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211 exam 1


ERV expiratory reserve volume
FRC functional residual capacity
IC inspiratory capacity
RV residual volume
TLC total lung capacity
TV tidal volume, normal breathing, we measure this
VC vital capacity: All of possible air in lungs under volitional control – we measure and patient needs coaching for this IRV+TV+ERV = VC
COPD airway damage, decrease ciliary function, inflamed mucosa lining, bronchial hyperreactivity, Hyperinflation = trapped air, decrease perfusion Hypercapnea = Increased CO2 consists of chronic bronchitis and emphysema
clinical presentation of COPD Increased CO2 Clinical Presentation – Chronic cough, expectoration, dyspnea, Decreased Thoracic excusion, increased accessory muscles, Flatter diaphragm, Barrel chest, protruding abdomen, clubbing digits
how does COPD effect reserve volume too much reserve volume
types of chronic obstructive lung diseases COPD (emphysema, chronic bronchitis) sometimes asthma
asthma Bronchospasms, wheezing, breathlessness, Inflamed airways, hyperactivity, SOB
types of asthma allergic/Extrinsic – Pollen, Mold, dander Non allergic/ Local inflammatory response/Intrinsic – Smoke, Infections, Cold Air
clinical presentation of asthma Hyperinflation, Accessory muscles used, Wheezing, Crackles RV and FRC are increased due to trapped air VC and IRV is reduced
cystic fibrosis Dz of the excretory glands where secretions are thicker which leads to infections, This causes narrow airways, hyperinflation, infection, tissue destruction
etiology of CF Autosomal recessive trait, 70% Dx at 1y/o
clinical presentation of CF Thick secretions Barrel chested Increased Kyposis Hypertrophy of accessories Increased RV and Increased FRC
restrictive lung disease (pulmonary fibrosis) Dz that have difficulty expanding the lungs
types of restrictive lung disease Plura dz, Neuromuscular dysfunction, Changes to the chest wall
what causes restrictive lung disease radiation therapy, inorganic dust, inhalation of noxious gases, asbestos, idiopathic pulmonary fibrosis (most common) scleroderma, TB, maybe COVID
clinical presentation of restrictive lung disease Dyspnea with activity Non productive cough,shallow breathing, limited chest expansion, inspiratory crackles Decrease in RV, VC, FRC and TLC
what might a pt with cardiopulmonary or respiratory issues complain of, what is hx? Chief Complaint is SOB. Also note cough, sputum production, wheezing, Occupation, social, family Hx, Meds
data collection for cardiopulmonary/ respiratory pts Vitals – HR, BP, O2sats, resp rate, temp, pain, Weight/BMI Observation, Inspection, Palpation Posture, Pallor/bluish, clubbing Functional assessment – 6 min walk test
MMT for respiratory pts check Inspiratory pressures (PT assessment)
what do you need to document for respiratory pts? Sx with exercise, changes in O2 sats with exer Determine THRR (THRrange) -40%-85% (Karvonen’s method) –suggest using a range rather than one Target (THR)
Severe Pulmonary patients will max out their ____ ability before their max ____. ventilator, Cardio
components of pulmonary rehab Aerobic training General Strength Training
strength training for pulmonary rehab Extremity Ventilatory muscle training- use a Threshold inspiratory muscle trainer Breathing Exercise
breathing exercises purse lip breathing strengthen accessory mm when the diaphragm is dysfunctional
____ breathing is more helpful with Chronic obs lung disease than ____ breathing Purse lip, diaphragmatic
use _____ to record parameters need to be lifelong commitment for cardiopulmonary pts with HEP exercise logs
pt education for respiratory/cardiopulmonary pts Pacing Energy saving techniques – e.g. stair climbing – Deep breath, exhale and walk 2 steps, recover, repeat. Relaxation/stress management Community resources
review postural drainage
devices for pulmonary rehab secretion removal Oral Airway Oscillation device Positive Expiratory Pressure (PEP) – as effective a postural drainage and percussion for removal of secretions High Frequency Chest Compression devices
observations that may indicate pulmonary issues Overuse of accessory muscles Furrowed brow and flaring nares Cyanosis or clubbing – thickening of fingers, blue Ask patient about Chronic nighttime hypoxemia
chronic nighttime hypoxemia O2 is < 90%, c/o head aches, sleep during the day, restless at night, c/o fatigue, need night time oximeter/Sleep study
posture for pts with pulmonary issues Pop Belly with Anterior tilt Kyphosis
chest shapes for pulmonary pts Circular shaped – “barrel chested” Primarily upper chest breathers Increased ‘Angle of Louis’
angle of louis Between manubrium and sternum because they use Traps for muscles of respiration
correct breathing sequence Diaphragm (abdominal rising) → lateral rib expansion →rise of upper chest)
scale for assessing dyspnea Modified Medical Research Council Scale (MMR)
MMR scale see slide 17
HR guidelines for stopping exercise drop below the resting rate or an increase of more than 20-30 beats/min above resting
BP guidelines for stopping exercise Drop of >10mm Hg below resting
O2 sat guideline for stopping exercise less than 90, unless pt has hypoxic drive (about 85-88% is normal for hypoxic drive)
symptoms of heart disease that indicate stopping an exercise session Angina, significant increase in dyspnea
what HR range should a cardiopulmonary pt start an exercise program at as low as 40%-60% of their HRmax
Heart rate reserve difference b/n HRrest and HRmax
betablocker bring HR down and keep it at certain level, can't use just HR on pts on beta blockers because it is nott accurate *need to use BORG scale*
see BORG scale slides 20 and 21
Created by: bdavis53102
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