Observe pattern of breathing - answer✔✔- RR (12-14rr/min)
- Rhythm (regular with a sigh every 90 breaths or so)
- Depth of breathing / tidal volume (5ml/kg)
- Relative time spent inspiration and expiration (ratio 2:3)
Inspect for extrapulmonary signs of pulmonary disease - answer✔✔Use what you find to
perform more detailed exam
Palpate - answer✔✔- Trachea at suprasternal notch
- Posterior chest wall (gauge fremitus / transmission through lungs of vibrations of spoken
words)
- Anterior chest wall (assess cardiac impulse)
Percussion - answer✔✔Identifies dull areas or hyperresonant areas
Auscultation - answer✔✔Lung sounds
Pulmonary Function Tests - answer✔✔Measures airflow rates, lung volumes, ability of lung to
transfer gas across alveoli-capillary membrane
What would indicate to FNP that patient needs PFT? - answer✔✔- 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 eval
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? -
answer✔✔- No
- PFTs are contraindicated in acute severe asthma, resp. distress, angina aggravated by testing,
pneumothorax, ongoing hemoptysis, active TB
How do you measure your patients PFTs to establish if they are normal or not? - answer✔✔-
They are measured against predicted values derived from large studies of healthy subject
- Vary with age, gender, height, weight, ethnicity
Tachypnea - answer✔✔Increased resp rate and decreased TV
Kussmaul resp - answer✔✔- Rapid large volume breathing leads to intense stimulation of resp
center
- R/T metabolic acidosis
Cheyne-Stokes resp - answer✔✔- 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 - answer✔✔- Digital clubbing
- Cyanosis
- Increased CVP
- BLE edema
Digital clubbing - answer✔✔- Lung abscess
- Empyema
- Bronchiectasis
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