Current cardiopulmonary problem Evidence for each problem based on clinical

features Most likely pathophysiological basis for each problem Treatment

Impaired airway clearance ? Ausc: inspiratory crackles in LL
? Known infection + difficulty expectorating
? Febrile
? Change of colour/ consistency of sputum
? Increased WCC/CRP suggesting inflammation (pneumonia)
? Moist cough
? CXR: consolidation Impaired Cough d/t pain ? decreased exp flow ?
impaired airway clearance Supported huff/cough
Analgesia to decrease pain
Impaired MCC caused by infection / smoking

Pneumonia = infection & sputum retention ? decreased cilia function ? inability to

clear secretions ? impaired airway clearance ABx to decrease infection
ACBT / TEE ? increase VT ? increase expiratory flow rate ? shear secretions
from CW
Ambulate/SOOB ? Increase VT ? increase expiratory flow rate ? shear
secretions from CW
Humidification
Nebulisation
VHI/MHI (improved alveolar ventilation by collateral ventilation & lung
interdependence
Impaired gas exchange ? Oxygen supply
? Decreased SpO2
? ABGs Respiratory acidosis (high CO2, low pH, low O2)
? Hypoxaemia
? CXR: hyperinflation / low, flat diaphragm Surg = Atelectasis ? decreased
ventilation ? V/Q mismatch ?
Hypoxaemia ? impaired gas
exchange Mobilise = natural deep
breaths ? increase exp force
? shear secretions
Sit upright = increase FRC ? increase alveolar ventilation
? increase gas exchange
SMI = increases FRC by
breath hold via
collateral ventilation/lung interdependence
Oxygen supply
COPD = Destruction of alveoli
walls ? decrease
SA ? V/Q mismatch ?
hypoxaemia ? impaired gas
exchange
Pneumonia = shunt ? V/Q
mismatch ? hypoxaemia ?
impaired gas exchange
Diffusion limitation
(emphysema)
Hypoventilation (neuro)
Airflow limitation ? COPD
? Decreased FEV1/FVC
? Decreased CE
? CXR: hyperinflation horizontal ribs, low flat diaphragm, barrel chest
? Increased FRC, TLC
? Ausc: wheeze on expiration
? Tight cough
? Adaptive breathing pattern: PLB, prolonged expiration time, increased
abdominal effort COPD = loss radial traction ? floppy airways ? early airway
closure ? obstruction of airways on exp ? increase resistance to exp flow ? airflow
limitation PLB = supplies PEEP ? splints airways open ? increases exp time ?
increases quantity of CO2 expelled ? decreases gas trapping ? decrease WOB
Forward lean = diaphragm is at a mechanical advantage ? pushes up on
abdominal contents ? increases LV ability to expand
UL fixation = fixes
accessory m/s ? switches O/I ? allows accessory m/s to assist with breathing ?
decreases dyspnoea
Bronchodilator
Asthma ? bronchoconstriction

Reduced lung volume ? Surgery

? Recumbent positioning / bed rest
? Atelectasis
? Increased RR / rapid shallow breathing d/t pain
? CXR: atelectasis / consolidation
? Ausc: decreased BS / insp crackles (late-fine) indicates atelectasis
? Reduced CE Pain ? rapid shallow breathing Sit upright increases
FRC ? increase alveolar inflation
CPAP = increases FRC
SMI = increases FRC by
breath hold via collateral ventilation/lung interdependence
Surgery / recumbent / anaesthesia ? Decreased surface area of alveoli ?
atelectasis ? reduced FRC ? reduced LV
Dyspnoea ? Borg scale
? Subjective
? Increase RR COPD = loss radial traction ? floppy airways ? early airway
closure ? gas trapping ? static hyperinflation ? horizontal ribs/low flat diaphragm
= mechanical disadvantage ? increase use of accessory m/s ? increased O2
requirement ? weakness ? increase lactic acidosis ? increase WOB ? increase RR ?
dynamic hyperinflation ? dyspnoea PLB = supplies PEEP ? splints airways
open ? increases exp time ? increases quantity of CO2 expelled ? decreases gas
trapping ? decrease WOB ? decrease dyspnoea
Forward lean = diaphragm is at a mechanical advantage ? pushes up on
abdominal contents ? increases LV ability to expand
UL fixation = fixes
accessory m/s ? switches O/I ? allows accessory m/s to assist with breathing ?
decreases dyspnoea
Pneumonia = lungs inflamed and infected and filled with fluid ? shunt ?
V/Q mismatch ? hypoxaemia ? impaired gas exchange ? inability to meet ventilatory
demands ? dyspnoea
Decreased exercise tolerance ? Subjective COPD = loss radial traction ?
floppy airways ? early airway closure ? gas trapping ? static hyperinflation ?
horizontal ribs/low flat diaphragm = mechanical disadvantage ? increase use of
accessory m/s ? increased O2 requirement ? weakness ? increase lactic acidosis ?
increase WOB ? increase RR ? dynamic hyperinflation ? dyspnoea ? decreased ex
tolerance Education that ex when breathless is not harmful
Spiral of disability deconditioned if dont exercise then become breathless
with less activity
Pneumonia = Pneumonia = lungs inflamed and infected and filled with
fluid ? shunt ? V/Q mismatch ? hypoxaemia ? impaired gas exchange ? inability to
meet ventilatory demands ? dyspnoea ? fatigue ? decreased ex tol
Pain ? Subjective Pleura = sharp, stabbing pain
Cardiac = severe pressure, ache, squeezing, tightness left of sternum, jaw, L
arm, neck Analgesia
Respiratory muscle dysfunction ? Abnormal breathing pattern paradoxical
? Resp muscle weakness
? Neurological complications
? Dyspnoea Increasing resp muscle strength
Musculoskeletal dysfunction COPD = stiff CW / kyphosis Muscle
strengthening and stretching
Neuromuscular = abnormal postures ? increase CW stiffness
Dysfunctional breathing pattern ? Abnormal breathing pattern paradoxical
? Resp muscle weakness
? Neurological complications
? Dyspnoea
? Airflow limitation Decrease WOB by relaxed breathing
Ventilation for SCI

Short term goals ? increase mobilisation / weaning O2 / 6MWT / increase ADL /

Improve Ausc, CXR, ABGs

Long term goals ? pulmonary rehab program / (PFT) Spiro / decreased admissions /
increase QOL / CRDQ