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CPT Test 2
Signs and symptoms of CP disease
75
Science
Graduate
02/19/2011

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Cards

Term
what are some causes of Dyspnea?
Definition

pulmonary or cardiac

analyze the gas transport system

mechanical factors, receptors

Term
for respiratory system dyspnea, what are the controller derangements
Definition
simulation to change rate and/or depth of breathing via efferent signals to the ventilatory muscles
Term
for respiratory system dyspnea..describe ventilatory pump derangements
Definition

maximal inspiratory effort needed to produce normal negative pleural pressure

more work than normal to move air into lungs

increased resistance to flow

end-inspiratory volume approximates TLC

Term
describe the gas exchange derangements for respiratory system dyspnea
Definition

1. destruction of diffusing membrane

2. fluid or inflammatory material at A-C membrane

Term
what are some acute causes of respiratory disease of dyspnea
Definition

bronchospasm

pulmonary embolism

pneumothorax

pulmonary infection

upper airway obstruction

Term
describe chronic causes f respiratory disease dysnpea
Definition

1. COPD

2. restrictive lung disease

Term
CV system dysnpnea is caused by inadequate 02 delivery to tissues what are some causes of this?
Definition

cardiac pump dysfunciton

1. actue myocardial ischemia

2. CHF

3. cardiac tamponade

anemia

Term
describe each number of the 1-4 dyspnea scale
Definition

1. mild: noticeable to pt, not observer

2. some difficult: noticable to observer

3. moderate difficulty: but can contiue

4. severe difficulty: pt. can't continue

Term
what are some therapeutic interventions to relieve dyspnea
Definition

1. exercise training

2. pharmacologic therapy

3. fans

4. breathing exercises/patterns

5. positioning

6. positive airway pressure (CPAP)

Term
there is non cardiac (MS, GI, chest wall, pulmonary) and cardiac chest pain
Definition
Term
describe the 4 point angina scale
Definition

1. mild, barely noticable

2. moderate, bothersome

3. moderately severe, very uncomfotable

4. most severe or intense pain ever experienced

(rating of 3 or pain that would cause pt. to stop normal activities) are reason to stop ecercise)

Term
what is claudication?
Definition

LE pain caused by ischemia of LE due to peripheral arterial occlusive disease

2. when 02 bloody supply is no adquate to meet demand of peripheral tissue

3. intermittent claduication: brought on by walking

Term
describe the 4 parts of the claduication scale
Definition

1. definite discomfort or pain, but only of intial or modest levels (established, but minimal)

2. moderate discomfort or pain from which the patient's attnetion can be diverted

3. intense pain (attention can't be diverted)

4. excuciating and unbearable pain

Term
what are some etiologies of chronic cough?
Definition

1. pulmonary disease (asthma, chronic bronchitis, bronchiectasis, respiratory infections)

2. cardiac disease (CHF, cardiac structures placing pressure on trachea/bronchi)

3. GERD

4. side effect of angiotension converting enzyme (ACE) inhibitors

Term
what does mucoid (white/clear) sputum mean?
Definition
asthma, COPD, viral pneumonia
Term
what does mucopurulent (yellow + mucoid) sputum mean?
Definition
chronic bronchitis, acute bacterial infection
Term
what does brown sputum mean?
Definition
old blood, klebsiella pneumonia
Term
what does red/bloody, hemoptysis sputum mean?
Definition
bronchiectasis, TB, lung cancer, pulmonary infarct
Term
what does pink/frothy sputum mean?
Definition
pulmonary edema
Term
  • alternating between apnea and hyperpnea
  • seen in strokes, brain injury or tumors, CHF, near death

 

Definition
Term
  • irregularly alternating periods of apnea
  • seen in brainstem dysfunction
Definition
Biot's
Term
  • deep and labored breathing with increased or normal rate
  • seen in acidosis
Definition
kussmaul's
Term
  • sustained respiratory pauses
  • seen in lesions of respiratory centers
Definition
Term
RCA supplies what?
Definition
  • RA & RV
  • AV node (90%)
  • posterior L ventricle (80-90%)

