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Medical and Surgical Interventions Flashcards

1
Q

Buproprion (Zyban)

A

Smoking cessation med

Antidepressant

Helps with withdrawal side effects

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2
Q

Varenincline (Chantix)

A

Partial nicotine receptor agonist

Helps prevent nicotine from stimulating receptors in the brain

Helps with withdrawal

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3
Q

Medications to Manage Secretions

A

Antitussives

Antihistamines

Decongestants

Mucolytics and Expectorants

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4
Q

Antitussives

A

Manages secretions

Cough medication

Suppresses cough reflex

Opioids also suppress this

Ex. hydrocodone, codeine...
Could be in OTC cough suppressant meds
Can be addictive
Can build a tolerance
Keep in mind that we need to get stuff out (minimize retainment of this)
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5
Q

Antihistamines

A

Manages secretions

Blocks histamine receptor

Some of these meds can cross BBB, so you can see CNS SEs (sedation, fatigue)

Ex. diphenhydramine (benadryl), cetirizine (zyrtec), loratadine (claritin)

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6
Q

Claritin

A

Decreases nasal decongestion

Decreases mucosal irritation

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7
Q

Zyrtec and Claritin

A

Don’t cross BBB

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8
Q

Decongestants

A

To manage secretions

Stimulates vasoconstriction in nasal vasculature

Often classified as alpha receptor agonists

Method of delivery affects side effects

Need to be aware of cardiovascular side effects

Ex. epenephrine (primatene), pseudoephedrine (sudafed)…
HA
Nausea
Nervousness
Can affect cardiac beta-1 receptors (arrhythmias, palpitations)

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9
Q

Mucolytics

A

Break up mucus in airway

Makes you want to cough

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10
Q

Expectorants

A

Facilitate mucus secretion and clearance

Makes you actually cough

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11
Q

Examples of Mucolytics and Expectorants

A

Mucomyst
Pulmozyme
Guaifenesin (Mucinex)

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12
Q

Beta-2 agonists

A

SHORT and LONG acting

Cause bronchodilation, relaxation of smooth mm by activating Beta 2 receptors and inhibit respiratory smooth mm contraction

Usually taken orally or inhaled (nebulizer, metered dose inhaler)

Albuterol
Salmetrol

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13
Q

Bronchodilators

A

Beta-2 agonists

Theophylline

Anticholinergics

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14
Q

Theophylline

A

Relaxes airway smooth mm, some anti-inflammatory effects

Usually taken orally, but can be injected

Xanthine derivative

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15
Q

Anticholinergics

A

Decrease ACh activity at various sites in the body, including the lungs… so inhibition of this facilitates bronchodilation

Limited use as not specific to the pulmonary system - may be used in combination with a beta-2 agonist

Atrovent
Spiriva

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16
Q

Anti-inflammatory medication

A

Corticosteroids - glucocorticoids

Leukotriene Modifiers

Cromones

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17
Q

Corticosteroids - glucocorticoids

A

Oral = prednisone, methylprednisone

Inhaled = triamcinolone (Asmacort), Flovent

Very effective at treating inflammation

Very useful in treatment of asthma

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18
Q

Steroid side effects

A 
Steroid myopathy
HTN
Gastric ulcers
Exacerbation of DM
Steroid induced DM
Glaucoma
Adrenal gland suppression
Osteoporosis
Skin breakdown
May have cushingoid look to face
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19
Q

Leukotriene Modifiers

A

Impact how leukotrienes work

Ex. Montelukast (singulair)

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20
Q

Leukotrienes

A

Lipid compound produced within cells lining respiratory mucosa that tend to augment the inflammatory response

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21
Q

Cromones

A

Help prevent inflammation in airway by inhibiting release of inflammatory mediators from cells in respiratory mucosa

Need to take BEFORE exposure to allergen/irritant

Help with prevention of an attack

Ex. Cromolyn (nasalcrom)

