Term
| What is Cardiopulmonary PT? |
|
Definition
| An essential, non-invasive medical intervention that can reverse or mitigate insults to the oxygen transport system. |
|
|
Term
| What is the basic importance of Oxygen Transport? |
|
Definition
|
|
Term
| T/F even a small disruption or threat to the oxygen transport system can be a medical emergency and it is always a medical priority. |
|
Definition
|
|
Term
| What are the components of the Oxygen Transport system? |
|
Definition
1. The delivery of fully oxygenated blood to the peripheral tissues.
2. The cellular uptake of oxygen.
3. The return of partially desaturated blood to the lungs. |
|
|
Term
| The demand of oxygen is driven by _______ and Cardiac Output. |
|
Definition
|
|
Term
| Cardiac Output is equal to? |
|
Definition
| Stroke Volume x Heart Rate |
|
|
Term
| What are the non respiratory functions of the lung? |
|
Definition
1. Chemical release - the release of Angiotensin Converting Enzyme (ACE converts Angiotensin I to Angiotensin II)
2. Breakdown of Histamine |
|
|
Term
| What are the respiratory functions of the lung? |
|
Definition
1. Ventilation = gas transport in/out of the lung.
2. Respiration = gas exchange (within the lung).
3. Vasoconstriction/dilation to impact BP (as well as ACE release)
4. Filter emboli (small emboli are filtered out easily, large ones are considered medical emergencies)
5. Vocalization |
|
|
Term
| What are the components of the Upper Airway? |
|
Definition
1. Nose
2. Mouth
3. Pharynx
4. Larynx |
|
|
Term
| What are the functions of the Upper Airway? |
|
Definition
1. To cleanse, heat, and humidify
2. To provide resonance |
|
|
Term
| What is the function of the Cilia in the Upper Airway? |
|
Definition
| To mobilize secretions upward. |
|
|
Term
| What structure divides the upper airway from the lower airway? |
|
Definition
| The vocal folds serve as a division between the two airways by protecting the opening of the lower airway. |
|
|
Term
|
Definition
| The potential space between and around the vocal folds. |
|
|
Term
| What are the components of the lower airway? |
|
Definition
1. The vocal folds
2. The glottis
3. The trachea
4. The main stem bronchi and the further (23) divisions of the bronchi leading to the alveoli
5. Alveoli |
|
|
Term
| What is the size difference between the right and left bronchi and why? |
|
Definition
| The right bronchus is wider than the left due to the fact that there are more lobes on the right side. |
|
|
Term
| We ventilate about 55% on the left bronchus and 45% on the right bronchus. T/F? |
|
Definition
| False, the right bronchus is wider and therefore ventilates more. |
|
|
Term
| What type of Alveolar Cells produce Surfactant? |
|
Definition
|
|
Term
| Surfactant is a phospholipid that increases or lowers the surface tension in the lung? |
|
Definition
| Surfactant lowers the surface tension. |
|
|
Term
| Potential mobility increases in what directions along the rib cage? |
|
Definition
| Inferiorly and anteriorly |
|
|
Term
| What is the first step in the sequence of ventilation? |
|
Definition
| There is an easy onset, subtle rise of the upper abdomen. |
|
|
Term
| What is the second step in the sequence of ventilation? |
|
Definition
| There is lateral costal expansion of the lower chest. |
|
|
Term
| What is the third step in the sequence of ventilation? |
|
Definition
| There is a gentle rise of the upper chest primarily in the superior and anterior planes. |
|
|
Term
| What components are in the "triad" of normal ventilation? |
|
Definition
1. Diaphragm
2. Intercostals
3. Abdominals |
|
|
Term
| The diaphragm is innervated by what nerve from what vertebral levels? |
|
Definition
|
|
Term
| T/F; the diaphragm does about 80% of the ventilation work in a healthy individual but only requires about 5% of the energy costs. |
|
Definition
|
|
Term
| T/F. As a PT do you want to implement complex interventions with someone who is having breathing problems. Why? |
|
Definition
| False, in people with breathing problems, they might be using a lot more energy to focus on breathing which makes learning difficult since their attention is not focused on the learning task. |
|
|
Term
| T/F. The diaphragm undergoes an eccentric contraction for controlled exhalation and speech. |
|
Definition
|
|
Term
| T/F. The diaphragm undergoes an concentric contraction for only quiet inhalation. |
|
Definition
| False, a concentric contraction occurs with both a quiet and forceful inhalation. |
|
|
Term
| How do the abdominals contribute to the work of the diaphragm? |
|
Definition
The diaphragm(including the central tendon) has many attachments to the abdominal viscera.
When the abdominals contract, the central tendon is pulled down which creates a positive pressure in the abdomen and a negative pressure in the thorax. |
|
|
Term
| What is the value of Atmospheric pressure? |
|
Definition
|
|
Term
| What innervates the intercostals? |
|
Definition
|
|
Term
| What is the primary function of the intercostals? |
|
Definition
| The intercostals stabilize the rib cage during inhalation and provide an eccentric control during exhalation and speech. |
|
|
Term
| What innervates the abdominals? |
|
Definition
|
|
Term
| T/F. The abdominals provide negative pressure in the abdomen when the diaphragm concentrically contracts. |
|
Definition
| False, the abdominals provide positive pressure when the diaphragm concentrically contracts. |
|
|
Term
| T/F. The abdominals provide the pressure for an effective cough. |
|
Definition
|
|
Term
| What muscles are considered accessory muscles? |
|
Definition
1. Trapezius
2. SCM
3. Pectoralis Muscles
4. Erector spinae
5. Serratus anterior
6. Scalenes
7. Any muscle that attaches to the thorax may be considered an accessory muscle |
|
|
Term
| What is paradoxical (seesaw) breathing? |
|
Definition
A condition where the diaphragm is innervated but the abdominals are not.
