MU PT 7890, Case Mgmt I, Acute and Chronic Medical & Surgical Conditions
Chap.
Page
1 – Anatomy
9
11-12
2 – Physiology
52-53
20
28
53
55
57
61
64-65
4
CHF
5 – RLD
120-121
121
141-142
185
186
186-187
188
212-213
216-217
220-231
220-221
242
6 -- COPD
245-247
249
257-259
Chap.6
258
258
10 – Pulm. Testing
432
434 435
436
436-437
438
439-442
443
446
PULMONARY – Hillegass
(… and a few other sources)
Mediastinum Fig. 1-4
Pleurae. Also, the CLINICAL NOTE on p.12 has important info about referred pain. You will
be relating this anatomical info to the pathologies described in p.212-214, including Fig 5-13,
Fig 5-14
Lung anatomy Fig.1-10, Fig.1-11; especially note the alveolar level
Vascular system, Fig.1-16. Note the difference in both volume and pressure for arterial vs.
venous
Gas Transport System, Ventilation (pay attention to these definitions) Fig.2-2. Ventilation=V,
Perfusion=Q. Diffusion at the alveoloar level is further described on p.436: DLCO. Also see
O'Sullivan p.563: "Respiration"
Chest wall motion - normal and C5 quadriplegia, Fig.2-3; also see p.220-221 Table 5-3:
Innervation levels of Respiratory Muslces, Fig.5-17: Paradoxical Breathing
Lung volumes Fig.2-5; Also see O'Sullivan p.562
Dependent ventilation Fig.2-7; also see Pulmonary blood flow p.67 Fig.2-16
Airway closure with forced expiration for the person with emphysema, Fig.2-13 "E" (more info
will be posted on the website to explain this). Also see p.619, Fig.16-5.
Oxyhemoglobin Dissociation Curve (don't worry … more explanation will be posted on the
website)
Paroxysmal Nocturnal Dyspnea PND
Orthopnea
Polycythemia, Anemia, Desaturation, Thrombocytopenia (anemia definition p.781)
Restrictive Lung Disease: Impairments and Pathologies - S&S - Fig.5-1
Restrictive Lung Disease RLD - lung volumes - F5-3
Work of Breathing (WOB)
* Restrictive Lung Disease RLD - S&S - Table 5-1
Pleural effusion: Fig.5-13; Clinical Note; Fig.5-14; Pneumothorax. Anatomy covered previously
in p.11-12. More posted online.
Pulmonary Edema: etiology & pathophysiology
RLD: Neuromuscular p.220-227 -- Musculoskeletal p.227-231
Innervation levels of Respiratory Muslces: Table 5-3, Paradoxical Breathing in SCI: Fig.5-17
Pneumothorax (PTX): Open PTX = ipsilateral tracheal deviation due to atelectasis;
Tension / Closed PTX = contralateral tracheal deviation  life threatening
RLD: caused by thoracic surgery
RLD: oxygen toxicity
COPD: intro, features, key concepts.
Focus on these COPD conditions: CF, Asthma, Bronchiectasis, Chronic Bronchitis,
Emphysema
Polycythemia
Pulmonary (artery) Hypertension: caused by damaged alveoloar/vascular tissue; leads to R
Heart Failure, Cor Pulmonale
Test for FVC: Fig.10-13
Pulmonary Function Tests (PFT): diagram comparing FEV1 & FEV1/FVC for normal, COPD,
and RLD, Fig.10-16, also Clinical Note
Pulmonary Function Tests - PFT with Bronchodilation (read in the 2nd column, the paragraph
starting: "The various tests…")
DLCO: test of Diffusion of O2 & CO2 at the alveolar / capillary junction
Flow Volume Loops, text and Fig.10-17. More examples posted on website.
Acid-Base (skip “Henderson-Hasselbalch Equation”)
read the Clinical Note in the lower right hand corner. Very important! It describes typical ABG
for acute vs. chronic respiratory conditions
Lab values for Complete Blood Cell Count (CBC): Hct, Hgb, RBC, WBC, platelets
12
13 -- Acute
485-486
486
512
519-521
526-528
529-530
16 –
Assessment
610644
616
17 -- Acute Intervention
623
623
625-628
653
659-660
660-661
666
19 – Pulm. Rehab
736-738
738-740
741-742
784




Lung Volume Reduction Surgery LVRS
BiPAP
Clinical Note: SBP Changes (7-8mm / MET) etc.
Airway adjuncts: Endotracheal tube (oral or nasal), Tracheostomy tube
FiO2 - Fraction of Inspired Oxygen (for various devices) Table 13-3; Clinical Note p.527
Incentive spirometer (inspiratory resistance device): focus on the Volume spirometers, not the
Flow type
Cardiovascular and Pulmonary Assessment (skip “Murmurs” p.629-630)
Angina - differential diagnosis Table 16-1, also p.632,: chest wall pain, and p.642-3:
types of angina
Clubbing of the digits, Fig.16-12
Sputum and cough characteristics, Table 16-3
Breath sounds, Voice sounds, Adventitious sounds: Table 16-5
Active Cyle of Breathing Techniqu (ACBT): also described in O'Sullivan p.581
Inspiratory Muscle Training: Weaning from ventilator: starts with a "sniff". Be careful not to
promote paradoxical abdominal contraction with inspiration! Resistive inspiratory training is
generally not proven / indicated for COPD unless in very early stages. Persons with RLD
secondary to neuromuscular pathology may be candidates, e.g. SCI (Kisner & Colby p.752-753
also address this). Controversial aspects: read Clinical Notes on pages 660, 742, 742. There
is a protocol for Inspiratory Muscle Trainers (IMT) on p.741-742
Chest Wall Stretching: therapist provides a quick-stretch (compression) prior to inspiration, etc.
Kisner & Colby -- sections we will be referring to in Pulmonary Lab: Breathing Exercises &
Ventilatory Training p.749-750; Diaphragmatic Breathing p.750-751; Lateral Costal Expansion
p.753-754; Pursed Lip Breathing (PLB) p.754-757; Coughing p.758-760; Postural Drainage &
Percussion p.760-766
O'Sullivan -- Pulmonary Meds: p.569 Table 15-2; p.570 Table 15-3
O'Sullivan -- Guide to PT Practice: Pulmonary Outcomes p.572
Dyspnea Index (2nd column) "… take a deep breath and count to 15 slowly …"
Relief of Dyspnea: note the difference in that for COPD, Pursed Lip Breathing (PLB) slows
respiratory rate and provides Positive Airway Pressure (PAP) all of which decreases their Work
of Breathing (WOB); however for RLD you do NOT want to slow their respiratory rate because
their Tidal Volume (TV) is fixed (Ve = TV x RR), so instead the patient with RLD will be more
energy efficient by taking rapid shallow breaths! Dyspnea postures. Pulse Oximetry (SpO2)
values with execise. Dyspnea Scale, Table 19-4 (see also p.686 Table 18-8)
Exercise prescription for mild, moderate, severe lung disease; Relief of Dyspnea
Respiratory Muscle Exercise: Inspiratory Muscle Trainer device (IMT), see also p.659-660
Atelectasis - definition
Minute Ventilation (Ve) = Tidal Volume (TV) x Respiratory Rate (RR)
Cardiac Output (CO) = Stroke Volume (SV) x HR
Cardiac Index (CI) = Cardiac Output (CO) / body area
Ejection Fraction (EF) = Stroke Volume (SV) / End Diastolic Volume (EDV)