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106 Cards in this Set

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Aspects of pulmonary function?
Perfusion-blood flow through pulm vessels, diffusion-movement of O2 and CO2 across alveolar spaces, ventilation-air exchange btwn alveolar spaces and the atmosphere
What happens on inspiration?
Alveolar pressure less than atomospheric pressure = air comes in
On expiration?
Alveolar pressure greater than atmospheric = air goes out
Pumonary Function Tests
Dysfunction from Obstruction, Restriction or both
Obstructive Impairment
when ventilation is disturbed by an increase in airway resistance
Restrictive Impairment
When ventilation is disturbed by a limitation in chest wall excursion
Obstructive Impairment
Examples and Causes
Peripheral Airway Dx-Bronchitis, Bronchial Asthma, CF; Pulmonary Parenchymal Dx-Emphysema; Upper Airway Dx-pharyngeal, tracheal or laryngeal tumors, edema, infections, foreign bodies, collapsed airway, stenosis
Restrictive Impairment
Examples and Causes
Chest Wall Dz-injury, MD; Extrathoracic Dz-obesity, ascites, pregnancy; Interstitial Lung Dz; Pleural Dz-pneumothorax, hemothorax, pleural effusion; Space Occupying Lesions
Mixed
Examples and Causes
Pulmonary congestion-bronchial edema,
What are some indications for doing the following tests?
Early detection of pulm or cardio-pulm dysfunctions, DDx of dyspnea, presurgical assessment, diff. btwn restriction and obstruction, det. diffusing capacity of lung, monitor bronchodilator therapy, detection of early resp failure, monitoring progress of pulm dz, those exposed to things harmful to lungs, inhalation allergies, epidemiology, worker's comp claims, monitoring drugs or post-surgery
Classifications of Tests-3
Airway Flow Rates
Lung Volumes and Capacities
Gas Exchange(Diffusion Capacity)
1. Airway Flow Rates
Instantaneous or Average airflow rates during a maximal forced exhalation. Assesses airway patency and resistance along with responses to inhaled bronchodilators or bronchial provocations. Shows severity of airway obstruction and identifies if the obstruction is central or peripheral.
Airway Flow Rates Tests
FEV, FCV, PEFR, PIFR,
Spirometer
Measures lung capacities, volumes and flow rates-airway function and patency of airway. Mechanical signal to an electrical signal which records the amount of gas breathed in and out-max. amt of air exhaled rapidly and forcibly after deep inhalation
FEV - Forced Expiratory Volume
(Spirometry)
Volume of air expelled in second intervals of FVC.
Normal = >80% predicted value
Obstuctive = airways are narrowed and resistance to flow is high = not much air can be expelled in 1 second.
Restrictive = amt of air inhaled is low but not b/c of airway resistance.
FEV1,2,3,4,or 5
Timed Vital Capacities
FEV after 1,2,3,4,or 5 seconds
What are these good for measuring?
A pt's response to bronchodilators.
If FEV1 is <80% predicted value for pt's age, gender, wt, ht, ethnicity, medical hx, etc then what?
Administer bronchodilators...an increase of 20% or more above prebronchodilator level = great response & is consistent with dx of reversible obstructive airway dz(emphysema pts don't show this response.)
FVC - Forced Vital Capacity
ML = >80% of predicted value
max amt of air that can be exhaled forcibly and completely after a maximal inspiration.
Less than expected values occur in obstructive and restrictive dzes.
FEV1/FVC NL Values
FEV1, 80%-85% of FVC
FEV2, 90%-94$ of FVC
FEV3, 95%-97% of FVC
What are the clinical implications of this test?
1. Obstructive Impairments = airway collapse occurs during forced expiratory effort leading to decreased airway flow rates. More severe forms = apparent loss of volumes.
Ratio is <80%
2. Chronic Lung Dzes = cause trapping of air leading to decreases values
3. Restrictive Impairments = FVC is reduced BUT flow rates can be NL or elevated.
Ratio is close to 80%.
PIFR
Peak Inspiratory Flow Rate
Maximum flow of air achieved during a forced maximal inspiration.
Measures function of the airways, identifies reduced breathing on inspiration and is totally dependent on the effort the patient makes to inspire.
PIFR NL values
300 L/min
Predicted values based on age, sex and height
PIFR implications...
Reduced = NM disorders, extrathoracic airway obstruction and upper airway obstruction
PEFR
Maximum flow of expired air during a forced expiratory maneuver. Used as an index of large airway function.
PEFR NL values
450 L/min
Predicted values based on age, sex and height
PEFR implications...
