Pulmonary Physical Therapy Review

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43. 21. 44. 118.

7.26-7.41 7.35-7.45 7.35-7.45 10-15 seconds 1220br/min 20mL 22-28 mEq/mL. 34-54 35-45 3545mmHg 40%-85%

What's the normal pH value for infants? What normal range for pH? What's the normal pH value for adults? The usual suctioning time is between? What's the normal value of Respiratory rate for adults? What's the tidal volume normal value for infants? What is the normal value of Bicarbonate (HCO ) within arterial blood? What's the PaCO normal value for infants (mmHg)? What's the PaCO normal value for adults (mmHg)? What's the normal value of PaCO within arterial blood in healthy individuals? At what percentage range should a pulmonary patient exercise intensity be calculated if using the Karvonen's formula? What's the normal value of Respiratory Rate for infant? What's the normal value of HR for adults?

179.

Abdominal binder

38.

45.

27.

Normal abdominal tone holds the abdominal contents directly under the diaphragm, assisting the return of the diaphragm to the normal high domed position. When a patient lacks functional abdomina musculature such as SCI patient, the diaphragm is lower in thorax dcreasing inspiratory reserve (IRV). The more upright body posiiton the lower the diaphragm and the lower the inspiratory capacity. What can be used to assist such a patient to maintain or support the abdominal vicera to assist in ventilation? What type of physical therapy intervention can be used for high cervical or high thoracic spinal cord injury patients whose abdominal muscles are too weak to provide the necessary support for the abdominal contents needed for passive exhalation? (be sure that binder does not restrict inspiration) This exercise is used when abominal muscles are too weak to provide an effective cough It is a cause for respiratory alkalosis It is a cause for respiratory acidosis Defined as: the ability to remove carbon dioxide from the pulmonary circulation and maintain pH What lung segment is being drained here? - Patient in trendelenburg, and sideline position, pillow under knees. - therapist claps with slightly cupped hand over lower ribs What lung segment is being drained here? - Patient is lying flat on back with pillows under the knees, hips are approximately at 45 angle - Therapist claps between clavicle and nipple on each side Early signs & symptoms of respiratory acidosis include?

136.

41.

Abdominal splinting

42.

22.

137.

135.

Abdominal strengthening Alveolar hyperventilation Alveolar hypoventilation Alveolar ventilation Anterior basal segments

37.

40br/min 60100bpm 60%-80%

54.

34.

55.

175.

At what percentage range should a cardiac patient exercise intensity be calculated if using the Karvonen's formula? What's the PaO normal value for infant (mmHg)? What's the normal value of BP for infants (mmHg)? What's the PaO normal value for adults (mmHg)? What's the normal value of BP for adults (mmHg)? What's the normal value of HR for infants? Suction system should be set approximately at how may mmHg? What's the tidal volume normal value for adults?

18.

39.

75-80 75/50 80-100 120/80 or less 120bpm 120mmHg 500mL

164.

35.

40.

36.

161.

Anterior segments

33. 117.

46.

57.

Anxiety, restlessness, dyspnea, headache

159.

Apical segments

What lung segment is being drained here? - Patient is in upright position in bed or chair leaned back at 30 angle - Therapist clasps markedly cupped hand over area between clavicale and top of scapula on each side Defined as no respirations If an Arterial line gets dislodge during treatment, what is the next thing to do?

102.

Atelectasis

180. 190.

Apnea Apply pressure immediately to or above the arterial insertion site to stop bleeding Aspiration pneumonia

Description: Collapse or airless alveolar unit, caused by hypoventilation secondary to pain during the ventilatory cycle (pleuritis, post operative pain, or rib fracture), internal bronchial obstruction (aspiration,mucus plugging). external bronchial compression (tumor or enlarged lymph nodes), low tidal volume (narcotic overdose, inappropriately low ventilator settings) or neurlogic insult It is caused by a blockage of the air passages (bronchus or bronchioles) Lung Collapse or by pressure on the outside of the lung. Signs & symptoms include: - Difficulty breathing, Chest pain, Cough Crackles or rales, repitations is an adventitious sound heard during inspiration. what pathology would these sounds indicate? Medications within pulmonary pupulation that usually alter vital signs are: What are the causes of Metabolic alkalosis?

85.

Atelectasis

77.

