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Mar: Sem 2 - Health Assessment > Exam 4 Obstructive lung disease Part II (Ash) > Flashcards

Exam 4 Obstructive lung disease Part II (Ash) Flashcards

1
Q

What 3 things may improve reversible componenets of asthma pre-operatively?

A

chest physiotherapy, antibiotics, and a bronchodilator

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2
Q

What is indicated when we are concerned about the adequacy of ventilation or oxygenation?

A

ABG

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3
Q

____ and ____ therapy should be continued until induction.

A

Anti-inflammatory and bronchodilator

Slide 22

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4
Q

T/F
Patients on systemic steroids within the last 6 months may need a stress dose of hydrocortisone or methylprednisolone

A

True

Slide 22

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5
Q

Asthma patients should be ____ and have a PEFR ____% of predicted or their personal best value before surgery

A

free of wheezing
>80%

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6
Q

Which characteristics of asthma should be evaluated pre-op?

A

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7
Q

COPD is a disease of ____ ____ ____

A

chronic airflow obstruction

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8
Q

COPD Sx include:
____ characterized by lung parenchymal destruction
____ chracterized by cough and sputum production and ____

A

emphysema, chronic bronchitis, and small airway obstruction

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9
Q

Pulmonary elastic recoil is lost d/t ____ destruction

A

bronchio-alveolar

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10
Q

COPD has a worldwide prevalence of ____ and is the ____ leading cause of death

A

10%
3rd

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11
Q

Risk factors for COPD

LONNNGGGG list… just know what you can here

A

Although cigarette smoking contributes to COPD, multiple other risks exist, including occupational exposure to dust & chemicals (esp coal mining), gold mining, textile industry, biomass fuel, air pollution, genetic factors ( s/a α1-antitrypsin deficiency), age, female sex, poor lung development during gestation such as from maternal smoking, low birth weight, recurrent childhood respiratory infections, low socioeconomic class, and asthma

Slide 24

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12
Q

CODP leads to 5 common things

A

1) pathologic deterioration in elasticity or recoil within the lung parenchyma, which normally keeps the airways in an open position
2) pathologic changes that decrease bronchiolar wall structure, thus allowing them to collapse during exhalation
3) an increase in gas flow velocity in narrowed bronchioli, which lowers the pressure inside the bronchioli and further favors airway collapse
4) active bronchospasm and obstruction resulting from increased pulmonary secretions
5) destruction of lung parenchyma, enlargement of air sacs, and development of emphysema

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13
Q

3 common Sx of COPD

A

dyspnea at rest or exertion
chronic cough
chronic sputum production

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14
Q

T/F
COPD exacerbations are c/b chronic worsening in airflow obstruction.

A

FALSE!
it is an acute worsening in airflow obstruction

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15
Q

as expiratory airflow obstruction increases, ____ and ____ ____ ____ become evident

A

tachypnea
prolonged expiratory times

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16
Q

As COPD progresses, ____ become more frequent and are often triggered by ____

A

Bacterial respiratory infections

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17
Q

in COPD breath sounds are ____ and a ____ wheeze is common

A

decreased
expiratory

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18
Q

providers should have a high degree of suspicion and low threshold to test for COPD in pts with ____ and ____ or ____

A

dyspnea
chronic cough
environmental exposures

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19
Q

What test gives us a definitive diagnosis of COPD?

A

Spirometry

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20
Q

PFTs in COPD show a ____ in FEV1:FVC ratio and an even greater ____ in the FEF 25-75% of VC.
FEV1:FVC is usually ____%, FRC and TLC are ____, and the DLCO (diffusing capacity for CO is ____

A

Decrease
Decrease
<70%
increased
reduced

Slide 27

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21
Q

What is responsible for the increase in RV in COPD? (2 things)

A

slowing of expiratory airflow and gas trapping behind prematurely closed airways

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22
Q

What is the advantage of an increased RV and FRC in pts with COPD related to?
What is the cost?

A

enlarged airway diameter
Cost is a greater work of breathing at higher lung volumes

Slide 27

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23
Q

what does spirometry look like with COPD in comparison to normal?

Flip the card to find out!

A

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24
Q

GOLD spirometric criteria for COPD severity is based on ____ measurement.
What are the stages and characteristics at each stage?

A

FEV1

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25
Q

What does a Chest X-ray look like in COPD patients?
What suggests emphysema? What confirms it?

