Lec 5 - Cardiopulmonary Interventions & Lec 6 - Pharmacology

pursed lip breathing helps with _______

anxiety

the goal of pursed lip breathing it to increase the time of ________

exhalation

Pursed lip breathing is especially beneficial in patients with what disease?

COPD

what position would be the hardest to perform diaphragmatic breathing in?

prone

what is segmental breathing?

similar to diaphragmatic breathing but you focus your breath over the area of restricted mobility

airway clearance techniques function

improve the mobilization of secretions from the peripheral to larger and more central airways

list some contraindications to airway clearance techniques

ICP > 20mmHG, head or neck injury, active hemorrhage, hemodynamic instability, PE, active spinal injury

what medications get used before airway clearance techniques? what medication gets used after?

bronchodilators, antibiotics

what is the goal of postural drainage?

move secretion from the periphery to larger more central airways

how long should you position a patient in postural drainage?

5-10 minutes

this is the postural drainage position for what lobe?

posterior, superior lobe

this is the postural drainage position for what lobe?

anterior superior lobe

this is the pastoral drainage position for what lobes?

right and left middle lobes

This is the postural drainage position for what lobes?

posterior inferior lobes

what is percussion

rhythmic force applied w cupped hands, can be applied in postural drainage positions

vibration should be applied before or after percussion?

after

what is the active cycle of breathing

movement of secretions to the central airway using breathing, huffing, coughing

what are the 3 cycles of the active cycle of breathing

1: breathing control, 2: thoracic expansion, 3: huffing/breath control

what are the steps of Active cycle of breathing?

1. postural drainage position

2. breath relaxed

3. take full 2 full deep breaths

4. 2 medium sized breaths followed by a huff

5. 2 deep breaths followed by a huff

6. end with a cough

should you use postural drainage position when going through autogenic drainage?

no! no postural draining

what are the 4 stages of a cough?

1. inspire enough air

2. close the glottis

3. contraction of the abdominals

4. open the glottis

positive expiratory pressure

helps you breath out

antiussitives fxn

suppress the cough reflex in the brain, most useful for dry, non-productive cough

patients on antiussitives may have ____ _____ _____

decreased airway clearance

an antitussive agent that suppressed the cough reflex but is a non-narcotic may make dizzy or drowsy: _________

dextromethorpan

decongestant fxn

acute treatment, treats congestion w/mucus discharge

decongestants bind to _______ receptors

alpha 1 adrenergic,

decongestants cause _____ which can reduce blood flow, decrease swelling and increase blood pressure

vasoconstriction

ephedrine causes _______

bronchodilation

what are the big 4 symptoms of using decongestants?

they mimic the sympathetic nervous system (act on adregenic receptors) 1. increase heart rate, blood pressure, 2. nervous, anxiety lack of sleep, 3 headache, tremors, 4. dry mouth

what are antihistamines used for?

allergic reactions, sedation, and parkinson’s disease (restore dopamine balance)

why would someone with parkinson’s take antihistamines?

to decrease tremors & rigidity, and increase mobility potential

antihistamines can slow reaction time, cause fatigue, and increase ____ ____.

fall risk

what is a histamine?

a chemical messenger released during immune responses.

the H2 receptor main effect stimulates secretion of _____ _____.

gastric acid

H1 blockers do what?

improve airway comfort and also slow CNS activity

antihistamine may reduce mucus production but this can be bad because why?

less natural airway clearance.

What is the primary mechanism of antihistamines in the respiratory system?

Blocking H₁ receptors to reduce histamine effects

mucolytics/expectorants fxn

meds that make mucous thinner and hence easier to clear airways. also prevent mucus accumulation

bronchodilators function

opens the airway

Which of the following best explains why bronchodilators improve functional exercise tolerance?

. They stimulate β₂ receptors to dilate the airways.

bronchodilators act on what type of muscle?

respiratory smooth muscle cells

when should a patient take bronchodilators?

before treatment.

