PATIENT ASSESSMENT

GLOSSARY OF TERMS

| Course 601 | Post Test |

Acidemia - abnormally high level of acid in the blood, low pH (< 7.35

Acidosis - condition resulting from accumulation of acid in the blood and tissues

Acute - In medical language, relatively brief in time. Example, a cold or flu is an acute illness.

Acute Interstitial Pneumonia (AIP) - Formerly called Hamman-Rich Syndrome (or disease), AIP has been redefined as a specific idiopathic interstitial pneumonia

Adult Respiratory Distress Syndrome (ARDS) - respiratory failure of sudden onset characterized by leakage of plasma into the lungs via damaged capillaries, resulting in fluid accumulation which deprives the lungs of their ability to expand. ARDS is a medical emergency. [ARDS Support Center website]

Air sacs - see Alveoli

Air trapping - the air caught behind collapsed bronchial branches during expiration

Airway - a passageway for air into or out of the lungs.

Airway Collapse - Actual collapse or closure of branches of the bronchial tree, caused by weakened bronchial walls secondary to disease.

All Trans Retinoic Acid (ATRA) - Vitamin A derivative being investigated for possible tissue regeneration in patients with mild to moderate emphysema. ATRA is known to be toxic when used systemically, but its use in treating acute promyelocytic leukemia (APL) has shown promising results (see ATRA Syndrome)

Alkalemia - a blood pH above normal (> 7.45).

Alpha1 Antitrypsin Deficiency (A1AD) - an inherited recessive disorder resulting in low or no production of Alpha1 Antitrypsin. Lack of this protein leads to organ damage, mainly to the liver and lung. [Alpha1 Assn]

Alveolar Macrophage (AM) - A cell in the lungs which engulfs bacteria and foreign material and produces enzymes to protect the lung.

Alveoli (pl) (singular: alveolus) - tiny air sacs at the end of the bronchioles where oxygen crosses capillaries into the bloodstream, exchanging it for carbon dioxide crossing from the bloodstream into the alveoli to be exhaled. Adults have roughly 300 million microscopic alveoli in their lungs

Antibiotic - medication that interferes with the growth of bacteria and may stop an infection.

Anti-inflammatory - a drug used to fight inflammation

Apnea - the absence of spontaneous respiration

Arterial Blood Gases (ABG) - a lab test of arterial blood (usually taken from the wrist) which measures carbon dioxide and oxygen levels as well as acid-base status.
Normal ABG values: pH 7.32 to 7.45
PO2 80 to 98 mmHg
PCO2 35 to 45 mmHg
SaO2 96 to 98%
SaO2 of 90% or above is considered adequate to support tissues and body functions. At less than 90% tissues and organs begin to suffer and supplemental oxygen may be prescribed.

Artery - one of the tubular branching vessels that carry blood from the heart to the organs and parts of the body; arteries usually carry oxygenated blood.

Asthma - a chronic inflammatory airway disease characterized by airway narrowing, bronchospasm and wheezing; asthma is considered a reversible condition. Asthma is often called a reactive airway disease when it's expected to be of short duration, i.e. 'outgrown' as a child ages.

Asthmatic Bronchitis - Coexistence of wheezing and chronic bronchitis.

Atelectasis - incomplete expansion of the lung

ATRA - See All Trans Retinoic Acid

ATRA Syndrome - a life-threatening complication that can occur during the treatment of acute promyelocytic leukemia (APL) by ATRA. Main clinical signs are respiratory distress, fever, pulmonary infiltrates, weight gain, pleural effusion, renal failure, pericardial effusion, cardiac failure and hypotension.

Bacteria - single-celled organisms which cause infections; they are usually treated with antibiotics.

Barrel chest - the shape of the chest in some patients with COPD when air trapping causes over-inflated lungs

BiPAP - Bi-Level Positive Airway Pressure - a machine which administers air under pressure via a nose mask to keep airways open and unobstructed. Respironics' (BiPAP®) units track the patient's breathing and lower the pressure during exhalation.

Blebs - Air-filled cysts near or on the surface of the lung. Blebs are less than 1cm in diameter. Compare to bullae

Blebs Disease - see Spontaneous Pneumonothorax

Blood Pressure (BP) - force exerted by the blood on the walls of the main arteries of the body. BP measurements are made both when the heart's ventricles are contracting (systolic pressure), and when the ventricles are at rest (diastolic pressure). In a young adult, a healthy pressure averages 120 systolic and 80 diastolic (recorded as 120/80). Hypertension occurs when BP is too high; hypotension is too low a BP. [symptoms of hypotension]

Blue Bloater - term for the COPD patient whose symptoms include hypoxemia, secondary polycythemia, CO2 retention, pulmonary hypertension and cor pulmonale. Compare to Pink Puffer Term is rarely used anymore.