If a chest x-ray initially shows pneumonitis, and in the chronic stage of disease shows necrotizing pneumonia with cavitation. What conditions is this finding associated with? Aspirated material causes an acute inflammatory reaction within the lungs. Usually found in patients with impaired swallowing (dysphagia), fixed neck extension, intoxication, impaired consciousness, neuromuscular disease, recent anesthesia What air clearance technique is being used here? - Patient is positioned against a solid surface in supine with head of bed in trendelenburg position or sitting with wheelchair against the wall or agains the therapist - The therapist's hand is placed below the patient's subcostal angle (similar to heimlich maneurver) - The patient inhales deeply, and as the patient attempts to cough, the therapist pushes inward and upwardly assisting the rapid exhalation of air This technique is used when the patient's abdominal muscles cannot generate an effective cough. (i.e. spinal cord injury) Condition that shows increased reactivity of the trachea and bronchi to various stimuli such as allergens, exercise, cold , and manifests by widespread narrowing of the airways due to inflammation, smooth muscle constriction, and increased secretions that is reversible in nature. The patient with this condition may show wheezing, possible crackles and decreased breath sounds.

48.

Atelectasis, fibrosis, pulmonary edema betal blockers, bronchodilators Bicarbonate ingestion, vomiting, duirectis, steroids, adrenal disease Bronchiectasis

74.

Aspiration pneumonia

32.

60.

111.

Assisted cough

82.

A chronic congenital or acquired disease characterized by abnormal dilatation of the bronchi and excessive sputum production A sound characterized by an intense, clear sound during auscultation, even at the lung bases. Which technique is being demonstrated here? - Patient is asked to say "99", and the words are auscultated clearly over the entire chest Medical equipment that is used to evacuate air or fluid trapped in the intrapleura space. (Usually found in post operative patients) The inflamed bronchi produce a lot of mucus. This leads to cough and difficulty getting air in and out of the lungs. This is called

52.

Bronchophony

173.

Bronchophony

110.

Assisted cough Asthma

146.

Chest Tubes

79.

156.

Chronic Bronchitis

155.

Chronic Bronchitis

A type of COPD defined as hypersecretion of mucus sufficient to produce a productive cough on most days for 3 months during 2 consecutive years. Hypersecretion of mucus usually begins in the large airways and is not associated with airway obstruction. Later hypersecretion progresses to the smaller airways, where airway obstruction begins initially. This is called: This condition is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressiveand associated with an abnormal inflammatory response of the lungs to noxious particles or gasses. A typical characteristic found is increased A-P diameter of chest wall. Pulmonary function tests showing decreased FEV , decreased FVC, increased FRC and RV, and decreased FEV /FVC ration are most likely associated with This condition is typified by difficulty expanding the lungs causing a reduction in lung volumes Pulmonary function tests usually reveal a: - reduction in Vital capacity (VC), Functional residual capacity (FRC), and Total lung capacity (TLC) Late signs & symptoms of respiratory acidosis include:? Keeping in mind normal adult levels of BP a therapist is getting ready to assist in performing a G.E.T. Baseline of BP 122/84 mmHg. During the test, the BP = 244/82 mmHg. What is the next thing to do based on guidelines of termination criteria for G.E.T? Keeping in mind normal adult levels of BP a therapist is getting ready to assist in performing a G.E.T. Baseline of BP 122/84 mmHg. During the test, the BP = 144/88 mmHg. What is the next thing to do based on guidelines of termination criteria for G.E.T? A pertinent finding with lung contusion during a physical examination is An adventious sound: a crackling sound heard usually during inspiration that indicates pathology (atelectasis, fibrosis, pulmonary edema). this is aka rales, crepitations

80.

Cystic Fibrosis

A genetically inherited disease characterized by thickening of secretions of ALL exocrine glands (glands that secrete their producs to ducts to a specific location), leading to obstruction of, for example, pacreatic, pulmonic, gastrointestinal. This condition may present as an obstructive, restrictive or mixed disease. Clinical s/s include: - meconium ileus, frequent respiratory infections (especially staphylococcus aureus and pseudomonas aeruginosa) - Inability to gain weight despite adequate caloric intake. - Diagnosis made post natally by a blood test showing the presence of trypsinogen or later by a positive sweat electrolyte test Chronic Restrictive Diseases have different etiologies which is typified by difficulty expanding the lungs causing a reduction in lung volumes Which statement is true about Chronic Restrictive Disease a) Restrictive disease can be due to alterations in lung parechyma and pleura b) Restrictive disease can be due to alteration in the chest wall c) Restrictive lung disease can be due to alterations in the neuromuscular apparatus d) All of the above statements are true Defined as: anatomical conducting airways or physiological (disease such as pulmonary emboli). it is a space that is well ventilated but no respiration (gas exchange) occurs Common complaints expressed amoung pulmonary diagnosed patients during a physical therapy examination usually include:

81.

