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Pulmonary Dx > Medical/Surgical Management of Pulmonary Dysfunction > Flashcards

Medical/Surgical Management of Pulmonary Dysfunction Flashcards

1
Q

What meds are used for smoking cessation? (3)

A
  • Nicotine Replacement Therapy—start with higher doses and wean down
  • Bupropion (Zyban) – antidepressant that helps cravings and withdrawal SE through binding in the brain
  • Varenincline (Chantix) –partial nicotine receptor agonist that could have an effect on the cardiovascular system bc have an affinity for nicotinic cathecholamines
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2
Q

Medications to Manage Secretions? (5)

A
  • antitussives
  • antihistamines
  • decongestants
  • mucolytics and expectorants
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3
Q

How do antitussives work? Name the category and 2 examples

A
  • (cough medication)—suppress cough reflex
  • Opioids (suppress cough reflex)
  • Ex: hydrocodone, codeine
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4
Q

How do antihistamines work? (2) Examples? (3) SE? (4)

A
  • block histamine receptor
  • Some of these meds can cross blood brain barrier, so can see side effects
  • Ex: diphenhydramine (benadryl), cetirizine (zyrtec), loratadine (claritin)
  • HTN
  • Unsteadiness
  • Drugged state
  • Irritate upper airways
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5
Q

Decongestants are classified as? How do they work? Need to be aware of? (2) Examples? (2) SE? (6)

A
  • Often classified as alpha receptor agonists
  • Vasoconstriction in nasal vasculature
  • Method of delivery affects side effects
  • Need to be aware of cardiovascular side effects
  • Ex: epinephrine (primatene), pseudoephedrine (sudafed)
  • HA
  • Nausea
  • Arrythmias and palpitations bc they target cardiac beta receptors
  • HTN
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6
Q

How do Mucolytics and Expectorants work? Examples? (3)

A
  • Mucolytics—break up mucus in airway
  • Expectorants—facilitate mucus secretion and clearance
  • Ex: mucomyst, pulmozyme, guaifenesin (mucinex)
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7
Q

Most used Bronchodilators are what category? Onset is? Cause? (4) Usually taken how? 2 examples?

A
  • Beta2 Agonists (beta-andrenergic agonist)
  • Short and long acting
  • Cause bronchodilation,
  • relaxation of smooth muscle by activating Beta2 receptors
  • inhibit respiratory smooth muscle contraction
  • maintain size of airways
  • Usually taken orally or inhaled (nebulizer, metered dose inhaler)
  • Albuterol (Ventolin®, Proventil®)
  • Salmeterol (Serevent®)
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8
Q

Two other categories of bronchodilators?

A

Theophylline

Anticholinergics

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9
Q

How common is theophylline? MOA? (2) Usually taken how? Example?

A
  • Relaxes airway smooth muscle, some anti-inflammatory effects
  • Usually taken orally, but can be injected
  • Xanthine derivative
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10
Q

How do anticholinergics work? Limited use why? SE? (3) Two examples?

A
  • Decrease acetylcholine 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 Beta2 agonist
  • tachycardia, blurred vision, jittery
  • Atrovent (ipratropium)
  • Spiriva (tiotropium)
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11
Q

3 types of anti-inflammatory meds?

A

Corticosteroids—glucocorticoids
Leukotriene Modifiers
Cromones

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12
Q

2 types of oral corticosteroids? Inhalde? (3) How effective? SEs?(11) Used for? (2) Not good for?

A
  • Oral = prednisone, methylprednisolone
  • Inhaled = triamcinolone (Azmacort), beclomethasone, fluticasone (Flovent)
  • Very effective at treating inflammation

Side effects:

  • Steroid myopathy
  • HTN,
  • gastric ulcers,
  • exacerbation of DM,
  • steroid induced DM,
  • glaucoma,
  • adrenal gland suppression,
  • osteoporosis,
  • skin breakdown
  • fluid retention
  • May have cushingoid look to face
  • Very useful in treatment of asthma, bronchitis
  • Not good for diabetics bc it throws sugar out of whack
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13
Q

Leukotriene Modifiers impact what? What are they? Example? SE?

A
  • Impact how leukotrienes work
  • Leukotrienes  lipid compound produced w/in cells lining respiratory mucosa that tend to augment the inflammatory response
  • Ex: Montelukast (singulair)
  • hepatotoxicity
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14
Q

Cromones help prevent? Need to take when? Help with? Example?

