pulmonary disease Flashcards
Who’s at risk for pulmonary problems?
pre existing pulmonary dx, thoracic or upper abdominal surgery, smokers, obesity, age >60 years, anesthesia longer than 3 hours
5 pulmonary symptoms that ID a patient at risk for pulmonary complications?
cough, expectoration, hemoptysis, chest pain, wheezing
How do you calculate pack years?
length of time smoking x # of packages of cigs smoked
Malnourished patients are predisposed to what type of pulmonary complication?
pneumonia
Clubbing is often seen in what?
chronic lung disease and malignancy
RR greater than what is early sign of respiratory failure?
25
How is pursed lip breathing an adaptation for obstructive lung dx?
self PEEP
How could you identify severe dyspnea?
unable to complete normal sent wout pausing for breath
What is inspiratory paradox?
abdomen goes in and chest wall expands= dysfunction of diaphragm
Reduced pulm vascular markings in hyperinflated lung volumes can be seen how on a chest xray?
lungs seem more translucent
IC spaces mildly elevated so wider between ribs implies what on a chest xray?
use of accessory muscles for respiration so hyperinflation of lungs
Dome flattened out and is below ant angle of __ rib so implies emphysema?
7th
3 common ABG findings w pulmonary pathology?
PCO2>45, PaO2
2 EKG changes in pts with lung dx?
low voltage QRS (bc of hyperinflation of lungs and increases distance of skin where electrodes are and electrical activity of heart), right BBB
RBBB seen in what leads?
2ndary R wave in V1-3
Where can you see cor pulmonale and pulmonary hypertension?
chest xray
Examples of symptoms and signs of pulmonary dysfunction warranting PFTs?
symptoms- wheezing, CP, dyspnea, orthopnea, cough, phlegm; signs- diminished breath sounds, overinflation of chest, exp slowing observed as purse lip, chest/spine deformity, unexplained crackles
IC is?
TV + IRV
VC is?
ERV + IRV + TV
TLC is?
IRV + ERV + TV + RV
FRC is?
ERV + RV
Maximal volume of air exhaled from end expiration?
ERV
Maximal volume of air inhaled from end inspiration?
IRV
Volume of air remaining in lungs after maximal exhalation?
RV
Volume of air in the lungs at resting end expiration?
FRC
Maximal volume of air that can be inhaled from the resting expiratory level?
IC
Largest volume measured on complete exhalation after full inspiration?
VC
Volume of air in lungs at maximal inflation?
TLC
If the patient has obstructive disease, how is that manifested on a slow VC (not forced vital capacity in other words) spirometry?
slow VC generally higher than forced VC bc airways collapse under rapid exhalation
Most widely used parameter to measure mechanical pressures of lung?
FEV1
In normal people, FEV1 reflects what?
greatest part of exhaled vol and reflects mech probs of lungs and medium sized airways
In obstructive airway dx how does that show up on FEV1/FVC?
FEV1 is reduced disproportionately to FVC. so ratio is
In restrictive airway dx how does that show up on FEV1/FVC?
FEV1, forced VC and TLC are all reduced but FEV1/FVC ratio normal or sometimes elevated
What is FEF 25-75%?
the midpoint of forced VC. so between 25 and 75 of expired vol is also called maximal midexp flow
FEF 25-75% reflects what? And is it recommended to measure that?
small airway disease; no
As a person ages, how do the lungs change?
less elasticity, smaller lung volumes, smaller capacities
4 variables which affect lung volumes/capacities?
age, gender, height, race
What does the volume time curve look like in obstructive lung dx?
What does the volume time curve look like in restrictive lung dx?
reduced FVC, reduced FEV1, normal ratio, but lower lung volumes so under the normal curve
Patients with obstructive dx need what 2 parameters? And what vent setting do they do better on?
PEEP and longer expiratory time, may do better on pressure support or pressure generated volume
When ventilating a person with restrictive dx, what do you want to do?
have smaller lung capacity so want to generally bring down volumes we use and increase the rate