Cystic Fibrosis

88.

Chronic Obstructive Disease

192.

78.

Chronic Obstructive Diseases Chronic Restrictive Disease Chronic Restrictive Disease Confusion, somnolence, coma Continue GET

87.

89.

58.

28.

Dead space

187.

30.

186.

Continue GET

decreased ability to perform ADLs or shortness of breath

97.

Cough with hemoptysis Crackles

47.

101.

Decreased breath sounds over effusion, bronchial breath sounds may be present around the perimeter of the effusion. Pleural friction rub may be possible with inflammatory process Decreases

A pertinent finding of pleural effusion during a physical examination is If there is retention (increased) of CO in the blood, what happens to the pH value? Which muscle is called the primary muscle of inspiration? This breathing exercise can be used with: - Post operative patients, post trauma patients, - Patients with obstructive or restrictive pulmonary lung diseases

121.

Diaphragmatic breathing

26.

1.

Diaphragm

What breathing exercise is being used here? - Position the patient semireclined (semifowler's position) - Place the therapist's hand gently over the subcostal angle of the patient's thorax - Apply gentle pressure throughout the exhalation phase of breathing - Ask patient to inhale against resistance of the therapist's hand - Release pressure allowing a full inhalation - Progress to independence of therapist's hand, in upright sitting, standing, walking and stair climbing What type of breathing exercise is used best to increase ventilation, improve gas exchange, decrease work of breathing, facilitate relaxation, maintain or improve MOBILITY of chest wall? Sign & symptoms of respiratory alkalosis include:

120.

Diaphragmatic breathing

122.

Diaphragmatic breathing

56.

Dizzness, syncope, tingling, numbness, early tetany Egophony

172.

Which technique is being demonstrated here? - Patient is asked to say "E" aloud, but the sound that is auscultated over the chest is "A" It is a nasal or bleating sound heard during auscultation. "E" sound are transmitted to sound like "A". A form of COPD, a condition that limits the flow of air when you breathe out. It occurs when the air sacs at the ends of your smallest air passages (bronchioles) are gradually destroyed. Smoking is the leading cause. What Pulmonary condition presents clinically with Shortness of breath, scant sputum production and barrel-shaped configuration of the chest wall, with increased subcostal angle? This airway clearance technique is used ONLY when regular cough technique, huffing, assisted cough and tracheal stimulation has failed to adequately remove secretions Defined as: volume of gas that can be exhaled beyond a normal resting TIDAL VOLUME

51.

Egophony

157.

Emphysema

158.

Emphysema

115.

Endotracheal suctioning

6.

Expiratory reserve volume

13.

Force Expiratory volumen in 1 second (FEV) Free floating hydrogen ions in the body Functional Residual Capacity fungal infection of the mouth and throat Healthy population Hemoptysis, and Cough and expectoration of LARGE amounts of mucopurulent secretions Hemothorax

The amount of air exhaled during the first second of Forced Expiratory Vital capacity (Vital capacity) What does pH indicates?

107.

Huffing

20.

11.

Defined as: The amount of air that resides in the lungs after normal resting Tidal Exhalation ( ERV + RV)
23.

Technique that is more effective in patients with collapsible airways, such as patients with chronic obstructive diseases (Asthma, cystic fibrosis,Bronchiectasis, Respiratory distress syndrome, Bronchopulmonary dysplagia). It prevents the high intrathoracic pressure which causes premature airway closure When PaCO > 45mmHg, this condition is called: Defined as: When PaO > 100mmHg When PaCO < 35mmHg, this condition is called: What medical device can assist a patient with an acute condition such as post trauma pain, or post operative pain, or acute lobar collapse to measure and encourage deep inspiration thereby assisting with achieve maximal inspiration during sustained maximal inspiration exercise? Anti-inflammatory agaents such as steroids, are used to decrease muscosal edema, decrease inflammation, reduce airway reactivity. Steriods can be administered either systemically or topically. what are the common side effects of systemic administration of steriods? What are the indications for postural drainage?

