1. 51
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) and forced expiratory volume in 1 second (FEV1).
Differentiate obstructive and restrictive pulmonary disease.

3. Lesson Objectives
Upon completion of this lesson, students should be able to:
Identify various pulmonary function tests and determine which are commonly performed by the medical assistant.
Perform spirometry testing.
Educate a patient to properly perform peak flow testing.

4. Lesson Objectives
Upon completion of this lesson, students should be able to:
Assist the physician with patient care by administering a nebulizer treatment.
Operate a pulse oximeter and understand the importance of the results.

5. Pulmonary Function Pulmonology Respiratory system
Study and treatment of diseases of respiratory system
Respiratory system
Trachea
Bronchial tubes
Lungs
Alveoli 5

6. Pulmonary Function Primary function of respiratory
To transport oxygen from lungs via the bloodstream to all cells in the body
To carry waste products (carbon dioxide and water) from the cells via bloodstream to lungs to be exhaled from the body 6

7. The Role of the Medical Assistant in Pulmonology
Pulmonary Function Tests (PFTs)
Evaluates lung volume and capacity
Assists in diagnosis of patients with suspected obstructive or restrictive pulmonary disease processes
To assess effectiveness of drug and other pulmonary therapies

8. The Role of the Medical Assistant in Pulmonology
Pulmonary Function Tests (PFTs)
Performed if patient has asthma, chronic bronchitis, emphysema, cystic fibrosis, or combination of these conditions
May be part of a yearly physical examination and/or pre-employment physical

9. Pulmonary Disorders Pulmonary Condition Symptoms Coughing Wheezing
Cyanosis
Rales
Stridor
Rhonchus
Hemoptysis

10. FIGURE Cyanosis as shown here at the patient’s fingertips results from a lack of oxygen in the tissues. Wellcome Image Library/Custom Medical Stock Photo

11. Pulmonary Disorders Chronic Obstructive Conditions Asthma
Chronic bronchitis
Emphysema
Chronic obstructive pulmonary disease (COPD)
Cystic fibrosis

12. Pulmonary Disorders General Respiratory Conditions
Acute rhinitis (common cold)
Sinusitis
Hay fever
Pharyngitis
Laryngitis
Malignancies

13. Pulmonary Disorders Infectious Conditions Mechanical Injuries
Pneumonia
Influenza
Tuberculosis
Pleuritis
Mechanical Injuries
Pulmonary emboli
Pneumothorax
Hemothorax

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

15. Pulmonary Function Tests
Spirometry
Noninvasive test that measures:
Elasticity of the lungs
Ability to ventilate (exhale)
Strength of respiratory muscles

16. FIGURE Computerized spirometry is used in medical office settings as well as in hospitals and other medical facilities.

17. Pulmonary Function Tests
Spirometry
Most are computerized
Consist of mouthpiece and tubing connected to recording device
Physician compares patient's pulmonary measurements to predicted values for patient's height, weight, age, race, and sex
Clinical status: patient's physical condition at the time of test

18. Pulmonary Function Tests
Forced Vital Capacity (FVC)
Maximum volume of air in liters expelled when patient exhales as forcibly and quickly as possible following one maximum inhalation
Forced Expiratory Volume (FEV)
Volume of air in liters that can be forcefully exhaled

19. Pulmonary Function Tests
Spirometry
Patients with healthy lungs, ratio as high as 90 percent exhaled in first second
Patients with COPD, ratio may fall below 70 percent exhaled in first second

20. Pulmonary Function Tests
Pulmonary Volumes
Tidal volume (VT)
Amount of air inhaled or exhaled during normal breathing (about 500 mL)
Expiratory reserve volume (ERV)
Amount of air that can be forcibly exhaled after a normal exhalation

21. Pulmonary Function Tests
Pulmonary Volumes
Inspiratory reserve volume (IRV)
Amount of air that can be forcibly inspired after a normal inhalation
Residual volume (RV)
Volume of air left in the lungs at the end of an exhalation (around 1,200 mL) 21

