Pulmonary Pt

Front 1

true vs. false vs. floating ribs

Back 1

True (costosternal) = 1-6 attach directly to sternum
False (costochondral) 7-10 attach to cartilage that attaches to rib
Floating = 11 and 12 have no anterior attachment

Front 2

What are considered the "respiratory unit"

Back 2

Respiratory bronchioles
alveolar ducts
alveolar sacs
alveoli

Where diffusion of gas and gas exchange takes place

Front 3

Primary and accessory mm of inspiration

Back 3

Primary: diaphragm and portions of the intercostals

Secondary (ribs): SCM, scalenes, serratus, levator costarum

Secodary (shoulder girdle): pecs, traps, serratus

Front 4

Mm of expiration

Back 4

No primary - occurs passively

Abdominals, portions of intercostals, QL, triangularis sterni

Front 5

Ventiation issues in pts who lack abdominal mm (SCI)

Back 5

Lower resting position of diaphragm = dec IRV
Upright is difficult b/c gravity pushes diaphgragm down even more

Normal abdominal tone usually keeps abdominal viscera directly under diaphragm

Front 6

Definitions
IRV
IC

Back 6

Inspiratory reserve volume: amount of volume available in lungs after normal inspiration in TV

Inspiratory capacity - total amount of gas that can be inhaled (TV + IRV)

Front 7

ERV
RV
FRC

Back 7

Expiratory reserve volume: amount of gas that can be exhaled above a normal TV expiration

Residual volume: volume of gas that remains in in lungs after ERV has been exhales

Functional residual capacity: Amount of air in lungs after normal TV (ERV + RV)

Front 8

FLOW RATES
FEV1

FEF 25%-75%

Back 8

The amount of air that can be exhaled in first second of FVC.
Normal = 70% (FEV1/FVC)

Forced expiratory flow rate: line drawn between points 25% and 75% of exhaled volume on a FVC test
More specific to smaller airways

Front 9

SaO2 and PaO2
When is supp oxygen indicated?

Back 9

Pa02 is amt. of oxygen in blood (normal = 80-100 mm hg)

SaO2 is amt of hemoglobin oxygenated in blood (>95% is norm)

<55 mm Hg for SaO2 and <88% PaO2

Front 10

Normal PaCO2

Back 10

35-45 mm Hg
Hypo and hypercapneia if above or below

Front 11

How does bicarbonate (HCO3) related to pH

Back 11

Normal is 22-28 mEq/mL
Direct relationship = increase HCO2 equals an increase in pH

Front 12

Ventilation/perfusion ration (V/P) in upright position

Back 12

Apices = higher V/P ratio and more dead space

Bases = lower V/P ration (shunt)

Front 13

Receptors and control centers for respiration

Back 13

Baroreceptors, chemoreceptors, stretch receptors

Cortex, pons, medulla, ANS

Front 14

8 tests/measures for PT exam of pulmonary pt (1st 4 are PT, second 4 are medical tests)

Back 14

1. vitals
2. observation
3. inspection and palpation
4. auscultation
5. radiographic exam
6. lab tests
7. bronchoscopy
8. ETT

Front 15

Things to pay attention during "observation" part of PT exam

Back 15

1. Peripheral edema and jugular venous distention indicates heart failure
2. Body posiitons - leaning forward to use accessory mm
3. Color: cyanosis, blue tinge to nail bends and around eyes/mouth = hypoxemia
4. Digital clubbing: chronic hypoxemia

Front 16

Components of inspection/palpation of pulmonary exam

Back 16

1. Neck - observe trachea (should be midline, superior to suprasternal notch)
2. Thorax: lung-recoil force, barreled chest, pectus excavatum
3. Right and left thorax should be symmetrical

Front 17

4 types of normal breath sounds

Back 17

1. Tracheal
2. Vesicular: soft, rustling, during inspiration
3. Bronchial: hollow, echoing sound
4. Bronchiovesicular

Front 18

2 types of Adventitious sounds

Back 18

Crackles: during inspiration (atelecttsis, fibrosis, edema)

Wheezes: expiration, musically pitched sound. COPD

Front 19

4 types of radiographic exams for pulmonary patient

Back 19

1. Chest x-rays: Detects abnromal material (blod) or change in pulmonary parenchyma (fibrosis, collapse)
2. CT
3. V/Q scan. For pulmonary embolism
4. Fluoroscopy: continuous x-ray for diaphragmatic excursion

