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RTH 121 > Dec 6th Test > Flashcards

Dec 6th Test Flashcards

1
Q

What kind of disease is cardiogenic pulmonary edema classified as?

A

restrictive lung disease

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2
Q

What is cardiogenic pulmonary edema also called?

A

hydrostatic pulmonary edema

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3
Q

What is cardiogenic pulmonary edema caused by?

A
  • left side heart failure

- fluid overload

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4
Q

What is pulmonary edema?

A

excessive amount of fluid in the lung tissue or alveoli due to an increase in pulmonary capillary pressure (resulting from abnormal left heart function)

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5
Q

What is the etiology of cardiogenic pulmonary edema?

A
  • left heart failure (i.e. coronary artery disease)
  • aortic stenosis
  • mitral valve stenosis
  • systemic hypertension
  • fluid overload
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6
Q

What is the result of cardiogenic pulmonary edema?

A

backup of fluid from the heart into the pulmonary capillaries, which become engorged

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7
Q

What happens when pulmonary capillaries are engorged?

A

fluid leaks into interstitial space and into the alveoli

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8
Q

What is the swam ganz catheter?

A
  • it measures the back pressure from the pulmonary veins

- done from the carotid or subclavian vein and into the right atrium, tricuspid and right ventricle

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9
Q

Is it possible to measure the pressure from the left heart?

A

no

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10
Q

Is it possible to measure the pressure from the right heart?

A

yes

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11
Q

What carries the swan ganz?

A

the right ventricle into the pulmonary artery

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12
Q

Where does the swan ganz measure pressure and what should it not exceed what?

A

only in front of the catheter; 5-8

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13
Q

How is the progress of treatment of pulmonary edema measured?

A

swan ganz catheter

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14
Q

How is pulmonary edema treated?

A
  • ionotropic (makes left side work harder: digoxin)

- lasix (gets excess fluid out of the body)

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15
Q

What is atrial fibrillation?

A

atopic phoxi; 350-600/min

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16
Q

What is atrial fibrillation caused by?

A

congestive heart of the left ventricle

  • acidemia
  • alkalemia
  • electrical imbalances
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17
Q

What are physical signs of pulmonary edema?

A
  • distended neck veins
  • frequent cough
  • distended abdomen
  • pitting edema
  • blue lips
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18
Q

What are typical vital signs associated with pulmonary edema?

A
  • BP 100/50
  • HR 145
  • RR 22
  • ABG: 7.56, co2 38, hco3 20, o2 51 spo2 70%
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19
Q

What shows up on an xray for pulmonary edema?

A
  • faint opacities in lower lobes bilaterally

- enlarged heart (left ventricle)

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20
Q

What treatment is used for pulmonary edema?

A
  • oxygen
  • intravenous digitalis (dobutamine)
  • furosemide
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21
Q

What does digitalis do for pulmonary edema?

A
  • ionotropic
  • increases myocardial force of contraction
  • increases stroke volume
  • antiarrhthmic used to treat atrial flutter and fibrillation
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22
Q

What does dobutamine do for pulmonary edema?

A
  • increases myocardial contaction

- increases stroke volume without increasing systemic vascular resistance

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23
Q

What does furosemide do for pulmonary edema?

A
  • causes diuresis by inhibiting reabsorption of sodium
  • loss of chlorine
  • loss of potassium
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24
Q

What kind of ABG result can furosemide cause?

A

metabolic alkalosis

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25
Q

What kind of breath sounds are associated with pulmonary edema?

A
  • inspiratory crackles over lower lobes

- expiratory wheezes over lower lobes

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26
Q

What kind of shunt is caused by pulmonary edema?

A

Alveoli filled with fluid

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27
Q

What is venous admixture for pulmonary edema?

A

good lung mixing with bad lung leading to lower PaO2

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28
Q

What happens to lung volumes in pulmonary edema?

A

get smaller

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29
Q

In pulmonary edema, what needs to be resupplied so lung volumes can return to normal?

A

surfactant

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30
Q

How is FVC affected with pulmonary edema?

A

smaller (middle line in picture)

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31
Q

How is lung compliance affected with pulmonary edema?

A

decreased

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32
Q

How is WOB affected with pulmonary edema?

A

increased

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33
Q

What is the gold standard treatment for cardiogenic pulmonary edema?

A

cpap mask

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34
Q

What is a pulmonary embolism?

A

obstruction of the pulmonary artery or one of its branches

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35
Q

What is an embolus?

