Pulmonary Flashcards
Most advantageous position for the diaphragm
supine
PaO2 levels (normal, hypo, hyper)
normal - 95-100 mmHg
hypoxemia <90 mmHg
hyperoxemia > 100 mmHg
PaCO2 levels (normal, hypo, hyper)
normal - 35-40 mmHg
hypocapnea - <35 mmHg
hypercapnea - >45 mmHg
PaCO2 and body pH relationship
increase in PaCO2 decreases body pH
decrease in PaCO2 increases body pH
normal HCO3 (bicarbonate)
22-28 mEq/L
bicarbonate and body pH relationship
increase in bicarbonate increases the body pH
decrease in bicarbonate decreases the body pH
common sequelae to chronic lung disease
right ventricular hypertrophy and dilation (cor pulmonale)
sign of chronic hypoxemia
digital clubbing
where are bronchial sounds heard
R superior anterior thorax
crackles (sound) are a sign of what
pathology - atelectasis, fibrosis, pulmonary edema
wheezes (sound) is a sign of what
airway obstruction (asthma, chronic obstructive pulmonary disease COPD, foreign body aspiration)
Stop exercise testing: A fall in PaO2 of ________ or a PaO2 _______
A fall in PaO2 of greater than 20mmHg or a PaO2 less than 55 mmHg
Stop exercise testing: A rise in PaCO2 of ________ or a PaCO2 ________
A rise in PaCO2 of greater than 10 mmHg or a PaCO2 greater than 65 mmHg
sarcoidosis
- how is it diagnosed
- how is it managed
restrictive lung disease - multisystem inflammatory disease consisting of granulomas in multiple organs (most often lungs, skin, lymph nodes, eyes, and liver)
often diagnosed as an incidental finding on chest films
managed w/ long term corticosteroids
Who is most affected by sarcoidosis?
persons of color more often than other races
atelectasis
alveolar collapse of lung
cardiogenic vs non-cardiogenic pulmonary edema
cardiogenic - results from increased pressure in pulmonary capillaries associated w/ left ventricular failure, aortic valvular disease, or mitral valvular disease
non-cardiogenic - results from increased permeability of the alveolar capillary membranes due to inhalation of toxic fumes, hypervolemia, or narcotic overdose
what can cause pulmonary hypertension?
- idiopathic pulmonary HTN
- L heart disease
- chronic lung disease/hypoxemia
- pulmonary artery obstruction
active cycle of breathing
1) normal diaphragmatic breathing
2) 3-4 deep breaths
3) hold breath 1-3 sec
4) relaxed exhale and cough/huff as needed
5) repeat
autogenic breathing
1) blow out all air
2) small breaths in and out x20
3) medium breaths x20
4) large breaths x20
5) cough
When to use active cycle of breathing vs autogenic breathing?
active cycle - assist in removal of peripheral secretions that coughing may not clear
autogenic - clear secretions w/o tracheobronchial irritation from coughing
segmental breathing - what is it used for?
apply pressure at end of exhalation
- improve ventilation to hypoventilated lung segments
pertinent physical findings of postoperative pulmonary complications
- increased temp
- increase in WBC count
- change in breath sounds
- abnormal chest x-ray
- decreased expansion of thorax
- shortness of breath
- change in cough and sputum production
aerobic conditioning for pulmonary patients
Frequency - 20-30 min for 3-5 x per week, (durations less than 20 min, 5-7 x per week)
Intensity - near max HR using RPE or Borg scale
Time - 20-30 of continuous before increase (interval if 20-30 of continuous is too much)
Type - aerobic circuit
normal FEV1
obstructive lung disease FEV1
restrictive lung disease FEV1
normal - 70-80%
obstructive - < 60% (harder to exhale_
restrictive - > 90% (harder to inhale)
Cheyne-Strokes respiratory pattern
Irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth of respirations
Biot respirations
Irregular respiration pattern characterized by highly variable respiratory depth and intermittent periods of apnea
Regular respiration pattern characterized by a rate of more than 24 breaths/minute
Tachypnea - respiratory insufficiency and fever as body attempts to rid itself of excess heat
Regular respiration pattern characterized by a rate of less than 10 breaths/minute
Bradypnea - impairment of the respiratory control center and may occur with an increased intracranial pressure, drug intake, or metabolic disorder.
What is common after abdominal surgery? How to combat this?
atelectasis - present in up to 95% of patient who undergo abdominal surgery
- Deep breathing (diaphragmatic breathing) is used to resolve atelectasis and increase oxygenation
continuous monophonic high-pitched crowing sound heard during inspiration
What causes this?
stridor - caused by upper airway obstruction
continuous musical sounds of variable pitch and duration that are heard on inspiration, expiration (most common), or both
What causes this?
high-pitched wheezes - caused by narrow airways or stenosis
inspiratory and expiratory grating, creaking sound like sandpaper or leather being rubbed together
What causes this?
pleural rub - caused by pleural inflammation
discontinuous, nonmusical, crackling sounds similar in sound to several hairs being rubbed together
What causes this? When is it most heard?
crackles (rales) - caused by sudden opening of closed airways or movement of secretions
- most often heard on inspiration
Normal excursion of the diaphragm is
1.2 to 2 inches
Diaphragmatic excursion is decreased in patients who have
COPD - flattened diaphragm (below 1.2 in)
