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Pulm Lecture 5/6
Pulm Lecture adn Lab 5/6
148
Medical
Graduate
11/29/2015

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Term
sputum indication: purulent (2)
Definition
clear colored
sign of bronchitis
Term
sputum indication: blood tinged (2)
Definition
TB
Flu
Term
sputum indication: Foul smelling (3)
Definition
infection
bronchiecsatis
acute respiratory infection
Term
sputum indication: brassy (2)
Definition
aortic aneurysm
golden/bronze colored
Term
sputum indication: frothy (3)
Definition
pink or yellow
light and bubbly
sign of CHF
Term
sputum indication: hemoptysis (2)
Definition
coughing up blood
pulmonary bloeed
Term
a good determinant of regional ventilation
Definition
rib excursion
Term
vibration of the voice or from secretions or movement of air in the lungs
Definition
fremitus
Term
what could hyporesonant fremitus be caused by (5)
Definition
COPD
fluid
collapse
hyperinflation
can't get air in
Term
why could hyperresonant fremitus be caused by (2)
Definition
echo of air moving in lung
consolidated pneumonia
Term
flat mediate percussion sound (2)
Definition
over viscera/organ, hyporesonant
Term
dull mediate percussion sound (2)
Definition
muffled/filtered d/t increased density
hyporesonant
Term
hyperresonant mediate percussion sound
Definition
amplified, echoes, means that there is air under there. can be d/t overinflation, lung is completely open, or there is air in teh open space
Term
how should the pt breathe during auscultations
Definition
through their mouth not their nose
Term
fremitus vs percussion: hyporesonance with air/overinflation
Definition
fremitus
Term
fremitus vs percussion: hyperresonance with air/overinflation
Definition
percussion
Term
fremitus vs percussion: hyporesonance with fluid
Definition
both
Term
fremitus vs percussion: hyperesonance with incresaed density
Definition
fremitus
Term
fremitus vs percussion: hyporesonance with decreased intensity
Definition
percussion
Term
adventitia sounds: discontinuous sounds like short bursts of poppping
Definition
rales/crackles
Term
adventitia sounds: fine crackles heard at end of inspiration suggests suddening opening of small airways like in what conditiosn (3)
Definition
CHF
Pulmonary fibrosis
Atelacstasis
Term
adventitia sounds: high pitched moist crackles occuring throughout breathing suggest fluid like in what (3) conditions
Definition
respiratory infection
infiltrates
pneumonia
Term
adventitia sounds: musical continous notes which may hrard during any phase of the breathing cycle
Definition
wheezes
Term
adventitia sounds: wheezes are indicative of what
Definition
airway obstruction d/t either mucous or bronchoconstriction
Term
adventitia sounds: wheezes are indicative of what
Definition
airway obstruction d/t either mucous or bronchoconstriction
Term
adventitia sounds: wheezes could mean what (5)
Definition
lesion/mass
foreign body
compression of airway (enlarged node or other)
inflammation/edema
increased secretions
Term
adventitia sounds: phonation is is indicative of what
Definition
consolidation
Term
adventitia sounds: 2 parts of phonation
Definition
Egophony
Bronchophony
Term
adventitia sounds: what is egophoy
Definition
E comes out sounding like A
Term
adventitia sounds: what is bronchophony
Definition
99 sound is amplified
Term
4 types of ventilator support
Definition
control mode
assist control mode
assist
ventilator support mode
Term
ventilator mode in which the ventilator maintains all of the respiratory functions without patient participation
Definition
control mode
Term
what does control mode of the ventilator control
Definition
rate
depth
pressure
Term
condition of the pt if they are on a ventilator control mode
Definition
sedate or pharmacologically paralyzed
Term
2 modes of assist control modes
Definition
IMV - Intermittent Mandatory
SIMV - Synchronized Intermittent Mandatory Ventilation
Term
Benefit of assist control modes over control modes
Definition
machine has a set rate but is also responsibe to patient initiation
Term
Assist Control Mode: Allows for what
Definition
the pt to breathe with voluntary control but with a set rate
Term
Assist Control Mode: also provides what
Definition
