Respiratory Procedures 2 (Exam 2)

Pulmonary function testing helps screen for and evaluate what?

Pulmonary disease, assess disease progression, quantify impairment, evaluate response to treatment, and assess risk before selected procedures or surgery

Spirometry measures airflow and exhaled volumes such as

FVC and FEV₁

Spirometry alone can suggest restriction when FVC is low, but it cannot confirm a

restrictive defect

A reduced total lung capacity (TLC) confirms what?

Restriction

FVC (forced vital capacity) is

Total volume forcibly exhaled after a full inspiration

FEV₁ is

Volume exhaled during the first second of the FVC maneuver

FEV₁/FVC is

Key ratio used to identify airflow obstruction; interpret against the appropriate
reference limit

FEF 25-75% is

Average flow over the middle portion of the FVC; may provide supporting
information but should not be used alone to diagnose obstruction

TLC (total lung capacity) is

Gas in the lungs after maximal inspiration; includes RV

RV (residual volume) is

Gas remaining after maximal expiration

FRC (functional residual capacity) is

Gas remaining after a normal, passive expiration

VC (vital capacity) is

Maximum volume exhaled after maximal inspiration

DLCO is

Assesses transfer of carbon monoxide from alveoli into pulmonary capillary blood

Primary issue of Obstructive pattern

Difficulty moving air out /increased airway resistance

Primary issue of Restrictive pattern

Reduced ability to expand lungs or chest wall

Obstructive pattern of FEV₁:

Often reduced, often disproportionately

Restrictive pattern of FEV₁:

May be reduced

Obstructive pattern of FVC

Normal or reduced

Restrictive pattern of FVC

May be reduced

Obstructive pattern of FEV₁/FVC

Typically reduced

Restrictive pattern of FEV₁/FVC

Often normal or increased

Obstructive pattern of TLC

Normal or increased; may be high with hyperinflation

Restrictive pattern of TLC

Reduced; confirms restriction

Obstructive pattern of Flow-volume loop

Concave or “scooped” expiratory limb

Restrictive pattern of Flow-volume loop

Often smaller/narrower loop with preserved general shape

Examples of obstructive pattern

Asthma, COPD, emphysema

Examples of restrictive pattern

Pulmonary fibrosis, severe scoliosis, obesity, neuromuscular weakness

Mixed/combined defect is what?

Evidence of obstruction plus a reduced TLC. A low FVC with obstruction may reflect air trapping rather than true restriction; lung-volume measurement helps distinguish them

Important interpretation rule is to

do not diagnose restriction from spirometry alone. Confirm with TLC.

Formula for Inspiratory Capacity (IC)

VT + IRV

Formula for Functional Residual Capacity

ERV + RV

Formula for Vital capacity

IRV + VT + ERV

Formula for Total lung capacity

VC + RV = IRV + VT + ERV + RV = IC + FRC

IRV is

inspiratory reserve volume

ERV is

expiratory reserve volume

RV is

residual volume

Hyperinflation generally means increased

TLC

Air trapping is reflected by an

increased RV and/or RV/TLC

A patient may have air trapping even when TLC is not markedly

markedly elevated

Restrictive disease reduces what?

TLC

DLCO is commonly measured using a

small concentration of carbon monoxide (CO), because CO binds strongly to hemoglobin and allows assessment of gas transfer.

Common causes of reduced DLCO include

emphysema (loss of alveolar-capillary surface area), interstitial lung disease/pulmonary fibrosis (thickened diffusion barrier), and pulmonary vascular disease (reduced pulmonary capillary blood volume). Anemia can also lower DLCO

DLCO may be increased with-

polycythemia and in some conditions with increased pulmonary blood volume, such as alveolar hemorrhage or asthma. Interpret results with hemoglobin and clinical context when available.

A restrictive pattern with a normal DLCO can suggest an-

extrapulmonary cause (e.g., obesity, chest-wall restriction, neuromuscular weakness); restriction due to interstitial lung disease often lowers DLCO

Obstructive disease is what?

Expiratory limb often appears concave or “scooped.”

Fixed upper-airway obstruction is what?

both inspiratory and expiratory limbs may be flattened, producing a box-like loop.

Variable extrathoracic obstruction is what?

inspiratory limb may flatten.

Variable intrathoracic obstruction is what?

expiratory limb may flatten.

A bronchodilator response is assessed by-

comparing post-bronchodilator values with baseline values.

The exam references a traditional criterion of an increase in-

FEV₁ of at least 12% and 200 mL; current interpretation standards may differ, so use the standard specified by your course.

FVC is effort-dependent and requires-

patient understanding, coaching, and cooperation

The patient generally performs the spirometry maneuver-

seated or standing, with a nose clip commonly used

You must obtain at least three acceptable spirometry maneuvers and assess repeatability according to-

ATS/ERS standard.

Forced maneuvers can increase-

Intrathoracic, intra-abdominal, and intracranial pressures and may cause dizziness or syncope.

For Spirometry you must screen for-

relative contraindications and defer testing or seek clinical direction when risk is significant.

