Module 5: Lungs and Thorax Flashcards
What is the most commonly used pulmonary function test?
Incentive Spirometry
T or F: Spirometry is used to measure forced expiratory flow rates and volumes.
True.
In the office setting, spirometry is typically used to detect, confirm, and monitor what?
COPD
What is wrong with volume sensing spirometers?
Volume sensing spirometers maintain accuracy over many years, but are more difficult to clean and are rarely used for office spirometry.
How accurate should the spirometers measure the force of expiratory volume?
Office spirometers should accurately measure the forced expiratory volume in one second (FEV1), forced expiratory volume in six seconds (FEV6), and forced vital capacity (FVC) and also provide quality checks and error messages.
Daily IS calibration checks are recommended with what?
A 3 Liter Syringe, since permanent flow meters can become clogged with secretions. When performing a calibration check, the three liter syringe should be discharged into the spirometer three times. The volumes read by the machine should be within 3.5 percent of three liters. If the spirometer reading remains outside these limits after replacing the flow sensor, the device should be removed from use until checked by the manufacturer.
How should the IS be performed?
With the patient seated, the deep inhalation should occur before the mouthpiece is placed in the mouth. Immediately after the deep inhalation, the mouthpiece is placed just inside the mouth between the teeth. The lips should be sealed tightly around the mouthpiece to prevent air leakage during maximal forced exhalation. Exhalation should last at least 6 seconds.
How should help the patient when performing IS?
Phase 1: Coach the patient to take as deep a breath as possible
Phase 2: Loudly prompt the patient to blast out the air into the spirometer
Phase 3: Encourage the patient to continue exhaling for at least six seconds (3 seconds for children)
What classifies an adequate test?
An adequate test usually requires three acceptable and reproducible FVC maneuvers.
What is the force vital capacity?
FVC- (also known as the forced expiratory volume) is the maximal volume of air exhaled with a maximally forced effort from a position of full inspiration and is expressed in liters.
What is the slow vital capacity?
The slow vital capacity (SVC) is the maximal volume of air exhaled after a maximal inspiration, but without a forced effort. The SVC is rarely measured outside of hospital-based pulmonary function labs. For normal subjects, the slow and forced vital capacities are very close, whereas patients with airflow limitation tend to have a much lower FVC than SVC.
What is the FV6?
Forced expiratory volume in 6 seconds — The forced expiratory volume in 6 seconds (FEV6) is sometimes used as a surrogate for FVC. The FEV6 has the advantage of being more reproducible than the FVC and less physically demanding for the patient.
Where can you hear bronchial breath sounds?
Bronchial or tracheal sounds are heard on the chest at sites which are close to large airways, over the trachea, also heard on the back between the scapulae and at the lung apices especially on the right. They may also be heard in the axillae. When they are heard in locations at a distance from large airways they signify consolidation. This is believed to be due to better transmission of the centrally generated lung sound through the consolidated lung. This is more likely to occur during the expiratory phase because the expiratory phase has a more central origin than the inspiratory phase.
Where are vesicular breath sounds?
Vesicular sounds are the most common sounds heard over the chest. They are present at sites that are at a distance from large airways. The vesicular sound is a soft sound that has been compared to that of wind blowing through trees. It is louder in inspiration than expiration. The vesicular sound is commonly decreased in chronic obstructive lung disease. It is also decreased over sites of pneumonia in the early stages of the illness. It is usually, but not always, decreased or absent in conditions where the ventilation to an area of lung is impaired: e. g. pneumothorax, misplaced endotracheal tube, mucus plugging.
Fine crackle lung sounds?
Crackles are intermittent explosive sounds that have been described as being similar to the crackling sound heard as wood burns. Considerable evidence has been presented in support of the hypothesis that crackles are caused by the sudden opening of airways. It is likely that they are also caused by fluid in the airways. On auscultation fine crackles are in general higher pitched, less intense and of shorter duration than coarse crackles. Note that the crackling sound can be transmitted throughout the chest.
What causes coarse crackles?
They are caused by airway openings and secretions in airways. Coarse crackles are in general lower pitched, less intense and of longer duration than fine crackles. The most common conditions associated with coarse crackles are congestive heart failure and pneumonia.
What causes wheezing?
Airway narrowing and secretions. Wheezes are believed to be caused by airway narrowing. While bronchospasm is a common cause of the narrowing that causes wheezing, a variety of other conditions can also produce this adventitious sound including airway edema, secretions, endobronchial tumors and extrinsic compression of an airway. Wheezing in congestive heart failure is likely due to increased fluid in peribronchial lymphatics causing airway compression.
What are ronchi?
Rhonchi are also described as “continuous” sounds. They are lower in pitch than wheezes and have a snoring quality. Although rhonchi are almost always due to airway secretions and usually clear with cough, they may be present in other conditions that cause airway narrowing.
What is one of the most common symptoms patient’s seek health care for?
Cough
What does cough promote?
Clearance of secretions and foreign bodies from the airways. Cough is absent in very young infants.
What are the 3 categories of cough duration?
- Acute, less than 3 weeks
- Subacute, lasting 3-8 weeks
- Chronic, lasting more than 8 weeks
Cough of recent onset is most likely what?
Viral or bacterial infection, allergies.
What is a cough > 3 weeks indicative of?
Chronic lung or heart disease
Cough associated with SOB usually suggests ?
Physical airway obstruction
What are the characteristics of acute asthma exacerbation?
Irritating nonproductive cough that can progress to tachypnea, dyspnea, wheezing, grunting, cyanosis, fatigue, and finally respiratory and cardiac failure.
What are some of the most important triggers of asthma in children?
Viral infections (RSV), parainfluenza viruses, and rhinoviruses
Child = Foreign body aspiration
True; coins are the most frequent foreign body.
A foreign body in the lower airway can also produce either _____ caused by a ball-valve phenomenon or complete distal ________ because of absorption of trapped gas.
Emphysema; atelectasis
A mobile foreign body can produce what?
A paroxysmal cough with cyanotic episodes and stridor
Runny nose with cough and mild fever followed by a persistent cough for more than 1 week with clear to off-white mucus greater in the morning suggests what?
Bronchitis
