Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
44 Cards in this Set
- Front
- Back
|
def
VT IRV ERV RV |
VT = Tidal volume - normal breathing
IRV = Inspiratory reserve volume - max inhalation ERV = expiratory reserve volume - max exhale RV = Residual volume - vol of air that is never exhaled |
|
|
give eqns for
IC FRC VC |
IC = Inspiratory capacity
IC = IRV + VT FRC = Functional residual capacity - ideally what you could breathe out FRC = ERV + RV Approx 75% of TLC VC = Vital capacity = ALL AIR EXCEPT RV VC = IRV + VT + ERV TLC = Total lung capacity |
|
|
diff betw Obstructive and restrictive lung disease
categorize COPD, asthma, and pulmonary fibrosis in to one of them |
OBS: Characterized by airflow limitation (more difficulty with expiration than with inhalation), increased lung volumes due to air trapping
Examples: Asthma COPD Emphysema Chronic bronchitis RESTRICTIVE-lungs cap restricted from not expanding Characterized by reduced lung volumes, and increased lung stiffness Examples: Pulmonary fibrosis |
|
|
what does a spirometer measure?
|
Measures forced expiratory volume more accurately than a peak flow meter and provides more detailed information
Measures Forced Vital Capacity (FVC) and graphs the pattern of expiration over time for the entire exhalation (eg, FEV1, FEV6 ) |
|
|
def
FEV-1 FEV-6 FVC |
-Forced Expiratory Volume in 1st second.
Volume of air exhaled in the first second of maximal respiration. - '" in 6 seconds - Forced Vital Capacity Total volume of expired air from maximal respiration. |
|
|
obstructive = think...
restrictive = think... |
obst = less exhale
rest = less capacity |
|
|
Pulmonary Function Tests
...are the most commonly measured ...is more reliable ...can be diminished by a decrease in TLC or by a lack of effort ...is independent of the patient’s size and TLC ...is used to stage obstructive disease and monitor progression or improvement |
FEV1 & FVC
FEV1/FVC ratio is more reliable FEV-1 is used to stage obstructive disease and monitor progression or improvement |
|
|
An acceptable expiratory effort must have...
1. 2. 3. |
1. sharp, maximal (peak) expiration with a total expiration duration greater than 6 seconds
2. be performed 2 or 3 times 3. the two highest FEV1 values are within 0.15L of each other |
|
|
What does the FEV-1/FVC ratio tell us?
What is it used for/ |
how well a patient can expire air during the first second of expiration compared to a complete exhalation
Used to identify presence of obstructive disease FEV1/FVC ratio less than 0.70 indicates airway obstruction |
|
|
Bronchodilator Test
describe |
Perform pre-bronchodilator spirometry
Administer albuterol MDI Re-test spirometry after waiting 10 minutes If spirometry results improve, indicates patient has a degree of reversibility to their pulmonary function An increase in FEV1 of > 12% and > 0.2L suggests an acute bronchodilator response |
|
|
Bronchoprovocation Test
describe the test...what do we use to do it? Used to diagnose asthma in patients who .. Requires |
Use histamine or methacholine (more common), or suspected allergen
Used to diagnose asthma in patients who display asthma symptoms, but have normal pulmonary function tests (spirometry) or thought to involve occupational or environmental causes of asthma Prepare serial dilutions of test substance (usually follow a protocol) Have patient inhale substance and undergo spirometry tests Requires 24 hour monitoring & availability of emergency medications/care |
|
|
What is methacholine used for?
How does it affect the human body? |
Bronchoprovocation Test agent
Cholinergic agent that stimulates muscarinic receptors induces smooth muscle contractions of the lungs and increases tracheobronchial secretions |
|
|
How do we use Bronchoprovocation to diagnose obst disease?
|
asthmatic's FEV1 will drop off sooner and faster for a lower dose of methacholine
|
|
|
How to use a peak flow meter
|
Move the marker on the peak flow meter to the bottom of the scale so that it reads zero or is at base level.
