PHTA 216 - Final (Cardiorespiratory)

12

total number of ribs per side

7

number of true ribs per side

3

number of false ribs per side

2

number of floating ribs per side

Costovertebral

name of the joint formed by the vertebrae & ribs

Down

the external intercostal muscles pull the upper rib ___

Up

the internal intercostals pull the upper rib ___

Phrenic

nerve that controls the diaphragm

Allow smooth sliding of the lungs along the ribs

function of the pleura & pleural fluid

Oblique

fissure on each lung that divides into upper and lower lobes

Horizontal

fissure on right lung only that divides into upper and middle lobes

Nose, mouth, pharynx, larynx

4 parts that make up the upper respiratory tract

Carina

point of division of the trachea

Right bronchus

part of the bronchial tree that is wider, shorter, more vertical, and splits in to 3 parts

Left bronchus

part of the bronchial tree that is longer, more oblique, and splits into 2 parts

Through the walls of the alveoli and the blood vessels

gas exchange occurs:

Plasma, hemoglobin

oxygen is transported in the blood either in the ___ or combined with ___

Hemoglobin, RBCs, CO2

the amount of oxygen that can be carried is dependent on the amount of ___, ___, and ___ in the blood

Pressure, pulmonary, thinner membrane, solubility

increased gas diffusion with: greater ___ difference and area of ___ membrane available, a ____, and ___ of gas in the pulmonary membrane

Inspiration

“bucket handle” and “pump handle” refer to ___

Diaphragm, external intercostals

muscles of resting inspiration (2)

SCM, scalenes, pec minor, pec major, SA, traps, LS, rhomboids

muscles of deep inspiration - accessory muscles (8)

Elastic recoil of tissues

mechanism of normal expiration

Abs, LD, internal intercostals, external pressure on rib cage

mechanism of forced expiration (3 muscles +1)

Evaluation, results, monitoring

in regards to a respiratory assessment, the PTA is responsible for: ___ of patient before treatment, evaluating the ___, and ___ patient’s status during

Inspection, palpation, percussion, auscultation, treatment activities, result of treatment

6 components of respiratory evaluation that the PTA is responsible for (IPPATR)

Color, clubbing, hypertrophy, accessory muscle use, vitals, breathing pattern

6 things to pay attention to when inspecting a patient (CCHAVB)

Orthopnea

SOB when laying down; resolved when seated/standing

Symmetry, location & type of movement, chest deformities

3 chest mobility inspection criteria (S, L, C)

Pectus excavatum

chest abnormality denoted by concavity around the sternum

Pectus carinatum

chest abnormality denoted by protrusion of the sternum

Auscultation

listening to the lungs with a stethoscope

Stridor

abnormal high-pitched breath sounds

Pleural rub

sounds like creaking at the end of inspiration and beginning of expiration

>100ml/day

abnormal sputum production

Alteration, bronchospasm, consciousness, color, accessory muscles, fatigued

sings of respiratory distress: ___ in respiratory pattern, development/increase of ___, altered state of ___, change in ___, increased use of ___, and patient appears ___

Directions, depth, pain, sputum

more signs of respiratory distress: decreased ability to follow ___, decreased ___ of respiration, development/increase of ___ level, and change in ___ color/production

Normal breathing

faint, low pitched, soft rustling, inspiration 2/3, expiration 1/3

Tidal volume

the amount of air that passes in & out of the lungs on quiet respiration

500mL

normal tidal volume

Inspiration capacity

the maximum amount of air that can be inspired into the lungs after resting expiration

3500mL

normal inspiratory capacity

Inspiratory reserve volume

the amount of air a person can breathe in after a resting inspiration (i.e. above the tidal volume)

3000mL

normal inspiratory reserve volume

Expiratory reserve volume

the amount of air that a person can exhale after a quiet expiration (i.e. above the tidal volume expiration)

1000mL

normal expiratory reserve volume

Vital capacity

the maximum volume of air that can be expelled from the lungs following the deepest possible inspiration

4.5L, 3.2L

normal vital capacity for men, women

Residual volume

the air that cannot be expired after forceful expiration

1500mL

normal residual volume

Functional residual capacity

the amount of air that remains in the lungs at the end of quiet expiration, at the resting respiratory level (ERV + residual volume)

2500mL

normal functional residual capacity

Forced expiratory volume

vital capacity is forced out as rapidly & completely as possible (normally 70-80% VC)

Maximal ventilation volume

breathing as deeply & rapidly as possible for 15 seconds and ventilation per minutes is then calculated

