Spirometry- basic pulmonary function unit

- Measures the amount of air inspired and expired

- 68X?

Steps:

Sit down and relaxed

Placed a nose lip on the patients nose

Ask the patient to take a deep breath and then hold for a few sec n ask the patient TO EXPIRE as hard as
fast as he could

Repeat the procedure for 3x.

15mins repeat again.

Pulmonary volumes and capacities.

FRC, ERV, IRV AND VC WHEN A PERSON LIES SUPINE FROM STANDING POSITION.

DEC. DEC. INC. DEC, RESPECTIVELY

INDICATION OF SPIROMETRY:

1. COPD
2. ASTHMA

CONTRAINDICATED TO PATIENTS WITH TB, HEMOPTYSIS AND SINCE IT IS AN AIR BORNE DISEASE.
THE THING THAT COULD BE DONE, DO A 6MINS WALK TEST – PULSE OX.

GROUP 2.
RESP. CALCULATION
1. SPIROMETRY – SUITED TO DESCRIBE THE EFFECTS OF OBS AND RESTRICTIVE USE TO DIAGNOSE LUNG
DAMAGES.

ANATOMIC DEAD SPACE ARE FOUND ON THE CONDUCTING AIRWAYS (TRACHEA) AND ALVEOLAR DEAD
SPACE (ALVEOLAR AREA)
NOT MEASURED BY SPIROMETRY

FRC

TLC
RV

PEAK FLOW:

STAND UP OR SIT UP STRT

ATTACH THE MOUTHPIECE ON THE INPUT

MAKE SURE THST YHE SLIDING INDIC IS AT THE BOTOOM

HOLD THE METER SO THAT THE FINGERS DON NOT BLOCK THE OUTLET OPENING

BLOW

THE FINAL POSITION OF THE INDIC IS THE PEFR

REP. 3X

MEASUREMENT OF PEAK EXPIRATORY FLOW RATE

2ND HAS THE HIGHEST
INTERPRET: DEPENDES ON THE PATIENTS PERSONAL BEST: 575 (DEPENDING ON THE HIEGHT AND THE
AGE)

GREEN ZONE IS 80% TO 100 OF PERSONAL BEST

IS IS MOVING THROUGH THE LARGE AIRWAYS IN THE PATIENTS LUNGS. THIS MEANS THAT THE PATIENT
CAN DO HIS USUAL ACTIVITIES AND GO TO SLEEP W/O TROUBLE. THE PT. CAN THEN CONTINUE TO
FOLLOW HIS ASTHMA PLASMA AS DRX BY THE HCP.

WHAT IS PEAK EXP. FLOW RATE: GREATEST FR ACHIEVED DURINGTHE EXPIRATORY MANEUVER.
CAN SHOW THE AMOUNT AND RATE PF AIR.

MAX TO MAX.
2. ADV. OF PEFR MONITORING AND MENTION CLINICAL CONDITIONS WHERE IS IT USEFUL.

1. MONITOR PATTERN OF PEAK FLOW

 2. TX IS WORKING
3. PREVENT S/S
4. ADJUST MEDICATION
5. ENVIRONMENTAL FACTORS.

YELLOW: NARROWING OF AIRWAYS.

CLINICAL CONDITION WHERE ITHIS IS USED (PEFR):

1. ASTHMA
2. COPD
3. EMPHYSEMA / DYSFUNCTIONAL TRANSPLANTED LUNGS.
4. EFFECTS OF OZONE AND POLLUTANTS

EXAMINATION OF THE CHEST AND LUNGS.

VIDEO CLIP -
LUNG AUSCULTATION – CLAVICLE – UPPER LOBES – MIDDLE LOBE OF RIGHT L – MID LOBE OF L LUNG
AND LOWER LOBE OF EACH LUNGS.

SCAP- MIDLINE- LOWER LOBE

EXAM. OF LUNGS: SITTING DOWN –REGULAR BREATHING

AUSCULATION – MOST IMPORTANT (CRACKLES OR PLEURAL FRICTION)
PNEUMONIA – ANTERIOR IS ALSO EXAMINED. INCLUDES TRACHEA/ANT. ABOVE STERNUM.

FREMITUS- NORMAL VIBRATORY FEELED WHEN THE PATIENTS SPEAKS.

