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Assessment of respiratory system ptx

  2. OUTLINE • Introduction • Indications of assessment of respiratory system • Purposes of assessment of respiratory system • Parts of respiratory system and their function • Preliminary measures • Assessment of respiratory system • Physical examination • Diagnostic evaluation 3/27/2023 2
  3. Introduction • The Respiratory tract extends from the nose to the alveoli and includes not only the air conducting passages also but the blood supply. • The primary purpose of the respiratory system is gas exchange , which involves the transfer of oxygen and carbon dioxide between the atmosphere and the blood. • The respiratory system is divided into two parts:- • The upper respiratory tract and the lower respiratory tract. 3/27/2023 3
  4. Indications of assessment of respiratory system Indications of respiratory system assessment:- • Dyspnea • Cough (wet or dry) • Sore throat • Running nose • Sneezing 3/27/2023 4
  5. Purposes • To detect the abnormality of organs. • To find out the abnormal sounds. • Interpretations of vital signs. • Inspection of patient’s breathing pattern. • Skin colour and respiratory status. • Auscultation of lung sounds, normal and abnormal. 3/27/2023 5
  6. Upper respiratory tract The upper respiratory tract includes- • The nose • Pharynx • Adenoids • Tonsils • Epiglottis • Larynx • Trachea 3/27/2023 6
  8. • The right lung is divided into three lobes- • Upper • Middle • Lower • The left lung into two lobes- • Upper and lower • The structures of the chest wall-ribs, pleura, muscles of respiration 3/27/2023 8
  9. Nose Also called external nares. • Divided into two halves by the nasal septum. • Contains the paranasal sinuses where air is warmed. • Contains cilia which is responsible, For filtering out foreign bodies. 3/27/2023 9
  10. Internal nares - opening to exterior • External nares - opening to pharynx • Nasal conchae - folds in the mucous membrane that increase air turbulence and ensures that most air contacts the mucous membranes. 3/27/2023 10
  11. Functions • Provides and airway for respiration. • Moistens and warms entering air. • Filters and cleans inspired air. • Resonating chamber for speech. • Detects odors in the air stream. 3/27/2023 11
  12. Pharynx • Common space used by both the respiratory and digestive systems. • Commonly called the throat. • Originates posterior to the nasal and oral cavities and extends inferiorly near the level of the bifurcation of the larynx and esophagus. • Common pathway for both air and food. • Walls are lined by a mucosa and contain skeletal muscles that are primarily used for swallowing. • Flexible lateral walls are distensible in order to force swallowed food into the esophagus. 3/27/2023 12
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  14. Nasopharynx:- • Contains the pharyngeal tonsils (adenoids) which aid in the body's immune defense. Oropharynx:- • Back portion of the mouth that contains the palatine tonsils which aid in the body's immune defense. Laryngopharynx:- • Bottom section of the pharynx where the respiratory tract divides into the esophagus and the larynx. 3/27/2023 14
  15. Larynx Voice box is a short, somewhat cylindrical airway ends in the trachea, prevents swallowed materials from entering the lower respiratory tract. 3/27/2023 15
  16. • Conducts air into the lower respiratory tract. • Produces sounds. • Supported by a framework of nine pieces of cartilage (three individual pieces and three cartilage pairs) that are held in place by ligaments and muscles. 3/27/2023 16
  17. Bronchial tree • A highly branched system of air-conducting passages that originate from the left and right primary bronchi. • Progressively branch into narrower tubes as they diverge throughout the lungs before terminating in terminal bronchioles. 3/27/2023 17
  18. • Incomplete rings of hyaline cartilage support the walls of the primary bronchi to ensure that they remain open. • Right primary bronchus is shorter, wider, and more vertically oriented than the left primary bronchus. • Foreign particles are more likely to lodge in the right primary bronchus. 3/27/2023 18
  19. Lungs • Each lung has a conical shape. • Its wide, concave base rests upon the muscular diaphragm. • Its superior region called the apex projects superiorly to a point that is slightly superior and posterior to the clavicle. • Both lungs are bordered by the thoracic wall anteriorly, laterally, and posteriorly, and supported by the rib cage. 3/27/2023 19
  20. • Toward the midline, the lungs are separated from each other by the mediastinum. • The relatively broad, rounded surface in contact with the thoracic wall is called the costal surface of the lung. 3/27/2023 20
