1. Pulmonary Function Lesson 1: Pulmonary Functions50
Pulmonary Function
Lesson 1:
Pulmonary Functions

2. Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
Explain forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximal midexpiratory flow (MMEF).
Differentiate between obstructive and restrictive pulmonary disease.

3. Lesson Objectives Operate pulmonary function equipment.
Identify by name and function the controls on a spirometer.
Perform spirometry testing.
Educate a patient to properly perform peak flow testing.
Operate a pulse oximeter and understand the importance of the results.

4. Pulmonary Function 4

5. Pulmonary Function
Pulmonology is the study and treatment of diseases of the respiratory system
The respiratory system includes trachea, bronchial tubes, lungs and alveoli
The primary function of the respiratory system is to transport oxygen to the lungs via the blood stream to all the cells in the body and carry waste products (carbon dioxide and water) to the outside of the body for elimination 5

6. Purpose of Pulmonary Function Tests
Evaluate lung volume and capacity
Assist in the differential diagnosis of patients with suspected obstructive or restrictive pulmonary disease processes
Assess the effectiveness of drug therapies

7. Upper Respiratory Conditions
Acute rhinitis (common cold)
Sinusitis
Hay fever
Pharyngitis
Laryngitis

8. Lower Respiratory Conditions
Obstructive diseases: chronic obstructive pulmonary disease (COPD), asthma, acute bronchitis, emphysema
Infectious diseases: pneumonia, influenza, tuberculosis, pleuritis, Legionnaire’s disease
Malignancies: cancer of the lungs and larynx and other organs
Mechanical injuries: pulmonary emboli, pneumothorax, hemothorax

9. Signs and Symptoms of Respiratory Conditions
Coughing: dry or productive (sputum)
Wheezing
Cyanosis due to lack of oxygen
Rales: crackles
Stridor: harsh, high-pitched sounds
Rhonchus: sounds of wheezing or squeaking heard when listening to chest
Hemoptysis: blood in sputum

10. Examples of Pulmonary Disorders
Asthma
Spasms of the bronchial tubes or swelling of the mucous membranes
Chronic bronchitis
Inflammation of the bronchial mucous membranes
Cystic fibrosis
Faulty exocrine glands secrete too much mucus, which obstructs the lungs
Emphysema
Permanent enlargement of air spaces beyond the terminal bronchioles

11. Types of Pulmonary Function Tests
Spirometery
Arterial blood gases
Lung volumes
Pulse oximetry
Diffusion capacity
Cardiopulmonary exercise tests

12. Spirometry
Noninvasive test that measures the ability of the lungs to exhale
Diagnostic spirometer is used to evaluate the patient’s ability to ventilate during a maximum forced exhale
Device measures and records the volume exhaled in a specific length of time (1 second, 3 seconds etc.)

13. Spirometry
Air movement is recorded on special paper with a vertical mark for each second and a horizontal mark for each liter of oxygen
Forced vital capacity (FVC) is the maximum volume of air expelled when the patient exhales as forcibly and quickly as possible following one inhalation

14. Spirometry
Patient must exhale as much air as possible and continue to exhale for 6 seconds to be considered a satisfactory test

15. Spirometry At least three efforts at exhaling must be demonstrated
Forced expiratory volume after 1 second (FEV1) is the volume of air in liters that is forcefully exhaled in the first second of exhalation
In patients with healthy lungs about 70 – 75 percent of air is exhaled in the first second

16. Spirometry The values are often reported as a ratio FEV1/FVC
Patients with normal lungs may have a ratio of 90 percent

17. Lung Volumes Tidal Volume (VT) Expiratory Reserve Volume (ERV)
Volume of air entering or leaving the lungs during normal breathing
Expiratory Reserve Volume (ERV)
Volume of air that can be expired after a normal expiration
Inspiratory Reserve Volume (IRV)
Volume of air that can be forcibly inspired after a normal inhale 17

18. Lung Volumes Residual Volume (RV)
Volume of air left in the lungs at the end of an exhale (around 1200mL) 18

19. Lung Capacities Total Lung Capacity (TLC) Vital Capacity (VC)
Volume of the lungs at peak inspiration; equal to the sum of the four volumes: tidal volume, expiratory reserve volume, inspiratory reserve volume, residual volume
Vital Capacity (VC)
Amount of air that can be exhaled following forced inspiration and including maximum expiration 19

20. Lung Capacities Inspiratory Capacity (IC)
Maximum volume that can be inhaled after a normal expiration
Functional Residual Capacity (FRC)
Volume of air left in the lungs after a normal expiration = ERV + RV 20

21. Volume Capacity Spirometry
Diagnostic spirometer used to evaluate the patient’s ability to ventilate during a maximum forced exhale
Device measures and records the volume exhaled and the time required to complete it

22. Volume Capacity Spirometry
Air movement is recorded on special paper with vertical second marks and horizontal liter marks in one of three ways:
Forced vital capacity (FVC): maximum amount of air exhaled after maximum inspiration during one of the two timed FVCs
Forced expiratory volume in 1 second (FEV1): amount of air exhaled during the first second of FVC maneuver
Maximal midexpiratory flow (MMEF): average flow rate during middle half of FVC

23. Preparing a Patient for a Spirometry Test
When the procedure is scheduled, a brochure explaining the test should be provided to the patient
Instruct the patient to refrain from smoking and eating a large meal for 4 to 6 hours and to not use bronchodilators or nebulizers for 6 hours prior to the test

24. Preparing a Patient for a Spirometry Test
On arrival, again explain the test, the steps involved, and determine if there are reasons the test should not be performed such as flu, cold, or allergy
Weigh, measure the patient’s height, and record vital signs
Demonstrate and explain in simple terms what you would like the patient to do

