Pulmonary Evaluation Flashcards
FEV/FVC scoring
normal: .75-.8
> 0.8 restrictive lung disease
< 0.7 obstructive lung disease
measures max amount of air inhaled and exhaled in determined time
Forced midexpiratory Flow (FEF 25-75)
volume of air exhaled over middle half of FVC
Max voluntary ventilation (MVV)
“Breathe as deeply and as rapidly as possible for 10, 12, 15 sec”
Measures max amount of air inhaled and exhaled in determined time
Tests of diffusion
DL
or
DLco
DLco
- in presence of O2, CO will bind to RBCs, give a tiny dose of CO, and breathe out
- Take difference of what was inhaled/exhale
- difference is the gas that has gone from the body
Measures the ability of blood to diffuse gas from the lungs
Why is the supine position difficult for pulmonary patients?
- organs pushing on diaphragm
- mucous moves back into lungs
T/F: patients often notice that their clubbing is abnormal and painful
False
Supplemental O2 considerations
- being used properly
- flow rate
- breathe to make use of the supplemental O2
pulmonary:
evaluation of the neck
- hypertrophy of SCM
- chronic forward bent posture (shortened SCM)
- JVD
- position of clavicle
resting chest evaluated for
- symmetry
- rib angles
- musculature
chest eval: rib angles
- normally rib angles < 90 deg and attach to vertebrae approx 45 deg angles
- abnormal angles > 90 deg
- abnormal vertebral angle > 45 deg
chest eval:
muscle
hypertrophy and/or adaptive shortening of SCM = chronic condition
Normal RR (bpm)
- infants: 30-60
- 3-6 y.o. : 22-34
- 6-12 y.o. : 18-30
- 12-18 y.o. : 12-20
Eupnea
normal rate, depth, and rhythm
bradypnea
- slow rate
- shallow or normal depth
- regular rhythm
tachypnea
- fast rate
- shallow depth
hyperpnea
- normal rate
- increased depth
- normal rhythm
hyperventilation
- fast rate
- increased depth
- regular rhythm
results in decreased arterial CO2
Evaluation:
Patient Speech
- dysnpnea on phonation
- how many words before next breath
wheezes
continuous high pitched sound
rhonchi
- subtype of wheeze
- low pitched like a snore
- obstruction of larger airway
crackles
- discontinuous adventitious sounds
- sounds like brief bursts of popping bubbles
pleural rub
sounds like two pieces of leather/sandpaper
pleural rub
sounds like two pieces of leather/sandpaper
cough assessment
- strength
- duration
- effectiveness
- quality
color of mucous indicating bacterial infection
yellow, orange, green
Paradoxical breathing
chest moves inward instead of outward during inhalation
paradoxical breathing causes
- airway obstruction
- mechanical disruption of chest wall
- phrenic nerve injury
- diaphragmatic dysfunction
- phrenic nerve injury
cause of flail chest
broken ribs
atelectasis
complete or partial collapse of a lung or lobe.
Trachea moves toward collapsed side
pneumothorax
- abnormal collection of air or gas in pleural space causing uncoupling of lung from chest wall
- air leaks into space and restricts lungs
- Trachea deviates AWAY
- air leaks into space and restricts lungs
Pneumothorax:
signs
- tachypnea
- assymetric lung expansion
- distant/absent breath sounds
- decreased tactile fremitus
- adventitious lung sounds
tumor: deviation of trachea
pushed AWAY
chest expansion measurements
- children: 2 cm
- “fit young man”: >5cm
- severe emphysema: may expand <1cm
crepitus:
- increasing edema in chest > scapula > neck to face
- crispy feeling and crackling when skin palpated
cause of crepitus
- air in subcutaneous tissue
- air leaks out of lungs follows fascial planes and enter subcutaneous later of the skin
- “ subcutaneous emphysema”
egophony
- say “EEEEE”
- healthy = eeeee
- unhealthy= nasal A or goal call
bronchophony
- say 99 repeatedly
- healthy = not understandable
- unhealthy = 99 understood. indicates consolidation
whispered pectoriloquy
- whispe 1-2-3
- healthy = not understood
- unhealthy = understood