A
  • Help prevent inflammation in airway by inhibiting release of inflammatory mediators from cells in respiratory mucosea
  • Need to take BEFORE exposure to allergen/irritant
  • Help with prevention of an attack
  • Ex: Cromolyn (nasalcrom)
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15
Q

Therapist should be aware of ? (3)

A
  • Therapist should be aware of patients with exercise-induced asthma (pre-medicate if appropriate) : Bring short-acting bronchodilator to PT session, in case an asthmatic attack occurs
  • Therapists should be aware of the proper metered dose inhaler technique (hand-breathing coordination)
  • Be aware of the side effects of cardiac effects of theophylline and beta-agonists as well as corticosteroid induced thinning of the skin and weakening of bones
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16
Q

Define
Wedge Resection

Bullectomy

Lobectomy

Pneumonectomy

Lung volume reduction (LVRS)

A

Wedge Resection: remove triangular slice of tissue

Bullectomy: bullae can rupture and cause PTX

Lobectomy: take part of lobe out

Pneumonectomy: entire lung

Lung volume reduction (LVRS): take 30% of the diseased lung out- shown to improve breathing ability, lung capacity

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17
Q

Lung Transplant Candidacy includes? (8)

A 
Idiopathic pulmonary fibrosis
COPD
Cystic fibrosis
Emphysema due to alpha-1-antitripsin deficiency
Pulmonary arterial hypertension
Bronchiolitis obliterans
Restrictive lung disease
Pulmonary vascular disease
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18
Q

Lung Transplant Absolute Criteria? (6)

A
  • Normal other organ function
  • No malignancy for 2-5 years
  • Severe obstructive or restrictive dz
  • Limited life expectancy
  • No contraindications to immunosuppressants
  • Ineffective or unavailable medical therapy
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19
Q

Lung Transplant relative Criteria? (7)

A
  • No resistant organisms
  • Ambulatory with rehabilitation potential
  • ## No current alcohol, smoking, substance abuse
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20
Q

Lung Transplant Absolute Contraindications? (6)

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 & reliable social network
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21
Q

Lung Transplant relative Contraindications? (5)

A
  • HIV infection (rel vs abs)
  • Significant extrapulmonary organ dysfcn
  • Obesity/underweight nutritional status
  • Age
  • Other co-morbidities
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22
Q

When do they do a bilateral lung transplant (BLT)? (3)

A

CF
COPD
PF

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23
Q

Lung transplant complications? (5)

A
  • Primary Graft Dysfunction
  • Airway Complications (ex: bronchial stenosis)
  • Infection
  • Acute Rejection
  • Chronic allograft dysfunction due to bronchiolitis obliterans
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24
Q

Lung transplants require a pt take what meds? Examples? (3) Cause?

A
  • On anti-rejection medications

Often tacrolimus (prograf), mycophenolate mofetil (MMF), & glucocorticoids

  • cause tremors
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25
Q

Median sternotomy is most?

A

Most commonly used for cardiothoracic surgery

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26
Q

Thoracoabdominal incision is for? Affects? (4)

A
  • For diaphragm and other major organs

- Affects the latissimus, serratus, obliques, rectus

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27
Q

Chest tubes function? What kind of seals? (2)

A
  • to drain the intrapleural space or the mediastinum
    Water seal
    Suction seal
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28
Q

Pleurodesis is for? How does it work?

A

pleural effusion or pleural anything; put talc inside to try to fuse pleura together

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29
Q

PT Implications of Surgical Procedures - watch? Look at? Thank about? Monitor? Why is it important to get pt moving?

A
  • Watch the tubing/pleurevac/etc
  • Look at breathing pattern and what you can do to improve it
  • Think about the implication of specific surgeries
  • monitor VS
  • might develop pneumonia or atlectosis if not moving
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30
Q

Indications for Oxygen Therapy? (5)

A
  • Hypoxemia
  • Increased work of breathing
  • Increased myocardial work
  • ## Decreased exercise/activity tolerance for patients who desaturate with exercise/activity
31
Q

Oxygen Toxicity aka? What is it? Can lead to? (5) In the lungs? Keep FiO2 at what %?

A
  • hyperoxia
  • Increased production of ‘free radicals’
  • Can damage cell membrane, proteins and DNA
  • Can lead to cell death and loss of organ function

In the lungs – this may lead to airway inflammation, increased alveolar permeability, pulmonary edema

Keep FiO2

32
Q

We breath what FiO2 regularly?