  21. Inhalation Breathing in is called inhalation (inspiration) each inhalation, the air pressure inside the lungs is equal to the air pressure of the atmosphere, which is about 760 mmhg. • Air to flow into the lungs, the pressure inside the alveoli • Must become lower than the atmospheric pressure. • This condition is achieved by increasing the size of the lungs. 3/27/2023 21
  22. Exhalation • Breathing out or exhalation starts when the inspiratory muscles relax. As • The diaphragm relaxes, its dome moves superiorly owing to its elasticity. • As the external intercostals relax, the ribs are depressed. • The pressure in the lungs is greater than the pressure of the atmosphere. Normal exhalation during quiet breathing. 3/27/2023 22
  23. It is a passive process because no muscular contractions are involved. Instead, exhalation results from elastic recoil of the chest wall and • Lungs, both of which have a natural tendency to spring back after they have been stretched. • Two inwardly directed forces contribute to elastic recoil: • A. The recoil of elastic fibers that were stretched during inhalation b. The inward pull of surface tension due to the film of alveolar fluid. 3/27/2023 23
  24. Physiology of respiration The process of gas exchange in the body, called respiration, it has three basic steps: 1. Pulmonary ventilation or breathing: - • It is the inhalation (inflow) and exhalation (outflow) of air and involves the exchange of air between the atmosphere and the alveoli of the lungs. 3/27/2023 24
  25. External (pulmonary) respiration:- • It is the exchange of gases between the alveoli of the lungs and the blood in pulmonary capillaries across the respiratory membrane. • In this process, pulmonary capillary blood gains o, and loses co₂ 3/27/2023 25
  26. 3. Internal (tissue) respiration:- • It is the exchange of gases between blood in systemic capillaries and tissue cells. In this step the blood loses 0, and gains CO₂. Within cells, the metabolic reactions that consume 0, and give off CO, during the production of ATP are termed cellular respiration. 3/27/2023 26
  27. Physical examination Preparation:- • Ask the person to sit upright and disrobe to the waist • Provide warm room,a warm diaphragm endpiece perform inspection,palpation, percussion and auscultation on the • Posterior and lateral thorax • Then repeat anterior chest • Clean the stethoscope end piece with alcohol wipe 3/27/2023 27
  28. Mouth and pharynx • Inspects the interior of the mouth for color, lesions, masses, gum retraction, bleeding, and poor dentation. • Tongue is inspected for symmetry and presence of lesions inspect pharynx for exudate, ulceration, swelling or postnasal. • Drip tonsils are noted for colour, symmetry and any enlargement. • Assess for gag reflex-indicates the cranial nerves IX and X are intact. 3/27/2023 28
  29. Neck Inspects for symmetry and presence of tender or swollen areas the lymph nodes are palpated while the patient is sitting erect with the neck slightly flexed. • Patient may have small, mobile, non-tender nodes (shotty nodes) which are not a sign of a pathological condition. • Tender, hard or fixed nodes indicates disease. 3/27/2023 29
  30. Thorax and lungs-inspection • Appearance-evidences of respiratory distress, tachypnea or use of accessory muscles. • Shape-elliptical shape with downward slopping ribs about 45 degrees relative to the spine . • Chest movements-equal, symmetry, ap diameter < transverse diameter by a ratio 1:2 3/27/2023 30
  31. Palpation of the trachea Palpate the trachea to assess for possible deviation. From in front of the patient gently place the index and middle fingers on either side of the trachea in the suprasternal notch. • In a normal patient the trachea will be placed in the centre. If there is deviation to one side there will be a bigger gap on one side compared to the other. • Reduction in the normal three to four fingers' width from the suprasternal notch to cricoid cartilage suggests over inflation of the chest. 3/27/2023 31
  32. Palpation of the chest • Palpate for any mass, tenderness, crepitus. • Apex beat: the apex beat is often impalpable in a chest which is hyper-expanded secondary to chronic airflow obstruction. • Movement of the apex beat from one side to the other may be caused by several conditions including pleural effusion, tension pneumothorax. • Location of the apex beat. 3/27/2023 32
  33. Chest expansion By assessing chest expansion the examiner aims to assess- • The range and symmetry of chest wall movements. • Place your hands firmly on the chest wall, with your thumbs slightly lifted off the chest so that they are free to move with respiration (placing your thumbs up provides the examiner with a visible marker to assess the range and symmetry of chest wall movements). 3/27/2023 33