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22
Q

Cardiac affects in PT

A

Theophylline and beta-agonists

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23
Q

Corticosteroid effects PT

A

Thinning of skin and weakening of bones

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24
Q

Wedge resection

A

Remove a triangular-shaped tissue

Lung tumor removal

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25
Bullectomy
Taking out bullae from emphysema patients
26
Lobectomy
Taking out one lobe of a lung
27
Pneumectomy
Removal of an entire lung
28
Lung Volume Reduction (LVRS)
Used to improve breathing in patients with severe emphysema
29
Lung transplant candidacy
``` Idiopathic pulmonary fibrosis COPD Cystic fibrosis Emphysema due to alpha-1-antitripsin deficiency Pulmonary arterial HTN Bronchiolitis obliterans Restrictive lung disease Pulmonary vascular disease ```
30
Absolute Criteria Lung Transplant
Normal other organ function No malignancy for 2-5 years Severe obstructive or restrictive disease Limited life expectancy No C/I to immunosuppressants Ineffective or unavailable medical therapy
31
Relative criteria
Case by case basis No resistant organisms Ambulatory with rehab potential No current alcohol, smoking, substance abuse
32
Absolute C/I Lung Transplant
Recent malignancy Active infection with HEP B or C Active/recent cigarette smoking, drug, or alcohol abuse Severe psychiatric illness Noncompliance with medical care Absence of consistent and reliable social netowrk
33
Relative C/I Lung Transplant
HIV infection Significant extrapulmonary organ dysfunction Obesity/underweight Nutritional status Age Other co-morbidities
34
Lung Transplant Complications
Primary Graft dysfuncton Airway complications (bronchial stenosis) Infection Acute rejection Chronic allograft dysfunction due to bronchiolitis obliterans (edema within 72 hrs of transplant)
35
Lung Transplant Anti-Rejection Meds
Tacrolimus (Prograf) - causes tremors Mycophenolate mofetil (MMF) Glucocorticoids
36
Lateral thoracotomy
Nipple line to scapula Latissimus NOT incised, but retracted Serratus and intercostals incised Wedge resections, lobectomies
37
Anterolateral thoracotomy
Pec major Wedge resections
38
Posterolateral thoracotomy
From spine of 4th vertebrae to 5th or 6th IC space at the anterior axillary line Serratus anterior divided close to the attachment Lobectomies or wedge resections
39
Axillary thoracotomy
Apical bleb resections
40
Median sternotomy
Most commonly used for cardiothoracic surgery Sternum close with stainless steel sutures
41
Thoracoabdominal incision
For diaphragm and other major organs ``` Affects... Rectus femoris Obliques Latissimus dorsi Serratus anterior ```
42
Clamshell/transverse sternotomy
For large-scale thoracic surgeries
43
Chest tubes
To drain the intrapleural space or the mediastinum Water seal Suction seal
44
Pleurodesis
Pleural space artificially obliterated Performed to prevent recurrence of pneumothorax or recurrent pleural effusion Generally avoided in CF population because lung transplantation becomes more difficult following this procedure
45
Pleurocentesis/thoracocentesis
Drainage of cavity
46
PT implications of surgical procedures
Watch the tubing, pleurevac, etc Look at breathing pattern and determie what you can do to improve it Early mobilization Breathing exercises
47
Indications for O2 therapy
Hypoxemia Increased work of breathing Increased myocardial work Decreased ex/activity tolerance for patients who desaturate with ex/activity
48
Oxygen toxicity
Increased production of free radicals Can damage cell membrane, proteins, and DNA Can lead to cell death and loss of organ function In lungs...this may lead to airway inflammation, increased alveolar permeability, or pulmonary edema Keep FiO2
49
Aerosol mask
Used to administer medications Often a nebulizer at 10-12 L/min FiO2 0.35-1.0
50
Venturi mask
Mixes O2 with RA - creates high-flow enriches O2 of a CONTROLLED concentration
51
Low flow O2
Nasal cannula | Face mask
52
High flow O2
``` Aerosol mask Venturi mask Non-rebreather Manual resuscitator Optiflow ```
53
