PCE page 75-125

___ - (e.g. fibrosis; asthma) Lung expansion is diminished and volume of air or gas moving in and out of the lungs is decreased - Decreased chest wall or lung compliance (or both) - become stiff and difficult to expand

____- Decreased lung compliance, stiff S&S: - Dyspnea - Severe O2 desaturation - Finger clubbing - Scarring (via CT scan)
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___ - (e.g. fibrosis; asthma) Lung expansion is diminished and volume of air or gas moving in and out of the lungs is decreased - Decreased chest wall or lung compliance (or both) - become stiff and difficult to expand

____- Decreased lung compliance, stiff S&S: - Dyspnea - Severe O2 desaturation - Finger clubbing - Scarring (via CT scan)
Restrictive Pulmonary disease - Rx: treat secondary infection, chest PT to help pt breath on their own.


Interstitial Lung Disease - Rx:O2 therapy - Pulmonary rehab - Lung transplant
____ - chronic, progressive, fibrosing condition, isolated to the lung tissue - Unknown etiology; either sporadic or familial, possibly TB, possibly inhaling harmful chemicals

___ - scarring and fibrotic tissue in the lung with no known cause. Type of interstitial lung disease that affects tissue and space around alveoli, not directly affecting the airways or blood vessels.
(Interstitial) Pulmonary Fibrosis - Rx: Pulmonary Rehab with aerobic exercise

Idiopathic Pulmonary Fibrosis
____ Interstitial pulmonary fibrotic disease caused by asbestos exposure (inhalation of harmful particles)

___ - interstitial lung disease caused by inhalation of coal dust over a long period of time. Complications often include: emphysema, chronic bronchitis, TB, R sided heart failure and PE
Asbestosis - Rx: Mobilization - Relaxation/energy conservation education - Manual techniques and suctioning

Coal Worker's Pneumoconiosis - Rx: Pulmonary PT
_____ - Chronic inflammation of the lungs/chronic inflammation disorder of the airways , characterized by bronchoconstriction, mucus secretion and airway narrowing via chronic remodelling

___ o Due to allergen o Mast cells release mediators which cause broncospasm and hypersecretion o Kids>adults
____ o Hypersensitivity to bacteria, virus, drugs, cold air, exercise, stress o Adults>kid
ASTHMA - Rx: education, Resp therapy, ACB, diaphragmatic breathing, aerobic exercise

Allergic or atopic (extrinsic)

Non allergic (intrinsic)
____ - infectious, inflammatory systemic disease that affects the lungs - due to airborne particles - Granulomas in lung tissue - Can disseminate to involve other organs

___ - Accumulation of fluid in the pleural space due to disease and results in decreased lung expansion (usually due to heart disease/congestive heart failure)
Tuberculosis - Rx: pt history, (wear PPE), and medicaiton

Pleural effusion (dull percussion/absent breath sounds)
___ - Increased fluid in interstitial spaces and alveoli - cause by heart or kidney failure, increased alveolar pressure

___ - Inherited autosomal disorder affecting all exocrine glands (including airways, sweat glands, pancreas, bilary tract and gut) - Dx with sweat test and FmHx
Pulmonary edema (fine crackles/pink sputum) Rx: vent/circulation support and anticoagulants

Cystic Fibrosis - Rx: Prophylactic chest PT - drainage, percussion, forced expiration, ACB, PEP mask, autogenic drainage, improve vent strength.
____ - due to atherosclerosis, obstruction of blood vessels (both arteries and veins) suppling extremities and major abdominal organs. - Usually have pain during activity, most often in calf, but can be in thigh

____ - due to endothelial damage in the arteries of the peripheries, resulting in blockage and subsequently abnormal blood flow to peripheries. Decreases body's ability to meet metabolic demands of muscle
PERIPHERAL VASCULAR DISEASE - Rx: Exercise - ADL modification dependent on claudication - Management of co-morbidities - Energy conservation

