Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mar: Sem 2 - Health Assessment > Exam 4 Obstructive lung disease part I (bri) > Flashcards

Exam 4 Obstructive lung disease part I (bri) Flashcards

1
Q

____ contribute to the risk of perioperative pulmonary complications

A

Obstructive respiratory diseases

slide 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • ____ complications play an important role in determining long-term mortality after surgery
  • Patient optimization prior to surgery can significantly decrease the incidence of these complications
A
  • Pulmonary

slide 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Obstructive respiratory diseases can be divided into 4 groups regarding their influence on anesthetic management:

A
  1. Acute upper respiratory tract infection (URI)
  2. Asthma
  3. Chronic obstructive pulmonary disease (COPD)
  4. Miscellaneous respiratory disorders

slide 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute upper respiratory tract infection

  • Ages ____ experience the “common cold” at a rate of 19% per year
  • Ages ____ experience it at a rate of 16% per year
A
  • Ages 25-44 experience the “common cold” at a rate of 19% per year
  • Ages 45-65experience it at a rate of 16% per year

Consequently, a fraction of scheduled surgery pts will have an active URI

slide 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infectious (viral or bacterial) nasopharyngitis accounts for ̴____% of all URIs

A

95%

slide 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common responsible viral pathogens of acute URI’s

A
  • rhinovirus
  • coronavirus
  • influenza virus
  • parainfluenza virus, and
  • respiratory syncytial virus (RSV)

slide 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Noninfectious nasopharyngitis can be ____ or ____ in origin

A
  • allergic or vasomotor
    Diagnosis is usually based on clinical signs and symptoms

slide 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

____ and ____ lack sensitivity, and are time and cost consuming
making them impractical in a busy clinical setting

A

Viral cultures & lab tests

slide 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  • Most studies on the effects of URI involve pediatric patients
  • Children with URI’s are at much higher risk of perioperative respiratory adverse events such as:
A
  • transient hypoxemia
  • laryngospasm
  • breath holding, and
  • coughing

slide 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • Data on adults with URI’s undergoing anesthesia is limited
  • A pt who has had a URI for ____ and is stable or improving can be safely managed without postponing surgery
A

weeks

slide 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If surgery is delayed, pts should not be rescheduled within ____ weeks as studies indicate that airway hyperreactivity may persist for that duration

A

6

slide 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • The COLDS scoring system is used to determine risk of proceeding with surgery
  • COLDS takes into account what?
A
  • current sx’s
  • onset of symptoms (higher risk w/n 2 weeks)
  • presence of lung disease
  • airway device (higher risk with ETT)
  • surgery (higher risk with major airway surgery)

slide 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anesthetic management of pts w/URI’s should include:

A
  • adequate hydration
  • reducing secretions
  • limiting manipulation of the sensitive airway

slide 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acute URI

  • Nebulized or topical local anesthetic on the vocal cords may reduce ____
  • Use of a LMA rather than an ETT may reduce the risk of ____
  • Considerations for induction and maintenance are similar to those with ____
  • When there are no contraindications, ____ may result in smoother emergence
A
  • upper airway sensitivity
  • laryngospasm
  • asthma
  • deep extubation

slide 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adverse respiratory events in pts with URIs include:

A
  • bronchospasm
  • laryngospasm
  • airway obstruction
  • postintubation croup
  • desaturation
  • atelectasis

slide 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

____ and ____ hypoxemia are common in acute URI and amenable to treatment with supplemental O2

A

Intraoperative and postoperative

slide 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

symptoms of acute respiratory infection vs influenza

A

slide 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what disease has chronic inflammation of the mucosa of the lower airways? and is an episodic disease with acute exacerbations and asymptomatic periods?

A

Asthma

slide 7/8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In Asthma:

  • Activation of the inflammatory cascade leads to infiltration of the ____ with eosinophils, neutrophils, mast cells, T cells, B cells, and leukotrienes
  • This results in ____, especially in the bronchi
  • There is also ____ that leads to thickening of the basement membrane and smooth muscle mass
A
  • airway mucosa
  • airway edema
  • airway remodeling

slide 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The main inflammatory mediators implicated in asthma include:

A
  • histamine
  • prostaglandin D2
  • leukotrienes

slide 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are asthma provoking stimulators?

A

slide 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

symptoms of asthma include:

A
  • expiratory wheezing
  • productive or nonproductive cough
  • dyspnea
  • chest tightness that may lead to air hunger
  • eosinophilia

slide 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most asthma attacks are short lived, lasting how long?

