Pulmonary Assessment of the Pulmonary System

Question 1

Cough

Answer 1

• irritation of the pulmonary system
• most frequent sign of pulmonary disease
• stimulus anywhere from upper to lower airway

Question 2

Hemoptysis

Answer 2

Sputum containing blood, old (clots) or new (pink or red streaks)

Question 3

Dyspnea

Answer 3

difficulty breathing - a conscious effort

- shortness of breath

Question 4

paroxysmal nocturnal dyspnea

Answer 4

in the middle of the night, the shortness of breath comes- (symptoms come and go)

Question 5

Pulmonary edema

Answer 5

accumulation of fluid in the alveoli in the lungs

• makes it harder for gas molecules to pass across,
• drowning to death from bot being able to breath in and breath out efficiently

Question 6

ARDS

Answer 6

Acute respiratory destress syndrome

• patients can no longer sufficiently oxygenate themselves
• often need ECMO

Question 7

Chest Xray

Answer 7

different tissues in our body absorb X rays at different intensities
- air (least opaque) –> bone/metal (most opaque, white)

5 densities (air, fat, soft tissue, bone, metal)

Question 8

The 6 P’s of Dyspnea:

Answer 8

• Pulmonary Bronchial Constriction
• Pulmonary embolus
• possible foreign body
• pneumothorax
• pump failure
• pneumonia

Question 9

Chest pain unrelated to heart problems

Answer 9

Retrosternal pain
Pleural pain
Musculoskeletal pain

Question 10

Physiological sighs of pulmonary disease

Answer 10

• hypoxia (reduction of oxygen in tissues)
• hypoxemia ( reduction of oxygen in blood supply)
• acute hypercarbia/hypercapnia - produce or “altered” mental state

Question 11

Hypoxemia

Answer 11

oxygen supply to the tissue is below physiologic levels

Question 12

Hypoxemia signs:

1. Tachycardia:
2. Tachypnea:
3. Arrythmias:
4. Dyspnea:

Answer 12

1. faster than normal heart rate (>100bpm)
2. Rapid breathing (>20 bpm)
3. Heart rate irregularity
4. difficult or labored breathing

Question 13

Normal Respiratory rate

Answer 13

10-18 per minute

Question 14

Cyanosis

Answer 14

diffuse, bluish discoloration of the skin and mucous membranes

• (central and peripheral cyanosis)
• appears first in nail beds, mucous membranes, anise and earlobes

Question 15

generalized edema

Answer 15

fluid (stuck in interstitial space) accumulation in the whole body
- renal, hepatic, endocrine, metabolic, and cardiac diseases
- Cor pulmonate: enlargement of RV secondary to pulmonary disease
High capillary pressures force plasma water into body tissue
- increased venous pressure

Question 16

Posturing

Answer 16

allows patient to stabilize shoulders

• enlist accessory muscles too augment effort
• increases tidal volume

Question 17

Percussion

Answer 17

Technique that determines the density or consistency of lung by evaluating sounds from tapping the chest wall

Question 18

Auscultation

Answer 18

Listen for sounds of air flow through tracheobronchial tree

Question 19

Pulmonary Function testing (PFT)

Answer 19

generic term to indicate multiple studies performed to evaluate the respiratory system and pulmonary function

• gives insight into underlying pathophysiology by comparing measured values
• percentage of predicted normal issued to grade the severity of the abnormality

Question 20

Purpose of PFT

Answer 20

to determine how much air volume can be moved in and out of lungs and how fast

Question 21

Contraindictions

- PFT is done on every patient before surgery unless:

Answer 21

• hemoptysis of unknown origin
• pneumothrorax
• unstable cardiovascular status
• thoracic, abdominal or cerebral aneurysm
• eye surgery
• recent MI
• Acute Respiratory infection

Question 22

Equipment: Spirometer

Answer 22

designed to measure changes in volume and can measure lung volume compartments that exchange gas with the atmosphere

Question 23

PFT test considerations:

Answer 23

• age
• gender
• body habitus
• race

Question 24

FVC- Forced vital capacity

Answer 24

after patient has taken the deepest possible breath, this is the volume of air which can be forcibly and maximally exhaled out of the lungs until no more can be expired

Question 25

FEV1 (forced expiratory volume in 1 second

Answer 25

volume of air exhaled from lungs in the 1st second of forced expiratory maneuver

Question 26

FEV1/FEV

Answer 26

ration of the FEV1 to FVC - indicated what percentage of the total FVC was expelled from lints during the 1st second of forced exhalation, this is the FEV1%

Question 27

Diffusing Lung Capacity Carbon Monoxide

Answer 27

the measure of the integration of the alveolar surface area, alveolar capillary perfusion and the rate of carbon monoxide

Question 28

Obstructive Defects

Answer 28

- reduce ability of the lungs to move air, whereas lung volume and capacities remain normal or increase - result in decrease in the volume of air a patient is able to move during the 1st second and in mid phase

Question 29

Restrictive Defects

Answer 29

- pathologic presence of fibrotic tissue in the lungs underlies the basic cause of restrictive - lungs cannot fully expand - increase elastic recoil pressure with a reciprocal decrease in compliance - decrease in lung volume and total lung capacity

Question 30

Intrinsic Restrictive Lung Disorders

Answer 30

Sarcoidosis, tuberculosis, pneumomonectomy (loss of lungs), pneumonia

Question 31

Extrinsic Restrictive Lung Disorders

Answer 31

Scoliosis, pleural Effusion, pregnancy, obesity, tumors, ascites

Question 32

Neuromuscular Restrictive lung disorders

Answer 32

related to generalized muscle weakness

Question 33

FEV1 obstruction value

Answer 33

``` >80 normal >60,<70 moderate >50 <60 moderately severe >35, <50 severe <35 very severe ```

Question 34

If FEV1/FVC is hight, then consider ____ lung disease

Answer 34

restricted

Question 35

If FEV1/FVC is low, then consider ____ disease

Answer 35

obstructive