PT 611 (Exam 2) - Pulmonary Health Conditions

Which ribs are your true ribs?

1-7

Which ribs are your false ribs?

8-12

Which ribs are your floating ribs?

11-12

What are your main muscles of inspiration?

Diaphragm and internal intercostals

Are exhalation and inspiration active or passive processes?

Exhalation (passive) and Inspiration (active)

How many lobes do the right and left lungs have?

Right lung has 3 lobes and left lung has 2 lobes.

What is the definition of ventilation?

Air moving in and out of lungs

What is minute ventilation?

RR x tidal volume (5L/min)

What is tidal volume?

Volume of air inhaled and exhaled each breath during quiet breathing. (350-500 mL)

What does gas exchange mean?

Gas exchange across semi-permeable alveolar-capillary membrane.

What are four types of obstructive pulmonary conditions?

Asthma, Chronic Bronchitis, Emphysema, Cystic Fibrosis

How many adults have been diagnosed with chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis?

4.2%

What is an Obstructive Lung Disease (OLD)?

Diseases that obstruct expiratory airflow. These are progressive diseases.

What are some signs and symptoms of Obstructive Lung Disease (OLD)?

◦ CXR: elevated shoulder girdle, horizontal ribs, barrel-shaped thorax (increased A-P diameter), flattened diaphragm

◦ Dyspnea on exertion (DOE)/decreased activity tolerance

◦ Secretion production and cough

◦ Anxiety

◦ Tripoding

◦ Wheezing

◦ Clubbing

◦ Cyanosis

What could Obstructive Lung Disease (OLD) result in?

◦ Retained secretions

◦ Inflamed mucosal lining of airway walls

◦ Bronchial constriction (increased tone or spasm)

◦ Weakened support structures of airway walls

What are two primary causes of obstructive lung disease (OLD)?

Inhalation factors

• Cigarette smoking

• Chemicals

• Air pollution

• Occupational dusts

Genetics

• Alpha-1 antitrypsin deficiency

Describe asthma.

It is reversible and episodic. It inflames the airway wall (Trigger → hypersensitivity reaction → smooth muscle contracts → vasoconstriction of the airway)

What does asthma cause?

Wheezing, breathlessness, coughing, and chest tightness

How does asthma specifically affect the airways?

Airway remodeling-thickening of airway walls in large and small airways

Describe chronic bronchitis.

Hypersecretion of mucus in small airways (Hypertrophy of submucosal glands)

How do you diagnose chronic bronchitis?

Productive cough lasting at least 3 months in 2 consecutive years.

What is chronic bronchitis strongly associated with?

Progression of COPD

Describe emphysema.

Enlargement of air spaces distal to the terminal bronchiole and destruction of alveolar walls. This is associated with decreased elasticity in the airways, airway collapse, and gas trapping.

What are the risk factors of emphysema?

◦ Main cause is cigarette smoking

◦ Genetic

What are three types of emphysema?

◦ Centrilobar

◦ Panlobular

◦ Distal acinar

Describe cystic fibrosis.

Inherited disorder of abnormal sodium-chloride transport affecting every organ system with epithelial surfaces

◦ Pulmonary, intestines, pancreas, gall bladder, reproductive system

How is cystic fibrosis diagnosed?

Autosomal recessive genetic disorder (CFTR gene)

◦ Diagnosed by sweat test or DNA mutation analysis

Describe some signs and symptoms in the pulmonary system for cystic fibrosis.

◦ Chronic airway obstruction and inflammation

◦ Thick mucus

◦ Recurrent bacterial infections

What some restrictive pulmonary conditions?

Pulmonary

◦ Interstitial Lung Disease

◦ Pneumonia

◦ Pulmonary Edema

Extrapulmonary

◦ Pleural Effusion

◦ Pneumothorax

Musculoskeletal

◦ Scoliosis

◦ Rib fractures

Neuromuscular

◦ CVA

◦ Parkinsons Disease

◦ Spinal Cord Injury (SCI)

Restrictive Lung Conditions - What are they characterized by?

Characterized by abnormal reduction in pulmonary ventilation

◦ Decreased expansion chest wall or lung

◦ Decreased lung compliance

◦ Decreased lung volumes and capacity

◦ Increased work of breathing

What are some signs and symptoms of restrictive lung conditions?

