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The fundamental difference between newborn and adult pulmonary testing is?
Cooperation
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There are three volumes that can be easily measure with out patient cooperation:
FRC, thoracic gas volume (TGV) and crying vital capacity (CVC).
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The range of PFT in infants varries. These vaules must be compaired against a standard unit. The three ways to get a standard unit is:
body weight (kg), body length (cm), or body surface area (ml/cm2)
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FRC is measured by two methods:
Closed system helium dilution and open system nitrogen washout
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This requires the use of a plethsmograph and measures all of the gas in the thoracic cavity whether it is communicating with the airway or not,
TGV
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By compairing the TGV with FRC, the clinitian can determine the presence of?
trapped air in the thorax
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is the measurement of tidal volume while the infant is crying. is useful in following infants who have lung diseases that cause changes in FRC and is difficult to measure.
CVC
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A method of measuring distribution of ventilation is available using a ?
nitrogen washout curve
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This divides the lung into fast, intermediate, and slow ventilating areas based on calulations from expired nitrogen concentrations obtained during a nitogen washout.
Pulmonary clearance Delay (PCD)
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Most imprtant clinical lung volume measurement.
FRC
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When FRC is high, the compliance is _____, resistance is _____, and PaCO2 is ______?
lower, higher, elevated
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When FRC is low, the compliance is ____, resistance is ____, and PaCO2 is ______?
very low, very high, and decreased (PaCO2 is increased)
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is a disease in which the FRC is increased.
Meconium aspiration syndrome
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is a measuremtn of the distensibilty of the lung. Calc. by dividing change in volume by change in pressure and requires measurement of tidal volume and transpulmonary pressure.
Compliance
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Most nurseries measure tidal volume by?
pneumotachography
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is the difference between airway pressure and pleural pressure. Approx. by measuring airway and esophageal pressure in intubated infants and esophageal pressure in nonintubated infants.
Transpulmonary pressure.
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is a measure of the inhibition of gas flow through airways. Calc. by dividing change in transpulmonary pressure by change in flow.
resistance
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Chest radiographs should be obtained in infants with evidence of?
acute unexplained repiratory problems.
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The two classic newborn lung diseases are?
RDS and MAS
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is a disease if inadequate surfactant production. immature alveoli have increased surface tension and collapse.
RDS
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is primarily an airway disease. Stressed mature fetus passes meconium into the amniotic fluid and the with gasping respirations inhales the meconium laden amniotic fluid into its lungs
MAS
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Ia a disease that has diagnostic radiographs. The aniotic fluid in the lung is incompletely resorbed at the time of delivery.
Transient tachypnea of the newborn (TTNB)
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Infants with obstructed airways still have what going on?
chest wall motion.
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Until the age of ____, it is important to include the birth history as part of the evaluation of these patients.
2
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The historian assessing the patient must begin to include a review of systems at the age of?
3 months
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The historian inquiring about the pulmonary symptoms in an older infant or chile is limited to?
signs that are visable or audible to the parent.
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Should be remembered that ______ and _____ do not occur in children.
hemoptusis and sputum expectoration
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is a common complaint in infants and children.
Gastrointestinal Upset
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These are major causes for hospitalization for children. These can be caused by pneumonia or pulmonary disease
Vomiting and diarrhea
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an infant or child who does not maintain growth appropriate for developmental age should be investigated for an underlying?
Chronic pulmonary disease.
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Two major respiratory disease in the young child are?
Croup and epiglottitis
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is a viral disease affecting the trachea and small airways.
Croup
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is usually a bacterial disease that causes significant edema and inflammation of the epiglottis. Drooling, dysphasia, and respiratory disress.
Epiglottitis
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is an increassingly prevalent disease in children of all ages beyond infancy. chronic airway disease that is caused by airway inflammation and hyperresponsiveness to irratants.
Asthma
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More than 50% of patients requiring the services of cardiopulmonary prefessionals are aged?
65 and up
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To conserve the patient's energy?
Organize your assessment
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The connection of aging with chonic illness and death may lead to this. means discrimination against old people.
Ageism
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Cell- mediated immunity decreases with?
Age
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Immunuzations, although not as effective in th elderly, are still ______.
recomended.
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Gentics, enviromental pollutants, socioeconomic status, and nutrition have what kind of effect on the immune system in the elderly?
decreases
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Some older patients will down play their symptoms, assuming the aches as part of?
Old age
-
is one of the body's first responces to infection or injury.
Inflammation
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typical presentations of cough, fever, and purulent sputum production.
Pneumonia
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Pneumonia infiltrate may be obscured by pulmonary edema or may not be detecable on the chest film until _______ after the patient has been hydrated.
24-48 hrs
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is the major source of chronic disability and the leading indication for hospitalization in adults over the age of 65.
heart failure
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About 50% of patients who die from MI are older than?
75
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Dyspnea and lethargy may be presenting symptoms of?
MI
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What percentage of adults older than 60 have asthma?
5%
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What percent of adults older than 70 have asthma?
7-9%
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The diagnosis of asthma shoould be considered in older adults who?
are wheezing
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what is vital to good patient care and cost effective disease management?
Assessment skills
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In patients older than 90 years usually have a temp of what?
96-97F
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In an inactive older adult, the pulse may decrease to?
50-55bpm
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Normal respirtatory rate in the elderly is?
16-25
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While sleeping, ederly may present this type of breathing.
Cheyne-Stokes
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Central cyanosis results from a decreased concentration of O2 in arterial blood and may be a result of advanced?
Lung disease or CHF
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In older adults there are two manifistations of cyanosis that may be noted.
Small vessel Syndrome and Raynaud's phenomenon
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This can be life threatening and should not be disregarded?
Dehydration
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tthe abnormal enlargement of the distal phalanges, most noted easily in the finger, and is not age related. Is a sign of COPD and othe lung diseases.
Clubbing
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