A

~21-23%

33
Q

Aerosol masks are for what? (4)

A
  • CF, asthma, anybody that needs a bronchodilator or steroid
34
Q

Venturi mask mixes what? To create? Used when?

A
  • Mixes oxygen with RA -> creates high-flow enriches O2 of a CONTROLLED concentration
  • Used when concerned about CO2 retention
35
Q

3 types of high flow O2?

A

Non-rebreather
Manual resuscitator (Ambu bag)
Optiflow

36
Q

What is a non-rebreather?

A

Face mask with a reservoir which prevents patient from re-breathing any expired air FiO2 is 100%

37
Q

A manual resuscitator (Ambu bag) delivers? Can be used to?

A
  • Delivers 100% oxygen

- Can be used to ambulate ventilated patients or for manual hyperinflation

38
Q

Optiflow can adjust? Can wear for?

A
  • Can adjust flow and FiO2 separately

- Can wear for transfers, but recommend Venti mask for ambulation

39
Q

3 types of artificial airways?

A

intubation
endotracheal tubes
tracheostomy

40
Q

Reasons for intubation? (4)

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)
41
Q

Endotracheal tube goes from - oral? Nasal?

A

Oral: from mouth to trachea
Nasal: from nose to trachea

42
Q

Tracheostomy tube goes where? Parts?

A
  • Directly to trachea via tracheostomy just below the vocal cords
  • Cuff
  • Cap
  • Speaking valve (ex: passy muir)
43
Q

When the cuff is inflated what happens to the air? Deflated?

A
  • goes into lungs

- you can talk over it a little

44
Q

Parts of the tracheostomy tube (trach)?

A
  • Outer cannula: what you see
  • Inner cannula: looked together to prevent from being coughed out
  • Obturator: window in it that could be used as a trial before trach is moved out, if they can breath normall and clear secretions
45
Q

Positive Pressure Ventilator delivers? This is opposite of? How does one exhale?

A
  • a positive pressure
  • This is opposite of normal negative pressure ventilation
  • positive pressure pushes air directly in but you have elastic recoil of lungs to come out
46
Q

Neg pressure ventilator aka? What is it?

A
  • Iron lung

- vacuum pump, creates negative pressure

47
Q

Mechanical Ventilation Terminology - define frequency, flow rate, spontaneous breath, trigger

A

Frequency: number of breaths per minute

Flow rate: the speed at which the ventilator breath is delivered

Spontaneous breath: breathing through the ventilator circuit without assistance

Trigger: variable that causes a breath to be delivered

48
Q

What is ventilator volume cycled? For what pts?

A

predetermined air amount based on their needs

- for pts that are more longer term vent support

49
Q

What is pressure cycled?

A

Getting certain amount of max pressure to deliver air, pressure reached, inspiration ends and passive recoil

50
Q

Two types of positive pressure ventilator (PPV) modes?

A
  • Controlled Mechanical Ventilation (CMV)

- Assist/Control (AC)

51
Q

CMV delivers? Usually at set? Pt usually? (2)

A
  • Ventilator delivers all breaths at a preset frequency and flow rate
  • Usually at set Volume &/or Pressure
  • Patient usually is sedated and paralyzed
  • Patient can NOT take a spontaneous breath or trigger the machine
52
Q

AC is based on? (3) Machine senses? If pts doesnt initiate breath, what happens? To breaths in general? Problem with volume modes?

A
  • Volume targeted mode (patient receives a preset volume),
  • Pressure targeted mode (patient receives a preset pressure),
  • frequency
  • Machine senses patient initiated breath by sensing negative pressure and then starts to supply a positive pressure breathe
  • If patient does not initiate the breathe, the machine will supply a breathe
  • ALL breathes are machine delivered

Problem with volume modes: as lung compliance decreases, need to increase pressure to supply the same volume

53
Q

3 other ventilator modes?

A
  • Intermittent Mandatory Ventilation (IMV)
  • Synchronized Intermittent Mandatory Ventilation (SIMV)
  • Pressure Support (PS)
54
Q

Intermittent Mandatory Ventilation (IMV) delivers? PT can?

A
  • Machine delivers set frequency & volume or pressure

- The patient can take spontaneous breaths in between

55
Q

Synchronized Intermittent Mandatory Ventilation (SIMV) delivers? Available in what modes? Used for?

