
Common Fibrotic pathologies
A
- Idiopathic pulmonary fibrosis (IPF): most common
- Asbestosis, silicosis, and interstitial lung disease
11
Q
Fibrosis Causes (not for IPF)
A
- Cigarette smoking, viral infection, environmental pollutants, chronic aspiration, and genetic predisposition
12
Q
Fibrosis Diagnostic findings
A
- CXR consistent with reticulonodular pattern (honeycombing)
- CT scan consistent with “ground glass” findings
- PFTs consistent with restrictive pathology
- ABGs consistent with decreased PaO2 with unchanged CO2 (difficulty getting in enough oxygen)
13
Q
Fibrotic Diseases: Hallmark Signs and Symptoms
A
- Diminished breath sounds with potential for crackles
- DOE
- Progresses to SOB at rest
- Dry, non‐productive cough
- Weight loss (need to work harder to breath so more energy expenditure)
14
Q
Fibrotic disease PT
A
- PHYSICAL THERAPY
- Breathing exercises
- Focus on inspiration
- Activity / exercise
- Breathing exercises
***aerobic activity (60-80%), interval training, UE/Le resistance training, long duration more favorable outcomes
15
Q
Given a diagnosis of fibrotic disease, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
A
- lung ascutation (how much can be inspired)
- expansion of chest wall (will be decreased with less inhaled)
- posture
- endurance testing
16
Q
Sarcoidosis
A
- Uniform, epithelioid, fibrotic granulomas within multiple organs
- Most common locations: lung and lymph nodes
- Pulmonary insufficiency results in death in 5‐7% of patients
17
Q
Sarcoidosis Diagnostic findings
A
- CXR consistent with diffuse infiltrates in bilateral lung fields
- Honeycomb appearance as disease progresses
- PFTs consistent with restrictive pathology
- ABGs consistent with hypoxia as disease state progresses
- Bloodwork consistent with leukopenia, anemia, and increased erythrocyte sedimentation rate
18
Q
Sarcoidosis: Hallmark Signs and Symptoms
A
- Diminished breath sounds with crackles in lower lobes (actelectic areas)
- Dyspnea of unknown onset
- Dry, non‐productive cough
- Malaise
- Fatigue
- Weight loss (working harder to breath)
19
Q
Sarcoidosis
A
- PHYSICAL THERAPY
- Breathing exercises
- Focus on inspiration
- Activity / exercise
- Endurance
- Strengthening as needed
- Consider energy demands
- Breathing exercises
20
Q
Given a diagnosis of sarcoidosis, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
A
- lung ascultation
- chest expansion
- endurance testing (objective measure)
- posture/facial expressions
21
Q
Acute Respiratory Distress Syndrome (ARDS)
A
- Endothelial injury damaging the alveolar‐capillary membrane
- Increased membrane permeability (more fluid passing through)
- Pulmonary edema limiting oxygen exchange
- Decreased lung compliance (cant inspire air)
***alveoli full of edema so cant get oxygen to blood supply
- Prognosis often poor
22
Q
ARDS Causes
A
- Sepsis, trauma, shock, multiorgan failure, drug overdose, infection, and inhaled noxious fumes
23
Q
ARDS Diagnostic findings
A
- CXR consistent with wide spread infiltrates (“white out”)
- Actelectic and areas of fluid from inc mem permeability
- PFTs consistent with restrictive pathology
- ABGs consistent with decreased PaO2 that is not responsive to supplemental O2 and increased CO2
- Adding O2 but cant get into lungs from fluid
- C02 cant go across membrane in other direction
- VQ scan consistent with severe mismatch
24
Q
ARDS: Hallmark Signs and Symptoms
A
- Diminished or absent breath sounds Crackles (if breath is able to move through edema)
- Significant dyspnea
- Tachypnea
- Tachycardia
- Hypotension
- Impaired cognition
25
ARDS PT
* PHYSICAL THERAPY
* Breathing exercises
* Dependent upon vent settings and patient’s ability to initiate breath
* Activity / exercises
* Coordinate with ventilator management and weaning
* Determine safe parameters
26
Given a diagnosis of ARDS, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
* lung ascultation
* chest wall symmetry/expansion
* endurance testing
* on vent, might not use traditional endurance tests
* ex sit on bed with assistance
* posture/facial expression
27
Pleural Effusion
* Fluid accumulation within the pleural space
\*\*\*pathological condition not disease. Fluid not out properly.
