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The right middle lobe corresponds anatomically with what lobe?
L Lingula (which is part of the L Upper Lobe)
How many lobes does the L Lung have? Name them
2 lobes: Upper Apical and Lower-basal
The ______ is the roof of the liver and is the primary ventilatory pump.
What accessory muscles contribute to inspiration (there are 4, some are only useful in certain positions)?
- 1. external intercostals
- 2. scalenes
- 3. pectorals when humerus is fixed in tripod position
- 4. SCM at manubrium
What is responsible for expiration? when this isn't enough, what muscles help (there are two)?
- passive recoil of the chest wall
- 1. abdominals
- 2. internal intercostals
_ _ _: the patient starts by performing a maximal inspiration followed by a maximal expiratory effort.
_ _ _: forced expiratory volum in the 1st second of forced exhalation.
_ _ _/_ _ _: normal ratio is 0.8
Forced Vital Capacity
Forced Expiratory Volume1
(PFT's) Forced Vital Capacity and Forced Expiratory Volume are Decreased for patients with RLD and COPD. Each disease has a specific reason for why this occurs?
- RLD- decreased lung compliance
- COPD- air trapping
FEV/FVC is _____ or _____ in RLD. Why?
FEV/FVC is _____ in COPD. Why?
- -normal or increased for RLD because the TLC is smaller and the amount expired in the 1st second may be a greater proportion than the TLC
- -decreased in COPD due to air trapping which greatly reduces the volume that can be expired quickly
When the alveolae are helathy and able to diffuse oxygen across the junction then _______ (_) is equal to 1.
When the pulmonary circulation is helathy and able to effectively delver CO2 and receive O2, the ______ (_) is equal to 1.
- 1. ventilation (V)
- 2. perfusion (q)
When ther is V:Q mismatch:
1. V:Q>1: means inadequate ________.
2. V:Q <1: means inadequate ________.
- 1. Perfusion: may be caused by pulmonary embolism or pulmonary hypertension.
- 2. Ventilation: may be caused by atelectasis, consolidation, alveolar destruction etc.
_______: airlessness, incomple expansion of airways/alveolae. Causes: pleural effusion, pneumothorax, pulmonary embolus etc...
Auscultation: list two
- Auscultation: diminished breath sounds/crackles
- Tactile Fremitus: diminished
- Percussion: Dull
- Tracheal Deviation: ipsilateral side
_______: exudates are fluids that leak out of tissus, typically because of an inflammatory process. They collect in the proximal airwarys and can fill up nad solidify alveolae tha would otherwise be aerated.
Cause: pneumonia, aspiration, inhaled noxious chemicals
Auscultation: list two
Transmitted voice sounds:
- Auscultation: bronchial breath sounds/crackles
- Tactile Fremitus: increased
- Percussion: dull
- Transmitted voice sounds: increased
_____ _____: persistent productive cough (clear to white sputum) on most days of a 3 month period for 2 or more consecutive years. Results in increased secretions and mucous plugs (thus narrowing) in airways
Auscultation: normal breath sounds
Tactile fremitus: decreased
______: irreversible destruction of airways distal to terminal bronchiole, causing air trappin and lung hyperinflation/which shows up in PFT as increased Residual volume (RV).
Auscultation: decreased/diminished/distant-possible crackles
Tactile Fremitus: decreased
Percussion: more resonant
______: classified as a disease within the categor of COPD, however it occurs in a reversible and episodic manner, rather than chronic.
Adventitious sounds: wheezes caused by bronchoconstriction
What kind of inhaler/drugs?
- Short acting "rescue inhaler" (albuterol or proventil) (inhaled corticosteroid or leukotriene modifier) may need long acting bronchodilator (salmeterol or Serevent)
_______: permanent dilation of a local segemet of the bronchus that collects or traps secretions which often becomes septic and purulent.
Auscultation: localized crackles
______ ______: hereditary disease of several systems involving secretory glands. Excessive viscous lung secretions that frequently beecome septic/purulent.
Auscultation: adventitious expiratory wheeze
Signs and Symptoms of RLD: there are 8
There are a ton of Etiologies of RLD but they affect 3 functions of of the Lung :What are they? (Big table objective 7; I also remember him saying to look at the flow chart in watchie pg. 83)
- S&S: dyspnea, tachypnea, hypoxia/cyanosis, non-productive cough, reduced lung compliance, decreased breath sounds, increased WOB, increased accessory muscle activity
- 1. Lung parenchyma
- 2. Pleura
- 3. Ventilatory Pump Action
____ ____: secondary to left ventricular yfailur or Mitral valve prolapse. Retrograde pressure in the pulmonary vein causes serum to leak out and flood the alveolae.
