pulmonary diagnostic tests and medications

what do you look for in a chart review?

current medical problems (diagnosis and date of event, hospital course), past med and surg history, diagnostic tests, home and or current medications, lab tests

what does a chest x-ray do?

provide static images of the lungs and surrounding tissues

what are the four x-ray views?

AP, PA, right and left lateral/side, oblique

what do normal lungs look like on an xray?

clear, and black which means they are airfilled.

what do abnormal lung fields look like on an xray?

white patches, consolidation (tumor/pneumonia), collapse

what does normal heart size look like on x-ray?

<50 % chest width

what does an abnormal heart size look like on an xray?

enlarged, possibly rounded

what does a normal diaphragm look like on an xray?

smooth, curved

what does an abnormal diaphragm look like on an xray

flattened (has COPD), obscured (effusion)

what do normal bones/soft tissues look like on an xray?

aligned, no masses

what do abnormal bones and soft tissues look like on an xray?

fractures, masses, displaced structures

what does a CT scan of the chest do?

provides images of the lungs, vascular structures and the heart

can show the severity of emphysema

exposed the patient to radiation (much more than xray)

Spiral CTs can show lung tumors

what does a CT pulmonary angiogram do?

it diagnoses a pulmonary embolism

you inject dye into the body which makes the arteries appear bright and white

what is a V/Q (ventilation profusion) scan?

examines airflow and blood flow in the lungs

often used to diagnose a PE if one is allergic to the dye or has kidney failure

requires injection of a radioactive tracer and inhalation of radioactive gas

what is the gold standard for diagnosing pulmonary embolism?

CT pulmonary angiogram

what does a chest MRI do?

evaluates blood flow, shows lymph nodes and blood vessels

detects aneurysms, blood clots and tumors in the chest

uses MRI so NO RADIATION

can use dye or not

takes ab 30 min

more specific than CT

what does thoracic ultrasound do?

a bedside tool that is able to diagnose traumatic (PTX or rib fracture), and non-traumatic (pleural effusions, pneumonia, and pulmonary edema)

what does a bronchoscopy do?

it allows direct visualization of trachea and major subdivisions

able to remove secretions and obtain tissue biopsy samples

what is a brief overview of pulmonary function tests?

measures lung volume capacity, rates of flow and gas exchange

what is arterial blood gas (ABG)?

method to determine how well the lungs are able to move O2 into the blood and remove CO2 from the blood

normal values:

pH: 7.35 -100 mmHg

PO2: 75-100 mmHg

PCO2: 35-45 mmHg

HCO3: 22-26 meq/L

What do SABAs do?

rapid relief, short duration of 4-6 hours

take before exercise to prevent exercise induced asthma

increases airflow by opening airways, and decreases bronchospasms

what is albuterol (proventil/ventolin)?

a SABA, taken before exercise to prevent exercise induced asthma, rapid relief!!

what is a LABA?

long term maintenance for asthma, COPD and chronic bronchities

it lasts 12-24 hours to relax the airway, and increase airflow

what are salmeterol (serevent) and formoterol (foradil)

LABA!!

what are common side effects of LABA and SABA?

• shakiness/tremors

• nervous

• headache

• hyperactivity

• tachycardia

  • difficulty sleeping

what are PT implications for those taking SABA or LABA?

• take before exercise for exercise induced asthma

• inhaler should be present during activity

• larger bouts of exercise, less SOB

do anticholinergics work on the parsympathetic or sympathetic?

parasympathetic

do beta 2 antagonists work on the parasympathetic or sympathetic?

sympathetic

what are anticholinergics?

they relax the airways and help decrease excess mucus production

take 1-4x a day

what is a SAMA?

• antocholinergic

• used for COPD

• Ipratropium (atrovent)

what are LAMAs ?

• anticholinergics

• used for daily maintenance for COPD

• tiotropium (spiriva) used for COPD only

what are side effects for SAMA and LAMAs?

• dry throat, eyes and nose

• bitter taste

• nausea and vomiting

• if i eyes it can lead to blurred vision

what are PT implications for SAMAs and LAMAs?

