PFT PRELIM Flashcards
History of Symptoms Associated with Pulmonary Disorders
Cough
Dyspnea
Wheezing
Basic Information and History Taking
Age
Gender
Body Height and Size
Race
As the person age, the natural elasticity of the lungs decreases.
Age
This translates to smaller and smaller lung volumes and capacities as we age.
Age
Usually the lung volumes and capacities of males are larger than females.
Gender
Even when males and females are matched for height and weight, males have larger lungs than females.
Gender
Has a tremendous effect
Body Height and Size
A smaller man will have a smaller PFT result than a man of same age who is much larger
Body Height and Size
Sometimes, as people age they begin to increase their body mass by increasing their body fat to lean body mass ratio. If they become too obese, the abdominal mass prevents the diaphragm from descending as far as it could so PFT result will demonstrate a smaller measured PFT outcome than expected.
Body Height and Size
Blacks, Hispanics, Native Americans, Caucasians have different PFT result compared to Asians
Race
Includes the name, age, gender, height in stocking feet, race and current diagnosis.
Basic Information
Includes whether the subject has ever has or has been told that he has allergies/hay fever, asthma, chest injury or surgery, recurring colds, pneumonia, tuberculosis, lung CA, bronchieactasis, emphysema, chronic bronchitis.
Personal Medical History
Includes type of medications prescribed and for what problems they are taken in the dose.
Medications Prescribed for Lung or Heart Problems
Includes type of medications prescribed and what problems they are taken in the dose prescribed the scheduled taken in and when they were last taken or used.
Medications Prescribed for Lung or Heart Problems
Includes the immediate family. Immediate family member’s history should be described as it relates to the disorders listed earlier under the heading of the subject’s personal medical history
Family History
Includes the age smoking began, years smoked, type of tobacco or other substance, past and current daily consumption.
Smoking History
Can be useful. This is especially true if the hobbies include the use of chemicals, art supplies or other possibly irritating or poisonous substances
Hobbies
A listing of types and numbers of pets are useful. This is true if their presences can be linked to pulmonary symptoms. Knowing whether they are maintained indoors or outdoors can be significant.
Pets
This can be useful in diagnosing certain endemic diseases.
Place of Residence
A chronological history of the subject’s occupation should be taken. A description of the actual job, exposures to fumes, dust, gases should be noted. A history of employment in farming mining, quarrying, textiles can be significant to pulmonary problems.
Occupational History
Physical Assessment
Vital Signs
Auscultation
Results of Xray Examination
The subject’s pulse, respiratory rate, blood pressure should be noted.
Vital Signs
Their subject should be auscultated and any abnormalities in the subject’s breath sounds should be recorded. With adventitious sounds such as wheezing, ronchi, or crackles, the intensity, location and relation of the sound to the breathing cycle must be noted
Auscultation
Significant information should be noted such as abnormal densities in the lung fields, hyperinflation, loss or vascular markings, presence of bullae, flattened diaphragm etc.
Results of Xray Examination
General Administration of PFT
The therapist should demonstrate a combination of concern, forcefulness, patience, supportiveness, humor, firmness and persistence are necessary for those who are less cooperative.
Clear and simple instructions must be given to the subject.
For successful PFT, two key factors are involved:
The skill of respiratory therapist administering the test.
The cooperation of the patient.
A complete evaluation of the respiratory system includes a patient history, physical examination, radiographic imaging, arterial blood gas analysis and test of pulmonary function.
Pulmonary Function Testing
Pulmonary Function Test Purpose
To identify and quantify changes in pulmonary function
To evaluate need and quantify therapeutic effectiveness
To perform epidemiologic surveillance for pulmonary disease
To assess patients for risk for postoperative pulmonary complications
To determine pulmonary disability
Principles of PFT
Sensitivity and Specificity
Validity
Reliability
First recorded spirometry test was performed by _______.
Greco - Roman
First recorded spirometry test was performed by Greco-Roman
Claudius Galen (129-200 A.D)
The measurement of the lungs residual volume was performed
1800 (Cladius Galen)
He had volunteer plug his nose to assure and accurate measurement of lung volumes, and to prevent air from escaping or entering from the nose.
