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Clinical Instruction (Kass) > PFT > Flashcards

PFT Flashcards

1
Q

A PFT is a useful tool for

A

Guiding management of patients with diagnosed lung diseases

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2
Q

A PFT is the primary diagnostic tool for evaluating and treating patients

A

Respiratory symptoms
Guiding management of patients with diagnosed lung diseases

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3
Q

What sign or symptoms would cause a physician to order a PFT?

A

Dyspnea
Intermittent wheezing
Monitor treatment response after lung disease is diagnosed

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4
Q

What are the pulmonary function categories that can be evaluated using a PFT?

A

Lung volumes and capacities
Expiratory flow rate and volume
Pulmonary diffusion capacity
Respiratory muscle strength

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5
Q

What is a PFT capable of detecting?

A

Airflow limitation
Restriction of lung volumes
Impaired gas transfer
Respiratory muscle weakness

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6
Q

What are PFTs used for in regards to treatment?

A

Efficacy

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7
Q

T/F: the use of filters negates the need to regularly clean and disinfect equipment

A

False

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7
Q

What are PFTs used for in regards to disease processes?

A

Monitoring of disease progression

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8
Q

What measures should be taken to control infection when administering a PFT?

A

Universal precautions
N95s if patient has airborne illness
Wear gloves when handling contaminated equipment
Use disposable mouthpieces or flow sensors between patients

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9
Q

Before administering a PFT, what kinds of things should you ask a patient regarding their pulmonary history?

A

History of pulmonary diseases
Tobacco exposure
Current medications
Cough
Allergies
Chest surgeries
Occupational exposures

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10
Q

Why is it important that patients withhold taking their respiratory medications prior to taking a PFT?

A

Because the medication can change the outcome of the PFT results

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11
Q

Before taking a PFT, how long should a patient stop taking LABAs?

A

12 hours

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11
Q

Before taking a PFT, how long should a patient stop taking albuterol?

A

4 hours

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12
Q

BEfore taking a PFT, how long should a patient stop taking slow release methylxanthines?

A

24 hours

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13
Q

Before taking a PFT, how long should a patient stop taking ipratropium for?

A

4 hours

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14
Q

Before taking a PFT, how long should a patient stop taking tiotropium for?

A

24 hours

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15
Q

Before taking a PFT, how long should a patient stop taking inhaled steroids for?

A

Maintain dosage

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16
Q

What are the steps involved in administering a PFT when checking pre and post bronchodilator results?

A

Ensure patient has not taken bronchodilator prior to test
Obtain 3 acceptable baseline FCV maneuvers
Administer bronchodilator
Wait at least 10 minutes
Repeat FVC, obtain 3 acceptable results
Compare pre and post bronchodilator FVC and FEV1

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17
Q

What dosage of bronchodilator does the american thoracic society recommend in order to ensure a full patient response?

A

4 separate 100 mg doses of albuterol delivered by MDI with spacer

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18
Q

When does weight affect the outcome of a PFT?

A

When their BMI is above 30
Can act as a restrictive mechanism

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19
Q

What is the most important measurement to get from a patient prior to taking a PFT?

A

Height

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20
Q

IF a patient does not know their height or their height cannot be accurately measured, how can you determine their height?

A

Wingspan = fingertip to fingertip

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21
Q

Describe the lung volumes of african americans, asians, and east indians in comparison to “normal” values

A

Typically 12% smaller

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22
Q

What are the 3 phases of the spirometry test?

A

Deep inhalation
Blast air out
Keep blowing until empty

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22
Q

Why is race considered when performing a PFT?

A

Different races have different lung volumes

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23
Q

How long does a proper FVC test take?

A

6 seconds

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23
Q

No more than ____ FVC maneuvers should be attempted

A

8

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24
Q

What occurrences would invalidate a PFT?

A

Slow start
A cough in the 1st second
Early termination
A valsalva maneuver
A leak
An obstructed mouthpiece
Evidence of an extra breath

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25
Q

If you are performing a PFT on a patient and notice a difference of __________ between the largest and next largest FVC/FEV1, the test must be repeated

A

0.150 liters or less

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26
Q

What are common spirometry errors?

