Pulmonary Flashcards
What is V/Q ratio? What should it be?
comparison of air that is passing through alveoli compared to blood flow
V - ventilation
Q - perfusion
normal is 0.8
What is V/Q mismatch?
insufficient air in alveoli or insufficient blood in blood flow
What is it called when there is excess air in the lungs? What might cause this to happen?
dead space
- occurs when there is a disruption of blood flow like a PE
What is used when there is an excess in perfusion compared to ventilation? What can cause this?
shunt
- lack of air flow (COPD, atelectasis)
What are primary inspiratory muscles?
- diaphragm
- external intercostals
Accessory muscles - SCM, scalenes, pecs, traps
What are primary expiratory muscles?
- rectus abdominus
- external/internal obliques
- internal intercostals
Apnea
- What causes it?
lack of airflow to the lungs for >15 seconds
- airway obstruction, cardiopulmonary arrest, narcotic overdose
Orthopnea
- What causes it?
Dyspnea that occurs in a flat supine position. Relief occurs with more upright sitting or standing
- Chronic lung disease, CHF
Bradypnea
- What causes it?
Ventilation rate <12 breaths per minute
- sedatives, narcotics, alcohol; neuro/metabolic disorders; fatigue
Tachypnea
- What causes it?
Ventilation rate >20 breaths per minute
- acute respiratory distress, fever, pain, emotions, anemia
Hyperpnea
- What causes it?
increased depth of ventilation
- activity, pulmonary infections, CHF
Hyperventilation
- What causes it?
Increased rate and depth of ventilation resulting in decreased PCO2
- anxiety, nervousness, metabolic acidosis
Hypoventilation
- What causes it?
Decreased rate and depth of ventilation resulting in increased PCO2
- sedation, neuro depression of respiratory centers, overmedication, metabolic alkalosis
Biot’s respiration
- What causes it?
Constant increased rate and depth of respiration followed by periods of apnea of varying lengths
- elevated intracranial pressure, meningitis
Cheyne-Stokes respirations
- What causes it?
Increasing depth of ventilation followed by a period of apnea
- elevated intracranial pressure, CHF, narcotic overdose
Kussmaul respirations
- What causes it?
Increased regular rate and depth of ventilation
- diabetic ketoacidosis, renal failure
Paradoxic ventilation
- What causes it?
Inward abdominal or chest wall movement w/ inspiration and outward movement w/ expiration
- diaphragm paralysis, ventilation muscle fatigue, chest wall trauma
Sighing respirations
- What causes it?
the presence of a sigh > 2-3 times per minute
- angina, anxiety, dyspnea
Hoover’s sign
- What causes it?
the inward motion of the lower rib cage during inhalation
- flattened diaphragm often related to decompensated or irreversible hyperinflation of the lungs
Normal PaO2
> 80 mm Hg
Normal PaCO2
35-45 mmHg
Normal pH
7.35 - 7.45
Normal HCO3
22-26 mEq/liter
air trapping
retention of gas in lung as a result of partial or complete airway obstruction
Bronchospasm
smooth muscle contraction of the bronchi and bronchiole walls resulting in a narrowing of the airway lumen
Consolidation
transudate, exudate, or tissue replacing alveolar air
Hyperinflation
over inflation of the lungs at resting volume as a result of air trapping
Hypoxemia
a low level of O2 in the blood, usually PaO2 < 60-80 mmHg
Hypoxia
low level of O2 in the tissue available for cell metabolism
Respiratory distress
acute onset of dyspnea, respiratory muscle fatigue, abnormal respiratory pattern and rate, anxiety, and cyanosis related to inadequate gas exchange, the clinical presentation that usually precedes respiratory failure
flail chest
blunt force trauma w/ rib fracture (2 or more), destabilizes the chest
wheeze sound during breath means what?
airway obstruction, more common on expiration
stridor sound during breath means what?
high-pitched wheeze, inspiration and expiration
Rhonchi sound during breath means what?
low-pitched from airway obstruction
- sounds like someone snoring
crackle sounds during breath means what?
bubbling, popping sounds from fluid/secretions or sudden opening of closed airway
- aka rails
what is mediate percussion?
evaluates tissue densities within thoracic cage
- tapping of distal fingers on back
goals for pulmonary rehab
- Promoting independent functional mobility
- Maximizing gas exchange
- Increasing aerobic capacity
- Increasing respiratory muscle endurance
- Patient education about condition
What position facilitates improved aeration to dorsal lung segments, improved V/Q matching, secretion drainage?
prone positioning
What could be wrong if bronchial sounds are heard in areas where vesicular sounds should be heard?
fluid or secretion consolidation
- pneumonia
What could be wrong if there is decreased or diminished vesicular sounds?
hypoventilation, severe congestion, or emphysema
What could be wrong if there are no lung sounds?
pneumothorax or lung collapse
hemoptysis vs hematemesis
hemoptysis - blood coughing from lungs
hematemesis - blood coughing from stomach
