Term
The lateral borders of the trachea run perpendicularly into the ______. |
|
Definition
|
|
Term
Describe the angle of Louis. |
|
Definition
(sternal angle) - angle between the sternal manubrium & body - point of attachment of the 2nd rib & tracheal bifurcation |
|
|
Term
Which ribs are "true", "false", & "floating"? |
|
Definition
1-6 - true single costochondral attachment to sternum 7-10 - false - share costochondral attachments before anchoring to sternum 11-12 - floating - no anterior attachment |
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|
Term
T/F. The pharynx is used for both respiration & digestion. |
|
Definition
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|
Term
The larynx connects the ____ & ____. |
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Definition
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|
Term
Where are the epiglottis & vocal chords located? |
|
Definition
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|
Term
What are the "conducting" airways? |
|
Definition
trachea to terminal bronchioles - transport air only - no gas exchange |
|
|
Term
What is the "respiratory unit"? |
|
Definition
respiratory bronchioles, alveolar ducts, alveolar sacs, & alveoli - diffusion of gas occurs through all these structures |
|
|
Term
Describe the anatomy of the R & L lungs. |
|
Definition
R - 3 lobes - has horizontal & oblique fissure - separated into segments, totaling 10.
L lung - 2 lobes, separated by 1 oblique fissure - separated into segments, totaling 8 |
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|
Term
Define parietal pleura, visceral pleura, & intrapleural space. |
|
Definition
parietal pleura - covers inner surface of thoracic cage, diaphragm, & mediastinal border of the lung
visceral pleura wraps around the outer surface of the lung, including the fissure lines
intrapleural space is between two pleura - maintains approximation of the ribcage & lungs |
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|
Term
Describe the position of the diaphragm at rest & with inspiration. |
|
Definition
at rest - domed inspiration - flattens - central tendon is pulled downward |
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|
Term
Which accessory muscle of inspiration raises the upper two ribs? What about the rest of the ribs? What other muscles can become muscles of inspiration? |
|
Definition
upper 2 - SCM & scalenes other ribs - levatores costarum & serratus other muscles - traps, pecs, serratus |
|
|
Term
List the accessory expiratory muscles. |
|
Definition
quadratus lumborum, portions of the intercostals, muscles of the abdomen, & triangularis sterni |
|
|
Term
In patients with spinal cord injury, which positions are most advantageous for them to breathe? Why? |
|
Definition
supine with a lack of abdominal musculature, the diaphragm is lower in the thorax, decreasing inspiratory reserve - the more upright the body, the lower the diaphragm & the lower the inspiratory capacity the more supine, the more adventageous the position of the diaphragm an abdominal binder may help, but ou must be careful not to constrict the thorax. |
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|
Term
exhalation = ______ pull of the lung parenchyma. |
|
Definition
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|
Term
inhalation = _____ pull of the lung parenchyma. |
|
Definition
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|
Term
|
Definition
resting end-expiratory pressure - the point at the end of resting tidal expiration where muscular action of pulling inward & outward is balanced |
|
|
Term
|
Definition
volume of gas inhaled & exhaled during a normal resting breath. |
|
|
Term
Define inspiratory reserve volume. |
|
Definition
volume of gas that can be inhaled beyond a normal resting tidal inhalation |
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|
Term
Describe expiratory reserve volume. |
|
Definition
volume of gas that can be exhaled beyond a normal resting tidal exhalation |
|
|
Term
Describe residual volume. |
|
Definition
The amount of gas that remains in the lungs after ERV has been exhaled. |
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|
Term
Define insipiratory capacity. |
|
Definition
IRV + TV: the amt. of air that can be inhaled from REEP. |
|
|
Term
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Definition
IRV+TV+ERV: the amount of air that is under volitional control; conventionally measured as forced expiratory vital capacity |
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|
Term
Define functional residual capacity. |
|
Definition
