Successful Cardiopul FInal

How is spirometry performed?

subject exhales as forcefully as possible after taking a full inhalation, in standing
values are compared to normative values

What are components of the spirometry safety scree?

generally seeing if they wouldn't be ale to tolerate the high pressure, ex. ear infection, eye surgury, aneurysm, chest surgery

what is TLC

total lung capacity. max volume of air at the end of inspiration

what is FVC?

forced vital capacity. max volume that can be expired after a full breath

what is IRV?

Inspiratory Reserve Volume:
the air that can still be breathed in after normal inspiration

what is ERV?

expiratory reserve volume. the amount of air that can be exhaled after a normal breath

what is FRC?

functional residual capacity. sum of the residual volume and the expiratory reserve

what is maximum voluntary ventilation

the max amount of air that can be inhaled in 12 seconds when breathing as much as possible
usually 40x greater than the FEV1

what is DLCO

diffusion capacity (of carbon monoxide)
an amount of CO is inhaled and then exhaled after 10 seconds to measure how much diffused into the blood
determined by volume inspired, pulmonary blood flow, Alveolar capillary surface area, hemoglobi, thickness of AC membrane

what does the flow volume loop measure on each axis?

Y axis: flow (liters/second)
x axis: volume expired
Expiration is on top, inspiration is on bottom

what is Peak expiratory flow PEF?

the highest airflow rate during the FVC part of the flow volume loop
normal values are within 80% of age predicted max

what is FEF or forced expiratory flow

the average flow from the points where 25, 50, 75% of lung volume has been expired. High drop off in patients with obstructive disorders compared to PEF

what is FEV1

forced volume expired in 1 second

what is FEV1/FVC represent?

the amount of air expired in 1 second to the total amount of air expired. normal FEV1 should be 80% of the FVC or 0.8

what does the flow volume graph look like for restrictive and obstructive disorders?

Restrictive: have a higher PEF and lower FVC than normal. could have a higher FEV1/FVC than normal. Looks like a think graph with big peaks
Obstructive: normal or slightly small PEF, then a quick drop off in flow. FEV1/FVC lower than normal

what are the stages for obstructive pulmonary disease based on FEV1/FVC

mild: \>.8
moderate .5-.8
severe .3-.5
very severe

what are the stages for restrictive disease based on FVC?

60-80% - mild
50-60% - moderate

how do the values for obstructive pulmonary disease compare to normal?

FEV1/FVC

How do the vales for restrictive pulmonary disease compare to normal?

FEV1/FVC: normal or increased
FEV1: decreased
FVC: decreased
TLC: decreased
RV: decreased
DLCO: decreased

what forces affect the work of breathing?

static lung recoil/chest wall recoil. decreases with restrictive, increases with COPD
Airway resistance like mucus

what conditions can be caused by chronic lung diseases?

R heart failure
sleep apnea
pulmonary HTN
A fib

what is digital clubbing and what is it caused by?

the fingers and nails become wide and circular
caused by heart and lung diseases that reduce perfusion to the fingers, most commonly lung cancer

what are the chronic obstructive pulmonary diseases? what are the septic obstructive pulmonary disease?

Chronic: Bronchitis, emphysema, alpha 1 anitrypsin deficiency, athsma(kinda its own category)
septic: Cystic fibrosi, bronchectasis

what is the most common risk factor for COPD

tobacco slonking

what is chronic bronchitis?

persistent cough and sputum production for 3 months a year for 2 years

what is an alpha-1 antitrypsin deficiency?

lack of substance that prevents proteolytic enzymes from breaking down lung tissue
genetic deficiency causing emphysema in the lower lungs

what is the pathophysiology of COPD?

toxic particle inhalation triggers immune response, leads to fibrosis of small airways and collapse of small airways on expiration

what happens to ventilation during emphysema?

decreased surface for gas exchange, less ventilation and a V/Q mismatch

What is chronic bronchitis?

overdevelopment of submucosal glands due to chronic exposure to toxins. leads to bronchiectasis or atelectasis
Blue bloater

what are some muscular changes with COPD

metabolic inefficency leading to fiber shift from type 1 to type 2
increased energy expenditure due to increased work of breathing
reduced fat free mass (in quads)
due to disuse atrophy, inflamatory changes

what are the diaphragmatic adaptations with COPD

can only generate 60% of pressure
shift in fiber type to type 1 reduces force production
stretching of diaphragm changes length tension

what are other impairments with COPD?

back and neck pain, reduced functional cpacity, impaired balance, reduced gait speed

what happens to chemoreceptors in COPD

they are overexposed to CO2, downregulate response to CO2, leading to hypoxemia, hypercapnea

what is the bode index

assesses 4 year survivibility of COPD based on FEV1, 6MWT,BMI, MMRC score

what are focal and diffuse bronchectasis?

