Pulmonary Conditions

contracts, expands, relaxes

diaphragm ______ and thoracic cage _____ during inspiration then diaphragm _____ during expiration

phrenic nerves, restrictive

_____ control thoracic cage movement and dysfunction can cause ______ disorder

vertebral column, misalignment, costovertebral, rib mobility

change in _____ causes _____ of _____ joints which hinders _____

diaphragm, SCM, scalenes, external intercostals, elevate

muscles of inspiration include _____ (primary) and _____/_____/_____ (accessory) work to _____ sternum/ribs

internal intercostals, depress, abdominal, internal obliques, external obliques, transversus abdominis, rectus abdominis, upward

muscles of expiration include _____ to _____ ribs and _____ muscles (_____/_____/_____/_____) to push diaphragm _____

quadratus lumborum, stabilize, erector spinae, latissimus dorsi, pectorals, UE, fixed, closed chain

other accessory muscles of breathing include _____ to _____ rib cage, _____, _____, and _____ (when _____ are _____, work in _____ for ribcage motion)

lobes, three, two, fissures, segments

lungs are divided into _____ (R = _____, L = _____) separated by _____ divided into bronchopulmonary _____

air sacs, tree

airway is connected to _____ in tracheobronchial _____

positioning

body _____ can affect breathing capability

phrenic nerve, diaphragm, contract, flatten, expands, increased, decreased, inspiration, relaxation, decreases, increases, expiration

breathing cycle: _____ activates _____ to _____ = _____, lung _____ (_____ volume = _____ pressure) causes _____; _____ of muscle, lung volume _____ and pressure _____ causes _____

movement, gas, lungs

ventilation is _____ of _____ in/out of _____

compliance, length tension, elasticity, pressure gradient, airway resistance

ventilation variables (5)

movement, gas, alveoli, capillary

central gas exchange is _____ of _____ between _____ and _____

pressure gradient, surface area, membrane thickness

central gas exchange variables (3)

RR, V_t

minute ventilation = _____ x _____

decreased, contracting, fibrotic

_____ compliance when diaphragm is _____ or _____ tissue

ROM, fill

thoracic _____ is necessary to _____ lungs appropriately

posture

_____ changes affect length tension relationships

elasticity, out

_____ is necessary to push air _____

movement, increased

pressure gradients cause air _____, _____ during deep breathing

decreased, increased, decreased

_____ gas exchange with _____ membrane thickness or _____ surface area

COPD, chronic bronchitis, emphysema, asthma, cystic fibrosis, bronchiectasis

obstructive pulmonary conditions include umbrella term of _____ (_____ and _____), _____, _____, and _____

cigarette smoking, environmental

COPD is related to _____ and other _____ factors

inflammation, excess mucus, bronchiole, proximal

chronic bronchitis involves _____ and _____ in _____ (_____ airway)

alveolar membrane, break down, distal

emphysema causes _____ to _____ (_____ airway)

trapping, inhalation, one way valve, inflammation, elasticity, exhalation

obstructive diseases cause air _____, _____ is possible but airway acts as _____ (due to _____ or lacking _____) and _____ is impaired

expansion, increase, relaxation, decrease

chest wall / lung _____ during inhalation causes global _____ in bronchiolar/alveolar dimension, chest wall / lung _____ during exhalation causes global _____ in bronchiolar/alveolar dimension

diameter, decreased, reduced, elasticity, reduced

if airway _____ is already _____ from COPD then airflow out is _____, if lung tissue has lost _____ then airflow out is _____

bronchospasm, swelling, clogged, mucus, exacerbation, episodes, chronicity, sensitivity, irritants

asthma causes _____, airway _____, and airways _____ by _____, obstructive during _____, increased number of _____ increases likelihood for _____, presents as increased _____ to _____

genetic, secretion, thick mucus, blocks, infection, inflammation, scar tissue

cystic fibrosis is _____ defect, causes _____ of _____ which _____ airway and promotes _____, _____ causes _____ formation

dilated, elasticity, destruction, infection, cycle

bronchiectasis causes _____ distal airways (decreased _____), _____ of bronchioles from repeated _____ following negative _____

residual volume, adapt, shape, severity, condition severity, anterior posterior diameter, transverse diameter

