pulmonary quiz 4

what are 5 pulmonary abnormalities

pulmonary edema, pulmonary embolism, pulmonary hypertension, cor pulmonale, (obstructive) sleep apnea

what are some clinical implications of pulmonary edema

\-can be cardiac orr noncarddiogenic- C results from backflow. NC alteratiioins in capillary permeability

\-increased tactile and vocal fremitus

\-may not tolerate supine due to dyspnea → semi fowlers

what are some clinical implications of pulmonary embolism

\-partial or full occlusion of the pulmonary vasculature

\-discontinue PT if a PE s/s become evident

\-diminished or absent breath sound distal to PE & decreased chest wall expansion

what are some clinical implications of pulmonary hypertension

\-increase in pulmonary artery pressure from disruption in alveolar capillary interface → hypoxia → reflective vasoconstriction

\->20mmHg show respiratory distress during exercise

\->35 mmHg may not tolerate exercise at all

what are some clinical implications of cor pulmonale

\- R heart hypertrophy/failure secondary to chronic pulmonary artery hypertension

what are some clinical implications of sleep apnea

\-tongue and palate relax and block airway

\-risks: CHF, COPD, male

what are SaO2 value for person who is 30

96%

what are SaO2 value for person who is 50

94%

what are SaO2 value for person who is 70

92%

what are SaO2 value for person who is 90

91%

what is SaO2 for a person who has COPD or CHF

85-88%

what are PaO2 value for person who is 30

92 mmHg

what are PaO2 value for person who is 50

82 mmHg

what are PaO2 value for person who is 70

74 mmH (mild hypoxemia0

what are PaO2 value for person who is 90

66 (mild hypoxemia)

what are PaO2 value for person who has COPD or CHF

50-56 mmHg (moderate hypoxemia)

what could lead to unreliable SpO2 reading

motion aritfact, bright light in room, arrhythmia, fingernail polish, poor circulation, raynauds, callouses, increased sweaty or oily hands

falsely high SpO2 readings may occur because of what

\-dark skin

\-cigarette smoking prior

\-carbon monoxide poisoning

how can a patient be dyspeneic and cyanotic yet register a normal PulseOximetry reading

a pt with anemia may register a normal SpO2 but show signs of fatigue and dyspnea. a low Hct but have good saturation of those RBC that exist → normal pulsox reading

pulmonary causes of dyspnea

acute: foreign body obstruction, asthma, PE, PTX, pneumonia, tumor, pulmonary edema

chronic: COPD, RLD

cardiac causes of dyspnea

CHF, myocardial ischemia, increased pressure in pulmonary vein

dyspnea is pulmonary in origin if

\-excess secretions are contributing to dyspnea

\-dyspnea is accompanied by accessory muscle use

\-bronchodilator relieves

\-increase AP chest diameter

\-tripod position relieves

dyspnea is cardiovascular in origin if

\-strictly related to activity

\-accompanied by irregular HR or extreme changes in BP

\-syncope, lightheadedness

\-nitro relieves

a pulmonary cough causes:

productive: pneumonia, bronchiectasis, CF, chronic bronchitis

non productive: RLD conditions, asthma, emphysema

a cardiovascular cough cause

CHF: non productive

non productive: dissecting aortic aneurysm

non productive: cardiovascular meds (ACE, BB)

what are signs of respiratory distress

\-dyspnea (especially at rest)

\-tachypnea

\-accessory muscle use

\-intercostal retractions

\-nasal flaring

\-cyanosis

\-stridor

\-confusion, agitation

respiratory failure is defined as PaO2 < __, regardless of whether the PaCO2 is > 50 mmHg

60 mmHg

what are some relative contraindications to exercise \[yellow flags\]

\-alcohol hangover

\-sympathetic stimulants

\-weight gain of >3# in 24 hours

\-recent large meal

\-severe sunburn

\-air pollution at high alert level

\-MI within last 2-3 months

how can inspiratory muscles be strengthened/trained using an inspiratory muscle training device

they have aa load adjustable valve to increase inspiratory effort and the muscles can be trained. can range in intensity from 15-60% of MIP for 10-15 minutes several times a day.

