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Cadiopulmonary Medicine > Ch. 13 and 14 > Flashcards

Ch. 13 and 14 Flashcards

1
Q

ATS guidelines for COPD is a

A

preventable and treatable disease, characterized as airflow limitation

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2
Q

COPD is primarily caused by

A

cigarette smoke

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3
Q

Chronic productive cough for 3 months and 2 successive years

A

chronic bronchitis

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4
Q

permanent enlargement of the air sacs distal to the terminal bronchioles w. destruction of bronchial walls

A

emphysema

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5
Q

The conducting airway are the primary structures that under go change in

A

chronic bronchitis

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6
Q

As a result _________ inflammation, the __________ walls are narrowed by vasodilation, congestion and mucosal edema

A

chronic; bronchial

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7
Q

Major pathologic associated w/ chronic bronchitis (5)

A
  • thickening of the walls
  • excessive mucous production
  • partial of total mucous plugging
  • smooth muscle constriction
  • air trapping hyperinflation
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8
Q

The weakening and permanent enlargement of the air sacs distal to the terminal bronchioles

A

emphysema

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9
Q

Major pathologic associated w emphysema

A
  • permananet enlargement and destruction of the air spaces
  • destruction of AC membrane
  • Weakening of the distal, primarily respiratory bronchioles
  • air trapping and hyperinflation
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10
Q

2 types of emphysema

A
  • panacinar (panlobular) emphysema
  • centriacinar (centrilobular) emphysema
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11
Q

Most common, emphysema chronic bronchitis, cigarette smoke

A

centrilobular

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12
Q

Less common, more severe, genetic factor Alpha- anti trypsin deficiency

A

panlobular

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13
Q

Chronic bronchitis, abnormal weakening and enlargement of the Respiratory bronchioles and alveoli in the proximal portion of the acinus

A

centrilobular emphysema

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14
Q

Abnormal weakening and enlargement of all air spaces distal to the terminal bronchioles

A

panlobular

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15
Q

How many people in the US have chronic bronchitis, emphysema or both?

A

10- million

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16
Q

Risk factors include (4)

A
  • genetic factors
  • age/ gender
  • lung growth/ development
  • exposure to particles
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17
Q

Diagnosis should be considered at what age, and with pts who experience these symptoms

A

40; dyspnea, chronic cough, sputum production, history of exposure risk factors

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18
Q

3 main spirometry test are to measure the severity of airflow limitation w/ suspected COPD

A
  • FVC
  • FEV1
  • FEV1/FVC ratio
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19
Q

What the primary goals of a COPD assessment (3)

A
  1. Establish the degree of airflow limitation
  2. Determine the effect of COPD on pt’s health
  3. Ascertain the risk for future events( exacerbation of hospitalizations)
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20
Q

GOLD recommended the assessment of the features independently (4 ASEC)

A
  1. Airway limitation
  2. Symptoms
  3. Exacerbation risks
  4. Comorbidities
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21
Q

GOLD 1 = MILD=

A

FEV1 Greater than or equal to 80% predicated

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22
Q

GOLD 2= MODERATE =

A

FEV1 50% - 79% predicted

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23
Q

GOLD 3 = SEVERE=

A

FEV1 30%-49% predicated

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24
Q

GOLD 4 = VERY SEVERE =

A

FEV1 Less than or equal to 29% or less than predicated

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25
Q

Characteristics of Emphysema (pink puffers)

A
  • barrel chest
  • dyspnea
  • reddish skin
  • decreased breath sounds
  • hyper resonance
  • accessory muscle used
  • diminished respiratory drive
26
Q

Characteristics of Chronic Bronchitis (blue bloaters)

A
  • digital clubbing
  • hypercapnic state
  • cyanosis
  • peripheral edema
  • polycythemia
  • cor pulmonale
    wheezes, crackles, rhonchi
27
Q

The heart appears long in narrow as a result being drawn downward by the descending diaphragm in which disease process

A

emphysema

28
Q

Translucent (dark) lung fields at the bases, depressed diaphragms and long and narrow heart appears in which disease process

A

chronic bronchitis

29
Q

In the PFT’s all of the tests are

A

decreased

30
Q

Mild to moderate stages 1 and 2 (Acute alveolar hypoventilation w/ hypoxemia)
pH is…… paco2 is…… hco3- is …… pao2 is…. sao2 is…..

A

pH increased
paco2 decreased
hco3- decreased
pao2 decreased
sao2 decreased

31
Q

Severe stages 3 and 4 (Chronic vent failure w/ hypoxemia)
pH is…… paco2 is…… hco3- is …… pao2 is…. sao2 is…..

A

pH normal
paco2 increased
hco3- increased
pao2 decreased
sao2 decreased

32
Q

lung volume and capacity findings: CB and emphysema
vT is or normal;
IRV is normal or;
RV is normal or;
VC is;
IC is normal or;
FRC is;
TLC is normal or;
RV/TLC is normal or

A

Increased
Decreased
Increased
Decreased
Decreased
Increased
Increased
Increased

33
Q

Chronic airway inflammation, history of respiratory symptoms like wheezing, SOB, chest tightening and cough

A

Asthma

34
Q

Asthma is also described as heterogenous disease that commonly has a set of observable characteristics that result from the interaction of the pt’s genotype w/ environment called

A

asthma phenotype

35
Q

The more common asthma phenotypes include

A
  • allergic or atopic asthma
  • nonallergic asthma
  • late onset asthma
  • asthma w/ fixed airflow limitation
  • asthma w/ obesity
36
Q

Most easily to identify , typically appears in childhood

A

allergic or atopic asthma

37
Q

seen in some adults who do not have allergies

A

nonallergic asthma

38
Q

develop asthma for the first time in adult life (especially in women)

A

late onset asthma

39
Q

long history of asthma develop a fixed airflow limitation caused by airway wall remodeling

A

asthma w/ fixed airflow limitation

40
Q

BMI greater that 30 , asthma is difficult to control

A

asthma w/ obesity

41
Q

NAEPP guidelines under 4 components (APCT)

A
  1. Assessment and monitoring
  2. Pt education
  3. Control factors contributing to asthma severity
  4. treatment medications
42
Q

Asthma is described as lung disorder characterized by (3)

A
  1. Reversible bronchial smooth muscle constriction
  2. Airway Inflammation
  3. Increased airway responsive to an assortment
43
Q

Pathologic changes during an asthma attack (6)

A
  • Smooth muscle constriction of bronchial airways (bronchospasm) (wheezing breath sound typically reversable)
  • Excessive production of thick, whitish bronchial secretions
  • Mucous plugging
  • Hyperinflation of the alveoli (air trapping)
  • In severe cases atelectasis caused by mucous plugging
  • Bronchial wall inflammation leading to fibrosis (in severe cases, caused by remodeling)
44
Q

How many adults and children suffer from asthma in the US

A

18.4 million(7.6%) and 6.2 million (8.4%)
total 25 million

45
Q

how many people suffer from asthma worldwide

A

235 million

46
Q

Risk factors for asthma (3)

A
  • genetics
  • obesity
  • sex
47
Q

What are GINA 2 guidelines to help clinical diagnosis of asthma

A
  1. history of variable Respiratory symptoms
  2. the evidence of variable expiratory airflow limitation
48
Q

what test helps to induce asthma attacks

A

bronchial provocation test (methacoline challenge)

49
Q

Allergy test measures the level of specific _____ via RAST (eosinophils)

A

IgE

50
Q

Measures fractional concentration of exhaled nitric oxide (FeNO)

A

Exhaled Nitric Oxide

51
Q

Chest assessment findings during asthma attacks (6)

A
  • Expiratory prolonged (I/E >1:3)
  • decreased tactile and vocal fremitus
  • Hypersonanate percussion note (b/c of air)
  • diminished breath sounds
  • wheezing (bronchospasm)
  • crackles
52
Q

PFT Moderate to Severe Asthma episode

A

ALL PFT’s are decreased

53
Q

Lung volumes and capacity

A
54
Q

GINA long term goals for asthma are (2)

A
  • symptom control
  • risk reduction of future exacerbation (removal of potential risk factors)
55
Q

Used for regular maintenance treatment

A

Controller medications

56
Q

Used for as needed relief of asthma symptoms

A

Reliever (rescue) medications

57
Q

Pt continues to have symptoms despite optimized treatment. Possibly adding on corticosteroids

A

Add- on therapies for pts w/ severe asthma

58
Q

In obesity, GERD, anxiety and depression, food allergy and anaphylaxis asthma is

A

difficult to treat

59
Q

Aerosolized Medication protocol for asthma

A
  • Bronchodilators
  • LABA’S
  • ICS
60
Q

Treat hypoxemia to decrease WOB, what protocol would you use?

A

Oxygen Therapy protocol

61
Q

Excessive mucous production and secretions, PEP therapy or Acapella may be used to mobilize secretions. What protocol would be used

A

Airway clearance therapy

62
Q

When a pt is status asthmatics (will not respond to therapy) and continue MV may be required what protocol may be used

A

Mechanical Ventilation Protocol

Cadiopulmonary Medicine (24 decks)

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