Body Box - see Plethysmography (THIS ONE'S FOR THE LIVING!!)

Bone Mineral Density (BMD) - bone density is the amount of bone tissue in a certain volume of bone. This measurement is taken using a special x-ray called quantitative computed tomogram

Bradypnea - decreased breathing rate, usually under ten breaths per minute. Bradypnea is often caused by the administration of narcotic analgesics such as morphine.

Bronchi (pl) (singular: bronchus) - branches of the bronchial tree

Bronchial tree - term used to describe the ductwork of the respiratory system which branch like a tree, the terminal 'branches' leading to the alveoli.

Bronchiectasis - a chronic inflammatory or degenerative condition of bronchi or bronchioles marked by dilation and loss of elasticity of the walls.

Bronchioles - tiniest branches of the bronchial tree, they lead into the alveoli

Bronchiolitis Obliterans (BO) - an obstructive process involving small airways in the lung periphery. It may occur following a bout of pneumonia or lung transplantation.

Bronchiolitis Obliterans Organizing Pneumonia (BOOP) - obstructive condition characterized by granulation tissue plugs within the small airways. This abnormal tissue extends into alveolar ducts and alveoli.
Bronchitis - acute or chronic inflammation of the bronchial airways or any part of them.

Acute Bronchitis - inflammation of cells lining the bronchi causes production of yellow or gray mucus which clogs airways resulting in shortness of breath, wheezing and pain in upper chest, especially when coughing.

Chronic Bronchitis - to be considered chronic, there must be a productive cough on most days for at least three months of the year, for at least two consecutive years.

Bronchoalveolar Lavage (BAL) - during bronchoscopy, a small amount of saline is injected into the distal (far) portions of the lung, then aspirated back through the bronchoscope, washing out the alveoli. The material recovered is then analyzed for cell count, differential or foreign bodies.

Bronchodilator - a drug that relaxes the smooth muscles in the constricted airway.

Bronchoscopy - a procedure where a lighted bronchoscope is inserted through the nose or throat to allow visual examination of the trachea, bronchi and select bronchioles.

Broncopulmonary Dysplasia (BPD) - abnormal development of the lung that results from oxygen toxicity in premature infants who receive prolonged respiratory assistance for hyaline membrane disease.

Bronchospasm - constriction of air passages of the lung by spasmodic contraction of the bronchial muscles, obstructing the flow of air.

Bullae (pl) (singular: bulla) - large air spaces within the lung, >1-2 cm in diameter, formed by ruptured alveoli. Compare to blebs.

Bullous Disease - See Vanishing Lung - also known as type 1 bullous disease and primary bullous disease of the lung

Carbon Dioxide (CO2) - a colorless, odorless, nonflammable gas produced in respiration, and given off by the tissues to the blood, to be exhaled by the lungs in exchange for oxygen.

Cardiopulmonary (C/P) - pertaining to both heart and lungs

Chest X-Ray (CXR) - images of the chest cavity can be used to assess lung disease. Dense structures of the body, like bone, will appear white; air will be indicated by areas in black ('air' is a void which can't be photographed). All other structures will appear as shades of gray.

Chronic - refers to a disease or disorder that shows little change in symptoms from day to day, but implies a continuing disease process with progressive deterioration.

Chronic Lung Disease (CLD) - broad term covering both obstructive conditions, characterized by a slow rate of forced expiration, and restrictive disease characterized by a reduction in total lung capacity.

Chronic Obstructive Pulmonary Disease (COPD) - COPD is diagnosed when chronic bronchitis and emphysema present themselves as one disease, most often in smokers and former smokers. The definition of COPD recognized by both the American Thoracic Society and the European Respiratory Society is a disorder characterized by reduced maximal expiratory flow and slow forced emptying of the lungs; features that do not change markedly over several months. This airflow limitation is only minimally reversible with bronchodilators.

Cilia (pl) - tiny hairlike cells that line the airways and beat constantly toward the pharynx to assist in removal of mucus and dust particles.

