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SRNAHealthAssessment > Leo-Pulmonary Assessment > Flashcards

Leo-Pulmonary Assessment Flashcards

1
Q

What are the 3 main things to consider for pulmonary Assessment?

A

1.Determine patient’s baseline
2.Recent changes in patient’s pulmonary
status:How would these changes affect the anesthetic
plan
3.Assess risk for pulmonary complications

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2
Q

Length of Surgery – risk

A

Increase after 2-3hrs

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3
Q

What further increases risk of pulmonary complications?

A

Increase Risk when incision approaches diaphragm

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4
Q

What is decrease after long surgery (pulmonary)?

A

FRC and postop VC

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5
Q

Pulmonary assessment

CCC SSSSS REM

A

– Current or Recent upper respiratory infection?
– Cough – productive? Need to be optimized before surgery?
– Coexisting diseases

– Shortness of breath (dypsnea/orthopnea)
– Sleep apnea
– Snoring
– Stridor, wheezing
– Smoking: Tobacco Use
– Recently hospitalized fordisease/infection
– Exercise tolerance
–Medications
■ What meds and their actions
■ Effectiveness for patient
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6
Q

Even in smokers, with no chronic

lung disease, Effect of smoking?

A

Smoking increases carboxyhemoglobin levels, decreases ciliary function, increases sputum production, stimulates CV system

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7
Q

Smoke-free interval of 12-18 hours shows

A

significant declines in carboxyhgb & normalization of

oxygen-HGB dissociation curve

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8
Q

■ 8 wks smoke free:

A

improves ciliary & small airway function; & decreases
risk of post-op pulm. complications.
– Increased reactivity

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9
Q

CXR and anesthetic plan

A

Only 5% had an impact on surgical/anesthetic plan

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10
Q

Physical Pulmonary Assessment (RCASSSWCT)

A 
Respiratory rate (RR)
■ Conversation
■ Auscultation of Lung Sounds
■ Skin color
■ Size/shape of chest
■ Work of breathing
■ Clubbing/ nail color
■ Tongue & Sublingual area
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11
Q

Surgical Physiologic Changes in Pulmonary Function mainly 2 types of surgeries

A

Abdominal and Thoracic surgeries

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12
Q

Surgical Physiologic Changes in Pulmonary Function Diaphragm change?

A

Diaphragmatic dysfunction

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13
Q

Surgical Physiologic Changes in Pulmonary Function TV

A

Decreased

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14
Q

Surgical Physiologic Changes in Pulmonary Function RR

A

Increased

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15
Q

Surgical Physiologic Changes in Pulmonary Function FRC FRC

A

Decreased FRC (up to 60-70%)

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16
Q

Surgical Physiologic Changes in Pulmonary Function TLC

A

Decreased TLC

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17
Q

Surgical Physiologic Changes in Pulmonary Function alveolar -arterial O2 tension

A

Increased Alveolar-to-arterial O2 tension gradient

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18
Q

________should be treated with antibiotics before undergoing surgery

A

■ Infections

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19
Q

How does Chest physiotherapy help–

A

improve sputum clearance & bronchial drainage

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20
Q

Treat cor pulmonale with

A

diuretics, dig, oxygen

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21
Q

Preop Assessment Goals

A 
■ Bronchodilation therapy
■ Stop smoking
■ Steroid therapy
■ Correct hypoxemia
■ Relieve bronchospasm
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22
Q

Other things to consider

A 
Procedure
■ Position
■ Estimated & Allowable Blood loss
■ Pain Control
■ Need for paralysis
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23
Q

General Anesthesia: on airway

A

Provides controlled airway to deliver desired oxygen

concentration

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24
Q

What are the benefits of Volatile Anesthetics

A

– Good bronchodilators
– Can even be used to treat status asthmaticus
– Beta2-adrenergic stimulation

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25
Q

■ Good choice for respiratory compromised patient

A

Local / Regional Anesthesia

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26
Q

Good choice when trying to avoid possibility

of bronchospasm d/t instrumentation

A

Local / Regional Anesthesia

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27
Q

High levels of blockade can produce

A

severe anxiety & initiate bronchospasm

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28
Q

LA Can block sympathetic input to lungs leading

A

even leading to increased airway resistance

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29
Q

Patients at Increased Risk for Pulmonary Complications

COUPLES

A 
COPD /Cardiac disease
Obese
Upper abdominal surgery
Prolonged bed rest
Long surgery
Elderly
Smokers
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30
Q