Non-rebreather
Face mask with a reservoir which prevents pt from re-breathing any expired air FiO2 is 100%
54
Manual resuscitator
Ambubag Delivers 100% O2 Can be used to ambulate ventilated patients or for manual hyperinflation
55
Optiflow
Can adjust flow and FiO2 separately Can wear for transfers, but recommend Venti mask for ambulation
56
Reasons for intubation
Airway obstruction Inability to protect the lower airway from aspiration Inability to clear secretions from the lower airways Need for positive pressure ventilation (apnea or ventilatory failure)
57
Oral endotracheal tube
Mouth to trachea
58
Nasal endotracheal tube
Nose to trachea
59
Tracheostomy
Incision in neck to allow for breathing
60
Tracheostomy tube
Directly to trachea via tracheostomy just below vocal cords Parts... Outer cannula Inner cannula Obturator
61
Fenestrated trach
Has holes
62
Positive Pressure Ventilator
Delivers a positive pressure This is opposite of normal negative pressure ventilation
63
Negative Pressure Ventilator
Iron lung
64
Frequency
Number of breaths per minute
65
Flow rate
The speed at which the ventilator breath is delivered
66
Spontaneous breath
Breathing through the ventilator circuit without assistance
67
Trigger
Variable that causes a breath to be delivered
68
Controlled Mechanical Ventilation (CMV)
Ventilator delivers ALL breaths at a preset frequency and flow rate Usually at set volume and/or pressure Pt usually is sedated and paralyzed Pt can NOT take a spontaneous breath or trigger the machine
69
Assist/Control (AC)
Volume targeted mode (pt receives a preset volume) Pressure targeted mode (pt receives a preset pressure) Frequency Machine senses pt initiated breath by sensing negative pressure and then starts to supply a positive pressure breath If pt does not initiate breath, the machine will supply a breath ALL breaths are machine delivered
70
Problem with volume modes
As lung compliance decreases, need to increase pressure to supply the same volume
71
Intermittent Mandatory Ventilation (IMV)
Machine delivers set frequency and volume or pressure The pt can take spontaneous breaths in between
72
Synchronized Intermittent Mandatory Ventilation (SIMV)
Mechanical and spontaneous breaths Available in volume or pressure modes Used for weaning
73
Pressure support (PS)
Pressure stays constant, but the volume needed to reach the pressure may vary depending on lung compliance, resistance, and patient effort Pt determines rate of breathing Machine will NOT deliver a breath without a pt trigger
74
Recruitment
Opening of previously collapsed airway (alveoli)
75
Derecruitment
Collapsing of previously opened alveoli
76
Positive End Expiratory Pressure (PEEP)
Maintains set pressure at the end of expiration to prevent airway collapse
77
Continuous Positive Airway Pressure (CPAP)
Spontaneous breathing with an elevated baseline airway pressure -- helps keep airway open Indicated for oxygenation Tells you mode/pressure/FiO2
78
BiPAP
Bilevel Positive Airway Pressure Indicated for ventilation - helps to blow off CO2 Can set inspiratory and expiratory pressures Can set FiO2 and PEEP
79
Mobilize with NIV?
NIPPV and BiPAP Yes, but source of O2 may limit distance Have RT around when mobilizing Both require tight fitting mask Some pts are not indicated for this - thoracic pts, esophagectomy pts
80
Ventilator screen
TV Breath type RR Pressure support FiO2 Alarms
81
C breath type
Control
82
S breath type
Spontaneous
83
High pressure vent alarm
Check for secretions or airflow obstruction May need to suction or use ambubag
84
Low pressure vent alarm
May be a leak in the circuitry or poor connection to pt
85
Apnea vent alarm
Pt did not trigger the machine to deliver a breath
86
Disconnection vent alarm
Usually low pressure alarm
87
Volume vent alarm
If not maintaining minute ventilation (pt may be fatiguing)
88
Suctioning
Need to maintain a STERILE FIELD Low vacuum setting (
89
Nicotine Replacement Therapy
Start with higher doses and wean down It's a way to attenuate someone's need for nicotine It can affect someone's cardiac system

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