spirometry

Question 1

physical description importants

Answer 1

age, height, male/female

Question 2

calculate pack years

Answer 2

packs smoked per day x years smoked

Question 3

how long should patient stop smoking before pft

Answer 3

minimum of one hour

Question 4

bronchodilators should be with held how long prior to testing

Answer 4

short acting beta2- 4 hours

long acting beta2- 12 hours

anticholinergics- 8 hours

steroids do not need to be held

Question 5

patients who wear o2 during a pft

Answer 5

may be necessary to place patient on o2 between maneuvers or tests

o2 should be removed at least 20mins prior to ABG

Question 6

contraindications to pft

Answer 6

hemoptysis in past 24 hours

unstable vital signs

unable to cooperate

Question 7

pft patients should avoid

Answer 7

consuming alcohol for at least 4 hours prior to testing

vigorous exercise at least 30 mins prior to testing

wearing restrictive clothing

eating a large meal 2 hours prior to testing

Question 8

spirometry testing

Answer 8

identify restrictive and obstructive diseases

volumes and flow rates

restrictive= decreased volume

obstructive= decreased flow rates

Question 9

slow vital capacity

Answer 9

maximum expiration following a maximum inspiration

typical = 4800mL or 4.8L

decreased with restrictive disease

best volume to diagnose a restrictive disease

Question 10

Tidal Volume

Answer 10

normal breathing

typcail= 500ml

decreased with restrictive diseases

Question 11

minute volume

Answer 11

tidal volume x respiratory rate

Question 12

inspiratory reserve volume

Answer 12

largest volume of has that an in inspired above a normal tidal volume

measured with a spirometer

typical= 3100 mL

decreased with restrictive diseases

Question 13

expiratory reserve volume

Answer 13

largest volume of gas tha can be expired from a rest end-expiratory level

measured with a spirometer

typical= 1200mL

decreased with restrictive disease

will be lower than IRV

Question 14

inspiratory capacity

Answer 14

largest volume that an be inspired from end-expiration

measured with a spirometer

typical = 3600mL

decreased with restrictive disease

Question 15

static volumes

Answer 15

TLC

FRC

RV

Question 16

Forced Vital Capacity

Answer 16

maximum inspiration followed by a forced and rapid maximum expiration

this maneuver generates the FVC which is a volume and may be substituted for the SVC to identify restrictive lung disease

Question 17

SVC VS FVC

Answer 17

a patient with normal lung function will have values that are approx. the same for both

if the SVC is greater than the FVC suspect obstructive lung disease

if the FVC is greater question the patients effort

Question 18

Technique for FVC

Answer 18

inspire as deeply as possible

breath hold

exhale as forcefully as possible

continue exhaling as hard as possible until an expiratory plateau occurs or expiration time of 15 seconds

Question 19

trouble shooting FVC

Answer 19

if the patient passes out dring the FVC maneuver= vaso vagal response

if FVC > 10% after bronchodilator can be suggestive or air trapping or positive post bronchodilator response

Question 20

Peak Expiratory Flow

Answer 20

the maximum flowrate achieved during a forced expiratory maneuver

typical= 10L/ sec

very dependent on patient effort

best way to measure asthma patients

Question 21

Forced Expiratory Flow 200-1200

Answer 21

the average flowrate that occurs during a forced expiratory maneuver after the first 200mL has been expired

typical = 6 L/sec

measures airflow within the large airways

decreased with tumors and obstructive disease

Question 22

forced expiratory flow 25%-75%

Answer 22

average flowrate during the middle half of a forced expiratory maneuver

typical= 4-5 L/sec

small airways

decreased with obstructive disease

most sensitive test to detect the presence of early small airway disease

Question 23

only value needed to diagnose obstructive disease is?

Answer 23

FEV1

Question 24

Forced Expiratory Volume/Time (FEV1)

Answer 24

volume of gas expired over a given time interval in seconds

decreased flows indicated obstructive disease
used to assess the degree of improvement after bronchodilator admin.

Question 25

Forced Expiratory Volume/Time/Forced Vital Capacity Ratio

Answer 25

the forced expiratory volume for a given time ineterval expressed as a % of the vital capacity minimum values FEV1/FVC%- 70% obstruction decreased with obstructive disease normal with restrictive disease

Question 26

calculating the FEV1/FVC%

Answer 26

divide the FEV1 by the FVC then multiply by 100

Question 27

Maximum Voluntary Ventilation

Answer 27

largest volume of air inhaled and exhaled over a 12 second period typical= 170 L/min if patient has a low tidal volume and a fast reparatory rate during the MVV procedure, this indicates restrictive lung disease

Question 28

MVV technique

Answer 28

patient breathes into a spirometer as deeply ans as rapidly as possible for a minimum of 12 seconds

Question 29

calculating MVV

Answer 29

of breaths x volume x 5

Question 30

estimating patients effort for MVV by using the FEV1

Answer 30

multiple the FEV1 by 35 if the mvv is less than that value suspect poor patient effort

Question 31

FVC to generate a FLow-Volume Loop

Answer 31

forced expiratory vital capacity maneuver followed by a forced inspiratory vital capacity maneuver volume is horizontal flow is vertical expiration above baseline and inspiratory below

Question 32

pre and post bronchodilatory testing

Answer 32

used to determine degree of reversible airway obstruction

Question 33

indications for bronchodilator testing

Answer 33

1. FEV1 below 80% on pre bronchodilator 2. cough of unknown etiology 3. known asthmatic condition 4. anytime airway hyperreactivity is suspected

Question 34

fastest acting bronchodilator

Answer 34

isoproterenol

Question 35

post bronchodilator results

Answer 35

the FEV1 must improve by at least 12% and 0.200L in order to be considered a reversible condition patients with asthma may improve as much as 50%

Question 36

calculating % change in pre and post bronchodilator

Answer 36

(post FEV1- pre FEV1) divide pre FEV1

Question 37

obstructive diseases

Answer 37

``` C Cystic Fibrosis B Bronchitis A Asthma B Bronchiectasis E Emphysema ``` secretions and bronchospasm reduce flow

Question 38

interpretation of PFT data

Answer 38

the measured value is divided by the predicted value to obtain a % predicted ``` > 80%.... normal < 80%... mild dysfunction <70%... moderate < 60%... moderate/severe < 50 %... severe < 35%... very severe ```

Question 39

pediatric spirometry testing

Answer 39

good start of test and are free of artifact for at least the first second are called usable