A

Failure to take a full breath
A hesitating start
Failure to BLAST out the air
Stopping to soon

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27
Q

By measuring a patients volumes, we are looking for evidence of a

A

Restrictive disorder

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28
Q

Define tidal volume

A

Volume of gas inhaled or exhaled during normal breathing

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29
Q

Define inspiratory reserve volume

A

Maximum volume of gas that can be inspired from the end of a normal inspiration

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30
Q

Define expiratory reserve volume

A

Maximum volume of gas that can be expired from the end of a resting expiration

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31
Q

Define residual volume

A

Volume of gas remaining in the lungs after a maximal expiration

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32
Q

Define vital capacity

A

Maximum volume of gas that can be exhaled from the lungs after a maximal inspiration or inhaled from a point of maximal exhalation

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33
Q

Define inspiratory capacity

A

Maximum volume of gas that can be inspired from the normal end expiratory position

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34
Q

hat pulmonary study function values can be obtained from a flow volume loop?

A

FVC
FEV1
FEF(25-75%)
PEFR
PIFR

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34
Q

Define total lung capacity

A

Volume of gas in the lungs at the end of a maximal inspiration

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34
Q

When is a flow loop produced?

A

When a patient inhales rapidly to measure Forced inspiratory vital capacity AFTER exhaling rapidly for 6 seconds

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34
Q

Define functional residual capacity

A

Volume of gas remaining in the the lungs at the end of a resting expiration

35
Q

Describe FEV1

A

The volume of air exhaled in the first second of exhalation

36
Q

What diseases would decrease the FEV1?

A

Obstructive diseases

37
Q

What pulmonary study function values are used to assess reversibility of disease condition?

A

FVC, FEV1, FEF(25-75%)

38
Q

What change in FVC is required to determine whether or not a bronchodilator was effective?

A

FVC > 10%

38
Q

What change in FEV1 is required to determine whether or not a bronchodilator was effective?

A

A change in FEV1 > 200 ml or 12%

39
Q

What change in FEF(25-75%) is required to determine whether or not a bronchodilator was effective?

A

FEF(25-75) > 20-30%

40
Q

How is the severity of COPD measured?

A

Based off of the FEV1/FVC ratio

41
Q

A patient with mild COPD would have an FEV1 of…

A

70-80% of predicted

42
Q

A patient with moderate COPD would have an FEV1 of

A

60-69% of predicted

43
Q

A patient with very severe COPD would have a FEV1 of

A

<35% of predicted

44
Q

A patient with moderate severe COPD would have an FEV1 of

A

50-59% of predicted

45
Q

A patient with severe COPD would have an FEV1 of

A

35-49% of predicted

46
Q

What is the FEV1/FVC ratio?

A

Volume of air expired in the first second expressed as a percent of FVC

47
Q

What does a reduced FVC with a normal FEV1/FVC ratio indicate?

A

Restriction

48
Q

What does a decreased FEV1/FVC ratio indicate?

A

Airflow obstruction

49
Q

Describe FEF 25-75%

A

Mean expiratory flow during the middle half of the FVC maneuver

50
Q

What does the FEF 25-75% represent?

A

Reflects flow through later emptying airways

51
Q

In a restrictive disease process, what would the FVC look like?

A

Decreased

52
Q

In a restrictive disease process, what would the FEV1 look like?

A

Decreased
Potentially increased in certain disease states due to increased elasticity recoil of the lungs

53
Q

In a restrictive disease process, what would the FEF 25-75% look like?

A

Normal or increased

54
Q

In a restrictive disease process, what would the FEV1/FVC look like?

A

Normal or increased

55
Q

In a restrictive disease process, what would the TLC look like?

A

Decreased

56
Q

In an obstructive disease process, what would the FVC look like?

A

Normal or decreased

56
Q

In an obstructive disease process, what would the FEV1 look like?

A

Decreased

57
Q

In an obstructive disease process, what would the FEF 25-75% look like?

A

Decreased

58
Q

In an obstructive disease process, what would the FEV1/FVC look like?

A

Decreased

59
Q

In an obstructive disease process, what would the TLC look like?

A

Normal or increased

60
Q

How are restrictive disorders characterized?

A

Reduced lung volumes
Decreased lung compliance

61
Q

What are obstructive disorders characterized by?

