Pulmonary Evaluation

Question 1

tidal volume

Answer 1

normal breath

Question 2

inspiratory reserve volume

Answer 2

extra after breathing in

Question 3

expiratory reserve volume

Answer 3

extra after breathing out

Question 4

vital capacity

Answer 4

max amount of air you can breath in and out

Question 5

residual volume

Answer 5

amount of air in lungs after max breath

Question 6

What does a residual volume of 0 mean?

Answer 6

collapsed lung

Question 7

What is FEV1/FVC?

Answer 7

ratio of total of air out during 1 sec over time

Question 8

normal FEV1/FVC

Answer 8

0.75-0.8

Question 9

high FEV1/FVC means what

Answer 9

> 0.8
- restrictive lung disease

Question 10

low FEV1/FVC means what

Answer 10

< 0.7
- obstructive lung disease

Question 11

What does an increased rib angle indicate? What does this do to the diaphragm?

Answer 11

rib angle > 90 deg
- indicates chronic hyperinflation that places an increased stretch on the diaphragm causing it to become flatter and less effective

Question 12

Eupnea
- rate, depth, and rhythm

Answer 12

normal rate, normal depth, regular rhythm

Question 13

bradypnea
- rate, depth, and rhythm

Answer 13

slow rate, shallow or normal depth, regular rhythm

Question 14

tachypnea
- rate, depth, and rhythm

Answer 14

fast rate, shallow deep

Question 15

hyperpnea
- rate, depth, and rhythm

Answer 15

normal rate, increased depth, regular rhythm

Question 16

hyperventilation
- rate, depth, and rhythm
- What does this result in?

Answer 16

fast rate, increased depth, regular rhythm
- results in decreased arterial carbon dioxide

Question 17

an increase in lung tissue density causes _______ sound transmission

Answer 17

increased

Question 18

a decrease in lung density (emphysema) would cause _________ sound transmission

Answer 18

decreased

Question 19

adventitious breath sounds

Answer 19

the abnormal noises heard only with a stethoscope

Question 20

Wheeze sound What does this indicate?

Answer 20

continuous but high pitched
- inflamed lung (asthma)

Question 21

Rhonchi sound What does this indicate?

Answer 21

wheeze, low pitch like a snore
- implies obstruction of larger airway

Question 22

crackles What does this indicate?

Answer 22

discontinuous adventitious lung sounds that sound like brief bursts of popping bubbles
- indicates fluid in lungs

Question 23

pleural rub What does this indicate?

Answer 23

sounds like 2 pieces of leather or sandpaper rubbing together
- indicates infection in pleural space

Question 24

What is paradoxical breathing?

Answer 24

chest moves inward instead of outward during inhalation

Question 25

What conditions cause tracheal deviation?

Answer 25

atelectasis and pneumothorax

Question 26

Atelectasis. Which way does the trachea move?

Answer 26

complete or partial collapse of a lung (alveolar collapse) - trachea moves toward the collapsed side

Question 27

Pneumothorax Which way does the trachea move?

Answer 27

abnormal collection of air in the pleural space that causes an uncoupling of the lung from the chest wall - creates restrictive lung disease - trachea moves away from involved lung

Question 28

S&S of pneuothorax

Answer 28

- tachypnea - asymmetric lung expansion - distant or absent breath sounds - decreased tactile fremitus - adventitious lungs sounds ED referral is you see these in a patient

Question 29

What is tactile fremitus?

Answer 29

vibrations created while talking and listening to lungs

Question 30

How much vibration will be felt if a patient has more air trapped (emphysema)? fluid trapped (pneumonia)? Air outside lung (pneumothorax)?

Answer 30

air trapped - less vibration fluid - increased vibration air outside lung - decreased

Question 31

sound from mediate percussion as thoracic air increases? - emphysema and pneumothorax

Answer 31

tympanic sound

Question 32

sound from mediate percussion as thoracic air decreases? - atelectasis, mucus, pleural effusion

Answer 32

hyporesonant/dull sound

Question 33

egophony. How is it tested and what are normal and abnormal results?

Answer 33

increased resonance of voice sounds - say "Eeeeeee" normal results = hear Eeeee abnormal results = nasal A or goat call heard

Question 34

Brinchophony How is it tested and what are normal and abnormal results?

Answer 34

abnormal transmission from lungs or bronchi - say "99" repeatedly normal = not understandable abnormal = 99 understood

Question 35

Whispered pectoriloquy How is it tested and what are normal and abnormal results?

Answer 35

increased loudness heard upon whispering - whisper "1-2-3" normal = not understood abnormal = understood 1-2-3

Question 36

What type of breathing would be done with post-op pts, dyspena at rest, or pts who have inefficiency with breathing?

Answer 36

diaphragmatic breathing training

Question 37

What type of breathing would be done with tachypnea and dyspnea pts?

Answer 37

pursed lip breathing

Question 38

What type of breathing would be done with pts with decreased lung volumes, decreased chest wall compliance, and V-Q mismatch?

Answer 38

segmental breathing - provide quick stretch over external intercostals as pt reaches full exhalation

Question 39

What breathing technique is good for patients who you don't want to hit or vibrate due to precautions/contraindications?

Answer 39

active cycle of breathing techniques

Question 40

How to perform active cycle of breathing technique

Answer 40

1) Normal diaphragmatic breathing 2) 3-4 deep breaths 3) Hold breath 1-3 sec 4) Relaxed exhale and cough/huff as needed 5) repeat

Question 41

How to perform autogenic drainage?

Answer 41

1) Blow out all air 2) Small breaths in and out for 10-20 breaths 3) Medium breaths in and out 4) Large breaths in and out 5) Cough 6) repeat

Question 42

anterior upper segment position (upper lobes)

Answer 42

sitting w/ head of bead raised w/ pillow under kness - used for anterior upper lobes

Question 43

posterior apical segment

Answer 43

sitting with flexed trunk forward w/ pillow under knees - posterior upper lobes

Question 44

anterior segments

Answer 44

supine with pillow under knees - anterior middle lobes

Question 45

right posterior segment

Answer 45

prone with right side slightly elevated - posterior right upper lobe

Question 46

left posterior segment

Answer 46

prone w/ head of bed raised and pillow under stomach/left side slightly elevated - posterior upper left lobe

Question 47

right middle lbe

Answer 47

supine with right side slightly elevated by pillow and foot of bed raised 12 inches - anterior lower right lobe

Question 48

left lingular

Answer 48

supine with left side slightly elevated by pillow and foot of bed raised 12 inches - anterior lower left lobe

Question 49

anterior segments (lower lobes)

Answer 49

supine w/ pillow under knees and foot of bed raised 18 inches - anterior middle/lower lobes

Question 50

right lateral segment

Answer 50

left side lying with foot of bed raised 18 inches - right lower lobe

Question 51

left lateral segment

Answer 51

right side lying with foot of bed raised 18 inches - left lower lobe

Question 52

posterior segments

Answer 52

prone with foot of bed raised 18 inches - lower posterior lobes

Question 53

superior segments

Answer 53

prone with pillows under stomach and feet - middle posterior lobes