ERV+RV: the amount of air that rests in the lungs after a normal resting tidal exhalation. |
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|
Term
Define total lung capacity. |
|
Definition
(IRV+TV+ERV+RV): the total amount of air that is contained within the thorax during a maximum inspiratory effort |
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Term
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Definition
amount of air exhaled in the first second of FVC in a healthy person, at least 70% of FVC is exhaled within the first second
FEV1/FVC x 100 = 70% |
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|
Term
Define forced expiratory flow rate. |
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Definition
FEF 25-75% - the slope of a line drawn between the points 25 & 75% of exhaled volume on a forced vital capacity exhalation curve - more specific to smaller airways & shows a more dramatic change with disease than FEV1. |
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|
Term
Partial pressure of oxygen in the atmosphere (PaO2) at sea level is _____. |
|
Definition
760 mm Hg x 21% = 159.6 mm Hg |
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|
Term
The partial pressure of O2 in the arterial blood depends on the integrity of the pulmonary system, circulatory system, & PaO2. PaO2 at room air is _____ in a young, healthy individual. |
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Definition
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|
Term
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Definition
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|
Term
Define hypoxemia & hyperoxemia. |
|
Definition
|
|
Term
|
Definition
percentage of O2 in air based on a total of 1.00. FiO2 of room air = 21% O2, or .21 |
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|
Term
Supplemental O2 is usually prescribed when the PaO2 falls below ____. |
|
Definition
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|
Term
Define pH and list the normal range. |
|
Definition
concentration of free floating hydrogen ions within the body - normal range for pH is 7.35-7.45 |
|
|
Term
|
Definition
partial pressure of carbon dioxide within the arterial blood, usually 35-45 mm Hg |
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|
Term
Define hypercapnea & hypocapnea. |
|
Definition
Hypercapnea: PaCO2 >45 mm Hg Hypocapnea: PaCO2 <35 mm Hg |
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|
Term
The normal amount of bicarbonate ions within the arterial blood is usually _____. |
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Definition
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|
Term
List the symbol for Ventilation & Perfusion. Optimal respiration ocurrs when ventilation & perfusion are ______. |
|
Definition
matched; Ventilation = VE, perfusion = Q |
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|
Term
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Definition
well ventilated, but no respiration (gas exchange is occurring) |
|
|
Term
|
Definition
No respiration occurs because of a ventilation abnormality - complete atelectasis of a respiratory unit allows the blood to travel through the pulmonary capillary without gas diffusion occurring. |
|
|
Term
Perfusion is _____-dependent. |
|
Definition
gravity - more pulmonary blood is found at base of lung in upright position. |
|
|
Term
Which alveoli are full at REEP & which are full at dynamic inspiration? |
|
Definition
REEP - apical alveoli dynamic inspiration - alveoli at base of lungs |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
The gravity independent area of the lung will act as a ______, while the gravity-dependent area of the lung will act as a _____. |
|
Definition
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|
Term
How do you calculate a pack-year? |
|
Definition
# of packs smoked per day x years smoked |
|
|
Term
List normal body temperature in terms of Farenheit & Celcius. |
|
Definition
|
|
Term
What values are considered Tachycardic? Bradycardic? |
|
Definition
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|
Term
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Definition
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|
Term
What are common cardiac sequelae to chronic lung disease? |
|
Definition
cor pulmonale (right ventricular dilation & hypertrophy |
|
|
Term
With obstructive pulmonary disease, the lung recoil force is ______, resulting in what? |
|
Definition
decreased - barreled chest & increase in A-P dimension. |
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|
Term
Intensity of inspiration & expiration will be quieter at the _____ than at the _____. |