Clubbing - refers to a condition where tips of the fingers enlarge and the nails become curved from front to back as a result of chronic low blood-oxygen levels.
Clubbing has 'reversed' in patients who underwent lung transplantation.
Compliance (Patient compliance) - in medical language, the practice of following medical direction fully and correctly.

Computerized Axial Tomography Scan (CAT or CT) - An x-ray procedure that uses a computer to produce a series of three dimensional images of the body and it's organs.

Congestive Heart Failure (CHF) - failure of the heart to maintain adequate blood circulation

Conserver - see Oxygen Conserver

Continuous Positive Airway Pressure (CPAP) - a machine which administers a continuous flow of air under pressure via a nose mask to keep airways open and unobstructed.

Cor Pulmonale - enlargement of the right ventricle resulting from pulmonary hypertension secondary to lung disorders

Corticosteroid - natural or synthetic hormones like those produced by the body's adrenal glands which are used to reduce swelling and inflammation

CPAP Titration (Test) - see Oximetry

Cyanosis - dusky bluish or purplish tinge to the skin caused by insufficient blood oxygen

Cystic Fibrosis (CF) - a disease of the mucus and sweat glands which causes disorders of the lungs and pancreas.
CF is the leading cause of chronic lung disease in children and young adults, and the most common fatal hereditary disorder affecting Caucasians in the US.

Demand Positive Airway Pressure (DPAP) - This machine monitors breathing. If spontaneous respiration doesn't occur within eight seconds, DPAP will provide the patient a 'breath' at whatever pressure flow necessary to move air into the lungs. Indications for DPAP usage is intolerable use of CPAP.

Desaturation - term commonly used to indicate decrease in oxygen saturation of hemoglobin.

Desquamative Interstitial Pneumonitis (DIP) - thought by some to be an early stage of idiopathic pulmonary fibrosis. This type of interstitial pneumonia occurs in current or past smokers

Diaphragm - a dome shaped muscle above the abdomen and below the lungs. When it contracts it creates negative pressure within the chest allowing air to be drawn into the lungs.

Diffuse Alveolar Disease (DAD) - See IPF

Diffusion - movement of oxygen or carbon dioxide across the membrane of the alveoli

Dyspnea - difficult or labored breathing; air hunger

Echocardiogram (ECHO) - a picture of the heart produced on a television screen by 'echoes' of ultrasound

Edema -an abnormal accumulation of fluid in connective tissue causing puffy swelling

Elastic recoil - ability of the lung to 'snap back' at the end of inspiration.

Electrocardiogram (ECG or EKG) - a record of the electrical activity of the heart; it records electrical impulses preceding contraction of the heart muscle.

Embolism - the sudden blocking of an artery by an embolus carried to thesite by the blood flow.

Embolus - clot, or foreign material (such as a fat globule)

Emphysema - a chronic obstructive pulmonary disease characterized by dilation and destruction of alveoli leading to large air spaces, decreased elastic recoil and air trapping. Emphysema is one of two conditions which present as a singular disease called COPD; the other is chronic bronchitis.

Endotracheal Tube (ET) - a tube which by which a patient is connected to a respirator, it's inserted through the patient's mouth or nose, passes through the throat (and vocal cords), and into the air passages. The patient will be unable to speak while the tube is in place.

End-stage Emphysema - "End-stage refers to the patient for whom the damage to their lungs has reached a stage where symptoms severely affect their quality of life and has begun to affect other organs, such as the heart. Drugs, progressive exercise programs, oxygen, lung reduction surgery, and ultimately lung transplants are considered in a step-wise fashion to maximize the oxygen delivery from what lung tissue remains."

End-stage Organ Disease - a disease that ultimately leads to functional organ failure. Examples: emphysema (lungs), cardiomyopathy (heart), and polycystic kidney disease (kidneys).

Etiology - the cause or origin of a disease or disorder.

Eupnea - normal respiration; implies normal tidal volume, with respiratory rate (adults) about 14-18

Exacerbation - a period when a disease or medical condition becomes worse.

Expiration - breathing out; exhaling

Expiratory Reserve Volume (ERV) - maximal amount of air that can be expired starting at Functional Residual Capacity (FRC).

Extracorporeal Membrane Oxygenator (ECMO) - a device that acts as an artificial lung, oxygenating the blood that passes through it from the patient's blood vessels.