Focal: localized to an area of the lung, caused by extrinsic, tumor outside area, or intrinsic, tumor or scarring in airway
Diffuse: widespread as part of infectious or chronic diseaase

What is cystic fibrosis?

a disorder in cell membranes that leads to excessive salty mucus production
affects liver,pancreas, lungs, GI, sweat, sinuses
usually causes death by lung infection

whats the difference between intrinsic and extrinsic restrictive lung disease?

Intrinsic: reduced airway compliance due to thickening and scarring
extrinsic: reduced compliance due to mechanical issues like obesity, chest wall issues, or diaphragm issues

Intrinsic chronic Restrictive lung disease causes:

idiopathic pulmonary fibrosis,
drugs: including chronic O2 therapy
occupation: coal mining, asbestos, silicosis
hypersensitivity pneumonitis
autoimmune disorder, RA

what are major signs and symptoms of intrinsic RLD?

insidious onset, frequent dry nonproductive cough. honeycombing of lung on imaging

what is idiopathic pulmonary fibrosis?

restrictive lung disease with no identifiable cause where progressive scar tissue forms reducing compliance

what is the most common type of intrinsic RLD?

sarcodosis

What is hypersensitivity pneumonitis?

hypersensitivity to allergens affecting the alveolar septa. has a very aggressive progression

what causes extrinsic restrictive lung disorders

Spinal cord injury (c345)
Burns
neuromuscular complications (brainstem and others)
obesity

what are paradoxical chest wall movements?

when the chest doesn't move as expected to breath in air. could be result of brainstem, spinal cord injury or polio
ex. post polio, the upper thorax rises and the abdomen sinks in

what are some respiratory complications with obesity

increased work of breathing due to reduced chest compliance and weak respiratory muscles
imbalance between respiratory muscle demand and capacity. shunting of blood away from other structures to respiratory muscles

do obese individuals have a higher or lower FRC

lower, however expiratory flow limitation leading to dynamic hyperinflation can seemingly normalize this

What is obesity hypoventilation syndrome?

increased demand on diaphragm leads to chronically elevated PaCO2 \>45 and can lead to HTN, headache, fatigue and R heart failure

how does obesity lead to sleep apnea?

increasd abdominal and chest wall fat, increased lung volume, as well as upper airway fat leads to collapsibility
this leads to sleep apnea, hypoxemia and cardio abnormalities

how is pulmonary hypertension diagnosed? what pressure is it diagnosed at?

right heart catherterization.
\>25 mm at rest, 30 during exercise

what are signs and symptoms of pulmonary hypertension?

progressive dyspnea, exertional syncope, normal spriotomy with reduced DLCO

Is small cell or non-small cell lung cancer more common?

non-small cell
most common in smokers are squamous cell and adenocarcinma

how can you prevent atelectasis from developing into pneumonia?

take at least 10 full breaths an hour, change position, early mobilization, encourage coughing

what are the 3 types of acquired pneumonia?

community acquired
health care associated
ventilator associated

which type of pneumonia has lobar consolidations?

bacterial

what are the 4 stages of bacterial pneumonia?

Congestion - fluid consolidates into lung tissue
Red hepatization - 2-3 days post exudate with fibrin and RBCs fill alveolar space. has the consistency of the liver
Grey hepatization - no new RBCs in consolidation gives it a grey color
Resolution - debris from inflammatory response has been cleared, little exudate remaining

what is Bronchiolitis obliterans?

characterized by diffuse destruction of small bronchioles caused by underlying disease like infection or lung transplant

what is cryptogenic organizing pneumonia?

acute lung disease affecting alveolar walls and distal bronchioles
accompanied by unproductive cough and dyspnea

what is pleural effusion?

fluid in the pleural space
causes decreased chest sounds, pleural rub, meniscus sign on CXR

what is the difference between transudative and exudative pleural effusion?

