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Pulmonary Flashcards

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1
Q

Which lung has 3 lobes? What are the fissures called?

A

a. Right lung

b. oblique and horizontal fissures

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2
Q

How many segments does the right lung have?

A

10 segments

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3
Q

How many segments does the left lung have?

A

8 segments

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4
Q

What pleura covers the inner surface of the thoracic cage, diaphragm, and mediastinal border of the lung?

A

parietal pleura

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5
Q

What pleura covers the outer surface of the lung including the fissure lines?

A

visceral pleura

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6
Q

definition

Potential space between the 2 pleurae that maintain the approximation of the rib cage and lungs allowing forces to be transmitted from one structure to another.

A

intrapleural space

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7
Q

What are the primary muscles of inspiration?

A
  1. diaphragm
  2. intercostals

Contraction: central tendon is pulled downward and flattens the diaphragm

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8
Q

What are the accessory muscles of inspiration?

A

Elevating ribs 1 and 2:
1. scalenes
2. SCM

Elevating other ribs
1. levator costarum
2. serratus

Note: if shoulder girdle is fixed the trapezius, pectorals, and serratus and become muscles of inspiration

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9
Q

When are expiratory muscles activated?

A

When a quicker and/or fuller expiration is desired

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10
Q

What are the expiratory muscles?

A
  1. QL
  2. intercostals
  3. abdominal muscles
  4. triangularis sterni
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11
Q

Those who lack adominal musculature have a (upper/lower) resting position of the diaphragm

A

Lower resting position

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12
Q

If a patient has a lower resting diaphragm, what does it do to inspiratory reserve?

A

decrease inspiratory reserve

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13
Q

The more upright the body position, the (lower/upper) the diaphragm is.

A

lower

+ lower inspiratory capacity

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14
Q

What is tidal volume?

A

Volume of gas inhaled during a normal breath

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15
Q

What is inspiratory reserve volume?

A

volume of gas that can be inhaled beyond a normal tidal inhalation

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16
Q

What is expiratory reserve volume?

A

volume of gas that can be exhaled beyond a normal tidal exhalation

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17
Q

What is residual volume?

A

volume of gas that remains in the lungs after expiratory reserve volume (ERV) has been exhaled

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18
Q

What is inspiratory capacity?

A

amount of air that can be inhaled from the resting end-expiratory position (REEP)

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19
Q

What is the formula for inspiratory capacity?

A

TV + IRV

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20
Q

What is vital capacity?

A

amount of air that is under volitional control

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21
Q

What is another name for vital capacity?

A

forced expiratory vital capacity (FVC)

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22
Q

What is the formula for vital capacity/forced expiratory vital capacity (FVC)?

A

TV + IRV + ERV

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23
Q

What is functional residual capacity?

A

amount of air that resides in the lungs after normal exhalation

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24
Q

What is the formula of functional residual capacity?