144.

Inhale steriods such as Vanceril and Azmacort main side effect is called thrust. what is it? Which population is FEV at least 70% of FVC? (FEV /FVC x 100 > 70%) In addition to pertinent found in most respiratory diseases such as cyanosis, clubbing, hypoxemia, dyspnea, tachypnea, a distinguishing finding in Bronchiectasis is/are

hypercapnea Hyperoxemia Hypocapnea Incentive Spirometer

16. 24.

14.

130.

84.

142.

95.

Description: Blood in the pleural space usually from a laceration of the parietal pleura One physical therapy consideration with regards to pneumonias of carcinogenic origin is that if they develop behind a COMPLETELY obstructed brochus, they CANNOT be cleared with physical therapy techniques. If a PT finds this condition to be true in a patient, What is the next thing to do if the PT needs to perform Chest PT?

91.

Hold Treatment until palliative therapy reduces the tumor size and relieves the bronchial obstruction Huffing

Increased blood pressure, sodium retention, muscle wasting, osteoporosis, GI irritation, and hypercholesteremia

103.

108.

The technique that will be a more effective airway clearance technique in patients with COPD such as asthma, cystic fibrosis, bronchiectasis, bronchopulmonary dysplagia, respiratory distress syndrome is: What air clearance technique is being used here? - Ask patient to inhale deeply, and immediately the patient forcibly expels the air saying "ha..ha..ha.."

Increased pulmonary secretions, Aspiration, Atelectasis or collapse Increased volume in the venous system and may be an early sign of R side Heart Failure (cor pulmonale) Increases Inspiratory capacity Inspiratory reserve volume

171.

109.

Huffing

During examination, a patient presents with jugular venous distention (veins are distended above the level of the clavicles), what is this condition indicative of? If there is removal of CO in the blood, what happens to the pH value? Defined as: The amount of air that can be inhaled from Resting End Expiratory Pressure (REEP) TV + IRV Defined as: volume of gas that can be inhaled beyond a normal resting TIDAL VOLUME

25.

9.

5.

126.

Intractable hypoventilation Kussmaul breathing

What condition renders the use of segmental breathing inappropriate? Defined as a deep and labored breathing secondary to metabolic acidosis e.g., Diabetic ketoacidosis but also renal failure. It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide in the blood due to increased respiratory rate and depth of respiration. Atrovent is an anticholinergic drug that inhibit the parasympathetic nervous system which causes an increase in the HR, BP and bronchodilation. What the known side effects of this type of drugs? What lung segment is being drained here? - Patient in trendelenburg, and lying on abdomen, then rotates 1/4 turn upward. Upper leg is flexed over a pillow for support - Therapist claps over uppermost portion of lower ribs Drains the Posterior R or L apical segments (upper lobes) What lung segment is being drained here? - Patient in trendelenburg postion with head down on Right side and rotates 1/4 turn backward. Pillow may be placed from behind from shoulder to hip. Knees should be flexed - Therapist claps over Left nipple area. Defined as: two or more lung volume added together (i.e. TV + IRV, etc...) Description: Blood and edema within the alveoli and interstitial space due to blunt chest trauma with or without rib fractures Drains Anterior R or L segments (upper lobes) Which postion patient with cardiopulmonary dysfunction can not tolerate? Drains Posterior R or L segments (upper lobes aka superior segments)

62.

Metabolic acidosis

181.

