Pulm Exam Flashcards
the primary function of the pulm system is the vent and respirate… where does the pulm system receive its automatic neural input
- medulla controls rhythmicity
2. pons control depth and rate
what are the five primary obstructive pulmonary disorders we should know
asthma, chronic bronchitis, emphysema, CF, and bronchiectasis
what are the two major restrictive pulm disorders we should know
atelectasis and pneumonia
what are the four special considerations for pulm disorders we should know
SCI, lung cancer, ARDS, and respiratory failure
CVP measurement is a direct reflection of _______
R sided heart function
before proceeding with tests and measures/activities assessment in the acute care setting with pulm patients, what are four objective things to consider
- stable vitals at rest
- no dyspnea at rest
- lab values
- any post op complications
what is the MMRC dyspnea scale
modified medical research council dyspnea scale
0 - only breathless during strenuous exercise
1 - short of breath hurrying on level ground or walking up a small hill
2 - slower than normal on level ground due to breathlessness or have to stop to catch breath
3 - must stop after 100m or a few minutes of walking on level ground
4. to breathless to leave the house or breathless when dressing
what is 0, 2, 5, and 10 on the modified borg scale for dyspnea
0 - nothing
2 - mild SOB
5 - strong/hard of breathing
10 - SOB severe enough to stop activity
what is the normal sequence of breathing
- diaphragm contracts and descends as the abdomen rises
- lateral costal expansion as ribs move up and out
- upper chest rises
what is diaphragmatic excursion
thumbs over costal margin tips near the xiphoid - instruct the patient to deep breathe and analyze chest expansion
where do you test chest wall excursion
- upper lobes - palms on anterior first 4 ribs
- right mid and lingular segments - palms on anterolateral chest at the xiphoid line
- lower lobes - palms on posterior cage below scap
what is fremitus
vibratory tremors
- ask pt to repeat “99” while palpating varioius segments
- normal = uniform vibration
- abnormal = increased vibration indicates secretions in the area
what is normal inspiration:expiration, how does it change in obstructive disease?
1: 2
1: 3-4 (expiration is prolonged)
normal RR?
12-20
RR > 25 indicates
primary pulm dysfunction, metabolic acidosis, or systemic stress
RR < 10 indicates
CNS abnormality or metabolic alkalosis
define
lack of airflow to lungs for > 15 s
apnea
define
increased rate and depth resulting in decreased PCO2
hyperventilation
define
RR > 20
tachypnea
define
RR < 12
bradypnea
define
increased depth of breathing
hyperpnea
define
decreased rate and depth of respiration resulting in increased PCO2
hypoventilation
define
breathing that results from hemiplegia and surgery
asymmetrical breathing
define
increasing depth of respiration followed by a period of apnea
cheyne-stokes respirations
define
inward abd/chest movement with inspiration and outward movement with expiration
paradoxical respiration
define
dyspnea that occurs supine but relieved with upright standing or sitting
orthopnea
maximal inspiratory pressure (MIP) is a good indication of _________
what is a score that denotes such an indication?
inspiratory muscle strength
MIP < 50% predicted in the presence of clinical signs
when is maximal expiratory pressure (MEP) decreased?
decreased in neuromuscular disorders and other cases of generalized muscle weakness
what are the two adventitious auscultation sounds
wheezing (usually on exhalation) and crackles (usually upon inspiration)
what is egophony
“e” get “a” is positive for fluid in airspaces
what is bronchophony
“99” heard clearly over the entire chest
+ for consolidation if phrases clearly audible in distal lung fields
+ for hyperinflation if less audible in distal lung fields
what is whispering pectroliquy
whispered “one, two, three” heard clearly with the same rules as bronchophony
in many situations, pts will achieve ventilatory maximum before cardio max; therefore, max exercise heart rate is _________ than predicted max HR due to pulmonary constraints
lower
what is the 6mwt threshold value for patients with COPD. I.e. patients below this value have a higher mortality
350m (1150ft)
what is the MCID for the 6mwt
86m
