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47 Cards in this Set

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PFT indications
1)detect the presence or absence of lung dysfunction suggested by history or physical signs and symptoms
2)Determine the category of disease
3)Quantify the impairment or prognosis of known lung disease
4) assess the change in lung function over time or following administration of or change in therapy
5)Quantify air reversibility or hyperresponsiveness
6)Assess the potential effects or response to environmental or occupational exposure
7)Assess impairment and/or disability compensation
8)Predict post-operative risk for procedures known to affect lung function
PV=Nrt
ideal gas law
P1V1=P2V2
Boyle's Law
V1/T1=V2/T2
Charles' Law
P1/T1=P2/T2
Gay-Lussac's Law
ATP
1)Ambient temperature
2)Barometric pressure
3)Fully saturated h20 vapor at ambient temperature
BTP
1)Body temperature
2)Barometric pressure
3)Fully saturated H20 at body temperature
Patient preparation
1)More than two hours after a large meal
2)Withholding bronchodilators, vasoactive drugs, and cigarettes
3)Loose fitting clothing
4)Accurate age, height, and weight
5)Questionaire
6)Pt in sitting position
7)proper instruction
8)Proper coaching
Spirometry Contraindications
1)Hemoptysis of unknown origin
2)Pneumothorax
3)Unstable cardiovascular staturs
4)Thoracic, abdominal, or cerebral aneuryisms
5)Recent eye surgery
6)Presence of an acute disease process that might interfere with test performance
Spirometry Hazards
1)Hypoxemia
2)Syncope, dizziness
3)Chest pain, hemodynamic instability
4)Rib or muscle injury
5)Bronchospasm
6)Hyperventilation
7)Nausea and vomiting
8)Paroxysmal coughing
9)Increased intracranial pressure
10)Nosocomial infection
Total Lung Capacity
1)Volume of Gas in the Lungs at maximum inspiration
Inspiratory Capacity
Maximum volume of gas that can be inhaled after a normal exhalation
Vital Capacity
Maximum volume of gas that can be exhaled after a maximal inhalation or the maximal volume that can be exhaled after a maximal inhalation
Functional Residual Capacity
Volume of gas that remains in the lungs after a normal exhalation
Inspiratory Reserve Volume
Volume of gas that can be exhaled after a normal exhalation
Reserve Volume
The volume of gas remaining in the lungs after a maximal exhalation(can only be measure indirectly)
Lung VOlumes and Capacities
1)Normal
2)obstructed
3)Obstructed with hyperinflation
4)Obstructed with hyperexpansion
5)Restriction
Slow Vital Capacity
The volume of gas measured on a slow, complete exhalation without an initial or forced or rapid effort (4.8L). Includes measurements of tidal volume, inspiratory reserve volume, and expiratory reserve volume used in static measurements
Forced Vital Capacity
The volume of gas that can be exhaled as rapidly, forcefully, and completely as possible after a maximal inhalation
Peak Expiratory Flowrate
the Maximum flowrate attained during an FVC, but can also be measured seperately with a peak flowmeter
Forced Expiratory Flowrate 200-1200
The average flowrate for the liter of gas exhaled after the first 200 cc during an FVC
FEV1
Volume of gas exhaled in the first second of an FVC
Forced Expiratory Flow 25%-75%
The average flowrate between 25 and 75% of the volume exhaled during an FVC, or the average flow of the middle 50% of the FVC
Maximal Voluntary Ventilation
1)Largest volume that can be forcibly breathed in and out at about 60% of the Vital Capacity for about 12-15 seconds
2)Volumes extrapolated to about one minute
3)Normal range 150-200L/M
Global statements about the MVV
1) Tests endurance and strength of the respiratory muscles, airway resistance, lung/thorax compliance,and patient motivation
2)Weaning parameter used to determine ventilator discontinuance or commitment
3)Factor in Pulmonary Stress Testing
SVC Performance Criteria for Acceptabilty (1)