The following may be described as a cause for a condition that increases the pH in blood. What is this condition called? - Diabetic, lactic or uremic acidosis,prolonged diarrhea The following may be cause of: - Bicarbonate ingestion, vomiting, diuretics, sterioids, adrenal disease A young individual PaO is measured to be < 90mmHg, what is this condition called? A PT at a local hospital is working with a pulmonary patient who lives on the 2nd. floor in a two story appartment building with no elevator. The patient presents with difficulty ascending a flight of stairs (12 steps). The PT instructs the following: - Before ascending the first step, inhale deeply and exhale slowly with pursed lips. Upon exhalation, ascend two steps and stop. Inhale again, and exhale with pursed lips. Upon exhalation, advance another two steps, etc. until you have reach the end. What techniques is being used here? This breathing technique is used to spread out the metabolic demands of any activity over time by slowing its performance. It is used when patients who becomes dyspneic during the performance of an activity or exercise What technique is being used here? - Break down any activity into manageable components that can be performed within the patient's pulmonary system's abilites. - Inhale at rest, and upon exhalation with pursed lips, complete the first component of the desired activity. - Stop the activity, and inhale at rest - Upon exhalation with pursed lips, complete the next component of activity - Repeat the above steps involving inhalation/ exhalation until activity is completed without shortness of breath. (This technique provides performance of activity on exhalation phase and rest on inhalation phase) A patient visits for the first time The Cardiopulmonary Rehabilitation Unit at a local hospital for his first appoiment. Before the examination as the PT walks towards waiting area, the patient is observed assuming the professorial position (leaning forward on knees or some object) and is demonstrating increased effort with breathing and increased used of accessory muscles. What can be concluded in this situation?

59.

Metabolic alkalosis Mild hypoxemia Paced breathing or activity pacing

15.

147.

lack of sweating,dry mouth, delusions Lateral basal segments

140.

166.

149.

Leaning forward in sitting position Lingular segments

138.

163.

Paced breathing or activity pacing Paced breathing or activity pacing

139.

8.

Lung capacities Lung contusion

96.

150.

Lying flat on back (pillow under knees) lying in bed with the head flat Lying on abdomen (pillow under abdomen) Lying on abdomen in trendelenburg Lying on back (trendelenburg)

169.

168.

151.

The patient has Chronic obstructive disease

154.

Drains Posterior Basal Segment (R or L)

152.

In trendelenburg position tilted R or L, Drains Middle lobes (R or L)

72.

Patient has developed respiratory acidosis, and GET should be terminated Perform treatment in the horizontal plane to accomodate for present condition

A patient is being administered a Graded Exercise Test in order to find his functional exercise capacity. if a PT confirms that the patient's PaCO has risen to > 10mmHg or is in fact > 65mmHg, what can be concluded in this situation? A PT who works in acute care at a local hospital is given a patient with increased pulmonary secretions/Aspiration/Atelectasis or collapse. According the patient's chart the Right middle lobe is the site of treatment. The PT is thinking of using the trendelenburg position to perform his treatment. If the patient is know to have any of the conditions below, what will be the next thing to do? - Circulatory system : Pulmonary edema, CHF, Hypertension - Abdominal problems: Obesity, ascites,pregnancy, hiatal hernia,nausea and vomiting, recent food consumption - Neurologicl system: Recent neurosurgery, increased intracranial pressure, aneurysm precautions - Pulmonary system: Shortness of breath Description: Excessive fluid between the visceral and parietal pleura. The main cuases of this condition are increased pleura permeability to proteins from inflammatory diseases such as : pneumonia, rheumatoid arthritis, systemic lupus, neoplastic disease, increased hydrostatic pressure within pleural space (CHF), decreased in osmotic pressure (hypoproteinemia), pertoneal fluid within the pleural space (ascites, cirrhosis) or interference of pleural re-absorption from tumor invading pleural lymphatics Description: A condition where air is in the pleural space, usually through a lacerated visceral pleura from a rib fracture or rupture bullae One reason for which a PT may not perform chest compressive manuevers and coughing in a patient with low platelet count is: One reason for which a PT may not perform chest compressive manuevers and coughing in a patient with pneumonia of carcinogenic origin is:

165.

Posterior basal segments

105.

What lung segment is being drained here? - Patient in trendelenburg and lying on abdomen, with pillow under hips. - Therapist claps over lower ribs close to spine on each side What lung segment is being drained here? - Patient is sitting leaning forward with forearm resting against a pillow at 30 angle - Therapist stands behind and claps over upper back on both sides A PT who works in acute care at a local hospital is given a patient with increased pulmonary secretions and/or aspiration or atelectasis or collapse. What physical therapy intervention will be appropriate for any of these indications? What will be an appropriate assistive device(s) for energy conservation for a pulmonary patient who finds showering very difficulty due to the activity itself and the humid environment that accompanies this task? Description: Excessive seepage of fluid from the pulmonary vascular system into the interstitial space. May be of cardiogenic or non cardiogenic origin Description: A thrombus from the peripheral venous circulation becomes embolic and lodges in the pulmonary circulation. A small emboli does not necessarily cause infarction

160.