controlled ventilations
Term
Assist Control Mode: IMV mode: regardless of pt's spontaneous efforts what is delivered
Definition
mandatory breath is delivered at a preset rate
Term
Assist Control Mode: which mode does the pt have more control IMV or SIMV
Definition
SIMV
Term
Assist Control Mode: difference between the mandatory breath between IMV and SIMV
Definition
IMV does not count spontaneous effort to RR
SIMV counts spontaneous effort to RR
Term
Assist Control Mode: if the pt breathes with the SIMV, what does this mode also ensure
Definition
that the pt is getting enough volume during their inspiration
Term
Difference between assist mode and assist control mode
Definition
does not have a set rate
Term
Assist mode abbreviation
Definition
PSV mode - Pressure Support Ventilation
Term
Assist mode: what is the role of PSV
Definition
pt initiates breath, ventilator makes sure they are getting enough volume. pt generated = 10 mL, volume requirement = 25, ventilator will provide 15 ml
Term
4 Ventilator Support Modes
Definition
PEEP- Positive End-Expiratory Pressure
IPPB - Intermittent Positive Pressure Breathing
Inspiratory Hold
CPAP - Continuous Positive Airway Pressure
Term
function of PEEP
Definition
increase pressure to maintain open airways so that greater gas exchange can occur and ensure the air can get out. timed with expiration
Term
PEEP is good for what lung pathology category
Definition
obstructive pathoglies
Term
purpose of IPPB
Definition
intermittently interjects postitive pressure into the tubing to provide sligh increase in time for gas exchange
Term
purpose of inspiratory hold
Definition
triggers a hold at end of inspiration to maintain ventilation and gas exchnage and even ventilation
Term
purpose of CPAP
Definition
maintian slightly higher than atmospheric pressure to prevent early airway closure
Term
CPAP is good for what specific pathology
Definition
emphysema
Term
purpose of an incentive spirometer
Definition
visual feedback to assist in deep breathing exercises
give quantitative goal for increasing inspiration
Term
how can O2 be delivered (2)
Definition
mask
cannula
Term
types of masks include (3)
Definition
aerosol
venturi/veni/VM
Face tent
Term
O2 mask which receives meds with O2 a few tiems a day
Definition
aerosol
Term
O2 mask that is most common
Definition
venturi/veni/VM
Term
pt populations for a face tent (4)
Definition
very sick pt's
negative pressure system
pediatric pts
mask won't stay on otherwise
Term
purpose of mask whiskers
Definition
to maximize high concentration O2
Term
what needs to be added when supplemental O2 is being used
Definition
humidity
Term
importance of humidifyig O2 masks
Definition
lack of moisture prevents body from absorbing O2 as well
Term
percentage of O2 to be considered high flow
Definition
>40%
Term
atmospheric O2 content
Definition
21%
Term
use of high flow O2 is considered for what individuals
Definition
acute respiratory distress
Term
how is high flow O2 delivered
Definition
through intubation when other assist is anticipated or required
Term
What should TV be for use of Low flow O2
Definition
300-700mL
Term
What should the RR be for use of low flow O2
Definition
<=25
Term
Low flow rates are <= to what
Definition
4L/min
Term
Low flow rate O2 if L/Min = 1
Definition
24% O2
Term
Low flow rate O2 if L/Min = 2
Definition
28% O2
Term
Low flow rate O2 if L/Min = 3
Definition
32% O2
Term
Low flow rate O2 if L/Min = 4
Definition
36% O2
Term
nasal cannula are used to deliver what volume of O2
Definition
less than 6L
Term
ventrui/venti mask (VM) is used for what percnetage of O2
Definition
25-30% of O2
Term
ventilators used for pt's with sleep apnea (2)
Definition
BiPAP and CPAP
Term
ventilator used with chronic ventialroy dependent pt's
Definition
CPAP
Term
a tracheostomy collar would be used to deliver what % of O2
Definition
25-60%
Term
when is a re-breather mask used
Definition
acute distress
Term
purpose of the re-breather mask
Definition
pt exhales into a bag so that the new air and bag air is rebreathed and the pt is inhaling both O2 and CO2 to prevent a respiratory alkolytic state
Term
why are pt's with COPD a relative contraindicaiton for high flow O2
Definition
