Spirometry, mucous clearance, problems of breathing and assessment Flashcards
what is spirometry?
- simple test used to monitor certain lung conditions by measuring how much air you can breathe out in one forced breath
what is tidal volume?
- amount of air in and out of the lung during a normal breath
what is inspiratory reserve volume?
- maximum amount of air breathed in
what is expiratory reserve volume?
- maximum amount of air breathed out
what is inspiratory capacity?
- maximum volume of air that can be inspired after reaching the end of a normal, quiet expiration
what is vital capacity?
- maximal amount of air you can inspire or expire in one breath
- total of tidal volume, inspiratory & expiratory reserve volume
what is total lung capacity?
- maximum volume of air in your lungs
what is residual volume?
- amount of air left after maximal breath
what is functional residual capacity? why is it important?
- amount of air left in your lungs after a normal breath out
- important because it is where gaseous exchange occurs
what happens when functional residual capacity decreases?
- gaseous exchange decreases
what feature protects the lung from bacteria entering?
- hairs in the nasal cavity stops debris going down into the respiratory tract
what mechanisms protect against bacteria that is breathed in? what do they prevent?
- coughing and clearing throat
- prevents chest infection
what does an impairment in the mucociliary escalator predispose you to? what does it cause?
- more predisposed to multiple infections and conditions
- causes lung tissue scaring
- causing chronic conditions
what are found in the lining of the respiratory epithelium? what do they do?
- cilia and goblet cells
- work to trap foreign matter (pollen, dust & bacteria)
- prevents it from reaching the lungs
how do goblet cells work?
- they secrete viscous mucus that forms a layer to trap foreign material
how do cilia cells work?
- produce wavelike actions to mobilise the mucus layer
- remove the foreign matter and prevent it from entering the lungs
what do people with cystic fibrosis have issues with? what does this normally do?
- issues with sodium chloride channels
- normally helps with keeping the sputum moist
what is the sputum like in cystic fibrosis individuals?
- thick and sticky sputum
- builds up in the lungs
what does more sputum mean?
- more sputum= more likely infected= more mucus production to fir bacteria
what are the 7 problems of hypoxia?
- secretions
- collapse
- pleural effusion
- fluid- pulmonary oedema
- pulmonary emboli
- pneumothorax
what do secretions affect?
- affects ventilation
- contributes to VQ mismatch
what does collapse mean? what can become collapsed?
- collapse means there is a loss of gas into the lungs & blood
- lung/ lobe/ alveoli can collapse
what is alveoli collapse called?
- atelectasis
what is pleural effusion?
- build up pushes on lung from the outside
- pressure greater than inside = compresses down on the lung causing lung to collapse
what is pleural effusion treated with? (small vs large)
- smaller effusion treated with diuretics
- larger effusion treated with chest drain
what is fluid- pulmonary oedema?
- fluid in interstitial space of alveoli increases distance that the gas has to flow across
- slow gas exchange
how do you treat fluid- pulmonary oedema? how does it work?
- treated with diuretics
- increases urine output
what is pulmonary emboli?
- area of the lungs where the capillary
network is blocked of - no blood flow to receive oxygen
what is pneumothorax?
- hole in pleural space causing the air to rush in and fill it
- pressure on lung so it collapses
how do you treat pneumothorax?
- treated via draining
what are the 4 problems of ineffective airway clearance?
- excessive secretions
- poor cough
- bronchospasm
- disease
what are excessive secretions? what is an example?
- volume of secretions is greater than your ability to clear them
e.g., chest infection
what are the causes of a poor cough?
- neuromuscular weakness
- scoliosis and kyphosis affect bucket handle movement
- pain e.g., rib fracture, major surgery
( can’t breathe before cough)
what is bronchospasm?
- narrowing of the airway
- so can’t get anything up the airway
how does disease contribute to ineffective airway clearance? what is an example?
- thick and sticky sputum can’t be cleared
e.g., cystic fibrosis
what are the two problems of excessive secretions?
- infection/ exacerbation of disease
- pneumonia
what diseases case excessive secretions?
- cystic fibrosis
- bronchiectasis
what is bronchiectasis?
