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Respiratory Assessment (Diagnostics (Lung Biopsy ((2) percutaneously or…

- - - - tumor/tissue excision and biopsy; cryotherapy
      - stenting; electrocautery
      - laser therapy; bronchoalveolar lavage (BAL)
- - - - Measurement of airflow rate in middle half of forced expiration;
      - indicator of disease of small airways; 70-75%
    - - 80% of predicted
      - Grades severity of airway obstruction.
    - - Deep breathing as rapidly as possible for specified period
      - use with exercise exam; About 170 L/min
    - - 80% of
        predicted
      - Amount of air that can be
        quickly and forcefully
        exhaled after maximum
        inspiration.
    - - Maximum airflow rate
        during forced expiration
      - Up to 600 L/min
  - - - Expiratory Reserve (ERV)
        
        Additional air that can be forcefully exhaled after normal exhalation
        
        1 L
      - Residual (RV)
        
        Amount of air remaining in lungs after forced expiration.
        
        1.5 L (for gas exchange between breaths)
      - Tidal volume (Vt)
        
        0.5 L
        
        Volume of air inhaled and exhaled with each breath
      - Inspiration reserve (IRV)
        
        Maximum volume of air that can be
        inhaled forcefully after normal inhalation.
        
        3 L
    - - functional residual (FRC)
        
        Volume of air remaining in lungs at end of normal exhalation
        
        2.5 L
      - vital (VC)
        
        Maximum volume of air that can be exhaled after maximum inspiration
        
        4.5 L
      - Total lung (TLC)
        
        6 L
        
        Maximum volume of air that lungs can contain
      - Inspiratory (IC)
        
        Maximum volume of air that can be
        inhaled after normal expiration
        
        3.5 L
- - - - Series of short-duration, discontinuous, high-pitched sounds heard just before the end of inspiration.
        bronchioles suddenly snap open. Similar sound to that made by rolling hair between fingers just behind ear
      - Result of rapid equalization of gas pressure when collapsed alveoli or terminal
    - - Continuous high-pitched squeaking or musical sound caused by rapid vibration of bronchial walls.
      - First evident on expiration but possibly evident on inspiration as obstruction of airway increases.
    - - Continuous rumbling, snoring, or rattling sounds from obstruction of large airways with secretions.
      - Most prominent on expiration. Change often evident after coughing or suctioning
    - - Continuous musical or crowing sound of constant pitch.
    - - Series of long-duration, discontinuous, low-pitched sounds caused by air passing through airway intermittently occluded by mucus, unstable bronchial wall, or fold of mucosa.
      - Evident on inspiration and, at times, expiration. Similar sound to blowing through
        straw under water. Increase in bubbling quality with more fluid.
  - - - drumlike, loud, empty quality
      - Means: gass filled stomach or intestines OR pneumothorax
    - - medium-intensity pitch and duration
      - Means: “mixed” solid, fluid-filled, pneumonia
    - - Loud, lower-pitched sound
      - Means: hyperinflated lungs, COPD, acute asthma
    - - Soft, high-pitched sound of short duration
      - Means: dense tissue w/o air, posterior chest below level of diaphragm
    - - Low-pitched sound
      - Means: normal lungs
  - - - Shape and symmetry of chest; width/depth ratio of chest 2:1
      - Respiration: Biot’s, Cheyne-Stokes, etc.
  - - - normal: 1 inch @ level of diaphragm
    - - Abnorm: nonmoving, tender