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Pulm > Medical and Surgical Interventions > Flashcards

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
Q

Bullectomy

A

Taking out bullae from emphysema patients

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26
Q

Lobectomy

A

Taking out one lobe of a lung

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27
Q

Pneumectomy

A

Removal of an entire lung

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28
Q

Lung Volume Reduction (LVRS)

A

Used to improve breathing in patients with severe emphysema

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29
Q

Lung transplant candidacy

A 
Idiopathic pulmonary fibrosis
COPD
Cystic fibrosis
Emphysema due to alpha-1-antitripsin deficiency
Pulmonary arterial HTN
Bronchiolitis obliterans
Restrictive lung disease
Pulmonary vascular disease
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30
Q

Absolute Criteria Lung Transplant

A

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

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31
Q

Relative criteria

A

Case by case basis

No resistant organisms

Ambulatory with rehab potential

No current alcohol, smoking, substance abuse

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32
Q

Absolute C/I Lung Transplant

A

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

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33
Q

Relative C/I Lung Transplant

A

HIV infection

Significant extrapulmonary organ dysfunction

Obesity/underweight

Nutritional status

Age

Other co-morbidities

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34
Q

Lung Transplant Complications

A

Primary Graft dysfuncton

Airway complications (bronchial stenosis)

Infection

Acute rejection

Chronic allograft dysfunction due to bronchiolitis obliterans (edema within 72 hrs of transplant)

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35
Q

Lung Transplant Anti-Rejection Meds

A

Tacrolimus (Prograf) - causes tremors

Mycophenolate mofetil (MMF)

Glucocorticoids

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36
Q

Lateral thoracotomy

A

Nipple line to scapula

Latissimus NOT incised, but retracted

Serratus and intercostals incised

Wedge resections, lobectomies

37
Q

Anterolateral thoracotomy

A

Pec major

Wedge resections

38
Q

Posterolateral thoracotomy

A

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
Q

Axillary thoracotomy

A

Apical bleb resections

40
Q

Median sternotomy

A

Most commonly used for cardiothoracic surgery

Sternum close with stainless steel sutures

41
Q

Thoracoabdominal incision

A

For diaphragm and other major organs

Affects...
Rectus femoris
Obliques
Latissimus dorsi
Serratus anterior
42
Q

Clamshell/transverse sternotomy

A

For large-scale thoracic surgeries

43
Q

Chest tubes

A

To drain the intrapleural space or the mediastinum

Water seal
Suction seal

44
Q

Pleurodesis

A

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
Q

Pleurocentesis/thoracocentesis

A

Drainage of cavity

46
Q

PT implications of surgical procedures

A

Watch the tubing, pleurevac, etc

Look at breathing pattern and determie what you can do to improve it

Early mobilization

Breathing exercises

47
Q

Indications for O2 therapy

A

Hypoxemia

Increased work of breathing

Increased myocardial work

Decreased ex/activity tolerance for patients who desaturate with ex/activity

48
Q

Oxygen toxicity

A

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
Q

Aerosol mask

A

Used to administer medications

Often a nebulizer at 10-12 L/min

FiO2 0.35-1.0

50
Q

Venturi mask

A

Mixes O2 with RA - creates high-flow enriches O2 of a CONTROLLED concentration

51
Q

Low flow O2

A

Nasal cannula

Face mask

52
Q

High flow O2

A 
Aerosol mask
Venturi mask
Non-rebreather
Manual resuscitator
Optiflow
53
Q

Non-rebreather

A

Face mask with a reservoir which prevents pt from re-breathing any expired air

FiO2 is 100%

54
Q

Manual resuscitator

A

Ambubag

Delivers 100% O2

Can be used to ambulate ventilated patients or for manual hyperinflation

55
Q

Optiflow

A

Can adjust flow and FiO2 separately

Can wear for transfers, but recommend Venti mask for ambulation

56
Q

Reasons for intubation

A

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
Q

Oral endotracheal tube

A

Mouth to trachea

58
Q

Nasal endotracheal tube

A

Nose to trachea

59
Q

Tracheostomy

A

Incision in neck to allow for breathing

60
Q

Tracheostomy tube

A

Directly to trachea via tracheostomy just below vocal cords

Parts…
Outer cannula
Inner cannula
Obturator

61
Q

Fenestrated trach

A

Has holes

62
Q

Positive Pressure Ventilator

A

Delivers a positive pressure

This is opposite of normal negative pressure ventilation

63
Q

Negative Pressure Ventilator

A

Iron lung

64
Q

Frequency

A

Number of breaths per minute

65
Q

Flow rate

A

The speed at which the ventilator breath is delivered

66
Q

Spontaneous breath

A

Breathing through the ventilator circuit without assistance

67
Q

Trigger

A

Variable that causes a breath to be delivered

68
Q

Controlled Mechanical Ventilation (CMV)

A

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
Q

Assist/Control (AC)

A

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
Q

Problem with volume modes

A

As lung compliance decreases, need to increase pressure to supply the same volume

71
Q

Intermittent Mandatory Ventilation (IMV)

A

Machine delivers set frequency and volume or pressure

The pt can take spontaneous breaths in between

72
Q

Synchronized Intermittent Mandatory Ventilation (SIMV)

A

Mechanical and spontaneous breaths

Available in volume or pressure modes

Used for weaning

73
Q

Pressure support (PS)

A

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
Q

Recruitment

A

Opening of previously collapsed airway (alveoli)

75
Q

Derecruitment

A

Collapsing of previously opened alveoli

76
Q

Positive End Expiratory Pressure (PEEP)

A

Maintains set pressure at the end of expiration to prevent airway collapse

77
Q

Continuous Positive Airway Pressure (CPAP)

A

Spontaneous breathing with an elevated baseline airway pressure – helps keep airway open

Indicated for oxygenation

Tells you mode/pressure/FiO2

78
Q

BiPAP

A

Bilevel Positive Airway Pressure

Indicated for ventilation - helps to blow off CO2

Can set inspiratory and expiratory pressures

Can set FiO2 and PEEP

79
Q

Mobilize with NIV?

A

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
Q

Ventilator screen

A

TV

Breath type

RR

Pressure support

FiO2

Alarms

81
Q

C breath type

A

Control

82
Q

S breath type

A

Spontaneous

83
Q

High pressure vent alarm

A

Check for secretions or airflow obstruction

May need to suction or use ambubag

84
Q

Low pressure vent alarm

A

May be a leak in the circuitry or poor connection to pt

85
Q

Apnea vent alarm

A

Pt did not trigger the machine to deliver a breath

86
Q

Disconnection vent alarm

A

Usually low pressure alarm

87
Q

Volume vent alarm

A

If not maintaining minute ventilation (pt may be fatiguing)

88
Q

Suctioning

A

Need to maintain a STERILE FIELD

Low vacuum setting (

89
Q

Nicotine Replacement Therapy

A

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

Pulm (10 decks)

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