>100L/minute

normal maximal ventilation volume

Peak flow

patient’s highest expiratory flow rate during forced expiration is measured and related to the FEV1 and MVV

12-20

normal RR for an adult

Anatomical dead space

remaining air in the air passages at the end of inspiration and can’t take part in gaseous exchange (about 150mL)

Alveolar dead space

volume of inspired air that enters the alveoli and is of no functional value; not used in gas exchange

Physiological dead space

alveolar and anatomical dead space together

Lung disease, pain, obstruction, deficits, muscle weakness, orthopedic, stress

indications for breathing activities: acute or chronic ___, ___ in the thoracic or abdominal area, airway ___ secondary to bronchospasms or retained secretions, ___ in the CNS causing ___, severe ___ abnormalities, or ___ reduction

Ventilation, effectiveness, impairments, respiratory muscles, mobility

goals of breathing exercises: improve ___ and cough ___, prevent pulmonary ___ (such as atelectasis), improve the strength/endurance/coordination of the ___, or maintain/improve chest & thoracic spine ___

Breathing patterns, relaxation, SOB attacks, functional capacity

more goals of breathing exercises: correct inefficient or abnormal ___, promote ___, help patients cope with ___, or improve overall ___ of patients

Reassure, rest, demonstrate, distress

principles of teaching breathing exercises: ___ clients (incl. safety), promote ___ as needed, ___ exercises, and know and respond to signs of ___

Chest mobility exercises

exercises that combine active movements of the trunk or extremities with deep breathing (may be specific or general)

Goal of chest mobility exercises

to improve chest mobility while simultaneously improving chest expansion and lung use

Coughing

normal mechanism of removing secretions from the lungs

Phase 1

phase of a cough with deep inspiration

Phase 2

phase of a cough where the glottis is closed

Phase 3

phase of a cough where the abs contract & diaphragm elevates

Phase 4

phase of a cough where the glottis opens & there’s an explosive expiration of air

Deep breath, forcibly, cilia, thickness

reasons for decreased cough: inability to take a ___, inability to ___ expel air, decreased action of the ___ in the bronchial tree, increased amount or ___ of the mucus

Postural drainage

method of clearing the mucus out of the lungs by tipping the person on an angle

Percussions

manual beating on chest over desired lung segment

Shaking

manual shaking during exhale

Vibrations

manual vibration during exhale

3-5 minutes

each target lung segment should be drained for:

Prior to & after

patient should be evaluated ___ treatment

Active cycle of breathing

3-4 deep breaths with breath hold (x2), 1-2 huffs, repeat

Autogenic drainage

self drainage technique combined with different speeds of breathing

Flutter, Acapella

2 devices that combine positive expiratory pressure & oscillatory vibration of the air

Immunosuppression, infection, inflammation

low WBC indicates ___, while high WBC indicates ___ and/or ___

Bleeding

a sudden drop in hemoglobin could indicate ___

Decreased

___ hemoglobin can result in SOB, hypotension, or limited endurance

Higher

lower platelet count indicates a ___ risk of bleeding

Low, high

___ INR = more likely to clot; ___ INR = higher risk of bleeding

Cardiac, renal

chronic ___ or ___ failure can lead to elevated levels of TnT-HS

Trend

with hemoglobin, it’s important to pay attention to the ___

Potassium

low ___ may cause arrythmias and/or muscle weakness, while high may cause arrhythmias, ventricular tachycardia, or asystole; may stabilize quickly

INR, platelets, hemoglobin

3 lab values that relate to bleeding

Trending downwards

after a cardiac event, if TnT-HS levels are ___, slowly return to activity

Elevated

WBC count will be ___ post-op

Obstructive

lung disease type characterized by increased retention of pulmonary secretions, narrowing & obstruction of airways, and structural deterioration of alveoli

Chronic bronchitis, emphysema, asthma, CF

4 examples of obstructive lung diseases

Restrictive

lung disease type characterized by: inability of the lungs to fully expand, extrapulmonary or pulmonary restriction, and pain

Extrapulmonary restriction

pleural disease, chest wall injury or stiffness, respiratory muscle weakness, inability of diaphragm to adequately move, pain

Pulmonary restriction

tumor, pneumonia, atelectasis, heart disease, pain

Hemoptysis

coughing up blood

Bronchiectasis

obstructive lung disease; scarring & mucus in airways; recurrent infections due to inability to clear mucus; chronic productive cough, hemoptysis, SOB, fever

Thoracotomy

incision in the chest wall between the ribs to access the lungs; restrictive; bleeding, pneumothorax, pain, pneumonia, infection, atelectasis, increased secretions