1
Q
has a large amount of functional reserve.
A
pulmonary system
2
Q
can result in a significant degree of pulmonary dysfunction
A
injury or illness
3
Q
can severely limit the length or quality of an individual’s life
A
pulmonary dysfunction
4
Q
in these forms, pulmonary disorders can cause death within minutes
A
acute
5
Q
can take years before resulting in an individual’s death, but many of those years may be spent with serious disability and a poor quality of life.
A
chronic disorders
6
Q
pulmonary disorders must be ___?
A
detected and treated at the earliest possible time.
7
Q
plays a significant role in modern health care
A
pulmonary function testing
8
Q
used to assess the integrated function of the structures that comprise the thoracic/pulmonary system.
A
pulmonary function testing
9
Q
structures of the thoracic/pulmonary system
A
- lungs
- air passages serving the lungs
- thoracic abdominal structures that surround the lungs
10
Q
lungs are composed of:
A
- parenchyma
- vasculature
11
Q
entire lobe of the lungs
A
parenchyma
12
Q
area of the lungs capable of gas exchange
A
parenchyma
13
Q
composed of blood vessels, blood
A
vasculature
14
Q
air passages serving the lungs are composed of:
A
- upper respiratory tract
- lower respiratory tract
15
Q
upper respiratory tract includes:
A
- mouth
- nose
- larynx
16
Q
lower respiratory tract includes:
A
- trachea
- mainstem bronchi
- all intrapulmonary airways
17
Q
thoracic/abdominal structures that surround the lungs include:
A
- pleura
- support structures of the thoracic wall
- muscles of ventilation and controlling nerves
- abdominal contents
18
Q
lung, cavity, and space between chest
A
pleura
19
Q
covers the outer surface of the lungs
A
visceral pleura
20
Q
forms the lining of the thoracic cavity
A
parietal pleura
21
Q
support structures of the thoracic wall include:
A
- ribs
- sternum
- costal cartilages
- thoracic vertebrae
22
Q
how many pairs of ribs?
A
12
23
Q
muscles for normal inspiration
A
- inner intercostal muscle
- diaphragm
24
Q
muscles for normal expiration
A
no muscles, lungs recoil naturally
25
muscles for forceful inspiration
```
SUPAS
Sternocleidomastoid
Upper Trapezius
Pectoralis Major
Anterior, Middle Posterior Scalene
Serratus APS
```
26
muscles for Forceful expiration
ASI
Abdominal muscle
Serratus API
Internal Intercostal muscle
27
controlling nerves that keep the diaphragm alive
c3, c4, c5
28
the additional volume of air that the lungs can inhale and exhale when breathing to the limit of capacity in times of stress
pulmonary reserve
29
can cause measurable abnormalities in pulmonary function.
dysfunction of one or more of the thoracic/abdominal structural components
30
a reduced ability to move air into and out of the lungs because of?
airway resistance problems
31
key method used for evaluating and managing pulmonary disorders.
pulmonary function testing
32
three basic factors that can, either individually or in some combination, contribute to a person having a limited tolerance for physical activities:
Poor conditioning.
The presence of a pulmonary dysfunction.
The presence of a cardiovascular dysfunction.
33
Limitations caused by pulmonary or cardiovascular dysfunction may be improved, at least to some degree, through the use of
therapeutic measures.
34
can be used both to detect the presence of dysfunction and to monitor
a subject's progress in either improving conditioning or benefiting from treatment.
cardiopulmonary stress testing
35
indications include:
medical diagnosis
surgery-related evaluation
disability evaluation
public health/research
36
medical diagnosis includes:
- determination of the presence of a disorder.
- Assessment of thane degree to which pulmonary function or exercise tolerance is affected by injury or disease.
- determination of the pathologic nature of a disorder.
- planning of therapy required for treating and managing a disorder
- evaluation of the therapeutic effectiveness of medical intervention for a disorder (bronchdilator therapy)
- monitoring the progression of a disorder (primary pulmonary disorders, neuromuscular disorders).
37
surgery-related evaluation include:
- Preoperative risk assessment (anesthesia /surgical procedure).
- postoperative assessment of the effects of thoracic surgery.
38
disability evaluation include:
-rehabilitation (to monitor the effects of a rehabilitation program on the progress
of a disorder).
-Insurance (documentation of baseline function or changes in function).
-Legal (doocumentation for Social Security, personal injury lawsuits, etc.)
39
public health/research includes:
- epidemiologic survey
| - general or specific data accumulation
40
The most extensive studies of functio and exercise tolerance are performed in
hospitals in a laboratory setting
41
other settings where pft can be performed
- The bedside, either in a general patient-care setting or in an critical-care area.
