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Flashcards in Pulmonary Deck (42)
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1

What are some basic questions you can ask to a patient with chronic lung disease?

when were they diagnosed? how severe is it? what medications are they on? do they have flare-ups? when do they have flare-ups? what triggers flare-ups? effective treatments for flare-ups?

2

What are some basic questions to ask to assess acute respiratory disease?

any recent infections? are you on atnibiotics? what are your current symptoms?

3

What kinds of basic questions could you ask your patient to assess previous anesthesia complications?

have you had any complications in the past? prolonged intubations? what kind of anesthesia have you had? family history of anesthetic complications?

4

What are the components of the observation/inspection portion of the pulmonary assessment?

look at the skin and soft tissues, shape of the chest, tracheal position

rate and pattern of respiration

effort of respiration

use of accessory muscles

5

What are the components of the auscultation portion of pulmonary assessment?

quiet respirations first, then deep breaths
listen top to bottom, right to left
listen anterior, posterior, lateral lung fields
use the diaphragm of the stethoscope

6

Where are bronchial breath sounds heard best?

trachea
right sternoclavicular joint
posterior R interscapular space

7

What is the pitch of bronchial breath sounds?

high pitch

8

Where are vesicular breath sounds normally heard?

over the lung tissue

9

What do vesicular breath sounds sound like?

low pitched, softer, with shorter expiration

10

What are abnormal findings when auscultating a patients lungs?

hearing bronchial breath sounds anywhere other than normal

absent ventilation in the alveoli

low pitched bronchial breathing (consolidations)

high pitched bronchial breathing (cavitary disease)

11

What are examples of adventitious breath sounds?

wheezing, rales, stridor

12

Who is an appropriate candidate for pulmonary function tests?

patients with evidence of COPD
smokers with persistent cough
wheezing
dyspnea on exertion
morbid obesity
thoracic surgery
open upper abdominal surgery
patients >70

13

What types of diagnostic tests would assess for abnormalities in gas exchange?

ABG
pulse ox
capnography

14

What type of diagnostic tests assess mechanical dysfunction of the lungs and chest wall?

spirometry

15

What are the limitations of spirometry testing?

it can be subjective
it is patient effort and cooperation dependent

16

What are normal values for spirometry?

volume - should be 80-120% of predicted values
flow - should be 80% of predicted values

17

How are normal values for spirometry determined?

based on age, gender, height/weight and ethnicity

18

Vital Capacity

most commonly measured using simple spirometry

it is maximal inspiration followed by maximal expiration, and is independent of the rate

values will decrease as the subject lies down

normal = 80% of predicted value

19

What are some questions you can ask to assess baseline pulmonary function?

SOB, dyspnea, orthopnea, functional level, smoking history, sleep apnea

20

FORCED VITAL CAPACITY (FVC)

maximal inspiration with a forced exhalation

measures resistance to flow

determines difference between restrictive and obstructive disease

it is effort and cooperation dependent

a normal value is 80-120% of predicted

21

Forced expiratory volume over 1 second (FEV1)

measures the volume of air forcefully expired in the first second

effort and cooperation dependent

normal value is >80% of the FVC

22

How do lung volumes change in restrictive disease?

FVC, FEV1, FRC and TLC all decrease!!

FEV1/FVC ratio and FEF25-75 will not change!!

23

How will lung volumes change in obstructive disease?

normal or slightly increased FVC, FRC and TLC

normal or slightly decreased FEV1

INCREASED residual volume

DECREASED FEV1/FVC ratio and FEF25-75, VC and ERV

24

What is FEF25-75?

mean Forced Expiratory Flow during the middle of the FVC

can be effort independent

most sensitive in the early stages of obstructive disease

more reliable than FEV1/FVC

normal value is >60%

25

What is MVV?

maximum voluntary ventilation: largest volume that can be breathed in one minute by voluntary effort

measures pulmonary endurance and the elastic properties of the lung

normal results can vary by up to 30%

MVV is reduced in obstructive disease
MVV is normal in restrictive disease

26

FRC - functional residual capacity

volume of gas remaining in the lungs after passive exhalation

used to quantify the degree of pulmonary restriction

measured indirectly using nitrogen washout attached to a spirometer

27

Residual volume

volume of gas left in the lungs after forceful maximal expiration

28

Describe pressure changes in the 3 zones of the lung in respect to blood flow and ventilation?

Zone 1 - PA > Pa > Pv

Zone 2 - Pa > PA > Pv

Zone 3 - Pa > Pv > PA

29

Where does the best ventilation/perfusion matching occur in the lung?

in zone 2

30

What are the pulmonary effects of PPV?

increased V:Q mismatch
increased barotrauma
increased dead space
increased risk of atelectasis
increased perfusion to the dependent lung