|
Definition
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|
Term
Define vesicular lung sounds. |
|
Definition
normal breath sound - a soft rustling sound heart throughout all of inspiration & the beginning of expiration |
|
|
Term
|
Definition
a more hollow, echoing sound normally found over only the right superior anterior thorax - corresponds to R main stem bronchus - all of inspiration & most of expiration are heard with bronchial breath sounds |
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|
Term
Descreased breath sounds only allow some of _____ to be heard and is usually associated with ____ lung diseases. |
|
Definition
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|
Term
What does adventitious mean? |
|
Definition
|
|
Term
|
Definition
aka rales, crepitations a crackling sound heard usually during inspiration that indicates pathology (atelectasis, fibrosis, pulmonary edema |
|
|
Term
|
Definition
A musical pitched sound, usually heard during expiration caused by airway obstruction (asthma, COPD, foreign body aspiration
wheezes may be heard on inspiration as well |
|
|
Term
vocal transmission is loudest near ____ & _____. |
|
Definition
trachea & main stem bronchus |
|
|
Term
|
Definition
a nasal or bleating sound heard during auscultation "E" sounds are transmitted to sound like "A". |
|
|
Term
|
Definition
characterized by an intense, clear sound during auscultation, even at the lung bases |
|
|
Term
Define whispered pectriloquy. |
|
Definition
occurs when whispered sounds are heard clearly during auscultation. |
|
|
Term
List the change to pH, PaCO2, & HCO3, causes, & S&S of respiratory alkalosis. |
|
Definition
ph - increased PaCO2 - decreased HCO3 - no change
Causes: hyperventilation S&S - dizziness, syncope, tingling, numbness, early tetany |
|
|
Term
|
Definition
characterized by an intense, clear sound during auscultation, even at the lung bases |
|
|
Term
List the change to pH, PaCO2, & HCO3, causes, & S&S of respiratory acidosis. |
|
Definition
pH: decreased PaCO2: increased HCO3: no change
Causes: alveolar hypoventilation
S&S: anxiety, restlessness, dyspnea, headache, confusion, somnolence, coma |
|
|
Term
List the change to pH, PaCO2, & HCO3, causes, & S&S of metabolic alkalosis. |
|
Definition
pH: increases PaCO2: no change HCO3: increases
Causes: bicarbonate ingestion, vomiting, diuretics, steroids, adrenal disease
S&S: weakness, mental dullness, early tetany |
|
|
Term
List the change to pH, PaCO2, & HCO3, causes, & S&S of metabolic acidosis. |
|
Definition
pH: decreased PaCO2: no change HCO3: decrease
Cause: Diabetic, lactic or uremic acidosis, prolonged diarrhea
S&S: secondary hyperventilation (Kussmaul breathing), nausea, lethargy, & coma |
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|
Term
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Definition
|
|
Term
List normal Hematocrit values. |
|
Definition
|
|
Term
LIst normal hematocrit values. |
|
Definition
|
|
Term
LIst Hemoglobin (Hgb) normal values. |
|
Definition
|
|
Term
List the cause of bacterial pneumonia. |
|
Definition
intra-alveolar bacterial infection |
|
|
Term
Gram-positive bacteria is usually acquired in the ______. |
|
Definition
|
|
Term
Lis the most common type of gram-positive pneumonia. |
|
Definition
pneumococcal pneumonia (streptococcal) |
|
|
Term
Gram-negative bacteria usually develop how? |
|
Definition
in a host who has underlying chronic debilitating conditions, severe acute illness, & recent antibiotic therapy |
|
|
Term
List common gram negative bacteria. |
|
Definition
Klebsiella, Haemophilus influenzae, Pseudomonas aeruginosa, Proteus, Serratia |
|
|
Term
Which pneumonia(s) have a productive cough with purulent, blood-streaked, or rusty sputum & Hypoxemia with hypercapnea? |
|
Definition
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|
Term
Which type of pneumonia has a recent history of URI & dry cough? |
|
Definition
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|
Term
What is the incubation period for TB? HOw long does the primary disease last? What is a post-primary disease infection for TB? When does it occur? |
|
Definition
Incubation period: 2-10 wks Primary disease lasts 10 days to 2 weeks Post-primary infection: reactivation of dormant tuberculous bacillus which can occur years after the primary infection
Two weeks on antituberculin drugs renders host non-infectious |
|
|
Term
How long must medication for TB be taken for? |
|
Definition
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|
Term
There is an increased incidence of TB in the patient population infected by ____. |
|
Definition