- a physician's clinic
- The workplace or other non-health care setting such as a shopping mall, school, etc.
42
often provide the first indication that an individual is experiencing some degree of dysfunction
Tests performed in non-health care settings
43
plays a significant role in the activities of a pulmonary function
laboratory.
specialized equipment
44
are instruments used to measure the volumes of air that are inhaled and exhaled during breathing
spirometers
45
published a paper on the use of water-sealed spirometer to measure vital capacities in 1846
john hutchinson
46
his work formed a basis for identifying pulmonary tuberculosis before it was clinically symptomatic
john hutchinson
47
spirometers can be classified as functioning by one of two possible operating principles:
primary volume measuring (PVM) spirometers
| primary flow measuring (PFM) spirometers
48
the volume of air moving into and/or out of the subject’s lungs is measured directly
primary volume measuring spirometers
49
Air flow rates must be determined indirectly.
PVM spirometers
50
air flow rates may be determined by measurements on a graphic tracing of the spirometer’s movement during the breathing maneuver.
some PVM spirometers
51
Air flow rates can also be determined by electronic systems linked to the spirometer.
PVM spirometers
52
Air flow rates can also be determined by ??? linked to the spirometer
electronic systems
53
directly measure the flow rate of the inhaled and/or exhaled air.
PFM spirometers
54
Volume must be determined indirectly
PFM spirometers
55
Electronic systems are generally used to calculate volumes because?
air flow rates can change significantly during a single breathing maneuver.
56
cannot easily be performed manually
volume determinations
57
fv loop sign of obstructive?
scooping
58
fv loop sign of restrictive?
small loop
59
3 components
Lung volumes and Capacities
Airway Mechanics
DLCO
60
are measured independently
lung volumes
61
derived from two or more lung volumes
lung capacities
62
It is the amount of air that can be forcibly inhaled after a normal tidal volume
inspiratory reserve volume (irv)
63
irv amount
3100 mL
64
It is the volume of air that can be exhaled forcibly after exhalation of normal tidal volume.
Expiratory Reserve Volume(ERV)
65
erv amount
1200 mL
66
It is the volume of air remaining in the lungs after maximal exhalation.
Residual Volume(RV)
67
lung volume that can't be measured normally
residual volume
68
can measure residual volume
nitrogen washout
helium dilution
body plethysmography
69
RV amount
1200 ml
70
It is the amount of air that can be inhaled or exhaled during one respiratory cycle
Tidal Volume(TV)
71
tv amount
500 ml
72
It is the maximum volume of air that can be inhaled following a resting state.
Inspiratory capacity(IC)
73
irv + tv
Inspiratory capacity(IC)
74
Inspiratory capacity(IC) amount
3600 ml
75
It is the amount of air remaining in the lungs at the end of a normal exhalation.
Function Residual Capacity(FRC)
76
erv + rv
Function Residual Capacity(FRC)
77
frc amount
2400 ml
78
It is the total amount of air exhaled after maximal inhalation.
Vital Capacity(VC)
79
TV+IRV+ERV
vital capacity
80
It is the maximum volume of air the lungs can accommodate
Total Lung Capacity(TLC)
81
vc amount
4800
82
tlc amount
6000 ml
83
lung capacities that cannot be measured by simple spirometry
FRC
| TLC
84
ability to perform inhalation and exhalation
airway mechanics
85
normal action of the diaphragm
piston motion
86
movement of diaphragm during inspiration
downward, outward
87
movement of diaphragm during exhalation
upward, inward
88
dlco meaning
diffusing capacity of the lungs for carbon monoxide
89
ability of the lungs to perform gas exchange
DLCO
90
PVN spirometers are of two categories
- volume-collectinglvolume-dispiacement spiromeeters
| - flow-through spirometers.
91
PVM spiroineters used iri the laboratory are generally
volume-collecting or volume-displacement devices.
92
the subject’s expiratory air moves into the spirometer, and his or her inspiratory air moves back out from it.
volume-collectinglvolume-dispiacement spirometers
93
Volume collecting or volume-displacement spirometers may be of
water-sealed
dry-sealed
beflows type
94
measures air as it passes completely through.
flow-through PVM spirometer
95
Volumes are not collected within the device.
flow-though
96
The only spirometer of this category is the rotor/turbine spirometer.
flow-through
97
The only spirometer of this flow-through is the
rotor/turbine spirometer.