28
Pleural Effusion causes
* Heart failure
* Pulmonary embolism
* Cirrhosis
* Cancer
* Kidney disease
29
Pleural effusion Diagnostic findings
* CXR consistent with opacities
* Begins in bases and may spread throughout the entire lung (large effusions)
* PFTs may be normal
* Decreased lung volumes with larger effusions
* Thoracoscopy to visualize pleura
\*\*\*fluid in pleural spaces not lungs/adjacent to lung bases
30
Pleural Effusion: Hallmark Signs and Symptoms
* Diminished breath sounds over area with effusion
* SOB
* Dry, non‐productive cough
* Orthopnea
* Chest pain
31
Pleural effusion PT
* PHYSICAL THERAPY
* Breathing exercises
* Focus on inspiration
* Activity / exercise
* Endurance
* Shoulder ROM in presence of chest tube
32
Given a diagnosis of pleural effusion, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
* lung ascultation
* chest expansion/symmetry (may be asymm on one side)
* pulm edema
33
Pneumonia
* Inflammation of the parenchyma or alveoli following a lung infection
* Increased mucous production
* Decreased gas exchange
34
Causes
* Community‐acquired or hospital‐acquired
* Inhalation of bacteria or virus
* Aspiration of gastrointestinal contents
35
Pneumonia Diagnostic findings
* CXR consistent with infiltrates in affected lung segments (white)
* PFTs may be normal
* In severe cases, will be consistent with restrictive pathology
* Lab work consistent with increased WBCs
* Sputum culture to determine type of infection
36
Pneumonia: Hallmark Signs and Symptoms
* Diminished breath sounds with crackles in affected lung segments
* Productive cough
* Rusty or green‐colored sputum
* Purulent sputum
* Dyspnea
* Fever and chills
* Sharp pleuritic chest pain
* Tachypnea
* Decreased chest expansion on affected side
* Fatigue
* Generalized aches
37
Pneumonia PT
* PHYSICAL THERAPY
* Airway clearance
* Cough
* Determine need for other mucous‐clearing interventions
* Breathing exercises
* Focus on inspiration
* Activity / exercise
* Activity‐based interventions in the setting of functional decline
* HYDRATION/ANTIBIOTICS
38
Given a diagnosis of pneumonia, what assessments must be performed to guide the selection of the most optimal physical therapy intervention(s)?
* lung ascultation to determine impaired segment
* cough assessment- produced/ clear secretions?
* expansion/symmetry--probably asymmetry
39
Tuberculosis
* Infection caused by mycobacterium tuberculosis
* Can present as a primary infection or as a reactivation of a prior infection
* Within developed countries, the majority of new infections occur within the immunosuppressed, incarcerated, elderly, malnourished, or immigrants from less‐developed countries
40
Tuberculosis
* Diagnostic findings
* CXR consistent with infiltrates within the apices
* Sputum culture for definitive diagnosis
* History consistent with contact with infected person
* PPD unable to distinguish between active or prior disease
41
Tuberculosis: Hallmark Signs and Symptoms
* Crackles within apices
* Frequent productive cough
* Dull chest pain
* Low grade fever
* Weight loss with anorexia
* Fatigue
* Malaise
42
Tuberculosis PT
* PHYSICAL THERAPY
* Airway clearance
* Cough (need to clear mucus)
* Breathing exercise
* Focus on inspiration
* Segmental breathing if indicated
* Activity / exercise
* Activity‐based interventions in the setting of functional decline
* Impact of airborne precautions (might need to do testing in room)
43
Sequelae Secondary to Musculoskeletal and Neuromuscular Conditions
* Conditions which impact the shape, strength, or flexibility of the chest wall and / or muscles of respiration can impact the pulmonary system
* Decreased compliance
* **Common pathologies**
* Kyphoscoliosis
* Ankylosing spondylitis
* Traumatic injury to the chest wall
* SCI
* ALS
* Muscular dystrophy
* Myasthenia gravis
* Guillain‐Barre
* Poliomyelitis and post polio