A

abnormalities minimal even w/ severe COPD
-hyperlucency in the lung periphery suggests emphysema
-bullae confirms emphysema, although only a small percentage of pts with emphysema have bullae

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26
Q

____ is much more sensitive at diagnosing COPD than ____

A

CT, CXR

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27
Q

what symptoms are suggestive of multi-organ loss of tissue (MOLT) COPD phenotype?
What is it associated with?

A

airspace enalrgement and alveolar destruction
loss of bone, muscle and fat
associated with higher rates of lung cancer

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28
Q

what symptoms indicate bronchitic phenotype? What is it usually accompanied by?

A

bronchiolar narrowing and wall thickening
metabolic syndrome and high rates of cardiac disease

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29
Q

Is CT usually used for COPD diagnosis?
What has prompted interest in expanding the protocol for all COPD cases?

A

No, but the wealth of information it provides has prompted interest in expanding the protocol for all COPD cases

Slide 30

30
Q

what factors does the BODE index look at?

A

BMI, degree of obstruction, level of dyspnea, exercise tolerance

all used to assess prognosis

Slide 31

31
Q

Higher BODE scores indicate greater risk of what?

A

COPD exacerbations, hospitalizations, and death c/b pulmonary complications

Slide 31

32
Q

____ deficiency is an inherited disorder associated w/ premature development of COPD
in blood testing, a low level indicates ____ and need for lifelong replacement therapy

A

alpha1-antitrypsin
genetic disease

Slide 31

33
Q

Which lab should be measured in pts w/ uncontrolled COPD despite adequate bronchodilator treatment?
What do high levels indicate?
Low levels are associated with?

A

eosinophils
high: need for inhaled glucocorticoids
low: poor response and increased risk of pneumonia

Slide 31

34
Q

____ often remains normal until COPD is severe.
____ doesnt usually decrease until FEV1 is ____ and PaCO2 may not increase until the FEV1 is ____

A

ABG
PaO2, <50%
PaCO2, even lower

Slide 31

35
Q

COPD treatment is designed to worsen symptoms and speed up progression.
T/F

A

False, haha
should alleviate symptoms and slow progression

Slide 32

36
Q

what is the 1st step in treating COPD?

A

reduce exposure to smoking and environmental pollutants

Slide 32

37
Q

smoking cessation can decrease disease progression and lower mortality by up to ____
What else may diminish or disappear as well?

A

18%
chronic bronchitis and lung degeneration

Slide 32

38
Q

Pharmacologic Treatment of COPD often begins with ____.
What is added if dyspnea persists?
the 3rd treatment, ____, is most effective with associated ____, ____, ____ and ____

A

long acting muscarinic antagonist inhaler
long acting beta 2 agonist
glucocorticoids, asthma, rhinitis, elevated eosinophils, and history of exacerbations

slide 32

39
Q

inhaled treatements improve symptoms & FEV1, and reduce exacerbations
T/F

A

True

Slide 33

40
Q

What are some other treatments for COPD not including the inhaled medications?

A

flu and pneumonia vaccines
diuretics (when RHF or CHF has developed)

Slide 33

41
Q

During exacerbations of COPD, what 3 types of medications may be necessary?

A

abx, corticosteroids, and theophylline

Slide 33

42
Q

What kind of COPD treatment can increase exercise capacity?

A

pulmonary rehab progreams

Slide 33

43
Q

long term home ____ is recommended when the ____ is < 55mmHg, ____ is >55%, or ther is evidence of ____ in order to decrease the risk of death

A

O2
PaO2
Hct
Cor pulmonale

Slide 34

44
Q

what is the goal of supplemental O2 in COPD patients?
What is usually needed to accomplish this?

A

PaO2>60mmHg
NC @2L/min

Slide 34

45
Q

How is the O2 flow rate titrated in COPD patients?

A

ABG or SpO2

Slide 34

46
Q

The relief of hypoxemia with ____ ____ is more effective than any drug therapy in decreasing pulmonary vascular resistance and pulmonary hypertension and in preventing erythrocytosis

A

supplemental O2

Slide 34

47
Q

Pts should be advised to do ____ or ____ to improve respiratory function post-operatively

A

deep breathing exercises
incentive spirometry

Slide 34

48
Q

COPD treatment chart

A

Slide 35

49
Q

what kind of surgery may be indicated in pts w/severe COPD, unresponsive to medical therapy who have overdistended, poorly functioning lung tissue

A

lung volume reduction surgery

Slide 36

50
Q

What does surgical removal of overdistended areas of the lung allow for?

