Pulmonary lab 2: sputum

Question 1

Mucus:

Answer 1

• is produced by goblet cells that line the trachea and bronchial tree.
• It acts as a medium to collect inhaled particles. - Mucus is composed of water, glycoproteins, carbohydrates and lipids.
• Normally, persons may raise 100 mL of mucus (clear to white) per day and not notice it.

Question 2

Mucociliary Transport System (mucociliary escalator or mucociliary blanket)

Answer 2

• refers to the action of the mucous layer and the cilia, which trap and then sweep the particles to be expectorated or swallowed.
• This is a defense mechanism that protects the lower airways from inhaled particles.
• Water, electrolytes and bacteria can change the thickness of the mucus. - The mucus/cilia layer can be affected by smoking, anesthesia, dehydration, pathologies that lead to thick/tenacious mucus, and or immobile cilia. (ciliary dyskinesia)

Question 3

Suptum

Answer 3

• mucus which becomes excessive and must be expectorated.
• Observation yields information on the source or pathology.
• Observe amount, color, consistency, and odor.
• Volume reflects disease progression.

Question 4

Amount of sputum

Answer 4

• Can be scant, minimal, moderate, copious.
• Or measured (teaspoon/tablespoon/ml).
• Is it more or less than usual

Question 5

Color of sputum: normal

Answer 5

• Normal mucus: thin, clear, white, and usually swallowed

Question 6

Mucoid

Answer 6

• white or clear not usually associated with infection but present with chronic cough
• cigarette smokers: greater amounts
• usually grey and thick

Question 7

White or pink-tinged and frothy, thin sputum;

Answer 7

an be associated with pulmonary edema

Question 8

Mucopurulent sputum:

Answer 8

• associated with infection;
• mixture of mucoid sputum and pus; green or yellow
• indicates cellular debris/infection

Question 9

Hemoptysis:

Answer 9

• blood in sputum; red, usually streaked, but can be large amounts.
• Blood can be the result of disruption (trauma) of blood vessels by bacteria, tuberculosis, cancer, (variety of pathologies)

Question 10

Brown:

Answer 10

presence of old blood

Question 11

Rusty:

Answer 11

characteristic of pneumococcal pneumonia

Question 12

Currant jelly sputum:

Answer 12

Klebsiella pneumonia; red, tenacious (thick, sticky) appearance

Question 13

Black:

Answer 13

characteristic of coal dust inhalation

Question 14

How do you describe the consistency of sputum

Answer 14

• Consistency:
  As sputum becomes thick and desiccated (dry): susceptible to infection.
• Mucoid impaction can occur (mucous plugs) that obstruct the airway and can lead to atelectasis.
• if the obstruction occurs it will impact V/Q

Question 15

How can you describe the odor of sputum

Answer 15

• Normal sputum is usually odorless
• Purulent: possibly sweet odor
• Anaerobic infection: extremely unpleasant odor, fetid (foul smelling); can occur with lung abscess, bronchiectasis, cystic fibrosis.
• In addition to the sputum odor, the individual’s breath odor should be assessed. Foul-smelling breath may indicate an anaerobic infection of the mouth or respiratory tract.
  when there is an odor = infection

Question 16

Consolidation/inflitration

Answer 16

• something has gotten into the airway other than air
• X-ray will show this
• could be stomach contents, blood, fluid
• consolidation: usually denser: such as mucus that is getting thick
• cough, SOB, tachycardia, possible fever

Question 17

Pleural effusion

Answer 17

• collection of fluid, air, or blood in the pleural space
• cough, pain, SOB, tachycardia
• between the lung and the chest wall
• can cause a lung collapse
• less space for the lung to expand

Question 18

Atelectasis and causes

Answer 18

• lung collapse
• pneumothorax: area in the pleural space
• compression
• adhesions
• etc