_____ _____: deep vein thrombosis
_____ (____) ____: intrinsic lung disease disrupts the alveolar capillary interface leading to vasoconstriction. This increases the pulmonary artery pressure.
___ ______: R heart hypertrophy/ failure secondary to choronic pulmonary artery hypertension.
_____ ____: most common cause is problem with oropharynx, the tongue and palate relax and block airway.
- 1. pulmonary edema
- 2. pulmonary embolism
- 3. pulmonary artery disease
- 4. Cor pulmonale
- 5. sleep apnea
Diff DX of pulmonary causes of Dyspnea:
-_____: discomfort of not being able to get enough air, often accompanied by uncomfortable sensation that another breath is urgently needed before exhalation is completed; develops with exertion initially but may occur at rest once cor pulmonale is present.
-_____: Feeling of inability to get enough air in accompanied by tachypnea, especially on exertion. Recall V=TVxRR. If TV is fixed, the only way to meet ventilatory need is to increase respiration rate which results in dyspnea.
_____: can be transient or persistent. Increased pressure in the pulmonary vein is cause by LV dysfunction.
Dyspnea Diff Dx: CHF or COPD
Likely _____ in origin if: excess secretions are contributor, accompanied by accessory muscle use, nasal flaring, or intercostal reactions; bronchodilator relieves, increased AP chest diameter, tripod position relieves.
Likely _____ in origin if: dyspnea is striclty related to activity; accompanied by irregular HR, or extreme changes in BP; syncope or light-headedness, nitroglycerine relieves.
Changes to Pulmonary system with aging:
1. increased stiffness in _____ ____.
2. reduced elastic _____ (this helps with #1) which raises residual volume.
3. increased thoracic _____ which reduces vital capacity.
4. decrease _____ function which reduces ability to protect lower airway.
5. decreased strength and flattening of the ______ reduces VC.
6. Changes in alveolae and capillaries cause reduced ______.
- 1. chest wall
- 2. elastic recoil (increases RV)
- 3. kyphosis (reduces VC)
- 4. cilliary function
- 5. diaphragm (decreases VC)
- 6. diffusion of O2 and CO2
Minute Ventilation (Ve)= _____ x_____
Persons with RLD must increase ____ in order to keep Ve stable. Therefore, RLD patients must not be taught _____.
- TV x RR
- Pursed lip breathing
SpO2 = ____
SaO2 = ____ Normal: ____ -___ %
PaCO2 = ____ Normal: ___ -____ mmHg
PaO2 = ______ Normal: ____-____ mmHg
pH norms = ____ -____
HCO3 = _____ Normal: ____ -_____mEq/l
- Pulse oximetry; less accurate (error +/- 2%)
- Arterial Oxygen Saturation: 95-100%
- Arterial Partial Pressure of Carbon Dioxide: 35-45
- Arterial Partial Pressure of Oxygen: 80-100
- pH: 7.35-7.45
- Arterial Bicarbonate: 22-26
Sputum production: must document 4 things?
amount (tsp), color, viscosity, odor
Medium intensity, medium pitch breath sounds with equal I-E and no pause
Where are these sounds found?
anterior over sternum, broncial area, between scapulae
soft (low) intensity, low pitch breath sounds with short E and no pause.
Where are these sounds found?
musical sounds produced during expiration with narrowing of airway
Pathologies include: (3)
- Asthma, Chronic Bronchitis, Bronchiectasis
Breath sounds like sound like hair or velcro?
Caused by: (3)
Secretions inside airways (pneumonia, CF, etc), Pulmonary edema/CHF, Atelectasis
Emphyesema, Atelectasis and RLD produce which abnormal breath sounds?
Distant or Diminished
What can cause absent abnormal breath sounds?
over pleural effusion, pneumothorax
Loud (high) intensity, high pitched breath sounds with equal I:E with pause between.
Where would these sounds be considered abnormal? Which is most likely caused by?
- Broncial (Tubular)
- Regions anywhere other than the sternal/manubrial zone
T/F Transmitted voice sounds are usually louder over areas of consolidation.
Voice sound where "e" sounds like "a"?
Voice sound where a whisper is heard clearly?
Voice sound where 99 can be understood?
Why is too much oxygen considered a danger?
Too much oxygen can cause toxicity which produces free radicals that can cause tissue damage and loss of organ function.
A CO2 retainer would have ABGs that show:
Would these patients benefit from use of oxygen?
normal, increased, increased
NO! It can disrupt O2/CO2 homeostasis and trigger respiratory failure.