Peripheral Artery Disease (type of ^^) RX:
Aerobic F: 3-5 days/wk
I: Moderate. ¾ on claudication scale or RPE 4-5/10
T: 30-60 mins. 10 min bouts with breaks in between. Start at 15 mins/day and increase by 5 mins every 2 weeks.
T: Weight-bearing exercise
Resistance Training
F: 2 days/wk, 2 day rest
I: RPE 4-5 T: 10-15 reps, 2-4 sets, 2-3 min rest between sets
T: Multi-joint exercises involving major muscle groups
___ - partial or complete occlusion of a vein by a thrombus with secondary inflammation (superficial or deep)

___- blood clot that forms in a deep vein of the leg or pelvis either partially or totally blocking the flow of blood - Can become pulmonary emboli
Thrombophlebitis

DVT
____ - inadequate venous return over a prolonged period, can cause blood to collect in veins

___ - faulty valves cause abnormal dilation of veins and leads to twisting and turning of vessels which puts pt at risk for thrombosis
Chronic Venous Insufficiency

Varicose Veins
____ - volume of air that can be expired in 1 sec after max inspiration - normal is 80% VC - ___ and __ = decreased


____ : size of heart in relation to thorax
Forced Expiratory Volume 1 (FEV1)

Restrictive and obstructive (Obstructive is more decreased)