98
consist of a double-walled, stationary cylinder that has water between the double walls
Water-sealed spirometers
99
is suspended above and inside the stationary cylinder of ws spirometer
freely moving cylindrical bell
100
serves as an airtight, low-friction seal for the bell.
water
101
It ensures that spirometer movement is in exact proportion to subject breathing volumes.
water
102
The spirometer bell moves downward as the subject ??? and upward as the subject ???.
inhales, exhales
103
can be simple or very complex systems
water-sealed spirometers
104
may have only a single breathing tube connected to the spirometer
simple system
105
Their use is limited to single-breath volume/flow studies
simple systems
106
with a double tube, one-way breathing arrangement
complex systems
107
can be used for studies that involve prolonged breathing on the spirometer.
complex systems
108
Spirorneter bells are available in different sizes, ranging from ??? of volume.
7 to 14 liters
109
determines the distance that the bell will need to move in response to a given breathing volume
bell diameter
110
small-diameter bells travel a ??? distance than do larger bells
greater
111
When volume determinations are made from a direct spirometer tracing, this ??? must be included in the calculations.
bell factor
112
there have been two configmations for watersealed spirometers
chain-compensated spirometer
| Stead-Wells spirometer
113
was the first spirometer to be used
chain-compensated spirometer
114
It was originally designed with a light-weight metal bell, although today it is available with a plastic bell.
chain-compensated spirometer
115
is suspended from a chain that is looped over a pulley
counterweight
116
In simple models, a pen attached to the counterweight may be used
to make ??
spirograms
117
used to make spirograms
kymograph
118
may experience dizziness because carbon dioxide may be rebreathed
simple systems
119
no separate instrument for exhalation
simple systems
120
is very accurate for simple volume measurement.
chain-compensated
121
with breathing maneuvers that include rapid respiratory rates or rapid changes in air flow rates, some accuracy is lost
chain-compensated
122
lost accuracy in chain-compensated due to the mass of the bell and counterweight and their resulting ??
inertia
123
may not change in immediate response to changes in the subject's breathing.
Spirometer movement
124
The use of ?? on more modern units somewhat reduces this inertia.
plastic bells
125
was developed in response to the inertia problems exhibited by the chain-compensated configuration
stead-wells spirometer
126
a system with better frequency response and better response to rapid flow rate changes
stead-wells
127
spirograms can be made with a pen attached directly to the spirometer bell.
stead-wells
128
very rugged and dependable
water-sealed spirometers
129
because of their size must be used primarily as stationary laboratory systems
water-sealed
130
Either??? or ??? may be used to make spirograms
mechanical recording systems
| electronic recording system
131
some volume measurement error can occur if there are ?? in the system.
Leaks
132
what produces system leaks in water-sealed
Damage to the tubing system or bell or inadequate water levels in the spirometer
133
With the chain-cmpensated type of spirometer, volume measurement
error can also result when mechanical problems cause
resistance to the movement of chain
134
They consist of a rod-mounted piston within a cylinder
dry-sealed
135
ds spirometer ?? is made of plastic or a lightweight metal.
piston
136
Because it is designed to move ???, the piston does not
| require a counterweight mechanism
horizontally
137
chain compensated spirometer inspiration, bell ??, pen ??
down, up
138
stead-well, bell up, pen ??
up
139
A pen for spirogram tracings can be attached to the
piston rod
140
is used to make the system airtight.
silicone plastic (silastic) rolling seal
141
consists of a tube that is approximately the same diameter as the piston/cylinder.
silicone plastic (silastic) rolling seal
142
The ?? is fastened to the inner wall of
| the cylinder.
”outside” free end of the seal
143
The ?? is attached to the edge of the piston.
”inside” free end
144
Maintenance of ?? is less of a problem than it is for water-sealed spirometers.
dry-sealed spirometers
145
may cause resistance to piston movement.
mechanical malfunctions
146
are constructed of a flexible plastic material that is designed to collapse in folds.
bellows spirometers
147
unfolds and expands with the subject’s expiration and collapses with his or her inspiration.
bellows
148
There are two possible bellows designs
fully expanding bellows
| wedge-shaped bellows
149
opens and closes like an accordion
fully expanding bellows
150
fully expands only along one edge, similar to the opening and closing of a book
wedge-shaped bellows
151
Smaller, more portable units generally make use of a bellows that expands
up and down vertically
152
Larger, primarily laboratory-based systems use bellows that expand
back and forth horizontally.
153
can offer the same accuracy as other PVM spirometers.
Large, horizonta1Iy expanding bellows systems
154
Little routine maintenance is required.
bellows spirometers
155
can cause the bellows folds to be more resistant to expanding
Collection of dirt and moisture within the bellows or aging of the bellows material
156
can occur in the bellows over time
cracks and tears
157
provide an excellent measure of breathing volumes.
