NPTE - Pulmonary Examination

Inspiratory reserve

Extra volume beyond normal inspiration

Inspiratory reserve normal volume

3,100 ml

Tidal volume

Normal inspiration and expiration

Tidal volume normal

500 mL

Expiratory reserve

Extra volume beyond normal expiration

Expiratory reserve normal volume

1,200 mL

Residual volume

Amount of air remaining in the lungs after a forced exhalation (leftover after expiratory reserve volume)

Functional residual capacity

Expiratory reserve and residual volume

Inspiratory capacity

tidal volume + inspiratory reserve volume

Vital capacity

All of the air that can go in and out

Everything except residual capacity

Total lung capacity

All of the air that can go in and out

Includes residual volume

For an obstructive pulmonary condition, all lung volumes decrease except

Tidal volume

Functional residual capacity

Residual volume

Total lung capacity

—> have difficulty getting air OUT, and tend to have lung HYPERINFLATION

FEV 1/FVC for obstructive conditions

< 70 %

—> of total air that is expired, not a lot of it comes out in 1 sec

FEV1/FVC for restrictive conditions

> 70%

—> of all air that can be expired, most of it is getting out in 1 sec because theres altogether not a lot thats coming out due to decreased total lung volumes

Mild COPD FEV1

80% or greater

Moderate COPD FEV1

50-80%

Severe COPD FEV1

30-50%

Very severe COPD FEV1

<30%

T/F: FEV1 will be high for obstructive conditions, and will increase with severity

False

Low and will decrease

(Less coming out and harder to get it out with increased severity of obstruction)

Vesicular breath sounds

Soft

Low pitch

Vesicular breath sounds auscultation

Over the lungs

Bronchovesicular breath sounds

Intermediate intensity and pitch

Bronchovesicular breath sounds auscultation

Anteriorly over 1-2 IC spaces

Posteriorly between scapula

Bronchial breath sounds

Loud

High pitched

Bronchial breath sounds auscultation

Over manubrium

Tracheal breath sounds

Very loud

High pitched

Tracheal breath sounds auscultation

Over trachea

Rhonchi

Low pitched

Rattling

SNORE-LIKE

Rhonchi can indicate

COPD

Bronchiectasis

Pneumonia

Chronic bronchitis

CF

Wheezes

High pitched

Constant

During expiration

Wheezes can indicate

Airway obstruction (COPD, asthma, foreign body)

Crackles (rales)

Brief, discontinuous

Popping

High pitched

During inspiration and expiration

Crackles (rales) can be a key indicator of

CHF

Pleural rub

Heard over lower lateral chest

Inspiration and expiration

Pleural rub can indicate

Pleural inflammation

Stridor

Harsh

High pitched

Crowing sound

Stridor can indicate

upper airway obstruction

Bronchophony

Spoken voice - ex: saying "99"

Positive: high resonance and clarity

Should be muffled

Egophany

Saying "EE"

Positive: sounds like "AA"

Whispered pectoriloquy

Increased loudness of whispers during auscultation

Fremitus

Say "99"

Feel for uniformity of vibrations

Positive: non-uniform

During a fremitus test, increased vibrations indicate ____, while decreased vibrations indicate ____

Consolidation or infection

Air (pneumothorax, COPD)

Bronchophony, egophany, whispered pectoriloquy all indicate

Increased secretions and/or consolidation

Normal blood pH

7.35-7.45

High blood pH

Alkalosis

Low blood pH

Acidosis

normal PaCO2

35-45 mmHg

PaCO2 with hyperventilation

< 35 mmHg

—> getting rid of too much CO2

PaCO2 with hypoventilation

> 45 mmHg

—> not getting rid of enough CO2

Normal HCO3

22-26 mEq/L

Respiratory imbalance relates to

PH and PaCO2

Normal relationship between pH and PaCO2

Inverse

Metabolic imbalance relates to

PH and HCO3

Normal relationship between pH and HCO3

Same

COPD will have (elevated/depressed) PaCO2

Elevated

Not getting rid of enough CO2 - cant get the air out

Fremitus - increased sound

Consolidation

Fremitus - decreased sound

Air

Percussion - increased resonance

Air

Percussion - decreased resonance

Consolidation