Patients at greatest risk for complications are

those with

A

preop pulmonary function measurements less than 50% of predicted

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31
Q

Vesicular

■ NORMAL

A

– inspiration/expiratory ratio of 3 to 1 (I:E of 3:1)

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32
Q

Over most of both lungs Which bronchial sounds

A

Vesicular

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33
Q

■ Inspiratory sounds last longer then expiratory

A

Vesicular

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34
Q

Soft sound with relatively low pitch

A

Vesicular

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35
Q

Distinct pause between I/E

A

Bronchial

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36
Q

Expiratory sounds last longer than inspiratory (1:3)

A

Bronchial

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37
Q

Bronchial breath sounds other than close to the trachea

may indicate

A

pneumonia, atelectasis, pleural effusions

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38
Q

High pitch

A

Bronchial

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39
Q

Breath sounds with high intensity

A

Bronchial

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40
Q

Abnormal in the lung periphery and may indicate an early infiltrate or partial atelectasis

A

Bronchovesicular

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41
Q

Inspiratory & expiratory almost Equal

A

Bronchovesicular

42
Q

Mixture of the pitch of the bronchial breath sounds

heard near the trachea and the alveoli with the vesicular sound

A

Bronchovesicular

43
Q

Medium intensity

A

Bronchovesicular

44
Q

Medium Pitch

A

Bronchovesicular

45
Q

Heard between scapula & in 1st & 2nd interspaces

anteriorly

A

Bronchovesicular

46
Q

Signs of Inadequate Airway pediatric

A

Stridor
■ Noisy respirations
■ Flaring of nares
■ Labored breathing with use of accessory
muscles (Supraclavicular& intercostalretractions

47
Q

Signs of Inadequate Gas Exchange

A 
Tachypnea
■ Decreased PaO2
■ Increased dead space
■ Central cyanosis
■ Chest infiltrates on x-ray evaluation
48
Q

Inadequate Ventilation manifestations of

A

Obstructed airway

49
Q

Chest wall and inadequate ventilation

A

Paradoxical motion involving significant portion of chest

wall

50
Q

PaO2, PaCo2, pH

A

PaO2 decreased
PaCo2 increased
pH decreased

51
Q

Central cyanosis associated with

A

inadequate ventilation

52
Q

Normal FRC =

A

30 mL/Kg (2-2.5L inaverage person)

53
Q

Associated with decreased FRC

A

FRC ↓ in supine position during general anesthesia & ARDS

54
Q

PEEP: How does it help in supine position

A

↑ FRC & ↓ airway closure

55
Q

Preoxygenate/ denitrogenate to keep Expired oxygen

A

> 90%

56
Q

After general anesthesia, how long does it take for FRC to return to normal

A

FRC can take 2 weeks to return to baseline after GETA

57
Q

Asthma is a

A

Chronic airway inflammation characterized by exacerbations & remissions

58
Q

Can cause bronchospasm

A

Manipulation &/or intubation of airway can cause

Bronchospasm

59
Q

Asthma and CO2 retention

A

CO2 retention is late finding in these patients
– May be hypocarbic with respiratory alkalosis d/t
hyperventilation

60
Q

Solubility of CO2 vs O2

A

– 20X more soluble than O2

61
Q

Asthma : What is universal finding during attack

A

hypoxemia

62
Q

During interview for asthma; Determine?

A 
Inciting factors
o Severity
o Reversibility
o Current status
o Last attack (May be hyperreactive for weeks!)
63
Q

For asthma know the last time they

A

Hospitalizations, bronchodilator use, systemic

steroid use

64
Q

What are the 3 Early signs of an asthma attack under general anesthesia

A
  1. Increased peak airway
    pressure
  2. Alteration of expiratory plateau on capnography
  3. Hypoxemia occurs as the attack progresses and
    worsens
65
Q

COPD Criteria to postpone surgery

A 
Elective surgery is postponed:
– Severe dyspnea
– Wheezing
– Pulmonary congestion
– Hypercarbia (paCO2>50 mm Hg)
66
Q

“Pink-puffers” - ________appearance

A

acyanotic

67
Q

Exhale thru pursed lips (PEEP)

A

Pink Puffers

68
Q

Pink puffers are COPD with

A

– Advanced disease, yet preserved arterial O2 tension until very late in disease

69
Q

What is the hallmark of chronic air flow obstruction?

