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Diagnostic Unit 1-2


Direct spirometry measures the exact volumes that a patient can breathe in and out of lungs
Indirect spirometry determines volumes that cannot be measured directly, RV, FRC, TLC.. These volumes cannot be exhaled by the patient.
A lung volume is a single? volume
A lung capacity is a? combination of one or more volumes
Primary lung volumes? VT, IRV, ERV, RV
Lung capacities? IC, VC, TLC, FRC
Volume of air that can be inhaled and then exhaled with each normal breath? VT
Amount of air that can be forcibly inhaled past a normal VT breath? IRV
Amount of air that can be forcibly exhaled past a normal VT breath? ERV
Amount of air that remains in lungs after a forced exhalation? RV
Maximum amount of air that can be inhaled after a normal expiration, VT+IRV= IC
Amount of air that can be exhaled after a maximal inspiration, VT+ERV+IRV= VC
Amount of air in the lungs after a maximum inspiration, RV+VT+IRV+ERV= TLC
Amount of air in the lungs after a normal expiration, ERV+RV= FRC
Dont do spirometry when? acute situations
SVC > FVC? obstructive disease, emphysema
Indirect spirometry methods? gas dilution(open or closed), body plethysmography
SVC and FVC accuracy is? effort dependent
Indirect spirometry accuracy is? not effort dependent
Gas dilution uses what principle? boyles law
By having a known gas concentration at the start and end of a gas dilution test, we can calculate? the unknown volume
If air is trapped in the lungs(emphysema) gas dilution techniques will? not work, can only measure volumes in communication with the conduction airways
Any accuracy differences between the open or closed circuit gas dilution methods? no difference, nitrogen is more common due to helium requiring a correction factor for tissue helium
Open circuit? nitrogen washout, measures the percentage on nitrogen in the alveolar gas after a patient breathes 100% O2 for 7 mins
What is the clinical significance of a patient who takes a long time to wash out? air trapping disease, such as emphysema
The test continues until nitrogen concentration falls to 1%, in a healthy patient this should take? 3-4 minutes
Closed circuit? Pt breathes in He mixed w/ air = 10-15%He concentration, use an absorber to remove exhaled CO2 so pt doesn't rebreathe it, small amount of O2 used so pt doesn't become hypoxic. Measures amount of He going in & out to determine volume
Helium dilution method sources of error? long procedure, leaks, slow lung units, non communicating lung units cause an underestimation of FRC
Some patients may take longer to reach equilibration with the HE mixture, this may indicate? emphysema or another obstructive disease
Body plethysmography? measures FRC, most accurate because it can measure trapped air.
The body box measures all the gas in the patients chest, so if higher FRC measured than with a gas dilution technique this indicates? the patient has some degree of airway obstruction
What is PVM? Primary volume measuring spirometers: measure the volume of air moving out of the pt's lungs then / it by the time requ to move this volume to determine flow
What is PFM? Primary flow measuring spirometers: measure the amount of flow moving out of the pt's lungs then x it by the amount of time to move this flow to determine volume
Your pt's FEF 25% 75% is below predicted, what does this indicate? early stages of obstructive or restrictive disease
FEF 25%-75%? medium to small airways, later in expiratory maneuver, normal is 4-5 l/sec,<80% pt on way to developing airway disease
FEF 200-1200? larger airways, earlier in expiratory maneuver, norma is 6-8 /sec. decreased with obstruction
Your pt's FEF 200-1200 is below predicted, what does this indicate? larger airways may be obstructed
What is the most negative pressure generated with inspiratory effort called? MIP/NIF
MIP/NIF is used for? strength test of the diaphragm, intercostals, and inspiratory accessory muscles.
What is a normal MIP? <-60 (-61,-62,-63, etc...)
If pt has an abnormal MIP what does this indicate? weakened inspiratory muscles, neuromuscular disease, chest/spine abnormalities
What is the greatest positive pressure that can be generated with expiration called? MEP, done after TLC when pt has taken their largest breathe in
MEP is used for? strength test for abdominal muscles and accessory expiratory muscles. if decreased pt may not be able to cough
Normal MEP? 80-100
A pre and post bronchodilator study is used to asses? if an obstructive airway disease is reversible, with an increase in FEV1 of >12% it is considered a positive result
Pre and post studies are indicated when? there is evidence of reactive airways, unexplained cough, to see if pt will benefit from bronchodilater therapy
Normal % predicted TLC 80-120, < restricted, > obstructed
Normal % predicted FRC 35-135, < restricted, > obstructed
FEV1/FVC < 80% = obstructed
FVC < 80% predicted = restricted
Your subject's spirometry results shows a VC, FRC, RV, and TLC less than predicted. This indicates... restrictive
An RV/TLC percentage of 55% indicates ? air trapping
American Thoracic Society (ATS) standards require all lung volumes be reported at? BTPS
A patient has an increased TLC, RV, and has a reduced peak flow. What does this suggest? obstruction
Reduced peak flow= obstruction
Reduced volume= restriction
Spirometer calibration? A 3 liter super syringe is normally used, Different flow rates are used, a rotary pump or rotometer may be used, is required by ATS guidelines, done daily
What study is indicated for subjects who have normal spirometry but periodic wheezing or SOB? bronchoprovocation
Bronchoprovocation? causes an acute temporary obstruction via inhalation or methacholine or histamine, determines if pt has hyper reactive airways, decrease in FEV1 of >20%= positive result
What type of study is indicated when the patient has a history of wheezing, is a known asthmatic, has a cough of unknown etiology, or to see if bronchodilater therapy will benefit pt? pre and post bronchodilater study, an increase in FEV1 > 12% indicates positive response, used to determine if obstructive disease is reversibe
Peak flow monitoring is used too? assess asthma severity and determine response to bronchodiltor
All PFM's use? a pneumotach to measure flow
Severe obesity will? seem restricted, reduce VC
Short & Fat Loops indicate obstruction
Tall & skinny loops indicate restriction
Scoop in the loop of expiratory side? obstruction, early is larger airways, later in smaller airways
Range for an acceptable FVC? 3 attempts within 5% or 200ml, do not exceed 8 attempts
Back extrapolation? done by the computer, used to correct for a pt's late start, cannot exceed 5% or 150ml
Where can spirometry be performed? Pt room, bedside, physician's office, PFT lab, outpatient clinic, hospital
Created by: juialynn92