A

a clot that travels through the bloodstream from its vessel of origin and lodges into a smaller vessel, resulting in flow obstruction

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36
Q

What are the possible sources of pulmonary emboli?

A
  • fat
  • air
  • bone marrow
  • tumor fragments
  • blood clots
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37
Q

What is the most common source of emboli?

A

blood clot

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38
Q

Where does an emboli usually originate?

A

in deep veins of the leg or pelvic area

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39
Q

Where does an emboli travel to?

A

back to the heart through the venous system where it eventually lodges in a pulmonary artery

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40
Q

Why does a clot usually form?

A
  • stagnation of blood flow
  • prolonged bed rest
  • immobility from trauma, surgery, paralysis or pain
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41
Q

What are some predisposing factors for emboli?

A
  • long travel
  • CHF
  • varicose veins
  • thromnophlebitis
  • traumatic injury
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42
Q

What should be looked at carefully in traumatic injuries?

A
  • bone fragments from pelvis
  • long bones of lower extremeties
  • extensive injury to soft tissue
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43
Q

What are some hypercoagulation disorders that cause embolis?

A
  • oral contraceptives
  • polycythemia
  • multiple myeloma
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44
Q

What does a blockage result in?

A

dead space ventilation (ventilation without perfusion), which causes a high V/Q mismatch

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45
Q

What causes a high V/Q mismatch?

A

dead space

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46
Q

What causes a low V/Q mismatch?

A

shunt

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47
Q

What is the initial V/Q ratio response and what does it lead to?

A

a high initial ratio which leads to a low V/Q mismatch

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48
Q

What causes a change from high to low V/Q mismatch?

A
  • activation of serotonin
  • histamine
  • prostaglandin
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49
Q

What is caused by the release of serotonin, histamine and prostaglandin?

A
  • alveolar atelectasis
  • alveolar consolidation
  • bronchoconstriction
  • shunting
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50
Q

What causes 10% of pulmonary emboli cases?

A

infarction

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51
Q

What dictates the pathophysiology of pulmonary emboli?

A

size of thromboembolism

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52
Q

What determines the impact of pulmonary emboli on the cardiovascular system?

A

size and number of pulmonary emboli

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53
Q

Where is the reduction of cardiac output seen with pulmonary emboli?

A

systemic side

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54
Q

What heart effects are seen in the pulmonary side with pulmonary emboli?

A
  • pulmonary hypertension

- increased right ventricular work load

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55
Q

What heart effects are seen in the systemic side with pulmonary emboli?

A
  • systemic hypertension

- decreased blood flow entering the left ventricle

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56
Q

How does the body attempt to compensate for the systemic side?

A

increased heart rate

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57
Q

What are the most common symptoms of pulmonary emboli?

A
  • dyspnea
  • tachypnea
  • pleuritic chest pain
  • cough
  • tachycardia
  • hypotension
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58
Q

What are additional findings of pulmonary emboli?

A
  • abnormal heart sounds
  • distended neck veins
  • swollen and tender liver
  • right ventricular heave or lift
  • right ventricular distension
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59
Q

What breath sounds are associated with pulmonary emboli?

A
  • inspiratory crackles
  • wheezes
  • pleural friction rub
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60
Q

When is pleural friction rub most common in pulmonary emboli?

A

when pulmonary infarction involves the pleura

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61
Q

What ABG result is commonly seen in mild to moderate pulmonary emboli?

A

acute alveolar hyperventilation with hypoxemia

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62
Q

What ABG result is commonly seen in severe pulmonary emboli with infarction?

A

acute ventilatory failure with hypoxemia

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63
Q

What happens when tissue hypoxia is severe enough to produce lactic acid?

A

the pH and HCO3 will be lower than expected for a particular PaCO2

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64
Q

Does a shunt increase or decrease the qs/qt fraction?

A

increase

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65
Q

Is oxygen delivery increased or decreased in pulmonary emboli?

A

decreased

66
Q

Is the oxygen extraction ratio increased or decreased in pulmonary emboli?

A

increased

67
Q

Does the SvO2 increase or decrease in pulmonary emboli?

A

decrease

68
Q

Is central venous pressure increased or decreased in pulmonary emboli?

A

increased

69
Q

Is pulmonary arterty pressure increased or decreased in pulmonary emboli?

A

increased

70
Q

What is normal pulmonary artery pressure?

