Studied by 2 people
Treating Impaired Ventilation
remove obstructions
restore integrity of chest wall 7 LUNGS
decrease inflammation & mucus
open & maintain integrity of airway
provide O2
control infection process
use mechanical ventilation if needed
What is Pneumonia?
causes inflammation of the lungs
occurs commonly in the bronchioles, interstitial lung tissue & alveoli
products of inflammation accumulate & cause consolidation
infectious process
droplet spread
Pneumonia Clinical Mani’s
sudden onset fever
sputum production
tachypnea
crackles in lungs
chills
loss of appetite
tachycardia
fatigue
dyspnea
pleuritic pain (consolidation impacts lung’s ability to move)
Diagnosing Pneumonia
HX & Physical Exam
CT scan
ABG
CBC
Gram stain
Pulse ox
Chest x-ray
culture & sensitivity
Pneumonia Treatment
restore optimal ventilation & diffusion
identify pathogen & target w/ proper pharm treatment
supplemental O2
incentive spirometry
What is Emphysema?
Irreversible enlargement of the air spaces beyond terminal bronchioles
destruction of the alveolar walls
obstruction of airflow
chronic smoking is most common implicated
Emphysema Clinical Mani’s
persistent cough
dyspnea
wheezing
pursed lip breathing
Diagnosing Emphysema?
HX & Physical exam
Chest X-ray
pulmonary function tests
hypercapnia/hypoxemia
Emphysema Treatment
maintain optimal lung function in order to allow individual to preform ADL’s
What is Chronic Bronchitis?
persistent/productive cough lasting ≥3 weeks for 2 or more consecutive years
What results from Chronic Bronchitis?
chronic inflammation & edema of airways
hyperplasia of bronchial mucous glands & smooth muscle
destruction of cilia
squamous cell metaplasia
bronchial wall thickening → fibrosis development
Chronic Bronchitis Clinical Mani’s
productive cough
dyspnea
hypoxemia & hypercapnia
adventitious lung sounds
cyanosis
purulent sputum
Diagnosing Chronic Bronchitis
HX & Physical Exam
ABG
Pulmonary function tests
Pulse Ox
Sputum analysis
Chronic Bronchitis Treatment
STOP SMOKING
Pulmonary Rehabilitation
Pharmacologic Therapy
bronchodilators
steroidal anti-inflammatory drugs
Mucolytic agents
Supplemental O2
What is Asthma?
airway obstructions due to:
bronchial hyper-responsiveness
chronic inflammation
broncho-construction
excess mucous production
Asthma Clinical Mani’s
wheezing
tachypnea/dyspnea
coughing
chest tightness
anxiety
excessive sputum production
Asthma Treatment
Monitor lung function
control environmental triggers
Pharm Treatment
PT education
Cystic Fibrosis (CF)
Autosomal recessive disorder of electrolyte & water transport
mutation of the CF gene
more prone to infection
excessive mucous production
Where does Cystic Fibrosis affect
the epithelial lining of
respiratory/digestive/reproductive
Cystic Fibrosis Clinical Mani’s
Respiratory
infections
chronic cough
purulent sputum
tachypnea
wheezing/crackles
hemoptysis
dyspnea on exertion
chest pain
Cystic Fibrosis Clinical Mani’s
GI
intestinal obstruction
large greasy stool
abdominal pain
Diagnosing Cystic Fibrosis
HX & Physical Exam
Sweat test
Genetic testing
Chest X-ray
Sputum analysis
Cystic Fibrosis Treatment
Respiratory
Chest Physiotherapy (PT)
Pharmacological agents
Lung transplant
Cystic Fibrosis Treatment
GI
optimal nutrition
pancreatic enzymes
What is Acute Respiratory Distress Syndrome
progression from lung injury to respiratory distress within 24-48hrs
Acute Respiratory Distress Syndrome Clinical Mani’s
tachypnea
dyspnea
retractions
crackles
restlessness
anxiety
PT gets rly sick rly fast
Acute Respiratory Distress Syndrome (ARDS) Treatment
remove causative factors
administer 100% O2
Mechanical ventilation
What is Ventilation?
breathing in & out (acquiring O2 & removing CO2 from blood)
neuronal impulse are directed by lung receptors
What is Impaired Ventilation?
a problem of blocking airflow in & out of the lungs
What are the two major mechanism implicated w/ Impaired Ventilation?
compression/narrowing of the airway (ex: asthma)
disruption of the neuronal transmissions needed to stimulate breathing (ex: decreased LOC)
What are the 2 possible scenarios of Impaired Ventilation-Perfusion?