22. Pulmonary Function Tests
Pulmonary Capacities
Total lung capacity (TLC)
Volume of the lungs at peak inspiration; equal to sum of the four volumes: tidal, expiratory reserve, inspiratory reserve, residual
Vital capacity (VC)
Amount of air that can be exhaled following forced inspiration and including maximum expiration 22

23. Pulmonary Function Tests
Pulmonary Capacities
Inspiratory capacity (IC)
Amount of air that can be inhaled after normal expiration
Functional residual capacity (FRC)
Amount of air remaining in the lungs after a normal expiration 23

24. Pulmonary Function Tests
Spirometry
Medical assistant will commonly perform spirometry testing as it relates to measuring patient's forced vital capacity
Patient must inhale deeply and exhale as forcefully as possible for as long as possible

25. Pulmonary Function Tests
Spirometry
Preparation begins when patient schedules appointment
Brochure explaining test provided to patient

26. Pulmonary Function Tests
Spirometry
Instruct patient to:
Refrain from smoking
Refrain from eating a large meal for 4 to 6 hours before test
Not to use bronchodilators or nebulizers for 6 hours before test

27. Pulmonary Function Tests
Spirometry
When patient arrives, explain the test, review steps involved, determine if there are reasons test should not be performed
Weigh patient, measure patient's height, and measure and record vital signs

28. Pulmonary Function Tests
Spirometry
Height and weight necessary for calculations after the test
Demonstrate and explain in simple terms what you would like patient to do

29. Pulmonary Function Tests
Spirometry
If patient has ill-fitting dentures ask for these to be removed
Have patient loosen any tight clothing (ties, girdles, bras, belts) that could impede the test
Patient should be encouraged to sit because light-headedness may cause dizziness

30. PROCEDURE Performing a Spirometry Test to Measure Forced Vital Capacity FIGURE A The patient must make a tight seal with the lips around the mouthpiece.

31. Pulmonary Function Tests
Spirometry
Patient's feet should be flat on floor, legs uncrossed, head and chin slightly elevated for entire procedure
Acceptable if patient preferred to stand during procedure; patient comfort important for acceptable results
Have chair nearby if patient should become dizzy during the test

32. Pulmonary Function Tests
Spirometry
Test should be repeated three times successfully (maneuver)
Results normal if patient's best result is 80 percent of pretest calculated values
Spirometric measurements depend on patient effort and on coaching by medical assistant

33. Pulmonary Function Tests
Peak Flow Meter
Measure patient's ability to move air into and out of the lungs
Helps physician develop effective treatment plan
Peak expiratory flow rate (PFER): fastest rate at which patient exhales after taking a maximum breath
Measures liters per second or liters per minute 33

34. FIGURE 51-6 Peak flow meter with marker for the zero position
FIGURE Peak flow meter with marker for the zero position. Blue Planet Earth/Shutterstock

35. Pulmonary Function Tests
Peak Flow Meter
Instruct patient to put mouth around mouthpiece and blow forcibly into meter, which will measure peak expiratory flow rate
Patient should keep a diary of flow rates to see if medication 35

36. Pulmonary Function Tests
Peak Flow Meter
Increased flow rates indicate a desirable response to medication
Helps physician to determine the most effective medication and treatment regimen 36

37. Critical Thinking Questions
What strategies might help you teach this type of procedure?
Would you use different techniques for children? 37

38. Pulmonary Function Tests
Pulse Oximeter
Oxygen content of blood (oxygen saturation)
Oximeter determines oxygen concentration in arterial blood
Reported as SpO2 (saturation of peripheral oxygen) 38

39. Pulmonary Function Tests
Pulse Oximeter
Normal oxygen saturation: 95 to 100 percent
Below 70 percent: life-threatening situations 39

40. FIGURE 51-7 A pulse oximeter. STOCK4B Creative/Getty Images

41. Pulmonary Function Tests
Pulse Oximeter
Selected based on patient's age, size, and condition
Available either cordless or with cords
In adult, fingertip pulse oximeter generally used
Nail polish should be removed for accurate results 41

