P1.2: RESPIRATORY: INTRO-COPD Flashcards
Normal Breath Sounds
- Tracheal Breath Sounds
- Vesicular Breath Sounds
- Bronchovesicular Breath Sounds
Normal Breath Sounds
- Heard over the trachea and are harsh and discontinuous
- E > I
Tracheal Breath Sounds
Normal Breath Sounds
- Soft, low-pitched sounds that are heard over the majority of the lung fields; sounds produced
- Produced by air moving through the bronchioles and filling the alveoli
- E < I
Vesicular Breath Sounds
Normal Breath Sounds
- Medium-pitched and continuous with muted characteristics of both bronchial and vesicular breath sounds
- Produced by air moving through large airways and are heard over the first and second intercostals spaces along the sterna border and between the scapula
Bronchovesicular Breath Sounds
Abnormal (Adventitious) Sounds
A. Crackles (crepitations, rales)
* Fine Crackles
* Coarse Crackles
B. Wheezes
Abnormal (Adventitious) Sounds
- Referred to as discontinuous sounds; they are intermittent, non-musical and brief
- May heard either upon inspiration or expiration
- The popping sounds produced are created when air is
forced through respiratory passages that are narrowed by
fluid, mucus, or pus
Often associated with inflammation or infection
Crackles (crepitations, rales)
Abnormal (Adventitious) Sounds
- A continuous, coarse, whistling sound produced in the respiratory airways during breathing
- Caused by air moving through narrowed airways
- Do not clear with coughing
Wheezes
Radiologic Tests
- Obtained to diagnose disorders of the lung
- Normal lung tissue is radiolucent and that foreign bodies, infiltrates, tumors and fluids appear as white areas or densities
- Performed in the radiology department or at the bedside with a portable unit; they are completed in a few minutes and are painless
Chest Roentgenograms
Abnormal (Adventitious) Sounds
- Soft, high-pitched, and very brief
- Sounds like a lock of hair rolled in between fingers
Fine Crackles
Radiologic Tests
- Performed to assess the perfusion of the lungs
- A radioactive contrast dye is injected into a vein or an artery and a series of X-rays of the chest are taken to detect blood flow abnormalities (these films provide a picture of the vasculature that can detect pulmonary embolism or infarction
Pulmonary Angiography (Pulmonary Arteriography)
Laboratory Tests
- Complete Blood Count (CBC)
- Arterial Blood Gases
- Sputum Analysis
Radiologic Tests
- Chest Roentgenograms
- Pulmonary Angiography (Pulmonary Arteriography)
Abnormal (Adventitious) Sounds
Are somewhat louder, lower in pitch, and last longer than
fine crackles
Sounds like opening a Velcro lock
Coarse Crackles
Special Tests
- Pulmonary Function Test
- Thoracentesis (Pleural Fluid Analysis)
- Lung Biopsy
- Breath Analyzer
- Fagerstrom Test
- Oxygen Saturation
- Skin Test (Mantoux Test
Laboratory Tests
Provides information about RBC, hemoglobin, hematocrit and WBC
Complete Blood Count (CBC)
Laboratory Tests
- Can be helpful in evaluating patients suspected of having tuberculosis, pneumonia or lung cancer
- It is vital for the care provider to emphasize to the patient the difference between saliva and sputum
Sputum Analysis
Laboratory Tests
- Provides information about patient’s oxygenation and ventilation hence deemed valuable in assessing the efficiency of pulmonary gas exchange.
