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Clinical Manefestations > Ch. 21 > Flashcards

Ch. 21 Flashcards

1
Q

What is a thrombus?

A

A blood clot that forms and remains in a vein

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2
Q

What is an embolus?

A

Blood clot that be becomes dislodged and travels to another part of the body.

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3
Q

What is pulmonary infarction?

A

When the embolus significantly disrupts arterial blood flow.

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4
Q

What is saddle embolus?

A

When a large embolus detaches form a thrombus and passes through the right side of the heart, It may lodge in the bifurcation of the pulmonary artery.

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5
Q

Why is a large saddle embolus quickly fatal?

A

Because it can can significantly block pulmonary blood form returning to the left ventricle and being pumped out to the systemic circulation.

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6
Q

What are the major pathologic or structural changes of the lungs?

A

• Blockage of the pulmonary vascular system
• pulmonale
• pulmonary hypertension
• pulmonary infarction
• altelectasis
• consolidation
• bronchial smooth muscle constriction

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7
Q

What are DVT and PE commonly clinically classified as?

A

Insidious disorders

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8
Q

If pulmonary embolism is relatively small will the early signs and symptoms be present?

A

Yes

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9
Q

Sudden death is often the first symptom in about how many percent of people who have PE?

A

25%

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10
Q

The possibility of a blood clot being lodged in the lung is often not considered until autopsy in about what percentage of a patient?

A

70-80%

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11
Q

In the U.S. how many people die each year from a PE?

A

100,000

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12
Q

PE is more common in males than females T or F?

A

True

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13
Q

What is the most common possible source of an PE?

A

Blood clot

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14
Q

Where do most blood clots originate or break away from?

A

Deep venous thrombosis in the lower part of the body

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15
Q

What are the 3 primary factors called associated with a DVT?

A

The Virchow triad

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16
Q

What does the Virchow triad include?

A

(1) venous stasis (i.e., slowing or stagnation of blood flow through the veins)
(2) hypercoagulability (i.e., the increased tendency of blood to form clots)
(3) injury to the endothelial cells that line the vessels.

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17
Q

What are some common risk factors associated with PE? Box 21.1

A
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18
Q

What are some common tests used to to detect a pulmonary embolism?

A

Blood test
D-dimer test
Ultrasonography
CXR
CPTA
V/Q scan
Pulmonary angiogram
MRI
MRA

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19
Q

What are some things looked for in a blood test?

A

(1) have a family history of blood clots
(2) have had more than one episode of blood clots
(3) have experienced blood clots for no known reason, the doctor may prescribe a series of blood tests to determine if there are any inherited abnormalities in the blood-clotting system.

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20
Q

What is another name for the D-dimer test?

A

Fibrinogen test

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21
Q

What is the D dimer test used for?

A

To check for an increase level of the protein fibrinogen. The test is relatively simple and fast it entails drawing a blood sample.

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22
Q

When are the results available for a d-dimer test?

A

Less than one hour

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23
Q

Values higher than what are considered positive?

A

500 ng/mL

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24
Q

What are some conditions that can increase in individuals d-dimer level?

A

Recent surgery

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25
Q

What is an ultrasonography test?

A

Uses high frequency sound waves to detect blood clots in the thigh veins. The test is not invasive

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26
Q

How long does the ultrasonography test take to perform?

A

30 minutes or less

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27
Q

What are some signs of symptoms, associated with pulmonary embolism? Box 21.2

A
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28
Q

True or false a chest x-ray is often normal in a patient with pulmonary embolism?

A

True

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29
Q

What is a chest x-ray used for?

A

Used to rule out conditions that mimic a pulmonary embolism, such as pneumonia and pneumothorax

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30
Q

What percentage of infiltrates or atelectasis will be seen in a chest x-ray for pulmonary embolism?

A

50%

31
Q

What percentage of an elevated hemidiaphragm occurs in a chest x-ray of pulmonary embolism?

A

40%

32
Q

What does CTPA stand for?

A

Computed tomography pulmonary angiogram

33
Q

T or F The CTPA is fast becoming the first line test for diagnosing suspected pulmonary embolism?

A

True

34
Q

True or false the CTPA is increasingly being referred to previous gold standards for diagnosing, a pulmonary embolism, ventilation perfusion, scanning or direct pulmonary angiography?

A

True

35
Q

Why is the CTPA preferred over other test?

A
  1. The scan requires only an intravenous line
  2. The image resolution is very good
  3. The volumetric skating allows the contrast
  4. material to be administered more economically and time
    5.The entire chess can be scanned in a single 6.breath, hold, or in several successive short breath holds
36
Q

What does VQ scan do?

A

The test confirms that the lungs are normal, or that there is a high probability of a pulmonary embolism

37
Q

T or F; The V/Q scan is rarely used today to identify a pulmonary embolus. The V/Q is reliable, only at the extremes of interpretation.