A

no greater than 25/10 mmHg

71
Q

What is normal mean pulmonary artery pressure?

A

15 mmHg

72
Q

What is normal mean pulmonary artery pressure for patients with emboli?

A

excess of 20 mmHg

73
Q

What are 3 major mechanisms that contribute to pulmonary hypertension?

A
  • decreased cross sectional area of the pulmonary vascular system
  • vasoconstriction induced by humoral agents
  • vasoconstriction induced by alveolar hypoxia
74
Q

What is seen on an xray that has infarction?

A

increased alveolar density in infarcted areas, which appear similar to pneumonia

75
Q

What is seen on a xray when there is a cardiovascular response?

A
  • dilation of pulmonary artery

- ventricular enlargement may cause it to appear similar to pulmonary edema

76
Q

What is a ventilation test?

A

patient breathes in xenon gas to test ventilation

77
Q

What is a perfusion test?

A

intravenous injection of radiolabeled particles that goes into the pulmonary vascular system. if blood flow is decreased or absent past emboli, fewer particles are present in the area

78
Q

What gold standard is used to confirm the presence of pulmonary embolism?

A

pulmonary angiography

79
Q

What is pulmonary angiography?

A

a catheter is advanced into the right heart and a radiopaque dye is injected into an artery

80
Q

How is pulmonary embolism confirmed with pulmonary angiography?

A

dark area appears on the angiogram distal to the emboli (radiopaque material is prevented from flowing past obstruction)

81
Q

Does pulmonary angiography have risks?

A

none unless patient has severe pulmonary hypertension about 45 mmHg, is in shock, or has an allergic reaction to contrast medium

82
Q

What is the best treatment for pulmonary emboli?

A

avoiding venous stasis

83
Q

Besides prevention, what are other ways to treat pulmonary emboli?

A
  • low dose heparin given subcutaneously
  • tight fitting socks
  • pneumatic stockings or boots
  • active or passive leg movements
84
Q

When are fibronolytic agents used and why?

A

only used when hemodynamic instability is severe due to excessive risk of bleeding

85
Q

What are the respiratory care treatment protocols associated with pulmonary emboli?

A
  • oxygen therapy
  • aerosolized medications
  • mechanical ventilation
86
Q

What is pleural effusion?

A

fluid accumulation in the pleural space

87
Q

What anatomic alterations of the lungs are associated with pleural effusion?

A
  • separation of the visceral and parietal pleura
  • compress the lungs
  • atelectasis
  • great veins may be compressed
  • cardiac venous return may be diminished
88
Q

What kind of disorder does pleural effusion produce?

A

restrictive lung disorder

89
Q

What are the two classifications of pleural effusion?

A
  • transudative

- exudative

90
Q

What is a transudate pleural effusion?

A
  • develops when fluid from pulmonary capillaries moves into pleural space
  • the fluid is thin and watery and contains a few blood cells and very little protein
91
Q

True/False: a pleural disease causes a transudate

A

false

92
Q

What is an exudate pleural effusion?

A
  • develops when the pleural surfaces are diseased
  • fluid has high protein content
  • great deal of cellular debris
93
Q

True/False: exudates are usually caused by inflammation

A

true

94
Q

What are the major causes of transudative pleural effusion?

A
  • CHF
  • liver disease
  • kidney disease
  • pulmonary embolus
95
Q

What are the major causes of exudative pleural effusion?

A
  • cancer
  • pneumonias
  • fungal diseases
  • disease of the GI system
96
Q

In addition to transudate and exudate, there are other pathologic fluids that can separate the ___ pleura from the ___ pleura

A

parietal; visceral

97
Q

What are the other pathologic pleural fluids?

A
  • empyema
  • chylothorax
  • hemothorax
98
Q

What is empyema?

A

the accumulation of pus in the pleural cavity

99
Q

Empyema commonly develops as a result of what?

A
  • infection

- inflammation

100
Q

How is empyema removed?

A

chest tube drainage

101
Q

What is used to confirm a diagnosis of empyema and determine the specific causative organism?

A

thoracentesis

102
Q

What is chylothorax?

A

chyle in the pleural cavity

103
Q

What is chyle?

A
  • a milky liquid produced from the food in the small intestine during digestion
  • consists mainly of fat particles in a stable emulsion
104
Q

How is chyle transported?

A

from intestinal lymphatics through the thoracic duct (in the neck) into the venous circulation and mixed with blood

105
Q

What results in chylothorax?