 

Term
PDA supplies:
Definition
  • posterior IV septum
  • inferior LV
Term
LCA supplies:
Definition
LA & LV
Term
LAD supplies:
Definition
Anterior LV
Term
LCx supplies:
Definition
lateral and inferior walls of LV
Term
for a MI: the more proimal the lesion, the greater extent of damage
Definition
Term
MI classification by ST segment and Q wave criteria: DESCRIBE ST ELEVATION MI (STEMI)
Definition
  • results from totally occluded artery
  • associated with full thickness (transmural) necrosis
  • marked increases in specific serum cardiac markers
  • Q wave formation
Term
MI classification by ST segment and Q wave criteria
Definition
  • diagnosed in pts with ST depression or other ST or T wave change accompanied by: rise in serum cardiac markers, subendocardial necrosis, non-Q wave MI
Term
clinical manifestation of acute MI
Definition
  • severe crushing chest pain
  • dyspnea
  • ecg changes
  • elevation of cardiac serum enzymes
  • diaphoresis
  • nausea, vomiting
  • lightheadedness, dizziness, syncope
  • apprehension or sense of impending doom
  • weakness
  • denial
Term
how is MI diagnosed
Definition

at least 2 of the followoing:

  • history of symptoms
  • ECG changes
  • rise and fall in serum cardiac enzymes
  • creatine kinase (CK) and CK-MB
  • troponin
Term
For ECG changes, describe what happens in ischemia, injury, and infarction
Definition
  • ischemia: ST segment depression or T wave inversion
  • injuty: ST segment elevation
  • infarction: Q waves
Term
what is a cardiac catheterization or angiogram used for?
Definition
  • disease
  • severity
  • guidlines for management: meds, surgery, lifestyle modifications, exercise
Term
Left ventricular heart failure(CHF)
Definition
  • LV dysfunction (systolic, diastolic or combined) leads to LV pump failure -as a result of MI, HTN, aortic valve dz; fluid accumlates back into lungs
  • reduction in renal BF and may lead to renal disease
  • reduced peripheral blood flow elads to skeletal muscle abnormalities
Term
Systolic heart failure
Definition
  • impaired contractility of ventricle
  • decrease in SV
  • decrease in EF
  • rising pulmonary pressures leads to transudation of intravascular fluid from capillaries into interstital space
  • dilated heart
  • INCREASED VENTRICULAR VOLUMES AND PRESSURES ARE REFLECTED BACKWARDS, RESULTING IN CONGESTION AND EDEMA
Term
Diastolic heart failure
Definition
  • increased ventricular stiffness (dec. compliance)
  • impaired ventricular relaxation
  • abnormal ventricular filling-can reduce CO, inc. ventricular and pulmonary vascular pressures)
  • at any volume, ventricular pressures are elevated and reflected backwards resulting in congestion and edema
Term
for clinical manifestation of CHF, what are the signs and symptoms of pulmonary congestion?
Definition
  • dyspnea, dry cough
  • orthopnea, paroxysmal nocturnal dyspnea
  • pulmonary rales
  • tachpnea
Term
for clinical manifestations of CHF what are signs and symptoms of low CO
Definition
  • hypotension
  • tachycardia
  • lightheadedness, dizziness
  • fatigue, weakness, decreased exercise tolerance
  • peripheral edema
  • S3 (third sound or ventricular gallop)
Term
Right Ventricular Heart Failure: causes
Definition
  • LV failure
  • mitral valve disease
  • pulmonary HTN
  • pulmonary embolus
  • RV infarction
  • chronic lung disease
Term
describe the pathophysiology of RV heart failure
Definition
  • increased pressure load on RV due to higher vascular pressure
  • leads to RV dilation with or without RVH
  • exentually RVEDP increases: reflected back to RA and venous system
Term
describe clinical manifestations of R heart failure
Definition
  • jugular vein distension (JVD)
  • peripheral edema
  • weight gain
  • hepatomegaly
  • ascites
  • anorexia, nausea, bloating
  • cold, pale, and cyanotic extremities
  • accentuated P2 (pulmonary component of 2nd heart sound)
Term
What are factors influencing myocardial 02 supply?
Definition

dependent on:

  • coronary BF
  • DBP
  • vasomotor tone
  • resistance to flow
  • LVEDP
  • 02 carrying capacity of blood
  • coronary artery antomy
  • diastolic filling time
  • net driving pressure
Term

describe myocardial 02 demand

Definition
  • closely related to myocardial 02 consumption (MV02)
  • determinants of myocardial 02 demand
  • HR
  • SBP
  • myocardial wall tension
  • contractility
  • LV characteristics (volume, wall thickness, diameter)
Term
Describe Rate Pressure Product (RPP)
Definition

relative changes in MV02 can be estimated by using an indirect index such as the rate pressure product

RPP=HR X SBP

Term
RCA supplies:
Definition
RA & RV, AV node (90%), Posterior LV (80-90%)
Term
PDA supplies
Definition

Post. IV sptum

portionof inferior LV

Term
LAD supplies
Definition
anterior LV
Term
LCx supplies
Definition
lateral and inferior walls of LV
Term

IRRestrictive Lung Disease

pathogenesis

 

Definition
  • decreased compliance
  • if pleural abnormalities compress the lung, normal lung expansion is inhibited
  • reduced lung volumes
    • IRV
    • ERV
    • VC,IC, TLC
    • TV decreases over time
    • RV may  be normal, increased or decreased
  • increase work of breathing
  • greater transpoulmonary pressure required to achieve normal TV
  • uneven/decreased alveolar ventilation
Term
describe hypoxic pulmonary vasoconstriction in RLD
Definition
  • pulmonary arteries constrict in response to hypoxia
  • direction blood flow away from hypoxic or poorly ventilated regions of lung and to better aerated parts of lung
  • contributes to pulmonary HTN
Term
clinical manifestation of RLD signs and symptoms
Definition
  • signs:
  • tachypnea
  • hypoxemia
  • decreased breath sounds
  • PFT: decreased lung volumes and capacities
  • possible decreased diffusing capacity
  • cor pulmonale if severe dysfunction
  • decreased exercise tolerance

symptoms:

  • dysnpnea
  • cough: dry, non-productive
Term
what are some clinical implications for PT in RLD?
Definition

physiological monitoring during PT sessions

continue monitoring

familiar with side effects of medications and how affect exercise

recognize signs and symptoms of hypoxemia and ventilatory muscle fatigue

PT interventions may benefit pts with RLD

Term

describe the signs and symptoms of hypoxemia for Pa02

  • 80-100
  • 60-80
  • 50-60
  • <50
Definition
  • 80-100:normal
  • 60-80: tachycardia, dyspnea
  • 50-60: malaise,  nausea, central cyanosis, vertigo, lightheadedness, restlessness,, poor judgement
  • <50: marked confusion, agitation, peripheral vasoconstriction, respiratory distress
Term

what are some signs and symptoms of respiratory muscle fatigue (RLD)

 

Definition
  • rapid, shallow breathing, retaining c02, hypoventilating
  • uncoordinated chest wall movements with breathing
  • increased accessory activity
  • dysnpnea
  • signs and symptoms of hypoxemia
  • signs and symptoms of c02 narcosis
Term
signs and symptoms of c02 retnetion or necrosis for (RLD)
Definition
  • hypercarbia, hypercapnea
  • headache
  • decrease mental status, confusion, drowsiness, coma
  • tachycardia
  • flushed/red skin
  • abnormal BP
  • diaphoresis
  • muscular twitching, myoclonic jerking
Term