  34. • Ask the patient to take a deep breath in and observe the range and symmetry of movement. • Reduced expansion on one side indicates a lesion on that side. This should be performed on the front and the back of the patient's chest. 3/27/2023 34
  35. Palpation –anterior chest • Palpate symmetric chest expansion. • Place hand on the anterior lateral wall with thumbs along the costal margin and pointing towards xiphoid process . • Ask the person to take a deep breath. • Watch the thumb move apart symmetrically • Assess tactile fremitus . • Palpate anterior chest wall for tenderness,lumps, masses. • Grating sensation indicates pleural friction fremitus. 3/27/2023 35
  36. • Abnormal costal wide angle occurs in emphysema. • Lag in expansion occurs in atelectasis, pneumonia, postoperative guarding. • Granting sensation indicates pleural friction fremitus. 3/27/2023 36
  37. Palpation-posterior chest • Confirm symmetry chest expansion by placing warmed hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10 and pinch a fold of skin. • Ask to inhale deeply thumbs should move apart symmetrically. • Unequal expansion seen in atelectasis, lobar pneumonia, pleural effusion, thoracic trauma, ribs, pacumothorax pain in deep breathing seen when the pleura are inflamed. 3/27/2023 37
  38. Percussion anterior wall As needed, percuss the anterior and lateral chest, again comparing both sides. • The heart normally produces an area of dullness to the left of the sternum from the 3rd to the 5th interspaces. • Dullness represents airway obstruction from inflammation or secretions. 3/27/2023 38
  39. • Because pleural fluid usually sinks to the lowest part of the pleural space (posteriorly in a supine patient), only a very large effusion can be detected anteriorly. • The hyperresonance of copd may obscure dullness over the heart. • The dullness of right middle lobe pneumonia typically occurs behind the right breast. • Unless you displace the breast, you may miss the abnormal percussion note. 3/27/2023 39
  40. Percussion-posterior chest Sequence for percussion- • Start at the apices and percuss the band of normally resonant tissue across the tops of both shoulders. • Percuss the interspaces, mark a side to side comparison all the way down the lung region, Percuss at 5cm intervals. • Avoid the damping effect of scapula and ribs. 3/27/2023 40
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  42. Tactile fremitus • Palpable vibrations transmitted through the broncho- pulmonary tree to the chest wall when the patient. • Ask the patient to repeat '99" or "1,1,1" while placing the ball of your hand or the ulnar surface of your hand on symmetrical parts of the chest increased in consolidation . • Decreased in pneumothorax, pleural effusion, pleural thickening, emphysema 3/27/2023 42
  43. • Variation in percussion note "Resonant" • When percussing a normal chest the noise generated should be resonant "Dull" • When percussing over a solid structure (such as the liver or a consolidated lung) produces a dull note, "Stony dull”. 3/27/2023 43
  44. • Percussion over a fluid filled area such as a pleural effusion produces a Stony dull note. • "Hyper-resonant" -percussion over hollow structures (e.G. Pneumothorax) may produce a hyper-resonant note- such as a pneumothorax ‘Tympanatic’. • High pitched sound while percussing gastric air bubble. 3/27/2023 44
  45. Diaphragmatic excursion Reason for assessing diaphragmatic excursion-to determine the movement of diaphragm that occurs during inspiration. Possible reasons for decreased descent include: atelectasis of lower lobes, emphysema, pleural effusion, pain, abdominal changes such as tumors and extreme ascites. • Normal range of diaphragm movement: 3-5cm but may be up to 7-8cm in well conditioned people. 3/27/2023 45
  46. Procedure 1. First, ask the person to take "exhale and hold it" while you percuss down the left scapular line until the sound changes from resonant to dull. Mark the area. This estimates the level of the diaphragm separating the lungs from the abdominal viscera. 3/27/2023 46
  47. 2. Allow the patient to take a few normal breaths. Then, ask the person to "take a deep breath and hold it." Continue percussing down from the first mark to the level where the sound changes to dull. Mark the area. 3. Measure the two marks. Repeat the same procedure on the right side. It should be equal bilaterally and measure about 3-5 cm. In adults. It may be up to 7-8 cm. In well-conditioned people. 4. Level of the diaphragm may be higher on the right side because of the liver. 3/27/2023 47
  48. Auscultation • When listening to the patients chest the diaphragm component of the stethoscope is usually used to instruct the patient to breath in and out with an open mouth every time you move the stethoscope. • Listen both to the supraclavicular areas, anterior, axillary and posterior aspects of the chest. 3/27/2023 48