A

areas of normal lung to expand and and improves lung function

Slide 36

51
Q

How is lung volume reduction surgery most commonly performed?

A

Median sternotomy
or
Video-Assisted Thoracoscopic Surgery (VATS)

Slide 36

52
Q

What mechanisms improve lung function in COPD?

A

1) increased elastic recoil, which increases expiratory airflow
2) decreased hyperinflation, which improves diaphragmatic and chest wall mechanics
3) decreased ventilation/perfusion mismatch, improving alveolar gas exchange

Slide 36

53
Q

What is included in anesthesia management of a patient have lung volume reduction surgery?

A

a double-lumen ETT
avoidance of nitrous oxide
minimizing excessive airway pressure

Slide 36

54
Q

What measurement is an unreliable guide for fluid management in COPD? Why?

A

CVP
d/t surgical alterations that will affect intrathoracic pressures

Slide 36

55
Q

What history should we look into with pro-operative COPD patients?

A

smoking history
current meds (esp recent corticosteroids)
exercise tolerance
exacerbation frequency
need for hospitalizations

Slide 37

56
Q

Any previous need for ____ or ____ should be determined pre-operatively in COPD patients

A

NIPPV- Noninvasive positive pressure ventilation
or
Mechanical ventilation

Slide 37

57
Q

Becuase smoking & COPD are associated w/ multiple comorbidities, pts should also be questioned on what>

A

Presence of other diseases such as DM, HTN, PVD, ischemic heart disease, heart failure, dysrhythmias, and lung cancer

Slide 37

58
Q

If a patient has pulmonary disease, ____ function should be assessed by ____ and ____

A

RV
clinical exam and echocardiogram

Slide 37

59
Q

which therapies should be continued until the morning of the surgery in COPD?

A

inhalation therapies

Slide 37

60
Q

What pre-operative therapies can reduce post-op pulmonary complications?

A

chest physiotherapy such as deep breathing, coughing, incentive spirometry, and pulmonary PT

Slide 37

61
Q

What findings are more predictive of pulmonary complications that spirometric tests?

A

clinical findings such as smoking, wheezing, and productive cough

Slide 37

62
Q

The value of routine pre-op PFT’s cannot be overstated…T/F?

A

False! pre-op PFT value is controversial

Slide 37

63
Q

What are the 9 indications for pre-operative pulmonary evaluation?

A

1) hypoxemia on room air or the need for home 02 without a known cause
2) a bicarbonate >33 mEq/L or PC02 >50 mmHg w/o diagnosed pulmonary dz
3) a history of respiratory failure d/t an existing problem
4) severe shortness of breath attributed to respiratory disease
5) planned pneumonectomy
6) difficulty assessing pulmonary function by clinical signs
7) the need to distinguish causes of respiratory compromise
8) the need to determine the response to bronchodilators
9) suspected pulmonary HTN
He Bikes His Seven Puppies Down Narrow Roads Perfectly

Slide 38

64
Q

Do COPD patients undergoing peripheral surgery require preop PFT’s?
when in doubt, what is sufficient to assess lung disease?

A

no
spirometry with FEV1

Slide 38

65
Q

Ventilatory function can also be assessed under ____ by measuring airflow related to lung volume

A

dynamic conditions

Slide 39

66
Q

Expiratory flow rates can be plotted against ____ to produce ____

A

lung volumes
flow volume curves

Slide 39

67
Q

when flow rates during inspiration are added to flow volume curves, what do you get?

A

Flow Volume Loops

Slide 39

68
Q

The flow rate is ____ at TLC before the start of expiration. Once forced expiration starts, the ____ ____ ____ is rapidly achieved. The flow rate then falls in a ____ as the volume decreases to ____.

A

0
peak flow rate
linear
RV

Slide 39

69
Q

During maximal inspiration from RV to TLC, the inspiratory flow is most rapid at the ____ of inspiration, causing a____ inspiratory curve

A

midpoint
U-shaped

Slide 39

70
Q

In COPD, there is a ____ expiratory flow rate at any given lung volume

A

Lower

Slide 39

71
Q

Flow volume loops have a ____ expiratory curve due to ____ emptying ofthe airways

A

concave
uniform

Slide 39

72
Q

Why is the RV increased in COPD?

A

Air trapping

Slide 39

Mar: Sem 2 - Health Assessment (32 decks)

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