This results in a lack of positive pressure buildup in the abdomen. |
|
|
Term
| Why do pregnant women breath more shallowly? |
|
Definition
| The diaphragm's usual pull downward is skewed. |
|
|
Term
| What patients would benefit from an abdominal binder? |
|
Definition
Patients with an SCI
Geriatric patients who may be deconditioned in abdominal region |
|
|
Term
| What are the respiratory centers in the medulla for? |
|
Definition
| They are responsible for the rhythmically of breathing. |
|
|
Term
| What is the apneustic center in the pons for? |
|
Definition
|
|
Term
| What is the pneumotaxic center in the pons for? |
|
Definition
| It is important in the regulation of duration of respiration (deep/shallow breaths). |
|
|
Term
| T/F. The Motor Cortex Group of breathing controls are considered the involuntary controls. |
|
Definition
| False, the Motor Cortex Group is under voluntary control and can bypass the Brainstem Group involuntary control. |
|
|
Term
| Your patient is holding their breath during lifting exercises. You want to correct this behavior but choose not to. Why might you not correct this? |
|
Definition
Holding your breath increases thoracic stability and the patient may be holding their breath because they need to.
The diaphragm plays a role in this stability.
You might want to work on thoracic stability exercises if you want the patient to not hold their breath. |
|
|
Term
| T/F. Oxygen is considered a drug. |
|
Definition
| True, changing O2 levels is outside the scope of practice for a PT. |
|
|
Term
| T/F. The afferent connections to the hypothalamus and limbic systems carry sensations of pain or alterations in emotions. |
|
Definition
| True; this is important because pain and change in emotions can alter breathing patterns. |
|
|
Term
| What do chemoreceptors do? |
|
Definition
| They sense alterations in blood pH, CO2 and O2. |
|
|
Term
Where are the Central Chemoreceptors located?
What are they sensitive to? |
|
Definition
Located in the medulla
Extremely sensitive and efficient at monitoring CO2 in CSF |
|
|
Term
Where are the Peripheral Chemoreceptors located?
What are these receptors sensitive to? |
|
Definition
Located in carotid artery and aortic arch
Responds to CO2 and O2 levels in blood |
|
|
Term
| What are Lung receptors sensitive to? |
|
Definition
1. Irritants - irritants in the lungs that trigger changes in breathing patterns
2. Stretch - triggered by stretching in the lung (ex. fluid buildup) |
|
|
Term
| The cough and gag reflexes are considered protective reflexes. T/F? |
|
Definition
|
|
Term
| What does lung/chest compliance mean? |
|
Definition
| The chest/lung has some give and elastic qualities. They can be stretched and then return to their original shape. |
|
|
Term
| What patients will have poor lung compliance? |
|
Definition
1. Patients with fibrosis
2. Premature newborns
*not an exclusive list* |
|
|
Term
| What patients will have poor chest compliance? |
|
Definition
1. Patients with severe burns over the chest may not have much movement in the chest wall
2. Patients with ossified chest walls
*not an exclusive list* |
|
|
Term
| Name a condition that results in too much lung compliance? |
|
Definition
|
|
Term
| What conditions result in too little lung compliance? |
|
Definition
| Restrictive disease and premature birth (no surfactant) |
|
|
Term
| T/F. Lung compliance can cause secondary changes in chest well mobility. |
|
Definition
|
|
Term
| T/F. Chest wall compliance does not influence the lungs. |
|
Definition
| False, chest wall compliance can cause secondary changes in the lungs. |
|
|
Term
| T/F. For optimal respiration, the distribution of gas and blood at the capillary level must be matched. |
|
Definition
|
|
Term
| What portion of V/Q matching is gravity dependent? |
|
Definition
| Perfusion - blood goes to where gravity forces it. |
|
|
Term
| What portion of V/Q matching relies on movement into the opening of least resistance? |
|
Definition
| Ventilation - air moves into the opening of least resistance. |
|
|
Term
| A patient has a left atelectasis so the PT positions the patient in a right side lying position. Why? |
|
Definition
Atelectasis is a condition where a lung or a segment of a lung is partially or totally collapsed.
V/Q matching tends to be greater in dependent positions.
Dependent position refers to the area where gravity is forcing the blood. |
|
|
Term
| Describe the V/Q mismatch shunt. |
|
Definition
Region of the lung with relatively more perfusion (compared to ventilation).
More blood flow compared to oxygen.
This is the case with edema and swollen areas. Pneumothorax is a condition with no respiration but blood flow remains intact. |
|
|
Term
| Describe the V/Q mismatch dead space. |
|
Definition
Region of the lung with relatively more ventilation (compared to perfusion).
There is more oxygen compared to the blood flow.
An example of this would be a blood clot where obviously blood flow is limited and oxygen is not. |
|
|
Term
|
Definition
| The amount of air that is left in the lung after complete expiration. Patients with emphysema have an increase in residual volume since there is great difficulty with getting air out of the lungs. |
|
|
Term
| What are the components of the cardiopulmonary chest examination? |
|
Definition
1. Inspection/observation
2. Auscultation
3. Palpation
4. Percussion
5. Vitals (at rest and with activity) |
|
|
Term
| What is body habitus and what are the different classifications of it? |
|
Definition
This term refers to the physique of the patient
1. Cachectic - ill health, malnutrition, and wasting
2. Normal
3. Obese |
|
|
Term
| What is Panniculus or Pannus |
|
Definition
| This is a term used to describe adipose tissue. |
|
|
Term
| What are some signs of Cyanosis? |
|
Definition
1. Bluish discoloration
2. Bluish nail beds or lips
3. Digital clubbing
4. Bluish tongue |
|
|
Term
| What are some signs that a patient is working hard to breath? |
|
Definition
1. Nasal flaring
2. Shoulders are retracted
3. Pursed-lip breathing
4. Over use of accessory muscles
5. Professorial posture - "tripod posture" or bent over posture
6. Panic look |
|
|
Term
| What is pectus excavatum? |
|
Definition
| Caved in chest (decreased Anterior/Posterior dimension) |
|
|
Term
| What is pectus carinatum? |
|
Definition
| When the chest sticks out at the sternum (increased Anterior/Posterior dimensions) |
|
|
Term
| When checking for skin integrity what might you notice? |
|
Definition
1. Nicotine stains
2. Shiny skins (hints to steroid dependency)
3. Edema |
|
|
Term
| What do distended neck veins indicate? |
|
Definition
Right atrial pressure has built up resulting in increased pressure in the superior vena cava and thus the jugular veins. This is seen best when the patient lies with head and neck at 45 degrees.