A

minutes to hours

slide 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

pt’s can experience periods of daily airway obstruction, ranging from ____ to ____

A

mild to severe

slide 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is status asthmaticus?

A

dangerous, life-threatening bronchospasm that persists despite treatment

slide 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When the history is obtained from an asthma pt, attention should focus on:

A
  • previous intubations
  • ICU admission
  • 2+ hospitalizations for asthma in the past year
  • the presence of coexisting diseases

slide 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q
  • Diagnosis of asthma d/o clinical history, symptoms, and objective measurements of airway obstruction
  • Asthma is diagnosed when a pt reports ____, ____, or ____ and demonstrates airflow obstruction on PFT that is at least partially reversible with ____
A
  • wheezing, chest tightness, or SOB
  • bronchodilators

slide 9

28
Q

Classification of asthma severity depends on:

A
  • the symptoms
  • PFTs
  • medication usage

slide 9

29
Q

what is the most clinically usefull spirometric test of lung function?

A
  • FEV1
  • FVC
  • FEV1/FVC ratio
  • maximum voluntary ventilation (MVV)
  • diffusing capacity

slide 10

30
Q

what are direct measures of the severity of expiratory obstruction?

A
  • Forced expiratory volume in 1 second (FEV1)
  • forced expiratory flow (FEF)
  • midexpiratory phase flow

These measurements can be used to assess the severity of an asthma attack

slide 11

31
Q

The typical symptomatic asthmatic pt who comes to the hospital has an FEV1 of what?

A

< 35%

slide 11

32
Q

how wil flow volume loop look like with asthmatic pt?

A

Flow-volume loops show a downward scooping of the expiratory limb of the loop

slide 11

33
Q

During moderate or severe asthma attacks, what happens to FRC and TLC?

A

the functional residual capacity (FRC) may increase substantially, but total lung capacity (TLC) usually remains normal

slide 11

34
Q

in asthma is diffusing lung capacity for carbon monoxide changed?

A

Diffusing lung capacity for carbon monoxide is not changed

slide 11

35
Q

asthma

  • In pts with ____ obstruction, relief of obstruction after a bronchodilator suggests the dx ofasthma
  • Abnormalities in PFTs may persist for several days after an attack despite the absence of ____
  • Since asthma is an episodic illness, its diagnosis may be suspected even w/ normal ____
A
  • expiratory obstruction
  • symptoms
  • PFT results

slide 11

36
Q

What is happening in graph B compared to A

A

B= bronchospasm. FEV1 < 80% of VC

slide 12

37
Q

how does a volume flow loop look like in obstructive vs restrictive diease?

A

slide 13

38
Q

with mild asthma how will abg look?

A

Mild asthma is usually accompanied by a normal PaO2 and PaCO2

slide 14

39
Q

During an attack, tachypnea and hyperventilation is caused by ____ not hypoxemia

A

neural reflexes of the lungs,

slide 14

40
Q

what are the most common ABG findings of symptomaticasthma

A

Hypocarbia and respiratory alkalosis

slide 14

41
Q
  • As the severity of expiratory obstruction increases, the associated ventilation/perfusion mismatching may result in a PaO2 of < ____ mmHg
  • The PaCO2 is likely to increase when the FEV1 is < ____% of predicted
A
  • < 60mmhg
  • < 25%

slide 14

42
Q

in asthma fatigue of the skeletal muscles necessary for breathing may contribute to the development of ____

A

hypercarbia

slide 14

43
Q
  • Pts w/severe asthma may demonstrate hyperinflation and hilar vascular congestion due to ____ and ____
  • ____ can be helpful in determining the cause of an asthma exacerbation and ruling out other causes
  • ____ may show signs of RV strain or ventricular irritability during an asthma attack
A
  • mucous plugging and pulmonary HTN
  • CXR’s
  • EKG

slide 15

44
Q

The differential diagnosis of asthma includes:

A
  • viral tracheobronchitis
  • sarcoidosis
  • rheumatoid arthritis w/bronchitis
  • extrinsic or intrinsic AW compression
  • vocal cord dysfunction
  • tracheal stenosis
  • chronic bronchiti
  • COPD
  • and foreign body aspiration

slide 15

45
Q

the aim of asthma treatment lie in controlling s/s and reducing exacerbations. What medications can be used?

