Cardiopulm: General Pulmonary Terminology And Pulm Conditions

Front 1

What is ventilation

Back 1

movement of air exchanged in the pulmonary system

Front 2

what is tidal volume

Back 2

amount of air that is inhaled and exhaled during normal breathing

Front 3

what is residual volume (RV)?

Back 3

volume of air remaining in the lungs following a full or maximal expiration

Front 4

what is expiratory reserve volume?

Back 4

volume of air that can be forcefully expelled following a normal expiration

Front 5

what is inspiratory reserve volume

Back 5

volume of air that can be forcefully breathed in following a normal inspiration

Front 6

what is forced vital capacity?

Back 6

the amount of air that is under volitional control

FVC = IRV + TV+ ERV

Front 7

What is forced expiratory volume?

Back 7

FEV1: volume of air that can be forcefully expelled in 1 sec following a full inspiration

Normally at least 75% FVC is exhaled within 1st second

Front 8

what is total lung capacity?

Back 8

the sum of the residual volume and the forced vital capacity (TV + IRV +ERV + RV)

Front 9

WHAT IS functional residual capacity?

Back 9

the volume of air remaining in the lungs following a normal expiration (ERV + RV)

Front 10

draw graph of lung volumes

Back 10

Front 11

What is atelectasis?

Back 11

-shrunken and airless state of part of the lung, acute or chronic, complete or partial

-often associated with infection

Front 12

what are symptoms of atelectasis?

Back 12

1. pain on affected side

2. dyspnea

3. cyanosis

4. drop in BP

5. tachycardia

6. diminished or absent breath sounds

7. dull or flat to percussion

8. fever

9. reduced chest excursion on affected side

Front 13

what is auscultation?

Back 13

listening to the respiration for breath sounds using a stethoscope

Front 14

Describe normal breath sounds and how can they be abnormal

Back 14

-Normal sounds are called vesicular = soft rustling sounds heard throughout all inspiration and at beginning of expiration

-breath sounds can be decreased or adventitious (extra sounds) such as crackles, wheezes, rhonchi

Front 15

what is deconditioning?

Back 15

decrease in aerobic fitness, VC, muscle strenght, and ROM as a result of prolonged bed rest or inactivity

-occasionally accompanied by orthostatic hypotension

Front 16

what is hyperventilation?

Back 16

-increased inspiration and expiration of air as a result of an increase in rate and/or depth of respiration

-results in depletion of carbon dioxide -->respiratory alkalosis with accompanying symptoms:

-fall in BP

-vasoconstriction

-sometimes syncope

-marked anxiety

-wrist cramping

Front 17

WHAT IS TREATMENT FOR HYPERVENTILATION

Back 17

-have pt breathe into a paper bag until the CO2 content of the blood returns to normal

-pt also needs to be reassured and calmed

Front 18

what is orthopnea?

Back 18

difficulty breathing except in the sitting or standing position

Front 19

What is Percussion?

Back 19

-use of fingertips to tap the body lightly but sharply to determine position, size, and consistency of an underlying structure and the presence of fluid or pus in a cavity

Front 20

when using percussion to evaluate what should be noted?

Back 20

1. pitch

2. vibration elicited

3. resistance encountered

-these determine the possibility of an underlying condition or problem

Front 21

what is percussion also used for (besides evaluating)?

Back 21

as treatment of pulmonary conditions

-force is rhythmically applied with the therapist's cupped hands to the involved segment

-used to incr amt of secretion cleared from the tracheobronchial tree

Front 22

what is perfusion?

Back 22

-volume of blood that circulates through the lungs

-is gravity dependent

-if pt has perfusion problem in lungs, tx should occur with the involved side down

Front 23

what is sputum?

Back 23

-substance expelled by coughing or clearing the throat

-contains variety of material from respiratory tract (e.g. cellular debris, mucus, blood, pus, and microorganisms)

-amount, color, and conditions of sputum can be used to differential diagnosis pulmonary conditions

Front 24

what does foul smelling sputum indicate?

Back 24

anaerobic infection

Front 25

what does purulent sputum indicate?

Back 25

(yellow or green) = infection

Front 26

what does frothy sputum indicate?

Back 26

pulmonary edema

Front 27

what does sputum that is mucoid indicate

Back 27

(thick, clear)

cystic fibrosis or conditions with a chronic cough

Front 28

what does hemoptysis mean?

Back 28

blood in sputum

Front 29

what is the valsalva's maneuver?

Back 29

attempting to forcibly exhale with the glottis, nose, and mouth closed

-causes increased intrathoracic pressure and dec return of blood to the heart

Front 30

what is the norm for PaO2?

Back 30

80-100 mmHg

Front 31

what is the norm for PaCO2?

Back 31

35-45 mm Hg

incr CO2, decr pH (more acidic)

Front 32

what is the norm for pH of body?

Back 32

7.35-7.45

incr pH = incr alkalinity

Front 33

what is the adult norm for TV?

Back 33

500 mL

Front 34

what is norm for bicarbonate?

Back 34

HCO^3- = 22-28 mEq/mL

Front 35

what are lab values for respiratory alkalosis?

Back 35

pH : incr

PaCO2: decr

HCO3-: WNL

Front 36

what are causes of respiratory alkalosis and signs and symptoms?

Back 36

alveolar hyperventilation

1. dizziness

2. syncope

3. tingling

4. numbness

5. early tetany

Front 37

what are lab value changes for respiratory acidosis?

Back 37

pH: decr

PaCO2: incr

HCO3-: WNL

Front 38

what are causes of respiratory acidosis and signs and symptoms?

Back 38

causes: alveolar hypoventilation

EARLY

1. anxiety

2. restless

3. dyspnea

4. HA

LATE

1. confusion

2. somnolence

3. coma

Front 39

what are lab value changes for metabolic alkalosis?

Back 39

pH incr

PaCO2: WNL

HCO3-: incr

Front 40

what are causes of metabolic alkalosis and signs and symptoms?

Back 40

CAUSES

bicarbonate ingestion

vomiting

diuretics

steroids

adrenal disease

SIGNS AND SYMPTOMS

vague symptoms

weakness

mental dullness

possibly early tetany

Front 41

What are lab value changes for metabolic acidosis?

Back 41

pH decr

PaCO2: WNL

HCO3-: decr

Front 42

what are causes of metabolic acidosis and signs and symptoms?

Back 42

CAUSES

diabetic

lactic or uremic acidosis

prolonged diarrhea

SIGNS AND SYMPTOMS

secondary hyperventilation (kussmaul breathing)

nausea

lethargy

coma

Front 43

what could be reason for hemoptysis during percussion?

Back 43

if pt is on anticoagulant (coumadin or heparin)

Front 44

what do bronchodilators do and side effects?

Back 44

bronchodilation = open airways to assist in breathing

(alupent, ventolin [albuterol], proventil, epinephrine)

-used prior to exercise to reduce negative effects of disease process (e.g. asthma)

-can incr HR and BP

Front 45

how are corticosteroids used to treat pulmonary conditions?

Back 45

ex: prednisone and cortisol

-decr edema and inflammation associated with COPD

-side effects

1. osteoporosis

2. muscle wasting

3. impaired/slowed wound healing

Front 46

Where do you auscultate lung lobes anteriorly?

Back 46

RIGHT

Upper lobe: between ribs 2 and ribs 4

Middle: between 4th and 6th ribs

Lower: below 6th rib]

LEFT

Upper: between 2nd and 4th

Lingula (still upper lobe bc no middle lobe on L side): between 4th and 6th

Lower: below 6th

Front 47

Where do you auscultate lung lobes posteriorly?

Back 47

Above spine of scapula = upper lobes

below spine = lower lobes

Cannot ausc. below 10th rib posteriorly

Front 48

What are Rales?

Back 48

aka Crackles

sound like rice-krispies

discontinuous and heard primarily during inspiration

-could be result of air bubbles in secretions or movement of fibrotic tissue during breathing

-associated with pulmonary edema

-basilar rales often accompany Left ventricular CHF

Front 49

what are Rhonchi?

Back 49

-continuous, low pitched, sonorous breath sounds that are most prominent during expiration

-could be result of air passing through airways narrowed by inflammation, bronchospasm or secretions

-present with asthma and chronic bronchitis

Front 50

what is stridor?

Back 50

continuous adventitous sound of inspiration associated with upper airway obstruction

Front 51

what are wheezes?

Back 51

continuous breath sounds that are high pitched, sibilant, and musical

-associated with asthma

Front 52

What is friction rub?

Back 52

caused by rubbing of pleural surfaces against one another, usually as a result of inflammation or neoplastic processes

-may be accompanied by pain during inspiration

Front 53

what are signs and symptoms of COPD?

Back 53

1. increased resistance to airflow

2. often hx of smoking

3. abnormal breath sounds

4. use of accessory breathing muscles

5. increased chest size

6. dry or productive cough

Front 54

what is asthma?

Back 54

increased reactivity of trachea and bronchi to various stimuli (allergens, exercise, cold) causing widespread narrowing of the airways due to inflammation, smooth muscle constriction, and increased secretions

Front 55

what are signs and symptoms of asthma?

Back 55

1. wheezing cough

2. dry or productive mucoid sputum with plugs

3. anxiety with severe bronchospasm may restrict airflow to the extent that no wheezing is heard

4. chest wall symmetrically decreased

Front 56

what are PT considerations with asthma?

Back 56

1. Use of bronchodilators prior to exercise or exposure to cold
2. Decrease the activity if the environmental conditions are unfavorable; e.g.,cold,dry air with allergens

Front 57

What is cystic fibrosis

Back 57

-genetically inherited disease

-characterized by thickening of secretions of all exocrine glands, leading to obstruction

-CF may present as an obstructive, restrictive or mixed disease

Front 58

What are signs and symptoms of CF?

Back 58

1. Frequent respiratory infections, especially Staphylococcus aureus and Pseudomonas aeruginosa
2. Inability to gain weight
3. Positive sweat electrolyte test
4. Rales, wheezing
5. Productive of large amounts of mucoid, mucopurulent, or purulent sputum
6. May have hemoptysis

Front 59

what is the treatment (PT) for CF?

Back 59

1. Percussion, vibration, shaking, and postural drainage may have to be performed many times per day if in acute stage or pneumonia develops
2. Suction in severe cases
3. Endurance exercises

Front 60

what is emphysema?

Back 60

-permanent abnormal enlargement and destruction of dead air spaces distal to terminal bronchioles

-associated with hx of smoking with cough and sputnum production (chronic bronchitis)

Front 61

what are signs and symptoms of emphysema?

Back 61

1. barrel chest

2. dyspnea

3. decreased breath sounds with/without wheezing

4. use of accessory mm of ventilation

Front 62

what are PT treatments for emphysema?

Back 62

1. pursed lip breathing with expiration

2. endurance exercises

3. pt education regarding disease

Front 63

what is Restrictive lung disease due to alterations in lung parenchyma and pleura

Back 63

Fibrotic changes within the pulmonary parenchyma or pleura resulting in decr lung compliance & due to:

1. idiopathic pulmonary fibrosis

2. asbestosis

3. radiation pneumonitis

4. oxygen toxicity

Front 64

What are Restrictive lung disease due to alterations in the chest wall?

Back 64

Restricted motion of bony thorax, with diseases such as:

1. ankylosing spondylitis

2. arthritis

3. scoliosis

4. pectus excavatum (caves in),

5.chest wall skin burns

6. scleroderma

Front 65

What are Restrictive Lung disease due to alterations in the neuromuscular apparatus:

Back 65

Decreased muscular strength results in an inability to expand the rib cage, seen in disease states such as:

1. multiple sclerosis

2. muscular dystrophy

3. Parkinson's disease

4. spinal cord injury

5. cerebrovascular accident (CVA)

Front 66

what is flail chest and symptoms?

Back 66

two or more fractures in two or more adjacent ribs

1. shallow breathing

2. crepitation during ventilation over fracture site

3. paradoxical movement of flail section during ventilation

Inspiration: flail section is pulled inward

Expiration: flail section moves outward

Front 67

what is treatment for flail chest?

Back 67

1. gentle breathing exercises

2. splinting

3. pain management

4. proper positioning

Front 68

what is pneumothorax?

Back 68

Air enters the pleural space, causing the lung to collapse due to loss of negative pressure

Front 69

what are signs and symptoms of pneumothorax?

Back 69

1. dry cough

2. decreased or absent breath sounds

3. trachea deviation away from affected site

4. local or referred pain

5. hyperresonant and tympanic percussion sound

Front 70

what is treatment for pneumothorax?

