Pulmonary exam Flashcards
How do you calculate pack years?
number of packs per day x years smoked
What RR indicates tachypnea?
> 20 breaths/min
What is cor pulmonale?
dilation of R ventricle d/t chronic lung disease
Typical tidal volumes for adults and children?
adults = 500ml children = 20ml
TV = volume of gas inhaled (or exhaled) over normal breath
Where will you see cyanosis if it’s present in your patient?
lips, around the eyes, nail beds
What is a sign of chronic hypoxemia found in the fingers/nailbeds?
digital clubbing
With obstructive pulmonary disease, what happens to the A-P dimension of the chest?
increases
- lung recoil is decreased, resulting in barrel chest, increased AP dimension
What is typical thoracic excursion in adults and how do you measure this?
2-3in, measured by base of lungs from full inspiration to full experiation
When auscultating your patient, you hear vesicular sounds. What are these?
normal breath sounds (heard all through inspiration, beginning of exp)
What do decreased breath sounds sound like? Associated with what kind of lung disease?
distant sounds where only some of inspiration is heard
- associated with obstructive lung disease (maybe restrictive though?)
What type of lung sound might you hear with atelectasis, fibrosis, or pulmonary edema?
crackles/rales
Your patient has a thoracic burn. What should you make sure to assess in your pulmonary assessment?
symmetric thoracic expansion
What are key points to assess with pulmonary inspection/palpation?
1) neck - trachea position, accessory muscle use
2) thorax - changes in bony thorax, AP dimension, symmetrical excursion, changes in skin, pain, scars
Where in the lung will you hear more intense inspiration/expiration sounds upon auscultation?
more loud/intense at apex
quieter at bases
What are the two adventitious breath sounds?
wheezes (heard on expiration)
rales (heard on inspiration)
What is atelectasis?
partial/complete collapse of the lunge
What is a pneumothorax?
presence of air/gas in the cavity between the lungs and chest wall, causing compression of the lung
- can cause atelectasis
Your patient has aspirated a foreign body. What adventitious breath sound might you hear?
wheezes
- vs crackles heard during atelectasis, fibrosis, or pulmonary edema
Your patient with COPD might demonstrate what adventitious breath sound?
wheezes (which are caused by airway obstruction)
What is pulmonary edema? What can cause it?
fluid in the lungs
- fluid collects in the sacs, making it difficult to breathe
- can be caused by congestive heart failure, or kidney failure (inability to excrete fluid from body, builds up in blood vessels)
What is congestive heart failure?
heart dysfunction that causes fluid buildup in lungs and surrounding tissue
What does normal transmission of vocal sounds sound like?
same as breath sounds: loudest near trachea and main-stem bronchi
- less clear but still intelligible at distal areas of lungs
If you can hear vocal sounds intensely and clearly in the bases of the lungs, what is this dysfunction called?
bronchophony
Why might there be abnormal transmission of vocal sounds?
fluid filled areas, areas of consolidation, cavitation lesions, pleural effusions
What is pleural effusion? Caused by what? How is it commonly treated?
excess fluid buildup between the lungs and the chest
- most commonly caused by congestive heart failure
- commonly treated with diuretics
Why would a chest x-ray be performed for a patient? (2)
1) to detect presence of abnormal material (exudate, blood)
2) change in pulmonary parenchyma (fibrosis, collapse)
What is exudate?
protein-rich fluid with other cellular elements that oozes out of blood vessels d/t inflammation and is deposited in nearby tissues
- fluid that leaks out around cells of capillaries
What type of scan might be performed to assess for the presence of pulmonary emboli?
V/Q scan - matches the ventilation pattern of the lung to the perfusion pattern
What is ventilation? Perfusion?
ventilation = air getting into alveoli perfusion = blood getting transported to alveoli in lungs
What is alveolar ventilation?
ability to remove CO2 from blood and maintain blood pH
Your patient exhibits dizziness, syncope, N/T. You check their chart prior to the session and recall that they’re lab values indicate a most recent pH of 7.6. and PaCO2 of 30. What could be occuring?
respiratory alkalosis (decreased pH = more alkaline)
What are the 4 types of abnormal acid-base balance?
respiratory alkalosis/acidosis
metabolic alkalosis/acidosis
What abnormal acid-base balance issue causes secondary hyperventilatino, nausea, lethargy, and/or coma?
metabolic acidosis
- both respiratory and metabolic acidosis can cause coma, more issues here than alkalosis
T/F: PaCO2 remains WNL for respiratory acidosis.
false -> remains the same for metabolic acidosis AND alkalosis
- increases for respiratory acidosis
A combination of a high pH and low PaCO2 can cause what?
respiratory alkalosis
- remember PaO2 only changes with respiratory acidosis/alkalosis
What does an FEV1/FVC value
obstructive lung issue decreasing airflow
What is FEV1?
amount of air that can be expelled in 1 sec
What is FVC?
forced vital capacity: how much air can be forcefully expelled after a full inhale
How many categories of obstructive lung disease are there?
4: mild, mod, severe, very severe
At what stage of obstructive lung disease do patients start to seek out medical care?
2 - may have an exacerbation or may have chronic respiratory problems
At what stage of obstructive lung disease is FEV1 <50%?
stage 3: <50 but >30
Cor pulmonale, increased JVD are signs of what stage of obstructive lung disease?
stage 4 - very severe
What is cor pulmonale?
abnormal enlargement of the R side of the heart d/t failure