Lung is ventilated, but NOT perfused
Lung is perfused but NOT ventilated
What is the goal of Altered Ventilation
acquire O2 needed for cellular metabolism
remove CO2 needed to maintain pH & optimal cell function
What is Ventilation Altered by?
obstruction/restriction of airflow
inhibition of neuronal stimulation & mechanics of breathing
which will lead to blocked airflow
hypoxemia, hypoxia, hypercapnia
acidosis
CELL DEATH!!!!
What does blood do in the body? & what is it responsible for?
primary transport system
involved in all pathologic activities of all organs
responsible for O2 transport
responsible for carrying CO2 away from cells
What is Hematopoiesis?
BLOOD CELL PRODUCTION
occurs in liver & spleen of fetus
occurs in bone marrow after birth
2-stage process involving Miotic division (proliferation) & maturation (differentiation)
What happens when the number of circulating cells decrease?
blood cell have stem cells that undergo mitosis when stimulated by a specific biochemical agent
Pluripotential stem cells mature to…
differentaited RBCs
neutrophils
eosinophils
basophils
monocytes
PLTs
What causes Erythropoiesis?
decrease of hemoglobin levels = decreased tissue oxygen tension in the kidney
in response to hypoxia erythropoietin is secreted
bone marrow is stimulated to produce more cells
What is Erythropoiesis?
DEVELOPMENT of RBCs
stimulated by erythropoietin (hormone in kidney)
cell changes from a large nucleated cell to a reticulocyte b4 maturing to an erythrocyte
What is Hemoglobin?
O2 carrying protein in mature RBCs
formed immature Red Cells (iron/proteins are required)
Vitamins (B12, folic acid, B6, Vit E)
Minerals
Oxyhemoglobin
Mild Anemia
usually no clinical symptoms
some elderly Pt’s w/ CV disease may have symptoms
Mild to Moderate Anemia
fatigue
generalized weakness
tachycardia
Moderate to Severe Anemia
tachypnea
tachycardia
headache
lightheadedness
BP drops w/position changes
tinnitus
Gas Transport: Oxygen
97% of O2 in the blood is REVERSIBLY bound to hgb for transport in the blood
SaO2 (95-100%)
SvO2 (60-80%)
PaO2 (80-100 mm/Hg)
PvO2 (30-45 mm/Hg)
What is the affinity of hemoglobin for O2 is affected by
temp (ex: FEVER: tissue needs more O2→body will alter affinity/pressure → hgb will let go of O2 & go to tissue)
acid-base balance
CO2
Anemia Clinical Mani’s
reduced O2 carrying capacity ( not enough RBC)
tissue hypoxia (not enough O2 circulating)
Compensatory Mechanism Activated
inc. pulmonary function (inc. RR)
inc. cardiac function (inc. HR & CO)
decreased affinity of hgb in tissues
increased erythropoietin activity
selective tissue perfusion provides shunting to vital organs
What is Anemia?
RBC deficit
tissue hypoxia related to low O2 carrying capacity of RBCs
What is Relative Anemia?
Normal Total RBCs plasma volume is decreased
What is Absolute Anemia?
Decreased in the # of RBCs (dec. production = inc. destruction)
What is Polycythemia?
INCREASE IN RBCs
increase in blood volume & viscosity
Anemia of Chronic Renal Failure
impaired erythropoietin production
dec. RBC & Low hgb/hct
deformed RBCs
Leukocyte count is NORMAL
What is MCV?
mean corpuscular volume
avg size of RBCs
What is MCH?
mean corpuscular hemoglobin
avg amt of hgb per RBC
What is MCHC?
mean corpuscular hemoglobin concentration
avg. amt of ngb in a single RBC
What are Reticulocytes?
IMMATURE RBCs
Hbg producing factory!!!
Mature in 24-48hrs
once mature it becomes am erythrocytes
What does it mean when you have an increased reticulocyte count?
this may indicate anemia due to RBCs being destroyed earlier than normal
Note 
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