click below
click below
Normal Size Small Size show me how
211 exam 1
Cardiopulmonary
Question | Answer |
---|---|
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 |
TLC | TV + IRV + ERV +RV |
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 |