A

Limitation of expiratory airflow so that the airways cannot empty as rapidly compared to normal

61
Q

What are some examples of restrictive disorders?

A

Interstitial fibrosis
Scoliosis
Obesity
Lung resection
Neuromuscular disease
Cystic fibrosis

62
Q

What are obstructive disorders characterized by?

A

Limitation of expiratory airflow so that the airways cannot empty as rapidly compared to normal

63
Q

What are examples of obstructive disorders?

A

Asthma
COPD
Cystic fibrosis

64
Q

How many BPM should a patient performing an MVV target?

A

90 bpm

65
Q

Describe maximum voluntary ventilation (MVV)

A

The largest volume of air that a patient can movie in and out of the lungs in a 12 second interval

66
Q

How are patients instructed to breath during a MVV test?

A

As rapidly and deeply as possibly

67
Q

The variability between MVV efforts should not exceed….

A

20%

68
Q

How many acceptable efforts should be recorded for an MVV?

A

2

69
Q

MVV tests can isolate what disease processes?

A

Vocal cord dysfunction
Tracheal stenosis

70
Q

Which patient population would Peak expiratory flow monitors be useful for in every day life?

A

Asthmatics

71
Q

Describe PEFR

A

Maximum flow rate achieved during FVC maneuver

72
Q

WHat is a potential problem with PEFR readings?

A

They are dependent on patient effort \

73
Q

What is considered the green zone for patients with asthma in regards to PEFR?

A

80-100% of personal best

74
Q

What is considered the yellow zone for patients with asthma in regards to PEFR?

A

50-80% of personal best

75
Q

What is considered the red zone for patients with asthma in regards to PEFR?

A

<50%

76
Q

What is the DLco test?

A

Dlco measures the ability of the lungs to transfer gas from the inhaled air to the red blood cells in pulmonary capillaries

77
Q

Describe how a DLco could help differentiate between a chest wall cause of restriction vs a interstitial lung disease

A

In a chest wall constriction, the DLco would be normal
In ILD, the DLco would be decreased

78
Q

How would a DLco help determine whether or not a patient is suffering from emphysema or asthma/simple bronchitis?

A

Emphysema = decreased DLco
Asthma/bronchitis = normal DLco

79
Q

What would the DLco of a patient with normal spirometry who complains of dyspnea and suffers from either pulmonary vascular disease or mild ILD present?

A

Low DLco

80
Q

T/F: A DLco can be a useful tool in determining disease progression in in patients with ILD

A

True

81
Q

Describe how the DLco test is performed

A

Patient wears nose clip and breaths through flanged rubber mouth piece connect to a spirometer circuit
Patient takes several large breaths and is then instructed to exhale to RV
Patient rapidly and fully inhales gas with 0.3% CO and inert gas tracer
Patient holds breath for 10 seconds and then exhales for 10 seconds

81
Q

How can a DLco be utilized in patients with systemic diseases?

A

To determine if there is pulmonary involvement

82
Q

How can DLco be utilized in cancer treatment?

A

To determine if radiation, chemotherapy or other drugs are inducing pulmonary dysfunction

83
Q

What factors affect an individual’s ability to facilitate gas exchange in their lungs

A

Surface area of membrane
Thickness of membrane
Hemoglobin and blood flow in capillaries
Matching of ventilation and perfusion

84
Q

A normal result on a DLco is…..

A

80-120% of predicted
Predicted what??

85
Q

Describe the 6 minute walk test

A

Simple exercise test to measure the functional status of patients with COPD

86
Q

Why is the 6 minute walk test preferred to FEV1 in patients capable of performing it?

A

The 6 minute walk test has been shown in several studies to independently predict mortality in COPD patients and to be a better predictor of motality that FEV1

87
Q

How far should healthy people be able to walk in 6 minutes?

A

400-700 meters

88
Q

How far should patients with mild COPD be able to walk in 6 minutes?

A

> 350 meters

89
Q

How far should patients with moderate COPD be able to walk in 6 minutes?

A

250-349 meters

90
Q

How far should patients with severe COPD be able to walk in 6 minutes?

A

150-249 meters

91
Q

How far can patients with very severe COPD walk in 6 minutes?

A

<149 meters

Clinical Instruction (Kass) (13 decks)

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