Pulmonary Screening

What are signs and symptoms of pulmonary disorders?

persistent cough, mucous sputum, SOB, cyanosis, pain patters

What does clear sputum indicate?

nonspecific, airway irritation

What does yellow/green sputum indicate?

infection

What does rust colored sputum indicate?

pneumonia

What is hemoptysis

spitting up bloodz

What might hemoptysis indicate?

infection, inflammation, abscess, tumor, infarction

What does dyspnea indicate?

hypoxemia or fear/anxiety

What is orthopnea?

dyspnea while laying dow (caused by redistribution of body water)

What is cyanosis?

bluish color of skin, nailbed, and mucous membranes dxue to decreased O2 sats

What is clubbing?

thickening and widening of the distal phalanges of the fingers and toes resulting in a loss of space between nail and nail bed

What are the most common pain referral sites for the pulmonary system?

chest, ribs, upper trap, shoulder, thoracic spine

True or false: pulmonary pain usually increases with inspiration movements such as laughing, coughing, sneezing, or deep breathing

true

What are some exposures/irritants that can lead to pulmonary disorders?

airbone pollutants, smoking

What is a pack year and why is it important?

packs per day x years smoked. determines “how much” a person smokes

True or false: the cardinal sign of acidosis is a high respiration rate

false: it is low respiration rate

Why does low respiration rate result in acidosis?

too much co2

Why does high respiration rate result in alkalosis?

not enough co2 = less acid, pH goes up

Respiratory acidosis has symptoms from the CNS, heart, MSK, and digestive systems. Name one from each

confusion, SOB, arrhythmia, weakness, nausea

Respiratory alkalosis has symptoms from the CNS, peripheral NS, MSK, and digestive system. Name one from each

stupor/confusion, numbness/tingling in face/hands/feet, twitching, nausea

What is COPD?

tissue instability due to inflammation

Is COPD when air cannot be inhaled or exhaled?

exhaled

True or false: COPD often goes undiagnosed in adults

true: 50% of adults have no idea they have COPD, they just feel out of shape

Is COPD a progressive or static condition?

progressive, it can get worse

What is acute bronchitis?

short term inflammation of the trachea and bronchi due to viral illness or chemical irritants (smoke, fumes, gas)

What are some symptoms of acute bronchitis?

`mild fever for 1-3 days, malaise, back/muscle pain, sore throat, cough w/ sputum, wheezing

When does acute bronchitis become concerning?

fever above 100.4, sx lasting greater than 3 weeks, or repeated episodes

True or false: a cough from acute bronchitis can last more than 3 weeks

false: this is no longer acute bronchitis and should be evaluated

What is chronic bronchitis?

mucous hypersecretion that obstructs the airways and leads to hypertrophied lung tissue

What is the criteria for chronic bronchitis?

persistent/productive cough lasting 3 months per year over 2 years with no other precipitating disease

True or false: chronic bronchitis is often accompanied with a fever

false: this is a red flag

What is emphysema?

type of COPD where the walls of alveolar ducts lose elastic tension and pulmonary capillaries are destroyed

What is the PT implication for emphysema?

monitor respiratory rate and O2 sats during exercise

Who is most likely to develop emphysema?

smokers, especially with a history of chronic bronchitis

Why can’t you give someone with emphysema more oxygen?

too much oxygen will depress the respiratory drive (aka there needs to be enough CO2 in the system to drive the need to breathe)

What is the MOST important factor in treating emphysema?

smoking cessation

Why might someone with emphysema breathe out with pursed lips?

increases resistance which maintains intrabronchial pressure and improves gas exchange

Barrel chest is a sign/symptom of what pulmonary disorder?

emphysema

What is asthma

hyperreaction to irritants that causes inflammation of the airway and bronchus restriction

True or false: asthma is irreversible

false: it is essentially the only fully reversible pulmonary disorder

What causes asthma?

largely environmental and genetic factors

PT implication for patients with asthma?

know when they’ve last taken their inhaler (can increase heart rate), ensure it is nearby during exercise, do not push these patients

What is status asthmaticus?

severe asthma where air is unable to get out, spiking pulmonary BP, leading to cor pulmonale

What is cor pulmonale?

follows status asthamticus, leads to hypertrophy and overload of the right ventricle and it begins to fail.