Stand up straight. Take a deep breath and fill your lungs all the way. Hold your breath while you place the device in your mouth, and close your lips around the mouthpiece. Do not put block the opening with your tongue or teeth. Blow out as hard and as fast as you can for one to two seconds. You want to move the marker as far as you can. Write down the number you receive. Repeat steps one to six for a total of THREE times. Record the highest of the three numbers — this is your “personal best.” |
|
|
How do we use peak flow meter results?
|
The patient is provided with a plan of action based on symptoms and peak flow readings. The peak flow values suggest when additional therapy or medical attention is needed
Traffic light zones: Provide patient with 3 number zones: GOAL: “green zone” = 80 – 100% of personal best CAUTION: “yellow zone” = 50 – 80% personal best MEDICAL ALERT : “red zone” = < 50% personal best |
|
|
What's the diff betw PFM (pk flow meter) and spirometry?
|
PFM - one quick exhale, meas PEFR (pk expir flow rate), quick, cheap ez, pt can use solo, for asthma monitoring
Spirometry - meas both expir rate AND VOLUME (FEV-1 and FVC), req office visit, used to diagnose and stage pulm disease. |
|
|
terminology
dyspnea crackles consolidation hemoptysis orthopnea ronchi rales stridor Paroxysmal nocturnal dyspnea (PND) |
Dyspnea—subjective sensation associated with unpleasant, uncomfortable respiratory sensations
Crackles - a discontinuous sound, as opposed to a wheeze, which is continuous. Crackles are known as fine or coarse and are also known as rales. Sound like rubbing hair, or a velcro fastener being pulled apart Consolidation – the replacement of air in the lungs with fluid Hemoptysis—bleeding from the lung; main symptom is coughing up blood Orthopnea—shortness of breath when in reclining position Rales – see crackles Rhonchi – see wheeze Stridor – high-pitched harsh sound heard during inspiration caused by obstruction of the upper airway Wheeze - continuous and musical sounds heard with breathing. Caused by airway obstruction from swelling or secretions. High or low pitched; also known as rhonchi = wheeze rales = crackles Paroxysmal nocturnal dyspnea (PND)—shortness of breath after going to sleep in recumbent position |
|
|
Strongest predictor of asthma?
others include... |
Atopic status
Initial severity Onset at school age Presence of bronchial hyperresponsiveness (BHR)-easily triggered broncho response |
|
|
Asthma
Major Characteristics |
Airflow obstruction
Edema Bronchospasm Hypersecretion BHR Airway inflammation |
|
|
Clinical Presentation of
CHRONIC ASTHMA |
EPISODIC dyspnea
cough (may be only) wheeze ATOPY decr FEV1/FVC decr FEV 15% post exercise METACHOLINE CHALLENGE FEV1 < 12.5 EOSINOPHILS in sputum |
|
|
Clinical Presentation of
SEV ACUTE ASTHMA |
severe dyspnea
acute atack cough TACHYPNEA, TACHYCARDIA PALE/CYANOTIC BARREL CHEST POOR SABA RESPONSE PER & FEV1 < 50% predicted NEUTROPHILS |
|
|
Diffs betw chronic & sever asthma?
|
acute = tachy, barrel chest, poor saba resp, PEF & FEV1 <50% predicted, neutrophils
chronic - chronic, persist cough; atopy, FEV1 improve w/SABA, FEV/FVC decr, methacholine challenge FEV1<12.5, eosinophils |
|
|
Def
Exercise-Induced Bronchospasm (EIB) |
Defined as a FEV1 drop > 15% from preexercise value (baseline)
|
|
|
list all the places with beta receptors
|
airway
heart vessels skeletal uterus metabolic |
|
|
drug review on quiizlet
GO NOW |
GO!!!
|
|
|
which asthma meds are for both copd and asthma?
|
LABA + ICS
Formoterol + Budesonide (Symbicort) Salmeterol + Fluticasone (Advair) |
|
|
Steps for Using Your Inhaler
|
Remove the cap and hold inhaler upright
Shake the inhaler Tilt your head back slightly and breathe out slowly Position the inhaler Press down on the inhaler to release medication as you start to breath in slowly Breathe in slowly (3 to 5 seconds) Hold your breath for 10 seconds to allow the medicine to reach deeply into your lungs Repeat puff as directed. Waiting 1 minute between puffs may permit second puff to penetrate your lungs better Spacers/holding chambers are useful for all patients. Recommended for young children and older adults and for use with corticosteroids. |
|
|
What % of dose is inhaled?
