121- Exam 2 Flashcards
What is the termination criteria for CPET?
- Chest Pain/Angina
- Mental Confusion
- Lightheadedness
- SPO2 <80%
- ECG shows ischemia or Arrythmias
- BP= S:>250 D:>120 or Sys falls >20
- Chronotropic insufficiency
- Cant bike 40 rpm
- Pt Request to stop
Indication for CPET
- unexplained or disproportionate dyspnea
- Determination of prognosis
- Surgical Risk
- Disability determination
- What is Anaerobic Threshold (aka Lactate Threshold)
- How do you determine max HR
- When HR is at or near max. Metabolism continues with low/no O2 which produces lactic acid
- 220-Age= Max HR
- What happens during exercise (CPET)
- What does the body do in response to
- As exercise increases, metabolism increases, O2 consumption increases and CO2 production increases
- Lungs increase Min Ventilation and Heart increases cardiac output
What is the approximate Vo2 at Rest for CPET
3.5 ml/kg/min
Contraindications and when to stop the 6 minute walk test?
Contraindications:
1. Absolute= Unstable Angina in previous month, MI, SOB, Chest pain
2. Relative= HR >120 BP >180/>100
When to stop:
- Chest pain
- intolerable dyspnea
- leg cramps
- diaphoresis
- pale, dusky appearance
How to perform a 6 minute walk test and why
- Pt can use O2, cane/walker and stop/rest as needed
- BORG scale done before and after
- HR/SPO2 monitored during test
- RT doesn’t walk with Pt
Why: For Pulmonary Rehab to see how far Pt can walk in 6 minutes
What to chart for Hallway Test and why
- Resting/Walking/Stairs SPO2
- Distance walked or flight of stairs
- Amount of O2 used and Pt response
- Any additional comments
Why: Evaluate the need for O2 during exercise
How to perform an exercise desaturation test (aka Hallway Test)
- Pt rests on room air. If O2 is used, remove and wait 15-20 minutes
- Check SPO2
- Pt walks pre-measured hallway while monitoring O2
- If SPO2 drops <88%, give O2, Rest and Continue
- Chart findings
What is FENO
What does it tell us about
Exhaled Nitric Oxide Test
High FENO supports Asthma Dx
Low FENO may reduce likelihood of asthma
How does an Exercise challenge work?
Is it Direct/Indirect-Why?
What indicates a positive result?
- Done on a treadmill or ergometer with nose clips
- Get baseline spirometry
- 8 minute of high intensity exercise
- Rest
- Spirometry done every 5 minutes for max 30 minutes
a 10% decline= Positive
Indirect test as it doesn’t affect smooth muscles directly
How is a Mannitol Test performed and What is it doing to the body?
Direct/indirect-why
What is a positive result
Osmotic agent given to draw fluid from surface of airways via MDI. Dehydrates to induce inflammation and onset of Asthma symptoms
Indirect as it doesn’t directly affect smooth muscles
Positive if it falls 15% from baseline or 10% between doses
How is a methacholine test done?
Direct/Indirect-Why?
What is a positive result
A drug to induce asthma
1. Baseline spirometry
2. Small nebulized dose of methacholine
3. Spirometry- If FEV1 drops by 20%= Positive
4. Continue until 20% drop or 6 doses are given
5. Albuterol to reverse
Direct as it directly affects smooth muscles of airways
Contraindications for Bronchoprovocation tests (5)
- No Bronchodilators on day of
- No Caffeine
- No Exercise
- 4-6 weeks after chest infection
- If FEV1 <60% predicted
What is PEFR/PEF?
What Disease process uses the test?
What are the zones?
Peak expiratory flow rate
Asthma Pts
Green=80%+ GOOD
Yellow= 50-80% QUICK RELIEF METHODS
Red= <50% EMERGENT, GO TO ED or SEE DR
What is RSBI?
What is it’s normal value?
When do we use it?
Rapid Shallow Breathing Index Ratio
60-105 with successful vent weaning <105
Used to determine pt readiness to wean of ventilator
Why do we measure MIP/MEP (NIF/NEF)
To test muscle (diaphragm) strength
to see if vented pts are ready for unassisted ventilation
What 5 diseases affect the alveolar capillary membrane
- Emphysema
- ILD
- PNA
- Pulm. Edema
- ARDS
What is DLCO and what does it measure
Diffusion Capacity of Carbon Monoxide
Measures the amount of CO that moves across the alveolar capillary to determine Diffusion rate in pt’s
What does an increased RV (Residual Volume) or TLC (Total Lung Capacity) indicate (2)
Air trapping & Hyperinflation
What does a reduced TLC indicate
Restrictive Disease
How does Nitrogen washout, Helium Dilution & Body Plethysmography work?
What do each one tell us?
Nitrogen Washout= Pt Breaths 100% O2 with no rebreathing until nitrogen is ‘washed out’. Max 7 minutes or until nitrogen is <1.5%. Tells us Functional Residual Capacity
Helium Dilution= Pt breaths a Known amount of gas with known vol of Helium. Looking for equilibrium between lungs and Known Helium amount. Tells us Function Residual Capacity.
Body plethysmography (aka Body Box)= Pt pants like a dog at 30-60 bpm in box. Box measure difference in thoracic pressures and box pressures. Best Test option as it measures residual volume and air trapping
What are the 3 tests to measure lung volumes?
Which is most common?
- Nitrogen Washout
- Helium Dilution
- Body plethysmography (BEST ONE)
What are the 3 reasons we would obtain lung volumes?
- Pts with obstruction or low FVC
- Pts with low FVC
- Pt with obstruction
How does restriction generally appear and what are the 3 diseases?