Volume-collecting/volume-displacement devices
158
may be a source of error with rapid changes in air flow rates or subject respiratory rates.
inertia of their moving physical components
159
Laboratory-based systems of this type are used to perform complex tests that
involve prolonged subject breathing on the spirometer.
Volume-collecting/volume-displacement spirometers
160
Recording systems for PVM spirometers can be either
mechanical or electronic.
161
involve the movement pen along one axis and paper movement
| along the perpendicular axis
mechanical systems
162
can be fastened to a rotating drum or may be moved linearly.
paper
163
is attached to the bell/piston/bellows
pen
164
electronic systems use a
potentiometer
165
positioned to rotate in response to movement of the bell/piston/bellows
potentiometer
166
the resulting electrical signal can be used to produce tracings by
the means of
electronic recorder
167
The air that leaves the subject is at
btps, body temperature and pressure
168
the only type of PVM spirometer that allow the measured air to pass completely through the device as the volume is measured.
rotor spirometers
169
The most frequently used rotor spirometer configuration is
wright-type spirometer
170
Measurement is based on the rotation of a rectangular, vanelike rotor
rotor spireometers
171
rotor spirometer Measurement is based on the
rotation of a rectangular, vanelike rotor
172
The rotor consists of a very thin, lighteight metal blade.
rotor
173
Measurement through the device is ?? because of how the slots and rotor blades are arranged.
unidirectional
174
Volume measurement by rotor spirometers is similar to the operation of a
turnstile
175
The instruction manual of one spirometer states that the rotor makes ?? for each liter of air passing through the chamber.
150 revolutions
176
Measurement error can result from ?? in rotor spirometers.
inertia of the mechanical components
177
Damage to the rotor can occur when flow rates exceed
300 l/min.
178
are limited primarly to handheld use at the bedside for measurement of unforced breathing maneuvers
rotor spirometers
179
Measurement of a ?? with a rotor spirometer can result in damage to the rotor
forced expiratory maneuver
180
provide a direct measurement of air flow rates.
PFM (primary flow measuring) spirometers
181
The flow-rate measurement can then be integrated electronically, on the basis of ???, into a volume measurement.
time
182
The different types of PFM spirometers
differential-pressure pneumotachometers
thermal anemometers
ultrasonic sensor spirometers.
183
have a flow-resistive structure (element) in the path of the gas stream
Differential-pressure pneumnotachometers
184
They function on the basis of how changes in air flow rates through the element affect upstream/downstream pressure relationships within the device
Differential-pressure pneurmotachometers
185
in differential pneumotachometer, ?? is greater than ??
p1, p2
186
As air flow rates increase, the difference between PI and P2 ???
also increases.
187
is used to measure the pressure difference within the device.
differential-pressure strain gauge transducer
188
is produced by the pressure transducer
DC analog electrical signal
189
Changes in the electrical signal are ??? to changes in the air flow rate.
directly proportional
190
V = AP/R
poiseulle's law
191
This relationship is true only if air flow through the sensor is
laminar
192
This helps prevent condensation within the device from moisture in the subject’s exhaled air
spirometer sensor is heated to approximately body temperature
193
sensor makes use of a corrugated metal element.
fleisch-type/ fleisch style
194
2 types of differential pressure pneumotachometers
fleisch
| lilly
195
most widely used PFM
differential pressure pneumotachometer
196
air flow rate is measured on the basis of how it affects the temperature of a heated element
thermal anemometer
197
The element is general;y a platinum wire or small metal bead that produces no resistance to air flow
thermal anemometer
198
used to keep the element at a fixed temperatre in termal anemometer
electrical current
199
Increases in electrical current are ?? to increases in air flow
rates within the sensor
directly proportional
200
is seriously affected by the humidity and temperature of the gas.
flow measurement by anemometers
201
Accuracy may also be affected by physical characteristics of the gas,
such as density
202
generally limited to unidirectional air flow measurement with separate inspiratory and expiratory sensors
anemometers
203
use a beam of ultrasonic sound waves to measure air flow
ultrasonic sensor spirometers
204
The beam detects a special type of gas stream turbulence called a
vortex
205
s are produced by a baffle in the gas stream with the ultrasonic sensor located
downstream from it.
vortices
206
Flow measurement in uss is based on an electronic count of the
pulses from the gas stream.
207
PFM spirometer sensors must be ?? in order for flow measurement to be accurate
laminar
208
designed to only measure peak expiratory flow rate (pefr)
dedicated peak flow meters
209
The main component is generally a movable vane, disk, or sphere
dedicated peak flow meter
210
two types of plethysmography systems.