Giovannin Alfonso Borelli (1608-1679)
He is believed to be the first person to have a patient block the nose, a technique that is still done to this day during spirometry testing.
Giovannin Alfonso Borelli (1608-1679)
Invented the gasometer, a container that store gas
1970 - James Watt(1736-1819)
The volume of air that can be inhaled in a single deep breath was first measured
1679
He laid the foundation of “pneumotherapy” and used his research to establish the “Pneumatic Institute at Clifton” for the treatment of disease by inhalation.
Thomas Beddoes (1760-1808)
Also known as the father of “Inhalation Therapy”
Thomas Beddoes (1760-1808)
He developed a method of collecting expired gas over mercury and attempted to determine how much those gases had been used by the body. He thought this was important because oxygen should be less than what is inhaled.
John Abernethy (1764-1831)
He also determine that exhaled oxygn would be higher in patient with certain lung diseases.
John Abernethy (1764-1831)
He also measure vital capacity of 3110
John Abernethy (1764-1831)
He was able to measure his VT at 210 ml
Sir Humphrey Davey (1778-1829)
He also calculated his residual volume to be about 600 ml
Sir Humphrey Davey (1778-1829)
Also devised a mechanism to determine how much oxygen was utilized by the body and how much carbon dioxide his body creadted.
Sir Humphrey Davey (1778-1829)
In 1846, invented water seal spirometer, which he measured the vital capacity of over 2000 subjects.
John Hutchinson
He observed the relationship between height and lung volume and that VC decreases with age, obesity and lung disease.
John Hutchinson
Determine that the volume of exhaled air has linear relationship with height.
John Hutchinson
Equipments use in PFT
SPIROMETER
SPIROGRAPHS
Primary instrument used in pulmonary function testing
Spirometer
Design to measure changes in volume
Spirometer
Can only measure lung volume compartment that exchange gas with the atmosphere.
Spirometer
A device that is usually attached to spirometer which measures the movement of gas in and out of the chest
Spirographs
Resulting tracing is called ______.
Spirogram
Types of Spirometer
Water Sealed Spirometer
Dry Sealed Spirometer
Rotor Spirometer
Bellows Spirometer
Has a double wall stationary cylinder that has water between the double walls.
Has a freely moving cylindrical bell suspended above and inside the cylinder.
Water sealed spirometer
The weight of the bell is balanced by the counterweight suspended from a chain that is looped over a pulley.
Chain Compensated type
Very accurate for simple volume measurement but the accuracy is lost with breathing maneuvers that include rapid respiratory rate and rapid changes in air flow rates.
Chain Compensated type
Developed in response to the inertia problems exhibited by the chain compensated configuration
Stead Wells type
Has a rod mounted piston with a cylinder and is made of plastic or lightweight metal
Dry Sealed Spirometer
Has a vane like rotor consisting of a light weight metal blade.
Rotor Spirometer
It is constructed of a flexible plastic material that is designed to collapse in folds
Bellows Spirometer
Are T or Y shaped valves that are used at the subject connection of spirometer breathing circuit.
Directional Breathing Valves
Directional Breathing Valves have three important characteristics:
Have low resistance to inspiratory and expiratory air flow
Have a small dead air space volume to minimize rebreathing of previously exhaled air
Be relatively easy to clean after use
They permit control and changes in the direction of the gas flow within the breathing circuit.
Directional Control Valves
Can be used to direct the flow at different times as needed during test to different portions of the breathing circuit.
Directional Control Valves
The main component is a movable vane, dik or sphere.
Peak Flow Meter
A classic version of Peak flow Meter
Wright’s Peak Flow Meter
A hand held medical device that measures the volume of your breath.
Incentive Spirometer
Indication for Incentive Spirometry
After Surgery
Pneumonia
COPD
Cystic Fibrosis
Other conditions ( Sickle cell anemia, asthma or atelectasis)
Contraindication of IS
- PATIENTS WHO CANNOT BE INSTRUCTED OR SUPERVISED TO ASSURE APPROPRIATE USE OF THE DEVICE.
- PATIENTS IN WHOM COOPERATION IS ABSENTS OR PATIENTS UNABLE TO UNDERSTAND OR DEMONSTRATE PROPER USE OF THE DEVICE.
