Pulmonary

Question 1

What is V/Q ratio? What should it be?

Answer 1

comparison of air that is passing through alveoli compared to blood flow

V - ventilation
Q - perfusion

normal is 0.8

Question 2

What is V/Q mismatch?

Answer 2

insufficient air in alveoli or insufficient blood in blood flow

Question 3

What is it called when there is excess air in the lungs? What might cause this to happen?

Answer 3

dead space

- occurs when there is a disruption of blood flow like a PE

Question 4

What is used when there is an excess in perfusion compared to ventilation? What can cause this?

Answer 4

shunt

- lack of air flow (COPD, atelectasis)

Question 5

What are primary inspiratory muscles?

Answer 5

• diaphragm
• external intercostals
  Accessory muscles - SCM, scalenes, pecs, traps

Question 6

What are primary expiratory muscles?

Answer 6

• rectus abdominus
• external/internal obliques
• internal intercostals

Question 7

Apnea

- What causes it?

Answer 7

lack of airflow to the lungs for >15 seconds

- airway obstruction, cardiopulmonary arrest, narcotic overdose

Question 8

Orthopnea

- What causes it?

Answer 8

Dyspnea that occurs in a flat supine position. Relief occurs with more upright sitting or standing
- Chronic lung disease, CHF

Question 9

Bradypnea

- What causes it?

Answer 9

Ventilation rate <12 breaths per minute

- sedatives, narcotics, alcohol; neuro/metabolic disorders; fatigue

Question 10

Tachypnea

- What causes it?

Answer 10

Ventilation rate >20 breaths per minute

- acute respiratory distress, fever, pain, emotions, anemia

Question 11

Hyperpnea

- What causes it?

Answer 11

increased depth of ventilation

- activity, pulmonary infections, CHF

Question 12

Hyperventilation

- What causes it?

Answer 12

Increased rate and depth of ventilation resulting in decreased PCO2
- anxiety, nervousness, metabolic acidosis

Question 13

Hypoventilation

- What causes it?

Answer 13

Decreased rate and depth of ventilation resulting in increased PCO2
- sedation, neuro depression of respiratory centers, overmedication, metabolic alkalosis

Question 14

Biot’s respiration

- What causes it?

Answer 14

Constant increased rate and depth of respiration followed by periods of apnea of varying lengths
- elevated intracranial pressure, meningitis

Question 15

Cheyne-Stokes respirations

- What causes it?

Answer 15

Increasing depth of ventilation followed by a period of apnea
- elevated intracranial pressure, CHF, narcotic overdose

Question 16

Kussmaul respirations

- What causes it?

Answer 16

Increased regular rate and depth of ventilation

- diabetic ketoacidosis, renal failure

Question 17

Paradoxic ventilation

- What causes it?

Answer 17

Inward abdominal or chest wall movement w/ inspiration and outward movement w/ expiration
- diaphragm paralysis, ventilation muscle fatigue, chest wall trauma

Question 18

Sighing respirations

- What causes it?

Answer 18

the presence of a sigh > 2-3 times per minute

- angina, anxiety, dyspnea

Question 19

Hoover’s sign

- What causes it?

Answer 19

the inward motion of the lower rib cage during inhalation

- flattened diaphragm often related to decompensated or irreversible hyperinflation of the lungs

Question 20

Normal PaO2

Answer 20

> 80 mm Hg

Question 21

Normal PaCO2

Answer 21

35-45 mmHg

Question 22

Normal pH

Answer 22

7.35 - 7.45

Question 23

Normal HCO3

Answer 23

22-26 mEq/liter

Question 24

air trapping

Answer 24

retention of gas in lung as a result of partial or complete airway obstruction

Question 25

Bronchospasm

Answer 25

smooth muscle contraction of the bronchi and bronchiole walls resulting in a narrowing of the airway lumen

Question 26

Consolidation

Answer 26

transudate, exudate, or tissue replacing alveolar air

Question 27

Hyperinflation

Answer 27

over inflation of the lungs at resting volume as a result of air trapping

Question 28

Hypoxemia

Answer 28

a low level of O2 in the blood, usually PaO2 < 60-80 mmHg

Question 29

Hypoxia

Answer 29

low level of O2 in the tissue available for cell metabolism

Question 30

Respiratory distress

Answer 30

acute onset of dyspnea, respiratory muscle fatigue, abnormal respiratory pattern and rate, anxiety, and cyanosis related to inadequate gas exchange, the clinical presentation that usually precedes respiratory failure

Question 31

flail chest

Answer 31

blunt force trauma w/ rib fracture (2 or more), destabilizes the chest

Question 32

wheeze sound during breath means what?

Answer 32

airway obstruction, more common on expiration

Question 33

stridor sound during breath means what?

Answer 33

high-pitched wheeze, inspiration and expiration

Question 34

Rhonchi sound during breath means what?

Answer 34

low-pitched from airway obstruction | - sounds like someone snoring

Question 35

crackle sounds during breath means what?

Answer 35

bubbling, popping sounds from fluid/secretions or sudden opening of closed airway - aka rails

Question 36

what is mediate percussion?

Answer 36

evaluates tissue densities within thoracic cage | - tapping of distal fingers on back

Question 37

goals for pulmonary rehab

Answer 37

- Promoting independent functional mobility - Maximizing gas exchange - Increasing aerobic capacity - Increasing respiratory muscle endurance - Patient education about condition

Question 38

What position facilitates improved aeration to dorsal lung segments, improved V/Q matching, secretion drainage?

Answer 38

prone positioning

Question 39

What could be wrong if bronchial sounds are heard in areas where vesicular sounds should be heard?

Answer 39

fluid or secretion consolidation | - pneumonia

Question 40

What could be wrong if there is decreased or diminished vesicular sounds?

Answer 40

hypoventilation, severe congestion, or emphysema

Question 41

What could be wrong if there are no lung sounds?

Answer 41

pneumothorax or lung collapse

Question 42

hemoptysis vs hematemesis

Answer 42

hemoptysis - blood coughing from lungs hematemesis - blood coughing from stomach