Respiratory Clinical Assessments

Question 1

Vitals

Answer 1

Heart rate and pulse
-wrist and chest monitors
-radial pulse
Blood pressure
ECGs if necessary
Pulse oximetry
-monitoring SpO2 levels at rest, during exercise, and after exercise is mandatory

Question 2

Pulse Oximetry

Answer 2

Measure O2sat at finger with pulse oximeter.
Middle finger tends to be best for circulation.
-can be altered with poor circulation or nail polish.
Normal levels >95%
Lung conditions may have as low as 85%
-aim for pre-exercise levels >92%
-cease exercise if levels drop <85%
-oxygen therapy is commonly used for those <88% O2sat

Question 3

Rating of Perceived Breathlessness

Answer 3

Dyspnea scale
-keep at <4/10 during exercise or at rest
-ask what they are sitting at during rest to get a good baseline understanding prior to exercise.
Monitor frequently
Proceed to recovery positions if >5/10

Question 4

Pulmonary Function Testing

Answer 4

Umbrella term for possible lung function testing to determine lung volume and breathing efficiency.
-spirometry
-lung volume tests
-diffusion capacity tests

Question 5

Lung Volume Tests

Answer 5

Measures amount of air lungs can hold throughout breathing stages.
Body plethysmography or gas dilution technique

Question 6

Diffusion Capacity Tests

Answer 6

Evaluates how well oxygen moves from the lungs into the bloodstream.

Question 7

Spirometry

Answer 7

Type of PFT that measures how well a person’s lungs are working.
-measures how much air a person can inhale and exhale as well as how quickly they can exhale.
Helps diagnose conditions like asthma, COPD, and other respiratory conditions.
-can be done before and after exercise.
-can be done before and after medications (shows if medications help reduce symptoms of asthma).

Question 8

Typical Measurements in Spirometry

Answer 8

Forced vital capacity (FVC)
Forced expiratory volume in one second (FEV1)
FEV1/FVC ratio
Peak expiratory flow (PEF)

Question 9

FVC

Answer 9

Forced vital capacity
total amount of air exhaled in test

Question 10

FEV1

Answer 10

forced expiratory volume in one second.
Amount of air exhaled in first second of expiration.

Question 11

FEV1/FVC ratio

Answer 11

comparison of FEV1 and FVC

Question 12

PEF

Answer 12

peak expiratory flow
maximum flow rate during exhalation

Question 13

Spirometry Interpretations for Asthma

Answer 13

Concave shape with scalloped delay.
Lower PEF or FVC
Spirometry measurements are taken both before and after administration of short acting beta2 agonist (SABA) medication to see reversibility of obstruction.
Airflow limitation is reversible if either:
-baseline FEV1 >1.7L and post SABA FEV1 is at least 12% higher than baseline.
-baseline FEV1 <1.7 and post SABA FEV1 is at least 200mL higher than baseline.
~70% of bronchodilation reponse is achieved in 3-4 minutes post administration.

Question 14

Spirometry Interpretations for COPD

Answer 14

Similar shape to asthma spirometry (both obstructive).
Irreversible obstruction even after bronchodilators.
-FEV1 <70% FVC
-FEV1 <80% of predicted FEV1
Interpretations of types in COPD notes

Question 15

Exercise Testing

Answer 15

Helps determine lung function in exercise.
Monitor HR, BP O2sat, RPE/RPB, possible ECG throughout testing
Take spirometry readings if needed
Can help diagnose exercise induced asthma.
Optional types of tests include 6 min walk test, GXT and ssx limited stress test, mCAFT step test.

Question 16

6 Minute Walk Test

Answer 16

Used to evaluate cardiorespiratory fitness as well as predicting morbidity and mortality rates.
Can predict VO2peak and equation is not as valid or useful.
Client completing <300m in 6 min demonstrates poorer short-term survival vs those who complete >300m
-looking at how far people can go in the 6 minutes.
Useful for older populations or those with chronic conditions (CVD, CHF, COPD, PAOD, etc.)