Exudate - the material composed of serum, fibrin and white blood cells in variable amounts that escapes from blood vessels into a superficial lesion

Fibrosis - a condition marked by relative increase in formation of interstitial fibrous tissue in any organ or region of the body (scar tissue is fibrous)

Flutter® - Brand name of a mucus clearing device

Forced Expiratory Flow (FEF) - a flow rate measurement of how much air can be expired from the lungs

Forced Expiratory Volume (FEV1) - the amount of air expelled the first second following maximal inspiration during the test for vital capacity

Forced Vital Capacity (FVC) - Forced vital capacity is the maximum volume of gas that can be expired forcefully after a maximum inspiration.

Functional Residual Capacity (FRC) - lung volume at the end of normal expiration.
At FRC, the tendency of the lungs to collapse is exactly balanced by the tendency of the chest wall to expand.

Gastroesophageal Reflux Disease (GERD) - flow of stomach contents back up into the esophagus.

Gunk - slang term for mucus.

Heart Rate (HR)- pulse; number of times the heart beats in one minute

Hypercapnia - an abnormally high carbon dioxide level in the blood (pCO2>45 mmHg)
Symptoms:
increased respiratory rate
headache
confusion
nausea and/or vomiting
lethargy

Hypertension - abnormally high blood pressure

Hyperventilate - to breathe abnormally fast and deep, resulting in excessive amounts of oxygen in the lungs and reduced carbon dioxide levels in the blood

Hypotension - abnormally low blood pressure
Symptoms:
lightheadedness
fainting
weak pulse
sweats
loss of circulation in the limbs

Hypoxemia - deficient oxygenation of the blood (PaO2 <55 mmHg or Sa02 <85%) [Hazards of hypoxemia: How to protect your patient from low oxygen levels CME Module]
Symptoms:
tachycardia is primary response
anxiety
agitation / mood changes
forgetfulness
inability to concentrate
altered levels of consciousness
pallor - skin may feel cool and clammy
Cyanosis is a late sign of hypoxemia

Hypoxia - deficiency of oxygen reaching tissues of the body

Idiopathic - of no known apparent cause or origin

Idiopathic Pulmonary Fibrosis (IPF) - Term for interstitial lung disease of unknown origin. Also called pulmonary fibrosis.

Immotile Cilia Syndrome (ICS) - Immotile Cilia Syndrome occurs when cilia in the body are unable to move. See PCD for more.

Immune System - a complex network of specialized cells and organs that protects the body against attack by "foreign invaders." When functioning properly it produces antibodies to fight off infections from bacteria, virus, fungi and other parasites.

Inflammation - redness, warmth and swelling in tissue following infection or injury; the immune system's protective reaction to an irritant. Chronic inflammation usually involves formation of new connective tissue. In COPD it can lead to airway obstruction; with ILD this causes a reduction in lung capacity.

Inhaler - the dispenser for metered-dose medications [Instructions for using an inhaler]

Inspiration - breathing in

Inspiratory Capacity (IC) - the maximal volume that can be inspired after a normal (non forced) expiration

Inspiratory Muscle Trainer (IMT) - a small device used to exercise and strengthen respiratory muscle endurance

Inspiratory Reserve Volume (IRV) - additional volume that can be inspired with maximum effort after a normal inspiration.

Interstitial - refers to tissue between alveoli of the lungs (called interstitium); outside the vascular system interstitial refers to the space in the tissues between cells

Interstitial Lung Disease (ILD) - term which includes more than 130 lung disorders characterized by fibrosing (scarring) in the lungs. A common link between various types of ILD is they all begin with an inflammation of known or unknown origin. Also called Pulmonary Fibrosis.
- Inflammation involving the bronchioles is called bronchiolitis
- Inflammation involving the alveoli (air sacs) is called alveolitis
- Inflammation involving the small blood vessels is called vasculitis.
When the cause of ILD is unknown, it's called "idiopathic" See pulmonary fibrosis for a partial list of terms which refer to interstitial lung disease
.

Kartagener's Syndrome (KS) - a condition where the heart is located on the right side of the body in patients with Immotile Cilia Syndrome

LAM - See Lymphangioleiomyomatosis

Lung - one of a pair of breathing organs located within the chest which remove carbon dioxide from and bring oxygen to the blood.

Lung Transplant (TX or XP) - surgery to replace one or both diseasedlungs with healthy ones from a human donor. [transplant links]

Lung Volume Reduction Surgery (LVRS) - Reduction Pneumoplasty is performed on patients with emphysema and chronic obstructive pulmonary disease (COPD). Varied surgical procedures allow the compressed lung to expand, thus establishing improved respiratory function. LVRS is also referred to as lung shaving, lung contouring, thoracoscopic bullectomy or simply lung reduction.