1)Tidal breaths at true FRC level
2)Maximal effort, optimal performance
3)At least 3 tidal breaths within 100cc of the patient's normal resting level before the SVC
SVC Performance Criteria for Acceptability (2)
1)Volume plateau at maximal inspiration and expiration
2)ERV and IC within 5% or 60 cc's, whichever is greater
2)Vt should be less than 1000cc
3)The SVC should be within 200 cc of the largest FVC
a)FVC=SVC normal, restrictive
b)FVC<SVc obstructive defect
4)the 2 largest tests out of 3 should be less than or equal to 200cc
Start of the FVC test
1)Maximal effort, and performance must be optimal
2)No leaks, hesitation, cough, or glottic closure
3)Back extrapolation <5% of the FVC, or 150 cc's, whichever is greater
4)Sharp peak flow on flow volume loop
5)no variable flows
Duration of Exhalation
1)less than 6 seconds
--volume plateau must be equal to two seconds
2)Greater than six seconds
--volume plateau must be equal to one second
3)No plateau
--exhalation equal to 15 seconds
4)FEV6 with or without plateau
5)Completed flow volume loop
FVC Performance Criteria for Acceptability
1)The two largest of the FVC and FEV1 should be less than or equal to a 200 cc difference
MVV Performance Criteria for Acceptability
1)Maximal effort and performance must be optimal for at least 12 seconds
2)No leaks, hesitation, or cough
3)Respiratory Rate should be greater than 60 BPM
4)VT should average 60 percent of the FVC
5)The MVV should be approximately equal to 35 X FEV1
6)Largest Two trials should be within 10 percent
Obstruction or FLow Limitation
1) A decrease in airflow without a decrease in airflow limitation
2)FEV1/FVC=less than 75 percent
3)PEFR. FEF200-1200,normal reduced
FEF25-75-less than 65 percent
Obstructive Causes
1)Decrease in airway diameter, due to brochospasm, increased mucus production, or inflammation
2)Emphysema, tracheal malacia, or tumor
Restrictive Causes
1) A decrease in lung volume without a decrease in airflow
2)FVC is less than 80 percent of predicted
3)FEV1/FVC=75 to 80 percent
4)normal PEFR, FEF200-1200, FEF 25-75
Restrictive Causes
PAINT
1)Pleural effusion, fibrosis, and patient effort
2)Alveolar filling process, pneumonia, cancer, or resection
3)Interstitial lung disease, IPF, CHF
4)Neuromuscular paralysis, myasthenia gravis, guillian-Barre
5)Thoracic Cage--kyphoscoliosis
Combined Obstructive/Restrictive Process
1)Decrease in Lung volume,and a decrease in airflow
2)FVC less than 80 percent of predicted
3)Reduced PEFR, FEF200-1200, normal Reduced FEF 25-75
Bronchodilator Response
1)more than 12 percent improvement in FEV1 and/or FVC is considered a positive response
2)Post-pre/preX100 equals the percent change
PEFR interpretation
1)80-100 of personal best equals normal
2)50-80 percent caution
3)0-50 percent med emerg
4)Daily variability of 30 percent is normal
Provocational Tests
1)_Methacholine challenge
2)Allergen
3)Occupational Exposure
4)Exercise
--asthma
--desaturation
--fitness level
FEF 25-75
The average flowrate for the middle 50 percent of the volume exhaled during an FVC
MVV
The largest volume that can be breathed in and out at 60 percent of the VC for 12-15 seconds
The MVV tests
1)muscle strength
2)lung compliance
3)airway resistance
4)patient motivation
What happens if Helium goes through a heated wire sensor?
Measurements will be off, since Helium cools 7x more than oxygen
Ultrasonic flow sensor
tunrbulent vortices form when gas flows over struts in the air stream
Define peakflow in your own words
peakflow respresents the maximal flow of air that can be exhaled within a predetermined length of time, after inhaling to TLC.
State the peakflow manuveur
1)Normal breath in
2)EXHALE
3)Inahle to TLC
4)seal on mouthpiece
5)exhale as forcefully as possible into the peak flow meter
ATS criteria for peakflow
1)Pt was sitting or standing up straight
2)Patient exhaled maximally
3)3 events recorded
4) largest flow recorded