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|
Term
Which pneumonia has upper lobe involvement with air space densities, cavitation, pleural involvement, & parenchymal fibrosis? |
|
Definition
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|
Term
Describe pneumocystis pneumonia. |
|
Definition
pulmonary infection caused by a fungus (Pneumocystis carinii) in immunocompromised hosts - most often found in patients following transplantation, neonates, or patients infected with HIV. |
|
|
Term
Which pneumonia is characterized by insidious progressive SOB, non-productive cough, & CXR with interstitial infiltrates. |
|
Definition
PCP - pneumocystis pneumonia |
|
|
Term
|
Definition
severe acute respiratory syndrome. - an atypical respiratory illness caused by a coronavirus |
|
|
Term
Which pneumonia is characterized by high temperature, dry cough, decreased wbc's, platelets, lymphocytes, increased liver function tests, & abnormal CXR with borderline breath sound changes |
|
Definition
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|
Term
Describe the 4 stages of COPD. |
|
Definition
Stage 1: FEV1/FVC <70% FEV1 >=80% predicted with or without chronic symptoms
Stage 2: FEV1/FVC <70% 50% often with symptoms of SOB w/ exertion
Stage 3 FEV1/FVC <70% 30%increased SOB, decreased ex. capacity, & exacerbations of their disease
Stage 4: FEV1/FVC <70% FEV1 <30% predicted FEV1< 50% with chronic respiratory failure symptoms impaired QOL exacerbations can be life threatening |
|
|
Term
which chronic obstructive disease is characterized by increased A-P diameter of chest wall, clubbing, CXR showing hyperinflation, flattened diaphragms, & hyperlucency? |
|
Definition
|
|
Term
What are characteristics of all pulmonary obstructive diseases? |
|
Definition
decreased FEV1, decreased FVC, increased FRC & RV, & decreased FEV1/FVC ratio |
|
|
Term
What classification of lung disease is CF? |
|
Definition
can be obstructive, restrictive, or both |
|
|
Term
What are clinical signs of CF? |
|
Definition
meconium ileus, frequent respiratory infections, (esp. Staph & Pseudomonas), inability to gain weight despite caloric intake - dx made postnatally by a blood test showing the presence of trypsinogen or positive sweat electrolyte test |
|
|
Term
|
Definition
a chronic congenital or acquired disease characterized by abnormal dilation of the bronchi & excessive sputum production |
|
|
Term
|
Definition
alveolar collapse in a premature infant resulting from lung immaturity, inadequate level of pulmonary surfactant |
|
|
Term
Which obstructive lung disease is characterized by a CXR with a classic granular pattern (ground glass) cause by distended terminal airways? |
|
Definition
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|
Term
Define bronchopulmonary dysplasia. |
|
Definition
sequelae of premature infants with RDS - results from high pressures of mechanical ventilation, high fractions of inspired O2, &/or infection |
|
|
Term
Which obstructive disease is characterized by a CXR that shows hyperinflation, low diaphragms, atelectasis, and/or cystic changes |
|
Definition
bronchopulmonary dysplasia |
|
|
Term
What are the three kinds of restrictive diseases? |
|
Definition
d/t changes in lung parenchyma & pleura d/t alterations in chest wall d/t alterations in neuromuscular apparatus? |
|
|
Term
What causes restrictive disease d/t alterations in lung parenchyma? |
|
Definition
idiopathic pulmonary fibrosis, asbestosis, radiation pneumonitis, oxygen toxicity |
|
|
Term
What causes restrictive diseases d/t changes in the chest wall? |
|
Definition
restricted motion of bony thorax (ankylosing spondylitis, arthritis, scoliosis, pectus excavatum, arthrogryposis), integumentary changes to chest wall - thoracic burns, scleroderma |
|
|
Term
What causes restrictive lung disease d/t alterations in the neuromuscular apparatus? |
|
Definition
decreased muscular strength seen in MS, muscular dystrophy, SCI, PD, or CVA |
|
|
Term
Define Bronchogenic carcinoma. |
|
Definition
tumor arising from the bronchial mucosa |
|
|
Term
What cell-types are seen in bronchogenic carcinoma? |
|
Definition
small cell (oat cell) & non-small cell (squamous, adenocarcinoma, & large cell undifferentiated) |
|
|
Term
|
Definition
2 or more fractures in 2 or more adjacent ribs |
|
|
Term
Define the paradoxical movement of flail ribs. |
|
Definition
During inspiration, flail section pulled inward; exhalation, flail moves outward |
|
|
Term
Define pneumothorax & possible causes. |
|
Definition
air in the pleural apace - usually through a lacerated visceral pleura from a rib fracture or ruptured bullae |
|
|
Term
|
Definition
