exam #1 study guide Flashcards
what does dyspnea mean
shortness of breath perceived by patient
what does orthopnea mean
difficulty breathing in supine position (flat on back)
ABG interpretation
PH- acidosis < 7.35 > alkalosis
CO2- alkalotic <35-45> acidotic
HCO3 acidotic <22-28>
alkalosis
what does the sputum color black indicate?
smoke or coal dust
what does the sputum color brown indicate?
cigarette smoker
what does the sputum color frothy white/pink indicate
pulmonary edema
what is overcorrected hypoxemia on O2
> 100mmhg
what is corrected hypoxemia on O2
<100-60mmhg
what is severe hypoxemia on O2
<60mmhg
mild hypoxemia ranges
60-79mmhg
moderate hypoxemia ranges
40-59mmhg
severe hypoxemia range
<40mmhg severe hypoxemia
what is type II respiratory failure, its associated names and symptoms
alveolar ventilation which is inadequate for the patients current metabolic rate
associated names- hypercapnic/ventilatory
symptoms- loss of consciousness and headache
what is the relationship between alveolar ventilation and PaCO2
VA and PaCO2 are inversely proportional
increased VA= decreased PaCO2
decreased VA= increased PaCO2
what does an ABG look like for acute respiratory failure
low PaO2 and CaO2, a high PaCO2 with acidotic PH, and an increased RBC
what is the treatment for acute asthma attack treatment
- oxygen
2.fast acting bronchodilators
3.svn - continuous bronchodilator therapy
- IV/PO corticosteroids
- monitor peak flow
- IV ketamine
8.IV magnesium sulfate - heliox therapy
- NIPPV
- mechanical ventilation
what does the PaCO2 in the different phases of asthma attack
Early asthmatic response- hypocapnia (low CO2)
late asthma response- normal PaCO2 indicates more severe obstructive
Hypercapnia is seen with impending respiratory failure
what is the main anatomic alteration seen in asthma?
airway inflammation, airway hyper-responsiveness, expiratory flow limitations
what is the definition of inspection (and what are you looking for while inspecting)?
Inspection involves assessment of the patients overall appearance.
1. look for level of consciousness
2. body habitus (general ill health)
3. position
4. respiratory rate
5. breathing pattern
6. speech pattern
7. skin
8. facial expression
9. personal hygiene
10. sensorium (mental health)
11. nose (nose flaring?)
12. lips (cyanosis or pursed lip breathing)
13. jugular veins (distended?)
14. trachea (midline?)
15. thorax (barrel chest indicating COPD?)
16. digits (digital clubbing?)
what is the definition of palpation?
applies the sensation of touch to evaluate underlying structure and function. palpation is performed to assess
1. tracheal position
2. evaluation vocal/tactile fremitus
3. estimate thoracic expansion
4. asses the skin and tissues of the chest and extremities
5. identify abdominal distention and tenderness
6. locate the hearts apical impulse
what is the definition of percussion?
involves tapping the body surface to evaluate the underlying structure, it produces a sound and a palpable vibration useful in evaluating underlying tissue and the position of the diaphragm and liver.
hyperresonant/hyporesonant
what is the definition of vocal fremitus?
it refers to the vibrations created by the vocal cords during speech. These vibrations are transmitted down the tracheobronchial tree and to the chest wall.
increased vocal fremitus occurs when tissue is more solid (pneumonia, lung consolidation)
decreased fremitus- occurs when something is blocking the transmission of sound (pleural effusion, pneumothorax, copd)
what is the definition of bradypnea?
a breathing rate less than normal
what is the definition of Cheyenne-stokes breathing?
deep rapid breaths followed by apnea, breaths gradually increase and then gradually decrease until apnea period. (indication of CHF and stroke)
what are the conditions associated with increased resonance?