A

RV + ERV

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25
What is total lung capacity?
total amount of air that is contained within the thorax during max. inspiration
26
What is the formula for total lung volume?
TV + IRV + ERV + RV
27
What is FEV1?
amount of air exhaled within first second of functional expirational capacity (FVC) ## Footnote FVC: amount of air under volitional control (TV + IRV + ERV)
28
What is the normal FEV1 in a healthy person?
> 70%
29
What is forced expiratory flow rate (FEF)?
Slope of line between 25% and 75% of exhaled volume on a FVC exhalation curve.
30
What is forced expiratory flow rate more specific for?
More specific for smaller airways and shows a more dramatic change from disease
30
What are measures of ventilatory muscle strength? What are they used to determine?
1. Maximal inspiratory pressure (MIP) 2. Maximal expiratory pressure (MEP) b. used as a guide for intubation and can be indicative of other disorders
31
What is the PaO2 at sea level?
159.6 mmHg
32
What is normal barometric pressure?
760 mmHg
33
What PaO2 is considered as mild hypoxemia?
< 80 mmHg ## Footnote normal PaO2: 75-100 mmHg
34
What PaO2 is considered as hyperoxemia?
> 100 mmHg
35
(true/false) PaO2 decreases with age in healthy individuals
true
36
What is FiO2?
percentage of oxygen in the air based on a total of 1.0
37
What is the FiO2 of room air?
21% | (0.21)
38
A normal PaO2 of 90-100% translates to an SpO2 of what?
98-100%
39
At what pressure does oxygen dissociate more quickly from Hgb?
55-60 mmHg | corresponds to SpO2 of 88-90%
40
What is the normal range of PaCO2 within the arterial blood?
35-45 mmHg
41
What is the PaCO2 for hypercapnea?
> 45 mmHg
42
What is the PaCO2 of hypocapnea?
< 35 mmHg
43
What is the normal range of bicarbonate (HCO-3)?
22-28 mEq/L
44
An increase in bicarbonate leads to a (decrease/increase) of pH.
increases | direct relationship
45
An increase in PaCO2 leads to a (decrease/increase) of pH.
decrease | inverse relationship
46
When does optimal respiration occur?
When ventilation and perfusion are matched
47
What is dead space? Is it well ventilated?
Dead space is a space that is well ventilated **but** **no** gas exchange occurs within the space.
48
What are the two types of dead space?
1. anatomical (conducting airways) 2. physiological (diseases such as PE)
49
What is atelectasis? What is the cause?
a. collapsed or airless alveolar unit b. hypoventilation secondary to pain in ventilatory cycle, internal bronchial obstruction, external bronchial compression, low TV, or neurologic insult
50
# definition Complete atelectasis of the respiratory unit that allows the blood to travel through the pulmonary capillaries without gas diffusion ## Footnote no respiration occurs due to pathology such as PNA, Pulmonary edema, or alveolar collapse
Shunt
51
What is V/Q ratio?
ratio of pulmonary alveolar ventillation to pulmonary capillary perfusion
52
What are the central control centers?
1. cortex 2. pons 3. medulla 4. ANS | sends a message to ventilatory muscles to alter respiratory cycle
53
What medications can mask or alter vital signs?
1. steroids (mask) 2. beta blockers (alter) 3. bronchodilators (alter)
54
What is normal temperature (afebrile)?
98.6 degrees (37 degrees celsius)
55
What are common sequelae to chronic lung disease?
Right ventricular hypertrophy and dilation (cor pulmonale)
56
What is an acute sign of hypoxemia?
cyanosis to nails, around eyes, and around mouth
57
What is digital clubbing a sign of?
chronic hypoxemia | bulbar distal phalanx of toes and fingers
58
With obstructive pulmonary disease, the lung recoil force is (increased/decreased) resulting in what deformity?
a. decreased b. results in barrel-chest (increased AP dimension)
59
# definition soft rustling sound heard throughout all of inspiration and beginning of expiration
vesicular sounds (normal breath sound)
60
# definition hollow, echoing sound during all of inspiration and most of expiration
bronchial breath sounds
61
Where are bronchial sounds heard?
Right superior anterior thorax (right main stem bronchus)
62
# definition intermediate breath sound between bronchial and vesicular sounds with equal periods of inspiration and expiration
bronchovesicular sound
63
When are decreased breath sounds commonly heard?
When obstructive lung diseases are present ## Footnote - allows only some of inspiration to be heard - not heard over healthy thorax
64
What is the normal HR for an infant?
120 bpm | Adult: 60-100 bpm
65
What is the normal BP for an infant?
75/50 mmHg | Adult: < 120/80
66
What is the normal RR for infants?
40 br/min | Adult: 12-20 br/min
67
What is the normal PaO2 for infants?
70-80 mmHg | Adult: 80-100 mmHg
68
What is the normal PaCO2 for infants?
34-54 mmHg | Adult: 35-45 mmHg
69
What is the normal pH for infants?
7.26-7.41 | Adult: 7.35-7.45
70
What is the regular tidal volume for infants?
20 ml | Adults: 500 ml
71
When does crackling/rales/crepitations occur?
During inspiration
72
# definition musically pitched sound caused by airway obstruction
wheezes
73
When are wheezes heard?
during expiration | Severe airway constriction can lead to wheezing during inspiration
74
Where does abnormal transmission of vocal sounds occur?
through fluid-filled areas of consolidation, cavitation lesions, and/or pleural effusion
75
# definition nasal or bleating sound heard during auscultation -- "E" sounds like "A"
egophony
76
# definition characterized by intense, clear sound during auscultation
bronchophony
77
# definition Occurs when whispered sounds are heard clearly during auscultation
whispered pectoriloquy
78
What are the GXT test termination criteria? | (10)
1. maximal SOB 2. Fall of PaO2 by > 20 mmHg or a PaO2 less than 55 mmHg 3. Increased PaCO2 by >10 mmHg or a PaCO2 greater than 65 mmHg 4. cardiac ischemia or arrythmias 5. s/s of fatigue 6. increase of DBP by > 20 mmHg; systolic HTN >250 mmHg; decreased BP with increased workloads 7. leg pain 8. total fatigue 9. signs of decreased cardiac output 10. reaching ventilatory maximum
