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My Flash: Pulmonary
| Question | Answer |
|---|---|
| What are the four accessory muscles of inspiration? | Scalenes, SCM, Levator Costarum and Serratus |
| What are the four accessory muscles of expiration? | Abdominals, Quadratus lumborum, Triangularis Sterni and Internal Intercostals |
| What are the three muscles that become muscles of inspiration with the girdle fixed? | Trapezius, Pectorals and Serratus |
| The more upright the body position, the lower is the diaphragm therefore the lower is the | Inspiratory reserve |
| This can be helpful in providing support to abdominal viscera thereby assisting ventilation | Abdominal binder |
| This covers the inner surface of the thoracic cage, diaphragm and mediastinal border | Parietal pleura |
| It wraps the outer surface of the lung including the fissure lines | Visceral pleura |
| It is the point of equilibrium where forces are balanced and occurs at the end tidal expiration? | REEP (resting end expiratory pressure) |
| It is the volume of gas inhaled (or exhaled) during a normal resting breath | Tidal volume |
| It is the volume of gas that can be inhaled beyond a normal resting tidal inhalation | Inspiratory reserve volume |
| It is the volume of gas that can be exhaled beyond the normal resting tidal exhalation | Expiratory reserve volume |
| It is the volume of gas that remains in the lungs after ERV has been exhaled | Residual volume |
| It is the amount of air that can be inhaled from REEP | Inspiratory capacity (IRV + TV) |
| It is the amount of air that is under volitional control; conventionally measured as the forced expiratory tidal capacity (FVC) | Vital capacity (IRV + TV + ERV) |
| It is the amount of air that resides in the lungs after a normal resting tidal exhalation | Functional residual capacity (ERV + RV) |
| It is the total amount of air that contained within the thorax during a maximum inspiratory effort | Total lung capacity (IRV + TV + ERV + RV) |
| The ability of the arterial blood to carry oxygen | Arterial oxygenation |
| The ability to remove carbon dioxide from the pulmonary circulation and maintain pH | Alveolar ventilation |
| Normal range of partial pressure of oxygen (PaO2) | 80-100mmHg |
| Normal range of partial pressure of carbon dioxide (PaCO2) | 35-45mmHg |
| Normal range of bicarbonate ions (HCO3) | 22-28 mEq/mL |
| Relationship of pH and PaCO2 | Inverse |
| Relationship of pH and HCO3 | Direct |
| Anatomical or physiological space that is well ventilated but with no gas exchange | Dead space |
| In gravity dependent, there is more blood than air, therefore V/Q ratio is | Low |
| In gravity independent, there is more air than blood, therefore V/Q ratio is | High |
| Normal value (adult and infant): HR | A: 60-100bpm I: 120bpm |
| Normal value (adult and infant): RR | A: 12-20br/min I: 40br/min |
| Normal value (adult and infant):BP | A: <120/80mmHg I: 75/50mmHg |
| Normal value (adult and infant): PaO2 | A: 80-100mmHg I: 75-80mmHg |
| Normal value (adult and infant): Tidal Volume | A: 500ml I: 20ml |
| A sign of chronic hypoxemia | Digital clubbing |
| How many inches is the thoracic excursion of the normal individual | 2-3inches |
| Normal breath sound; soft rustling sound heard throughout inspiration and start of expiration | Vesicular sound |
| A more hollow echoing sound normally found over the right superior anterior thorax. Heard in all of inspiration and most of inspiration | Bronchial breath sound |
| A very distant sound not normally heard over a healthy thorax. Associated with obstructive lung disease | Decreased breath sound |
| Two adventitious sounds | Crackles and wheezes |
| Also termed as rales or crepitations | Crackles |
| A crackling sound heard usually during inspiration that indicates pathology (atelectasis, fibrosis, pulmonary edema) | Crackles |
| A musical pitched sound usually heard during expiration caused by airway obstruction | Wheezes |
| As with normal breath sounds, vocal transmission is loudest in what areas | Trachea and main bronchi |
| Normally, words should be intelligible though soft and clear at what area | At more distal areas of the lungs |
| Is a nasal or bleating sound heard during auscultation. E is heard as A. | Egophony |
| Intense, clear sound during auscultation, even at lung bases | Bronchophony |