Transudative: caused my mechanical factors, lack of drainage and increased pulmonary capillary pressure
exudative: caused by an infection

what is likely the cause of rib fractures in children?

abuse

what is a flail chest?

fractures on two or more locations in the same rib of 3 or more adjacent ribs
results in opposite chest movemts during breathing and can be life threatening

What is a pneumothorax?

air in the plural space causing lack of pressure gradient and lung collapse
can cause tracheal shift or JVD

what are the causes of pneumothroax?

primary
secondary: COPD related
Iatrogenic: due to diagnostic procedure
traumatic: either puncturing or non puncturing

What is a tension pneumothorax?

pneumothorax with a one way valve causing airflow in but not out. results in mediastinal shift

what are the levels of wells score for PE

\>6 high
2-6 moderate

what is pulmonary Edema?

Abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs. Caused by plasma moving from blood into alveoli
produces pink frothy sputum

What is ARDS

acute onset of noncardiac pulmonary edema and hypoxia requiring ventilation
involves a series of cellular events leading to protein rich edema, stiffness and decreased compliance of the lungs

what is the difference between type 1 and type 2 respiratory failure?

Type 1: hypoxia wi/o hypercapnia. Low SpO2

how do you treat respiratory failure?

through non invasive airway ventilation CPAP or BiPAP, or mechanical ventilation

what is respiratory failure a balance of?

increased load on the lungs, decreased respiratory strength

how long does it take for ventilator induced diaphragmatic dystrophy to set in?

12-18 hours for fast and slow twitch fibers to decrease in count

what are components of examining someone's respiratory function?

respiratory muscle performance
chest wall mobility
respiration
ventilation
lung segment exam
visual exam
cough exam
QoL report
exercise test
balance
mobility
strength

what should you look for in a visual chest inspection?

disposition
skin
body position/posuture
breathing pattern (paradoxical wall mvmt)

what are flared nostrils, pursed lips, hunched over posture a sign of during a visual exam?

COPD emphysema

what is an appropriate respiratory rate?

12-20 breaths a min

what does SpO2 and SaO2 measure?

SpO2 measures the amount of O2 saturation in hemoglobin in the blood indirectly usually 95-100
SaO2 is a direct arterial measurement of O2 using ABG

what is hemoptysis a sign of?

pulmonary embolism

What is frothy pink sputum indicative of?

pulmonary edema

what is stringy mucoid sputum a sign of?

increased mucus production, possibly during asthma

What is the mMRC dyspnea scale?

grades dyspnea on a 0-4 point scale with 0 being no trouble breathing except strenuous exercise
4 being breathless when dressing or undressing
possibly better than GOLD classification for COPD QoL changes

what is SGRQ (st georges respiratory questionare)

50 question specific disease respiratory test graded on a scale 0-100 with 100 being more limitation

how do you want the pt do breath during ausculation?

deep breaths thru the mouth

in vesicular sounds, do you hear more inspiration or expiration?

inspiration

what are absent breath sounds a sign of?

air or fluid in lungs
overinflation
reduced airflow to lung
thick chest wall

what are increased breath sounds a sign of?

consolidaiton of compression of that segment

what are crackles, wheezes, stridor and a pleural rub a sign of?

crackles: compressed alveoli from fluid. atelectasis if in one field on one side. cardiogenic (pulmonary edema) if BIL and doesn't resolve with couging
wheezes: asthma, mucus, inflammation, obstructing bodies
Stridor: foreign body in upper airway
pleural rub: inflamation of pleural linings

what are abnormal voice sounds a sign of?

atelectasis or consolidation
clearer wispers or voice sounds, ayy sound with egophany

what is a cause of increased tactile fremitus

consolidation of the lung
pleural effusion deminishes fremitus

what are different percussive sounds a sign of?

dull sounds: atelectassis, consolidation
hyperesonant sounds: emphysema

what is the lowest rib you can palpate by the sternum?

7th rib

what does a compression test of the ribs test for?

fracture of the rib

what are asymetrical chest wall mvmts a sign of?

lesion of the lagging side chest wall, pleura, upper lobe

what is normal chest wall excursion

from full expiration to inspiration, 2-3 inches

how does pursed lip breathing help people with COPD breath out?

prevents premature airway collapse in COPD by increasing the back pressure on the airways

what is deep slow breathing used for?

can help relieve pain by taking deep breaths for 6-8 minutes to reduce anxiety and take mind off of pain

what is paced breathing?

expire during exertion to prevent dyspnea during activity

what is segmental breathing? who is it used for?

puting hands on the thoracic wall as a proprioceptive cue to get those lobes of the lung to expand more
used for patients with limited chest wall expansion

what positions help relieve dyspnea

supporting the arms, spine or accessory muscles

what is postural drainage?

changing the position of the patient to allow those segments to drain. often used with manual percussion

how long do you do manual percussion for?

3-5 each segment
30-45 total