42. Pulmonary Function Tests
Arterial Blood Gases
Measure amount of oxygen, carbon dioxide, and pH of the blood
Blood gas levels helpful in evaluating breathing conditions such as COPD and pneumonia
Provides information on effectiveness of oxygen treatment and pH of the blood 42

43. Pulmonary Function Tests
Arterial Blood Gases
pH of the blood must be stable between ranges of 7.35 to 7.45 or patient is in life-threatening situation
The more carbon dioxide increases in the blood, the more acid the blood pH becomes 43

44. Pulmonary Function Tests
Arterial Blood Gases
Usually drawn by respiratory specialists or IV technicians
Arterial blood drawn from 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 44

45. Pulmonary Treatments Nebulizers
Deliver medication directly to deeper areas in lungs through fine aerosol mist that is inhaled
Small-volume nebulizer
Sometimes used to treat breathing difficulties 45

46. Pulmonary Treatments Nebulizers Handheld nebulize
Small amount of aerosolized liquid medication mixture placed in chamber; sterile saline or water added 46

47. FIGURE 51-8A Nebulizing equipment and inhaler medications
FIGURE 51-8A Nebulizing equipment and inhaler medications. Sarema/Shutterstock

48. Pulmonary Treatments Nebulizers
Patient puts nebulizer in mouth and breathes deeply for 8 to 10 minutes
High-pressure gas stream of air or oxygen passes through small opening creating the aerosol
Aerosol delivered into patient's respiratory tract through mouthpiece or mask 48

49. FIGURE 51-8B Nebulized medications can be delivered through a mouthpiece. Juanmonino/Getty Images

50. FIGURE 51-8C Nebulized medications can also be delivered through a mask. Juanmonino/Getty Images

51. Pulmonary Treatments Nebulizers
Note patient's baseline data (auscultation, vital signs, oximeter reading, peak expiratory flow rate)
Assemble handheld nebulizer and select a mouthpiece or a mask for delivery
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 51

52. Pulmonary Treatments Nebulizers
Mask should be used only when patient is unable to take treatment with a mouthpiece
Measure proper dosage of drug and diluent into nebulizer
Set gas flow to nebulizer at 6 to 8 L/min
Position patient in a semi-Fowler's position or in as seated position 52

53. Pulmonary Treatments Nebulizers
Instruct patient to take deep breaths, from time to time, and to hold a breath for about three to five seconds
Treatment will end when aerosol stops flowing
Monitor and evaluate patient's response to the treatment 53

54. Pulmonary Treatments Nebulizers
Encourage patient to cough well, quantifying amount and describing type of sputum if cough is productive
Monitor patient's pulse, breath sounds, peak expiratory flow rates, blood oxygenation 54

55. Pulmonary Treatments Nebulizers
Disassemble and store equipment properly
Record the data in patient's chart 55

56. Pulmonary Treatments Inhalers
Delivers measured amount of medication into respiratory tract to dilate the airways
Metered-dose inhaler (MDI) holds about 200 doses of prescribed medication in a pressurized container with an attached mouthpiece 56

57. FIGURE 51-9 (A) A metered-dose inhaler
FIGURE (A) A metered-dose inhaler. (B) A metered-dose inhaler with a spacer. (A) Zvyagintsev Sergey/Shutterstock; (B) David Freund/Getty Images

58. Pulmonary Treatments Inhalers
As with instructions on how to use nebulizers, demonstrate for patient first and then ask him or her to repeat demonstration for you
Provide written material to the patient
Patient should put mouth over mouthpiece of inhaler and inhale when medication container is pressed into inhaler 58

59. Pulmonary Treatments Inhalers
Spacer (extender) is used to improve delivery and to facilitate absorption of medication
A puff of medication will be dispensed
After dose is dispensed, remove medication and clean plastic inhaler with soap and water 59

60. FIGURE 51-10 Delivery of medication to the lungs using a metereddose inhaler extender.

61. Questions? 61