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MS Pulmonary

lecture & independent study

respiration gas exchange in body
ventilation mass exchange of air in & out of body during inspiration & expiration
mm of inspiration diaphram, scalenes & parasternal intercostals
mm of expiration sternocleidomastoid, upper trap, pec major & minor & subclavious
mm during exertion pec maj, quadratus laborum, internal intercostals
mm during forced expiration abs
direction of chest expansion w/inspiration up and out
compliance how easy lungs inflate w/inspiration (fibrosis may inhibit- so may emphysema
airway resistance depends on diameter of lumen in airways (smaller = increased resistance- increases w/asthma, bronospasm or mucus)
flow rates amount of air moved in & out of airway in an amount of time -COPD decreases flow rate
upper respiratory nasal cavity, pharynx, larynx - cleas & warms & moistens air
lower respiratory airways of trachiobronchial tree- 23 branches & lungs
# of lobes in R lung 3 & 10 bronchopulmonary segments
# of lobes in L lung 2 & lingula & 8 bronchopulmonary segments
pleura covers lungs (visceral)/ lines inside thoracic wall (parietal)
mental status level of consciousness or awareness- alert, responsive, or cooperative vs lethargic, disoriented or inattentive
color cyanosis (bluish appearance) perifpherally (nailbeds) or centrally (lips)
shape of chest barrel, pectus excavatum (funnel breast), pectus carinatum (pigeon breast)
barrel chest circumference of upper chest appears larger than that of lower chest. COPD
pectus excavatum funnel breast- lower part of sternum is depressed and the lower ribs flare out
pectus carinatum pigeon breast-sternum is prominent and protrudes anteriorly
posture often leans fwd on hands or forearms to stabilize and elevate the shd girdle to assist with inspiration
preferred sleeping position increased HOB
dyspnea distressed, labored breathing as the result of shortness of breath
tachypnea rapid, shallow breathing; associated w/ restrictive or obstructive lung dx and use of accessory mm for inspiration
bradypnea slow rate with shallow or normal depth and regular rhythm; may be associated with drug OD
hyperventilation deep, rapid respiration; increase tidal volume and increased rate of respiration, regular rhythem
orthopnea difficulty breathing in supine
apnea cessation of breathing in expiratory phase
apneusis cessation of breathing in inspiratory phase
cheyne-stokes cycles of gradually increasing tidal volumes followed by a series of gradually decreasing tidal volumes and then a period of apnea. this is sometimes seen in the pt w/ a severe head injury
crackles/rales fine, discontinuous sounds (similar to the sound of bubbles popping) primarily head during inspiration
wheeze/rhonchi continuous & more during expiration-whistle
coughing strength/depth weak, shallow, soft, throaty or ineffective
frequency/duration a sudden onset of cough or sustained cough often is described as paroxysmal or spasmodic
productive the productivity of the cough and secretions produced by the cough should be assessed
color of secretions clear, yellow, green, blood stained
consistency of secretions viscous, thin, frothy
amount of secretions minimal to copious
odor no odor to foul-smelling
other areas of examinatino ROM esp shd, strength, functional mobility, assistive devices, suctioning
Types of pulmonary dx Obstructive & restrictive
types of obstructive COPD, chronic bronchitis, emphysema, asthma, bronchiectasis, cyctic fibrosus & broncho pulmonary dysplasia
S & S of obstructive increased mucous, narrowing/destruction airways, destruction of alveoli, bronchial walls, inability to effectively remove air from lungs, trouble breathing out
S&S of restrictive hard to breathe in, inability to fully expand lungs, pain, stiffness, postural deformity, mm wk & paralysis,
types of restrictive pheumonia, TB, tumor, pulmonary edema or embolism
most common cause of death with COPD respiratory failure
contraindications for postural drainage severe hemoptysis (bloody spit), untreated acute conditions- severe pulmonary edema, CHF, large pleural effusion, pulmonary embolism, pneumothroax
rx procedures check VS, practice positions, percussion/vibration, coughing, VS
diaphragmatic breathing anything but quadriplegic
pursed lip breathing more for obstructive
glossopharyngeal breathing just for quadriplegic or ventilator
chest mobilization ex's can use on anybody
teach effective cough use on anyone except high level quadriplegic
cough with splinting chest sx
manual assist cough & suctioning mainly for quadriplegic
incentive spirometry not for obstructive issues
sleep apnea main cause obesity, dx w/ polysomnography, rx w/wt loss & CPAP (continuous positive airway pressure) device used @ night
pulmonary tuberculosis type of damage to lungs granulomas lead to caseous necrosis leads to cavity formation
pathogen causing TB mycobacterium tuberculosis
mode of transmission of TB aerosol droplets exhaled by infected individuals
risk factors for TB weakened immune sys, international connections, substance abuse, poor (cramped, poorly ventilated housing)
symptoms of TB may be asymtomatic, onset insidious- cough, lassitude, malaise, hemoptysis, fatigability, night sweats, anorexia, afternoon fever, wt decrease, pleuritic chest pn, wheezing
dx TB SPUTUM ANALYSIS, PE, chest x-ray, or CT scan, bronchoscopy & positive teberculin test
meds for TB antibiotics-give for 6-9 months, cause n & v
isolation for TB bed rest & isolation, we would need custom fitted mask- neg pressure rooms
lung abcess area of necrotized lung tissue containing purulent material-more frequent in lower dependent portions of lungs & in R lung which has more vertical bronchus
pneumothorax collection of air or gas in pleural cavity
pleurisy inflammation of visceral (inner) & parietal (outer) pleural membranes that envelope each lung-feels like heart attack, sharp pn limits mvmt on affected side of chest, pn worse with inspiration, cough or sneeze
pneumoconiosis inhaling bad stuff a long time. most common silicosis
atelectasis complete or partial collapse of lung-allows unoxygenated blood to pass unchanged thru the area-produces hypoxia-result of pneumothorax
pulmonary fibrosis scarring of lungs-tissue thickened & stiff
flail chest compound fx of 2 or more ribs on same side
ARDS (acute respiratory distress) acute respiratory failure secondary to severe trauma, disease in the body. rx problem, mechanical ventilation. prognosis guarded
tidal volume amount of air exchange in relaxed inspiration & expiration
vital capacity sum of tidal volume & inspiratory reserve volume & expiratory reserve volume
Created by: jessigirrl4
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