Pulmonary Flashcards
What information do you want to gather during the history of a pulmonary pt?
- Baseline pulmonary function
- exercise tolerance
- dyspnea
- orthopnea
- smoking
- OSA
- chronic lung disease
- severity
- medications
- recent hospitilizations
- frequency of exacerbations
- effective treatments
- Acute lung disease
- recent URIs
- antibiiotics
- current symptoms
- Previous anesthesia
- complications?
- Medical clearance
- evaluate for current status
- labs/diagnostic tests
What are the components of physical assessment?
- inspection/ observation
- auscultation
- palpation
- percussion
What can you observe about your pts pulmonary status?
- rate, pattern, effort of respiration
- tracheal position
- expansion of thorax and use of accessory muscles
- characteristics of skin and soft tissues
What do you hear with normal auscultation?
- First you will hear the tracheobronchial tree
- where: heard best over trachea, right sternoclavicular joint, posterior right interscapular space
- Quality: higher, hollow pitch; equal on inspiration and expiration w/ short pause
- Vesicular
- Where: lung tissue
- Quality: lower pitched, softer, shorter expiration
You shouldn’t hear bronchial air sounds anywhere other than the bronchial tree. What does it mean if you do?
- It means that there is no ventilation into the alveoli
- Could be caused by:
- Consolidation- sounds like low pitched bronchial breathing (pulm edema, etc)
- Cavitary disease- sounds like high pitched bronchial breathing. (tb, malignant, etc)
What are the abnormal adventitious sounds?
- Wheeze (high pitched), Rhonchi (low pitched)
- musical, usually on expiration but may be on inspiration
- Stridor
- high pitched, usally inspiration
- Crackles/Rales
- tearing velcro open
What is the purpose of pulmonary function tests?
When are they indicated?
- Purpose:
- standardized
- objective
- Indication
- assist in diagnosis of a disease
- to evaluate a treatment
- to monitor disease progression
- Assess the risk- will they tolerate removal of part of lung, etc.
Who would be appropriate patients to do PFTs on?
- Patients with evidence of COPD
- smokers with a persistent cough
- wheezing or dyspnea on exertion
- morbid obesity
- thoracic surgery patients
- open upper abdominal procedures
- patients >70 years
- Routine PFTs are NOT recommended
What are tests that assess abnormalities in gas exchange?
Mechanical dysfunction?
- Abnormalities of gas exchange
- ABG
- pulse oximetry
- capnography
- Mechanical dysfunction of lungs and chest well
- spirometry
- **All are considered PFTs
What are the normal values for Volume and flow?
How are these determined?
- Spirometry
- Volume- normal 80-120% of predicted value
- Flow- normal is 80% of predicted value
- Predicted values based on:
- age
- height/weight
- gender
- ethnicity
Quick review of pulmonary disease:
Obstructive
Restrictive
- Obstructive
- airflow obstruction- chronic bronchitis or emphysema; progressive
- Asthma- chronic inflammatory disorder; reversible
- Restrictive
- proportional decreases in ALL lung volumes
What is Vital capacity?
- Most commonly measured; measured by simple spirometry
- Maximal inspiration followed by maximal exhalation to RV
- independent of rate of effort
- values should decrease as person goes from sitting to supine
- Normal is >/=80% of predicted value
What is Forced Vital Capacity (FVC)?
How do you interpret the results?
- Pt takes in maximum inspiration and forces exhalation
- Function of volume/time
- measures resistance to flow
- depends on pts effort and cooperation
- Interpretation:
- normal: 80-120%
- Mild: 70-79%
- Moderate: 50-69%
- Severe: <50%
What is the Forced expiratory volume in 1 second (FEV1)?
- Volume of air forcefully expired from full inspiration in the first second
- Normal is 75-80% of FVC
- Depends on effort and cooperation
- Interpretation:
- Normal: >75%
- Mild: 60-75%
- Moderate: 50-59%
- Severe: <49%
How do pulmonary function tests compare btw obstructive and restrictive disease?
(table)