A
  • trauma to the neck or thorax

- tumor that occludes the thoracic duct

106
Q

What is hemothorax?

A

the presence of blood in the pleural space

107
Q

What are the causes of hemothorax?

A
  • trauma (i.e. penetrating or blunt chest trauma, chest wall, diaphragm, lung or mediastinum)
  • rupture of small blood vessels
  • iatrogenic hemothorax (trauma causes by the insertion of a central venous catheter)
108
Q

What are the cardiopulmonary symptoms of pleural effusion?

A
  • symptoms vary according to the size of the effusion

- decree of lung compression

109
Q

What are the lung volume and capacity changes associated with pleural effusion?

A
  • restrictive lung defects

- decreased lung volumes

110
Q

What chest assessment findings are associated with pleural effusion?

A
  • chest pain
  • decreased chest expansion
  • cough (dry, nonproductive)
  • tracheal shift
  • decreased tactile and vocal fremitus
  • dull percussion note
  • diminished breath sounds
  • displaced heart sounds
111
Q

What are the radiologic findings associated with pleural effusion?

A
  • opacity (white)
  • blunting of costophrenic angle
  • depressed diaphragm
  • possible mediastinal shift to unaffected side
  • atelectasis
112
Q

What is the diagnosis of pleural effusion generally based on?

A

chest xray film

113
Q

Pleural effusion chest xray facts

A
  • fluid first accumulates posteriorly in the most dependent part of the thoracic cavity, between the inferior surface of the lower lobe and diaphragm
  • as the fluid volume increases, it extends upward around the anterior, lateral and posterior thoracic walls
  • on the typical radiograph, the lateral costophrenic angle is obliterated and the outline of the diaphragm on the affected side is lost
114
Q

Pleural effusion chest xray facts cont’d

A
  • in severe cases, the weight of the fluid may cause the diaphragm to become inverted (concave)
  • first identified with a posteroanterior (PA) or lateral chest radiograph
  • confirmed with a lateral decubitus radiograph
  • free fluid gravitates along the horizontal plane to the lowest level
115
Q

What is the treatment of pleural effusion?

A
  • thoracentesis
  • chest tube insertion (for larger pleural effusions)
  • oxygen therapy
  • hyperinflation therapy
116
Q

What is thoracentesis?

A

removal of pleural fluid

117
Q

When is hyperinflation therapy used and how does it treat pleural effusion?

A

after the removal of pleural fluid; inflates the compressed lung

118
Q

What should you monitor post thoracentesis?

A

watch for signs of hemothorax and pneumothorax associated with accidental puncture of the lung

119
Q

What is guillain-barre syndrome described as?

A

a relatively rare disorder of the peripheral nervous system in which flaccid paralysis of the skeletal muscles and loss of the reflexes develop in a previously healthy patient

120
Q

What are the pathologic changes of the peripheral nerves associated with guillain-barre syndrome?

A
  • microscopically the nerves show: demyelination, inflammation, edema
  • nerved impulse transmission decreases leading to paralysis
121
Q

What is the etiology of guillain-barre syndrome?

A
  • probably an autoimmune disorder

- lymphocytes and macrophages attack and strip off the myelin sheath of the peripheral nerves

122
Q

What are four facts about autoimmune disorders associated with guillain-barre?

A
  • studies show high serum antibody titers in the early stages of the syndrome
  • elevated levels of lgM and complement activating antibodies against human peripheral nerve myelin
  • anti-PMN antibody
  • antibodies reduced rapidly during the recovery phase
123
Q

What is the onset of guillain-barre?

A
  • occurs one to four weeks after a febrile episode
  • upper respiratory
  • gastrointestinal
  • bacterial and viral
  • vaccinations
124
Q

What bacterial and viral causes are associated with guillain-barre?

A

infectious mononucleosis associated with as many as 25 percent of cases

125
Q

What vaccinations are associated with guillain-barre?

A

in 1976 40 million people were vaccinated for swine flu. 500 of which developed guillain-barre and 25 died from it

126
Q

What are the early symptoms of guillain-barre?

A
  • fever, malaise, nausea, prostration
  • tingling sensation and numbness in the extremities (distal paresthesia)
  • skeletal muscle paralysis and loss of deep tendon reflexes in the feet and lower portions of the leg
127
Q

What are the progressive symptoms of guillain-barre?