Back 70

Chest tube
-Pulls air/fluid out of pleural space
-Restores negative pressure and allows the lung to inflate
-Chest tube must remain properly attached to the patient at all times
-Chest PT is a precaution in the area of the tube

Front 71

what is tuberculosis facts?

Back 71

infection spread by aerosolized droplets from an untreated infected host

-after 2 weeks, meds make host noninfectious

-incr incidence of TB in HIV population

Front 72

what are signs and symptoms of TB?

Back 72

1. slight non productive cough

2. slight fever

3. hemoptysis

4. dyspnea

5. chest wall pain

6. possible chest x-ray changes

Front 73

what is pulmonary edema

Back 73

Excessive seepage of fluid from the pulmonary vascular system into the interstitial space;

Due to:

1. Left ventricular failure

2. aortic valvular disease

3. mitral valvular disease

4. inhalation of toxic fumes

5. narcotic overdose

Front 74

Signs and symptoms of Pulmonary edema:

Back 74

1. Dyspnea on exertion or paroxysmal nocturnal dyspnea
2. Fatigue
3. Pink frothy sputum
4. Positive chest x-ray
5. Crackles
6. Peripheral edema if cardiogenic

Front 75

Treatment of Pulmonary edema:

Back 75

1. Medication, including oxygen and diuretics
2. Reduction of salt intake
3. Bed rest (head elevated)

Front 76

what is Pulmonary emboli?

Back 76

A thrombus from the peripheral venous circulation lodges in the pulmonary artery leading to obstruction of blood flow to the lungs

Front 77

Signs and symptoms of Pulmonary emboli

Back 77

Without infarction:

1. tachypnea

2. anxiety

3. restlessness

4. rales (crackles)

5. wheezing,

6. decreased breath sounds
With infarction:

1.chest pain

2. hemoptysis

3. pleural friction rub

4. fever

5. positive chest x-ray

Front 78

Treatment of Pulmonary emboli:

Back 78

1. Low-dose heparin
2. Analgesics
3. Pulmonary vasodilators

Front 79

what is a normal hematocrit?

Back 79

Male: 40-54%

Female: 37-47%

Newborn:50-62%

Front 80

what are hemoglobin norms

Back 80

12-16 g/100 mm

Front 81

what is obstructive pulmonary disease characterized by?

Back 81

reductions in airflow with or without reductions in vital capacity

Front 82

what are restrictive lung disorders characterized by?

Back 82

decreased VC with normal expiratory airflows

Front 83

What is the

TLC

FRC

RV

VC

PaCO2

FEV1

for both Obstructive and Restrictive diseases

Back 83

OBSTRUCTIVE

TLC: incr

FRC: incr

RV: incr

VC: decr

PaCO2: incr

FEV1: sharp decr

RESTRICTIVE

TLC: decr

FRC: decr

RV: decr

VC: decr

PaCO2: decr

FEV1: normal

Front 84

How is obstructive lung disorder categorized?

Back 84

mild

moderate

severe

based on VC, FEV1, and FEV1/FVC

Front 85

what is

VC

FEV1

FEV1/FVC

normally?

Back 85

VC: >80%

FEV1>80%

FEV1/FVC > 70%

Front 86

what is

VC

FEV1

FEV1/FVC

for mild obstructive pulmonary disease?

Back 86

VC 66-80%

FEV1: 66-80%

FEV1/FVC 60-70%

Front 87

what is

VC

FEV1

FEV1/FVC

for moderate obstructive pulmonary disease?

Back 87

VC: 50-65%

FEV1: 50-65%

FEV1/FVC: 45-59%

Front 88

what is

VC

FEV1

FEV1/FVC

for severe obstructive pulmonary disease?

Back 88

VC: <50%

FEV1: <50%

FEV1/FVC: <45%

Front 89

what is arterial oxygen saturation?

Back 89

SaO2

ratio of amount of oxygen in a known volume of blood to the amount of oxygen that could be carried by that volume of blood

-measured using a pulse oximeter

Front 90

what SaO2 indicates poor gas exchange and a need for supplemental O2? what PaO2 does this correspond to?

Back 90

<88%

PaO2 58 mmHg (assuming arterial pH is in normal range

-supplemental O2 needs a medical doctor's prescription before it can be given to a patient