Nursing 460: Pulmonary Function Tests
Nursing 460: Pulmonary Function Tests 460
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This 3 page Class Notes was uploaded by ndp33 on Thursday July 7, 2016. The Class Notes belongs to 460 at Niagara University taught by in Summer 2016. Since its upload, it has received 9 views. For similar materials see Nursing Concepts IV: Health of Maturing Adults / Chronic Disease in Nursing and Health Sciences at Niagara University.
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Date Created: 07/07/16
Chapter 27: -why vital capacity decreases in older adults: Weakening of intercostal muscles and calcification of costal cartilage Vertebral osteoporosis Diaphragmatic flattening and loss of elasticity -Pulmonary function tests forced expiratory volume (FEV) o Amount of air that can be exhaled in one second Functional residual capacity (FRC) o Volume of air left in lungs after normal exhalation forced vital capacity (FVC) o amount of air that can be exhaled forcefully and rapidly after maximum air intake inspiratory capacity o total amount of air that can be inhaled following a normal quiet exhalation o Calculated by adding TV and IRV total lung capacity (TLC) o total volume of lungs at maximum inflation o calculated with total volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), and residual volume (RV) total volume aka tidal volume (TV) o volume inhaled and exhaled with normal quiet breathing o 500 mL inspiratory reserve volume (IRV) o maximum amount of air that can be inhaled over and above a normal inspiration Expiratory reserve volume (ERV) o Maximum amount of air that can be exhaled following a normal exhalation Residual volume (RV) o Amount of air remaining in lungs after maximal exhalation o 1200mL -oxygen delivery Non breather mask: 60-80% O2, flow rate 10-15L Venturi mask ranges from 24-50% O2, flow rate 3-15 L/min NC 24-44%O2, flow rate 1-6L/min -Mantoux test Reaction at injection site occurs 48-72 hrs after injection of purified protein derivative (PPD) given ID in forearm Reaction: o Induration )palpable raised hardened area) o Erythema o Diameter is measured at its widest part o Induration of 5mm or greater may be sig for individuals at risk such as HIV patients o Induration of 10 mm or greater is sig in individuals with normal or mildly impaired immunity Will also be positive in individuals who received BCg vaccine used routinely in Europe and S. America to provide resistance ot TB (develops antibodies) -drugs for pulmonary tuberculosis Isoniaziad (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) o INH has resulted in hepatitis, neuopahty (burning, tingling), seizures; monitor for hyperglycemia in DM o Rifampin: nephrotoxic o PZA monitor for hyperuricemia and sx of gout or arthralgia o EMB: monitor visual acuity secondary to optic neuritis o Overall, drugs help inhibit cell synthesis EMB included in initial tx until drug susceptibility cultures are determined -barrel chest AP diameter: AP diameter/transverse diameter ratio: 2:1 -normal adult AP diameter: AP diameter/transverse diameter ratio: 1:2 -Dx tests for COPD: Chest x-ray: marked overinflation, a flattened diaphragm Sputum gram stain and culture: infection present? Serum theophylline level: elvated levesl over the therapeutic range of 5-20 mcg/L o Theophylline is a weak bronchodilator, may be used in COPD to assist with increasing contractility of fatigued diaphragms FEV1: <70% o b/c COPD patient has obstruction, has difficulty exhaling WBC: likely to be elevated ABC: shows academia, hypoxemia, or hypercarbia ECG: to differentiate from heart failure -Diagnostic tests for pulmonary infections: Chest x-ray Chest CT Sputum Gram stain and culture Transtracheal aspiration Bronceoalveoalr laage: involves passage of bronchoscope to collect specimen WBC > 11K Serology: id blood or fluid sample ABG -Diagnostic tests for cf: Sweat chloride test: > 60 mEq/L Chest x-Ray: o hyperinflation (early stage); bronchiectasis, pulmonary hypertension Fecal fat: fecal fat concentrations elevated Pancreatic enzymes: decreased Pulmonary function studies o Decreased forced expiratory flow o Decreased FVC and forced expiratory volume Serum glucose: elevated in some patients Semen analusis: sperm count abnormally low DNA analysis: 2 CF-related mutations Liver enzymes: elevated -Diagnostic tests for pulmonary embolism ABGS: abnormal in some cases: massive with hypercapnia, respiratory, and metabolic acidosis Pulse oximetry: decreased in some cases WBC: may be normal or elevated Troponin: Elevated in 30-50% of patients with large or moderate PE, resolves in 2 days ECG o Non-specific ST segment and T-wave changes o Atrial dysrhythmias Chest x-rays o Usu subtle o Atelectasis, pulmonary opacities, pleural effusion, cardiomegaly D-Dimer test: Abnormal if >250 ng/ML o IF positive, further tests needed o Degradation of cross-linked fibrin; the body is trying to break down clots through fibrinolytic pathway VQ scan: if high score, 95% chance of PE Pulmonary angiography: positive Ultrasound: may detect presence of lower extremity DVT Spiral Ct scan (CT angiography = CTA)
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