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106 Cards in this Set
- Front
- Back
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Aspects of pulmonary function?
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Perfusion-blood flow through pulm vessels, diffusion-movement of O2 and CO2 across alveolar spaces, ventilation-air exchange btwn alveolar spaces and the atmosphere
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What happens on inspiration?
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Alveolar pressure less than atomospheric pressure = air comes in
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On expiration?
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Alveolar pressure greater than atmospheric = air goes out
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Pumonary Function Tests
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Dysfunction from Obstruction, Restriction or both
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Obstructive Impairment
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when ventilation is disturbed by an increase in airway resistance
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Restrictive Impairment
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When ventilation is disturbed by a limitation in chest wall excursion
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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
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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
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Mixed
Examples and Causes |
Pulmonary congestion-bronchial edema,
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What are some indications for doing the following tests?
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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
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Classifications of Tests-3
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Airway Flow Rates
Lung Volumes and Capacities Gas Exchange(Diffusion Capacity) |
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1. Airway Flow Rates
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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.
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Airway Flow Rates Tests
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FEV, FCV, PEFR, PIFR,
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Spirometer
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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
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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. |
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FEV1,2,3,4,or 5
Timed Vital Capacities |
FEV after 1,2,3,4,or 5 seconds
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What are these good for measuring?
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A pt's response to bronchodilators.
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If FEV1 is <80% predicted value for pt's age, gender, wt, ht, ethnicity, medical hx, etc then what?
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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.)
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FVC - Forced Vital Capacity
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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. |
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FEV1/FVC NL Values
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FEV1, 80%-85% of FVC
FEV2, 90%-94$ of FVC FEV3, 95%-97% of FVC |
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What are the clinical implications of this test?
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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% |
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2. Chronic Lung Dzes = cause trapping of air leading to decreases values
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3. Restrictive Impairments = FVC is reduced BUT flow rates can be NL or elevated.
Ratio is close to 80%. |
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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. |
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PIFR NL values
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300 L/min
Predicted values based on age, sex and height |
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PIFR implications...
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Reduced = NM disorders, extrathoracic airway obstruction and upper airway obstruction
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PEFR
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Maximum flow of expired air during a forced expiratory maneuver. Used as an index of large airway function.
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PEFR NL values
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450 L/min
Predicted values based on age, sex and height |
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PEFR implications...
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Reduced = obstructive dz, during acute exacerbations of asthma, upper airway obstruction, severe restrictive situations
NL = restrictive lung dz |
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II. Lung Volumes and Capacities
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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 |
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Capacity
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Combo of two or more volumes
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FRC
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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
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FRC NL Value
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2500-3500 mL
Observed value should be 75%-125% of the prediced value |
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FRC Implications...
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<75% = restrictive impairment
>125% = Air-trapping(hyperinflation), consistent w/obstruction |
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RV
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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
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RV NL Values
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1200-1500 mL
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RV Implications...
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Increase = air-trapping(seen in young asthmatic pts - is reversible), emphysema(permenant), chronic bronchial obstruction
Decrease = dzes that occlude alveoli <75% = restriction |
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ERV
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Largest volume of gas that can be exhaled from end-tidal expiration. Measures lung or chest wall restriction. VC - IC = ERV
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ERV NL values
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1200 - 1500 mL
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ERV implications...
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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
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IC
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Largest vol of air that can be inhaled from the end-tidal exp level. Identifies lung or chest wall restrictions. TV + IRV = IC
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IC NL Value
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3000-3300 ML
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IC Implications...
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Decreses = restrictive or obstructive
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VC
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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
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VC NL values
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4500-5000 mL
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VC Implications...
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Decrease = <80% of predicted, depression of resp center in brain, NM dzes, pleural effusion, pneumothorax, pregnancy, ascites, tumors
Increase = athlete |
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TLC
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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
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TLC NL Value
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5700-6200 mL
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TLC Implications...
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Increase = obstruction
Decrease = edema, neoplasms, pulm conjestion, pneumothorax and thoracic restriction |
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III. Gas Exhange (Diffusing Capacity)
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DLCO-Carbon Monoxide Diffusing Capacity
MVV-Maximum Voluntary Ventilation MRP-Maximal Resp Pressure CV-Closing Volume VisoV-Volume of Isoflow |
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DLCO
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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
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DLSO NL Values
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25 mL/min/HHmg
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DLSO Implications...
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Decrease = pulm emboli, emphysema, lung resection, pulm fibrosis, anemia
Increase = polycythemia, lt to rt shunts, pulm hemorrhage, exercise |
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Don't think we have to know...pages 917-21
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MVV, MRP, CV, VisoV
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Pages 464-66
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*see printed charts Table 7.2 and 7.3
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I don't think we need to know the following...correct?
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MVV-Maximum Voluntary Ventilation
MRP-Maximal Resp Pressure CV-Closing Volume VisoV-Volume of Isoflow |
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Mosby's LAb Book
Some of this is redunant...sorry!! |
Pages 1200-1205
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Routine Pulmonary Function Tests
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Spirometry, Air Flow Tests, Lung Volumes and Capacities
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Requested but not Routine Test
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Gas diffusion&inhalation
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What does Exercise Pulmonary Stress Testing tell us?