PALPATION – PERCUSSION – AUSCULTATION

1. VIBRATION – 99 – W/ VIB – NORMAL

2. PERCUSSION NOTE – DIPJ CHEST – NORMAL LUNG J=HAS A GOD PERCUSSION QUALITY.

3. VESICULAR – NORMAL LUNG SOUND

VIBRATION PERC. NOTE BREATH SOUND

AIR IN THE PLEURAL DEC HYPERRESONANT DEC OR ABS

V. LOUD/LOWER PITCH/ LONGER DURATION

FLUID IN THE PLEURAL DEC DULL TO FLAT DEC

 SOFT/ H. PITCH/ SHORT DURATION

SOLIDIFICATION MORE PRONOUNCED DULL MEDIUM BRONCHIAL

LUNG SEGMENT MEDIUM/MEDIUM PITCH/ MED DURATION

EX. LIVER AND SPLEEN.

2.WHEEZES – HEARD CONTINUOUSLY (INS AND EXP)

AIRWAYS NARROWES BY CONTRICTION

SWELLING AND PARTIAL AIRWAY NARROWED

SIBILANT BRONCHI – HIGH PITCHED

SONOROUS – LOWER PITCH – SNORING/MOANING QUALITY BRONCHITIS

CRACKLES – DISCONTINUOUS SOUNDS/ INTERMITTENT/ NON MUSICAL

FINE – SOFT / VERY BRIEF – INTERSTITIAL PNEUMONIA. PULMON. FIBROSIS

ROUGH – COPD

EGOPHONY – INCREASE RESONANCE OF THE VOICE SOUND, E TO A CHANGE.

+ SOME CONSOLIDATION OF LUNG TISSUE (PNEUMONIA)

- NORMAL LUNG TISSUE, SAME SOUND OR E

FALSE + ON FIBROTIC LUNG PARENCHYMA.

CASE 1

MAINTENANCE – SERETIDE AND SALBUTAMOL MDI

PARAMATERS OF OBS. AIRWAY DSE.

1. FEV1/FVC,
2. FEC (FORCED EXIRATORY RATIO)

PARAMETER FOR REVERSIBILTY

- DISTINGUISH ASTHMA TO OTHER OBS DSE.

- 1. SPIROMETRY TEST
- 2. SALBUTAMOL
 - 3. REST FOR 15MINS
- 4. SEC. SPIROMETRY TEST (3X)

THE EXPECTED SPIROMETRY RESULT FOR BRONCHIAL ASTHMA ARE THE FF.

LESS 70PERCENT FEV1/FVC

IRREVERSIBLE – PERMANENT DESTRUCTION

FEV1 DOESNOT IMPROVE BY 12% AND 200ML AFTER NEB.

BRONCHIAL ASTHMA – UNDER COPD

DIFI=FICULTY ON RESPIRATION – DESTROYED ALVEOLAR WALL./ FAILURE TO DEFLATE CANT BE

RELEASE DURING EXPIRATION .

NARROWING – DESTROYED PARENCHYMA

EXP>INSP
BARREL SHAPED CHEST.

3. WORK OF BREATHING = PRESSURE X CHANGE IN VOLUME ( DIRECTLY PROPORTIONAL)

a. COMPLIANCE WORK OR ELASTC WORK
b. TISSUE RESISTANCE
c. AIRWAYS RESITANCE
4. FACTORS INFLUENCING ELASTC RECOILS
a. SURFACE TENSION
i. SURFCTANT
ii. SIZE OF ALVEOLI

B. LUNG VOLUME

C. RESPIRATORY RATE. – INC, DEC IN WORK OF BREATHING

5. FACTORS AFFT=ECTING THE NON ELASTIC RESISTANCE

1. LUNG VOLUME (H LV, DEC AIRWAY RESISTANCE)

2. BRONCHIAL SMOOTH MS. TONE

3. DENSITY AND VISCOSITY OF GAS – DEEP SEA DIVE,

4. RESPIRATORY RATE
S/S OF NENE

INTERPRET THE INITSL ABG RESULTS.

3 STEPS:

1. PH : ACIDIC OR ALAKALINIC
2. HCO3 : METABOLLIC / RESPIRATORY/ MIXED
3. UC/ FC/ PARTIAL

Ph 7.48 – 7.35-7.45 incresed – alkalosis

35 decreased - respiratory

22 decreased – normal - uncompensated

Case 2.