  49. • Remember to compare left with right at each level. • Auscultation of the lungs allows an appreciation of the intensity and quality of breath sounds and the presence of additional sounds best described as crackles, wheezes, and rubs. 3/27/2023 49
  50. Ascultation-anterior chest Listen to the chest anteriorly and laterally as the patient breathes with mouth open, and somewhat more deeply than normal. • Compare symmetric areas of the lungs, using the pattern suggested for percussion and extending it to adjacent areas, if indicated. 3/27/2023 50
  51. • Listen to the breath sounds, noting their intensity and identifying any variations from normal vesicular breathing. • Breath sounds are usually louder in the upper anterior lung fields. Bronchovesicular breath sounds may be heard over the large airways, especially on the right. 3/27/2023 51
  52. Breath sounds Breath sounds are produced by vibrations due to turbulent airflow through out the airways. These sounds are transmitted through the smaller airways and lungs to the chest wall. 1. Vesicular breath sounds: • The intensity of the sounds increase during inspiration and then fade away during the first third of expiration. • Low pitched. 3/27/2023 52
  53. 2. Bronchial breath sounds:- • Expiration is longer than inspiration. They result from enhanced transmission of higher frequency sounds through solid lung tissue as in consolidation, pulmonary edema. 3. Bronchovesicular sound:- • Inspiration and expiration are equal. Typically heard in the 1’’ and the 2’’interspaces and between the scapulae. 3/27/2023 53
  54. 4. Bronchial (tracheal) sounds:- • High pitched loud . • Hearded over trachea and larynx. 3/27/2023 54
  55. Adventitious sounds Crackles (rales):- • Non continuous explosive popping sounds heared more often on inspiration can also present on expiration it may be fine and coarse. • Coarse crackles are associated with larger airways and fine crackles are associated with smaller branches. • Seen in asthma, copd, bronchiectasis, pulmonary edema, pneumonia, lung cancer, pulmonary fibrosis. 3/27/2023 55
  56. • Wheezes • Continual, high pitched musical sounds heard at the end of inspiration or at the start of expiration. • Seen in asthma, copd, respiratory tract infection airway narrowing allows airflow induced oscillation of airway walls producing acoustic waves. • Monophonic wheeze- single notes. • Polyphonic wheeze-different tones. 3/27/2023 56
  57. Pleural rub A pleural rub is a discontinuous, low-frequency, grating sound that arises from inflammation and roughening of the visceral pleura as it slides against the parietal pleura. This nonmusical sound is biphasic, heard during inspiration and expiration, and often best heard in the axilla and base of the lungs. 3/27/2023 57
  58. Mediastinal crunch • A mediastinal crunch is a series of precordial crackles synchronous with the heartbeat, not with respiration. • Best heard in the left lateral position, it arises from air entry into the mediastinum causing mediastinal emphysema (pneumomediastinum). • It usually produces severe central chest pain and may be spontaneous. • It has been reported in cases of tracheobronchial injury, blunt trauma, • Pulmonary disease, use of recreational drugs, childbirth, and rapid ascent from scuba diving. 3/27/2023 58
  59. Bronchophony • Ask the patient to say "ninety-nine." • Normally the sounds transmitted through the chest wall are muffled and indistinct. • Louder voice sounds are called bronchophony localized bronchophony and egophony are seen in lobar consolidation from pneumonia. • In patients with fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood of pneumonia. 3/27/2023 59
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  61. Egophony You will normally hear a muffled long ee sound. • If "ee" sounds like "A" and has a nasal bleating quality, an e-to-a Change, or egophony, is present. • Seen in over consolidation or compression. 3/27/2023 61
  62. Whispered pectoriloquy • Ask the patient to whisper "ninety-nine" or "one-two-three." • The whispered voice is normally heard faintly and indistinctly, if at all. • Louder, clearer whispered sounds are called whispered pectoriloquy seen in mild consolidation. 3/27/2023 62
  63. Pursed lip breathing A breathing practice often taught which includes a long slow expiration against pursed lips. • Seen in COPD • Inflammation of the airways leads to destruction of lung parenchyma results in reduction in elastic recoil fibrosis, and muscle hypertrophy causes increased airways resistance and premature airway closing on expiration or expiratory airflow limitation this results in air trapping at end expiration and with time hyperinflation. 3/27/2023 63