A
  • short acting inhaled β2 agonist
  • daily inhaled corticosteroids
  • inhaled muscarinic antagonists
  • leukotriene modifiers
  • mast cell stabilizers

slide 16

46
Q

what is the 1st line of tx in pts with milde asthma?

A

short-acting inhaled β2 agonist.
This is only recommended in those w/ < 2 exacerbations/month

slide 16

47
Q

what do inhaled coritcosteroids do for asthma?

A

improve sx’s, reduce exacerbations and decrease risk of hospitalization

slide 16

48
Q

if sx remain uncontrolled what can be added?

A

daily inhaled β2 agonist

slide 16

49
Q
  • ____ are reserved for severe asthma, uncontrolled with inhalational medications
  • Studies show that ____ decreases use of long-term medications and may improve quality of life
A
  • Systemic corticosteroids
  • SQ immunotherapy

slide 16

50
Q

____ is recently approved and the only nonpharmacologic tx for refractory asthma

A

Bronchial thermoplasty (BT)

slide 17

51
Q
  • BT uses bronchoscopy to deliver radiofrequency ablation of airway smooth muscles to all lung fields except the ____
  • The procedure is performed in three sessions and uses intense heat, which carries a risk of ____
A
  • right middle lobe
  • airway fire

slide 17

52
Q
  • Loss of airway smooth muscle mass is thought to reduce____
  • Serial PFTs can be useful for?
  • When the FEV1 improves to about ____% of normal, pts usually have minimal or no symptoms
A
  • bronchoconstriction
  • monitoring response to treatment
  • 50%

slide 17

53
Q

what disease happens when bronchospasm doesn’t resolve despite usual treatmenat and is considered life threatening

A

Acute severe asthma

slide 18

54
Q

how do you treat acute severe asthma?

A

Emergency tx consists of:
* high-dose, short-acting β2 agonists
* systemic corticosteroids

slide 18

55
Q

INH β2 agonistscan be administered every ____ minfor several doses w/o adverse hemodynamic effects, although pts may experience unpleasant sensations resulting from ____

A
  • 15-20 min
  • adrenergic overstimulation

slide 18

56
Q
  • IV corticosteroids are administered early, why?
  • The 2 corticosteroids most commonly used:
A
  • because onset takes several hours
  • hydrocortisone & methylprednisone

slide 18

57
Q
  • in acute severe asthma Supplemental O2 is given to help maintain O2 saturation >____%
  • Other drugs used in more severe cases include:
A
  • > 90%
  • magnesium and oral leukotriene inhibitors

slide 18

58
Q

What is the treatment for acute severe asthma?

A

slide 19

59
Q
  • Bronchospasm has been reported in ____% of asthmatics undergoing GA
  • Risk of bronchospasm is correlated with ____ and ____.
A
  • 0.2-4.2%
  • the type of surgery (higher with upper abdominal and oncologic surgery) and how recent the last attack occurred

slide 20

60
Q

GA mechanisms that increase airway resistance:

A
  • depression of cough reflex
  • impairment of mucociliary function
  • reduction of palatopharyngeal muscle tone
  • depression of diaphragmatic function
  • increased fluid in the airway wall

slide 20

61
Q

Other factors that play a role in bronchospasm include:

A
  • airway stimulation by intubation
  • PNS activation
  • and/or release of neurotransmitters such as substance P and neurokinins

slide 20

62
Q

Preop evaluation of pts with asthma requires an assessment of:

A
  • disease severity
  • effectiveness of current tx
  • and the need for additional therapy before surgery

slide 21

63
Q

what should we make note of when assessing asthmatic pt?

A
  • history of symptom control
  • frequency of exacerbations
  • need for hospitalization or intubation
  • previous anesthesia tolerance
  • Physicalappearance
  • use of accessory muscles

slide 21

64
Q

why is auscultation of the chest important when assessing an asthmatic?

A

to detect wheezing or crepitations

slide 21

65
Q

what often mirror the degree of airway inflammation?

A

eosinophil counts

slide 21

66
Q

Asthma Preop Assessment

  • Preop PFTs (esp FEV1) before and after bronchodilator may be indicated
  • A reduction in FEV1 or forced vital capacity (FVC) to < ____% of predicted, and/orFEV1:FVC ratio < ____% of predicted, is a risk for periop respiratory complications
A
  • < 70%
  • < 65%

slide 21

Mar: Sem 2 - Health Assessment (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions