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Cardio Pulmonary > Pulmonary Eval > Flashcards

Pulmonary Eval Flashcards

1
Q

what is the purpose of Pulmonary Function Tests?

A
  1. tests of lung volumes and capacity
  2. tests of gas flow rates
  3. tests of diffusion
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2
Q

list tests of lung volumes and capacity

A
  1. tidal volume
  2. inspiratory reserve volume
  3. expiratory reserve volume
  4. vital capacity (4000-5000 ml)
  5. residual volume
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3
Q

list tests of gas flow rates

A
  1. FVC
  2. FEV1
  3. FEV1/FVC
  4. Forced midexpiratory flow (FEF)
  5. Maximum voluntary ventilation (MVV)
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4
Q

describe MVV

A

maximum voluntary ventilation

“breath as deeply and as rapidly as possible for 10, 12, 15 seconds”

measures the max amount of air that can be inhaled and exhaled in a determined time

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5
Q

list tests for diffusion

A

DL or DLCO

diffusing capacity of the lung or the amount of gas entering the pulmonary blood flow per unit time

measures the integrity of the functional unit of the lung

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6
Q

what is included in the evaluation/physical examination of a pulmonary exam?

A
  1. general appearance
  2. use of supplemental oxygen
  3. evaluation of neck
  4. resting chest eval
  5. breathing patterns
  6. speech
  7. lung sounds
  8. cough/sputum
  9. palpation
  10. percussion
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7
Q

general appearance examination during a physical exam

A
  1. posture → kyphosis and scoliosis are 2 postures that functionally limit VC
  2. positioning → can they tolerate supine?
  3. skin color → cyanosis
  4. presence of external monitoring and equipment
  5. effort of breathing
  6. clubbing → distal enlargement of fingers w/down slopping nails
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8
Q

Physical exam: supplemental oxygen

A
  1. check to ensure that it is being used properly
  2. check the flow rate
  3. breath in a manner that makes use of the supplemental O2
  4. check facial signs of pulmonary distress including nasal flaring, sweating, paleness, and focused, or enlarged pupils
  5. pursed-lip breathing → clinical sign of COPD
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9
Q

Physical exam → evaluation of the neck

A
  1. check of hypertrophy of SCM
  2. chronic forward-bent posture → shortening of SCM
  3. adaptive changes of the SCM may indicate chronic pulmonary condition
  4. JVD
  5. position of clavicle → often very prominent in pulmonary pathologies
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10
Q

the resting chest is evaluated for what?

A
  1. symmetry
  2. rib angles
  3. muscles
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11
Q

describe chest symmetry

A

normal AP diameter (measurement from xiphoid to the vertebrae) is ½ of the transverse diameter (lateral side to lateral side)

hyperinflated chest → ratio approaches 1

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12
Q

a normal chest will have what shape?

A

jelly bean

with obstructive disorders and air trapping you see the AP direction grow resulting in a barrel chest

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13
Q

chest eval → rib angles

A
  1. rib angles should be observed for abnormalities that might suggest the presence of chronic disease
  2. normally, rib angles measure less than 900 and they attach to the vertebrae at approximately 450 angles
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14
Q

how does chronic hyperinflation impact rib angles?

A

causes rib angles to increase placing an increased stretch on the diaphragm causing it to become flatter and less effective

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15
Q

chest-evaluation → muscles

A

check for hypertrophy and/or adaptive shortening of the SCM → may indicate a chronic pulmonary condition

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16
Q

list normal RR ranges across age groups

A
  1. infants → 30-60 bpm
  2. 3-6 years → 22-34 bpm
  3. 6-12 years → 18-30 bpm
  4. 12-18 years → 12-20 bpm
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17
Q

list and describe different breathing patterns

A
  1. Eupnea → normal rate, depth and regular rhythm
  2. Bradypnea → slow rate, shallow or normal depth, regular rhythm
  3. Tachypnea → fast rate, shallow depth
  4. Hyperpnea → normal rate, increased depth, regular rhythm
  5. Hyperventilation → fast rate, increased depth, regular rhythm
    1. results in decreased arterial CO2
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18
Q

describe things to look for relating to pt speech

A
  1. dyspnea of phonation → when speech is interrupted for a breath
  2. ID how many words can be expressed before the next breath
  3. one-word dyspnea would mean that speech is interrupted for a breath between every word
    1. great to write goals off of
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19
Q

things to consider relating to lung sounds

A
  1. produced from the turbulence of airflow in the airways
  2. heard through a stethoscope
  3. an increase in lung tissue density causes increased sound transmission
  4. a decrease in lung tissue density, as in the empysematous lung, would cause decreased sound transmission
  5. normal breath sounds → normal noises of breathing
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20
Q

list and describe several different abnormal lung sounds

A
  1. adventitious breath sounds → abnormal noises heard only with stethoscope
    1. wheezes → continuous but high pitched
    2. rhonchi → subtype of wheeze; low pitched like a snore; implies obstruction f larger airway
    3. crackles → are discontinuous adventitious lung sounds that sound like brief bursts of popping bubbles
    4. pleural rub → sounds like 2 pieces of leather or sandpaper rubbing together
      1. occurs with both inspiration and expiration
21
Q

what are you looking at with a cough during the physical exam?

A
  1. strength
  2. duration
  3. effectiveness
    1. intrathoracic pressures of up to 300 mmHg and expiratory velocities approaching 500 mph
  4. qualities of the cough-strength, depth and length
22
Q

describe mucous

A

a material from the lungs that is produced (brought up) by coughing

is sticky and this helps to trap dust particles, bacteria and other inhaled debris

23
Q

what to consider/look at with sputum during the physical exam

A
  1. is there mucous?
  2. amount
  3. consistency
  4. color → white, opaque, grey, orange, green, brown
    1. yellow, orange = bacterial infection
  5. change over time
  6. mucoid, purulent, mucopurulent, frothy, viscous
  7. bloodstained?
24
Q

describe the 2 types of cough

A
  1. productive cough
    1. produces mucus or sputum
    2. generally should not be suppressed
    3. associated with lung infections
  2. non-productive cough
    1. dry and does not produce sputum
    2. lung neoplasms
25
Q

assessing breathing during the physical exam

A
  1. rate
  2. use of diaphragm
  3. effort
  4. accessory muscle use
  5. paradoxical breathing?
26
Q

describe paradoxical breathing

A
  1. chest moves inward instead of outward during inhalation
  2. can be caused by a strong contraction of the diaphragm with no support from the intercostals or abdominal muscles. Excessive and rapid abdominal rise and upper chest collapses. Inefficient but sufficient
  3. weak diaphragm but strong accessory muscles
    1. the abdomen is drawn inward during inspiration
    2. chest rises and abdomen falls
27
Q

what could cause paradoxical breathing?

A
  1. presence of airway obstruction
  2. mechanical disruption of the chest wall (trauma)
  3. phrenic nerve injury
  4. flail chest → broken ribs
  5. diaphragmatic dysfunction
28
Q

what is included with palpation during the pulmonary physical exam?

A
  1. assess muscle tone esp. accessory muscles in neck
  2. tracheal position (mediastinum)
  3. assess use of diaphragm
  4. symmetry of costal expansion
  5. presence of crepitus
  6. assess for tactile fremitus
29
Q

describe how to assess tracheal position

A

place an index finger n the medial aspect of the suprasternal notch. Repeat on opposite side. An equal distance between the clavicle and the trachea should exist bilaterally

30
Q

list conditions that cause tracheal deviation

A
  1. Atelectasis → complete or partial collapse of a lung or lobe of a lung. trachea moves toward the collapsed side
  2. Pneumothorax → an abnormal collection of air or gas in the pleural space that causes an uncoupling of the lung from the chest wall. Air leaks into the space between one’s lungs and chest wall and creates a restrictive lung situation. Traches deviates away
31
Q

list some repercussions of a pneumothorax

A
  1. tachypnea
  2. asymmetric lung expansion
  3. distant or absent breath sounds
  4. decreased tactile fremitus
  5. adventitious lung sounds → ipsilateral crackles, wheezes
32
Q

how would the presence of a tumor impact tracheal position?

