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Acute Care Module 3 > Pulm Exam > Flashcards

Pulm Exam Flashcards

1
Q

the primary function of the pulm system is the vent and respirate… where does the pulm system receive its automatic neural input

A
  1. medulla controls rhythmicity

2. pons control depth and rate

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2
Q

what are the five primary obstructive pulmonary disorders we should know

A

asthma, chronic bronchitis, emphysema, CF, and bronchiectasis

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3
Q

what are the two major restrictive pulm disorders we should know

A

atelectasis and pneumonia

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4
Q

what are the four special considerations for pulm disorders we should know

A

SCI, lung cancer, ARDS, and respiratory failure

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5
Q

CVP measurement is a direct reflection of _______

A

R sided heart function

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6
Q

before proceeding with tests and measures/activities assessment in the acute care setting with pulm patients, what are four objective things to consider

A
  1. stable vitals at rest
  2. no dyspnea at rest
  3. lab values
  4. any post op complications
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7
Q

what is the MMRC dyspnea scale

A

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

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8
Q

what is 0, 2, 5, and 10 on the modified borg scale for dyspnea

A

0 - nothing
2 - mild SOB
5 - strong/hard of breathing
10 - SOB severe enough to stop activity

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9
Q

what is the normal sequence of breathing

A
  1. diaphragm contracts and descends as the abdomen rises
  2. lateral costal expansion as ribs move up and out
  3. upper chest rises
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10
Q

what is diaphragmatic excursion

A

thumbs over costal margin tips near the xiphoid - instruct the patient to deep breathe and analyze chest expansion

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11
Q

where do you test chest wall excursion

A
  1. upper lobes - palms on anterior first 4 ribs
  2. right mid and lingular segments - palms on anterolateral chest at the xiphoid line
  3. lower lobes - palms on posterior cage below scap
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12
Q

what is fremitus

A

vibratory tremors

  1. ask pt to repeat “99” while palpating varioius segments
  2. normal = uniform vibration
  3. abnormal = increased vibration indicates secretions in the area
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13
Q

what is normal inspiration:expiration, how does it change in obstructive disease?

A

1: 2
1: 3-4 (expiration is prolonged)

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14
Q

normal RR?

A

12-20

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15
Q

RR > 25 indicates

A

primary pulm dysfunction, metabolic acidosis, or systemic stress

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16
Q

RR < 10 indicates

A

CNS abnormality or metabolic alkalosis

17
Q

define

lack of airflow to lungs for > 15 s

A

apnea

18
Q

define

increased rate and depth resulting in decreased PCO2

A

hyperventilation

19
Q

define

RR > 20

A

tachypnea

20
Q

define

RR < 12

A

bradypnea

21
Q

define

increased depth of breathing

A

hyperpnea

22
Q

define

decreased rate and depth of respiration resulting in increased PCO2

A

hypoventilation

23
Q

define

breathing that results from hemiplegia and surgery

A

asymmetrical breathing

24
Q

define

increasing depth of respiration followed by a period of apnea

A

cheyne-stokes respirations

25
Q

define

inward abd/chest movement with inspiration and outward movement with expiration

A

paradoxical respiration

26
Q

define

dyspnea that occurs supine but relieved with upright standing or sitting

A

orthopnea

27
Q

maximal inspiratory pressure (MIP) is a good indication of _________

what is a score that denotes such an indication?

A

inspiratory muscle strength

MIP < 50% predicted in the presence of clinical signs

28
Q

when is maximal expiratory pressure (MEP) decreased?

A

decreased in neuromuscular disorders and other cases of generalized muscle weakness

29
Q

what are the two adventitious auscultation sounds

A

wheezing (usually on exhalation) and crackles (usually upon inspiration)

30
Q

what is egophony

A

“e” get “a” is positive for fluid in airspaces

31
Q

what is bronchophony

A

“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

32
Q

what is whispering pectroliquy

A

whispered “one, two, three” heard clearly with the same rules as bronchophony

33
Q

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

A

lower

34
Q

what is the 6mwt threshold value for patients with COPD. I.e. patients below this value have a higher mortality

A

350m (1150ft)

35
Q

what is the MCID for the 6mwt

A

86m

Acute Care Module 3 (11 decks)

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