If distended bilaterally it indicates a cardiac cause such as CHF.
If distended unilaterally then it indicates a localized problem. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| A temporary halt in breathing |
|
|
Term
|
Definition
| A rapid, shallow breathing pattern |
|
|
Term
|
Definition
| A breathing pattern under 12 bpm |
|
|
Term
|
Definition
| A sensation of breathlessness |
|
|
Term
|
Definition
| The rate of perceived dyspnea scale is a scale from 0-10 with 0 being no dyspnea, 8 being the beginning of severe dyspnea, and 10 being the worst. |
|
|
Term
| What does an Incentive Spirometer measure? |
|
Definition
|
|
Term
| What are the four phases of cough? |
|
Definition
1. Inhalation
2. Holding
3. Pressure or force
4. Expulsion |
|
|
Term
| How can you as a PT describe secretions? |
|
Definition
1. Texture - thin, mobile, thick, tenacious
2. Color - clear, white, yellow, green
3. Volume - how many cc's? |
|
|
Term
| What are some possible interventions that can be used from the Cardio/Pulm perspective? |
|
Definition
1. Improve hydration
2. Secretion mobilization program/devices
3. Secretion expectoration program/devices
4. Ventilatory strategies to improve cough |
|
|
Term
| When evaluating talking the PT can get an objective measure on how long the patient can hold a vowel sound. What are the norms (adult and child) for holding a vowel sound? |
|
Definition
| 15 seconds (adult) and 10 seconds (child) |
|
|
Term
| Expiratory muscles use what type of contraction to produce sound? |
|
Definition
Concentric
Inspiratory muscles use eccentric contractions to control and stabilize the chest wall. |
|
|
Term
| T/F. Passive breathing is considered an abnormal breathing pattern. |
|
Definition
| False, this is considered normal breathing. |
|
|
Term
| Why do patients with emphysema have issues with passive breathing? |
|
Definition
| The lungs have lost their recoil and passive breathing relies on the elasticity of the lung to force exhalation. |
|
|
Term
| What is auscultation used for? |
|
Definition
| To evaluate breath and heart sounds. |
|
|
Term
| Which heart sounds are normal and which are abnormal? |
|
Definition
S1 and S2 are considered normal
S3 (ventricle gallop) and S4 (atrial gallop) are considered abnormal (under the age of 30, S3 can still be ok but over 30 can indicate heart failure). |
|
|
Term
| What is a metabolic equivalent? |
|
Definition
| Multiples of resting energy metabolism |
|
|
Term
|
Definition
1 Met = 3.5 mL O2/(kg*min)
1 Met = resting metabolic rate in sitting |
|
|
Term
| What are the two groups of Pulmonary Pathology? |
|
Definition
1. Obstructive Lung disease
2. Restrictive Lung dysfunction |
|
|
Term
| T/F. Obstructive Lung disease is more common than Restrictive Lung dysfunction. |
|
Definition
| True, Obstructive Lung disease is the 4th leading cause of death in the U.S. |
|
|
Term
| What causes Obstructive Lung disease? |
|
Definition
| Increased resistance to airflow inside the lumen and the wall of the airway |
|
|
Term
| What are the two types of COPD? |
|
Definition
1. Type A: emphysematous type
2. Type B: bronchitis type |
|
|
Term
| What are the radiological findings in advanced cases of Obstructive Lung disease? |
|
Definition
1. Hyperinflated lungs
2. Flattened diaphragms
3. Enlarged right ventricle as a result of increased pulmonary pressure |
|
|
Term
| How is chronic bronchitis defined? |
|
Definition
| Patient has a cough producing sputum for at least three months for two consecutive years. |
|
|
Term
| What are some characteristics of chronic bronchitis? |
|
Definition
1. Excessive mucous production as a result of goblet cell hyperplasia.
2. Increase in size of tracheobronchial mucous glands
3. Decreased number of cilia
4. Bronchiolar narrowing |
|
|
Term
| What causes chronic bronchitis? |
|
Definition
| Long term irritation of the tracheobronchial tree (i.e. cigarette smoking) |
|
|
Term
| How is Emphysema defined? |
|
Definition
| Pathologic accumulation of air in tissues |
|
|
Term
| What are the two types of Emphysema? |
|
Definition
1. Centrilobular
2. Panlobular |
|
|
Term
| T/F. Centrilobar Emphysema is the most common type of Emphysema. |
|
Definition
|
|
Term
| What is the difference between the two types of Emphysema? |
|
Definition
Centrilobar is the destruction of upper bronchioles; the alveolar sacs stay intact.
Panlobar is the destruction of air spaces of acinus especially in the lower lung.