- UNABLETO DEEPBREATHE EFFECTIVELY DUE TO PAIN, DIAPRAGMATIC DYSFUNCTION OR OPIATE ANALGESIA.
Used in determination of lung volumes not measurable by direct spirometry
Indirect Spirometry
Three Indirect Techniques
Helium Dilution
Nitrogen Washout
Body Plethysmograph
Techniques measure whatever gas is in the lungs at the beginning of the test if the gas is in communication with unobstructed airways.
Helium Dilution and Nitrogen Washout
Measure all the gas in the thorax including the gas that is trapped distal to obstructed airways or gas in the pleural space.
Body Plethysmograph
Volume Measured
Thoracic Gas Volume
Based upon the assumption that the concentration in the lung is 78%.
Open Circuit Method (Nitrogen Washout)
Based upon the assumption that a known volume and concentration of helium in the air begin in a closed spirometer.
Closed Circuit Method
Maintained to assure accurate helium concentration measurements and the subjects rebreathes the gas in the system until and equilibrium of helium concentration is established.
Constant Volume
Uses volume and pressure changes to measure lung volumes
Body Plethysmography
Types of Plethysmography
Body Plethysmography
Inductive Plethysmography
Requires that the subject’s entire body be enclosed within the boxlike cabinet during testing.
Body Plethysmography
Involves the use of sensors that are strapped around the subjects thorax and abdomen
Inductive Plethysmography
Used to make indirect measurement of ventilatory patterns without physical connection to the subjects airway
Respiratory Inductive Plethysmography
Components of Body Plethysmography
Cabinet
Measuring System
Non Constant Volume Plethysmograph
Constant Volume, variable pressure plethysmograph
Recording System
Computer
Has a volume approximately 600 liter and is large enough for the subject to sit within
Cabinet
Measuring System
Pneumotachometer
Shutter
Pressure Transducer
Measuring the ventilatory airflow
Pneumotachometer
When activated occluded the mechanical airway of the pneumotachometer
Shutter
Located between the shutter and the subject. It is used mainly to measure the mouth pressure
Pressure Transducer
Directly measures the quantity of air that is forced to enter or leave the cabinet
Non Constant Volume Plethysmograph
It has pressure transducer connected to an opening in the cabinet wall.
Constant Volume, variable pressure plethysmograph
Used for plotting pressures measured by plethysmograph against either ventilatory flow rates or cabinet volume changes
Recording System
A recent development. It allows rapid assessment of subjects performance and test results.
Computer
Provide and immediate presentation of data
Allows operator to quickly assess patients performance and test result.
Monitor Displays
Types of Monitor Display
Analog Display
Digital Display
Screen Display
Use of moving dial or scale to display changes in data input or over a present range of values
Analog Display
Takes analog - type input but provides direct visual representation in the form o alphanumeric data
Digital Display
Presents alphanumeric data, graph, line drawings and other complex visual data
Screen Display
Provides a permanent graphic record of the test data
Recorders
Types of Recorders
Mechanical Chart Recorder
Electronic Chart Recorder
Optical Chart Recorder
Requires movement of both the paper and recording pen.
Used in volume collecting PVMS system
Mechanical Chart Recorder
Any measuring system that can produce an electrical signal
Electronic Chart Recorder
Uses a light sensitive paper that is moved past an oscilloscope display
Optical Chart Recorder
Lung Volumes
Tidal Volume
Residual Volume
Expiratory Reserve Volume
Inspiratory Reserve Volume
The sum total of all four volumes
Total Lung Capacity
The volume inhaled from end expiration to total lung capacity
Inspiratory Capacity
This is the total volume that can be moved in and out of the lung or the volume between TLC and RV
Vital Capacity
The volume that remains in the lung at the of a normal tidal volume excursion or end inspiration
Functional Residual Capacity
Lung Capacity
Total Lung Capacity
Inspiratory Capacity
Vital Capacity
Functional Residual Capacity
The volume that a person moves in and out during quiet, normal breathing.
Tidal Volume
Volume of gas in the lung after a full and complete expiration
Residual Volume
Volume that expired from the end of a normal breath
Expiratory Reserve Volume