◦ Tachypnea

◦ Hypoxemia

◦ Decreased breath sounds

◦ Cyanosis

◦ Clubbing

◦ Dyspnea

◦ Muscle wasting

◦ Cor pulmonale

◦ Pulmonary hypertension

◦ Cough

Describe interstitial lung disease.

Chronic, progressive, and irreversible

• Not a single disease- a term for many diseases that affect the tissue in and around the alveoli

• Idiopathic Pulmonary Fibrosis is the most common type (Causes scarring of the lungs)

What are some risk factors for interstitial lung disease (ILD)?

◦ Genetic

◦ Environmental exposure (cigarette smoking; environmental dusts, inhalation of mold or fungal spores)

◦ Radiation

Describe pneumonia.

•Acute lung injury

•Caused by inflammatory process in lung parenchyma

•Can be bacterial, viral, fungal or micoplasmal (viral+bacterial)

Describe pulmonary edema.

Excess fluid in lungs

◦ Interstitial spaces

◦ Alveoli

Cardiogenic

◦ Left heart failure

Non-Cardiogenic

◦ Adult respiratory distress syndrome (ARDS)

◦ Renal failure

What are some signs and symptoms of pulmonary edema?

• Shortness of breath (SOB)

• Cyanosis

• Increased RR

• Labored breathing

• Pallor

• Diaphoresis

• Cough with pink, frothy sputum

Describe pleural effusion.

Caused by fluid in the pleural space

Can be caused by multiple diseases

◦ Heart failure, cancer, renal disease, liver disease, ARDS, pulmonary emboli, pneumonia, infections, etc

Describe pneumothorax.

Air in the pleural space

◦ Decreased lung volumes and lung compliance

◦ Impaired gas exchange

What is a typical treatment for pneumothorax?

Chest tube

What are two different types of pneumothorax?

Open

◦ Air in the pleural space communicates freely with the outside environment

◦ Unable to maintain negative pressure → decreased air moving into lungs

Tension

◦ Air can enter the pleural cavity but cannot escape

◦ Life-threatening

What are two musculoskeletal pulmonary health conditions?

Scoliosis and rib fracture

What are some neuromuscular pulmonary health conditions?

Paralysis, weakness, impaired motor control

◦ Spinal Cord Injury

◦ Stroke (CVA)

◦ Parkinson’s Disease

◦ Multiple Sclerosis

What are some invasive management strategies for pulmonary conditions?

◦ Chest tube

◦ Surgery

◦ Mechanical ventilation

What are some medical management strategies for pulmonary conditions?

◦ Bronchodilators

◦ Anti-inflammatory

◦ Volume reduction

◦ Pain control

◦ Supplemental oxygen

What are some behavior management strategies for pulmonary conditions?

◦ Smoking cessation

◦ Promote daily activity

For pulmonary conditions, what is the PT’s role in primary care (prevention)?

◦ Prevention on COPD development

◦ Prevention of progression of disease

◦ Awareness of indications for screening/referral

For pulmonary conditions, what is the PT’s role in secondary care?

◦ Rehabilitation during and after disease exacerbation

◦ Rehabilitation after surgery

◦ Awareness of precautions and contraindications

For pulmonary conditions, what is the PT’s role in tertiary care?

◦ Critical care rehabilitation

◦ Exercise training

Pulmonary Conditions - Describe a PT’s history (examination)

◦ Quality of sleep

◦ Dyspnea at rest or with activity

◦ Pallor or diaphoresis with activity

◦ Activity tolerance

◦ Cough

◦ Pain

◦ History of smoking/other risk factors

◦ Work history

Pulmonary conditions - Describe a PT’s systems review (examination)

1. Observation

◦ Posture

◦ Skin (color, integrity, digital clubbing)

◦ Breathing pattern (Shortness of breath at rest and with speech, Accessory muscle use)

2. Anthropometric measurements

◦ Height, weight, body mass index (BMI), body circumference (waist, hip, limbs), skinfold thickness

3. Vitals

◦ HR, RR, BP, Temperature

4. Lung Auscultation

5. Pain

6. Sensation (Dermatomes)

7. Capillary Refill (Decreased refill time may indicate decreased oxygenation)

8. Deep Tendon reflexes

9. Mobility (Monitor vital signs, activity tolerance, SPO2, Shortness of breath)

What are some PT precautions and contraindications?

•Vital signs monitoring

•Supplemental oxygen prescription

•Awareness of body positioning and impact on ventilation and gas exchange