blood in the pleural space usually from a laceration of the parietal pleura |
|
|
Term
|
Definition
excessive seepage of fluid from the pulmonary vascular system into the interstitial space; may eventually cause alveolar edema |
|
|
Term
Which lung disease is characterized by pink, frothy secretions & a CXR with increased vascular markings, opacities in gravity dependent areas of the lung in a typical butterfly pattern, & atelectasis? |
|
Definition
|
|
Term
|
Definition
excessive fluid between the visceral & parietal pleura. |
|
|
Term
|
Definition
collapsed or airless alveolar unit, caused by hypoventilation secondary to pain during the ventilatory cycle (pleuritis, post-op pain, or rib mucus plugging), external bronchial compression (tumor or enlarged lymph nodes), low tidal volumes, or neuro insult |
|
|
Term
List three indications for the use of postural drainage. |
|
Definition
Atelectasis, Increased secretions, & Aspiration |
|
|
Term
Duration of postural drainage can be up to ______, with ____ of percussion per postural drainage position |
|
Definition
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|
Term
What typically follows positioning & percussion with postural drainage? |
|
Definition
|
|
Term
Describe how to drain the upper lobe apical segments. |
|
Definition
Patient in sitting & leans back on pillow 30 deg. against therapist - therapist applies percussion over area between clavicle & top of scapula each side |
|
|
Term
Describe how to drain the upper posterior lobes. |
|
Definition
Patient in sitting, flexed forward 30 deg. over pillow - percussion over upper back on both sides |
|
|
Term
Describe how to drain the upper lobe anterior segments. |
|
Definition
Patient in hooklying (knees bent up with feet on mat) with pillow under knees percussion between clavicle & nipple bilaterally. |
|
|
Term
Describe how to drain the RML. |
|
Definition
patient on L side, rotated backwards 1/4 turn with knees flexed - foot of table elevated 16 in.
Percussion over R nipple area - in females - under armpit & fingers forward beneath breast |
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|
Term
Describe how to drain the LUL (lingula). |
|
Definition
Patient on R side, rotated backwards 1/4 turn, with foot of table elevated 16 in. percussion over L nipple area - in women, hand under armpit & fingers extending forward beneath breast |
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|
Term
Describe how to drain the lower lobe, anterior basal segments. |
|
Definition
lie on side opp. the side you need to drain - lie on side with head down & pillow under knees - foot of bed elevated 20 in. |
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|
Term
Describe how to drain the lower lobe lateral basal segments. |
|
Definition
foot of table elevated 20 in. - patient comes up 1/4 turn towards side to be drained from prone with pillow between legs to support - ex. L turn 1/4 up on R side |
|
|
Term
Describe how to drain the posterior basal segment of the lower lobes. |
|
Definition
foot of bed elevated 20 deg. - pt. in prone with head down & pillow under hips - percussion over lower ribs close to spine |
|
|
Term
Describe how to drain superior segments of lower lobes. |
|
Definition
bed flat - pt. prone with 2 pillows under hips - percussion over middle of back at inf. angle of scap or either side of spine |
|
|
Term
How many repetitions of shaking are usually performed? |
|
Definition
5-10 deep inhalations with shaking is generally accepted |
|
|
Term
When are huffing & assisted coughing used? |
|
Definition
huffing - when patients have collapsible airways - prevents high intrathoracic pressure which can cause premature airway closure |
|
|
Term
describe the different types of suction gauges. |
|
Definition
14 french gauge - adults 10 Fr - older children 5-6 Fr - younger children & infants |
|
|
Term
Suction is usually set at ____ mm Hg. |
|
Definition
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|
Term
Normal suction time is between ____ sec. |
|
Definition
|
|
Term
Describe a flutter device. |
|
Definition
Acapella device: an independent program using an external device that vibrates the airways on exhalation to improve airway clearance with intermittent PEEP |
|
|
Term
low pressure PEP masks have low pressures at ____. |
|
Definition
|
|
Term
High pressure expiratory masks use pressures between ___-___. |
|
Definition
|
|
Term
List an example of a sustained maximal inspiration technique? |
|
Definition
|
|
Term
LIst exercise paramaters for patients with lung disease. |
|
Definition
(max HR - resting HR)(40-85%) + resting HR = safe range for exercise intensity
