Pulmonary Evaluation

Question 1

FEV/FVC scoring

Answer 1

normal: .75-.8
> 0.8 restrictive lung disease
< 0.7 obstructive lung disease

measures max amount of air inhaled and exhaled in determined time

Question 2

Forced midexpiratory Flow (FEF 25-75)

Answer 2

volume of air exhaled over middle half of FVC

Question 3

Max voluntary ventilation (MVV)

Answer 3

“Breathe as deeply and as rapidly as possible for 10, 12, 15 sec”

Measures max amount of air inhaled and exhaled in determined time

Question 4

Tests of diffusion

Answer 4

DL

or

DLco

Question 5

DLco

Answer 5

• in presence of O2, CO will bind to RBCs, give a tiny dose of CO, and breathe out
• Take difference of what was inhaled/exhale
• difference is the gas that has gone from the body

Measures the ability of blood to diffuse gas from the lungs

Question 6

Why is the supine position difficult for pulmonary patients?

Answer 6

• organs pushing on diaphragm
  
  • mucous moves back into lungs

Question 7

T/F: patients often notice that their clubbing is abnormal and painful

Answer 7

False

Question 8

Supplemental O2 considerations

Answer 8

• being used properly
• flow rate
  
  • breathe to make use of the supplemental O2

Question 9

pulmonary:
evaluation of the neck

Answer 9

• hypertrophy of SCM
• chronic forward bent posture (shortened SCM)
• JVD
  
  • position of clavicle

Question 10

resting chest evaluated for

Answer 10

• symmetry
• rib angles
  
  • musculature

Question 11

chest eval: rib angles

Answer 11

• normally rib angles < 90 deg and attach to vertebrae approx 45 deg angles
• abnormal angles > 90 deg
  • abnormal vertebral angle > 45 deg

Question 12

chest eval:

muscle

Answer 12

hypertrophy and/or adaptive shortening of SCM = chronic condition

Question 13

Normal RR (bpm)

Answer 13

• infants: 30-60
• 3-6 y.o. : 22-34
• 6-12 y.o. : 18-30
  
  • 12-18 y.o. : 12-20

Question 14

Eupnea

Answer 14

normal rate, depth, and rhythm

Question 15

bradypnea

Answer 15

• slow rate
• shallow or normal depth
  
  • regular rhythm

Question 16

tachypnea

Answer 16

• fast rate
  
  • shallow depth

Question 17

hyperpnea

Answer 17

• normal rate
• increased depth
  
  • normal rhythm

Question 18

hyperventilation

Answer 18

• fast rate
• increased depth
  
  • regular rhythm

results in decreased arterial CO2

Question 19

Evaluation:
Patient Speech

Answer 19

• dysnpnea on phonation
  
  • how many words before next breath

Question 20

wheezes

Answer 20

continuous high pitched sound

Question 21

rhonchi

Answer 21

• subtype of wheeze
• low pitched like a snore
  
  • obstruction of larger airway

Question 22

crackles

Answer 22

• discontinuous adventitious sounds
  
  • sounds like brief bursts of popping bubbles

Question 23

pleural rub

Answer 23

sounds like two pieces of leather/sandpaper

Question 24

pleural rub

Answer 24

sounds like two pieces of leather/sandpaper

Question 25

cough assessment

Answer 25

* strength * duration * effectiveness * quality

Question 26

color of mucous indicating bacterial infection

Answer 26

yellow, orange, green

Question 27

Paradoxical breathing

Answer 27

chest moves inward instead of outward during inhalation

Question 28

paradoxical breathing causes

Answer 28

* airway obstruction * mechanical disruption of chest wall * phrenic nerve injury * diaphragmatic dysfunction

Question 29

cause of flail chest

Answer 29

broken ribs

Question 30

atelectasis

Answer 30

complete or partial collapse of a lung or lobe. Trachea moves toward **collapsed** side

Question 31

pneumothorax

Answer 31

* abnormal collection of air or gas in pleural space causing uncoupling of lung from chest wall * air leaks into space and restricts lungs * Trachea deviates **AWAY**

Question 32

Pneumothorax: signs

Answer 32

* tachypnea * assymetric lung expansion * distant/absent breath sounds * decreased tactile fremitus * adventitious lung sounds

Question 33

tumor: deviation of trachea

Answer 33

pushed AWAY

Question 34

chest expansion measurements

Answer 34

* children: 2 cm * “fit young man”: \>5cm * severe emphysema: may expand \<1cm

Question 35

crepitus:

Answer 35

* increasing edema in chest \> scapula \> neck to face * crispy feeling and crackling when skin palpated

Question 36

cause of crepitus

Answer 36

* air in subcutaneous tissue * air leaks out of lungs follows fascial planes and enter subcutaneous later of the skin * “ subcutaneous emphysema”

Question 37

egophony

Answer 37

* say “EEEEE” * healthy = eeeee * unhealthy= nasal A or goal call

Question 38

bronchophony

Answer 38

* say 99 repeatedly * healthy = not understandable * unhealthy = 99 understood. indicates consolidation

Question 39

whispered pectoriloquy

Answer 39

* whispe 1-2-3 * healthy = not understood * unhealthy = understood