pt is overinflated already, will overinflate more, will throw off gas distribution
Term
why would a pt who is alert and in need of ventilatory assistance tolerate SIMV best
Definition
allows them to breathe on their own while only getting support from the SIMV
Term
why is an occasional sign programmed into most control mode protocols
Definition
increases the thoracic mobility, gives a nice break to the gas diffusion rates, allow more CO2 out
Term
why would ventilatory support which increases O2 delivery pressures and PEEP be therapeutic for a pt with long standing COPD complicated by a respiratory infection and CHF
Definition
more fluid d/t infeciton/CHF so bad O2 exchange. there is time for CO2/O2 exchanges, reestablishes pressures from CO2 and O2
Term
emphysema: inspection findings (3)
Definition
increased anteroposterior diamter
use of accessory mm
thin individual
Term
emphysema: palpation/fremitus
Definition
decreased tactile fremitus
Term
emphysema: percussion findings (2)
Definition
increased resonance
decreased excursion of diaphragm
Term
emphysema: auscultatoin findings (2)
Definition
decreased lung sounds
decreased vocal fremitus
Term
chronic bronchitis: inspection findgins (2)
Definition
possible cyanosis
short, stocky individual
Term
chronic bronchitis: palpation
Definition
often normal
Term
chronic bronchitis: percussion
Definition
often normal
Term
chronic bronchitis: auscultation
Definition
early crackles
Term
pneumonia: inspection findings
Definition
possible cyanosis
Term
pulmonary embolism: inspection findings (2)
Definition
sudden onset of dyspnea
chest pain
Term
pneumothorax: inspection findings
Definition
rapid onset
Term
pleural effusion: inspection findings
Definition
may be no outward clinical sign
Term
atelectasis: inspection findings
Definition
often no outward clinical signs
Term
penumonia palpation findigns (2)
Definition
increased tactile fremitus
splinting on affected side
Term
pneumonia percussion
Definition
dull
Term
pneumonia auscultations (2)
Definition
late crackles
bronchial breath sounds
Term
pulmonary embolism palpation
Definition
usually normal
Term
pulmonary embolism percussion
Definition
usually normal
Term
pulmonary embolism auscultation
Definition
usually normal
Term
pneumothorax: inspection
Definition
rapid onset
Term
pneumothorax: palpation (3)
Definition
absent fremitus
trachea may be shifted to other side
may have decreased chest wall excursion on affected side
Term
pneumothorax: percussion
Definition
hyperresonant
Term
pneumothorax: auscultation
Definition
absent breath sounds
Term
pleural effusion: palpation (3)
Definition
decreased fremitus
trachea shifted to other side
decreased chest wall excursion on affected side
Term
pleural effusion: percussion
Definition
dullness
Term
pleural effusion: auscultation
Definition
absent breath sounds
Term
atelectasis: palpation (3)
Definition
decreased fremitus
trachea shifted to same side
decreased chest wall excursion on affected side
Term
atelectasis: percussion
Definition
dullness
Term
atelectasis: auscultation
Definition
absent breath sounds
Term
issues to be addressed in the SCI acute phase (3)
Definition
wean off ventilator
improve/maintain respiratory status
improve inspiratory capacity
Term
Intervention during SCI acute phase: maintain
Definition
chest mobility and compliance as the pt may not be moving and breathing as deep as they used to
Term
Intervention during SCI acute phase: strengthen
Definition
accessory mm and diaphragm as much as possible
Term
Intervention during SCI acute phase: re-train
Definition
diaphragm
anything above mid-thoracic level will affect the diaphragm
Term
2 most common reasons for death in SCI pt's
Definition
lung infections
wound infections
Term
Intervention during SCI acute phase: 4 other options
Definition
corset/pneumobelt if needed
postural drainage with percussion and vibration
assisted coughing
education
Term
SCI Subacute/Outptphase: issues to be addressed (3)
Definition
continue to strengthen accessory mm and diaphragm
improve ventilatory capacity as much as possible
posture and balance control
Term
SCI Subacute/Outptphase interventions: exercises for what (2)
Definition
posture and balance
Term
SCI Subacute/Outptphase interventions: strengthen