duration of 20-30 minutes of continuous exercise 5x/wk desired before increase in intensity is considered |
|
|
Term
|
Definition
(inspiratory muscle training)
load the muscles of inspiration by breathing through a series of graded aperture openings. |
|
|
Term
|
Definition
|
|
Term
|
Definition
removal of a lobe of a lung |
|
|
Term
Define Segmental resection. |
|
Definition
removal of a segment of a lobe. |
|
|
Term
|
Definition
removal of a portion of a lung without using anatomical divisions |
|
|
Term
Define large volume reduction surgery |
|
Definition
removal of large emphysematous, non-functioning areas of the lung in order to restore normal thoracic mobility & improve gas exchange of the healtier remaining lung. |
|
|
Term
|
Definition
used for most lung resections - incision follows a path of the fourth intercostal space |
|
|
Term
Describe sympathomimetics. |
|
Definition
short-acting B-2 agonists - mimics SNS, so increases bronchodilation - can also increase HR & BP - given through metered dose inhaler |
|
|
Term
List examples of sympathomimetics. |
|
Definition
Ventolin (albuteral), Alupent (metaproterenol), Maxair (pirbuterol), Serevent (salmetrerol xinafoate) |
|
|
Term
Describe anticholinergics & list examples. |
|
Definition
inhibit parasympathetic nervous system - Atrovent (ipratropium |
|
|
Term
Describe methylxanthines & list examples. |
|
Definition
produce smooth m. relaxation - limited use secondary to toxicity - aminophylline & theophylline |
|
|
Term
Describe leukotriene receptor antagonists & list examples |
|
Definition
blocks leukotrienes released in an allergic reaction montelukast (Singulair) |
|
|
Term
Describe cromolyn sodium and examples. |
|
Definition
anti-allergic drug - prevents release of mast cells after contact with allergens - Intal |
|
|
Term
Describe anti-inflammatories used for lung pathology & examples. |
|
Definition
used to decrease mucosal edema, decrease inflammation, & reduce airway reactivity. - steroids can be administered systemically or topically Vanceril (beclomethasone, MDI), Azmacort (triamcinolone, MDI) |
|
|
Term
Define thrush - what causes it? |
|
Definition
a fungal infection of the mouth & throat - side effect of inhaled steroids |
|
|
Term
Supplemental O2 increases the FiO2 up to ____. |
|
Definition
|
|
Term
Supplemental O2 is indicated if SaO2 is ____ or PaO2 is _____ |
|
Definition
|
|
Term
T/F Oxygen is considered a form of medication & must be prescribed by a physician. |
|
Definition
|
|
Term
List what Hydrostatic pressure d/t aquatic therapy does to IRV, FVC, & work of breathing. |
|
Definition
IRV decreased & FVC decreased
work of breathing increased |
|
|
Term
Basilar rales often accompany _________. |
|
Definition
left ventricular heart failure. |
|
|
Term
|
Definition
continuous, low pitched sonorous sound heard during expiration - usually indicative of constricted airways due to inflammation, brochospasm, & secretions, as with asthma & chronic bronchitis |
|
|
Term
|
Definition
a continuous adventitious sound heard during inspiration associated with upper airway obstruction |
|
|
Term
|
Definition
Adventitious sound that occurs as a result of the pleural surfaces rubbing together, usually as a result of inflammation or neoplastic processes
may be accompanied by pain on inspiration |
|
|
Term
Describe treatment for acute exacerbations or development of pneumonia with CF. |
|
Definition
bronchial hygiene must be performed several times/day (percussion/vibration/shaking/postural drainage) |
|
|
Term
List energy activities at levels of 1-2 mets, 3-4, 5-6, 6-7, & 7-10 mets. |
|
Definition
1 met - patient can sit & read, walk at 1 mph 2 mets - patient can sit & type, walk at 2 mph or ride bike at 5 mph 3 - patient can golf (with golf cart), walk at 3 mph or ride bike at 6 mph, light weights (2-3 lbs) 4 - slow stair climbing, balance and mat activities with light resistance 4-5 mets - house painting, walking at 3.5 mph or riding bicycle at 8 mph, raking leaves, resistance exercises 10-15 lbs max
5-6 mets - 5 mets required for ADL's, shoveling light soil, horseback riding, light aerobics, walking at 4 mph
6-7 mets - snow shoveling, cycling 11 mph, downhill skiing
7-10 mets - jogging, basketball, vigorous skiing, rapid cycling with hills |
|
|
Term
List changes to an EKG made by AV blocks. |
|
Definition
ST segment depression (indicates ischemia if >2-3mm) or elevation (indicates new infarct or pericarditis)
inverted T wave (ischemia)
widened QRS (bundle branch block - abnormal delays or failure to conduct electrical signal from atria to ventricles |
|
|
Term
T/F. percussion and shaking are permissible around a chest tube. |
|
Definition
|
|