Question 19

Pneumonia vs pulmonary edema

Answer 19

• pneumonia is usually within one particular lobe
• pulmonary edema is diffuse throughout the lung

Question 20

Tactile fremitus

Answer 20

• Detected by palpation.
• Palms or ulnar border on the chest wall while patient repeats “99”.
• Presence of vibration felt through the chest wall with voice sounds.
• Can be felt in normal lungs but is increased in lungs with presence of consolidation (fluid or secretions)

Question 21

Transmitted breath sounds

Answer 21

• normal phonation is audible during auscultation but should diminish in more distal airways.
• The presence of consolidation may increase the intensity and clarity of spoken sounds.
• An increase in lung density (as seen in presence of consolidation) increases sound transmission/ a decrease in lung density (as seen in hyperinflation) causes decreased sound transmission.

Question 22

What is the theory that is used for transmitted voice sounds

Answer 22

• more dense the lung tissue will carry sound and vibration more efficiently (more consolidation = increase density)

Question 23

Egophany

Answer 23

• voiced E sounds like a A in the periphery

Question 24

Pectoriloquy

Answer 24

• Evident when patient is asked to speak, and the words are distinctly heard using a stethoscope.
• Test is positive for consolidation if clearly audible in distal airway

Question 25

Types of pectoriloquy and explain

Answer 25

• Bronchopany – Occurs when the patient repeats “99” and the words are transmitted clearly in the periphery of the lung. Results as in whispered pectoriloquy. Bronchophony
• Whispered pectoriloquy – Occurs when patient whispers and it is her distinctly with the stethoscope in the denser tissue.

Question 26

Mediate percussion

Answer 26

• Diagnostic
• Refers to listening to quality of sounds produced by a fingertip tapped on the middle finger of the opposite hand placed flat against the body.
• Can be resonant (air filled organs), hyper-resonant (excess air) or dull (dense organs like heart or liver).
• A positive sign is dullness in a region of the lung that should be resonant
• dense: will feel thunked

Question 27

Airway clearance techniques

Answer 27

• defined as manual or mechanical procedures that facilitate mobilization of secretions
• conventional methods for airway clearance include effective cough of huff technique, postural drainage, percussion/vibtration

Question 28

Indications for airway clearance techniques

Answer 28

• Impaired mucociliary transport
• Excessive pulmonary secretions
• Ineffective or absent cough

Question 29

4 phases of cough

Answer 29

• Stage 1 – Inspiration beyond tidal volume
• Stage 2- Glottal Closure
• Stage3 – Building intrathoracic and intra-abdominal pressure through muscle contraction
• Stage 4 – Glottal opening and forceful expulsion of the inspired air.

Question 30

Huffing

Answer 30

• Quiet breathing is performed prior to a mid to large inspiration initiated from lower rib cage, glottis remains open and air is forced out in a breathy sound with the mouth shaped like an ”o”.
• This is less stressful and more effective than constant forced coughing. Can use cotton balls, ping pong balls, tissue to teach (create movement with huff)

Question 31

Controlled cough

Answer 31

• patient takes three deep breaths, exhaling normally after the first two and then coughing firmly on the third.
• The first two breaths reduce atelectasis and increased the volume of the cough

Question 32

Serial coughing

Answer 32

• small breath, small cough, bigger breath, bigger cough, finally a really deep breath with forceful cough

Question 33

Active cycle breathing

Answer 33

• The active cycle of breathing (ACB) consists of a series of maneuvers performed by the patient to emphasize independence in secretion clearance and thoracic expansion

Question 34

Precautions for postural drainage, percussion, vibration

Answer 34

• Pulmonary edema
• Hemoptysis
• Massive obesity
• Large pleural effusion
• Massive ascites

Question 35

relative contraindications for postural drainage, percussion, vibration

Answer 35

• Increased intracranial pressure
• Hemodynamically unstable
• Recent esophageal anastomosis
• Recent eye, face, neck or head trauma that impacts position