Flashcards in Pulmonary Deck (68)
If a patient has ongoing pulmonary disease, then they should really be cleared by
their pulmonologist or medical doctor prior to surgery
A person usually (underestimates/overestimates) how much they smoke per day?
During auscultation, patients should take ____ breaths first, and then ___ breaths
quiet, then deep
Describe bronchial breath sounds
Normal breath sounds of the tracheobronchial tree (large airways).
Heard best at: Trachea, sternoclaviular joint, and the right posterior interscapular space
Sounds like: High pitch and rapid/loud air movement
With bronchial breath sounds there is a ____ between inspiration and expiration
Describe vesicular breath sounds
Normal sounds you should hear over lung tissue
Softer and lower pitched than bronchial
No pause between inspiration and expiration.
Expiration is shorter (meaning we will hear more during inspiration)
When are bronchial breath sounds abnormal
Whenever they are heard somewhere they shouldn't be (in the periphery)
What is lung consolidation?
Lung tissue that has been filled with liquid
What type of breath sounds should you hear in consolidation?
Low pitched-bronchial (more bronchial because the tissue that should be making vesicular sounds are not opening)
What is cavitary disease?
Disease where normal lung tissue is replaced by a cavity
What type of breath sounds should you hear in cavitary disease?
High pitched bronchial, because the lung tissue that should be making vesicular sounds is replaced by a cavity (essentially a large-airway).
When are crackles insignificant?
If they clear with deep breathing
What is wheezing?
Musical noise as air passes through constricted bronchioles. Usually heard on expiration (when the airways constrict), but can be heard on inspiration as well.
What is stridor?
High pitched sound on inhalation due to narrowing of the larynx. Think about how hard you would be truing to breathe in if your larynx was constricted!
Can PFTs be used alone to make a diagnosis?
No, they must be taken into consideration with other factors
What are PFTs used for?
Evaluate disease progression and treatment
Assessing risk of pulm compliations
Who are good candidates for PFTs?
Smokers with persistent cough
Wheezing or dyspnea on exertion
Morbid obesity (once they have pulm HTN or OHS)
Thoracic surgery patients (lung surgery)
Open upper abdominal procedures
Those > 70
Remember that PFTs are NOT routinely recommended. Just for those you questions how well they will do from a pulm standpoint post-op
Tests that assess abnormalities of gas exchange
1) Volume (Normal is 80-120% of predicted value)
2) Flow (normal is 80-100% of predicted value)
Predicted values for spirometry are based on
Asthma is a disease of
What happens to lung volumes in restrictive disease?
A proportional decrease in ALL lung volumes
What is the most commonly measured parameter in spirometry
What is normal VC?
Normal is >80% of predicted value
What is FVC?
Forced vital capacity (max inspiration followed by a FORCED expiration--meaning the patient has to cooperate with the test).
It graphs volume vs. time (meaning that it measures FLOW).
Test measures resistance to flow:
80-120% is normal
70-79% = mild
50-69% = moderate
<50% = severe
In COPD, FVC will be
Reduced (even if their VC is normal)
This is because the small airways close early and cause gas trapping
What is FEV1?
The amount of air you can forcefully expire in 1 second.
70-80% = normal
60-75% = mild obstruction
50-59% = moderate obstruction
<50% = severe obstruction
What is FEF25-75%?
Forced expiratory flow during the middle portion of FVC.
May reflect effort independent expiration and small airway status.
Sensitive in early stages of obstructive disease