Pulm Dx and Therapeutic Skills - Exam 1 Flashcards
When percussing why would the lungs sound dull?
consolidation, pleural effusion, tumors or could be the liver
When percussing the lungs why would they sound hyperresonant?
air, emphysema, asthma or pneumothorax
Which PFTs measure against predicted values?
spirometry and plethysmography
What are the 5 indications of PFTs?
● Evaluate patients with respiratory symptoms or rib fracture
● Assess progression of previously diagnosed lung disease
● Monitor the efficacy of treatment
● Evaluate patients preoperatively
● Monitor for potentially toxic side effects of certain drugs
What are some limitations to PFTs?
patient must cooperate and be able to follow directions
kids usually 5 and older
______ is the volume of air inspired or expired with each normal breath at rest
tidal volume
______ is the maximum volume of air
that can be inspired over and above the tidal volume
inspiratory reserve volume
______ is the volume of air that can
be expired after the expiration of the tidal volume
expiratory reserve volume
______ is the volume of air that remains in the lungs after maximal exhalation
residual volume
Draw the PFT chart with volumes
What is this called? What is its function?
spirometry
Non-invasive assessment of maximum
inspiratory and expiratory volume as
well as maximal expiratory effort
- can be done pre and post bronchodilator
What are the pt directions for how to use a spirometry?
When is a spirometry indicated?
diagnostic and monitoring of lung and neuromuscular diseases that affect
breathing
prevention of post-surgical/traumatic pulmonary complications
When is spirometry contraindicated?
○ recent (<6wks) since abdominal, intracranial, or eye surgery or a
pneumothorax
○ thoracic, abdominal and cerebral aneurysms
○ unstable angina or a recent MI
○ acute severe asthma, acute respiratory distress, active TB
_______ the greatest volume of air that can be expelled from the lungs after
taking the deepest possible breath
vital capacity
______ the maximal speed at which air can be exhaled with force
peak expiratory flow rate
What is the gold standard for PFT? What does it measure? When is it indicated?
Plethysmography
Measures the total volume of air held in the lungs
Indicated if decreased FVC on
spirometry
What is this?
Plethysmography
air tight chamber with various transducers that measure pressures in the airway and within the box
What is the difference between obstructive and restrictive lung disease?
Obstructive - difficulty exhaling air from the lungs
○ Restrictive - difficulty expanding the lungs during inhalation
**What is the cutoff that determines responsiveness to bronchodilators for adults? for kids?
What does the green graph indicate? red? blue?
green: normal PFT
blue: restrictive
red: obstructive
How much air is in the reserve volume? How much air does the normal lung hold?
reserve: 2 liters
normal: 6 liters
**Draw the flowchart that is used to interpret PFTs
What is maximal respiratory pressures? When is it assessed?
When is it indicated?
part of plethysmography, forced expiration (with cheeks
bulging) through a blocked mouthpiece
after a full inhalation that measures respiratory muscle strength
unexplained decrease in
VC or suspected respiratory muscle weakness
____ is the most sensitive PFT. What does it assess?
Diffusing capacity (DLco)
assesses the transfer of oxygen and carbon dioxide
Which PFT assesses oxygenation during exertion and the distance a patient
can walk? What do you need to monitor for? What is considered a normal test?
6 minute walk test
monitor for s/s of dyspnea and fatigue. Also need to monitor oxygen saturation at rest and while walking
normal is 1300-2300 without symptoms and pulse ox above 95%
What does peak flow measure? When is most commonly used? What is the pt education?
Measures peak expiratory flow (PEF) rate
Utilized to determine adequate control of asthma
blow a “fast hard blast” versus slowly emptying your lungs
What should you do if your peak flow is in the green range? yellow? red?
green: all clear-> no treatment necessary
yellow: caution -> implement treatment plan prescribed by PCP
Red: medical alert -> contact provider and start bronchodilator therapy immediately
What does a pulse oximetry measure? What is normal?
○ Reading is provided as a percentage of hgb that is
oxygenated
● Normal 95% or higher
What are some limitations of the pulse oximetry?
○ nail polish, pigmented skin
○ bright lighting
○ patient movement, improper placement
○ poor perfusion
○ CO poisoning
a pulse oximetry is unable to differentiate between ____ and _____
carbon monoxide (CO) and oxygen (O2)
What does capnography measure?
the measurement and
and monitoring of
the concentration
of CO₂ in expiratory
gases
What is a better representation of impending hypoxia, capnography or pulse ox?
capnography is better because CO₂ will rise 30-60 seconds before O₂ drops in respiratory
depression
What are the 4 phases of capnography? Where does inhalation and exhalation happen? Draw the curve/graph
What is a normal EtCO2 level? What does it mean if it fall below that? above?
● normal EtCO₂ levels are 35-45 mmHg
EtCO₂ < 35 mmHg = Hypocapnia
■ Etiologies: hypothermia, low
cardiac output, pulmonary
embolism, hyperventilation
EtCO₂ > 45 mmHg = Hypercapnia
■ Etiologies: Malignant hyperthermia,
shivering, fever, sepsis, severe
hypothyroidism¹, hypoventilation
What does obstructive lung disease capnography look like?