Reduced = obstructive dz, during acute exacerbations of asthma, upper airway obstruction, severe restrictive situations
NL = restrictive lung dz
II. Lung Volumes and Capacities
TLC - Total Lung Capacity
TV - Tidal Volume
IC - Inspiratory Capacity
IRV - Inspiratory Reserve Volume
RV - Residual Volume
FRC - Functional Residual Volume
ERV - Expiratory Reserve Volume
VC - Vital Capacity
Capacity
Combo of two or more volumes
FRC
Volume of gas contained in the lungs at the end of a NL quiet expiration. Evaluates both restrictive and obstructive lung defects. Reflects changes in the elastic properties of the lungs. FRC = ERV + RV
FRC NL Value
2500-3500 mL
Observed value should be 75%-125% of the prediced value
FRC Implications...
<75% = restrictive impairment
>125% = Air-trapping(hyperinflation), consistent w/obstruction
RV
Volume of gas remaining in lungs after a max exhilation. Distinguishes btwn restrictive and obstructive defects. FRC - ERV = RV b/c can't measure this with spirometer
RV NL Values
1200-1500 mL
RV Implications...
Increase = air-trapping(seen in young asthmatic pts - is reversible), emphysema(permenant), chronic bronchial obstruction
Decrease = dzes that occlude alveoli
<75% = restriction
ERV
Largest volume of gas that can be exhaled from end-tidal expiration. Measures lung or chest wall restriction. VC - IC = ERV
ERV NL values
1200 - 1500 mL
ERV implications...
Decrease = chest wall restriction from non-pulm causes, elevated diaphragm, massive enlargement of the heart, pleural effusion, kyphoscoliosis, obstruction from an increase in RV impinging on ERV
IC
Largest vol of air that can be inhaled from the end-tidal exp level. Identifies lung or chest wall restrictions. TV + IRV = IC
IC NL Value
3000-3300 ML
IC Implications...
Decreses = restrictive or obstructive
VC
Defects of lung or chest wall restriction. Largest volume of gas that can be expelled from the lungs after the lungs are first filled to the max then slowly emptied to the max. IC + ERV = VC
VC NL values
4500-5000 mL
VC Implications...
Decrease = <80% of predicted, depression of resp center in brain, NM dzes, pleural effusion, pneumothorax, pregnancy, ascites, tumors
Increase = athlete
TLC
Evaluates obstructive defects. differentiates restrictive from obstructive. Measures the volume of gas contained in the lungs at the end of max inspiration. VC + RV = TLC
TLC NL Value
5700-6200 mL
TLC Implications...
Increase = obstruction
Decrease = edema, neoplasms, pulm conjestion, pneumothorax and thoracic restriction
III. Gas Exhange (Diffusing Capacity)
DLCO-Carbon Monoxide Diffusing Capacity
MVV-Maximum Voluntary Ventilation
MRP-Maximal Resp Pressure
CV-Closing Volume
VisoV-Volume of Isoflow
DLCO
Det. the rate of gas transfer across the alveolar capillary membranes. Dxes pulm vascular dz, emphysema, pulm fibrosis. Evaluates the extent of functional pulmonary capillary bed w/alveoli
DLSO NL Values
25 mL/min/HHmg
DLSO Implications...
Decrease = pulm emboli, emphysema, lung resection, pulm fibrosis, anemia
Increase = polycythemia, lt to rt shunts, pulm hemorrhage, exercise
Don't think we have to know...pages 917-21
MVV, MRP, CV, VisoV
Pages 464-66
*see printed charts Table 7.2 and 7.3
I don't think we need to know the following...correct?
MVV-Maximum Voluntary Ventilation
MRP-Maximal Resp Pressure
CV-Closing Volume
VisoV-Volume of Isoflow
Mosby's LAb Book
Some of this is redunant...sorry!!
Pages 1200-1205
Routine Pulmonary Function Tests
Spirometry, Air Flow Tests, Lung Volumes and Capacities
Requested but not Routine Test
Gas diffusion&inhalation
What does Exercise Pulmonary Stress Testing tell us?
Pulmonary Reserve
Spirometry
Measures air volumes.
(Air volumes + Time = Air Flow Rates.)
Values can be predicted based on age, height, weight, race and sex.
>80% of predicted values = NL
Spirometry provides what info?
Obstruction or Restriction of Air Flow
COPD or CRPD
Air Flow Rates
Obstruction
Isoflow Curves
Flow-Y axis
Volume-X axis
Maximally Inhale
Forcible Exhale
Shape of curve
Identifies and Quantifies airway obstruction
Diminished Air Flow Rates
<60% of NL
Repeat Test after bronchodilator used-should see a 20% or > Air Flow Rate
What does not improve with bronchodilator therapy?
Emphysema and Restrictive Lung DZ
What does improve?
COPD w/asthmatic component
Lung Capacity measures?
Air Trapping in the Lungs
Gas Exchange studies Measure?
Diffusing capacity of the Lung(Dl)-the amt of gas exchanged across the alveolar-capillary membrane/minute
When is gas exchange abnormal?
