Session 14 _ Arterial blood gases & Obstructive/ Restrictive lung disease Flashcards Preview

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Flashcards in Session 14 _ Arterial blood gases & Obstructive/ Restrictive lung disease Deck (56)
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Patient example: COPD with PO2 75, PCO2 70 and pH 7.37; if add oxygen to relieve hypoxia and bring PO2 to 90, what happens?

patient has no stimulus to increase respiration
(theoretically will stop breathing... because hypoxic drive is reduced)


List examples of conditions that impact the pulmonary system:

obstruction of the airway, drowning, lung cancer, scoliosis, asthma, premature birth, ruptured diaphragm, atelectasis, metabolic acidosis, interstitial lung disease (ILD), rib fracture, pneumothorax, tuberculosis, pneumonia, paralysis of respiratory mms
COPD, CO poisoning, EN (asbestos...)


Pulmonary disease is a leading cause of morbidity and mortality. There are two types of pulmonary disease; obstructive and restrictive. What is obstructive characterized by?

• airflow obstruction
• increased airway resistance
• often affects expiratory flow rate


Pulmonary disease is a leading cause of morbidity and mortality. There are two types of pulmonary disease; obstructive and restrictive. What is restrictive characterized by?

• reduced lung compliance
• reduced thoracic compliance
• often affects inspiratory volume
•• less elasticity


List obstructive lung disease:

1. chronic bronchitis
2. emphysema
3. bronchiectasis
4. Asthma
(5. CF)


List restrictive lung diseases:

1. Interstitial lung disease
2. Idiopathic Pulmonary fibrosis (IPF)


In pulmonary function tests (PFTs)
Normal =
Obstructive =
Restrictive =

Normal = FEV1 = 3 L / FVC 4L / ration 75%
Obstructive = FEV1 = 1 L / FVC 4L / ration 25%
Restrictive = FEV1 = 2.5 L / FVC 3L / ratio 83%
(no difficulty getting air out, but the volume only goes up to 3 L; can't get as much air in so ---> ratio is higher)
** ratio of a restrictive disease is usually higher than 80%


In pulmonary function tests, what is normal ratio?



Describe the typical characteristics of obstructive lung disease?

• 3rd leading cause of death in the US
• US estimated 12.7 million diagnosed with obstructive lung disease
•> women dies from diagnosis of COPD than men
• smoking is the primary risk factor for COPD


What do we see in radiographs of individual with obstructive diseases:

• flattened diaphragm
• hyper inflated lungs due to air trapping
• Enlarged heart with enlarged right ventricle
• barrel chest - sign of lung disease
• may see small pockets of air (1-2 cms) = blebs
(due to the destruction of alveoli)
• if bleb pops, air goes into pleural cavity
• elasticity lost, walls become fragile
• bullae = > 2 cm of air


What are some potential consequences of obstructive lugs disease:

• destruction of lung tissue resulting in emphysema
• inflammation of airways
• pulmonary hypertension (getting blocked --> less capilaries and arterioles for blood to flow through --> less area for blood to flow through
(* develop it from L side HF or idiopathic --> blood can't go from lung to heart, get back flow in lung --> dmanage and increase pressure)
• hypoxemia
• dysrhythmias
•sleep disorders
• repeated infections
• build up of secretions


Consequences (continued):

• polycythemia
• adaptation to chronically low O2
• sluggish blood flow
• right heart failure
• resistance to air flow-increased work of breathing
• normal or increased lung capacity


Example of COPD: Chronic Bronchitis. Diagnosis =

greater than 3 months of productive cough most days in for at least 2 consecutive years


Example of COPD: Chronic Bronchitis. Causes =

• irritation of the bronchial tree; risk factor - smoking or exposure to smoke
• genetics
• exposure to particles (EN hazards, occupational dust, indoor air pollution, outdoor air pollution, respiratory infections, alpha 1 antitryspin disorder)


S and S of obstructive lung disease:

• secretion production
• reduced cilia action leading to build up of secretion and bacteria
• repeated infection, pneumonia
• hypoexemia


Emphysema = end stage COPD; defined =

abnormal, permanent increased size of air spaces distal to terminal bronchioles by the destruction of alveolar walls


What other changes occur during end stage COPD?

• alveolar destruction
• over-inflation of the lungs
• lungs cannot empty (expiration)
• emphysematous bullae
• chronic hypoxia and hypercapnea

** surgical Rx: potential for lung reduction surgery


What are some characteristics of restrictive lung disease:

• decreased expansion of the lung
• decreased total lung capacity
• Hypoxemia [examples = disease of pleura (pneumothorax), disease of chest wall (kyphoscoliosis, obesity - lungs expand), extrapulmonary mass restricting the expansion of lungs)
• rupturing blebs --> more resistance to filling lungs
• stiffening of the lung tissue preventing expansion
• structural limitations preventing lung inflation: examples anklylosing spondylosis, kyphoscoliosis, obesity.
•Interstitial lung disease (ILD)
• Pleural abnormalities "trapped lung"
• Mass
• Systemic lupus erythematosus (SLE)
• Pneumothorax
• Connective tissue disease - scleroderma
• Radiation therapy
• Idiopathic pulmonary fibrosis (IPF)


what is ankylosing spondylosis?

fused not, much movement or expansion


What are characteristics of pulmonary fibrosis?

•Onset middle age (50-70)
• 4-5 years mean life expectancy
• Increased respiratory rate (30-40)
• Hypoxemia, cyanosis - GIVE OXYGEN
• treat inflammation before turns to fibrosis (corticosteroids)


What are some medical treatments for lung diseases?

• steroids - usually for presence of inflammation
• antibiotics - for presence of infection
• oxygen - to treat hyoexemia
• inhalers - for bronchospasm
• assisted ventilation - invasive or non-invasive
• lung transplant
• lung reduction surgery - to make smaller pockets where air can sit


Is there a measure for SaCO2?

no convenient non-invasive measure


What should a typical PT assessment include?

• O2 ned at rest
• O2 need for activity
• Blood gases PaO2, PaCO2, pH
• Auscultation
• RR
• Breathing patterns (symmetrical?)
• Endurance
• Perceived exertion
• timing of rest breaks
• time to return to baseline HR and RR
• Safe exertion levels
• O2 saturation
• O2 requirements as evidence by O2 saturation
• Gait safety
• Prior level of function? Prior O2 use
• Education needs, such as not tripping on O2 cords
• Need for lifestyle changes ??
• Psychosocial influences affecting potential outcomes



• people w/ chronic lung disease may have chronic hyoxemia. A certain level of hypoxemia is required to trigger inspiration. Over oxygenating these patients may decrease their inspiratory drive
• Target O2 sat is lower than usual: 88-92%
• Time to return to steady state may be prolonged
• Few or no symptoms at low O2 saturations - Low O2 saturation will overtax the heart and result in cell death and maybe actual death


**** ALERTT***** w/ • ILD and O2 desaturation

• Monitor w/ a pulse oximeter from the start if you have a with diagnosis of ILD
• Be prepared to see O2 saturation drop like a rock with minimal activity
• Always have access to a full O2 tank
• Ambu-bag


List some PT treatments:

• breathing control - diaphragmatic, PLB
• pacing skills/ work simplification
• endurance training
• strengthening
• education e.g. O2 management, fatigue scale
• confidence building
• Carefully include those with: older age, hypercapnia, severe impairment
• Patient's own goals: couch vs marathon?