Collectively these two conditions are known as centriacinar emphysema. |
|
|
Term
| Describe the physical appearance of someone with emphysema. |
|
Definition
Typically are thin with an increased AP chest diameter
Increased use of accessory muscles
Support UEs
Pursed lip breathing |
|
|
Term
| What are some symptoms of emphysema? |
|
Definition
Increased shortness of breath at rest
Exaggerated shortness of breath with activity
Decreased breath sounds on auscultation |
|
|
Term
| What are the some typical pulmonary function test findings for a patient with COPD (either chronic bronchitis or emphysema)? |
|
Definition
1. Decreased vital capcity (difficulty with expiration so naturally you can't expel the same amount of air)
2. Decreased Forced Expiratory Volume (same thinking as above)
3. Decreased max voluntary ventilation
4. Increased Total Lung Capacity and residual volume due to air being trapped in the lungs. |
|
|
Term
| What is Asthma characterized by? |
|
Definition
1. Increased responsiveness of the trachea and bronchi to various stimuli resulting in widespread narrowing of the airways
2. Lumen narrowing from smooth muscle spasms
3. Inflammation and overproduction of mucus |
|
|
Term
| Asthma is also known by what other name? |
|
Definition
| Reactive airway disease or "twitchy lung" |
|
|
Term
| What are the symptoms of asthma? |
|
Definition
1. Cough
2. Dyspnea
3. Wheezing
4. Chest tightness |
|
|
Term
| What is the difference between extrinsic and intrinsic asthma? |
|
Definition
Extrinsic is where there is a known allergen such as pollens, inhalants, foods, medications, smoke, animal dander
Intrinsic is where there is no known allergen; it could be from bacterial or viral infection, air pollution, occupation fumes/dusts; emotions and laughter are other possibilities |
|
|
Term
| What does an Asthma attack look like? (think symptoms) |
|
Definition
1. Extreme dyspnea
2. Wheezing and coughing
3. Use of accessory muscle
4. Hyperinflated lungs
5. increased pulse
6. Tachypnea
7. Sputum |
|
|
Term
| T/F. Status Asthmaticus is not considered an emergency. |
|
Definition
| False, this is a condition that cannot be altered with routine care and is therefore a medical emergency. |
|
|
Term
| Describe pulmonary function in patients with asthma. |
|
Definition
1. Expiratory flow rates reduced
2. Vital capacity is decreased because airways close prematurely toward the end of full expiration
3. Increased airway resistance
4. Arterial hypoxemia due to V/Q mismatch which does not make for a good opportunity for gas exchange |
|
|
Term
| What special questions need to be asked of a patient with asthma? |
|
Definition
1. What triggers the asthma? This way the PT knows what to avoid.
2. PT needs to ask if medications are being taken regularly or if taken only before therapy. |
|
|
Term
| What intervention works well for patients with asthma? |
|
Definition
| Aquatics because the warm, moist air is good the airways. |
|
|
Term
| How is Bronchiectasis defined? |
|
Definition
| Abnormal dilation of the medium-size bronchi and bronchioles (4th to 9th generations) generally associated with a previous, chronic necrotizing infection. |
|
|
Term
| T/F. Bronchiectasis is characterized by ciliated epithelium replaced with non ciliated mucus-secreting cells. |
|
Definition
| True, the mucus that ends up in the airway is an infection risk. |
|
|
Term
| What is the clinical presentation for someone with bronchiectasis |
|
Definition
25% of patients have clubbed fingers
Chronic cough, thick sputum
Limited change on pulmonary function tests |
|
|
Term
| How does aging impact the respiratory system? |
|
Definition
1. Decrease in pulmonary function
2. Decrease in chest and lung compliance
3. Decrease in diaphragm strength
4. Decrease in number and speed of cilia
5. Increase in work of breathing |
|
|
Term
| How is Cystic Fibrosis defined? |
|
Definition
| Complex automsomal-recessive genetically inherited disease among Caucasian children |
|
|
Term
| T/F. Cystic Fibrosis is characterized by an endocrine gland dysfunction resulting in extremely viscous secretions. |
|
Definition
| False, exocrine gland; exception being the sweat and saliva glands which contain high amounts of sodium chloride. |
|
|
Term
| What is the primary cause of death for patients with cystic fibrosis? |
|
Definition
| Respiratory involvement - treatment focus is on secretion clearance |
|
|
Term
| How is restrictive lung dysfunction characterized? |
|
Definition
The lungs are prevented from expanding fully due to decreased compliance of either lung or chest.
The pulmonary function tests show a decreased vital capacity, inspiratory capacity and total lung capacity. Residual volume is normal or reduced |
|
|
Term
| What are some symptoms of Restrictive lung dysfunction? |
|
Definition
1. Dyspnea
2. Cough - irritating, dry, non-productive
3. Cachectic appearance due to burning more energy because the patient has to work harder to breath |
|
|
Term
| How is Idiopathic Pulmonary Fibrosis defined? |
|
Definition
| Destruction of the respiratory membrane in one or more lung regions that occur after an inflammatory phase in which the alveoli become infiltrated with macrophages and fibrosis phase in which the alveoli become scarred with collagen. |
|
|
Term
| How is adult respiratory distress syndrome defined? |
|
Definition
| A clinical syndrome caused by acute lung injury and characterized by severe hypoxemia and increased permeability of the alveolar capillary membrane. |
|
|
Term
| How is pleural effusions defined? |
|
Definition
| Accumulation of fluid within the pleural space. |
|
|
Term
|
Definition
| A treatment for pleural effusion in which a long needle is inserted through intercostal space into the pleural space and pull fluid off the pleural space. |
|
|
Term
| What is pneumonia and how is it treated? |
|
Definition
| An inflammatory process of the lung parenchyma treated by antibiotics. |
|
|
Term
| What are the pulmonary function test findings for a patient with pneumonia? |
|
Definition
| Decreased lung volumes and compliance; decreased gas exchange, increased respiratory rate, increase in inspiratory pressure, increase work of breathing |
|
|
Term
| How is Pulmonary Edema defined? |
|
Definition
| Increase in the amount of fluid within the lung |
|
|
Term
| What causes pulmonary edema? |
|
Definition
Increase in pulmonary capillary hydrostatic pressure
Increased alveolar capillary membrane permeability |
|
|
Term