Front 20

4 types of lab tests for pulmonary patient

Back 20

1. ABGs
2. electrocardiogram
3. Sputum studies (gram stain, culture and sensitivity)
4. Pulmonary function tests

Front 21

RESPIRATORY ALKALOSIS
pH, PaCO2, HCO3
Cause
S/S

Back 21

pH inc, PaCO2 dec, HCO3 WNL

Hyperventilation

Dizzy, snycope, n/t, early tetany

Front 22

RESPIRATORY ACIDOSIS
pH, PaCO2, HCO3
Cause
S/s

Back 22

pH dec, PaCO2 inc, HCO2 wnl

Hypoventilation

Anxiety, restlessness, dyspnea, HA

Front 23

METABOLIC ALKALOSIS
pH, PaCO2, HCO2
Cause
S/s

Back 23

pH inc, PaCO2 wnl, HCO3 inc

vomiting, diuretics

Weakness, metanl dullness

Front 24

METABOLIC ACIDOSIS
pH, PaCO2, HCO3
Cause
S/s

Back 24

pH dec, PaCO2 wnl, HCO3 dec

Diabetic, lactice, prolonged diarrhea

Secondary hyperventilation, nausea, lethargy, coma

Front 25

Changes in PFT with obstructive lung disease

Back 25

Increased TLC
Increased RV and FRC, but decreased ERV.
Decreased VC

Front 26

Changed in PFTs in restrictive pulmonary disease

Back 26

All volumes and capacities are decreased
FEV1/FVC is normal, although individually both ar decreased

Front 27

normal FEV1/FVC

Back 27

80%
Decreased in COPD

Front 28

4 types of pneumonia

Back 28

Bacterial
Viral
Aspiration
Pneumocystis (fungus)

Front 29

Graded exercise test termination criteria

Back 29

Max SOB
PaO2 falls < 20 mm Hg
PaCO2 rises > 10 mm Hg or greater than 65 mm Hg
DBP inc of 20 mm Hg
SBP > 250 mm Hg

Front 30

FEV1 for 4 stages of COPD

Back 30

1. > 80% predicted
2. 50-80%
3. 30-50%
4. <30% symptoms at rest

Front 31

PFT with COPD

Back 31

Decreased FEV1, FVC, FEV1/FVC

Increased FRC and RV

Front 32

Physical findings with COPD

Back 32

Cough/sputum
DOE
Decreased breathsounds with adventitious sounds
Inc'd A-P diamater
Hypercapneia

Front 33

Physical findings with asthma

Back 33

Wheezing, crackles decreased breath sounds during exacerbations
Tachycardia and tachypnia
Hypocapnea

Front 34

Physical findings of CF

Back 34

DOE
Hypercapnea
Tachypnea
Can be obstructive or restrictive

Front 35

What is bronchiectasis

Back 35

Chronic congenital or acquired disease characterized by abnormal dilation of the bronchi and excessive sputum production

CXR shows increased bronchial markings wit interstitial changes

Front 36

What is RDS

Back 36

Respiratory distress syndrome (hyaline membrance disease)
Alveolar collapse in infants

Front 37

Cuases of restrictive lung disease and pertinent physical findings

Back 37

Alterations in lung parenchyma and pleura
Alteratiions in chest wall
Alterations in neuromuscular apparatus (MS, SCI, CVS)

Hypoxemia and hypocapnea

Front 38

Things to look for if you suspect rib fracture

Back 38

Shallow breathing and splinting
Flail chest that is pulled inward during inhalation and outward during exhalation

Front 39

Indications for postural drainage, percussion, and shking.

Treatment time?

Back 39

Pulmonary secretions, aspiration, stelectasis

20 minutes postural drainage
3-5 minutes percussion
5-10 inhalaltions for shaking

Front 40

Airway clearance techniques

Back 40

1. Cough
2. Huffing (ha ha ha - COPD or collapsed lung)
3. Assisted cough (supine - up and in under xiphoid process)
4. Trachal stimulation for TBI or stroke, who are unable to initiate cough

Front 41

5 types of independent secretion removal tehcniques

Back 41

1. active cycle of breathing
2. autogenic draingage
3. FLUTTER or Acapella device
4. Low-pressure positive expiratory pressure (PEP) mask
5. High-pressure positive expiratory pressure (PEP) mask

Front 42

What is active cycle of breathing

Back 42

independent program to assist in removal of more peripheral secretions that coughing may not clear
1. Controlled, diaghpragmatic fashion
2. Thoracic expansion exercieses
3. Inhale at resting TV, contract abs, and use expiratory huff from mid to low lung volume to raise secretions
4. Huff from high lung volume or cough to clear

Front 43

What is autogenic drainage?