Posterior segments

104.

Postural drainage

100.

Pleural effusion

141.

Provide a shower seat, hand held shower, and use of terry cloth robe after showering, so the patient does not have to stand, hold his/her breath as often, or dry off in the humid environment, thus reducing the energy cost of activity Pulmonary edema

98.

94.

Pneumothorax

93.

Possible Ecchymosis (bruising) Possible fractures from thoracic bone metastasis

99.

Pulmonary emboli

92.

133.

Pursed lip breathing

It is primarily for patients with OBSTRUCTIVE disease who experience dyspnea at rest or with minimal activity/exercise or who use an ineffective breathing pattern during activity/exercise This breathing exercise is used to reduce the respiratory rate, increase tidal volume, reduce dyspnea, decrease mechanical disadvantage of an impaired ventilatory pump, improve gas mixing at rest for patient with COPD, and facilitate relaxation What breathing exercise is being used here? - Slowly inhale through nose or mouth - Passively exhale (position the mouth as if you were blowing out candles) - Additional hand pressure from the therapist applied to abdomen can be used to gently prolong expiration - Abdominal muscle contraction can be used judiciously to increase exhale volume. Care must be taken NOT to increase intra thoracic pressure which might produce airway collapse. Defined as: volume of gas that remains in the lungs after ERV (maximal exhalation) has been exhale Defined as: The diffusion of gas across the alveolar capillary membrane Formerly known as hyaline membrane disease. Alveolar collapse in premature infant resulting from lung inmaturity, inadequate level of pulmonary surfactant If a Chest X-ray does confirm the presence of the classic granular pattern ("ground glass") caused by distended terminal airways and alveolar collapse. What condition is this finding associated with? Special population such as patients with spinal cord injury lack functional abdominal musculature. What characteristic this population exhibit in terms of resting position of the diaphragm and inspiratory reserve volume?

162.

Right middle lobe

132.

Pursed lip breathing

What lung segment is being drained here? - Patient in trendelenburg postion with head down on left side and rotates 1/4 turn backward. Pillow may be placed from behind from shoulder to hip. Knees should be flexed - Therapist claps over right nipple area. Signs & Symptoms of metabolic acidosis are?

63.

134.

Pursed lip breathing

Secondary hyperventilation (Kussmaul breathing), nausea, lethargy, and coma Segmental breathing

123.

This breating exercise is used to: - Improve ventilation of hypoventilated lung segments - Alter regional distribution of gas - Maintain or restore residual capacity - Maintain or improve mobility of chest wall and prevent pulmonary compromise This breathing exercise is used with patients who have pleuritic, incisional or posttrauma pain that is causing a decreased movement in a portion of the thorax or are at risk for developing atelectasis What breathing exercise is being used here? - Position patient to facilitate inhalation to a certain segment, such as postural drainage postions, Upright sitting - Apply gentle pressure to the thorax over the area of hypoventilation during EXHALATION - Increase to firm pressure just prior to inspiration - Ask patient to breathe in against resistance of the therapist's hand - Release resistance allowing a full inhalation A pulmonary patient at a local hospital is at risk for developing atelectasis or collapse. What breathing exercise is most appropriate to address this condition? What position should be used when performing diaphragmatic breathing? Which positions are most commonly found in patients with cardiopulmonary dysfunction?

124.

Segmental breathing

7.

Residual volume

127.

19.

Respiration Respiratory Distress Syndrome Respiratory Distress Syndrome

Segmental breathing

83.

86.

3.

Resting position of the diaphragm is lower in the thorax decreasing the inspiratory reserve volume

125.

Segmental breathing

119.

Semi-Fowler's position Semi-fowler's position in bed or sitting over the side of the bed or chair

170.

50.

Severe airway obstruction Shunt

Wheezes is normally heard during expiration, but which condition is wheezes may also be heard heard during inspiration? Defined as: 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 occuring. Drains Anterior Basal Segments (R or L) Drains the Anterior R or L apical segments (upper lobes

131.