79
# Diagnosis pH: increased PaCO2: decreased HCO3: WNL
respiratory alkalosis
80
# diagnosis pH: decreased PaCO2: increased HCO3: WNL
respiratory acidosis
81
# diagnosis pH: increased PaCO2: WNL HCO3: increased
metabolic alkalosis
82
# diagnosis pH: decreased PaCO2: WNL HCO3: decreased
metabolic acidosis
83
What is the cause of respiratory alkalosis?
alveolar hyperventilation
84
What is the cause of respiratory acidosis?
alveolar hypoventilation
85
What are the causes of metabolic alkalosis?
1. HCO3 ingestion 2. vomiting 3. diuretics 4. steroids 5. adrenal disease
86
What are causes of metabolic acidosis?
1. DM 2. ETOH 3. renal failure 4. starvation 4. prolonged diarrhea
87
What are the indications for postural drainge, percussion, and vibration?
- atelectasis or collapse - increased secretions - aspiration
88
What is the maximum amount of time for a postural drainage treatment?
20 minutes **PER POSITION**
89
What is the maximum amount of time to perform percussion?
3-5 minutes **PER POSITION**
90
What treatment technique is commonly used following percussion in the appropriate postural drainage position?
vibration ## Footnote following a deep inhalation, vibration is applied during exhalation
91
Why is percussion used in conjunction postural drainage?
To increase the amount of secretions cleared from the tracheobronchial tree
92
How many vibration reps are most appropriate for secretion removal?
5-10 ## Footnote > 10 can cause hyperventilation < 5 can be ineffective
93
What should a patient do when sitting in the upright position between each lung area has been treated?
cough
94
What airway clearance technique is more effective in patients with collapsible airways? Why?
a. huffing b. prevents high intrathoracic pressure that causes premature airway closure | Deep inhalation followed by forced "Ha Ha"
95
When is assisted coughing used?
When the patient's abdominal muscles cannot generate an effective cough
96
When is tracheal stimulation warranted during airway clearance techniques?
When the patient is unable to cough on demand ## Footnote Thumb is placed on suprasternal notch and a quick inward and downward force is put onto the trachea
97
What pressure should a suctioning system be set at when performing endotracheal suctioning for secretions?
120 mmHg
98
What size of suction catheters should be used for adults?
14 french gauge
99
What size of suction catheters should be used for older children?
10 french gauge
100
What size of suction catheters should be used for children?
8 french gauge
101
What size suction catheters should be used for infants?
5-6 french gauge
102
What is the usual suctioning time?
10-15 seconds
103
What are complications associated with suctioning?
- hypoxemia - altered HR - altered BP - increased ICP - atelectasis - tracheal damage - infection
104
What is autogenic drainage?
Program used to sense peripheral secretions and clear them without irritation from coughing
105
What are the steps of autogenic drainage?
1. **unstick phase:** quiet breathing at low lung volumes to affect peripheral secretions 2. **collect phase**: breathing at mid-lung volumes to affect middle airway secretions 3. **evacuation phase**: breathing from mid-high volumes to clear secretions from central airways 4. repeat steps corresponding to the area of retained secretions
106
Which phase of autogenic draining replaces coughing as a means to clear secretions?
evacuation phase
107
What is a oscillatory positive expiratory pressure device (PEP)?
External device that vibrates the airways on exhalation to improve airway clearance with intermittent, positive expiratory pressure
108
What is high frequency chest wall oscillation?
Pt wears a vest that fills with air and then rapidly increases/decreases pressure to loosen secretions | 12-16 Hz (inflates until snug on patient's chest) duration: 20-30 mins
109
(true/false) High frequency chest wall oscillation can be performed in postural drainage positions.
true
110
What is diaphragmatic breathing used for?
- Decrease work of breathing - facilitate relaxation - maintain or improve chest wall mobility - increase gas exchange and ventilation
111
What is segmental breathing used for?
- improve ventilation to hypoventilated lung segments - alters regional distribution of gas - maintain or restore functional residual capacity - maintain or improve chest wall mobility - prevention of pulmonary compromise
112
What is the contraindication for segmental breathing?
contraindicated with intractable hypoventilation until medical stability
113
What is sustained maximal inspiration used for?
- increase inhaled volume - sustain or improve alveolar inflation - maintain or restore functional residual capacity
114
Sustained maximal inspiration is used for (acute/chronic) cases
acute
115
What training technique is used to load the muscles of inspiration by breathing through a series of graded aperture openings on a handheld device?
inspiratory muscle training (IMT)
116
What cases will benefit from inspiratory muscle training?
Those with: - decreased compliance - decreased intrathoracic volume - resistance to airflow - alteration in length-tension relationship of ventilatory muscles - decreased strength of respiratory muscles
117
What breathing technique is used to spread out metabolic demands of activity over time by slowing its performance?
Paced breathing (activity breathing)
118
What is the indication for use of paced breathing?
those who become dyspneic during exercise
119
# definition removal of a portion of a lung without anatomical divisions
wedge resection
120
# definition Removal of large emphysematous, nonfunctioning areas of the lung to normalize thoracic mobility and improve gas exchange of the remaining lung
lung volume reduction surgery (LVRS) | also called pneumectomy

NPTE (22 decks)

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