Pulmonary Evaluation Flashcards
tidal volume
normal breath
inspiratory reserve volume
extra after breathing in
expiratory reserve volume
extra after breathing out
vital capacity
max amount of air you can breath in and out
residual volume
amount of air in lungs after max breath
What does a residual volume of 0 mean?
collapsed lung
What is FEV1/FVC?
ratio of total of air out during 1 sec over time
normal FEV1/FVC
0.75-0.8
high FEV1/FVC means what
> 0.8
- restrictive lung disease
low FEV1/FVC means what
< 0.7
- obstructive lung disease
What does an increased rib angle indicate? What does this do to the diaphragm?
rib angle > 90 deg
- indicates chronic hyperinflation that places an increased stretch on the diaphragm causing it to become flatter and less effective
Eupnea
- rate, depth, and rhythm
normal rate, normal depth, regular rhythm
bradypnea
- rate, depth, and rhythm
slow rate, shallow or normal depth, regular rhythm
tachypnea
- rate, depth, and rhythm
fast rate, shallow deep
hyperpnea
- rate, depth, and rhythm
normal rate, increased depth, regular rhythm
hyperventilation
- rate, depth, and rhythm
- What does this result in?
fast rate, increased depth, regular rhythm
- results in decreased arterial carbon dioxide
an increase in lung tissue density causes _______ sound transmission
increased
a decrease in lung density (emphysema) would cause _________ sound transmission
decreased
adventitious breath sounds
the abnormal noises heard only with a stethoscope
Wheeze sound What does this indicate?
continuous but high pitched
- inflamed lung (asthma)
Rhonchi sound What does this indicate?
wheeze, low pitch like a snore
- implies obstruction of larger airway
crackles What does this indicate?
discontinuous adventitious lung sounds that sound like brief bursts of popping bubbles
- indicates fluid in lungs
pleural rub What does this indicate?
sounds like 2 pieces of leather or sandpaper rubbing together
- indicates infection in pleural space
What is paradoxical breathing?
chest moves inward instead of outward during inhalation
What conditions cause tracheal deviation?
atelectasis and pneumothorax
Atelectasis. Which way does the trachea move?
complete or partial collapse of a lung (alveolar collapse)
- trachea moves toward the collapsed side
Pneumothorax Which way does the trachea move?
abnormal collection of air in the pleural space that causes an uncoupling of the lung from the chest wall
- creates restrictive lung disease
- trachea moves away from involved lung
S&S of pneuothorax
- tachypnea
- asymmetric lung expansion
- distant or absent breath sounds
- decreased tactile fremitus
- adventitious lungs sounds
ED referral is you see these in a patient
What is tactile fremitus?
vibrations created while talking and listening to lungs
How much vibration will be felt if a patient has more air trapped (emphysema)? fluid trapped (pneumonia)? Air outside lung (pneumothorax)?
air trapped - less vibration
fluid - increased vibration
air outside lung - decreased
sound from mediate percussion as thoracic air increases? - emphysema and pneumothorax
tympanic sound
sound from mediate percussion as thoracic air decreases? - atelectasis, mucus, pleural effusion
hyporesonant/dull sound
egophony. How is it tested and what are normal and abnormal results?
increased resonance of voice sounds
- say “Eeeeeee”
normal results = hear Eeeee
abnormal results = nasal A or goat call heard
Brinchophony How is it tested and what are normal and abnormal results?
abnormal transmission from lungs or bronchi
- say “99” repeatedly
normal = not understandable
abnormal = 99 understood
Whispered pectoriloquy How is it tested and what are normal and abnormal results?
increased loudness heard upon whispering
- whisper “1-2-3”
normal = not understood
abnormal = understood 1-2-3
What type of breathing would be done with post-op pts, dyspena at rest, or pts who have inefficiency with breathing?
diaphragmatic breathing training
What type of breathing would be done with tachypnea and dyspnea pts?
pursed lip breathing
What type of breathing would be done with pts with decreased lung volumes, decreased chest wall compliance, and V-Q mismatch?
segmental breathing
- provide quick stretch over external intercostals as pt reaches full exhalation
What breathing technique is good for patients who you don’t want to hit or vibrate due to precautions/contraindications?
active cycle of breathing techniques
How to perform active cycle of breathing technique
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
How to perform autogenic drainage?
1) Blow out all air
2) Small breaths in and out for 10-20 breaths
3) Medium breaths in and out
4) Large breaths in and out
5) Cough
6) repeat
anterior upper segment position (upper lobes)
sitting w/ head of bead raised w/ pillow under kness
- used for anterior upper lobes
posterior apical segment
sitting with flexed trunk forward w/ pillow under knees
- posterior upper lobes
anterior segments
supine with pillow under knees
- anterior middle lobes
right posterior segment
prone with right side slightly elevated
- posterior right upper lobe
left posterior segment
prone w/ head of bed raised and pillow under stomach/left side slightly elevated
- posterior upper left lobe
right middle lbe
supine with right side slightly elevated by pillow and foot of bed raised 12 inches
- anterior lower right lobe
left lingular
supine with left side slightly elevated by pillow and foot of bed raised 12 inches
- anterior lower left lobe
anterior segments (lower lobes)
supine w/ pillow under knees and foot of bed raised 18 inches
- anterior middle/lower lobes
right lateral segment
left side lying with foot of bed raised 18 inches
- right lower lobe
left lateral segment
right side lying with foot of bed raised 18 inches
- left lower lobe
posterior segments
prone with foot of bed raised 18 inches
- lower posterior lobes
superior segments
prone with pillows under stomach and feet
- middle posterior lobes