| Occurs when whispered sounds are heard clearly during auscultation | Whispered pectoriloquy |
| A radiographic examination that identifies the presence of pulmonary emboli | Ventilation perfusion scan |
| Continuous xray beam that allows observation of diaphragmatic excursion | Flouroscopy |
| Causes and SSx: Respiratory alkalosis | Alveolar hyperventilation; Dizziness, syncope, tingling, numbness and early tetany |
| Causes and SSx: Respiratory acidosis | Alveolar hypoventilation; Early: anxiety, restlessness, dyspnea and headache Late: Confusion, somnolence, coma |
| Causes and SSx: Metabolic alkalosis | Bicarbonate ingestion, vomiting, diuretics, steroids and adrenal disease; Vague symptoms: weakness, mental confusion and possible tetany |
| Causes and SSx: Metabolic acidosis | Diabetic, lactic, uremic acidosis and prolonged diarrhea; Secondary hyperventilation (Kaussmall breathing), nausea, lethargy and coma |
| Normal WBC | 5000-10000 |
| Normal Hematocrit | 35-48% |
| Normal Hemoglobin | 12-16g/dL |
| 10 Criterion for Termination of ETT | Max SOB Fall in PaO2 of >20 or PaO2 of <55mmHg Rise in PaCO2 of >10 or PaCO2 of >65mmHG Cardiac ischemia/arrythmia Sx of fatigue 10mmHg inc DBP, SBP of 250, or dec'g BP c inc'g workload Leg pain Total fatigue Signs of insufficient CO Reach ventil |
| An intra-alveolar bacterial infection of the lungs | Bacterial pneumonia |
| Most common type of gram positive pneumonia | Pneumococcal pneumonia |
| WBC in TB shows | Increased lymphocytes |
| CBC count in Pneumocystis pneumonia shows | No evidence of infection |
| GOLD Stage 1 for COPD | Mild FeV1 >=80% With or without complications |
| GOLD Stage 2 for COPD | Moderate FeV1 <80% SOB with exertion |
| GOLD Stage 3 for COPD | Severe FeV1 <50% Greater SOB, decreased exercise capacity and exacerbation of disease |
| GOLD Stage 4 for COPD | Very Severe FeV1 <30% Impaired quality of life, exacerbation of the disease may be life threatening |
| PFTs in COPD shows | Decreased FeV1, decreased FVC, decreased FeV1/FVC ratio, increased FRC and RV |
| Increased reactivity of the trachea to various stimuli with narrowing of the airways due to inflammation | Asthma |
| Cystic Fibrosis: 4 | Genetic, there is thickening of secretions of the exocrine glands, may present as obstructive, restrictive or both, onset of symptoms usually in early childhood |
| 3 Clinical signs of CF | Meconeum ileus, frequent respiratory infections, inability to gain weight despite adequate caloric intake |
| Diagnosis of CF | (+) Trypsinogen, (+) Sweat electrolyte test |
| It is congenital or acquired, characterized by abnormal dilatation of the bronchi and excessive mucus production | Bronchiectasis |
| Characterized by alveolar collapse in a premature infant due to lung immaturity and inadequate level of pulmonary surfactant | Respiratory Distress Syndrome /Hyaline Membrane Disease |
| Air in the pleural space due to a lacerated visceral pleura from a rib fracture or ruptured bullae | Pneumothorax |
| Blood in the pleural space due to laceration of the pleural space | Hemothorax |
| Blood and edema within the alveoli and interstitial space | Lung contusion |
| Cough with pink frothy secretion | Pulmonary edema |
| CXR of Pulmonary edema | Shows typical butterfly pattern |
| A thrombus from the peripheral venous circulation becomes embolic and lodges in the pulmonary circulation | Pulmonary emboli |
| Excessive fluid between the visceral and parietal pleura due to increased pleural permeability to proteins from inflammatory disease | Pleural effusion |
| Collapsed or airless alveolar unit caused by hypoventilation secondary to pain during the ventilatory cycle | Atelectasis |
| CXR of Atelectasis shows | Platelet streaks |
| Indications of pulmonary drainage, percussion and shaking | Increased pulmonary secretions Aspiration Atelectasis |
| Duration of the pulmonary drainage | 20 minutes per postural drainage position |
| Postural drainage: Upper lobe apical segments | Bed flat Px leans backward at 30 deg angle against the patient PT percusses at area between the clavicle and scapula |
| Postural drainage: Upper lobe posterior segments | Bed flat Px leans forward at a pillow at 30 deg angle PT percusses at the upper back |