25. Patient Instructions
If the patient has ill-fitting dentures ask these to be removed
Have the patient loosen any tight clothing, ties, girdles, bras, or belts that could impede the test
Patient should be encouraged to sit because light-headedness may cause dizziness

26. Patient Instructions
Patient’s feet should be flat on the floor, legs uncrossed, and head and chin slightly elevated for the entire procedure
If the patient prefers a standing versus sitting position, it is acceptable because that makes no difference with the results, and patient comfort is important

27. Purpose of the Peak Flow Meter
Peak flow meter: A portable, inexpensive handheld device used to measure how air flows from the lungs in one fast breath 27

28. Purpose of the Peak Flow Meter
Measures
Patient’s ability to move air in and out of the lungs
Fastest rate at which the patient exhales after taking a maximum breath (peak expiratory flow rate, or PEFR)
Helps physician identify patterns of breathing problems and determine appropriate treatment 28

29. Patient Use of the Peak Flow Meter
Uses the meter at home to monitor breathing over time
Takes baseline reading on a “good” day
Compares other days to baseline 29

30. Role of the Medical Assistant
Teach patient and family members the procedure for using the peak flow meter
Peak flow meters may be used at home
Patients need to be taught and practice in the office until it is assured that they can do the procedure correctly 30

31. Critical Thinking Question
What strategies might help you teach this type of procedure?
Would you use different techniques for children? 31

32. Instructions to Patient
Put mouth securely over the mouthpiece
Blow forcibly into the meter
Meter measures your peak expiratory flow rate
Record your meter readings as directed
Readings provide information on effectiveness of treatments 32

33. Purpose of the Oximeter
Determines the oxygen content of the blood or oxygen saturation
Allows for the measurement of blood oxygenation indirectly at times before clinical signs of hypoxia are present
Can be used to measure content over time or at different levels of exertion 33

34. Use of the Oximeter General instructions
Attach the sensor following the manufacturer’s directions
Connect the sensor to the pulse oximeter
Record the oxygen saturation level in the patient’s record at intervals ordered by the physician
If the oxygen saturation level is abnormal, follow facility protocol for notifying supervisors or the physician 34

35. Influences on Oximetry
Burdick pulse oximeter. Source: Courtesy of Cardiac Science Corp. 35

36. Arterial Blood Gases
Measure the amount of oxygen, carbon dioxide, and pH of the blood
Blood gas levels are helpful in evaluating breathing conditions such as COPD and pneumonia
Provide information on the effectiveness of oxygen treatment and the pH of the blood 36

37. Arterial Blood Gases
The pH of the blood must be stable between the ranges of 7.35 to 7.45 or the patient is in a life-threatening situation
The more carbon dioxide increases in the blood the more acid the blood pH becomes 37

38. Arterial Blood Gases
Usually drawn by respiratory specialists or IV technicians
Arterial blood is drawn from the wrist, groin, or arm after cleansing the site
Specimen must be kept on ice and tested immediately
Direct pressure to the area is applied for 5 to 15 minutes to prevent bleeding 38

39. Nebulizers Deliver medication directly to deeper areas in the lungs
The small-volume nebulizer is sometimes used to treat breathing difficulties 39

40. Nebulizers
If a handheld nebulizer is used, a small amount of aerosolized liquid medication mixture is placed in a chamber
Then the patient is asked to put the nebulizer in the mouth and breathe deeply for 8 to 10 minutes
A high-pressure gas stream of either air or oxygen passing through a small opening actually creates the aerosol
The aerosol is then delivered into the patient through either a mouthpiece or a mask 40

41. Procedure for a Nebulizer
Note the patient’s baseline data (auscultation, vital signs, oximeter reading, and peak expiratory flow rate)
Assemble the handheld nebulizer and select a mouthpiece or a mask for delivery 41

42. Procedure for a Nebulizer
Using a mask can decrease the amount of drug that reaches the lungs by about 1 or 2 percent because of deposition on the face
The mask should be used only when the patient is unable to take the treatment with a mouthpiece
Measure the proper dosage of drug and diluent into the nebulizer 42

43. Procedure for a Nebulizer
Set the gas flow to the nebulizer at 6 to 8 L/min
Position the patient in a semi-Fowler’s position
Implement the therapy and encourage the patient to breathe slowly through the mouth
Instruct the patient to deeply inspire periodically and to hold a breath for about 4 to 10 seconds 43

44. Procedure for a Nebulizer
When no aerosol is flowing, discontinue treatment
Monitor and evaluate the patient’s response to the treatment
Encourage the patient to cough well, quantifying the amount and describing the type of sputum if the cough is productive
Monitor the patient’s pulse, breath sounds, peak expiratory flow rates, and blood oxygenation 44

45. Procedure for a Nebulizer
Disassemble and store the equipment properly
Record the data in the patient’s chart 45

46. Inhalers
Used to deliver a measured amount of medication directly into the respiratory tract to dilate the airways
One type of inhaler, a metered-dose inhaler (MDI), holds about 200 doses of the prescribed medication in a pressurized container with an attached mouthpiece
Patient teaching is very important because MDIs are frequently misused, resulting in inadequate treatment 46

47. Inhalers
As with instructions on how to properly use nebulizers, demonstrate for the patient first and then ask him or her to repeat the demonstration for you
Written backup material is provided to the patient as well 47

48. Procedure for use of an Inhaler
The patient should put the mouth over the mouthpiece of the inhaler and inhale when the medication container is pressed into the inhaler 48

49. Procedure for use of an Inhaler
An extender is used to improve the delivery and to facilitate absorption of the medication
A puff of medication will be dispensed
After the dose is dispensed, remove the medication and clean the plastic inhaler with soap and water 49

50. Questions? 50