COPD, Pneumothorax (heard in the presence of excessive air)
what are the indications of pleural effusion (TD, PALP, PERC, BS)
tracheal deviation- shifted away from the affected area (push)
palpation- decrease in vibrations (decreased fremitus)
percussion_ hyporesonant dull sound associated with increased density
Breath sounds- diminished or absent due to fluid accumulation preventing lung expansion and sound transmission
what are the normal and abnormal percussion notes and there causes?
Resonant- are normal percussion notes, clear, low-pitches and hollow quality like the sound of tapping on a drum.
Hyperresonant- are louder and lower pitched heard in the presence of excessive air seen in patients with COPD and pneumothorax.(tympanic)
Hyporesonant- dull sound associated with increased density, seen in patients with pneumonia, atelectasis, and pleural effusion. (flat)
what are the causes of tracheal deviation (shifting)
tracheal deviation shifts away from the affected area (Push) seen in pneumothorax, and pleural effusion patients.
tracheal deviation shifts towards the affected area (pull) seen in atelectasis and fibrosis patients
what does retractions indicate?
Indicates inward sinking on or around the chest all and occur due to increased WOB.
(intercostal, subcostal, and substernal/suprasternal effected)
what causes unilateral lung expansion and what is it
occurs when one lung expands more than the other, it can be caused by pneumonia, pneumothorax, and rib fractures)
what are the two chest cavity abnormalities
Pectus carinatum- outward sternal profusion(pigeon breast)
pectus excavatum- funnel shaped depression over the sternum (funnel chest)
what are all the indicating factors of a pneumothorax
chest inspection- unequal/unilateral expansion may be a sign of pneumothorax
tracheal deviation- shifts away from the affected area (push)
chest palpitations- decreased fremitus (decrease in vibrations)
crepitus- subcutaneous emphysema (small gas bubbles under the skin, feels like crackling when palpated)
hyperresonant- lower pitch heard in the presence of excessive air
what are the 2 diseases that make up COPD
emphysema and chronic bronchitis
what are the PFT findings in patients with COPD
They have increased residual volumes, total lung capacity, and functional residual capacity
They have decreased values for peak expiratory flow rate, forced vital capacity and forced expiratory volume in 1 second(FEV1)
FEV1/FVC <0.7 confirms the presence of non-reversible airflow obstruction
how do you calculate pack years?
years smoking X number of packs/day= pack yers
EX: 30 years X 2 1/2 packs/day = 75 pack years
what is the pathophysiology of emphysema?
emphysema- condition that is characterized by abnormal, permanent enlargement of the alveoli and destruction of the alveolar walls.
1. dilation and destruction of lung parenchyma
2. tissue destruction decreasing surface area of alveoli
3.terminal bronchioles lose elastic fibers and collapse during exhalation
4. results in air trapping and poor gas exchange
what is pathophysiology of chronic bronchitis
chronic bronchitis- condition that is characterized by a chronic productive cough for at least 3 months/year for at least 2 consecutive years
1. inflammation leds to mucus glands growing larger, which leads to increased ,mucus production
2. excessive mucus production and inflammation in smaller airways impairs airflow to alveoli
what are the X-Ray findings in patients with COPD
- hyperinflation
- flattened diaphragm
- elongated (vertical) heart
- Bullae (blebs)- air that filled spaces within the lung parenchyma that form because of the destruction of alveolar tissue
what is the treatment for Alpha 1 anti-trypsin deficiency?
given Prolastin (alpha 1-proteinase inhibitor-human) given by IV and weekly administered (for life) associated with slowed rate of decline of lung function and improved survival
what are the COPD symptoms upon inspection?