Body plethysmography
| Inductive plethysmography
211
requires that the subject’s entire body be enclosed within a boxlike cabinet during testing.
body plethysmography
212
involves the use of sensors strapped around the subject’s thorax and abdomen.
The equipment is smaller and less complicated
inductive plethysmography
213
used for making two kinds of pulmonary function measurements.
body pleth
214
. This can be used to determine total lung capacity
intrathoracic gas volume
215
body pleth 2 function measurements
intrathoracic gas volume
| airway resistance
216
three types of direct measurements made with a Body pleth
- Inspiratory and/or expiratory air flow rakes during the subject’s breathing cycle.
- Air volume changes inside the sealed cabinet that result from expansion and contraction of the subject’s thorax.
- Changes in air pressure at the subject’s mouth.
217
are used to reflect changes in lung volume.
Cabinet air volume changes
218
Mouth pressure changes, when the subject’s airway is mechanically obstructed, are interpreted as
changes in alveolar pressure
219
Readings of mouth (alveolar) pressure compared against
| changes in cabinet air volume are used to determine
lung volume.
220
cabinet air volume changes compared against subject ventilatory air flow rates are used to determine
airway resistance.
221
The cahinrt has a volume of approximately
600 liters
222
In newer, well-designed models, the cabinet is constructed
| largely of
plexiglass.
223
This allows for good visibility of the subject. It also reduces any
claustrophobia that may be experienced by the subject.
plexiglass
224
used for measuring ventilatory air flow rates that can vary with the brand of
plethysmograph used
pneumotachometer
225
when activated, occludes the mechanical airway of the pneumotachometer
shutter
226
it is used to measure pressure at the mouth
pressure transducer
227
There are two very different methods for measuring body
| pleth cabinet volume changes.
nonconstant-volume plethysmography cabinet
| constant-volume, variable-pressure plethysmography cabinet.
228
referred to as volume- or flow-type plethysrmographs.
nonconstant volume pleth
229
These systems directly measure quantities of air that are forced to enter and leave the cabinet.
nonconstant-volume pleth
230
have a pressure transducer connected to an opening in the cabinet wall.
constant-volume, variable-pressure plethysmograph
231
pressure-type pleth
constant-volume, variable-pressure plethysmograph
232
The transducer directly measures changes in cabinet pressure during subject breathing.
constant-volume, variable-pressure plethysmograph
233
Some systems have a small leak built into the cabinet to allow for temperature
equilibrium
234
recording system is an important BP component
biaxial (x-y) recorder with a very good frequency response.
235
used to make indirect measurement of ventilatory parameters
respiratory inductive plethysmographs (rips)
236
They allow the operator to determine breathing volumes without a
physical connection to the subject's airway
rips
237
This is done by evaluating the changes in thoracic and abdo~~al girth that the subject experiences during breathing
rips
238
rips are measured by a
rib-cage strap (RC) and an abdominal strap (AB)
239
The straps consist of ?? that are coiled like a te~ep~o~ie receiver cord.
teflon-insulated wires
240
produces a magnetic field around the wires
alternating current
241
resistance in the current flow through wires
inductance
242
The RC strap is placed around the subject's
chest with its upper border just below the axilla.
243
The AB strap is placed at the
umbilical level with its upper border just below the rib cage
244
may be easier to use than a standard spirometer with infants, subjects on mechanical ventilation, sleeping subjects, and small animals
RIPS
245
need frequent calibration to maintain accuracy
RIPS
246
are often used in spirometer systems to control the movement of gas flow through the system.
Directional breathing valves and directional control valves
247
T- or Y-shaped valves that are used at the subject connection of a spirometer breathing circuit
directional breathing valves
248
have three gas flow ports, and the subject’s mouthpiece is attached to one of them.
directional breathing valve
249
Well-designed directional breathing valves must
- Have a low resistance to inspiratory and expiratory air flow.
- Have a small deadspace volume to minimize rebreathing of previously exhaled air.
- Be relatively easy to clean after use
250
The purpose of the directional breathing valve is
to separate the direction of the subject’s inspiratory air flow from the direction of the expiratory air flow.
251
are similar in their purpose to traffic signals
Directional control valves
252
They permit control and changes in the direction of gas flow within the
breathing circuit.
Directional control valves
253
used to direct the flow at different times as needed during a test io different portions of the breathing circuit
Directional control valves
254
are often necdcd when more complex tests are performed with a spirometer system.
Directional control valves
255
simple dcv systems controlled
manually by technologist
256
complex systems dcv controlled
computer
PFT
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