Back 43

Independent program to sense peripheral secretions and clear without coughing
1. Unstick phase: quite breathing at low lung volumes to affect peripheral secretions
2. Collect phase: mid lung volumes to affect secretions in middle airways
3. Evacuation phase: mid to high lung volumes to clear central airways

Front 44

What is a FLUTTER or Acapella device?

Back 44

External device that vibrates airways on exhaation
1. breathe with normal TV and exhale thru device 5-10x
2. Full inhallation with 3 sec hold
3. Huff or cough to clear secretions

Front 45

low and high pressure positive expiratory pressure masks

Back 45

Uses positive expiratory resistance
High is used for unstable airays and mask stays on

Front 46

5 types of breathing exercises

Back 46

1. Diaphragmatic breathing
2. Segmental breathing
3. Sustained maximal inspiration
4. Pursed lip breathing
5. Abdominal strengthening

Front 47

When to use segmental breathing?

Back 47

Hypoventilated lung segments, mobilize chest wall.
Used for patients who are splinting post truama and others
Can use postural drainage position

Front 48

When would you use Sustained maximal inspiration (SMI)

Back 48

Acute situtaitons: post truama, postof pain, acute lobar collapse

Front 49

Karvonen's formula

Back 49

40-85%(Max HR - Resting HR) + resting HR

Front 50

What is inspiratory muscel trainers (IMTs)

Back 50

Breathe through a series of graded aperture openings to strengthen mm of inspiration

Front 51

4 activities for increasing functional abilities in pulmonary patients

Back 51

1. General conditioning (20-30 min 3-5x/week or 5-7x/week if can't do)
2. Inspiratory mm trainers
3. Paced breathing (activity pacing)
4. Energy conservation

Front 52

types of incisions in pulmonary surgeries

Back 52

1. midternotomy
2. thoracotomy
Encourage full ROM post-op

Front 53

Rescue drug for pulmonary pt

Back 53

Beta 2 agonists (sympathomimetic)
Albuterol, metprotenerol, pirbuterol

Front 54

Maintenance drugs for pulmonary pt

Back 54

Beta-2 agonists (Serevent)
Anticholignerics (atrovent)
Methylxanthines
Leukotriene receptor antagonists (singulair)
Steroids for anti-inflammatory

Front 55

Normal VC
Normal FEV1
Normal FEV1/FVC

Back 55

>80% VC
>80% FEV1
>70% FEV1/FVC

Front 56

Sputum abnormalities (meaning):
Foul smelling
Purulent
Frothy
Mucoid
Hemoptysis

Back 56

Foul smell: anaerobic infectin
Purulent (green/yellow): infection
Frothy: pulmonary edema
Mucoid: thick - CF
Hemoptysis: blood in sputum

Front 57

Examples of bronchodilators:
beta agonists
anticholinergics

Back 57

Beta agonists: epi, albuterol, ventolin, proventil (all Salbutamol)

Anticholinergic: used for COPD, not asthma. tiotropium (Spiriva) and ipratropium bromide, atropine

Front 58

Abnormal breath sounds:
Rhonchi
Stridor
Friction rub

Back 58

Rhonchi: air passing thru airways narrowed by inflamm, spasms, or secretions. Asthma and chronic bronchitis

Stridor: inspiration sound associated with upper airway obstruction

Friction rub: inflammation of pleura

Front 59

s/s of:
Respiratory acidosis
Respiratory alkalosis

Back 59

acidosis: disorientation, stupor, coma

Alkolosis: N/T of extermities, dizziness, anxiety, hyperreflexia

Front 60

Indications for terminating a ETT

Back 60

Mod to severe angina
Acute MI
Drop in SBP
Seriou sarrhythmias (Vtach)
Unusual SOB
CNS symptoms (ataxia, vertigo, confusion)

Front 61

typical clinical manifestations of CF

Back 61

Affects exocrine glands of hepatic, digestive, and respiratory systems (NOT ENDOCRINE)
Inability to gain weight despite excessive appetite
Lung infections common, other infections (UTI) not any more common

Front 62

Wear to hear heart valves?

Back 62

Atrial = Right, 2nd intercostal
Pulmonary = left, 2nd intercostal
Tricuspid = left, 4th intercostal
Bicuspid = left, 5th intercostal, midclavic