  64. Tracheal tug Downward displacement of thyroid cartilage during inspiration most common- respiratory distress/COPD campbell's sign. • Less common-arch of aorta aneurysm (oliver’s sign). 3/27/2023 64
  65. Barrel chest • Anterioposterior diameter tranverse diameter with ratio of 1:1 • Ribs are horizontal indicated normal. • Downward slope soon in normal aging and hyperinflated lungs such as COPD. • Due to overactivity of scalene and sternocleidomastoid muscle which lifts the upper ribs and sternum and this overase causes remodelling of the chest. 3/27/2023 65
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  67. Pectus excavatum-funnel breast A markedly sunken or concave appearance of sternum and adjacent cartilages depression begins with 2nd intercoastal becoming depressed most at junction of xyphoid process congenital disorder. 3/27/2023 67
  68. Pectus carinatum -pigeon chest A forward protrusion of the sternum with ribs sloping back at either side and vertical depression along costochondral junctions congenital disorder. 3/27/2023 68
  69. Scoliosis A lateral s-shaped curvature of the thoracic and lumbar spine with involved vertebrae rotation. 3/27/2023 69
  70. Kyphosis-dowager's hump Exaggerated posterior curvature of the thoracic spine (humpback). 3/27/2023 70
  71. Harrison's sulcus (harrison's groove) Visible depression of the lower ribs above the costal margin, at the area of attachment of the diaphragm. • Seen in rickets, severe asthma in childhood, cystic fibrosis, pulmonary fibrosis. • Before the bone mineralize and harden the downward tension from the diaphragm and other accessory muscles used during increased respiratory effort can bend the ribs inwards over time. 3/27/2023 71
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  73. Hoover's sign • Paradoxical inward movement of the lower costal margins on inspiration . • Seen in emphysema, chest hyperinflation- C.O.P.D. • When the chest becomes hyperinflated, the diaphragm often becomes stretched, which causes contraction of diaphragm at inspiration results in an inward movement, bringing the costal margins with it, as opposed to normal downward movement. 3/27/2023 73
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  75. Diagnostic evaluation Oximetry:- Arterial 02 saturation can be monitored noninvasively and continuously using a pulse oximetry probe on the finger, toe, ear, forehead, or bridge of the nose. • The abbreviation spo2is used to indicate the o2 saturation of hemoglobin as measured by pulse oximetry. Spo2 and heart rate are displayed on the monitor as digital readings. • Normal spo2 values are 94% to 99% 3/27/2023 75
  76. BLOOD STUDIES Hemoglobin:- • Test reflects the amount of hemoglobin available for combination with oxygen. • Normal-13.5 to18mg/dl (men) , 12 to 16 mg/dl (women) Hematocrit:- • Test reflects ratio of red cells to plasma. • Increased hematocrit found in hypoxemia. • Normal-40 to 54% (men) ,38 to 47 (women) 3/27/2023 76
  77. Arterial blood gases ABGs are obtained to determine oxygenation status and acid-base balance. • ABG analysis includes measurement of the pao2, paco2 (the partial pressure of CO2 in arterial blood), acidity (ph), bicarbonate (HCO3 ), and sa02. • Blood for ABG analysis can be obtained by arterial puncture or from an arterial catheter, which is usually inserted into the radial or femoral artery. • Both techniques allow only intermittent analysis, but an arterial catheter permits abg sampling without repeated arterial punctures. • The normal pao2 decreases with advancing age. 3/27/2023 77
  78. SPUTUM STUDIES Culture and sensitivity:- • Single sputum specimen is collected in a sterile container. • Purpose is to diagnose bacterial infection, select antibiotics and evaluate treatment. • Takes 48-72 hours for results. 3/27/2023 78
  79. Gram stain:- • Staining of sputum permits classification of bacteria into gram negative positive types. • Results guides therapy until culture and sensitivity results are obtained. Acid fast smear and culture:- • Test is to performed to collect sputum for acid fast bacilli. • A series of three early morning specimen is used . 3/27/2023 79
  80. Cytology Single sputum specimen is collected in special container with fixative solution. • Purpose is to determine presence of abnormal cells that may indicate Malignant condition. 3/27/2023 80
  81. Chest x-ray It is most commonly used test for assessment that exposes a patients respiratory system used to assess progressive of disease and response to treatment. • The most common views used are the posterior-anterior view and lateral. 3/27/2023 81