describe the example of RLD atelectasis

definition

clinical features

medical

pt interventions

Definition
  • def: collapse of part or all of lung
  • caused by blockage of air passages (bronchioles) or pressure on the lung
  • clinical features: symptoms: dyspnea, chest pain cough
  • signs: CXR, fever, low 02 saturation
  • medical treatment: goal is to remove secretions and reexpand affected lung, aerosolized respiratory meds to open airway, remove obstruciton by bronchoscopy
  • PT treatments: deep breathing exericses (inceptive spirometry) and coughing, CPT to loosen and drain mucus, mobilize pt
Term

describe the RLD, IDIOPATHIC PULMONARY FIBROSIS, basic

Definition

chronic, primary restrictive lung disease

iflammatory process involving alevolar wall

can progress to gross distortion of lung architecture

 

Term
what are the signs of the RLD-idiopathic pulmonary fibrosis (IPF)
Definition
  • signs
  • decreased TLC, VC< FRC, RV
  • dec. DLCO
  • as disease progresses-decrease TV, inc RR
  • decrease in Pa02
  • intially hypoxemic with exercise, eventually hypoxemic at rest
  • dry rales and decrease breath sounds
  • pulmonary HTN if cap beds destroyed
Term
what are the symptoms of IPF
Definition
  • DOE, evenutall dyspnea at rest
  • repetitive non productive cough, some will have mucuous hypersecretion
  • weight loss
  • decrease appetitie
  • fatigue
  • sleep distrubrances
Term
what is the medial and PT treatment for the RLP IPF?
Definition
  • medical: coricosteroids, cytoxic drugs, supportive: smoking cessation, maintaining 02/ventilation, nutrition, lung transplant
  • PT: assessment of 02 with functional activities, exercise and pulm rehab to improve functional limitations
Term
generally describe COPD
Definition
  • obstruction to airflow
  • lung compliance increased
  • mechanical function affected
  • gas exchanging capability is affected

 

Term
signs of COPD
Definition
  • hyperinflation
  • barrel chest
  • hypoxemia
  • +/- hypercarbia
  • decrease expiratory flow rates
  • increased lung volume (TLC, RV)
  • V/Q mismatch
  • decreased diffusing capacity
  • breathing pattern: prolonged expiration
  • breathing sounds: decreased, wheezes, rales
Term
symptoms of COPD
Definition
chronic cough, sputum, DOE
Term
what are some treatment options of OPD
Definition

health ed

medications

PT interventions

pulmonary rehab

supportive measures: 02 therapy, nutrtional support

management of acute exacerbations

surgical interventions

Term
what are some non-septic and septic examples of OLD?
Definition

non-septic: asthma, emphysema, chronic bronchitis

septic: CF, bronchiectasis

Term
what are some clinical features of emphysema?
Definition

barrel chest

chest radiograph: hyperinflation, flatten diaphragms

accessory muscle use/hypertrophy

pursed lip breathing

decreased breath sounds

assumes posture with arms/upper body supported

abnormal pulmonary function test (PFT)

FRC, TLC, RV increased, FEV1 and FVC are decreased

low diffusing capacity

 

Term

treatment for emphysema: medial and PT

 

Definition

medical: stop smoking, prevent respiratory infections, meds, 02

PT: exercise, pulm rehab, education: breathing retraining, energy conservation, inspiratory muscle training, smoking cessation

Term
differences between OLD and RLD
Definition

OLD:

obstruction to airflow

increased airway resistance

increased lung volume

 

RLD:

problems with breathing mechanics

decreased compliance

reduced lung volumes

Term
how does FEV1/FVC used to determine obstruction and restriction
Definition

FEV/FVC: <70% OBSTRUCTION

Look @ FEV1 (% predicted for degree of obstruction)

assess FVC for restrictive component (FVC<80%)

if FEV1/FVC normal, look at FVC

if FVC normal (FEV1/FVC normal): no obstruction or restriction

if FVC is reduced: restriction

look at FVC (%predicted) for degree of restriction

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