| What is the goal of the PT for a patient who may be susceptible to pulmonary emboli? |
|
Definition
To keep the patient from being too sedentary
PE's are not uncommon for people who sit on long flights without moving around
Orthopedic patients are a high-risk group as well |
|
|
Term
|
Definition
| Progressive degenerative disease of the nervous system involving upper and lower motor neurons resulting in both flaccid and spastic paralysis |
|
|
Term
|
Definition
| Viral disease attacking motor nerve cells of the spinal cord and brain stem |
|
|
Term
| Define Guillain-Barre Syndrome |
|
Definition
| Demyelinating disease of the motor neurons of the peripheral nerves |
|
|
Term
|
Definition
Chronic neuromuscular disease characterized by progressive muscular weakness on exertion
Autoimmune attack on the acetylcholine receptors at the post synaptic neuromuscular junction |
|
|
Term
| T/F. RA can affect the lungs and pleurae. |
|
Definition
|
|
Term
| Define Systemic Lupus Erthematosus |
|
Definition
| A systemic collagen vascular disease however 50-90% have pleural or pulmonary involvement |
|
|
Term
|
Definition
Thickening and fibrosis of the connective tissue
1/2 to 2/3 of cases have pulmonary involvement |
|
|
Term
| How does kyphoscoliosis affect the pulmonary system? |
|
Definition
Atelectasis develops from decreased thoracic cage mobility
Respiratory muscle insufficiency |
|
|
Term
| How does ankylosing spondylitis affect the pulmonary system? |
|
Definition
| Decreased thoracic cage mobility with the ribs fixed in an inspiratory position eliminating intercostal muscle function |
|
|
Term
| What are some Restrictive Extrapulmonary Conditions? |
|
Definition
1. Chylothorax
2. Empyema
3. Hemothorax
4. Pleural Effusion
5. Pneumothorax
6. Flail Chest |
|
|
Term
|
Definition
| Presence of lymph in pleural space |
|
|
Term
|
Definition
| Presence of anaerobic bacterial pus in the pleural space |
|
|
Term
|
Definition
| Characterized by the presence of blood in the pleural space from damage to the pleura and great or smaller vessels |
|
|
Term
| Define spontaneous pneumothorax |
|
Definition
| Presence of air in the pleural space resulting from visceral pleural perforation with movement of air from within the lung |
|
|
Term
| Define traumatic pneumothorax |
|
Definition
| Chest wall with a partial pleural perforation with movement of air from the atmosphere |
|
|
Term
| What is the difference between open and closed pneumothorax? |
|
Definition
Closed - without air movement into the pleural space during respiration
Open - with air moving in and out of the pleural space during respiration |
|
|
Term
|
Definition
| Caused by double fracture of 3 or more adjacent ribs resulting from a crushing injury or vigorous cardiopulmonary resuscitation |
|
|
Term
| What are the indications for Pulmonary Function Tests? |
|
Definition
To detect respiratory disease
To assess disease progression
To screen preoperative patients |
|
|
Term
| What is Forced Vital Capacity? |
|
Definition
The maximum volume of air that can be expired forcefully and quickly following maximal inspiration
Equal to the sum of the IRV, TV, and ERV |
|
|
Term
| What is Functional Residual Capacity? |
|
Definition
| The volume of air remaining in the lungs at the end of a normal expiration |
|
|
Term
| How does Functional Residual Capacity help differentiate between obstructive and restrictive respiratory patterns? |
|
Definition
Increased FRC indicates an obstructive respiratory pattern
Decreased FRC indicates a restrictive respiratory pattern |
|
|
Term
| What is Forced Expiratory Volume? |
|
Definition
The volume of air expired over a given interval during the performance of a Forced Vital Capacity
The most common screening test for obstructive airway disease |
|
|
Term
|
Definition
| The percent of FVC that can be expired over a given time interval, usually 1 sec |
|
|
Term
| What is the function of an oral endotracheal tube with balloon tip? |
|
Definition
| Short term airway management (1-7 days) |
|
|
Term
| What is the function of a Tracheostomy? |
|
Definition
Long term airway management (>7 days)
Can be used with or without a ventilator but if used without the tracheostomy is used to deliver humidified oxygen or room air |
|
|
Term
| What are the 3 types of Tracheostomies? |
|
Definition
1. Cuffed
2. Cuffless/uncuffed
3. Fenestrated |
|
|
Term
| Describe the Cuffed Trach. |
|
Definition
Has internal cuff sealing upper airway from the lower airway
Has a pilot balloon to indicate if cuff is inflated or deflated
Does not allow breathing or speaking through upper airway if fully inflated |
|
|
Term
| Describe the Cuffless/Uncuffed Trach. |
|
Definition
Allows for breathing through trach tube and upper airway since there is no inflated cuff to block the upper airway
Typically used for long term care over the cuffed trach |
|
|
Term
| Describe a Fenestrated Trach. |
|
Definition
May be cuffed or cuffless
Trach tube with a hole or many holes in trach itself which allows for increased air passage over vocal cords
Allows for speaking and is therefore used when going to be trached longer term |
|
|
Term
| What are Trach precautions? |
|
Definition
1. Avoid torsion on trach
2. Keep trach shield in place if no speaking valve or plug is present
3. The trach shield is used to prevent introduction of contaminants into patient's airway and also to protect you from sputum |
|
|
Term
| T/F. If the trach comes out, your patient will be ok for a 2-3 days. |
|
Definition
| False, this is an issue that requires immediate medical attention. |
|
|
Term
| What is the most common type of one way valve? |
|
Definition
Passey muir valve - allows patient to breath into the lungs through trach, however they can exhale through nose/mouth, which allows the patient to talk
These assist with normalizing swallow |
|
|
Term
| T/F. The trach plug is the first step in the weaning process. |
|
Definition
| False, it is the last step because it completely blocks the trach so the patient has to breath exclusively through upper airway |
|
|
Term
| Why is a Trach Button used? |
|
Definition
It is used for a patient with a guarded status
Allows for access if the patient needs suctioning and recannulation |
|
|
Term
| What is the number 1 precaution with any weaning device? |
|
Definition
| If there is a cuffed trach it needs to be completely deflated in order for the patient to be able to breath through upper airway. |
|
|
Term
| T/F. If trach button pops out, patient requires immediate medical attention to replace. |