Not enough air in the lungs to begin with, Stiffness in the lungs, Pathological, Decrease lung volumes and capacities
- Pulmonary Fibrosis
- Sarcoidosis
- Obesity
How does Obstruction generally appear and what are the 6 associated diseases?
Enough air in lung, but hard to get out. Inflamed and easily collapsable airways, obstruction to airflow, problems exhaling, Frequent medical visits or hospitalization, increasing residual volume
- Asthma
- COPD
- Emphysema
- Bronchitis
- Bronchiectasis
- Cystic Fibrosis
What are the 5 obstructive characteristics
- Bronchial Secretions
- Bronchospasms
- Mucus plugging
- Distal airway weakening or air trapping
- Flow of gas reduced on forced exhale
Obstructive vs. restrictive
- If FEV1/FEV are decreased, what does it indicate?
Obstructive Disorders
Obstructive vs. restrictive
- If FEV% is normal or increased what does it indicate?
Restrictive disorders
What are the 4 common errors during a PFT?
- Coughing especially in 1st second
- Failure to expire to FVC “Curve with no plateau”
- Slow Start “Curve has S shape”
- Air leak “curve will dip down rather than rise steadily”
What do the 4 flow Volume lopps look like
Normal= steep increase, gradually decrease, bubble bottom
Early Small Obstruction= Steep increase, gradual decrease with slight scooping, bubble bottom
COPD/Obstruction= Steep increase, gradual decrease with large scooping, bubble bottom THINK: ‘b’
Restrictive= Steep increase, Steep decrease, narrow bubble bottom. THINK: ‘R’
What are the 7 acceptability criteria’s of the ATS for PFT?
- No slow start
- No cough in 1st sec
- No early end
- No Valsalva Maneuver
- No Leak
- No obstructed mouthpiece
- No extra breaths
What is reproducibility criteria and how many are done for PFT?
Minimum of 3 tests that all meet acceptability criteria. No more than 8 tests to be attempted. If acceptability criteria cannot be met, note would be made indicating failure to meet reproducibility
What is FVC?
What is FEV1?
What do they indicate
Forced Vital Capacity & Forced expiratory volume in 1 second
(When divided by each other= FEV%)
What is FEV% and what does it indicated
FVC/FEV1
When less than 70%= Obstruction
When greater than 70%= No Obstruction (look at FVC >80%?) Yes= Normal Spirometry. No= Possible Restriction needing further testing
What is FEV1 and what does it measure
Forced Expiratory Volume in 1 second. How much air pt can get out in 1 second
What is FVC and what does it measure.
What is important to remember about the test?
How is the test done?
Forced Vital Capacity. Amount of air you can forcefully exhale after max inspiration
Most common maneuver. Pt must be sitting as they may pass out
Big deep breath in, Blast it out as hard as possible and as long as possible.
How long should a pt refrain from using these 3 inhalers before spirometry?
Short Acting bronchodilator= 4 hrs
Long acting= 12 hours
Ultra long action= 24 hours
What pt info is needed prior to spirometry (4)
- Meds Hx
- Smoking Hx including how long and what
- Height, Age, Gender, Ethnicity
- How long since last respiratory medicine
How is spirometry calibration Done
- Daily
- 3L syringe AKA super syringe
- 3 pumps of syringe with varying flows 2-12 L/sec
- what is pumped into machine should match. Acceptable range +/- 3.5%. varies depending on facility
What are the 4 things normal values are based on?
Heigh, Age, Gender, Ethnicity
Public Health indications look for what?(3)
- Epidemiologic Surveys
- Establish normal values
- Clinical Research
Disability indications look for what?(2)
- Assess level of disability from lung disease
- Assess risk for insurance evaluation
Monitoring indications look for what?(3)
- change in lung function with med administration
- monitor adverse drug affects
- assess effect of environmental or occupational exposure
Diagnostic indications look for what?(4)
- abnormal signs, symptoms, lab results
- How a disease is affecting pulmonary function
- screening and preoperative risks
- health status pre-exercise plan
What are the 4 indications for spirometry
- Diagnostics
- Monitoring
- Disability
- Public Health
What is the most common PFT test and what is it testing for?
Spirometry
Testing for airflow obstruction or restriction
What 4 lung volumes make up the total lung capacity?
- Inspiratory reserve Volume
- Tidal Volume
- Expiratory reserve volume
- Residual volume
What 2 lung volume make up the functional residual capacity?
- Expiratory reserve volume
- Residual Volume
What 3 lung volumes make up the Vital Capacity?
- Inspiratory Reserve Volume
- Tidal Volume
- Expiratory Reserve Volume
What 2 lung volumes make up the inspiratory capacity?
- Inspiratory Reserve Volume
- Tidal Volume
What are the 4 lung Capacities?
- Inspiratory Capacity
- Vital Capacity
- Functional Residual Capacity
- Total Lung Capacity
What are the 4 lung volumes?
- Inspiratory Reserve Volume
- Tidal Volume
- Expiratory Reserve Volume
- Residual Volume
FEV1/FVC Chart Break down
Greater than 70?
Yes= No Obstruction= is FVC greater than 80? Yes= Normal Spirometry. No= Possible restriction further testing needed
Greater than 70?
No= Yes Obstruction. What severity is FEV1 Ranked (mild, mode, severe, very severe)? Is that %change >200ml & 12%+?
Yes= Yes to significant response to bronchodilator
No= No significant change to bronchodilator
GOLD COPD Chart Severity Levels?
Gold 1= Mild= 80%+
Gold 2= Moderate=50-79
Gold 3= Severe= 30-49
Gold 4= Very Severe= <30
