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Interstitial Pulmonary Fibrosis/Peripheral Vascular Disease (ICF…
Interstitial Pulmonary Fibrosis/Peripheral Vascular Disease
Medical Management
PVD
:
Diagnostic Testing
Doppler, ABI, angiogram, MRA, CTA
Pulmonary Function tests: FEV1 = 2.8L (60% predicted), FVC = 3.0L (64% predicted), FEV1/FVC ratio = 93%
Treatment
Medications: blood pressure, antithrombotics, diuretics, beta blockers
Interstitial Pulmonary Fibrosis:
Diagnostic Testing
VQ Scan, Pulmonary Function Test, chest x-ray
Treatment
Activity modification: Avoid exposure to toxins, utilize portable
respirators and masks with extremely
fine pores
Medications: Corticosteroids, Immunosuppressive therapy, Oxygen, Pulmonary vasodilators
ICF
Body function and structure
SOB since age 35, severe chest tightness
Moderately severe intermittent claudication in right calf
Activities
SOB with ADL's
Difficulty working on the farm
Participation
Actively works on the family farm
Avid tractor-pull participant
Frequently tips cows in the field
Goes to the rodeo and line dances bi-weekly
Personal Factors
Mr. Buckwheat Barley: 55 y.o male, Former smoker, grain farmer
PMH: Respiratory allergies
Environmental Factors
Lives on family farm with wife and 5 children
Around second-hand smoke often
Pathophysiology
PVD
Any condition that affects the blood vessels between the heart and lungs
Symptoms
: SOB, chest pain, syncope with exertion, numbness or weakness in legs/feet, ischemia, claudication in calf musculature, feelings of coldness in LE, changes of color in feet elevated vs dependent positions, decreased wound healing
Can be caused by atherosclerosis (plaque build-up on walls of arteries)
Narrows blood vessels and decreases blood flow to heart
Can lead to peripheral hypertension, claudication, intermittent claudication, blood clots, heart attack, stroke, TIA
Risk Factors:
Elevated cholesterol, HTN, DM, smoking, inactivity, overweight/obese, over 50 (+) years old, heart disease, autoimmune conditions/ inflammation of vessels
Interstitial Pulmonary Fibrosis ("Farmer's Lung")
Hypersensitivity pneumonitis secondary to exposure and the inhalation of moldy crops (including hay, grain, corn, pesticides and straw) which commonly contain thermophilic Actinomyces species
Inflammatory response begins. The severity of the inflammatory response depends on the person's sensitivity to the antigen.
Increases in neutrophils and lymphocytes --> additional recruitment of other inflammatory mediators --> direct cellular damage and changes in pathways --> increased vascular permeability and leukocyte migration to the lung --> Can cause hypoxemia and decreased lung compliance
In cases of prolonged exposure, increases in collagen deposits and destruction of lung parenchyma occurs --> decreased lung volume --> potential to develop into chronic form
Chronic Symptoms:
Occasional fever and night sweats
Dyspnea
Chronic cough
Generalized aches and pains
Appetite depression and weight loss
Weakness
Malaise
Loss of energy
Depression
Acute Symptoms: Fever
Chills
Dripping nose
Harassing cough
Blood-streaked sputum
Difficulty breathing with tightness in the chest
Crackling breathing
Muscular pain
Depression
PT Evaluation
Hx, Auscultation, Pain Scale, RPE, Gross MMT, Gross Movement Assessment (transfers, bed mobility, ambulation) 2MWT, Walk and Talk Test, Breathing Assessment (MARM + 4-Question Breathing Outcome Measure), Stress Index Questionnaire