|
Definition
|
|
Term
| What are the 5 Modes of Mechanical Ventilation |
|
Definition
1. Assist Control(A/C)/Continuous Mechanical Ventilation
2. Synchronous Intermittent Mandatory Ventilation (SIMV)
3.Continuous Positive Airway Pressure (CPAP)
4. Pressure Control
5. Pressure Support |
|
|
Term
| Describe A/C or CMV Ventilation |
|
Definition
Full support
For patients who are unable to initiate breaths (SCI) |
|
|
Term
| Describe pressure control |
|
Definition
Delivers an airway pressure versus preset volume
Tidal volume varies depending upon lung status
Used for patients with non-compliant lungs such as neonates (their lungs cannot handle high consistent pressure repeatedly) |
|
|
Term
|
Definition
| Provides full to partial support ventilation |
|
|
Term
| Describe CPAP ventilation |
|
Definition
No breaths delivered to patients; patient breathes spontaneously
Vent delivers preset amount of positive pressure throughout inspiration and expiration
Used often with weaning or individuals with sleep apnea |
|
|
Term
| Describe Pressure Support |
|
Definition
Pressure enhances patient spontaneous breathing efforts
Commonly used with SIMV |
|
|
Term
| On the ventilator, what is the Tidal Volume? |
|
Definition
| Preset volume of air delivered with each breath by ventilator |
|
|
Term
| What is the fraction of inspired oxygen for room air? |
|
Definition
|
|
Term
| What does Positive End Expiratory Pressure do? |
|
Definition
| Maintains a preset positive pressure in airway at the end of exhalation to prevent alveolar collapse and enhance oxygenation |
|
|
Term
| What is Spontaneous Tidal Volume in regards to ventilation? |
|
Definition
| Volume of air exchanged by patient independently |
|
|
Term
| What is Minute Volume in regards to ventilation? |
|
Definition
Respiratory rate x tidal volume
This is the air exchanged in 1 minute
Usually 8-10 Liters |
|
|
Term
| If a patients minute volume is greater than 20-25 L should you as the PT push for more exercise? |
|
Definition
| No, activity should be discontinued |
|
|
Term
| If a patient's alarm goes off while you are working with them, the proper actions to take are? |
|
Definition
1. Silence the alarm
2. Assess the patient
3. check for source of problem
4. Correct the problem
5. Reset the alarm |
|
|
Term
|
Definition
Employs pressure support and CPAP
Administered via nasal mask, pillows, trach with heated humidity
Usually "last ditch" prior to ventilator
Used to treat sleep apnea |
|
|
Term
| What are the 6 supplemental O2 delivery devices? |
|
Definition
1. Nasal Cannula
2. Simple Mask
3. Venti Mask/ Venturi Trach
4. Non-rebreather mask
5. Oximizer
6. Ambu Bag |
|
|
Term
| Nasal cannula description |
|
Definition
Used with low flow rates (1-6L)
Usually use humidification if > 3L
Can assume that FiO2 is increased by 3-4% with each 1L/min flow rate |
|
|
Term
|
Definition
Provides 35-55% O2 at flow rates of 5-10L
Preferred if patient is a "mouth breather"
Need flow rate rate at least 5L/min to prevent CO2 build up in mask |
|
|
Term
| Venti Mask/Venturi Trach description |
|
Definition
Delivers 24-100% FiO2
Adjustable port to regulate FiO2
Venturi trach bypasses upper airway therefore need heat and humidity |
|
|
Term
| Non-rebreather mask description |
|
Definition
Delivers 100% O2
Provides no room for the patient to increase their O2 |
|
|
Term
|
Definition
Allows increased oxygen flow via nares
Up to 15L can be administered
provides "reservoir" for oxygen |
|
|
Term
|
Definition
| Can manually pump oxygen through bag |
|
|
Term
| Where can a Pulse Oximeter be placed? |
|
Definition
|
|
Term
| Name 4 types of Central Lines. |
|
Definition
| 1. Pulmonary Artery Catheter - directly measures BP 2. Central Venous Pressure Line - measures BP of left side of heart 3. Percutaneous Intracardiac Catheter (PICC) - via brachial artery to heart for medication delivery 4. General Central Lines - via femoral artery to heart with fenestrations to delivery medication all over body |
|
|
Term
| Name 2 types Peripheral Lines |
|
Definition
1. Intravenous Lines
2. Arterial Lines |
|
|
Term
| What is the purpose of a Intravenous Line? |
|
Definition
| Used for administering drugs |
|
|
Term
| What is the purpose of a Arterial Line? |
|
Definition
| Used for monitoring systems, usually used with a splint so that movement is limited to prevent the line from being pulled out which would result in heavy bleeding due to high pressure and possible blood thinners the patient may be on |
|
|
Term
| Describe what an Epidural Catheter is. |
|
Definition
The purpose is to infuse pain medication
The line runs from the low back
Usually inserted in a backpack that the patient carries with them |
|
|
Term
| What is the purpose of Chest tubes? |
|
Definition
Drain fluid or air from pleura
Keep drainage system below level of tube insertion
Avoid tipping drainage system over |
|
|
Term
| What are the different types of Enteral Nutrition? |
|
Definition
1. Nasogastric tube (NG tube)
2. Gastrostomy tube (G tube)
3. Jejunostomy tube (J tube)
4. TPN (Total Parenteral Nutrition) |
|
|
Term
| T/F. When working with a patient with a feeding tube it is acceptable to have the patient lay completely in supine or prone. |
|
Definition
| False, the head of bed needs to be elevated at least 30 degrees to prevent reflux and aspiration |
|
|
Term
|
Definition
| The patient's blood is mechanically circulated through a semipermeable tube that is surrounded by a dialysate solution in the artificial kidney |
|
|
Term
| What is Continuous Ambulatory Peritoneal Dialysis (CAPD)? |
|
Definition
A dialysis method that uses the peritoneal cavity as a semipermeable membrane between dialysate fluid and the blood vessels of the abdominal cavity
This method uses manual inflow and outflow of dialysate fluid
Requires 4-5 exchanges per day beginning with outflow |
|
|
Term
| A patient undergoing dialysis goes to PT after seeing their physician. The physician told your patient that he suspected she may have osteoporosis but went into no more detail. Your patient now would like to know how they could have developed OP. PT response might be what? |
|
Definition
| Due to the dialysis there is decreased levels of calcium which can lead to an increased risk of OP. |
|
|
Term
| Normal range for total WBC |
|
Definition
|
|
Term
| Normal range for total RBC |
|
Definition
Female: 4.2-5.4 million/uL
Male: 4.6-5.9 million/uL |
|
|
Term
| Normal values for Hemoglobin |
|
Definition
Female: 12-16 g/100ml