% wasted to swallow? what device incr amount to lungs? |
10/90
spacer |
|
|
how to use DPI
|
Exhale
Mouth must be placed around the device Activate a dose by sliding the handle back Breathe in as steadily and deeply as possible Hold breath for ~10 sec Close/click inhaler Rinse mouth (if ICS) |
|
|
How to Use a Turbuhaler
|
Twist off cover
Load medicine Exhale Hold horizontally Inhale Hold breath ~10 sec Exhale Replace cover |
|
|
which type of inhaler doesn't require shaking?
|
turbuhaler (tube inhaler with twist)
|
|
|
sweet taste and a spinning capsule are normal for this type of inhaler
|
single dose dpi
|
|
|
Rule of 2s
|
“Do you…”
“Use your quick-relief inhaler more than 2 times per week?” “Wake up at night with asthma symptoms more than 2 times per month?” “Refill your quick-relief inhaler more than 2 times per year?” |
|
|
GREEN ZONE: Go!!!
|
≥ 80% of personal best peak flow reading
Example: Patient has --ALL-- of these: Breathing is easy No coughs or wheezing No problems with sleep Can work and play!! |
|
|
YELLOW ZONE: Caution!!!
|
Between 50-80% of personal best
Patient has --ANY-- of these: Some difficulty with breathing Chest tightness, cough, wheezing Difficulty with work and play Wake up at night |
|
|
RED ZONE: Emergency!!!
|
Patient has --ANY-- of these:
Cannot work or play Can’t talk, walk, or eat well Medicine is not helping Tired lethargic Breathing hard or fast cyanotic |
|
|
This is a method to assess the current control of an asthmatic
A score of ____ or greater indicates that a patient should be seen by PCP |
Asthma Control Test
19 |
|
|
systemic corticosteroids:
side effects |
HPA-axis suppression
Increase in blood glucose, hypertension Other: GI upset, jitteriness, insomnia |
|
|
systemic corticosteroids:
Used for ____ exacerbations Can be admin ____ or ____ Patient should be tapered off corticosteroid if used____ |
short
im/iv >3wks (long term) |
|
|
Do Patients Need to Be Tapered Off Corticosteroids?
|
Intermediate Risk
10-20mg of prednisone (or equivalent) per day for ~3 weeks High Risk > 20mg of prednisone (or equivalent) per day for ≥ 3 weeks Received bedtime doses of glucocorticoid Cushingoid appearance |
|
|
Anticholinergics
Mechanism: Less effective than ____ Not ____ approved for asthma, but still used Available inhaled anticholinergics include: |
bronchodilator
Less effective than β2-agonists Not FDA approved for asthma, but still used Available inhaled anticholinergics Ipratropium – used for asthma Tiotropium: studies inconclusive for use in asthma, mostly for COPD |
|
|
Ipatroprium is typically used as ____ therapy when incomplete resp to _____
|
adjunct
SABA |
|
|
def
Status Asthmaticus |
A prolonged severe attack of asthma
Unresponsive to initial standard therapy Characterized Dyspnea (especially) Dry cough Wheezing Hypoxemia May lead to respiratory failure |
|
|
tx
Status Asthmaticus |
Primary therapy
Short-acting β2-agonist (SABA) Additional therapy depending on severity SYSTEMIC corticosteroids (ipatroprium sometimes used here) Inhaled anticholinergic O2 |