- barrel chest
- accessory muscle use
- tri-pod position
- cyanosis
- digital clubbing
- dyspnea
- JVD (sign of HF)
what are the COPD symptoms upon palpation
- decreased fremitus
- decreased chest expansion
COPD symptom upon percussion
hyperresonance
COPD symptoms upon auscultation
- decreased breath sounds with prolonged expiration due to reduced airflow
- wheezing can occur due to bronchospasm
- coarse crackles/rhonchi can occur when secretions are present
COPD symptoms related to cough
- frequent, productive cough
- alteration in color is indicative of infection
COPD symptoms in relation to ABG’s
- acute ventilatory/hypoxemic failure
- chronic ventilatory/hypoxemic failure
- acute on chronic respiratory failure
COPD symptoms related to labs (CBC)
increased RBC, HB, HCT due to chronic hypoxemia
WBC is increased when infection/fever present
what is the etiology of COPD
- smoking- 80-90% of COPD related deaths
- environmental/occupational exposures (air pollution, biomass fuels, ad chemicals)
- genetic- Alpha-1 antitrypsin deficiency
what are the effects of cigarettes
80-90% of COPD related deaths, cigarette smoking kills more than 480,000 Americans each year
what is the treatment for acute exacerbations?
- Inhaled bronchodilators
SABA: Albuterol
SAMA: Ipratropium bromide - Inhaled steroids
Budesonide - IV steroids
Solu-medrol - Antibiotics
If infection is suspected - Oxygen therapy
Nasal cannula (most used)
Maintain SpO2 that is appropriate for individual patient - NIPPV
Has shown to decrease morbidity and mortality
Intubation and mechanical ventilation - Secretion mobilization
Chest physiotherapy (CPT) or postural drainage and percussion (PD&P)
Vibratory PEP or HFCWO therapy
how is COPD classified?
- Patients can be categorized by severity of symptoms and frequency of exacerbations
- COPD assessment test (CAT) score or mMRC dyspnea scale can be used to assess symptom severity
*Scored ABCD- class A is less symptomatic and 0-1 exacerbations a year
Class B- frequent symptoms but not a lot of exacerbations
Class C- greater or equal to 2 exacerbations a year but less daily symptoms (unicorn)
Class D-two or more exacerbations a year and high symptom burdens
COPD treatment based on classification
ACUTE TREATMENT
- Inhaled bronchodilators
SABA: Albuterol
SAMA: Ipratropium bromide - Inhaled steroids
Budesonide - IV steroids
Solu-medrol - Antibiotics
If infection is suspected - Oxygen therapy
Nasal cannula (most used)
Maintain SpO2 that is appropriate for individual patient - NIPPV
Has shown to decrease morbidity and mortality
Intubation and mechanical ventilation - Secretion mobilization
Chest physiotherapy (CPT) or postural drainage and percussion (PD&P)
Vibratory PEP or HFCWO therapy
COPD treatment based on classification
CHRONIC MANAGEMENT
- Inhaled bronchodilators
LABA: formoterol
LAMA: tiotropium
Variety of combo inhalers available - Inhaled steroids
Budesonide, fluticasone
Variety of combo inhalers available - Vaccination
Influenza, pneumococcal, covid-19, pertussis
Helps prevent secondary infections - Oxygen therapy
Long term administration in patients with severe hypoxemia has shown to increase survival rates - NIPPV or CPAP
Home use of NIPPV has been shown to decrease hospital readmissions for exacerbations
CPAP may be preferred in patients with known obstructive sleep apnea - Pulmonary rehab
Exercise training
Education
Managing symptoms
Typically, 6-8 weeks in length
Associated with significant reduction in hospital length of stay - Prevention
Identifying and reducing exposure to risk factors
Smoking cessation
Avoid exposure to occupation irritants
Avoid exposure to environmental irritants
COPD based on classification
ADVANCED TREATMENT
- Lung volume reduction surgery
Areas of the lung with the most hyperinflation are resected
Improves lung mechanics of remaining tissue
Higher mortality rates are associated in patients with severe emphysema - Endobronchial valves
Less invasive approach to lung reduction
Valve opens during exhalation and allows air to escape
During inhalation, the valves close and prevents air from entering the treated lobe
Patients tend to have lower number of exacerbations post treatment - Lung transplantation
Considered for patients who are not candidates for LVRS
Very severe COPD patients (FEV1 <20%)
Limited availability due to cost and shortage of donor organs