• take daily to reduce COPD exacerbations

• longer relief

what are corticosteroid inhalers?

• not for bhroncodilation

• reduce swelling/inflammation of the airways

• help prevent the symptoms of asthma

what are the two corticosteroid inhalers we need to know?

• budesonide (pulmicort)

• fluticasone (flovent)

  • BOTH used to treat asthma and chronic disease

what are common side effects of corticosteroid inhalers?

• dysphonia: weak voice muscles leads to an impaired voice (50-60% of users)

• wash mouth or ORAL THRUSH

what are PT implications for corticosteroid inhalers?

• take to tolerate treament

• decrease inflammation in airways

what are the combination drugs (aerosol therapy)?

• combivent and duoneb (SABA and anticholinergic)

• advair: (LABA and glucocorticoid)

• Symbicort: LABA and glucocorticoid)

what ar the three types of inhalers to know?

metered dose inhaler, dry powder inhaler, nebulizer (more severe or kids)

what are expectorants?

• brings moisture into respiratory track to thin mucus

  • treats the common cold

    • guaifenesin (OTC)

      • mucinex DM or robitussin chest congestion

what are mucolytic agents?

• treats CF and bronchitis

  • dornase alfa (pulmozyme)

  • acetylcysteine (mucomyst)

what are side effects of expectorants and mucolytic agents?

• nausea and vomiting

• diarhea

• runny nose

• throat irritation

what are PT implications of expectorants and mucolytic agents?

• help with secretion clearance

• leads to better oxygenation

• take prior to chest PT!!

what is an antitussive?

• act on the CNA or PNS to suppress the cough reflex

• often used for the management of a dry, unproductive cough

what are the common types of antitussives?

• robitussin

• tessalon perles

• codeine

THEY ALL SUPPRESS COUGH

SIDE EFFECTS VERY

DONT DO PT

what are leukotriene modifiers?

• helps to block chemicals that contribute to asthma and allergy symptoms to reduce inflammation and bronchoconstriction

what are the three leukotriene modifiers?

• montelukast (singulair)

• zafirlykast (accolate)

• zileuton (zyflo)

what are the side effects of (montelukast (singulair)?

could cause depression, aggression or suicidal thoughts

what are the side effects of leukotriene modifers?

headache, stomach pain, flu symptoms

what are PT implications for leukotriene modifiers?

• take as prescribed

• keeps airways open during exercise

• decrease inflammation in airways

what are oral corticosteroid tablets?

• potent anti-inflammatory agents (systemic) that are used to treat COPD exacerbations or asthma flare ups and interstitial lung disease

• used to treat rejection for heart and lung transplantation (immune suppression)

what two oral corticosteroid tablets should we know?

prednisone and methylprednisolone (medrol)

what are the side effects of prednisone and methylprednisolone oral corticosteroid tablets?

• weight gain

• masks hyperglycemia

• high BP

• cataracts

• lose bone density

• cause proximal weakness ( quad and glutes, makes sit <> stands hard)

what are PT implications for oral corticosteroid tablets?

• start resistance training

• monitor blood sugars

what are antibiotics for pulmonary?

used to treat pulmonary infections and COPD exacerbations

what is a ‘rescue pack”?

short course of steroids and antibiotics issued in advance of people with COPD

they prevent hospitalization

what is the purpose of supplemental oxygen?

• improve oxygenation

• prvent hypoxemia

• support oxygen delivery to the tissues

• oxygen is a medication and requires a prescription

• dose is determined by flow rate

• refer to MD orders but typically the goal is to keep SpO2 88-90% o (COPD) or above 95% for non COPD depending on underlying medical dx

what are side effects of supplemental oxygen?

dry nasal passages, nosebleeds, skin irritation from masks/tubes, morning headaches

what happens with too little oxygen?

decreased exercise tolerance, impaired judgment and cognition

what happens with too much oxygen?

damage lung tissue, and can cause patients with chronic retention of CO2 to slow their breathing

what are PT implications for supplemental oxygen?

pulse ox and O2 rate are so important