when is it not appropriate to use IMT device

advanced emphysema

what is the purpose and function of incentive spirometer

\-given to patients post op for prevention or if there are pulmonary secretions that threaten to consolidate and create environment for pneumonia

\-prevent pulmonary complications

what are the two types of incentive spirometers

volume mode and flow velocity mode

what is the volume mode incentive spirometer

\-most effective

\-long and slow is the goal

\-improvements in sustained maximal inspiration

\-keep the ball in the middle

what is the flow velocity mode incentive spirometer

\-quick maximal inspiration similar to PFT for vital capacity

\-does not move as much volume of air into the lung

what is the action of positive expiratory pressure (PEP) for pursed lip breathing (PLB)

uses positive expiratory pressure to splint open the airway during expiration to keep them from collapsing

what PEP devices are used for airway clearance

flutter valve, acapella, PEP valves

\-provides back pressure that helps splint open the airway to decrease air trapping.

what is the risk and danger of oxygen toxicity from an excessively high flow rate

\-cause damage to many cellular components, cell death can occur with subsequent loss of tissue and organ function.

\-airway inflammation, increased permeability, and pulmonary edema → death

describe an oxygen prescription that would allow titration for exercise

“titrate oxygen between 2-4 liters/min as needed to maintain SpO2 above 90-92%

what is clinical management oof permissive hypoxemia for the person with chronically low PaO2 levels

a person with chronic lung disease may be on supplemental oxygen, but still have elevated PaCO2 and low PaO2 (with normal pH).

given an E cylinder of oxygen, calculate the remaining minutes in the tank for specified flow rate.

(PSI x 0.28) / flow rate in liters per minute

nasal canula requires _ lpm of oxygen to achieve an FiO2 of 0.24

1

venturi mask requires _ lpm ox O2 to achieve an FiO2 of 0.24

4

FiO2 should be less than ___ for the patient to be safely mobilized

PEEP (positive end expiratory pressure) should be less than _____ for the patient to be safely mobilized.

less than 10 cc H2O

when pH is low and relating to PaCO2, what is happening

respiratory acidosis → low pH and high PaCO2

when pH is low and relating to HCO3, what is happening

metabolic acidosis → low pH and low HCO3

when pH is high and relating too PaCO2, what is happening

respiratory alkalosis → high pH and low PaCO2

when pH is high and relating to HCO3, what is happening

metabolic alkalosis → high pH and high HCO3

if a pt has acute respiratory acidosis, it causes what

alveolar hypoventilation

if a pt has acute respiratory acidosis, what are some common conditions

pneumonia, GBS, or CNS depression

what are some conditions for compensated respiratory acidosis

COPD

what occurs with compensated respiratory acidosis within the ABG

\-pH becomes normal

\-PaCO2 remains high

\-HCO3 raises and comes to the rescue causing prolonged high PaCO2

acute metabolic acidosis is caused by what

diabetic hyperglycemic ketoacidosis, lactosis, alcohol abuse or starvation

what does compensated metabolic acidosis look like

pH norma, HCO3 remains low, Kussmauls breathing technique comes in which lowers PaCO2. not a permanent solution though → coma or death.

a hypoxemic state with elevated PaCO2 > ___ is termed hypercapnia

45 mm

define permissive hypoxemia

therapist expects abnormally low SpO2 levels as the persons baseline, need to watch carefully.

what is the significance and possible cause of a right shift in the oxyhemoglobin dissociation curve

-when PaO2 drops slightly, there is not much difference, but when it drops to around 50, the Hgb will release its O2 more freely.

-for a healthy person, exercise can cause this

-with pathological conditions of high body temperature can cause it

-signs are

• increased temperature

• increased PaCo2

  • decreased pH

when given a chest radiograph, how is the patient orientated toward you

when you look at a radiograph, it is as though the person is facing you

when given a chest radiograph, what the continuum of radiodensity based on tissue type

bone, appears white- most radiopaque

water, appears gray

fat, appears gray/black

air, appears black- most radiolucent

when given a chest radiograph, how do pneumonia, or common infections with COPD look like

whiter area

how are PA chest radiographs taken

taken in standing, radiation enters from the persons back

how are AP chest radiographs taken

for people who are bed bound, radiation enters from the front, quality if inferior