Lymphangioleiomyomatosis (LAM) - rare lung disease that affects only women; abnormal muscle cells invade the lung and airways, as well as blood and lymph vessels, causing them to become obstructed.

Lymphocytic Interstitial Pneumonia (LIP) - Lymphocytic interstitial pneumonia is a syndrome of fever, cough and dyspnea, with bibasilar pulmonary infiltrates consisting of dense interstitial accumulations of lymphocytes and plasma cells.

Magnetic Resonance Imaging (MRI) - a diagnostic technique which uses magnetic fields and radio waves to produce cross-sectional images of soft tissue without X-rays or other radiation.

Maintenance - continuing on a long-term basis, as in "maintenance therapy" or "rehab maintenance"

Metabolic Equivalent (MET) - the amount of oxygen required while sitting very quietly at rest (approximately 3.5 milliliters of oxygen per kilogram of body weight).

Metered Dose Inhaler (MDI) - device which dispenses a specific amount of medication in aerosol or powdered form

Mucus - slippery secretions that serve to moisten and protect the mucous membranes by special cells within the bronchial tree, usually as a result of irritation, inflammation or infection of the airways. (pretty synonymous with phlegm)

Nasal Cannula (NC) - a rubber or vinyl tube which extends around the user's face with curved prongs that fit into the nostrils for delivery of oxygen at low flow rates. Also referred to as "nose hose" (slang)

National Emphysema Treatment Trial (NETT) - a multicenter randomized trial comparing maximal medical therapy versus maximal medical therapy with LVRS in patients with moderate to severe emphysema to determine efficacy of this surgical procedure for the purpose of resuming Medicare reimbursement (which was halted in 1996).

Nebulizer - an atomizer device that sprays liquid medication in aerosol form into the air a patient breathes

Nose Hose - aka Nasal Cannula (NC)

Nuclear Scan (also called Ventilation Perfusion (VQ) Scan) - test using small amounts of radioactive material to compare left and right lung functions (blood flow and gas exchange)

Obstructive Sleep Apnea (OSA) - a common respiratory sleep disorder characterized by snoring and episodes of breathing cessation that causes blood oxygen levels to fall below acceptable levels.

Open Lung Biopsy (OLB) - a small piece of lung tissue is obtained for examination by surgical incision of the chest wall (thoracotomy) performed under general anesthesia by a Thoracic Surgeon.

Organic Dust Toxic Syndrome (ODTS) - a febrile illness occurring after heavy organic dust exposure; symptoms resemble those of acute farmer's lung.

Osteoporosis - weakening of bones by decrease in bone mass and mineral density, and enlargement of bone spaces producing fragility; caused by disturbances of nutrition and mineral metabolism. [CME module on Steroid-induced Osteoporosis ]

Oximeter - a noninvasive device for measuring continuously the estimated degree of oxygen saturation of the circulating blood. The oximeter 'clips' to a finger, toe, nose or ear lobe and is painless to use.

Oximetry - noninvasive measurement of the estimated level of arterial oxygenation in circulating blood; report usually includes baseline functional O2 saturation and heart rate, as well as lowest functional O2 saturation and heart rate during monitored activity (i.e. exercise, oxygen therapy)

Oxygen (O2) - colorless, odorless gas essential for all life processes; the most important component of air. See Hypoxemia for symptoms of insufficient oxygenation

Oxygen Conserver - device designed to maintain adequate oxygenation with a reduction in flow rate.

Oxygen debt - cumulative deficiency of oxygen that develops in the body during periods of intense activity and must be made good when the body activity returns to a normal level. In patients with severe pulmonary insufficiency, climbing a step or two can be considered 'intense activity'

Oxygen Therapy - use of supplemental oxygen to assure the body receives an amount sufficient to provide for its needs. (SaO2 of 90 or greater)

Oxygen Titration Test - see Oximetry

Pack Years - a measure of cigarette smoking over someone's lifetime, figured as the number of packs per day times the number of years a person has smoked. Ten pack-years could refer to a smoking history of two packs a day for five years, one pack/day for 10 years, or half a pack a day for 20 years. One "pack year" means 7300 cigarettes, or 1460 cigars, or 7.3kg of pipe tobacco.

Palliative - a therapy that relieves symptoms, such as pain, but does not alter the course of disease. Its primary purpose is to improve the quality of life (QOL).

