Kussmaul respiration - ✅✅ - Rapid large-volume breathing leads to intense
stimulation of the respiratory center
- R/T metabolic acidosis
Cheyne-Stokes respiration - ✅✅ - Rhythmic
- Waxing/waning of rate and TV
- Regular periods of apnea
- Seen in end-stage LV failure, neurologic dx, sleeping at high altitude
Extrapulmonary signs of intrinsic pulmonary disease - ✅✅ - Digital clubbing
- Cyanosis
- Increased CVP
- BLE edema
Digital clubbing - ✅✅ - Lung abscess
- Empyema
- Bronchiectasis
- CF
- Idiopathic pulmonary fibrosis
- AV malformations
- Late presentation of concomitant lung cx
Cyanosis - ✅✅ - Blue or bluish-gray discoloration of skin & mm due to amounts of
unsaturated HgB in capillary blood
Anemia - ✅✅ May prevent cyanosis from appearing
Polycythemia - ✅✅ Cyanosis in mild hypoxemia
Cyanosis not reliable indicator of hypoxemia - ✅✅ Get arterial PO2 or HgB saturation
measured
Increased CVP - ✅✅ - Indirectly measures pulmonary HTN (major complication of
chronic lung dx)
- Impaired ventricular function
- Pericardial effusion or restriction
- Valvular heart dx
- COPD
Use of accessory muscles, intercostal / sternocleidomastoid muscles - ✅✅ High work
of breathing (use of accessory muscles at rest) is a sign of significant pulmonary
impairment
Observe pattern of breathing - ✅✅ - RR (12-14rr/min)
- Rhythm (regular with a sigh every 90 breaths or so)
- Depth of breathing / tidal volume (5ml/kg)
- Relative time spent on inspiration and expiration (ratio 2:3)
Inspect for extrapulmonary signs of pulmonary disease - ✅✅ Use what you find to
perform more detailed exam
Palpate - ✅✅ - Trachea at suprasternal notch
- Posterior chest wall (gauge fremitus / transmission through lungs of vibrations of
spoken words)
- Anterior chest wall (assess cardiac impulse)
Percussion - ✅✅ Identifies dull areas or hyperresonant areas
Auscultation - ✅✅ Lung sounds
Pulmonary Function Tests - ✅✅ Measures airflow rates, lung volumes, ability of lung
to transfer gas across alveoli-capillary membrane
What would indicate to FNP that patient needs PFT? - ✅✅ - Assess type/extent of
lung dysfunction
- Dx of causes of dyspnea and cough
- Detect early evidence of lung dysfunction
- Follow-up response to therapy
- Pre- op assessment
- Disability evaluation
Patient presents with acute asthma exacerbation with mild resp. distress. You want to
perform a PFT to see how well gas exchange is occurring. Is this correct management
for the patient? - ✅✅ - No
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