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Pulmonary Reserve
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Spirometry
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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 |
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Spirometry provides what info?
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Obstruction or Restriction of Air Flow
COPD or CRPD |
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Air Flow Rates
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Obstruction
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Isoflow Curves
Flow-Y axis Volume-X axis |
Maximally Inhale
Forcible Exhale |
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Shape of curve
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Identifies and Quantifies airway obstruction
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Diminished Air Flow Rates
<60% of NL |
Repeat Test after bronchodilator used-should see a 20% or > Air Flow Rate
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What does not improve with bronchodilator therapy?
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Emphysema and Restrictive Lung DZ
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What does improve?
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COPD w/asthmatic component
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Lung Capacity measures?
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Air Trapping in the Lungs
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Gas Exchange studies Measure?
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Diffusing capacity of the Lung(Dl)-the amt of gas exchanged across the alveolar-capillary membrane/minute
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When is gas exchange abnormal?
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CHF, pneumonia, dzes that fill the alveoli with fluid or exudate, dzes that cause deposition of material in the interstitium of the lung
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Why would someone faint during the FVC maneuver?
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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.
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What are the significances of Pulmonary Fibrosis and Interstitial Lung Dzes?
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Reduced lung volumes and capacities and Diffusing Capacity.
Hypoxemia. NL FEV1/FVC ratio. |
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What are some causes of Interstitial Lung Dzes? (perialveolar inflammation followed by fibrosis)
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Asbestosis, ARDS, radiation fibrosis, collagen vascular dzes, Goodpasture Dz, amyloidosis, sarcoidosis, end-stage hypersensitivity pneumonitis.
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What are the significances of tumors?
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NL PFTs w/cancers of the peripheral small bronchi.
Reduced PIFR=tumors of the trachea and large bronchi |
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What are the significant results of Chest Wall Trauma? (fractured ribs or resent surgury)
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Reduces lung volumes and capacities.
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What are the significant results of emphysema, ashtma and bronchitis?
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Reduced air flow rates(FEV1) and VC.
ABNL air flow curves. Increased RV and ERV. |
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Inhalant pneumonitis?
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Reduced lung volumes.
Impaired diffusing capacity. Exercised Induced Hypoxemia. Mostly NL Air Flow Rate. |
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Post-pneumonectomy?
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Reduced lung volumes and capacities.
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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. |
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Airway infection?
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Transient air flow obstruction.
Reduced Air Flow Rates. |
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Pneumonia?
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Reduced Lung volumes and capacities and diffusing capacity.
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NM DZ?
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Reduced lung volumes and capacities.
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Hypersensitivity Bronchospasm?
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Reversible airway obstruction.
Reduced air flow rates and lung volumes. |
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What other 2 tests can be used to test pulmonary function?
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ABGs and Chest X-Rays
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If a guy throws up and you hear lung sounds indicating pneumonia, what does he have and why?
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Klebsiella pneumoniae-
He aspirated an absess |
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Things to look at from these 2 lectures...
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Clinical Cases
1/24 and 1/31 notes PulmonaryLesson3-graphs Matthews graphs P. 463-66 in lab book |
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Gram +
Cocci Catalase + |
Staphylococcus aureus,
epidermidis, and saprophyticus |
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Gram +
Cocci Catalase - |
Strep
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Gram +
Cocci Catalase - Strep Alpha |
Causes hemoysis
Strep pneumoniae Strep mutans |
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Gram +
Cocci Catalase - Strep Beta |
Causes partial hemolysis
A Strep pyogenes B Strep agalactiae D Enterococcus |
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Gram +
Cocci Catalase - Strep Gamma |
Causes NO hemolysis
Peptostrep Enterococcus |
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Gram +
Rods |
Clostridium
Corynebacterium Listeria Bacillus |
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Gram -
Cocci |
Neisseria meningitis
Gonorrheal |
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Gram -
Rods |
H. influenzae
Pasteurella Bortetalla pertussis |
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Gram -
Lactose Fermenting Rods |
E. coli
Enterobacter Klebsiella pneumoniae |
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Gram -
Lactose Non-fermenting Rods |
Shigella
Salmonella Proteus Pseudomonas aeruginosa |
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Rules of Pneumonia
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Memorize
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Child
6 wk - 18 y |
Rid My Child'S.pneumonia
RSV Mycoplasm Chlamydia S. pneumoniae |
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Adults
18 y - 40 y |
Mom'S.pneumonia
Mycoplasm S. pneumoniae |
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Adults
40 y - 65 y |
Mammi Has A Virus & S. pneu
Mycoplasm H. influenzae Anaerobic Virus S. pneumoniae |
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Elderly
>65 |
(grandma has) HSV
H. influenzae S. pneumoniae Virus |
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Rules of Meningitis
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Memorize
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Newborn
0-6 mo |
Group Strep B
E. coli unprotected anal sex Listeria Milk |
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Child
6 mo - 6 y |
He Said Not meningitis
H. influenzae S. pneumoniae N. meningitis |
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Adults
6 y - 60 y |
He Said No meningitis Either
HSV S. pneumoniae N. meningitis Enterovirus |
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Elderly
>60 |
S. pneumonia
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