Cardiothoracic index
Breath Sounds: ___ - low-pitched, soft sound during expiration heard over most of the lungs ___ - Medium intensity and pitch - where bronchi and central lung tissue are more superficialVesicular Bronco-vesicularBreath Sounds: ____ - high-pitched and longer, heard primarily over the trachea ___ - Due to air bubbling, discontinuous low-pitched sounds ___ high pitched sound during inspiration, always obstructed b/o inflammation - trachea and upper segmentsBronchia Crackles - Early insp = Pulmonary Edema, Late Insp = atelectasis, both = excessive secretions = resp infection Stridor___ - continuous high or low pitched, mono or polyphonic, occurs with expiration ___ - creasking sound hear during inspiration and expiration b/o parietal and visceral pleura rubbing. = inflammation of pleural layersWheeze - always obstructive bronchospasm, Asthma and Congestive heart failure (CHF) Fiction rub - occasionally when chest tube in placepH: 7.__ to 7.___ PaCO2: ___-___ (resp level, over ___=acid) HCO3 - :___-__ (met level, over 26=base)7.35-7.45 (over 7.45=base=) 35-45 (resp level, over 45=acid) 22-26 (met level, over 26=base)_____ - Indications - ineffective cough in the following: SCI, chemically paralyzed, weak resp muscles Contraindications - ruptured diaphragm ____ - Indications - adjunct to manual techniques, assist with secretion clearance, useful for thoracic/abdominal surgery pt who find that increased pressure from closed glottis impairs ability for effective coughAssisted Cough - Precautions - inferior vena cava filter, rib #, abdominal or thoracic surgery, pneumothorax, perforated bowel Huffing____ - take breath, hold, add breath, hold, and repeat until capacity is reached, slow exhalation (can follow with pursed lip breathing Contraindications to postural drainage: - Active ___ with hemodynamic instability - Active hemoptysis (blood in sputum) - Pulmonary edema association with ___ - Aged, confused or anxious pt Contraindications for Trendelenberg: - *Uncontrolled airway at risk for aspiration - Increased ___ - Uncontrolled___ - Distended abdomenSegmental breathing hemorrhage, HF ICP, HTNContraindications to Manual resp techniques: - Subcutaneous emphysema (bubble feeling - painful) - Recent ___ - Recent skin graft on thorax - Burns, ___ or infection on thorax - Recently placed pacemakers - Suspected TB - Lung contusion - ____- Bleeding disorder - ____ painepidural, open wounds, Osteoporosis, Chest wallGeneral Instructions for Positive expiratory pressure device. - 3 sets, ___ followed by ___huffs - Take slightly larger than normal breath - Breathe out through the device past point of ___ for __ seconds - Keep nanometer at ___ cm line10 breaths - 2-3 huffs exhalation, ~7 secs (this isn't forced expiration) 20cmoscillating PEP device ____ - Tilt head to change vibration, but need to be sitting up for it to be effective - Contraindications: increased ___, nausea, vomiting, angina, ___ (due to back pressure) ___ can be used in supine ___ - can be used with a nebulizer so pt can also breathe in with device, has to be used sitting up, good for COPDFlutter ICP, pneumothorax Acapella Aerobika___ - Purpose: provide visual input in regarding inspiratory effort as a menas of encouraging pts to take slow, deep breaths several times an hour ___ - for those who cannot produce a cough (ie. GBS) [relatively new] - Set inspiratory pressure and expiratory pressure, delivered by machine in a closed systemIncentive Spirometry Cough Assist (Intra-pulmonary percussor ventillation)Pulmonary rehab - Aerobic Prescription a. For those with well- controlled asthma or COPD F:___ I: RPE __/10 T: __ mins/day of continuous or intermittent physical activity T: ___ b. For those with moderate to severe COPD F:___ I: ___ T: ___T: ___ c. Resistance training - same as the guidelines for older, healthy adults F:___ I: RPE __ T: ___ SPO2 should not fall below ___ Borg should not be above__F: 3-5 day/wk - Same for B. 2days wk for C (Resistance). I: 5-6/10, B: 60-80% (so 3-5/10), C: 5/10 T: F: 20-60min, B: intermittent until able to tolerate constant, C: 10-15 reps T: A&B: walking/cycling. C: major muscle groups (8-10 exercises) 88% 5___ - rare sex linking genetic disorder which results in a deficiency of plasma clotting factor ____ - decreased Hb count, effects how much O2 can be delivered to the rest of the body ___ - decreased WBC count, regulates body's ability to fight infectionHemophilia - RICE - work with HCP Anemia - scale back exercise if below 8g/dL Neutropenia - avoid public exercises____ - low platelet count, norm 150-400,000 mcL - Increased risk of bruising or bleeding ___ - hyperthyroidism, F>M o Autoantibodies stimulate the thyroid (TSH receptor), T3 and T4 will be high (these inhibit the secretion of TSH) ___- hypothyroidism, F>M o Autoimmune destruction of thyroid gland, T3 and T4 are low, TSH is highThrombocytopenia - if lower than 10,000 no exercise just ADLS. GRAVES' DISEASE HASHIMOTO THYROIDITISLiver disease ___ -Virus transmitted by fecal oral route, usually self-limiting bout o RISK FACTORS § International travel, daycare, vaccine available ___ - Transmission § Percutaneously (needle stick, drug use) § Non percutaneous (sexual), Hemodialysis ___ - Infection of liver, can persist and become chronic, long standing can lead to cirrhosis (scarring/fibrosis of liver) and hepatocellular carcinoma (primary liver cancer)Hepatitis A Hepatitis C Hepatitis B - spread