Male: 13-18 g/100ml |
|
|
Term
Normal values for Hematocrit
Decreased levels of Hematocrit indicates what? |
|
Definition
Female: 37-48%
Male: 42-52%
Anemia |
|
|
Term
| Normal values for Platelets |
|
Definition
|
|
Term
| What does Prothrombin Time examine and what do its results indicate? |
|
Definition
Examines clotting factors I, V, VII, X, prothrombin and fibrinogen
Used to assess the adequacy of warfarin therapy or to screen for bleeding disorders
When elevated there is a risk for hemorrhage. When decreased indicates a risk for thrombus formation |
|
|
Term
| What does Partial Thromboplastin Time (PTT) examine and what do its results indicate? |
|
Definition
Examines clotting factors VIII, IX, XI, and XII
Used to assess the adequacy of heparin therapy or to screen for bleeding disorders
Elevated PTT indicates risk for hemorrhage. Decreased PTT indicates risk for thrombus formation |
|
|
Term
| Normal range for International Normalized Ratio (INR) |
|
Definition
For healthy individuals the ideal value is INR = 1
Therapeutic range is 2-3.5
>3.5 generally means mobility or aggressive ROM is not appropriate
> 5 indicates the patient needs to be on extreme bed rest |
|
|
Term
| Fasting blood glucose norm range |
|
Definition
65-120 mg/dL
Textbook value is 80-110 mg/dL
if > 300 mg/dL exercise is not appropriate |
|
|
Term
| What do BUN, Creatinine, and BUN/CR measure for? |
|
Definition
|
|
Term
| High and low levels of Potassium can lead to what condition? |
|
Definition
|
|
Term
| Normal range for Potassium |
|
Definition
|
|
Term
| Why are protein and albumin levels measured? |
|
Definition
| They contribute to wound healing |
|
|
Term
| Why is Bilirubin measured? |
|
Definition
|
|
Term
| What are HDLs? and normal levels |
|
Definition
"good cholesterol"
35-60 mg/dL |
|
|
Term
| What are LDLs? and normal levels |
|
Definition
"bad cholesterol"
< 160 mg/dL |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Normal values for blood pH |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the steps in airway clearance? |
|
Definition
1. Mobilization - moving secretions from the lungs to the central airways
2. Expectoration - moving the secretions from the lower to upper airway; includes cough
3. Management - manipulating the secretions once in the upper airway by swallowing, spitting, or drooling in order to move the secretions away from the trachea to avoid aspiration |
|
|
Term
| What is postural drainage? |
|
Definition
| Changing/assuming specific body positions that allow gravity to drain secretions from individual lung segments |
|
|
Term
| How long should lung segments be drained? |
|
Definition
| At least 10 minutes but preferably 15-20 minutes |
|
|
Term
| What are precautions to postural drainage? |
|
Definition
1. Pulmonary emboli
2. Hemoptysis - spitting up blood
3. Massive obesity
4. Large pleural effusion
5. Massive ascites - accumulation of fluid in the peritoneal cavity causing abdominal swelling |
|
|
Term
| What is the rate at which percussion should be done? |
|
Definition
|
|
Term
| What are active cycles of breathing? |
|
Definition
| Series of maneuvers performed by the patient to emphasize independence in secretion clearance to provide for thoracic expansion |
|
|
Term
| What are the techniques involved in active cycles of breathing? |
|
Definition
1. Breathing control: quiet relaxed breathing; this technique may be used in between other techniques in order to prevent brochospasms
2. Thoracic expansion exercise: deep inhalation with relaxed exhalation
3. Forced expiratory techniques (huffing and "chicken wings") |
|
|
Term
| What is autogenic drainage and what are the phases of it? |
|
Definition
"self drainage" without use of postural drainage positions
1. Breathing at low lung volumes to unstick mucus
2. Breathing at mid lung volumes (tidal volume) to collect mucus
3. Breathing at high lung volumes to evacuate mucus |
|
|
Term
| What are Positive Expiratory Pressure Devices? |
|
Definition
Consist of a mask or a mouthpiece connected to a one-way breathing valve to which expiratory resistors are attached, resulting in positive pressure with exhalation
Used in cycle of about 10 breaths at tidal volume followed by huffing or coughing to expectorate secretions |
|
|
Term
| Name some PEP mechanical devices |
|
Definition
1. Flutter
2. Acapella
3. Thera-PEP
4. ABI vest |
|
|
Term
| Describe the Head flexion assist technique |
|
Definition
This is an independent skill usually taught later in a patient's rehabilitation
Technique: look up, head up, inhale; look down, head down, exhale or cough |
|
|
Term
| What are the four periods of respiratory system development? |
|
Definition
1. Pseudoglandular period (6-16 weeks)
2. Canalicular period (16-26 weeks)
3. Terminal saccular period (26 weeks - birth)
4. Alveolar period (32 weeks to 8 years) |
|
|
Term
| At what development stage does the appearance of pulmonary capillaries occur? |
|
Definition
| Canalicular period (16-26 weeks) |
|
|
Term
| T/F. Newborns have a large number alveoli which makes sense since they also have a high respiratory rate. |
|
Definition
| False, few alveoli to go along with the high respiratory rate |
|
|
Term
| What are some S/S of persistent pulmonary hypertension? |
|
Definition
| Cyanosis, tachypnea, intercostal retractions, nasal flaring, grunting |
|
|
Term
| Describe Pediatric Respiratory Distress Syndrome |
|
Definition
Hyaline Membrane Disease
Almost exclusively in prematurity (<37 weeks PCA)
Respiratory failure is common
S/S includes RR greater than 60 bpm and nasal flaring |
|
|
Term
| T/F. There is a known cause for SIDS which has contributed to its decreased incidence. |
|
Definition
| False, no positive etiology has been discovered but incidence has decreased due to public awareness (Back to Sleep Campaign) |
|
|
Term
| What is Meconium Aspiration Syndrome? |
|
Definition
The aspiration of fecal matter normally present in fetal colon late in gestation
Preventable with suction immediately after delivery |
|
|
Term
| What is Bronchopulmonary Dysplasia? |
|
Definition
Chronic lung disease
Increased risk associated with being young or premature as well as low birth weight |
|
|
Term
| What is Transient Tachypnea of the newborn? |
|
Definition
Delayed clearance of amniotic fluid from the lungs
Common in full and post term infants |
|
|
Term
| How often should a patient be repositioned? |
|
Definition
|
|
Term
In patients with long term pulmonary disease (e.g. COPD), what mechanism drives breathing?