A

the muscle paralysis moves upward (ascending paralysis):

  • to the arms, neck, pharyngeal and facial muscles (cranial nerves IX and X)
  • the patient’s gag reflex is generally decreased or absent and swallowing is difficult (dysphagia)
  • aspiration is likely unless the airway is protected
128
Q

What are the common non-cardiopulmonary manifestations associated with guillain-barre?

A
  • progressive paralysis of the ascending skeletal muscles
  • tingling sensation and numbness (distal paresthesia)
  • loss of deep tendon reflexes
  • sensory nerves impairment
  • peripheral facial weakness
  • decreased gag reflex
  • decreased ability to swallow
129
Q

What is the progress and recovery time for guillain-barre?

A
  • paralysis generally peaks in less than 10 days
  • after paralysis reaches its maximum it usually remains unchanged for a few days or weeks
  • recovery generally begins spontaneously and continues for weeks or in rare cases months
130
Q

Describe open pneumothorax

A

air can go in and out of the chest cavity freely

131
Q

What is pendelluft?

A

air moves from one lung into the other lung and then all back out. it is seen in open pneumothorax

132
Q

Describe closed pneumothorax

A

air moves into the lungs then out of the lung into the pleural space

133
Q

Describe open tension pneumothorax

A

air moves into the lung area with an open wound but when air tries to move back out, the wound closes

134
Q

What do you seen on inspection of pneumothorax?

A

one chest wall is moving higher than the other

135
Q

What do you hear on percussion of pneumothorax?

A

hyperresonance

136
Q

What breath sounds do you hear for pneumothorax?

A

diminished breath sounds

137
Q

What happens to the alveoli that are affected by pneumothorax?

A

it becomes hypoventilated and creates a venous admixture in the blood

138
Q

What is the most severe form of ARDS?

A

pulmonary edema

139
Q

What is the mortality rate of pulmonary edema?

A

40-90%

140
Q

What type of respiratory failure occurs with pulmonary edema?

A

acute hypoxic respiratory failure

141
Q

What is the cause of ARDS?

A
  • increased capillary permeability
  • fluid leak
  • inflammation mediators
142
Q

What is ARDS also called?

A

acute lung injury

143
Q

What are the primary risk factors for ARDS?

A
  • toxic inhalation
  • near drowning
  • lung contusion
  • gastric aspiration
  • pneumonia
144
Q

What are the secondary risk factors for ARDS?

A
  • burn injuries
  • sepsis
  • pancreatitis
  • shock
  • prolonged systemic hypotension
  • multiple blood transfusions
  • drug overdose
  • fulminant hepatic failure
  • multiple trauma
  • sickle cell crisis
145
Q

What are the other risk factors for ARDS?

A
  • prolonged cardiopulmonary bypass
  • fat emboli
  • immunologic reactions (goodpastures syndrome)
  • increased ICP
  • CNS disorders
  • pulmonary ischemia
  • intravascular coagulation
  • radiation-induced lung injury
  • drug overdose
146
Q

How long is the exudative phase?

A

1-3 days

147
Q

How are the alveoli damaged in ARDS?

A

destruction of type 1 pneumocytes

148
Q

How do microvascular injuries in ARDS happen?

A

destruction of capillaries

149
Q

In ARDS, where is there an influx of inflammatory fluids?

A

interstitial space and alveoli

150
Q

What membrane forms in ARDS?

A

hyaline membrane

151
Q

How does a patient present with ARDS?

A
  • severe dyspnea
  • tachypnea
  • refractory hypoxemia
152
Q

How long is the proliferative phase in ARDS?

A

3-7 days

153
Q

What does the fribroproliferative phase begin after?

A

inflammatory injury is controlled

154
Q

During the fibroproliferative phase, which cells experience hyperplasia (increase of cells)?

A
  • type 2 pneumocytes

- fibroblasts (interstitial alveolar fibrosis)

155
Q

What is SOAP?

A

getting objective information

156
Q

What breath sounds are heard in ARDS?

A

crackles

157
Q

What is seen on xray in ARDS?

A

bilateral fluffy infiltrates

158
Q

What is a typical ABG for a patient with ARDS?

A

pH 7.51
PaCO2 29
PaO2 52
HCO3 22

159
Q

What would you seen on a hemoglobin curve with ARDS?

A

acute alveolar hyperventilation with moderate hypoxemia

160
Q

What are the pulmonary mechanics of ARDS?

A
  • all lung volumes decreased
  • compliance is decreased
  • resistance is increased
  • WOB is increased

RTH 121 (9 decks)

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