CHF, pneumonia, dzes that fill the alveoli with fluid or exudate, dzes that cause deposition of material in the interstitium of the lung
Why would someone faint during the FVC maneuver?
Valsalva effect- performed by forcibly exhaling against closed lips and pinched nose, forcing air into the middle ear if the Eustachian tube is open. This maneuver with slight modifications can be used as a test of cardiac function and autonomic nervous control of the heart or to ‘clear’ the ears (equalize pressure) when external pressure increases, as in diving or aviation.
What are the significances of Pulmonary Fibrosis and Interstitial Lung Dzes?
Reduced lung volumes and capacities and Diffusing Capacity.
Hypoxemia.
NL FEV1/FVC ratio.
What are some causes of Interstitial Lung Dzes? (perialveolar inflammation followed by fibrosis)
Asbestosis, ARDS, radiation fibrosis, collagen vascular dzes, Goodpasture Dz, amyloidosis, sarcoidosis, end-stage hypersensitivity pneumonitis.
What are the significances of tumors?
NL PFTs w/cancers of the peripheral small bronchi.
Reduced PIFR=tumors of the trachea and large bronchi
What are the significant results of Chest Wall Trauma? (fractured ribs or resent surgury)
Reduces lung volumes and capacities.
What are the significant results of emphysema, ashtma and bronchitis?
Reduced air flow rates(FEV1) and VC.
ABNL air flow curves.
Increased RV and ERV.
Inhalant pneumonitis?
Reduced lung volumes.
Impaired diffusing capacity.
Exercised Induced Hypoxemia.
Mostly NL Air Flow Rate.
Post-pneumonectomy?
Reduced lung volumes and capacities.
Bronchiectasis?
(chronic dilation of bronchi or bronchioles as a sequel of inflammatory disease or obstruction. Infection is the mechanism by which the disease progresses. The disease, left untreated, will continue to damage lung tissue and bronchial tubes and cause emphysema and severe breathing difficulties.)
Reduced air flow rates.
ABNL air flow curves.
Airway infection?
Transient air flow obstruction.
Reduced Air Flow Rates.
Pneumonia?
Reduced Lung volumes and capacities and diffusing capacity.
NM DZ?
Reduced lung volumes and capacities.
Hypersensitivity Bronchospasm?
Reversible airway obstruction.
Reduced air flow rates and lung volumes.
What other 2 tests can be used to test pulmonary function?
ABGs and Chest X-Rays
If a guy throws up and you hear lung sounds indicating pneumonia, what does he have and why?
Klebsiella pneumoniae-
He aspirated an absess
Things to look at from these 2 lectures...
Clinical Cases
1/24 and 1/31 notes
PulmonaryLesson3-graphs
Matthews graphs
P. 463-66 in lab book
Gram +
Cocci
Catalase +
Staphylococcus aureus,
epidermidis, and saprophyticus
Gram +
Cocci
Catalase -
Strep
Gram +
Cocci
Catalase -
Strep
Alpha
Causes hemoysis
Strep pneumoniae
Strep mutans
Gram +
Cocci
Catalase -
Strep
Beta
Causes partial hemolysis
A Strep pyogenes
B Strep agalactiae
D Enterococcus
Gram +
Cocci
Catalase -
Strep
Gamma
Causes NO hemolysis
Peptostrep
Enterococcus
Gram +
Rods
Clostridium
Corynebacterium
Listeria
Bacillus
Gram -
Cocci
Neisseria meningitis
Gonorrheal
Gram -
Rods
H. influenzae
Pasteurella
Bortetalla pertussis
Gram -
Lactose Fermenting Rods
E. coli
Enterobacter
Klebsiella pneumoniae
Gram -
Lactose Non-fermenting Rods
Shigella
Salmonella
Proteus
Pseudomonas aeruginosa
Rules of Pneumonia
Memorize
Child
6 wk - 18 y
Rid My Child'S.pneumonia
RSV
Mycoplasm
Chlamydia
S. pneumoniae
Adults
18 y - 40 y
Mom'S.pneumonia
Mycoplasm
S. pneumoniae
Adults
40 y - 65 y
Mammi Has A Virus & S. pneu
Mycoplasm
H. influenzae
Anaerobic
Virus
S. pneumoniae
Elderly
>65
(grandma has) HSV
H. influenzae
S. pneumoniae
Virus
Rules of Meningitis
Memorize
Newborn
0-6 mo
Group Strep B
E. coli
unprotected anal sex
Listeria
Milk
Child
6 mo - 6 y
He Said Not meningitis
H. influenzae
S. pneumoniae
N. meningitis
Adults
6 y - 60 y
He Said No meningitis Either
HSV
S. pneumoniae
N. meningitis
Enterovirus
Elderly
>60
S. pneumonia