A. Hypercapnia
B. Hyperoxemia
C. Hypoxia
D. Hypocapnia |
|
Definition
C. Hypoxia
Hypercapnia drives breathing in healthy individuals |
|
|
Term
In a patient with a complete right lung atelectasis, what position would maximize VQ matching?
A. Prone
B. Supine
C. Semi fowler
D. Fowler
E. Trendelenberg
F. Left side lying
G. Right side lying |
|
Definition
|
|
Term
Which of the following implies increased work of breathing?
A. Nasal flaring
B. Panic look
C. Pursed lip breathing
D. All of the above |
|
Definition
|
|
Term
| T/F. Fremitus is used to check vibration sounds in the lungs from side to side to check for lung consolidation. |
|
Definition
|
|
Term
Chronic Obstructive Pulmonary Disease (COPD) refers to a number of disorders that affect movement of air in and out of the lung including which of the following?
A. Chronic Bronchitis
B. Emphysema
C. Asthma
D. All of the above
E. None of the above |
|
Definition
|
|
Term
How is chronic bronchitis defined?
A. Having cough producing sputum for 3 months in 2 consecutive years
B. Having chronic cough and inflammation for 2 consecutive years
C. Having productive cough with wheezing for 2 out of 3 years
D. Having chronic cough with wheezing for 2 months for past 3 years |
|
Definition
| A. having cough producing sputum for 3 months in 2 consecutive years |
|
|
Term
Which of the following is NOT typically found on assessment with patients with COPD?
A. Stocky build
B. Dusky color
C. Increased use of accessory muscles
D. Vesicular Breath sounds
E. Polycythemia
F. Intercostal retraction
G. Edema (extremities)
H. Neck vein distention |
|
Definition
D. Vesicular Breath sounds
Should hear wheezing because vesicular breath sounds are always normal |
|
|
Term
| T/F. Hypoxemia is deficient oxygenation of arterial blood. |
|
Definition
True
Hypoxia is a decrease of O2 in the tissues |
|
|
Term
Which of the following is NOT a direct sign or symptom of pulmonary disease?
A. Cheyne-Stokes Respiration
B. Cough
C. Tachycardia
D. Dyspnea
E. Chest Pain
F. Hemoptysis
G. Digital clubbing |
|
Definition
|
|
Term
Room air has what percentage of Oxygen?
A. 5%
B. 12%
C. 21%
D. 29% |
|
Definition
|
|
Term
Which of the following does NOT lead to inaccuracies in pulse oximetry reading?
A. Dark Nail polish
B. Light skin pigmentation
C. Vasoconstriction
D. Artifact |
|
Definition
| B. Light skin pigmentation |
|
|
Term
Which of the following is NOT an indication for mobilization or exercise?
A. Alveolar hypoventilation
B. Pulmonary consolidation
C. Deconditioning
D. Cardiac Tamponade |
|
Definition
| D. Cardiac Tamponade - this is a medical emergency |
|
|
Term
| T/F. Airway clearance techniques are manual or mechanical procedures that facilitate clearance of secretions from the airways. |
|
Definition
|
|
Term
Which of the following is NOT a goal of airway clearance?
A. To reduce airway obstruction
B. To improve mucociliary clearance
C. To reduce expectoration
D. To optimize gas exchange |
|
Definition
| C. To reduce expectoration |
|
|
Term
Which of the following is NOT a component of Chest PT?
A. Active cycles of breathing
B. Postural drainage
C. Percussion
D. Vibration
E. Shaking |
|
Definition
| A. Active cycles of breathing |
|
|
Term
During what period of prenatal respiratory development does surfactant production begin?
A. Pseudoglandular period
B. Canalicular period
C. Terminal Saccular period
D. Alveolar period |
|
Definition
|
|
Term
What is a normal respiratory rate in a newborn?
A. 12 breaths per minute
B. 20 breaths per minute
C. 23 breaths per minute
D. 37 breaths per minute |
|
Definition
|
|
Term
What condition is not associated with primary respiratory impairments?
A. Transient Tachypnea of the Newborn
B. Hyaline Membrane Disease
C. Retinopathy of prematurity
D. Meconium Aspiration |
|
Definition
| C. Retinopathy of prematurity |
|
|
Term
What PT intervention is contraindicated in children?
A. Incentive spirometry
B. Postural drainage
C. Vibration
D. All of the above
E. None of the above |
|
Definition
|
|
Term
Which of the following would NOT be a candidate for glossopharyngeal breathing?
A. An 18 year old with Duchesnes' muscular dystrophy
B. A 60 year old with post polio syndrome on SIMV mode of the ventilator
C. A 30 year old with a L5 level SCI s/p MVA
D. A 50 year old with Lou Gehrig's disease (ALS) |
|
Definition
| C. A 30 year old with a L5 level SCI s/p MVA |
|
|
Term
Which of the following statements about glossopharyngeal and neck muscle accessory breathing is TRUE?
A. Both are quick, easy, and effective interventions to help individuals with breathing issues
B. Both are commonly utilized interventions in the acute rehab setting
C. A respiratory therapist must be involved in the use of both interventions
D. When mastered these techniques will improve TV and VC |
|
Definition
| D. When mastered these techniques will improve TV and VC |
|
|
Term
| A patient has a blood platelet count of 19,000uL. What kind of exercise is appropriate? |
|
Definition
|
|
Term
| A male patient has a hemoglobin level of 12 g/100ml. What kind of exercise is appropriate? |
|
Definition
|
|
Term
| A patient has a hematocrit level of 27%. What kind of exercise is appropriate? |
|
Definition
|
|
