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Health Assessment (Spring 2023) > Exam 4 obstructive > Flashcards

Exam 4 obstructive Flashcards

1
Q

What diagnosis obstructive sleep apnea?

A

– Polysomnography recording

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2
Q

What does it look at?

A

Apnea, hypopnea, respiratory effort-related arousal

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3
Q

What kind of reduction of air flow is considered apnea?

A

90%

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4
Q

What is an obstructive apnea event?

A

Breathing effort during apnea

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5
Q

What is a central apnea event?

A

No breathing effort during apnea

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6
Q

How long does an apnea event have to last to be counted?

A

10sec

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7
Q

What is the AHI?

A

The number of apnea & hypopnea events in an hour

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8
Q

An AHI >15 means what?

A

Pt has OSA

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9
Q

What are the criteria for OSAS?

A
  • AHI >5
  • daytime somnolence > 2wks
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10
Q

What does one have to be very aware of when inducing a Pt with an AHI >30?

A

Pt’s sats can drop from 100% to 30% quick on induction. Be very aware with these Pt’s

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11
Q

What are some metabolic consequences of OSA?

A
  • Systemic inflammation
  • ↑SNS activity
  • hormonal changes
  • insulin resistance
  • metabolic syndrome
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12
Q

What are the most common sites for airway narrowing?

A

Retropalatal and retroglossal regions of the oropharynx

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13
Q

What kind of obstruction will be seen a lot?

A

Excess soft tissue/tonsils

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14
Q

What is functional collapse?

A

Forces that can collapse the upper airway > the forces that dilate the upper airway

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15
Q

What increases airway obstruction while supine?

A

Increases the effect of extraluminal positive pressure against the pharynx

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16
Q

What stimulates the arousal response?

A

Hypercapnia, hypoxia, upper airway obstruction & work of breathing

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17
Q

What are the day S/S of sleep apnea?

A
  • Dry mouth or headache upon waking
  • sleepiness
  • falling asleep during monotonous situations
  • subjective impairment of cognitive function
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18
Q

What are the night S/S of sleep apnea?

A
  • Frequent awakening
  • awaking from own snoring w/ choking sensation
  • loud snoring
  • observed pauses in breathing during sleep
  • tachycardia
  • non-restorative sleep
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19
Q

What are the risk factors for OSA?

A

Age, obesity, minorities, male, pregnancy, smoking

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20
Q

What surgery is recommended for OSA?

A

Maxillomandibular advancement (MMA)

21
Q

What does the electrical stimulation surgery do for someone with OSA?

A

It stimulates hypoglossal nerve → contracts to keep airway open. (Very expensive)

22
Q

A Mallampati score of 2 results in what odds for OSA?

A

A 5 point increase for odds of Pt having OSA

23
Q

What does STOP-Bang stand for & what does it check?

A

A scale to show risk for OSA (Pts that have not been diagnosed for OSA)
Snore, Tired, Observed, Pressure, BMI >35, Age >50, Neck >17”, Gender (male)

24
Q

What anesthetic considerations are there for a Pt with OSA?

A
  • Less is more
  • Elevate HOB
  • Pre-oxygenate
  • Possible difficult intubation
  • Use minimal to no opioids
  • Regional is better than GA
25
Q

What are the S/S for an URI?

A
  • Nonproductive cough
  • sneezing
  • rhinorrhea
26
Q

How long is elective Sx delayed for a current URI?

A

6wks

27
Q

When do you proceed with Sx in someone that has a URI?

A

If S/S are getting better → proceed w/ sx

28
Q

What equipment is preferred for someone with an URI?

A
  • An LMA > ETT
  • If using ETT use lidocaine & suppress SNS airway stimulation or nebulizer with lidocaine in pre-op
29
Q

What are possible adverse induction events for someone with an URI?

A
  • Bronchospasm
  • laryngospasm
  • airway obstruction
  • postintubation croup
  • desaturation
  • atelectasis
30
Q

What stimuli provoke asthma?

A

Allergens, ASA, NSAIDs, beta-antagonist, infections, exercise, stress, endorphins & vagal mediation

31
Q

Where specifically is the airway edema in asthma?

A

In the bronchi

32
Q

What inflammatory mediators are released in asthma?

A
  • Histamine
  • prostaglandin D2
  • leukotrienes
33
Q

How is asthma diagnosed?

A

Airflow obstruction on pulmonary function testing that is at least partially reversible with bronchodilators

34
Q

What are the usual PFT results in someone with asthma?

A
  • FEV1 < 35% of normal
  • FRC - may increase substantially
  • TLC - within normal range
35
Q

What PaO₂ indicates severe asthma?

A

PaO₂ <60 mm Hg on room air

36
Q

When is an asthmatic Pt stress dosed?

A

If been on IV or PO steroids for while then give stress dose

37
Q

What are the 2 meds that have long-acting bronchodilator & steroid combo?

A
  • (Symbicort) Budesonide + formoterol
  • (Advair) Fluticasone + salmeterol
38
Q

What induction drugs are best for asthma Pt’s?

A
  • Lidocaine, propofol or ketamine
  • Avoid histamine-releasing NMBDs
39
Q

What are the risk factors for COPD?

A

Pollution, recurrent childhood resp infections, low birth weight, asthma, age, female, poor lung development, lower socioeconomics

40
Q

What are the S/S for COPD?

A
  • Dyspnea on exertion or at rest, chronic cough, and chronic sputum production
  • Exacerbations… acute worsening airflow obstruction
  • Tachypnea and prolonged expiratory time
  • Decreased breath sounds, expiratory wheezes
41
Q

When does a COPD’er get long-term O2 therapy?

A

PaO2 <55 mmHg, Hct >55% or cor pulmonale

42
Q

What is the PaO2 goal for a COPD’er?

A

> 60 mmHg

43
Q

What would we want a COPD’er albumin level to be?

A

At least 3.5 mg/dL (lower albumin = increased pulm risks)

44
Q

Which abnormal ABG labs would lead to an Pulmonology consult?

A
  • Bicarbonate > 33 mEq/L
  • PCO2 > 50 mm Hg
45
Q

What VA agent is best suited for a COPD’er?

A

Sevoflurane

46
Q

What VA agent should be avoided with COPD’ers?

A

Nitrous oxide

47
Q

What is the minimum time a smoker should stop smoking before elective surgery?

A

Minimum 6 weeks

48
Q

– What is the elimination half-life of carbon monoxide?

A

approximately 4–6 hours

Health Assessment (Spring 2023) (11 decks)

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