Week 8- Lung Sounds V/Q Issues

Question 1

Chest Auscultation for Lung Sounds

Answer 1

• Listening for normal and abnormal breath sounds
• Using a stethoscope
• Called auscultation
• Min of 4 locations on either the anterior chest wall OR
• Posterior 4 locations
• Evaluate air entry into the lungs and compare right to left sides

Question 2

Normal breath sounds are classified as

Answer 2

• Tracheal
• Bronchial
• Bronchovesicular
• Vesicular sounds
• The patterns of normal breath sounds are created by the effect of body structures on air moving through airways

Question 3

In addition to their location, breath sounds are described by:

Answer 3

• Duration (how long the sound lasts)
• Intensity (how loud the sound is)
• Pitch (how high or low the sound is)
• Timing (when the sound occurs in the respiratory cycle)
• Sounds diminish as they go through the smaller airways

Question 4

Tracheal

Answer 4

• Directly over the trachea
• Harsh sounding like air through a pipe

Question 5

Bronchial

Answer 5

• Present over large airways in the anterior chest near the 2nd and 3rd intercostal spaces
• Loud and high patched

Question 6

Bronchovesicular

Answer 6

• Posterior chest between the scapulae and in the centre of the anterior chest
• Softer than bronchial sounds, equal during expiration and inspiration

Question 7

Vesicular

Answer 7

• Over the lung tissues
• Soft, blowing or rustling sounds normally heard

Question 8

What would cause diminished air flow?

Answer 8

• Obstruction
• Edema
• Allergic rxn
• Mucus, blood

Question 9

What would cause absent airflow?

Answer 9

• Collapsed lung, pneumo
• Severe bronchoconstriction
• Severe obstruction

Question 10

What would cause differences in air flow from right to left?

Answer 10

• Flail chest
• Pneumo
• Intubation pushed to far
• Pneumonia
• Tumours

Question 11

Adventitious (not normal) Lung Sounds

Answer 11

• Crackles
• Wheezes
• Stridor

Question 12

Crackles

Answer 12

NITRO
- Light cracking, popping sounds produced by air passing through moisture
- bronchitis, heart failure

Question 13

Wheezes

Answer 13

VENTOLIN
- High pitched, musical sounds produced when air moves through smaller, partially obstructed airways (sounds like a whale)
- Asthma, partial obstruction spasm

Question 14

Stridor

Answer 14

• High pitched inspiratory sound from partial obstruction in the larynx or trachea
• Croup

Question 15

Pleural Friction Rub

Answer 15

• Squeaking or grating sounds of the pleural linings rubbing together when the linings rubbing together when the linings are inflamed and lose their lubrication
• They appear during the entire respiratory cycle

Question 16

Consolidation

Answer 16

• Infectious pus causing collapse of the alveoli (area of infection in the lungs)

Question 17

Effusion

Answer 17

• Fluid in the pleural space causing a decrease in functioning lung tissue

Question 18

What is ventilation?

Answer 18

• Process of air movement in and out of the lungs

Question 19

What does ventilation requires?

Answer 19

• Neurological control for inflation
• Contact: brain stem to the muscles
• Functional diaphragm
• Functional intercostal muscles
• Patent and functional airway
• Functional alveoli

Question 20

What are some ventilation problems?

Answer 20

• Airway obstruction (foreign body, epiglottitis)
• Chest wall impairment (trauma, muscular dystrophy)
• Neurological control impairment (CNS depressant drugs, stroke)

Question 21

Treatment we can use for ventilation…

Answer 21

• Patent and unobstructed airway maintained
• OPA/ NPA/ King LT/ ETT
• Assist ventilation
• BVM

Question 22

Diffusion

Answer 22

• Process of gas exchange between capillaries and alveoli

Question 23

What does diffusion require?

Answer 23

• Alveolar and capillary walls that are permeable to respiratory gases
• Interstitial spaces not enlarged or filed with fluid
• Surface area of sufficient size
• Presence of gases for diffusion

Question 24

What are diffusion problems?

Answer 24

• Inadequate oxygen concentrations (fire environments, CO poisoning)
• Alveolar pathologies (lung disease, inhalation injury)
• Interstitial space pathologies (pulmonary edema, near-drowning)
• Capillary bed path pathologies (severe atherosclerosis)

Question 25

Treatment we can use for diffusion...

Answer 25

- Increase O2 concentration - Reduce inflammation - Remove fluid in the interstitial spaces

Question 26

Perfusion

Answer 26

- Circulation of blood through the pulmonary capillary bed

Question 27

What does perfusion require?

Answer 27

- Adequate blood volume - Adequate hemoglobin - Functioning pulmonary capillaries - Functioning left ventricle

Question 28

What are perfusion problems?

Answer 28

- Impaired blood flow (shock, anemia, pulmonary embolus) - Capillary bed pathologies (trauma(

Question 29

What is the treatment perfusion problems...

Answer 29

- Ensuring adequate circulating volumes of fluid - Raise hemoglobin levels - Optimizing left ventricular function

Question 30

V/Q Mismatch

Answer 30

- V= Ventilation - Q= Perfusion - When your lungs are functioning properly, 4 L of air enter the resp. track per min and 5 L of blood go through the capillaries per min. This leads to a V/Q of 0.8. Once the air is humidified by the respiratory tract, it ends up in the vicinity of 1.0 - Ideally, V/Q is equal meaning there is just enough O2 to fully saturate the blood

Question 31

Shunt & Dead Space

Answer 31

- An area with perfusion but no ventilation (V/Q of O) is termed shunt - An area with ventilation but no perfusion is termed dead space - Very rarely can anyone have "True/Pure" shunts or dead space, as this is incompatible with life - Most often it's a condition between normal and wither of the 2 conditions

Question 32

Shunt

Answer 32

- Pathological condition which results when the alveoli of the lungs are perfused with blood as normal, but ventilation (supply of air) fails to supply the perfused region (low V/Q)

Question 33

Dead Space

Answer 33

- Alveoli are ventilated but no perfused (high V/Q)

Question 34

Oxygen Control of Blood

Answer 34

- Oxygen is present in blood in 2 forms: (dissolved in the plasma, bound to hemoglobin) - When carries as oxyhemoglobin, each hemo can carry 4 O2 molecules= fully saturated - Nears full saturation at PO2 of 80-100 mmHg

Question 35

Oxygen Saturation

Answer 35

- Increases rapidly when the PO2 is 10-60 mmHg (up to about 90% at 60 mmHg) - Further increases in PO2 relate to a small change in saturation - After this point, changes in O2 concentration relates to small changes in O2 saturation

Question 36

Blood plasma

Answer 36

- PO2 is the most important factor in determining how well oxygen binds to HB

Question 37

Pulse Oximetry

Answer 37

- In normal adults be 95-100% - SPO2 of less than 90 is a clinical emergency - Cyanosis may not be present until SPO2 is less than 90% - Cyanosis may not be evident in anemic or dark skinned pts

Question 38

What are factors that affect reading?

Answer 38

- Light- bright lights may affect the probe - Shivering- movement may make it difficult for the probe to pick up a signal - Pulse volume- the oximeter only detects pulsatile flow. When BP is low, pulse may be weak and may not be able to detect a signal - Vasoconstriction- reduces blood to the peripheries. If pt is cold may be difficult to detect - CO Poisoning- may give false readings - Nail polish

Question 39

Assessments- Initial

Answer 39

- Toxic environments - Alterations in mental status - Cyanosis - Absent breath sounds - Audible stridor - One-two word dyspnea - Tachycardia - Pallor and diaphoresis - Accessory muscle use