| Postural drainage: Upper lobe anterior segments | Bed flat Px lies flat with pillows under the knees PT percusses between the clavicle and nipples |
| Postural drainage: Right Middle lobe | Foot of bed elevated at 16 inches Pt lies on his left side, turns 1/4 backward. Shoulder and hip with pillows and knees flexed. PT percusses at the right nipple area. |
| Postural drainage: Left Lingular lobe | Foot of bed elevated at 16 inches Px lies on his right, turn 1/4 backward. Shoulder and hip with pillow, knees flexed. PT percusses at the left nipple area. |
| Postural drainage: Lower lobe anterior segments | Foot of bed elevated at 20 inches. Px lies on one side. PT percusses at the lower rib area. |
| Postural drainage: Lower lobe superior segments | Bed flat. Px lies on abdomen with 2 pillows under the hips. PT percusses the middle back at the tip of the scapula. |
| Postural drainage: Lower lobe posterior segments | Foot of bed elevated at 20 inches. Px lies on abdomen with a pillow under the hips. PT percusses at the lower ribs near the spine |
| Postural drainage: Lower lobe lateral segments | Foot of bed elevated at 20 inches. Px lies on abdomen, turns 1/4 upwards with pillows on flexed knee for support. PT percusses the uppermost portion of the lower ribs. PT |
| Bouncing maneuver applied after percussion | Shaking |
| Duration for shaking | 5-10 deep inhallations Less than 5 is ineffective More than 10 can cause hyperventilation |
| Effective in clearing secretions on major central airways | Cough |
| Used in COPD patients. Prevents high intrathoracic pressure which causes premature airway closing | Huff |
| Used for patients who cannot cough on command | Tracheal stimulation |
| Used when all other forms of airway clearance fails | Endotracheal suctioning |
| Endotracheal suctioning is set at | 120 mmHg of suction |
| Usual suctioning time | 10-15 seconds |
| Complications associated with suctioning (7) | Hypoxemia Bradycardia or tachycardia Hypotension or hypertension Increased intracranial pressure Atelectasis Tracheal damage Infections |
| Segmental breathing is inappropriate in intractable hypoventilation until medical situation is resolved | True |
| Pursed lip breathing is used to (6) | Reduce respiratory rate Increase tidal volume Reduce dyspnea Improve gas mixing at rest for COPD pxs Decrease the mechanical disadvantage of impaired ventilatory pump Facilitate relaxation |
| Patients with severe and very severe pulmonary disorders will likely reach a pulmonary endpoint before a cardiovascular endpoint | True |
| How and where is paced breathing or activity pacing used? | Used to spread out the metabolic demands of an activity, used with patients who become dyspneic during performance of an activity |
| Beta 2 agonists drugs | Are sympatomimetic drugs that causes bronchodilation, increase HR and BP |
| 3 examples of short acting beta 2 agonists | Ventolin (albuterol) Alupent (metaproterenol) Maxair (pirbuterol) |
| Example of long acting beta 2 agonists for maintenance | Serevent (salmeterol xinafoate) |
| Anticholinergics | inhibits PNS therefore causes bronchodilation, increase HR and BP |
| Side effects of anticholinergics | Lack of sweating, dry mouth and delusions |
| Example of anticholinergics | Atrovent (ipratropium) |
| Methylxantines | Produces smooth muscle relaxation |
| Examples of methylxantines | Aminophylline Theophylline |
| If tube of mechanical ventilator is moved, a nurse or respiratory therapist should check the placement of the tube | Correct |
| If tube of the mechanical ventilator is dislodged, a physician or anesthesiologist needs to replace the tube | Correct |
| Used to evacuate air or fluid trapped in the intrapleural space | Chest tubes |
| If the chest tube is dislodged during treatment, cover the defect and seek assistance | Correct |
| For IVs, the UE should not be raised above the level of the IV medication for any length of time or backflow of blood will occur | Correct |
| Artery usually used for arterial line | Radial artery |
| If arterial line is dislodged, immediate firm pressure needs to be applied to or above the arterial insertion site to stop bleeding | Correct |
| Supplemental oxygen is indicated for (SaO2 and PaO2) | SaO2 of <88% or PaO2 <55mmHg |
Created by:
dreamchaser
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