Is asthma the only condition in which cor pulmonale occurs?

no, it can occur with pulmonary embolism and CHF

What are some signs and symptoms of cor pulmonale?

peripheral bilateral edema, chronic cough, central chest pain, exertional/rest dyspnea, distended neck veins, fatigue, wheezing

Pneumonia can be caused by what 3 forms of infection?

viral, bacterial, fungal

Influenza is often a precursor to?

pneumonia

What are the 3 main types of pneumonia (how it is acquired)?

hospital, ventilator associated, or community acquired

Why is the hospital a common site for pneumonia development?

hospitalization often leaves patients bedridden, leading to decreased mobility and normal secretions begin to pool in the airways and facilitates bacterial growth

What are the risk factors for hospital acquired pneumonia?

COPD, over 70, prolonged hospitalization, malnutrition, serious comorbidities, impaired consciousness

True or false: older clients with pneumonia often present with fever and respiratory symptoms

false: they will often present with confusion/altered mental status due to the changes in temperature regulation and decreased likelihood to “spike” a fever

What type of infection is TB?

bacterial infection

How is TB spread?

via inhalation

is TB a obstructive or restrictive lung disorder?

both, often starts out as obstructive, but with scarring can become restrictive in nature

Why are healthcare workers (PTs) at a higher risk for TB?

centralized ventilation of hospitals or facilities

What people are at a higher risk of developing TB?

healthcare workers, older adults, overcrowded housing, prisoners, immigrants from TB areas, immunocompromised people, alcoholics

Signs and symptoms of TB

fatigue, malaise, anorexia, weight loss, low grade fever, night sweats, frequent productive cough, dull chest pain, dyspnea

What is systemic sclerosis/scleroderma?

restrictive lung disease of unknown etiologic origin characterized by the inflammation and fibrosis of many organs, especially the skin and lungs

symptoms of scleroderma/systemic sclerosis?

dyspnea on exertion, nonproductive cough, peripheral edema, orthopnea, paroxysmal nocturnal dyspnea (CHF) hemoptysis

What is bronchogenic carcinoma?

lung cancer

What are some risk factors for lung cancer?

age >50, first/secondhand smoker, hx of cancer, environmental exposure, low fiber consumption, family hx, lung disease

What are some red flag symptoms that would make you suspect lung cancer?

high risk factor prevalence, shark shoulder/chest/scapular/rib/thoracic/neck pain that WORSENS with inspiration, hemoptysis, sudden unexplained weight loss, pulmonary symptoms

What is the difference between lung cancer and a pancoast tumor?

pancoast tumor is a cancerous mass on the apical of the lung specifically, whereas general lung cancer can occur anywhere

True or false: a pancoast tumor symptoms are reproduced with neck movements

false: it will not be reproduced because it doesn’t stem from the neck

What are the vitals warning signs of a pulmonary embolism?

HR increases, BP and O2 sats drop

signs and symptoms of a pulmonary embolism

dyspnea, pleuritic chest pain, diffuse chest discomfort, persistent cough, hemoptysis, apprehension/anxiety, tachypnea/cardia

What is a normal blood pH of the body?

7.35-7.45

When blood pH is less than 7.35, the body is in….

respiratory acidosis

When blood pH is greater than 7.45, the body is in….

respiratory alkalosis

What is the pathophysiology of cystic fibrosis?

accumulation of salt in the cell lining of lungs and digestive tissues causes mucous to become thick and sticky, obstructing ducts in the lungs, liver, pancreas

Why does the increased thickness/stickiness of mucous cause issues with CF?

obstructs the bronchioles and traps air, leading to infection and increased mucous production and bronchial obstruction, which ends up in a neverending cycle that causes infection and inflammation

Signs and symptoms of CF?

tachypnea, sustained chronic cough with mucous, barrel chest, cyanosis, digital clubbing, exertional dyspnea

What is a pneumothorax?

free air in the pleural cavity that occurs secondary to pulmonary disease or trauma

When can a pneumothorax occur?

more common after surgery or accidents, but can be from scuba diving or spontaneously with exercise (rare)

signs and symptoms of a pneumothorax?

dyspnea, change in respiratory movements ipsilaterally, sudden sharp chest pain, weak and rapid pulse < 100bpm, drop in BP, sitting upright is most comfortable