Peak Expiratory Flow Rate (PEFR) - the fastest speed a person can expel air from the lungs after taking in as big a breath as possible

Peak Flow Meter (PFM) - small device used to measure a person's peak expiratory flow rate.

Perfusion - passage of blood through the lungs

Perfusion Scan - test to determine the status of blood flow to an organ.

Phlegm - thick, gluey, stringy mucus secreted in the respiratory passages usually as a result of inflammation, irritation or infection of the airways, and discharged through the mouth. (often synonymous with mucus, this word is no longer widely used)

Pink Puffer - term describing the COPD or emphysematic patient whose symptoms are breathlessness, hyperinflation, mild hypoxemia and a low PCO2 . Compare with Blue Bloater. Term is rarely used anymore.

Pleura - either of a pair of two-walled sacs of serous membrane that covers and protect the lung.

Pleural Cavity - the space between the two layers of pleura; the chest cavity

Pleural Space - the fluid-filled "space" between the two pleural walls (visceral and parietal pleura).

Pleurisy - inflammation of the pleura with or without diffusion of an exudate into the pleural cavity

Plethysmography or Body Box - an airtight chamber with clear doors where one sits to have lung volumes measured. Breathing is accomplished through a mouthpiece.

Pneumothorax (PTX)- presence of air in the pleural cavity, caused by rupture of the plural membrane or by trauma through the chest wall; often referred to as a collapsed lung. Compare to Spontaneous Pneumothorax

Pneumonoultramicroscopicsilicovolcanoconios - a lung disease caused by the inhalation of very fine silicate or quartz dust and occurring especially in miners.
This is the longest word in the English language. To pronounce it split into parts. Easy, no?
pneu mono ultra micro scopic silico volcano co niosis

Polycythemia - Too many red blood cells. The condition exists when the hemoglobin, red blood cell (RBC) count, and total RBC volume are all above normal. .

Positive Airway Pressure (PAP) - Positive airway pressure adjuncts are used to mobilize secretions and treat conditions such as atelectasis, or to keep airways open and unobstructed in patients with sleep apnea. They include continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), expiratory positive airway pressure (EPAP). and bilevel positive airway pressure (BiPAP)

Positive End Expiratory Pressure (PEEP) - a method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lung at the end of expiration, thus keeping alveoli open and improving gas exchange.

Positive Pressure Ventilation (PPV) - process of forcing gases down a patient's trachea using either a manual control technique or using an automatic ventilator. PPV can be done using a manual resuscitator or the rebreathing bag on the anesthesia machine; for long term use an automatic ventilator is usually prescribed.

Post Nasal Discharge (PND) - the sensation of mucus accumulation in the throat or a feeling that mucus is dripping downward from the back of the nose into the throat. Also called Post Nasal Drip

Primary Ciliary Dyskinesia (PCD) - condition where cilia in the body fail to beat effectively causing mucus to become trapped in various parts of the respiratory system.

PCD, Immotile Cilia Syndrome (ICS) and Kartagener's Syndrome (KS) refer to the same condition, with the exception that in KS the heart is located on the right side of the body.

Primary Immunodeficiency (PIDS) - Primary immune deficiency diseases are inherited disorders in which part of the body's immune system is missing or fails to function properly. Often presenting as 'common' infections or conditions (such as asthma or sinusitus), PIDs can go undetected for many years resulting in permanent damage to organs, and even the patient's death.
Ten warning signs of PIDS
- Eight of more new ear infections within one year,
- Two or more serious sinus infections within one year.
- Two or more months on antibiotics with little effect.
- Two or more pneumonias within one year.
- Failure of an infant to thrive (gain weight or normal growth).
- Recurrent deep skin or organ abscesses.
- Persistent thrush in mouth or elsewhere on skin, after age one.
- Need for intravenous antibiotics to clear infections.
- Two or more deep-seated infections such as osteomyelitis, cellulitis, or sepsis.
- A family history of primary immune deficiency.

Primary Pulmonary Hypertension (PPH) - see Pulmonary Hypertension
Productive Cough - a cough in which mucus or phlegm is dislodged, enabling a person to clear the lungs.

Puffers - slang term for aerosol metered dose inhalers

Pulmonary - pertaining to the lungs

Pulmonary Alveolar Proteinosis (PAP) -a rare condition characterized by a disturbance in surfactant turnover which causes the alveoli to fill with eosinophilic, proteinaceous material closely resembling surfactant. Treatment consists of bronchoalveolar lavages.

Pulmonary Artery (PA) - blood vessel that delivers oxygen-poor blood from the right ventricle to the lungs

Pulmonary Edema (PE) - condition (usually acute, but sometimes chronic) that occurs when too much fluid accumulates in the lungs, blocking transport of oxygen into the blood.

Pulmonary Embolism (PE) - the closure or narrowing of the pulmonary artery, or one of its branches, by an embolus.

Pulmonary Fibrosis (PF) - condition characterized by deposition of scar tissue in the lung. Pulmonary Fibrosis by other names:
Acute Interstitial Pneumonitis
Chronic diffuse fibrosing
Chronic diffuse sclerosing
Chronic interstitial pneumonia
Cryptogenic fibrosing alveolitis
Diffuse idiopathic interstitial fibrosis
Diffuse idiopathic pulmonary fibrosis
Diffuse infiltrative pulmonary disease
Desquamative interstitial pneumonitis
Fibrosing alveolitis
Hamman-Rich Disease or Syndrome
Honeycomb lung
Honey lung
Idiopathic fibrosing alveolitis
Idiopathic interstitial fibrosis of lung syndrome
Shrinking Lung
Stiff Lung
Usual interstitial pneumonitis (UIP)

Pulmonary Function Tests (PFT) - set of tests to evaluate the mechanical properties of the lung by studying lung volumes and capacities (term often used interchangeably with spirometry) Quick Ref Evaluation of PFT's
Related terms:
TLC - Total Lung Capacity - volume of lungs following maximum voluntary inspiration
RV - Residual Volume - the amount of air left behind after a maximum expiratory effort
VT - Tidal Volume - volume of a normal inspiration or expiration during relaxed breathing
FRC - Functional Residual Capacity - volume of air remaining in the lung after a normal
expiration
VC - Vital Capacity - the total lung capacity minus the residual volume
FEF - Forced Expiratory Flow
FVC - Forced Vital Capacity - maximum volume of gas an individual can exhale
with force after a maximum inspiratory effort
FEV1- Forced Expiratory Volume in the first second after a maximal inspiratory
effort
DLCO- Diffusing capacity of carbon monoxide

Pulmonary Hypertension (PH) - occurs when blood pressure in the pulmonary artery is too high. Increased pressure within the lung causes the right ventricle of the heart to become enlarged and may result in shortness of breath, syncope (fainting), dizzy spells and heart failure. [PH Assn] [PH Central] [PPH Cure Foundation]

PPH, or primary pulmonary hypertension, exists when its cause is unknown. This condition is extremely rare.

PH, pulmonary hypertension, occurs as a result of other medical conditions, including COPD. PH is sometimes referred to as SPH (secondary PH)

Pulmonary Insufficiency (PI) - Chronic impairment of gas exchange due to clinically documented pulmonary disease .

Pulmonary Rehabilitation (PR) - a personalized program which incorporates therapy, support and education in attempting to assist the patient achieve the maximum obtainable functional capacity allowed by his handicap.

Pursed Lip Breathing (PLB) - technique used to slow breathing to maintain even lung pressure and control shortness of breath

Quality of Life (QOL) - is defined as the 'physical, social and emotional aspects of a patient's well-being that are relevant and important to the individual'.

Rating of Perceived Exertion (RPE) - a self-assessment scale to rate breathlessness and fatigue during exercise.

Reactive Airway Disease (RAD) - condition caused by reaction to a trigger (i.e. allergen, odor or hypersensitivity). Asthma and Hypersensitivity Pneumonitis are examples of RAD.

Rescue Medication - short-acting medication designed to relieve symptoms quickly

Residual Volume (RV) - amount of air left behind after a maximum expiratory effort; lowest voluntary volume obtainable

Respiration - Respiration has two meanings in physiology. Along with breathing, respiration includes all chemical processes that occur in the body converting oxygen and food to water, energy and carbon dioxide.

Respiratory Distress Syndrome (RDS) - breathing complications experienced by newborns when immature lungs lack enough surfactant to keep air spaces open. Also called hyaline membrane disease.

Respiratory System - entire system of organs and tissues involved in breathing; these include the nose, throat, larynx, trachea, bronchi and lungs


SaO2 - percent saturation of hemoglobin with oxygen in the arterial blood; in the venous blood - SvO2

Shock Lung - clinical terminology for Adult Respiratory Distress Syndrome (ARDS)

Signs - objective findings discovered by a physician, i.e. heart murmur. See symptoms

Spacer - device designed to hold an aerosol metered-dose inhaler (MDI) for optimum delivery of the drug into the lungs; i.e. Aerochamber®

Spirometer - an instrument for measuring volume of air entering and leaving the lungs

Spirometry - best test available in primary care for early detection of many lung disorders, this procedure provides following key parameters
Forced Vital Capacity (FVC)
Forced Expiratory Volume in 1st second following maximal inspiration (FEV1)
Forced Expiratory Ratio in 1st second (FEV1/FVC%)

Spontaneous Pneumothorax (SP) - an inherited condition characterized by weak areas in the pleural lining of the lung. Small air-filled blisters, called blebs, may form which occasionally rupture causing air to leak from the lung into the chest cavity. Also called Blebs Disease.

Sputum - mucus, phlegm or other substances coughed up from therespiratory tract

Symptoms (SX) - subjective indications experienced by the patient, i.e. chest pain (see signs)
 

Tachycardia - relatively rapid heart rate

Tachypnea - increased rate of respiration

Thoracoscope - instrument used to directly visualize the pleura and lung surfaces; introduced into the thorax under general anesthesia, it facilitates the collection of tissue samples (see Open Lung Biopsy

Thorascopy (VATS) - a minimally invasive "keyhole" surgical procedure which allows the surgeon to directly examine the chest cavity without a big incision. Often referred to as VATS (Video Assisted Thoracic Surgery)

Thoracotomy - surgical incision of the chest wall

Tidal Volume (TV or VT) - volume of a normal inspiration or expiration during relaxed (normal) breathing

Total Lung Capacity (TLC) - volume of the lungs after a maximum voluntary inspiration

Transplant (TX or XP) - surgery to replace a diseased organ or organs with healthy ones from a human donor.

Transtracheal oxygen (TTO2) - delivery of oxygen by insertion of a thin catheter directly into the trachea.

Upper Respiratory Infection (URI) - affecting any, or a combination, of the five parts comprising the upper respiratory tract: nose, sinuses, pharynx, larynx, trachea

Usual Interstitial Pneumonia (UIP) - a later stage of idiopathic pulmonary fibrosis (IPF), it is more patchy in appearance than DIP with marked interstitial infiltrate and thickening of alveolar walls

Vanishing Lung Syndrome - a progressive disorder characterized by presence of large upper lobe bullae occupying at least one-third of the hemithorax, and compressing surrounding normal lung. Also called "type 1 bullous disease" and "primary bullous disease of the lung.

Ventilation - the movement of gas in and out of the lungs to facilitate blood oxygenation and carbon dioxide removal

Ventilation Perfusion (VQ) Scan - a test that compares right and left lung function (blood flow and gas exchange) through the use of a small amount of radioactive material.

Ventilators - machines used in operating rooms (OR) and intensive care units (ICU) for respiratory support of patients who cannot breathe on their own. There are five main parameters:
1. Tidal Volume (egg. 700 ml) [Volume of gas injected into trachea with each breath]
2. Respiratory Rate (egg. 12 breaths/minute)
3. FIO2 (Fraction of Inspired Oxygen) (egg. 0.6 or 60% oxygen)
4. PEEP (Positive End Expiratory Pressure) (egg. 5 cm H2O)
5. I:E ratio (egg. 1:3) Time for inspiration in relation to time for expiration

Ventricle - one of the two pumping chambers of the heart; the right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the aorta

Video Assisted Thoracic Surgery (VATS) - Thorascoscopy is a minimally invasive 'keyhole' surgical procedure which allows the surgeon to directly examine the chest cavity without a big incision.]

Virus - organism that causes a wide variety of infections, including colds and influenza. What the Heck is a Virus explains these unique entities.

Vital Capacity (VC) - the maximum volume of air that can be exhaled following a complete lung inflation. The difference between Total Lung Capacity (TLC) and Residual Volume (RV).

Wheezing - the sound made by air moving through partially obstructed airways

X-Ray - a form of electromagnetic radiation which can penetrate a body to produce in image on film.

References
· Bowers AC, Thompson, JM: Clinical Manual of Health Assessment, ed. 4, St Louis, 1992, Mosby.
· A Guide to Physical Examination and History Taking, Seventh Edition by Barbara Bates, published by Lippincott in 1999
· Malasanos L et al: Health Assessment, ed. 4, 1990, St Louis, Mosby.
· Wilkins RL, Sheldon RL, Krider SJ, editors: Clinical Assessment in Respiratory Care, ed. 3, St Louis, 1995, Mosby.

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