Definition
accessory mm
trunk/core mm
Term
SCI Subacute/Outptphase interventions: how to strengthen the accessory mm (3)
Definition
P flex
resistive breathing
scoop technique
Term
SCI Subacute/Outptphase interventions: 2 other interventions
Definition
assisted coughing if still needed
pt and family education
Term
How does lung cancer lead to pulmonary edema/pleural effusion
Definition
as WBC count goes up, other inflammatory agents show up causing inflammation which results in pulmonary edema/effusion
Term
leading cause of death from cancer for men and women
Definition
lung cancer
Term
lung cancer will cause these 3 impairemtns
Definition
ventilation
compliance
other inflammation (pulmonary edema/effusion)
Term
Lung cancer interventions (3)
Definition
remove mass/tumor if there is one
surgery or meds to attempt to maintain V/Q
fucking quit smoking
Term
leading cause of lung cancer
Definition
smoking
Term
how do all cancers impact the cardiopulmonary system
Definition
increased demand on heart and lungs due to body fighting the disease
Term
how do some cancers affect the circulatory system
Definition
some cancers affect RBC, plateletes, iron
Term
which cancers will affect the body's metabolic systems (4)
Definition
renal
liver
intestinal
stomach
Term
cancers that affect the body's metabolic system will have what affect on the pulmonary system
Definition
changes to metabolic system will result in body pH changes which will affect the respiraotry system
Term
what becomes paramount as the cancer becomes terminal?
Definition
positoning (body can't fight cancer and infection at the same time)
Term
cancer's physical effects from a endurance standpoint
Definition
pt will fatigue quicker
recovery takes longer
Term
circulatory or blood volume changes as a result of cancer to be watched for (2)
Definition
bruising
cyanosis
Term
cardiac comlications d/t trauma (6)
Definition
cardiac arrest
cardiac ischemia or infarct
cardiac tamponade
pericardial effusion
arrhythmias
cardiac contusion
Term
Pulmonary complications d/t trauma (5)
Definition
pneumothorax (atelectasis if less severe trauma)
pleural effusion
rib fractures/bruised ribs
lung contusion
pulmonary edema (not as common as inflammation is usually surrounding the lung)
Term
Interventions with trauma/multiple trauma
Definition
keep in mind positioning, breathing, and activity tolerance regardless of what is being tx (integ, ortho, neuro)
Term
post trauma cardiopulmonary complications (4)
Definition
PE
pneumothorax
destabilizing arrhythimas
atelectasis
Term
Mgmt of the geriatric age: pt's ______ vs age
Definition
function
Term
type of exercise that may be more suited to the geriatric population as a whole
Definition
short bursts of exercise but more frequently throughout the day
Term
pulmonary congenital anomalies (3)
Definition
tracheal atresia
bronchoplumonary atreasia
chest/abdominal wall abnormalities
Term
pulmonary congenital anomalies: what is tracheal atresia
Definition
narrowing or a smaller formation of a structure.
Cartilage isn't formed all the way so the trachea is very soft. Baby will be intubated but trachea may form around the tube and attach to the tube. Once pt becomes stable, the tube becomes smaller and smaller so the trachea doesn't form around the tube
Term
pulmonary congenital anomalies: what is bronchopulmonary atresia
Definition
seen in premature newborns. need ventilator right away. may or may not be dependent on ventilator for the rest of their life. Lungs didn't have enough tie to develop prior to birth since they are premature
Term
pulmonary congenital anomalies: chest or abdominal wall abnormality examples (3)
Definition
hemidiaphragm abnormality
congenital absence of diaphragm
mild malformations during development
Term
childhood acquired disorders: (4)
Definition
infant RDS
bronchopulmonary dypslasia
asthma
CF
Term
infant RDS is seen in which population and why?
Definition
premature babies because they lack surfactant
Term
what is bronchopulmonary dysplasia (BPD)
Definition
fibrotic changes, decreased airway clearance
child may develop RSV (respiratory syncytial virus). can be fatal. chronic respiratory problems
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