A
  • Mechanical and spontaneous breaths
  • Available in volume or pressure modes
  • Used for weaning
56
Q

Pressure Support (PS) - pressure is? Pt determines? Machine will not?

A
  • Pressure stays constant, but the volume needed to reach the pressure may vary depending on lung compliance, resistance, and patient effort
  • Patient determines rate of breathing
  • Machine will NOT deliver a breathe without a patient trigger
57
Q

Positive Airway Pressure terms - define recruitment, derecruitment, function of Positive End Expiratory Pressure (PEEP)?

A

Recruitment
Opening of previously collapsed airway (alveoli); helps with ease of breathing

Derecruitment
Collapsing of previously opened alveoli

Positive End Expiratory Pressure (PEEP)
Maintains set pressure at the end of expiration to prevent airway collapse

58
Q

Function of Continuous Positive Airway Pressure (CPAP)? (3)

A
  • Spontaneous breathing with an elevated baseline airway pressure -> helps keep airway open
  • Indicated for oxygenation
  • Tells you mode/pressure/FiO2
59
Q

What is plateau pressure?

A

Moment btwn insp and exp; it can tell you how sick the lung is = peak pressure

60
Q

What is NIPPV?

A

noninvasive positive pressure ventilation

61
Q

What is BiPAP? Indicated for? Can set? (2)

A
  • (bilevel positive airway pressure)
  • Indicated for ventilation (helps to blow off CO2)
  • Can set inspiratory and expiratory pressures
  • Can set FiO2 and PEEP
62
Q

CPAP does what?

A

Prevents lungs from collapsing

63
Q

On both NIPPV and BiPAP you can do what? Both require?

A
  • On both of these you can mobilize patients, BUT source of O2 may limit distance  Have RT around when mobilizing
  • Both require tight fitting mask
64
Q

Who isn’t indicated for positive pressure intervention? (2)

A

thoracic pts, esophagectomy pts

65
Q

Assist Control (old CMV) - control what? Has a set? (6) Can set? May see?

A
  • Control volume going in regardless of trigger
  • Has a set RR, TV, flow, CPAP, FiO2, and PEEP
  • Can set trigger so easier or harder to trigger breath
  • May see dys-synchronous breathing (pt fighting vent)
66
Q

SIMV (synchronous intermittent minute ventilation) has a? (6)

A

Has a set rate, TV, flow, pressure support, FiO2, PEEP

67
Q

Can look on ventilator screen to see? (6)

A 
TV
Type of breath (“C” = control vs “S” = spontaneous)
RR
Pressure Support
FiO2
Alarms
68
Q

If don’t see a set RR rate, that means?

A

If don’t see a set rate, that means the patient is breathing on his/her own and is most likely on CPAP mode

69
Q

Ventilator alarms for? (5)

A 
high pressure
low pressure
apnea
disconnection
volume
70
Q

Check for what if high pressure alarm goes off? May need? Low pressure - may be? Apnea alarm can go off? Disconnection usually? Volume goes off if? (2)

A 
- High pressure
Check for secretions or airflow obstruction
May need to suction or use Ambu bag
- Low pressure 
May be a leak in the circuitry or poor connection to patient
- Apnea – no breathe
Pt did not trigger the machine to deliver a breath
- Disconnection 
Usually low pressure alarm
- Volume 
If not maintaining minute ventilation
Pt may be fatiguing
71
Q

What to do if vent isn’t working properly?

A

Disconnect pt from ventilator and start ambu bagging while calling for help

72
Q

PT with a Patient on Mechanical Ventilation - PT roles? (5)

A
  • positional rotation to maintain airway clearance
  • breathing retraining and proper posture
  • exercise to prevent immobility
  • assist w weaning by identifying optimal positions for ventilation function
  • adaptive devices to improve function
  • Suggestions for t-piece (regular air comes in, no longer ventilator)
73
Q

Suctioning - need to maintain? What kind of setting? Insert? Apply suction how? Do not? How long? May suction how? (3)

A
  • Need to maintain a sterile field
  • Low vacuum setting (below 120mm Hg)
  • Insert catheter gently until cough is stimulated by contact with the carina
  • Apply suction while REMOVING catheter from airway
  • DO NOT suction while inserting catheter
  • Only 5-15 seconds
  • May suction orally, via trach, or nasally

Pulmonary Dx (5 decks)

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