  82. Computed tomography A computed tomography, which exposes a patients to radiation may be used to examine cross section of the entire body. • Used to evaluates areas that are difficulty to assess by conventional x rays. • Common types of CT scan are helical or spiral CT in which contrast dye is usually used in high resolution CT contrast dye is not used. • Spiral CT is most common non invasive imaging procedure used to diagnose pulmonary embolism. 3/27/2023 82
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  84. Magnetic resonance imaging In a strong magnetic field the alignment of spinning nuclei can be changed with a super imposed radio frequency and the rate at which they return to alignment with the field can be measured the patient is not exposed to radiation. 3/27/2023 84
  85. Ventilation-perfusion scan A ventilation perfusion scan is used primarily to check the presence of pulmonary Embolism, but it cannot determine with 100% certainty of the presence of PE. • An iv isotope is given and the pulmonary vasculature is outlined and photographed the patient inhales a radioactive gas (xenon, krypton) which outlines the alveoli and another photograph is taken. 3/27/2023 85
  86. Pulmonary angiography Pulmonary angiography is the most specific examination used to confirm the diagnosis of pulmonary edema. • A series of x-ray is taken after radio opaque dye is injected into the pulmonary artery. This test also detect congenital and acquired lesions of the pulmonary vessels. 3/27/2023 86
  87. Positron emission tomography Positron emission tomography scans the use of radio nuclides with short half lives used to distinguish benign and malignant solitary pulmonary nodules, because malignant lung cells have an increased uptake of glucose. 3/27/2023 87
  88. Bronchoscopy Bronchoscopy is a procedure in which the bronchi are visualised through a fiberoptic tube. • Used to obtain biopsy specimen and assess changes resulting from treatment small amount (30ml) of sterile saline may be injected through the scope and withdrawn and examined for cells ,a technique termed as bronchoalveolar lavage used to diagnose pneumonia, mucus plug, foreign bodies. 3/27/2023 88
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  90. Mediastinoscopy A scopy is inserted through a small incision in the supra sternal notch and advanced through mediastinum to inspect and biopsy lymph nodes. • The test is used to diagnose carcinoma, non-hodgkins lymphoma, granulomatous infections, and sarcoidosis. 3/27/2023 90
  91. Lung biopsy Lung biopsy may be done - 1. Transbronchially 2. Percutaneously or via transthoracic needle aspiration 3. Video assisted thoracic surgery 4. As an open lung biopsy Purpose is to obtain tissue cells or secretion for evaluation. 3/27/2023 91
  92. Thoracentesis It is the insertion of a large bore needle through the chest wall into pleural space to obtain specimen for diagnosis, evaluation, remove pleural fluids, or instil medications into the pleural space. • The patient is positioned upright with elbows in an overbed table and feet supported. • The skin is cleansed and a local anesthetic is instilled subcutaneously. • A test tube may be inserted to permit further drainage of fluids 3/27/2023 92
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  94. Pulmonary function test • Pulmonary function test measures lung volumes and airflow the results of PFT are used to diagnose pulmonary disease, monitor disease progression evaluate disability and evaluate response to bronchodilators airflow is measured by a spirometer and administered by trained personal. • The patients inserts a mouth piece, takes as deep breath as possible and exhales as hard fast and long as possible. 3/27/2023 94
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  96. Spirometry • Spirometry may be ordered before and after the administration of bronchodilator to determine the degree of response. • Home spirometry may be used to monitor lung function in person with asthma or cystic fibriods. 3/27/2023 96
  97. Exercise testing Exercise testing is used to diagnose in determining exercise capacity and for disability evaluation A complete exercise test involves walking on a threadmill while expired. • Oxygen and carbon dioxide, respiratory rate, heart rate, and heart rhythm are monitored a modified test (desaturation test) may be used to monitor spo2. 3/27/2023 97
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  99. Skin test Skin test may be performed to test for allergic reactions or exposure to tuberculosis bacilli or fungai. • It involves the intradermal injection of an antigen. • A positive result on a TB skin test indicate the TB is currently active. • A negative results indicates patients has exposed to TB. 3/27/2023 99
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