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ARCHIVED: Assessment > Exam 2: Pulmonary > Flashcards

Exam 2: Pulmonary Flashcards

1
Q

Observation pieces of pulmonary assessment:

A 
Rate/pattern/effort of breathing
Tracheal position
Thorax expansion
Skin/soft tissue appearance
Trach scar/stoma
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2
Q

Bronchial breath sounds are normally heard:

A

In the tracheobronchial tree

Trachea, R sternoclavicular

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3
Q

Characteristics of bronchial breath sounds:

A

I/E components equal with a pause between

Higher pitch, louder

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4
Q

Vesicular breath sounds are normally heard:

A

In the lung tissue

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5
Q

Characteristics of vesicular breath sounds:

A

Lower pitched and softer

Expiration shorter than inspiration without a pause between breath sounds

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6
Q

Consolidation sounds like:

A

Low pitched bronchial breathing

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7
Q

Cavitary disease sounds like:

A

High pitched bronchial breathing

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8
Q

Three adventitious sounds:

A

Wheeze
Stridor
Crackles

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9
Q

Seven appropriate candidates for PFTs:

A 
COPD
Smokers with persistent cough
Wheezing/dyspnea on exertion
Morbid obesity
Thoracic surgery
Open upper abdominal surgery
> 70 y/o
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10
Q

Two categories of PFT:

A

Abnormalities of gas exchange (ABG, pulse ox, capnography)

Mechanical dysfunction of lungs/chest wall (spirometry)

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11
Q

Normal %s of volume & flow in spirometry:

A

Volume: 80-120% of predicted
Flow: 80% of predicted

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12
Q

Examples of obstructive lung disease:

A

COPD

Asthma

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13
Q

Examples of restrictive lung disease:

A

Pregnancy
NM disease
Obesity

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14
Q

Normal vital capacity result:

A

> 80% of predicted value

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15
Q

Type of disease that affects VC:

A

Restrictive diseases ↓ VC

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16
Q

Interpretation of FVC results:

A

80-120% Normal
70-79% Mild
50-69% Moderate

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17
Q

FVC measures:

A

Resistance to flow; max inspiration with forced expiration

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18
Q

FEV1 measures:

A

Volume of air forcefully expired from full inspiration in the 1st second

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19
Q

Interpretation of % FEV1/FVC:

A

> 75% Normal
60-75% Mild
50-59% Moderate

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20
Q

Type of disease that affects FEV1/FVC:

A

Obstructive disease will ↓ ratio

21
Q

FEF25-75 measures:

A

The effort independent middle portion of expiration and the status of the smaller airways

22
Q

Interpretation of % FEF25-75:

A

> 60% Normal
40-60% Mild
20-40% Moderate

23
Q

Type of disease that affects FEF25-75:

A

Obstructive disease, even in early stages

24
Q

FRC is measured by:

A

Nitrogen wash-out with an analyzer on spirometer; end-point is when alveolar nitrogen concentration falls below 7%

25
Q

Relative PA, Pa, and Pv in Zone 1:

A

PA > Pa > Pv

26
Q

Relative PA, Pa, and Pv in Zone 2:

A

Pa > PA > Pv

27
Q

Relative PA, Pa, and Pv in Zone 3:

A

Pa > Pv > PA

28
Q

Best V/Q match is in Zone:

A

Zone 2

29
Q

Describe Zone 1:

A

Arterial pressure falls below alveolar pressure so capillaries are compressed, alveoli are enlarged; does not happen under normal circumstances, only when BP drops below alveolar pressure; more ventilation than perfusion.

30
Q

Describe Zone 2:

A

Pulmonary artery pressure exceeds both venous pressure and alveolar pressure, so good flow past alveoli and good V/Q match

31
Q

Describe Zone 3:

A

Venous pressure exceeds alveolar pressure, so capillaries are engorged and crushing alveoli; more perfusion than ventilation.

32
Q

Distribution of pulmonary blood flow upright/supine:

A

Upright: flow strongest bases –> apex
Supine: flow equal bases to apex, but strongest in posterior/weakest anterior

33
Q

Pulmonary effects of PPV:

A 
Increases in: 
Zone 1 
Blood flow to dependent lung
Ventilation to independent lung
Dead space
34
Q

CV effects of PPV:

A

Decreased preload and BP

Can increase R to L shunt with atrial septal defect

35
Q

Counteracting CV effects of PPV:

A 
Positioning
TED hose
Fluid administration to ↑ volume load/preload
ɑ/β agonists
Inotropic support
36
Q

Effects of smoking cessation at 12-14 hours:

A

↓ carboxyhemoglobin levels to normal

37
Q

Effects of smoking cessation at 2-3 weeks:

A

Mucociliary function returns

↑ secretions!!

38
Q

Effects of smoking cessation at 4 weeks:

A

Reduced secretions

39
Q

Effects of smoking cessation at 8 weeks:

A

↓ rate of post-op pulmonary complications

40
Q

Tx for bronchospasm:

A

β-agonists
Anticholinergics
Methylxanthines
Corticosteroids (for inflammation)

41
Q

Restrictive pulmonary disease and anesthetics:

A

Titrate sedation carefully d/t ↓ FRC
Careful with NO and sats
Inhaled agents have accelerated uptake d/t ↓ FRC
SaO2 will drop quickly due to lower stores

42
Q

Restrictive disease and regional anesthesia:

A

Regional anesthesia > T10 may impair ventilation (accessory muscles)

43
Q

Restrictive disease and mechanical ventilation:

A 
↑ PAP
↓ volumes (4-8 ml/kg)
↑ respiratory rate (14-18)
Use PEEP
Pressure control mode better than volume
44
Q

FRC change in supine position:

A

10-15% ↓

45
Q

FRC change with GA:

A

5-10% ↓ additional

46
Q

VC changes after upper abdominal procedure:

A

Up to 40% ↓ and up to 14 days to recover

47
Q

Strategies for obstructive pulmonary disease and anesthesia:

A

Reduce airway reactivity
Avoid spontaneous ventilation under GA
Keep regional anesthesia low-level
Careful with NO

48
Q

Strategies for reducing airway reactivity:

A

Bronchodilator therapy
High alveolar concentrations of inhalation agents
IV opioids/lidocaine prior to airway manipulation
Single dose corticosteroids

49
Q

PPV for obstructive disease:

A

Large TV
Slower rate to allow full expiration
Low I:E ratio
Keep PIP below 40

ARCHIVED: Assessment (11 decks)

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