from mother to child - lesser spread through sex/drug useAutoimmune diseases ___ - Chronic excess glucocorticoid (cortisol) secreted from adrenal cortex à affects metabolic function, stress response, inflammatory and immune responses ___ -Also known as primary adrenal insufficiency & hypocortisolism o Autoimmune destruction of adrenal cortex o Adrenal glands cannot produce enough steroid hormonesCUSHING'S DISEASE ADDISON'S___ - Affects the entire GI tract from mouth to anus, small and large intestine • Ulcers, fissure and fistulas, get alterations in digestion and absorption & malnutrition ___ Same as ^^ but no skipped lesions, Affects only the colon, Can have significant bleeding and anemiaInflammatory bowel disease CROHNS - Can have skipped lesions - wound/inflammation skips a segment and it is unharmed (normal) ULCERATIVE COLITIS___ - congenital malformation of lymph system ___- cancer (lymph node removal and radiation), trauma, infection, venous disease, endocrine disease, immobility and limb dependency, morbid obesityPrimary (inherited) Lymphedema Secondary (acquired) Lymphedema Rx: Compression is most important.. Gentle resistance stimulates muscle pumps and increases lymph flow - Aerobic increases intra-abdominal pressure which facilitates pumping of thoracic duct____ - Presence of whole body inflammatory state (SIRS) and presence of known or unknown infection ____: - Severe sepsis, but hypo/perfusion abnormalities in spite of adequate fluid resuscitation - Immune system spirals out of control ___ - Poor distribution of blood at the microcirculation level - Decreased tissue perfection = needs of cell are not met and leads to cell deathSepsis/infection - SIRS - System Inflammatory Response Syndrome - Whole body in state of inflammation Septic shock Shock:*Red flags for antepartum through pregnancy - Changes in ___, or sexual function - ___ LBP - ___ pain ____ - pregnancy induced, acute HTN after 24 wks gestation ___ - due to increased fluid, hormone changes, poor lifting or carrying techniques of toddler/newbornbowel and bladder, Non-mechanical, Suprapubic or groin Preeclampsia Carpal Tunnel Syndrome____ - complaint of any involuntary leakage on effort or exertion, or on sneezing or coughing Incoordination, PFM +/or sphincter weakness, pain, increased intra-abdominal pressure (pregnancy, obesity, chronic cough) _____ - neurological, idiopathic, infection, environmental/learned _____ - complaint of involuntary leakage association with urgency and with exertion, effort, sneezing or cougingStress incontinence Urge incontinence Mixed incontinence Other - overflow, obstruction, neurological (injury, reflex bladder, dyssynergy, SCI/MS/Parkinson's etc.), transient (UTI, medication)____ - form of dermatitis or inflammation of epidermis - Itchy, red, scaly disorder 2 types: ____ - genetic tendency to develop an intensely, itchy, inflammatory skin disorder ____ - Allergic - immune hypersensitivity to an allergen in contact with the skin (poison ivy) Irritant - contact of skin with something that primarily causes direct local irritation (harsh detergents, chemicals) ___- (dandruff) - Occurs in areas of higher sebaceous gland activity (oily areasEczema Atopic Dermatitis Contact Dermatitis Seborrheic DermatitisZones (Jackson's Burn Wound Model) ____ - cell death and immediate coagulation of cellular proteins ___ - damage resulting in compromised circulation (untreated will lead to necrosis) ___ - damage causing inflammatory mediators and leading to dilation of blood vesselsZone of coagulation Zone of stasis Zone of hyperaemia___ - Chronic autoimmune - one of the most serious rheumatic diseases - Affects any organ; range of microvascular, biochemical and hematological abnormalities ___ - Unknown etiology characterized by fibrosis of skin and visceral organs, accompanied by specific antibodies and microvascular disturbances - Intermediate: CREST syndrome o Calcinosis (not in jt, what differentiates it from gout) o Raynaud's o Esophageal dysmotility (dysphagia) o Sclerodactyly o TelangiectasisSystemic Lupus Erythmatosus (SLE) - Rx: HEP for arthritis - reduce pain, stiffness, and inflammation, improve jt ROM and functional mobility - Protection from sun exposure - Management of fatigue, Aerobic exercise for mild SLE. Progressive Systemic Sclerosis (Scleroderma) - Rx: Paraffin wax and hand exercises o ROM best started prior to loss of range o Multi-jt stretches o Performed frequently and aggressively____ - Causes striated muscle weakness in neck, trunk, proximal limb muscles and pharynx - Females>males - Exacerbations and remission ___ - etiology unknown, chronic pain syndrome affecting muscle and soft tissue (non-articular rheumatism)Polymyositis and Dermatomyositis (Derma = Poly but with rash) - Rx: Prevent/decrease contractures, maintain/increase muscle strength, maintain function FIBROMYALGIA____ - cells target immune cells(CD4+ cells) ____ defective type I collagen synthesis w/ slow formation and turnover à bone fragility & frequent fracturesHuman Immunodeficiency Virus OSTEOGENESIS IMPERFECTA:____: uterine packing problem Foot DF and everted at birth, spontaneously corrects if not rigid/stiff ___ - postural deformity d/t unilateral contraction/shortening/ischemia/fibrosis of SCM à skull abnormalities and potentially TMDCALCANEOVALGUS FOOT TORTICOLLIS: - RX à parental education++, positioning (play, cuddling, etc), passive stretching (careful, progressive, slow