- abnormal widening of the bronchi
- causes risk of infection
what are the five problems of V/Q mismatch?
- secretions affects ventilation
- pulmonary emboli affects perfusion
- collapse/ atelectasis
- pleural effusion/ pulmonary oedema
- pneumothorax
what does pleural effusion and pulmonary oedema increase?
- both increase pathway length
what is breathing like when there is an increased work?
- heavier breathing
- laboured
- rapid
- accessory muscle involvement
- splinting of diaphragm (abdominal recruitment)
what is the 1st sign of a problem of breathing?
- respiratory rate
what are the four problems of increased work of breathing?
- increased secretions
- volume loss
- hypoxia
- V/Q mismatch
what does increased secretions mean relating to increased breathing work?
- less capacity to exchange gas so need to work harder to generate the same levels of gaseous exchange
what does volume loss result in?
- collapse
- atelectasis
- pneumothorax
- fluid
what does obstructive mean?
- can’t get air out
- air trapping
- flow problem
what are the four main examples of obstructive?
- COPD
- asthma
- emphysema
- chronic bronchitis
how is asthma obstructive?
- bronchospasms stop the air from getting out
what is emphysema?
- condition in which the air sacs of the lungs are damaged and enlarged
- causes breathlessness
how is emphysema obstructive?
- alveoli loses elasticity
what is chronic bronchitis?
- productive cough of more than 3 months occurring within a span of 2 years
what does restrictive mean? what type of problem is it?
- can’t get air in
- volume problem
what are the 6 main examples of restrictive?
- pulmonary fibrosis
- cystic fibrosis
- neuromuscular disease
- scoliosis
- kyphosis
- obesity
why is pulmonary fibrosis described as restrictive?
- unable to expand
why is neuromuscular disease described as restrictive?
- weakness
- not big enough breaths
why is scoliosis and kyphosis described as restrictive?
- because they effect bucket handle mechanisms
why is obesity described as restrictive?
- because abs are unable to flatten
what is abnormal splinting?
- where the work of breathing is so hard so they start splinting their abdominal muscles to help excel the air
can someone have a combination of both obstructive and restrictive?
- yes
how are acute respiratory patients normally? what is it important to do?
- normally disoriented and anxious if they are unable to breath
- important to build a rapport to stabilise participant
what would a subjective assessment focus on in respiratory care?
- medical
- drug
- social history
what is the objective assessment of someone in respiratory care?
- A to E
- airway
- breathing
- circulation
- disability
- exposure
what should you look for in the airway?
- is it patent?
- any signs of obstruction?
what do you look for in breathing?
- respiratory rate
- ventilation (self, non- invasive or invasive) > how much & quickly
- are they on oxygen e.g., nasal, face masks
- oxygenation via SP02
- arterial blood gas (PP02, pH)
- palpation
- oscillation sound
- position
- accessory muscles
what do you look for in circulation?
- skin colouring
- capillary refill time (less than 2 seconds)
- heart rhythm/ rate
- blood pressure
- temperature
what do you look for in disability section?
- overall function: muscle strength, ROM, glucose levels, WBC count (infection sign), level of consciousness, Hb level, clotting
- need to know how the kidney is functioning
why do you need to know if the kidney is functioning in the disability section?
- pt with acute kidney injury/ renal failure retain fluid
- low urine output so fluid enters the blood to heart/ lungs
- will end up in the interstitial fluid causing pulmonary oedema
what is ACVPA?
- alert
- confused
- voice
- pain
- unresponsive
what do you look for in the exposure section?
- wounds
- firm distended abdomen (affects lung function as pushes up on diaphragm)
- scars
- skin damages
- rashes
- attachments e.g., drains
what is the A to I process in a chest X-ray?
- assessment of airway/ quality of film
- bones and soft tissue
- cardiac
- diaphragm
- effusion
- fields, fissures and foreign bodies
- great vessels and gastric bubble
- hilar and mediastinum
- impression
what are the 6 sections of the ICF framework?
- health condition
- body function & structure
- activities
- participation
- environmental factors
- personal factors