A

Decrease in Forced Expiratory Volume (FEV1)/Forced Vital Capacity ratio

70
Q

In COPD there is diminished flow in

A

Diminished airflow at all lung volumes

71
Q

May have hyperinflation & gas trapping

A

COPD

72
Q

CXR- COPD changed

A

flat diaphragms, hyperlucent lung fields, heart appears

small, decreased pulm. vasculature

73
Q

COPD patients May have pulm. bullae which put them at risk

A

– high risk of pneumothoraxes intraop, especially with positive pressure

74
Q

Characteristics of Blue Bloaters

A

“Blue-Bloaters” – cyanotic
– Arterial O2 desaturation (even early in disease)
– Bloated appearance

75
Q

Chronic Bronchitis

A

Copious secretions → occlude airways
– d/t proliferation & hypertrophy of bronchial goblet cells; hyperreactivity of bronchial smooth muscle
– Chronic productive cough/wheeze

76
Q

Blue bloaters may have RHF with

A

Possible right-sided failure, cor pulmonale
– Peripheral edema
– Increased hepatojugular reflux

77
Q

In chronic Bronchitis: Lung volume

A

– Near normal in chronic bronchitis (except acute

exacerbation)

78
Q

In emphysema :lung volume

A

Increased TLC, Increased FRC, Increased RV in

emphysema

79
Q

Beware of too much oxygen for COPD why?

A

– Can dangerously elevate PaO2 if pts are CO2 retainers
■ Depend on chemoreceptors to make them breathe when hypoxic
– Elevating PaO2 above 60 mmHg can lead to respiratory failure

80
Q

Acute Intrinsic Pulmonary Disorders

A

– Pulmonary edema
– ARDS
– Infectious pneumonia
– Aspiration pneumonitis

81
Q

Chronic Intrinsic Pulmonary Disorders

A

– Interstitial lung disease
– Chronic inflammation of alveolar walls, & progressive
pulmonary fibrosis.

82
Q

Acute Intrinsic Pulmonary Disorders: surgery

A

no, postpone elective

83
Q

Preop treatment of:

A 
– Heart failure
– Fluid overload
– Optimize oxygenation & ventilation
– Decompress abdomen, drain ascites
– Use PEEP (helps c/restrictive airway disease)
84
Q

Chronic Intrinsic pulmonary disorders you will see on CXR

A

– CXR –”Ground-glass to honeycomb”

85
Q

Late stage of chronic intrinsic pulmonary disorders

A

In late stages, signs of right ventricular failure/cor pulmonale

86
Q

Extrinsic Restrictive Pulmonary Disorders

A 
–Pleural effusions
– Pneumothorax
– Mediastinal mass
– Kyphoscoliosis
– Pectus excavatum
– Neuromuscular disorders
– Marked obesity
– Increased intraabdominal pressure
■ Ascites, pregnancy, bleeding, pneumoperitoneum
87
Q

FEV1: What is it?

A

forced expiratory volume in one second

– total volume of air a patient can exhale in the first second during maximal effort

88
Q

FVC: What is it

A

forced vital capacity: total volume of air a patient can exhale for the total duration of the test during maximal effort

89
Q

The percentage of the FVC expired in one second

A

FEV1/FVC ratio

90
Q

FEF25–75%:

A

forced expiratory flow over the middle one-half of the FVC

91
Q

FEF25–75%: is the average flow from the point at which

A

– Average flow from the point at which 25% of the FVC has been exhaled to the point at which 75% of the FVC has been exhale

92
Q

Determine If the FEV1/FVC Ratio Is Low
Obstructive?
National Asthma Education and Prevention Program

A

Gold Criteria <0.70 (70% obstructive)

< 85% (0.85)

93
Q

What is the best test for early stage COPD

A

■ FEF25-75% Decreased

94
Q

Obstructive: VC is

A

Normal or Decreased

95
Q

Restrictive what is decreased

A

VC, TLC, RV

96
Q

Obstructive: RV is

A

Increased

97
Q

FEV1/FVC in obstructive

A

Decreased

98
Q

FEV1/FVC in Restrictive

A

normal or INCREASED

99
Q

TLC in obstructive

A

Normal or increased

100
Q

Restrictive Disease

A

TLC - < 80% of predicted in age

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