A

True

38
Q

What does a pulmonary angiogram do?

A

Provides a clear image of the blood flow in the lungs arteries. it is an extremely accurate test for a diagnosis of pulmonary embolism

39
Q

How long is a pulmonary angiogram usually take?

A

It is an invasive procedure that takes about one hour

40
Q

True or false a pulmonary angiogram is usually perform only when other test have failed to provide a definitive diagnosis?

A

True

41
Q

What does an MRI do?

A

It is used for individuals whose kidneys may be harmed by dyes used an x-ray test and for women who are pregnant.

42
Q

What is an MRA and what does it do?

A

Magnetic Renaissance angiography; used to differentiate among blood, thromboemboli, and tumor emboli in patients with malignancy.

43
Q

What is the general management of a pulmonary embolism?

A

Fast acting, anti-coagulants
Thrombolytic agents
preventative measures

44
Q

What are some fast acting anticoagulants and what do they do? And the two classifications?

A

Heparin; prevents existing blood clots from growing and prevent the formation of new ones.
•High molecular weight heparin
•low molecular weight heparin

45
Q

How is heparin administered?

A

IV

46
Q

What is high molecular weight heparin (unfractionated heparin)?

A

The unfractionated heparin dosing must be governed by frequent monitoring of the activated partial thromboplastin time (APTT). This is because bleeding from unfractionated heparin can develop.

47
Q

What is low molecular weight heparin?

A

They are more cost-effective and do not necessitate APTT monitor- ing. Doctors strive to achieve a full anticoagulant effect within the first 24 hours of treatment.

48
Q

What is a slow acting anticoagulant?

A

Warfarin

49
Q

What is the timeframe that warfarin and heparin are given together?

A

5 to 7 days until blood test show that the warfarin is effectively preventing clotting

50
Q

If a pulmonary embolism is caused by a temporary respecter. How long is treatment given?

A

2 to 3 months

51
Q

If pulmonary embolism is caused by long-term condition how long is treatment given?

A

3 to 6 months

52
Q

What are some thrombolytic agents?

A

Streptokinase
urokinase
alteplase
Reteplase

53
Q

What do thrombolytic agents do?

A

Dissolve blood clots (clot busters)

54
Q

What are thrombolytic agents sometimes used in conjunction with?

A

Heparin

55
Q

What are some preventative measures?

A

Walking
Exercise while seated
Drink fluids
Where graduated compression stockings

56
Q

What is the inferior vena cava (greenfield) vein filter?

A

It is surgically placed in the inferior vena cava to prevent clots being carried into the pulmonary circulation

57
Q

What is pneumatic compression?

A

Uses thigh- high cuffs, and automatically Inslee every few minutes to massage and compress the veins in the patient’s legs

58
Q

What is pulmonary and embolectomy?

A

Surgical removal of blood clots from pulmonary circulation.

59
Q

What protocols do you use for pulmonary embolism?

A

Oxygen therapy protocol
Aerosolized medication protocol
Lung expansion protocol

60
Q

What does oxygen therapy protocol do?

A

Treats hypoxemia
decreases WOB
Decrease myocardial work

61
Q

What does the aerosolized medication protocol do?

A

Both sympathetic and para sympathetic agents may be used to induce bronchial smooth muscle?

62
Q

What is pulmonary hypertension?

A

An increase in mean arterial pressure greater than 25 mmHg.

63
Q

What is the normal range for pulmonary hypertension?

A

10 to 20 mmHg at rest

64
Q

Is pulmonary hypertension, more common among men or women? What is the ratio?

A

Woman; 3:1

65
Q

What are the five different group classifications for pulmonary hypertension?

A

Pulmonary arterial hypertension (PAH)
Pulmonary hypertension because of left heart disease
Pulmonary hypertension because of lung disease and or hypoxia
Chronic thromboembolic pulmonary hypertension another pulmonary artery obstructions
pulmonary hypertension, with unclear and or multifactorial mechanisms

66
Q

What are some common signs and symptoms of PH?

A
67
Q

What is the diagnosis of PH based on?

A

based on the patient’s medical and family histories, physical examination, and the results from a variety of tests and procedures.

68
Q

What are some different tests and procedures used to diagnose pulmonary hypertension?

A
69
Q

What are the causes of right sided heart failure?

A

COPD, coronary artery disease, pulmonic stenosis, tricuspid stenosis, and tricuspid regurgitation

70
Q

What is the most common cause of PH?

A

left-sided heart failure (congestive heart failure)

71
Q

What is biventricular failure?

A

Both left and right sided heart failure

72
Q

What are some therapies used to treat PH?

A

Diuretics
Phosphodiesterase inhibitors
Blood thinning medication
Cardiac glycosides
Oxygen therapy
Physical activity
inhaled nitric oxide
riocugat

73
Q

Common signs of both left and right sided heart failure?

A

Clinical Manefestations (20 decks)

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