E-cylinder minutes remaining calculation:
(_______ x ______)/ ________
liters remaining x .25/ flow rate in liters/min
With pulmonary/cardiac rehabilitation, what must you progress first? Then ____ can be progressed.
What RPE level must be kept throughout?
Contraindications of Postural Drainage:
Contraindications of Percussion:
increased ICP, unstable hemodynamics, diaphragmatic hernia, head trauma, eye surgery, spinal injury/fusion
hemoptysis, untreated pneumothorax, low platelets, impaired integument
Which consists of 3 rounds of?
Active Cycle of Breathing Technique
deep inspiration, hold for 3 seconds, passive expiration; coughing can be included after each cycle if patient is able to.
Signs of Respiratory Distress: name 8
- 1. Dyspnea
- 2. tachypnea
- 3. accessory muscle use
- 4. intercostal retractions
- 5. nasal flaring
- 6. cyanosis
- 7. stridor
- 8. confusion, agitation
Relative Contraindications of exercise: 7
- alcoholic hangover
- sympathetic stimulants
- weight gain of 3# in 24 hours
- recent large meal
- severe sunburn
- air pollution
- MI within past 2-3 months
- 60-80 mmHg
- 40-60 mmHg
- <40 mmHg
Removal of apices via sternotomy which improves ____, diaphragm length and _____.
- Lung Volume Reduction Surgery
- FEV1 and decreased RV
Atelectasis, pneumonectomy/lobectomy can cause _____ tracheal deviation.
Tumor, pleural effusion and pneumothorax can cause _____ tracheal deviation.
Blowing off less CO2 = _____ and will raise PaCO2 > 50 and lower pH.
Blowing off more CO2 = ____ and will lower PaCO2 < 30 and raise pH.
______ Acid Base balance operates slowly to restore homeostasis.
The kidneys may retain more bicarbonate, lactic acid and ketone body acids. An elevated blood sugar level is also called _______.
When pH and PaCO2 levels read the opposite direction: probably a ____ problem
When pH and PaCO2 read in the same direction: probably a ____ problem
Exercise in healthy persons and high body temperature can cause _____ shift in oxyhemoglobin curve, which means Hgb releases O2 more freely.
Hyperventilation in high altitudes and hypothermia can cause _____ shift in curve, which means hgb wants to hang onto O2 more tightly.
A hypoxic state with elevated PaCO2 < 50 mm is termed _____. This results in a lowered pH.
To help elevate pH, the kidneys can retain more ______ to buffer the acidic blood.
Levels of Innervation:
- C2-3, CN XI
- C3-4, CN XI
Paradoxical breathing includes ____ of the chest and _____ of the abdomen with inspiration.
PA and lateral radiographs are taken in ______.
AP chest radiographs are used for _______.
Patients are told to do what before the chest x-ray?
Pneumonia, lung infections with COPD can show up ____ on radiograph.
- bed bound patients
- take a deep breath
- whiter (duhhhh)
With exercise, the goal is to keep SpO2 at least ____-___%.
Falsely low readings can come from: 6
Falsely high readings can come from: 3
poor perfusion (cold hands), polish, callouses, sweaty hands, arrythmia, Raynaud's
Anemia, carbon monoxide poisoning, cigarette smoking
____ _____ are frequently given to patients post operatively for preventing/controlling atelectasis or for pulmonary secretions that can create pneumonia.
____ _____ ______: device that looks like a kazoo and used to increase inspiratory effort. Protocol is 20-30% of max I effort, performed for 10-15 min, several times a day.
This can be appropriate for ______. Contraindicated for cardiac pump failure.
Inspiratory Muscle Training (IMT)
Flutter valve, Acapella and PEP are used for _____ training. These devices have a vibratory or percussive effects to aid in secretion management.
PEP stands for:
Passive devices like the _____ provide extra pressure to prop open airways that lack ventilatory support or have obstructive airway impairments.
____ _____ ____ can also cause the same type of positive airway pressure during expiration.
Positive Expiratory Pressure
Pursed lip breathing
____ ______: breathing intervention for ventilatory pump dysfunction and decrease use of accessory muscles
____ _____: useful in asymmetrical conditions of the ribs that focuses on ventilatory effort and rib cage expansion in an area of atelectasis or consolidation.
____ ____ ____ : SMI; used as part of ACBT breathing
___ ___ ___: used to prevent valsalva manuever
___ _____: breathing technique using I:E ratio of 1:3 or 1:5 with activity
Gulp, Gulp, Gulp breathing: ______ ______ :)
- Diaphragmatic breathing
- Segmental breathing
- Sustained maximal inspiration
- Exhale on effort
- paced breathing
- glossopharyngeal breathing