Obstructive disease results in a rounded ascending phase and
upward slope in the alveolar plateau
Name the 3 indications for capnography
● Ensuring proper ventilation during:
○ general anesthesia
○ procedural sedation
● Confirmation of proper ET tube
placement and ventilator settings
● Ensuring adequacy of chest
compressions in cardiac arrest
When would you order a sputum culture? What are some important collection instructions?
find cause of LOWER respiratory infection OR to look for abnormal cells under a microscope
○ collect before initiating antibiotics
○ prefered early morning collection
○ rinse mouth out with plain water
○ breathe deeply to stimulate coughing and expectoration
○ refrigerate the container until processing takes place
○ avoid adding saliva or nasopharyngeal secretions to the sputum
sample
What are the 2 major types of CT scans? Which one is used most?
conventional and helical**- MC
What are some advantages of helical CT? What are some disadvantages?
● Faster and more anatomic coverage
● Allows for cardiac imaging
● Eliminates respiratory artifact during breathing
● Sharper, more high-definition 3D images
radiation exposure: 7 mSv
(standard UV exposure to 3 mSv per year)
What are some indications for lung CT?
● Inconclusive x-rays or abnormality on physical examination
● Assess cardiothoracic space for tumors and other lesions
○ monitor response of tumors to treatment
● Intrathoracic injury/bleeding
● Complicated infection
● Unexplained chest pain
● Obstructions
● Provide guidance for biopsies and/or aspiration of the tissue from the chest
What are some risks/CI/cautions with CT?
pregnancy especially in the first trimester
hx of large amounts of radiation exposure
What are some risks/CI/cautions with contrast dye? **What is the important one to remember?
■ Allergy to contrast dye
○ Severe renal impairment - GFR < 20 mL/min
○ Hyperthyroidism or thyroid goiter - may potentiate thyrotoxic crisis
○ Pheochromocytoma - may induce hypertensive crisis
Metformin use - drug must be discontinued prior to contrast and
held for 48 hours after
What is the weight limit for a CT? What happens if a metal object is scanned inside the body?
450 lbs
looks like a starburst
What common GI test can limit the effectiveness of a CT scan?
barium in esophagus from
recent barium study
When is contrast indicated? What is contrast mostly composed of?
Indicated if assessing vascular disease or to
delineate area of concern from adjacent structures
iodine!!!
What does a CTA show?
only shows pulm vasculature
What is a V-Q scan show? When is it indicated?
A nuclear medicine scan that uses radioactive material to
examine air flow (ventilation) and blood flow (perfusion) in the
lungs. VQ scans detect poor blood flow in the pulmonary vascular and
uneven air distribution
diagnose or rule out a pulmonary embolism (PE) when
CT is contraindicated
What is the procedure for a V-Q scan?
V-Q scan: if the ventilation scan is abnormal but the perfusion scan is normal. What does this indicate?
abnormal airways in all or part of the lung
COPD or asthma
V-Q scan: if the perfusion scan is abnormal but the ventilation scan is normal. What does this indicate?
depends on the difference between the two scans but a PE might be present
V-Q scan: both the ventilation and perfusion scans are abnormal. What does this indicate?
pneuomonia, COPD or PE
suspect a PE in a preg pt, what imaging do you order?
V-Q scan is preferred in preg pts
What are some risks associated with a V-Q scan?
● Radiation is very minimal and usually out of system in a few days
● Pregnancy: radiology will use a smaller amount of radioactive dye
● Breastfeeding: mothers must discard milk for 24 hours post scan
● Mild and rare chance of allergic reaction - MC hives
______ dx technique is the gold standard in diagnosing acute PEs
pulmonary angiography
Describe the procedure for pulmonary angiography. What will a PE look like?
● A “filling defect”
or abrupt cutoff
of a small vessel is
indicative of
embolus
Besides a potential PE, what are 4 additional indications for pulmonary angiography?
● AV malformation of the lung
● Congenital narrowing of pulmonary vessels
● Pulmonary artery aneurysms
● Pulmonary hypertension
What are some risks associated with pulmonary angiography?
● Allergic reaction to contrast dye
● Kidney damage from contrast dye
● Damage to blood vessel or nerve from needle or catheter
● Injury to nerves at puncture site
● Excessive bleeding, blood clot or hematoma formation
● MI or stroke
What are some differences between CT angiography and pulmonary angiography?
_______ procedure used to
directly visualize the airways
and diagnose lung disease. What are the 2 types? What types of sedation do you need for both
bronchoscopy
flexible- MC- procedural sedation
rigid- general anesthesia
What are some indications for bronchoscopy?
● Evaluation and removal of airway FB’s or other obstructions
● Diagnosis and staging of bronchogenic carcinoma
● Evaluation of hemoptysis
● Diagnosis of pulmonary infections
● Transbronchial lung biopsy
● Bronchoalveolar lavage
What is the CI for bronchoscopy? What are some common complications? What is the rate of major complications?
● SEVERE bronchospasm or bleeding diathesis
Transient hypoxemia, pneumothorax, hemorrhage
less than 1%