T/F: if O2 levels get too high and individual will stop breathing

True

what is an anti-inflammatory drug used in chronic disease?

glucocorticoids (corticosteroids)

what is the function of an anti-inflammatory drug in someone with asthma or chronic bronchitis?

controls inflammatory mediated bronchospasm

what are some side effects of take antinflammatories?

osteoporosis, skin breakdown, mm wasting, hyperglycemia, hypertension

Which of the following is a major reason PTs must understand cardiac medications?

to identify how medications affect vitals and exercise response

pt on mucolytics may benefit most from what type of pt?

chest pt, postural drainage

nitrats function

open vessels to decrease pain and improve blood flow

what are two benefits in the CV system caused by taking nitrates?

decreased preload and after load, increased oxygen delivery

function of calcium channel blockers?

slow down heart rate to lower blood pressure by reducing mm contraction(vasodilation)

beta blocker function

slow down heart rate and lower blood pressure

how do betta blockers work?

blocks effects of hormones (epinephrine and norepinephrine) from binding onto beta receptors

fxn anticoagulants

prevent clot formation by interfering with coagulation cascade and blocking vitamin k

taking anticoagulants can improve _____ ______ and hence increase exercise tolerance and reduce ischemic symptoms

coronary perfusion

fxn of ace inhibitors

lower blood pressure and protect the kidneys

what is the mechanism of an ACE inhibitor

stop the body from making angiotensin II (narrows blood vessels) from angiotensin 1

fxn Diuretics

increase urine output

mechanism of diuretic

excretion of sodium and water through kidneys, decreases blood volume, decreases cardiac workload.

fxn of positive inotropes

strengthen heart contraction improve cardiac output

what is the mechanism of positive inotropes

increase intracellular calcium levels.

normal pH blood

7.35-7.45

what is acidic blood levels?

below 7.35

what is alklaotic blood ph?

above 7.45

what is a normal arterial pressure of CO2 (paCO2)

35-45 mmHG

normal PaO2

80-100 mmHg

normal HCO3 (bicarbonate concentration) value

22-30 mmHg

Bohr efffect

hemoglobin affinity for oxygen decreases in response to lower ph (high acidity) or higher levels of CO2.

respiratory acidosis

too much CO2 in blood

respiratory alkalosis

too little CO2 in blood

metabolic acidosis

too little HCO3 in blood

metabolic alklalosis

too much HCO3 in blood

abnormal ABG means patient is ______

uncompensated

normal range ABG means patient is ______

compensated

polycethemia

too many red blood cells - dehydration, pulmonary problem, COPD

anemia

low RBC - fatigue, irregular heart beat, immune system difficult to fight

mean corpuscular volume

average size of red blood cells: normal is 80-100fL

hemoglobin

amount of oxygen binding to the red blood cells

hematocrit

ratio of the volume of red blood cells to the total blood volume

if WBC’s are trending downward pt is:

higher risk for fever - leukopenia

if WBC count is on teh rise:

pt usually has infection (Leukocytosis)

neutropenia

an abnormally low concentration of neutrophils - high risk of infection and low immune response

fxn of platelets

blood clotting

thrombocytopenia

not enough platelets, trending down bone marrow

thrombocytosis

too many platelets - greater than 450,000 - watch for sudden onset of chest pain/SOB

hypokalemia

low potassium - mm weakness, cramping, difficulty moving

hyperkalemia

too much potassium - cardiac issues

sodium fxn in panel

primary determinant of extracellular fluid volume

hyponatremia

too little sodium - often due to too much H20

hypernatremia

too much sodium - dehydration

blood glucose normal value range

70-100 mg/DL

glucose levels <70 pt . . .

needs snack

glucose levels >200 pt . . .

watch closely, see if it elevates with activity

troponin 1

proteins that are important for skeletal and cardiac mm. can be used as an indicator that patient had a stroke or heart attack

serum proteins fxn

provide osmotic pressure needed to draw water from tissues into capillaries. maintains blood volume nad pressure

if liver is damage you will see increased ____ levels

ammonia

prothrombin should clot within ______

11-12.5 seconds

look at arterial blood gas study sheet please nad make sure didnt miss anything superrrrr important