pulmonary examination/interventions Flashcards
tidal volume
air inspired during normal relaxed breathing
500mL
inspiratory reserve volume (IRV)
5 to 6x bigger than tidal volume
- additional air that can be forcibily inhaled after the inspiration of the normal tidal volume
expiratory reserve volume, ERV
2-3x more than tidal volume
- additional air that can be forcibily exhaled after the inspiration of the normal tidal volume
residual volume
volume of air remaining in the lungs after the expiratory reseve volume is exhaled
vital capacity
total amount of air that can be expired after fully inhaling
total lung capacity - residual volume
or
VC=TV+IRV+ERV
inspiratory capacity
max amount of air that can be inspired
IC=TV+IRV
functional residual capacity
amount of air remaining in the lungs after normal expiration
- air in the lungs after your have expired TV
restricted vs obstructive
restrictive - cant get air in
obstructive - cant get air out
what volumetric measurements increase with obstructive diseases
tidal volume
residual volume
functional residual capacity
total lung capacity
what volumetric measurements changes occur with restrictive diseases
they all decrease
classifications of COPD severity
Stage 1: mild >80
Stage 2: mod 50-80
Stage 3: severe 30-50
Stage 4: very severe >30
what does the FEV1/FVC have to be to be considered COPD
<70
what are the normal breath sounds
vesicular
broncho-vesicular
bronchial
tracheal
compare norma sounds
- vesicular
- bronchovesicular
- bronchial
- tacheal
vesicular:
- inspiration longer than expiratory
- soft and low
- heard over most lungs
bronchovesicular
- inspiratory and expiratory equal
- intermediate intensity and pitch
- between 1st and 2nd interspace anteriorly and between the scapule
bronchial
- expiratory longer than inspiratory
- loud and high
- heard over the manibrum
tracheal
- both inspiratory and expiratory are equal
- very loud and relative high
- heard over trachea
what are the abnormal respiratory sounds
ronchi
wheeze
crackles
pleural rub
compare abnormal respiratory sounds
- rhonchi: cont low pitched, rattling lung sounds that often resemble snoring
- wheeze: high pitched sound heard in expiration, caused by airway obstruction
- crackles: brief, discontinuous, popping lung sounds that are high pitched. can be heard in both phases of expiration
- pleural rub: auscultation in the loweer lateral chest areas it occurs with inspiration and expiration. It can be an indication or pleural inflammation
s1
s2
s3
s4
s1 - lub
s2- dub
s3 - CHF, athletes, pregnancy
s4 - MI, HTN
types of voice sounds
bronchophony
egophony
whispered pectoriloquy
bronchophony
increased vocal resonance with greater clarity and loudness of spoken words
ex: 99
denver bronchos won the superbowl in 99
egophony
a form of bronchophony in which the spoken long “E” sounds changes to a long, nasal sounding “A”
EA sports - E to A
whispered pectoriloquy
an increased loudness of whispering. recognition of whispered words “1,2,3”
ranges for blood gases
pH: 7.35-7.45
PaCO2: 35-45 mmHg
HCO3-: 22-26 mEq/L
blood gases -“ROME”
ROME
respiratory = opp
metabolic = equal
if pH drops into a more acidic range, what is contributing to it
respiratory related
steps to consider when looking at blood gases
- look at pH
normal 7.35-7.45: answer is compensated - look at PaCO2
normal 35-45: answer is metabolic - look at HCO3
normal 22-26: answer is respiratory - none of these are normal
answer is partially compensated
COPD is what kind of blood gas derivative
respiratory acidosis
key positions for postural drainage
superior segments of lower lobes= prone with 2 pillows under pelvis
posterior apical segments of upper lobes = sitting on a chair, leaning fwd over folded pillow
anterior apical segments of upper lobes = sitting in recliner, leaning slightly back
anterior segments of upper lobes = supine lying on bed with pillows under the knees
contraindications and precautions to postural drainage
diaphoresis
cold sweats
when can you incorprate strength traininng in cardiac rehab - what phase
phase 3
you can begin with elastic bands and light hand weights, 1-3lbs or 30-50% of max weight used to complete 1RM
avoid UE resistance as soft tissue is still healing
weight reduction guidelines for obesity
