pulm a

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  1. triangularis sterni muscle
    • transversus thoracis
    • xiphoid --> 2nd-6th costal cartilages
    • helps w forceful exp
  2. vital capacity
    • the amount of air that is under volitional control
    • inspiratory reserve volume + tidal volume _ expiratory reserve volume
    • aka forced expiratory vital capacity (FVC)
  3. functional residual capacity
    • air in lung after tidal expiration
    • expiratory reserve volume plus residual volume
  4. total lung capacity
    IRV + TV + ERV + RV

    RV = residual volume (vol of gase in lungs after ERV has been exhaled)
  5. FEV1 vs FEF
    • FEV1: amount of air exhaled in first second of forced exhalation (forced exp vital cap FVC) - should be at least 70% of the FVC
    • FEF: forced expiratory flow rate -- flow rate btwn 25-75% of forced exhalation -- shows changes in smaller airways, and changes more w disease than FEV1 does
  6. supplemental O2 is usually prescribed when PaO2 falls below __
    • 55 mmHg
    • or SaO2 is below 88%
  7. if PaCO2 and HCO3- each increase, how does pH change
    • as CO2 increases, pH decreases
    • as bicarbonate increases, pH increases
  8. apex and base of heart and lung
    • it's screwy
    • heart: apex is on the bottom, base is on the top
    • lung: apex is on top, base is on the bottom
    • the base is the wider part
  9. V/Q
    • ventilation perfusion ratio
    • at the apex (top) of lung it's high
    • middle of lung about 1
    • and in base it's low

    thing is, the blood flow (perfusion) is gravity dependant, so the Q will be greatest in the region closest to the floor
  10. "dead space" in the lung
    • well ventilated but no gas exchange
    • Could be because it's just a conducting airway or bc of a disease
    • (gravity indep area)
  11. shunt region in a lung
    • blood is traveling thru but no gas exchange bc of a ventilation abnormality
    • (gravity dependent area)
  12. infant normal HR
    120 bpm
  13. infant BP norm
  14. infant PaO2 and PaCO2 norms
    • 75-80
    • 24-54
  15. adult vs infant tidal vol
    • 500 ml
    • 20 ml
  16. vesicular breath sound
    • normal
    • soft rustling heart throughout insp and at start of exp
  17. bronchial breath sound
    hollow, echoing, normally only heard over superior R ant thorax (over the R main stem bronchus)
  18. crackles / rales / crepitations
    • crackling sound
    • during insp
    • 2/2 atelectasis, fibrosis, pulm edema
  19. wheezes
    • during exp
    • 2/2 obstruction (asthma, COPD, foreign body)
    • can be heard on insp if severe enough
  20. egophany
    • E sounds like A
    • 2/2 fluid filled areas, cavitation lesions, plural effusions, consolidation
  21. bronchophany
    intense clear sound during auscultation even at lung bases 2/2 fluid-filled areas of consolidation, cavitation lesions, or pleural effusions
  22. whispered pectriloquy
    whispered sounds heard clearly during auscultation 2/2 fluid-filled areas of consolidation, cavitation lesions, or pleural effusions
  23. fluoroscopy for lungs does what?
    continuous x-ray beam allows observation of diaphragmatic excursion
  24. WBC norms
  25. cause of respiratory alkalosis and acidosis
    • resp alk: alveolar hypervent
    • resp acidosis: alveolar hypoven
  26. S&S of resp alkalosis vs acidosis
    • alkalosis: dizy, tingly, numb, tetany
    • acidosis: anxiety, HA, dyspnea, confusion, coma
  27. causes of metabolic alkalosis vs acidosis
    • alk: vomiting, diuretics, steroids, adrenal disease, bicarb ingestion
    • acid: diabetic, lactic, or uremic acidosis diarrhea
  28. changes in lung volumes for restrictive vs obstructive
    • restrictive: IRV and ERV decrease
    • obstructive: ERV decreases and RV increases
  29. stop exercise if PaO2 changes how?
    falls more than 20 mmHg or gets lower than 55 mmHg
  30. stop exercise of PaCO2 changes how?
    increases > 10 mmHg or gets above 65 mmHg
  31. bronchiectasis
    • chronic congenital or acquired
    • abnormal dilation of bronchi
    • excessive sputum production
  32. respiratory distress syndrome aka
    • hyaline membrane disease
    • alveolar collapse in premature infant
  33. cor pulmonale
    enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lung
  34. bronchopulm dysplasia
    • obstructive¬†
    • seen in premies 2/2 high pressures of mechanical vent 2/2 resp distress syndrome
  35. restrictive disease -- O2 and CO2?
    both will be low, but can get hypercapnea as it  gets more severe
  36. polycythemia
    abnormally increased concentration of hemoglobin in the blood, through either reduction of plasma volume or increase in red cell numbers
  37. force and duration of manual secretion percussion
    • force: enough to make pt's voice quiver
    • duration: depends on pt's needs and improvement, but 3-5 min
  38. anticholinergics do what?
    • inhibit the parasymp nervous system -- increase HR, BP, bronchodilation
    • side effects: lack of sweating, dry mouth, delusions
  39. methylxanthines do what?
    • smooth muslce relaxation
    • side effects: increased BP, HR, arrythmias, GI problems, ...
  40. leukotrien receptor antagonists do what?
    • block the leukotrienes (tied with inflammation) released in allergic reactions
    • inhibit airway edema and smooth muscle contraction
    • anti-inflam
    • ex: montelukast / singulair
  41. cromolyn sodium
    • antiallergic drug
    • prevents release of mast cells (histamine) after contact w allergens
    • can prevent exercise-induced bronchospasm and asthma
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pulm a
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