A

ipsilateral pull towards the atelectasis

33
Q

describe how to assess tracheal position

A

place an index finger n the medial aspect of the suprasternal notch. Repeat on opposite side. An equal distance between the clavicle and the trachea should exist bilaterally

34
Q

describe chest expansion measurement

A

can be measured with tape meter around the chest at about the level of the nipples or 4th intercostal space in males, or just below the breasts in females on deep max inspiration and on max forced expiration.

take the difference between these 2 measurements

35
Q

list norms for chest expansion measurements

A
  1. in children → 2 cm
  2. in a fit young man may expand 5 cm (ranges from 5-8 cm)
  3. in severe emphysema → may expand less than 1 cm
36
Q

describe crepitus

A

hallmark sign is increasing edema chest > scapula > neck to face with rice crispy feeling and crackling when skin palpated (or like popping those plastic air bubbles)

37
Q

what causes crepitus?

A
  1. due to presence of air in the subcutaneous tissue
  2. air leaks out of the lungs follows fascial planes and enters the subcutaneous layer of the skin
  3. called subcutaneous emphysema
38
Q

describe tactile fremitus

A
  1. spoken words produce vibration over the chest wall
  2. when the PT’s hands are placed over the chest wall, the vibrations of a spoken word can be felt
  3. the presence of absence of these vibrations of tactile fremitus provides info about the density of the underlying lungs and thoracic cavity
  4. sound waves are transmitted with less decay in a solid medium (the consolidation) than in a gas medium (aerated lungs)
39
Q

when is tactile fremitus decreased?

A

decreased or absent over areas of pleural effusion or pneumothorax

when there is air outside of the lung in the chest cavity, preventing lung expansion and creating more space in the lung and limiting or preventing sound transmission

40
Q

describe percussion technique

A

makes use of the fact that striking a surface which covers an air-filled structure (normal lung) will produce a resonant note while repeating the same maneuver over a fluid or tissue filled cavity generates a relatively dull sound

41
Q

what would create a deadened tone during percussion?

A

if the normal, air-filled tissue has been displaced by fluid (pleural effusion)

or infiltrated with white cells and bacteria (pneumonia)

42
Q

what would create a hyper-resonant/drum-like sound during percussion?

A

air-trapping

43
Q

describe the process of performing percussion

A
  1. try to focus on striking the distal inter-phalangeal joint of your L middle finger with the tip of the R middle finger
  2. the last 2 phalanges of your L middle finger should rest firmly on the pt’s back. Try to keep the remainder of your fingers from touching the pt, or rest only the tips on them
  3. when percussing any one spot, 2-3 sharp taps should suffice
44
Q

with percussion, as you move down towards the base of the lungs ________

A

the quality of the sound changes

45
Q

list the 3 elicited sounds that could be heard with auscultation

A
  1. Egophony
  2. Bronchophony
  3. Whispered pectoriloquy
46
Q

describe egophony

A

increased resonance of voice sounds

  1. say “Eeeeee”
    1. healthy = Eeeee heard on auscultation
    2. unhealthy = nasal “A” or “goat call” sound auscultated
47
Q

describe bronchophony

A

abnormal transmission from lungs or bronchi

  1. say “99” repeatedly
    1. healthy = not understandable
    2. unhealthy/consolidation = “99” understood
48
Q

describe whispered pectoriloquy

A

increased loudness heard upon whispering

  1. whisper “1, 2, 3’
    1. healthy = not understood
    2. unhealthy = understood “1, 2, 3” or a clear separation in sound

Cardio Pulmonary (21 decks)

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