Examples of potential relative contraindications for Spirometry includes

recent cataract surgery, unstable cardiovascular status, and hemoptysis of unknown origin.

A recently treated pneumothorax requires careful-

assessment and adherence to local/current guidance.

Infection prevention includes-

perform hand hygiene between patients; use appropriate gloves and respiratory protection based on the suspected pathogen and precautions; and clean, disinfect, sterilize, or discard patient-contact components according to manufacturer instructions and infection-control policy.

Accuracy is how?

Close a measurement is to the true/reference value.

Precision is how?

consistently repeated measurements agree with each other. A device can be precise but inaccurate.

Linearity is how?

well accuracy is maintained across the measurement range.

Range/capacity is what?

the span or amount the instrument can measure.

A calibrated 3-L syringe (“super syringe”) is used to check what?

spirometer volume accuracy across appropriate flows.

The exam’s expected response for volumetric calibration during continual use is at least daily which follow the-

applicable device instructions and current laboratory quality-control protocol.

Comprehensive quality assurance includes what?

instrument performance, technologist performance, patient maneuver quality, and compliance with applicable testing standards.

Spirometric values measured under ambient conditions are commonly reported after what?

conversion to BTPS (body temperature, ambient pressure, saturated with water vapor).

Flow-measurement range of-

0–16 L/s

Body plethysmography uses what?

Boyle’s law (at constant temperature, pressure and volume vary inversely) to estimate thoracic gas volume/FRC.

Helium dilution and nitrogen washout are gas-dilution/washout methods used to estimate what?

lung volumes that include RV.

Body plethysmography can measure what?

trapped gas that may be underestimated by gas dilution methods in severe obstruction.

Flow-volume loops measure airflow and exhaled volume patterns but-

they do not directly measure RV

Tracheostomy indications may include what?

bypassing upper-airway obstruction, prolonged airway management, and long-term mechanical ventilation.

Tracheostomy potential complications include what?

bleeding, pneumothorax, subcutaneous emphysema, false passage, tube obstruction/displacement, infection, and injury to nearby structures.

An uncuffed tube does not provide a what?

reliable seal for positive-pressure ventilation and does not reliably protect against gross aspiration.

A speaking valve such as a Passy-Muir valve requires what?

a patent upper airway and cuff deflation (or a cuffless tube); never use it with an inflated cuff because exhalation can be obstructed. Follow specialist assessment and device instructions.

Verify cuff availability for the exact Jackson/Silver or other tube model rather than what?

Assuming all models share the same configuration

(Tube designs vary by manufacturer and model)

Macintosh laryngoscope blade is what?

curved blade; its tip is placed in the vallecula to lift the epiglottis indirectly.

Miller blade is what?

A straight blade; it can lift the epiglottis directly

Confirm endotracheal tube placement using what?

sustained exhaled CO₂ detection/capnography when available, clinical assessment including bilateral chest rise and breath sounds, and additional confirmation such as chest radiography for tube depth when indicated. (Auscultation alone is not sufficient)

Extubation readiness includes what?

The improvement/resolution of the cause of respiratory failure, adequate oxygenation and ventilation, adequate respiratory muscle strength, ability to

protect the airway, and a coordinated plan for post-extubation monitoring/support.

Immediately after extubation is-

assess airway patency and work of breathing, auscultate breath sounds, monitor vital signs and oxygen saturation, and provide oxygen or other

support as indicated.

Key point: Albuterol

Short-acting beta₂ agonist bronchodilator

Exam-related reminder: Albuterol

Common unit-dose nebulizer presentation is 2.5 mg; volume depends on product concentration.

Key point: Xopenex (levalbuterol)

Short-acting beta₂ agonist bronchodilator

Exam-related reminder: Xopenex (levalbuterol)

Common nebulized strengths include 0.31 mg,

0.63 mg, and 1.25 mg.

Key point: Atrovent (ipratropium)

Short-acting muscarinic antagonist bronchodilator

Exam-related reminder: Atrovent (ipratropium)

The test wording says “Atovent”; likely intended

Atrovent. Verify the prescribed product and

dose.

Key point: Mucomyst (acetylcysteine)

Mucolytic

Exam-related reminder: Mucolytic

Inhalation solutions have been supplied in 10% and 20% concentrations; verify current product labeling.

Key point: Pulmicort Respules (budesonide)

Inhaled corticosteroid

Exam-related reminder: Pulmicort Respules

(budesonide)

Common respule strengths include 0.25 mg/2 mL and 0.5 mg/2 mL; prescribed dose varies.

Common arterial sampling sites include-

The radial, brachial, and femoral arteries; site selection depends on patient condition, clinician competency, and local policy.

The radial artery is commonly-

preferred when suitable because it is accessible and generally easier to compress.

Needle bevel orientation and insertion angle depend on the-

Selected artery, equipment, and approved procedure. Follow the technique taught in your lab and current institutional policy rather than relying on a single angle for every site.

The test’s keyed responses for bevel orientation and angle should be

checked against your course’s procedural reference before memorization.