- In this test, the examiner obtains a blood sample (2mL) by direct puncture of a radial, brachial or femoral artery
Arterial Blood Gases
Looking for the gastreous content of the blood
Special Tests
- Refers to a non-invasive method of assessing the functional capacity of the lungs
- Measures air flow rates and calculate lung volumes and lung capacities
Pulmonary Function Test
The volume of air inspired or expired can be measured during breathing with a recording device called WHAT
Kymograph
Terms to describe Lung Capacities
- Tidal Volume (TV)
- Inspiratory Reserve Volume (IRV)
- Expiratory Reserve Volume (ERV)
- Residual Volume (RV)
Lung Capacities (determined by combining two or more lung volumes)
Refers to the amount of air remaining in the lungs at the end of normal exhalation (approximately 1,200mL)
Functional Residual Capacity (FRC)
Term to describe Lung Capacities
Refers to the amount of air inspired or exhaled during normal, quiet breathing
Tidal Volume (TV)
- Amount is approximately 500mL in a 70kg person
- Volume capacities are 20-25% lower in women
- A decrease in TV without a decrease in respiratory rate (RR) indicates a restrictive disorder such as pulmonary fibrosis
- A decrease in TV with a decrease in RR indicates a neurological
- problem
Term to describe Lung Capacities
This refers to the amount of air can be inhaled after a normal or tidal inspiration (normal is approximately 3,300mL)
Inspiratory Reserve Volume (IRV)
Term to describe Lung Capacities
Refers to the mount of air that can be forcibly exhaled after normal or tidal expiration
Expiratory Reserve Volume (ERV)
Terms to describe Lung Capacities (determined by combining two or more lung volumes)
- Vital Capacities (VC)
- Inspiratory Capacity (IC)
- Functional Residual Capacity (FRC)
- Total Lung Capacity (TLC)
- Forced Vital Capacity (FVC)
Lung Capacities (determined by combining two or more lung volumes)
Refers to the amount of air that can be inhaled with maximal effort after normal exhalation (approximately 3,000mL)
Inspiratory Capacity (IC)
Term to describe Lung Capacities
Refers to the amount of air remaining in the in the lungs after forced, maximal expiration (approximately 1,000mL)
Residual Volume (RV)
Lung Capacities (determined by combining two or more lung volumes)
- Refers to the maximal amount of air that can be exhaled after maximal inspiration (approximately 5,000mL)
- Refers to the total of the TV, IRV and ERV
Vital Capacities (VC)
Lung Capacities (determined by combining two or more lung volumes)
Refers to the amount of air in the lungs with maximal inspiration (approximately 6,000mL)
Total of the four lung volumes: TV + IRV + ERV + RV
Total Lung Capacity (TLC)
Special Tests
Performed to obtain fluid samples from the pleural space, relieve pressure from accumulated fluid and obtain tissue for biopsy
Thoracentesis (Pleural Fluid Analysis)
COPD embraces several diseases which includes:
- Chronic Bronchitis
- Emphysema
Lung Capacities (determined by combining two or more lung volumes)
Refers to the amount of air expelled with maximally forced exhalation
Forced Vital Capacity (FVC)
Used to describe a group of conditions that is characterized by permanent changes in the airways leading to the impairment of air flow
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
- Literally means “looking inside”
- Refers to a procedure which allows the examiner to visualize internal structures through the use of an instrument known as endoscope
Endoscopy
Special Tests
- A test to determine the presence of tuberculosis
- A small amount of purified protein derivative (0.1mL) is injected intradermally in the forearm and then the area is examined 48-72 hours later to note any swelling and erythema
Skin Test (Mantoux Test)
Special Tests
- Used to determine whether or not a patient has been smoking
- A simple, non-invasive way to measure carbon monoxide poisoning in a patient
Breath Analyzer (Carbon Monoxide Breath Test)
Special Tests
A simple questionnaire used to determine nicotine dependence
Fagerstrom Test
Special Tests
- Performed to obtain tissue samples for microscopic examination
- May be performed through either open or closed technique
Lung Biopsy
- Open Technique- performed in the operating room and require general anesthesia
- Closed Techniques- involves the use of local anesthesia and may be accomplished through needle biopsy
Special Tests
- Measures the amount of oxygen dissolved in the arterial blood
- Measure through pulse oximetry which makes use of spectrophotometer to determine the amount of light absorbed by the hemoglobin in arterial blood
Oxygen Saturation
Normal saturation levels: 96% - 100%
A recurrent inflammation of the bronchial walls with hypertrophy of the mucous goblet cells, characterized by hypersecretion of mucus accompanied by a chronic/recurrent productive cough for a minimum of 3 months a year for two successive years
CHRONIC BRONCHITIS
With excessive mucus and decreased effectiveness of mucocillary blanket, there is mucus stasis, which initiates inflammation and infection
Risk Factors for CHRONIC BRONCHITIS
- Cigarette smoking
- Immunological factors
- Familial predisposition
- Respiratory infection
Cycle of airway obstruction and destruction with:
* Hypertrophy of the goblet cells
* a decreae in ciliated epithelial cells
* a decrease in mucociliary clearance
CHRONIC BRONCHITIS
Patients with this disorder were described as BLUE BLOATERS because the increased secretions and airway obstruction causes hypoxemia (hence cyanosis [blue]) and peripheral edema from right sided heart failure (hence bloater).
Refers to an abnormal irreversible enlargement of air spaces distal to terminal bronchioles caused by a complex obstruction and destruction of alveolar walls, resulting in decreased elastic recoil properties of lungs.
EMPHYSEMA
A condition characterized by loss of lung elasticity, narrowed bronchioles and abnormal dilation of terminal airspaces caused by the destruction of the alveolar walls
EMPHYSEMA
Risk Factors of EMPHYSEMA:
- Cigarette smoking
- Deficiency of alpha 1 – anti-trypsin (AAT)
- Infectious agent
- Environment/Industrial pollution
- Hereditary
- Aging
EMPHYSEMA
Administration of medications:
- Bronchodilators (ipratropium and albuterol, salmetrol)
- Corticosteroids if bronchodilators are not sufficient
