Week 8- Lung Sounds V/Q Issues Flashcards
1
Q
Chest Auscultation for Lung Sounds
A
- Listening for normal and abnormal breath sounds
- Using a stethoscope
- Called auscultation
- Min of 4 locations on either the anterior chest wall OR
- Posterior 4 locations
- Evaluate air entry into the lungs and compare right to left sides
2
Q
Normal breath sounds are classified as
A
- Tracheal
- Bronchial
- Bronchovesicular
- Vesicular sounds
- The patterns of normal breath sounds are created by the effect of body structures on air moving through airways
3
Q
In addition to their location, breath sounds are described by:
A
- Duration (how long the sound lasts)
- Intensity (how loud the sound is)
- Pitch (how high or low the sound is)
- Timing (when the sound occurs in the respiratory cycle)
- Sounds diminish as they go through the smaller airways
4
Q
Tracheal
A
- Directly over the trachea
- Harsh sounding like air through a pipe
5
Q
Bronchial
A
- Present over large airways in the anterior chest near the 2nd and 3rd intercostal spaces
- Loud and high patched
6
Q
Bronchovesicular
A
- Posterior chest between the scapulae and in the centre of the anterior chest
- Softer than bronchial sounds, equal during expiration and inspiration
7
Q
Vesicular
A
- Over the lung tissues
- Soft, blowing or rustling sounds normally heard
8
Q
What would cause diminished air flow?
A
- Obstruction
- Edema
- Allergic rxn
- Mucus, blood
9
Q
What would cause absent airflow?
A
- Collapsed lung, pneumo
- Severe bronchoconstriction
- Severe obstruction
10
Q
What would cause differences in air flow from right to left?
A
- Flail chest
- Pneumo
- Intubation pushed to far
- Pneumonia
- Tumours
11
Q
Adventitious (not normal) Lung Sounds
A
- Crackles
- Wheezes
- Stridor
12
Q
Crackles
A
NITRO
- Light cracking, popping sounds produced by air passing through moisture
- bronchitis, heart failure
13
Q
Wheezes
A
VENTOLIN
- High pitched, musical sounds produced when air moves through smaller, partially obstructed airways (sounds like a whale)
- Asthma, partial obstruction spasm
14
Q
Stridor
A
- High pitched inspiratory sound from partial obstruction in the larynx or trachea
- Croup
15
Q
Pleural Friction Rub
A
- Squeaking or grating sounds of the pleural linings rubbing together when the linings rubbing together when the linings are inflamed and lose their lubrication
- They appear during the entire respiratory cycle
16
Q
Consolidation
A
- Infectious pus causing collapse of the alveoli (area of infection in the lungs)
17
Q
Effusion
A
- Fluid in the pleural space causing a decrease in functioning lung tissue
18
Q
What is ventilation?
A
- Process of air movement in and out of the lungs
19
Q
What does ventilation requires?
A
- Neurological control for inflation
- Contact: brain stem to the muscles
- Functional diaphragm
- Functional intercostal muscles
- Patent and functional airway
- Functional alveoli
20
Q
What are some ventilation problems?
A
- Airway obstruction (foreign body, epiglottitis)
- Chest wall impairment (trauma, muscular dystrophy)
- Neurological control impairment (CNS depressant drugs, stroke)
21
Q
Treatment we can use for ventilation…
A
- Patent and unobstructed airway maintained
- OPA/ NPA/ King LT/ ETT
- Assist ventilation
- BVM
22
Q
Diffusion
A
- Process of gas exchange between capillaries and alveoli
23
Q
What does diffusion require?
A
- Alveolar and capillary walls that are permeable to respiratory gases
- Interstitial spaces not enlarged or filed with fluid
- Surface area of sufficient size
- Presence of gases for diffusion
24
Q
What are diffusion problems?
A
- Inadequate oxygen concentrations (fire environments, CO poisoning)
- Alveolar pathologies (lung disease, inhalation injury)
- Interstitial space pathologies (pulmonary edema, near-drowning)
- Capillary bed path pathologies (severe atherosclerosis)
25
Q
Treatment we can use for diffusion…
A
- Increase O2 concentration
- Reduce inflammation
- Remove fluid in the interstitial spaces
26
Q
Perfusion
A
- Circulation of blood through the pulmonary capillary bed
27
Q
What does perfusion require?
A
- Adequate blood volume
- Adequate hemoglobin
- Functioning pulmonary capillaries
- Functioning left ventricle
28
Q
What are perfusion problems?
A
- Impaired blood flow (shock, anemia, pulmonary embolus)
- Capillary bed pathologies (trauma(
29
Q
What is the treatment perfusion problems…
A
- Ensuring adequate circulating volumes of fluid
- Raise hemoglobin levels
- Optimizing left ventricular function
30
Q
V/Q Mismatch
A
- V= Ventilation
- Q= Perfusion
- When your lungs are functioning properly, 4 L of air enter the resp. track per min and 5 L of blood go through the capillaries per min. This leads to a V/Q of 0.8. Once the air is humidified by the respiratory tract, it ends up in the vicinity of 1.0
- Ideally, V/Q is equal meaning there is just enough O2 to fully saturate the blood
31
Q
Shunt & Dead Space
A
- An area with perfusion but no ventilation (V/Q of O) is termed shunt
- An area with ventilation but no perfusion is termed dead space
- Very rarely can anyone have “True/Pure” shunts or dead space, as this is incompatible with life
- Most often it’s a condition between normal and wither of the 2 conditions
32
Q
Shunt
A
- Pathological condition which results when the alveoli of the lungs are perfused with blood as normal, but ventilation (supply of air) fails to supply the perfused region (low V/Q)
33
Q
Dead Space
A
- Alveoli are ventilated but no perfused (high V/Q)
34
Q
Oxygen Control of Blood
A
- Oxygen is present in blood in 2 forms: (dissolved in the plasma, bound to hemoglobin)
- When carries as oxyhemoglobin, each hemo can carry 4 O2 molecules= fully saturated
- Nears full saturation at PO2 of 80-100 mmHg
35
Q
Oxygen Saturation
A
- Increases rapidly when the PO2 is 10-60 mmHg (up to about 90% at 60 mmHg)
- Further increases in PO2 relate to a small change in saturation
- After this point, changes in O2 concentration relates to small changes in O2 saturation
36
Q
Blood plasma
A
- PO2 is the most important factor in determining how well oxygen binds to HB
37
Q
Pulse Oximetry
A
- In normal adults be 95-100%
- SPO2 of less than 90 is a clinical emergency
- Cyanosis may not be present until SPO2 is less than 90%
- Cyanosis may not be evident in anemic or dark skinned pts
38
Q
What are factors that affect reading?
A
- Light- bright lights may affect the probe
- Shivering- movement may make it difficult for the probe to pick up a signal
- Pulse volume- the oximeter only detects pulsatile flow. When BP is low, pulse may be weak and may not be able to detect a signal
- Vasoconstriction- reduces blood to the peripheries. If pt is cold may be difficult to detect
- CO Poisoning- may give false readings
- Nail polish
39
Q
Assessments- Initial
A
- Toxic environments
- Alterations in mental status
- Cyanosis
- Absent breath sounds
- Audible stridor
- One-two word dyspnea
- Tachycardia
- Pallor and diaphoresis
- Accessory muscle use