Sustained maximal inspiration Sustained maximal inspiration Sustained maximal inspiration

It is used in acute situations for patients with post trauma pain, post operative pain, acute lobar collapse This breathing exercises is used to increased inhaled volume, sustain or improve alveolar inflation, maintain or restore functional residual capacity What breathing exercise is being used here? - Inspire slowly through nose or pursed lips to maximal inspiration - Hold maximal inspiration for 3 seconds - Passively exhale the volume what is being performed on the following procedure? - place the palms of your hands lightly on the chest wall ande ask the patient to speak a few words or say 99 several times Defined as the vibration felt while palpating over the chest wall as a patient speaks Keeping in mind normal adult levels of PaCO2, a therapist is getting ready to assist in performing a G.E.T. Baseline of PaCO2 = 40mmHg. During the test, the PaCO2 = 52mmHg. What is the next thing to do based on guidelines of termination criteria for G.E.T? Keeping in mind normal adult levels of BP a therapist is getting ready to assist in performing a G.E.T. Baseline of BP 122/84 mmHg. During the test, the BP = 108/84 mmHg. What is the next thing to do based on guidelines of termination criteria for G.E.T? Keeping in mind normal adult levels of BP a therapist is getting ready to assist in performing a G.E.T. Baseline of BP 122/84 mmHg. During the test, the BP = 254/82 mmHg. What is the next thing to do based on guidelines of termination criteria for G.E.T? Keeping in mind normal adult levels of BP a therapist is getting ready to assist in performing a G.E.T. Baseline of BP 122/84 mmHg. During the test, the BP = 140/106mmHg. What is the next thing to do based on guidelines of termination criteria for G.E.T? A therapists is getting ready to assist in performing a Graded Exercise Test (GET). Keeping in mind normal adult levels of PaO2. Baseline PaO2 = 90mmHg for this patient. During the test, the PaO2 is measured to be 54 mmHg. What is the next thing to do based on guidelines of termination criteria for G.E.T?

29.

128.

129.

153.

Sidelying in trendelenburg Sitting upright in bed or chair Sterile gloves/clean gloves steroids Suction Catheter

148.

177.

116.

What kind of medical asepsis should be used when performing endotracheal suctioning? Medications within pulmonary population that usually mask vital signs are: After performing assisted cough on a spinal cord injury patient, the PT notices that expectoration for this patient is problematic (has difficulty clearing secretions), what equipment should be used to help this patient? What lung position is being drained here? - Patient lying on abdomen with pillows under hips (which position hips approximately 45 angle) - Therapist claps over middle of back at tip of scapula on either side of spine Normal abdominal tone holds the abdominal contents directly under the diaphragm, assisting the return of the diaphragm to the normal high domed position. When a patient lacks functional abdomina musculature such as SCI patient, the diaphragm is lower in thorax dcreasing inspiratory reserve (IRV). The more upright body posiiton the lower the diaphragm and the lower the inspiratory capacity. what position is most advantageous for the diaphragm? If a patient either O2sat < 88% or PaO2 < 55 mmHg, what is the next thing to do? Regardless of activity, if Oxygen saturation levels decrease to less than 88% or PaO is less than 55mmHg, then: A recently diagnosed pulmonary patient has a documented PaO < 55 mmHg. What can be concluded about this patient before therapy session is initiated?
183. 176.

Tactile fremitus

31.

Tactile fremitus Terminate GET

112.

184.

167.

Superior segments

189.

Terminate GET

178.

Supine position

188.

Terminate GET

185.

Terminate GET

191.

Supplemental Oxygen Supplemental Oxygen is indicated Supplemental oxygen is needed

145.

Terminate GET

17.

182.

Terminate GET

A therapists is getting ready to assist in performing a Graded Exercise Test (GET). Keeping in mind normal adult levels of PaO2. Baseline PaO2 = 90mmHg for this patient. During the test, the PaO2 is measured to be 68 mmHg. What is the next thing to do based on guidelines of termination criteria for G.E.T? A patient is in the cardiopulmonary lab at a local hospital. A Graded Exercise Test (GET) is being administered in order to find his functional exercise capacity. During the test, the PT notices that PaO has decreased to < 55mmHg. The most appropriate course of action to take is: A patient is in the cardiopulmonary lab at a local hospital. A Graded Exercise Test (GET) is being administered in order to find his functional exercise capacity. During the test, the patient is showing signs of exercise discomfort. The Pt suspects that the patient's PaCO has either increased to > 10mmHg or is in fact > 65mmHg. If the PT does confirm that either of the two condtions is true, what is the next thing to do? A patient is in the cardiopulmonary lab at a local hospital. A Graded Exercise Test (GET) is being administered in order to find his functional exercise capacity. During the test, the PT notices that the patient developed symptoms of fatigue. The most appropriate course of action to take is: A patient is in the cardiopulmonary lab at a local hospital. A Graded Exercise Test (GET) is being administered in order to find his functional exercise capacity. During the test, the PT checks for Blood pressure. If the patient SBP is either > 250mmHg, or DBP increases to > 20mmHg from baseline or BP decreases with increasing workload. What should the PT do if any of these conditions is confirmed to be true? If a patient while performing a Graded Exercise Test shows any of these conditions, what should the PT do? - Leg pain, TOTAL fatigue, sings of insufficient cardiac output - Reaching a ventilatory maximum A patient is in the cardiopulmonary lab at a local hospital. A Graded Exercise Test (GET) is being administered in order to find his functional exercise capacity. During the test, the PT notices that PaO has increased to > 20 mmHg. The most appropriate course of action to take is:

68.

Terminate GET

A patient is in the cardiopulmonary lab at a local hospital. A Graded Exercise Test (GET) is being administered in order to find his functional exercise capacity. During the test, the PT notices that the ECG readings shows Cardiac Ischemia and/or arrhythmias. The most appropriate course of action to take is: A patient is in the cardiopulmonary lab at a local hospital. A Graded Exercise Test (GET) is being administered in order to find his functional exercise capacity. During the test, the PT notices that the patient is showing signs of Maximal Shortness of Breath. What is the most appropriate course of action to take? Two pulmonary patients have been prescribed two different medications to treat their airway reactivity and decreased mucosal edema. One of them is taking Vanceril (beclomethasone, MDI) and the other Azmacort (triamcinolone, MDI) What is the main side effect of inhaled steroids? Defined as: volume of gas inhaled (or exhale) during a normal resting breath Defined as: ( IRV + TV + ERV + RV). The amount of air that is contained within the thorax during a maximum inspiratory effort. This airway clearance technique is used with patients who are unable to cough on command, such as infants, and patients following brain injury or stroke What airway clearance technique is being used here? - The therapist's finger or thumb is placed just above the suprasternal notch and quick inward and downward pressure on the trachea elicits the cough reflex Bronchogenic Carcinoma referes to a tumor which arises from the brochial mucusa. Smoking and occupational exposures are the most frequent causal agents. A pertienent finding during examination of this condition in addition to dyspnea, weakness, fatigue, wheezing, atelectasis or bacterial pneumonia will include: The best position for airway clearance techniques such as coughing is:

66.

Terminate GET

64.

Terminate GET

67.

Terminate GET

143.

Thrust

69.

Terminate GET

4.

Tidal volume Total lung capacity Tracheal Stimulation

12.

70.

Terminate GET

113.

114.

Tracheal Stimulation

71.

Terminate GET

90.

Unexplained weight loss, and Hemoptysis

65.

Terminate GET

106.

Upright sitting position

61.

Vague symptoms: weakness, mental dullness, possibly early tetany Viral Pneumonia viral pneumonia or pneumocystis pneumonia Vital Capacity Wheezes Wheezes and crackles with decreased breath sounds When more rapid or deeper inhalation is required or in disease states Whispered pectoriloquy

Signs & Symptoms of metabolic alkalosis are?

73.

A condition where interstitial or intra-alveolar inflammatory process caused by viral agents (influenza, adenovirus, cytomegalovirus, herpes, parainfluenza, respiratory syncytial virus, measles) If a chest X-ray confirms the presence of interstitial infiltrate, What conditions is this finding associated with? Defined as: The amount of air that is under volitional control conventionally measured as forced expiratory vital capacity (IRV + TV + ERV) A musical pitched sound, usually heard during expiration caused by airway obstruction (asthma, chronic obstructive pulmonary disease, foreign body aspiration). In addition to common signs & symptoms such as fever, chills, dry cough, headaches, hypoxemia and hypercapnea, tachypnea, cyanosis etc. A pertinent finding that may not be found in viral pneumonia but found in aspiration pneumonia is: When is accessory muscles of inspiration most likely to be used?

76.

10.

49.

75.

2.

174.

Which technique is being demonstrated here? - Patient is asked to whisper a word. whisper "99", and the whispered words are clearly and distinctly heard through the stethoscope. Occurs when whispered sounds are heard clearly during ausculation

53.

Whispered pectoriloquy