Agenda

� Evidence based guidelines:� Each take one, read, analyze, write up, report

� WinSim practice assessment test:� Run WinSim, 178assess.dat� Check your score, should get > 70%

� PFT testing ppt & practice test� Test 3 Patient-ventilator interaction

PFT’s� Provides the basis for classifying pulmonary

diseases into two major classifications:

� Obstructive

� Restrictive

ResistanceResistance

ResistanceResistance

PFT’s

Characteristics Obstructive Restrictive

Anatomy affected Airways Non-airways

Breathing phasedifficulty

Expiration Inspiration

Pathophysiology Increasedairwayresistance

Decreasedlungcompliance

Usefulmeasurements

Flows Volumes

PFT’s

� Obstructive� affects the airways (increased airway resistance)

� Restrictive� affects the alveoli� the thoracic cage or� the accessory muscles

Research or Lab PFT’s

� Considered a Diagnostic Test� Can be used to diagnosis the following types

of patients:� Severity of disease� Pre-Op� Reversibility of disease (bronchodilator)� Obstructive Vs. Restrictive� Pt. c/o of SOB

PFT’s� Can be performed at the bedside.

� Not as complete

� Or a Full PFT could be performed.� Equipment used to perform a bedside PFT� Wright� Drager� Bourns

Bedside or Screening PFT’s

� Not Considered a Diagnostic Test� Can NOT be used to diagnosis ANYTHING!� Can be used (UCC) to identify the

reversibility of disease (bronchodilator)� Screen for Obstructive Vs. Restrictive� Screening NOT diagnosis!!!

PFT’s

� What does bedside spirometry measure?� VC FVC FEV1sec FVC1%� Vt� RR� VE� MNIP� Cannot measure: RV, FRC or TLC

Public PFT Screening

�Provides the basis for identifying people who may have the early stages of pulmonary disease.� Uses two major classifications:

�Obstructive�Restrictive

PFT Classification & Characteristics

Characteristics Obstructive Restrictive

Anatomy affected Airways Non-airways

Breathing phasedifficulty

Expiration Inspiration

Pathophysiology Increasedairwayresistance

Decreasedlungcompliance

Usefulmeasurements

Flows Volumes

PFT’s

� Obstructive� affects the airways (increased airway resistance)

� Bronchospasm� Airway edema� Fixed

� Tumor� Foreign object

� Restrictive� affects the alveoli� the thoracic cage or� the accessory muscles

Equations

FEV1% =Actual FEV1

Actual VC

This is the screening equation, % of actual VC patientcan expire in one second. If less than 80%, need Further testing, may have obstructive changes.

Equations

VC% of Predicted =Actual VC

Pred. VC

This is the screening equation, % of actual VC patientcan expire compared to predicted for age and sex.If less than 80%, need further testing, may haverestrictive changes.

� What are you testing?� What does this mean?� Will I die?

� Yes � No

� Am I abnormal?� Do I have lung disease?� What is an FVC? FEV1%, Etc. on my sheet?

Counseling: What does the test mean?

Counseling: Smoking effects on lung

� How does it effect lung function, can you explain it? In lay terms?

� What if they have smoked but test is okay, what do you say?

� What if test is not okay?� If they quit, how will it help?� If they say should I show this to my MD?

Counseling Continued..

� Subject: Chest Xray and Lung questionTopic Area: Respiratory - OtherForum: The Respiratory Disorders ForumQuestion Posted By: Karen03 on Friday, March 07, 2003

� Hello

I am an ex smoker of almost a year now. I smoked about 15 yrs. I have always worried about the damage I have done but know that I cannot turn back time so I try to just be happy I quit and move ahead.

I have had 3 chest xrays over the past year ( I have a herniation in 2 areas so I've had back and chest xrays). I was always pleased to read that "lungs appear clear" yet in my non-smoking group (QuitNet) someone said I shouldn't be happy about that because only a cat scan of the lungs will show tumors not chest xrays.

Is this true? Is a chest xray not accurate?

ANSWER:You should be “pleased to read that “lungs appear clear…”, indicating that your chest x-rays have shown no sign of tumor. Most lung tumors are diagnosed by chest x-ray. A chest CT scan shows more detail than a plain chest x-ray. Since a CT scan is more sensitive it allows for detection of lung tumors at an earlier stage in their growth. Sputum cytology is another way to detect tumors early, sometimes even before they are visible on a CT scan. Sputum or mucus that is coughed up from the lungs is examined for tumor cells.

The best way to uncover a breathing problem before it may show up on a chest x-ray is with breathing tests. Spirometry is a simple breathing test. It measures how your lungs are working. Pulmonary function tests are a variety of breathing tests that provide detailed information about how your lungs are working. With these breathing tests it may be possible to find a lung problem before you are having symptoms.

Acceptable Statements

� Good test, keep up the good work, don’t start smoking!

� Your test is okay, however it is on the low end of normal, perhaps the smoking has started to have some effects, stop now and the effects can be reversed in 2 years.

� Your test is below the screening percent, which indicates further testing is needed to determine if they are below normal, take these results and let your physician decide if further testing is needed, and stop smoking!

Acceptable Statements

� If you continue to smoke, the test results will keep decreasing indicating your lung is not functioning to it full capacity.

� These tests are for screening purposes only, not for diagnostic testing, we cannot diagnose lung disease, only classify function according to these preliminary screens.