as air becomes trapped over time (increased _____) chest wall and ribcage _____ and change _____ (_____ is dependent on _____), _____ is greater than _____

fiber alignment, direction, contraction, length tension

chest wall deformity leads to change in muscle _____, _____ of _____, and _____ relationships

progresses, shortened, ROM, ventilation, intercostals, outward, thoracic mobility, diaphragmatic breathing

as COPD _____, _____ diaphragm has decreased _____ to allow _____, _____ line of pull becomes _____, need _____ exercises as _____ is only helpful in mild cases

resting, inspiration above V_t, expiration after V_t, deep, remaining in lungs, full volume

tidal volume = _____ breathing, inspiratory reserve volume = _____, expiratory reserve volume = _____, vital capacity = _____ breathing, residual volume = air _____, total lung capacity = _____

static, dynamic hyperinflation, residual volume, lowers, prolonged quiet exhalation

COPD experiences _____/_____ (increased _____, _____ other volumes), cue _____ during exercise

decreased, air trapping, residual volume, compliance

in COPD _____ pressure gradients from increased _____ (increased _____) contributes to decreased thoracic _____

alveoli, elasticity, surface area, pressure gradients, air trapping

in COPD _____ destroyed decreases _____ which decreases _____ and _____ from increased _____

1:1, ventilation, perfusion, gas exchange

should be _____ ratio of _____ to _____ in all lung spaces for _____

chest wall, lung, gravity, positions, position, breathing pattern, equalize

properties of _____/_____ tissue and _____ in different _____ alters V/Q ratio, normally change in _____ and _____ cause ratio to _____ over time

top, open, ventilation, gravity, density, closing, bottom, perfusion

in upright position, _____ of lung space is more _____ (increased _____) while _____ and tissue _____ cause _____ in _____ (increased _____)

decreased, normal, nonoptimal

_____ ventilation with _____ perfusion cause _____ V/Q

compliance, elasticity, muscles, alignment, length tension, oxygen, diameter, resistance, surface area, dead space

decreased ventilation can occur from decreased chest wall _____ or _____, respiratory _____ with altered _____/_____ relationships or _____ supply, decreased airway _____ or increased airway _____, decreased pulmonary _____ from increased _____

pressure gradient, ventilation, residual volume, surface area, trapping, membrane thickness, secretion

diffusion is affected by decreased _____ (from decreased _____ and increased _____), decreased _____ (from air _____), and increased _____ (from retained _____)

hypoxic vasoconstriction, compensate, V/Q mismatch, ventilate, shunts blood, vasoconstriction, hypoxic, afterload, right ventricle

perfusion is affected when _____ occurs, mechanism to _____ for _____ (area of lung does not _____, body _____ to other areas, _____ of _____ area, increases _____ of _____)

smoking cessation, risk factor avoidance, exercise, airway clearance, breathing retraining, formal pulmonary rehab

COPD behavioral management (6)

prevention, thoracic mobility, peripheral, efficiency

behavioral management focuses on _____, exercise maintains _____, chronic cases can still optimize _____ system with exercise by increasing _____

bronchodilators, mucolytics, corticosteroids, vasodilators, supplemental oxygen, noninvasive positive pressure ventilation

COPD pharmacological management (6)

resistance, sympathetic, beta 2 agonist, HR, BP, contractility

bronchodilators decrease airway _____ by increasing _____ output (_____), precaution for increased _____/_____/_____

mucus production

mucolytic agents decrease _____

antiinflammatories, immune, bone mineral density, muscle, skin

corticosteroids act as _____, precaution for decreased _____ function, decreased _____/_____ health, and _____ breakdown

pressure gradient

supplemental oxygen increases _____

mechanical ventilation, lung resection, lung transplantation

COPD invasive management (3)

ventilation, perfusion, hypoxemia, hypercarbia, exacerbations, infection, subthreshold

goals of COPD management are optimize _____/_____, minimize _____ and _____, prevent _____ and _____, and facilitate more _____ work

exposure, irritants, infections, hospital, disease

history includes _____ to lung _____, previous lung _____, and previous _____ admissions for lung _____

observation, breathing pattern, accessory muscles, posture, vital, oxygenation, auscultation, lungs, heart

physical examination includes _____ of _____, use of _____, and _____; _____ signs; _____; and _____ of _____ and _____

complete blood count, arterial blood gases, sputum culture

lab tests (3)

pulmonary function, chest radiograph, chest CT/MRI, ventilation perfusion scan

diagnostic tests (4)

both, interpret, decision making, fatigue, severity, restoration, compensation, safety, stability, progression, standing, communicate, management

_____ medical and therapy team conduct examination components, therapist should _____ lab/imaging data to help with clinical _____ (determine why _____, what _____, using _____ vs _____) and ensuring _____ (_____ and appropriate _____), may have _____ orders, _____ with team for appropriate _____

infection

COPD exacerbation is likely due to _____

acid base balance, ventilation, oxygenation, kidney, arterial line, continuous, blood draw, severity

arterial blood gases measure _____, adequacy of _____ and _____, indirect measure of _____ function, performed by _____ (_____ measurement) or individual _____, determine _____ of condition

pH, homeostasis, chemical reactions, enzyme proteins

regulation of body fluid _____ is one of most important physiological functions of _____ because activity of most _____ via _____ is dependent

pH, optimal, breakdown, enzyme, cellular

specific _____ needed for _____ function (avoid protein _____ required for _____ and _____ function)

CO_2, H⁺, acid, HCO₃^-_, buffer, base

increased _____ favors _____ formation (strong _____), _____ acts as _____ (_____)

trapping, CO₂, drops, respiratory acidosis, chemical reactions

air _____ = retaining _____, blood pH _____ causing _____ and affecting _____

7.35-7.45

normal blood pH = _____

35-45

normal pCO₂ = _____

80-100

normal pO₂ = _____

21-28

normal HCO₃^- = _____

respiratory acidosis

low pH with high PCO₂

metabolic acidosis

low pH with low HCO₃^-

respiratory alkalosis

high pH with low PCO₂

metabolic alkalosis

high pH with high HCO₃^-

compensated, complimentary, lungs, kidneys

acid base disorder may be _____ by _____ system (_____ and _____)

ventilation, ROM, breathing

therapy techniques for respiratory acidosis include increasing _____, increasing _____, using _____ techniques

pH, PO₂, PCO₂, HCO₃^-

arterial blood gases are represented in _____/_____/_____/_____ order

in, moved in, out, well, predicted, observed, percent predicted, preintervention, postintervention

pulmonary function tests measure how much air is _____ lungs, how much air can be _____/_____, how _____ the lungs move air, _____ vs _____, _____, and _____ vs _____ results

relative, normative

predicted vs observed and percent predicted are _____ to _____

bronchodilator, obstructive, restrictive

preintervention vs postintervention compares with _____, shows _____ vs _____ disease

volumes, capacities

pulmonary function tests look at lung _____, 2+ = _____

age, sex, height, race

predicted values are based on _____, _____, _____, and maybe _____

forced vital capacity, forced expiratory volume first second, FEV1/FVC ratio

spirometry report values (3)

75

reference FEV1 is _____% of FVC

vital capacity, decreased, trapping, increased residual volume

FVC is normally equal to _____ but is _____ in obstructive disorders due to air _____, concurrent _____

decreased, both

FEV1 is _____ in _____ obstructive and restrictive limitations

resistance, exhalation, inhale, volume

in obstruction FEV1 decrease is due to increased _____ to _____, in restriction FEV1 decrease is due to decreased ability to _____ an adequate _____ of air

flow, same, volume, slower

_____ differentiates between restriction (_____ slope with less _____) and obstruction (_____ slope)

diameter, elasticity, pace, slower, fuller, lower, cumulative

obstruction to exhalation is from reduction in airway _____ or lung tissue _____, should cue _____ breathing (_____ and _____) with _____ intensity _____ exercise

compliance, vital capacity, mobility, flexibility

restriction is from decreased pulmonary/thoracic _____ limiting _____, prescribe thoracic _____ and _____

ratio, isolation

_____ is better discriminator of pulmonary disorder than values in _____

decrease, obstructive, increase, restrictive

_____ in FEV1/FVC indicates _____ while _____ in FEV1/FVC indicates _____

improvement, bronchodilator, resistance

NO _____ with _____ indicates NOT airway _____

GOLD, FEV1, severity

_____ grades use _____ for COPD _____

very severe, progression, energy conservation

GOLD 4 is _____ rating, therapy will use less _____ and more _____