Medical / Surgical Management of Pulmonary Dysfunction Flashcards
Smoking cessation medications:
- Nicotine Replacement Therapy: patch, gum, tablets, inhalers.
- Bupropion (Zyban): antipressant: helps reduce cravings & withdraw effects.
- Varenincline: nicotine receptor agonist
Codeine, hydrocodone
- Opioids
- Antitussives
- Cough medication
- Supress cough reflex
Antihistamines:
- block histamine receptor
- decrease nasal congestion, sinusitis & allergies
- benadryl, claritin
Antitussives:
- Cough medication
- Opioids
- codeine, hydrocodone
decrease nasal congestion, sinusitis & allergies
Antihistamines
benadryl, claritin
Mucolytics and Expectorants:
- Mucolytics break up mucus in the airways.
- Expectorants: facilitate mucus secretion and clearance.
- Mucomyst, pulmozyme, guaifenesin (mucinex).
alpha receptor agonist
- Decongestant
- Alpha1 receptors: constrictor, post-sypnaptic, norepinephrine
- Vasoconstriction
- increases BP
Beta2-agonists are a type of ______________. This means that they relax and enlarge (dilate) the airways in the lungs, making breathing easier.
bronchodilator
_____________ cause relaxation of smooth muscle by activating Beta2 receptors and inhibiting respiratory smooth muscle contraction.
Beta2 agonists
Beta2 agonists are selective for
respiratory tissues
Bronchodilators
Theophylline:
- Bronchodilator.
- Relax airway smooth muscle, also has some anti-inflammatory effects.
3 types of bronchodilators:
- Beta2 Agonist (beta-adrenergic agonist): inhibit smooth muscle contraction.
- Theophylline: relax airway smooth muscle, also has some anti-inflammatory effects
- Anticholinergics: inhibit acetylcholine activity.
Anticholinergics:
- Bronchodilator
- Decreased acetylcholine activity at various sites. So inhibition of this facilitates bronchodilation.
- Not specific to pulmonary system.
What type of bronchodilator is specific to the pulmonary system?
Beta2 agonist (beta-adrenergic agonist)
What type of bronchodilator is not specific to the pulmonary system?
Anticholinergics
Decrease acetylcholine activity at various sites of the body, including the lungs. So inhibition of this facilitates bronchodilation.
- Oral prednisone, methylprednisolone.
- Inhaled: triamcinolone, beclomethasone, fluticasone.
are what type of medications?
corticosteroids, glucocorticoids
Anti-inflammatory Medications
best anti-inflammatory medication but worse side effects
corticosteroids - glucocorticoids
side effects of glucocorticoids
- osteoporosis
- steroid myopathy
- HTN, gastric ulcers, exacerbation of DM, steroid induced DM, glaucoma, adrenal gland suppression, skin breakdown.
Leukotriene modifiers
- Impact how leukotrienes work.
- Leukotrienes are inflammatory molecules made by WBC that cause bronchoconstriction and augment inflammatory response.
- Montelukast (singulair)
Prevent inflammation of the airways by inhibiting releasing of inflammatory mediators from cells in respiratory mucosa.
Cromones
Must be taken before exposure to allergen/irritant. Help preventing attacks. Prevent inflammation of the airways by inhibiting releasing of inflammatory mediators from cells in respiratory mucosa.
Cromones
Cromolyn
if pt has exercise induced asthma
bring short acting bronchodilator to PT session
When a pt is taking corticosteroids, the therapist should be aware of
thinning of the skin and weakening of bones
what should a therapist should be aware when a patient is taking theophylline
increase in heart rate, abnormal heart rhythms, and CNS excitation
reduce size by removing %ge of diseased lung tissue (emphysema) → room for lung to expand.
Lung Volume Reduction Surgery
Pneumonectomy:
removal of entire lung.
Bullectomy:
removal of 1 or more bullae.
Wedge resection:
removed a section of the lung, usually triangle shaped.
an inflammatory obstruction of the bronchioles. The bronchioles become damaged and inflamed by chemical particles or respiratory infections, particularly after organ transplants, leading to extensive scarring that blocks the airways.
Bronchiolitis obliterans
Absolute lung transplant contraindications:
- recent malignancy, active infection with hep B or C, active recent smoking/acohol abuse, severe psychiatric illness, noncompliance with medical care, absence of consistent and reliable social network.
Lung transplant candidates:
- COPD
- idiopathic pulmonary fibrosis
- cystic fibrosis
- emphysema due to alpha-1-antitripsin deficiency,
- pulmonary arterial HTN
- bronchitis obliterans
- restrictive lung disease
- pulmonary vascular disease.
nipple line to scapula
muscles incised?
Lateral thoracotomy
- Latissimus not incised, but retracted
- Serratus and intercostal are incised.
- Wedge resections, lobectomies.
Lung transplant complications:
- graft dysfunction
- airway complications (airway stenosis)
- infection
- acute rejection
- allograft dysfunction due to bronchiolitis obliterans.
incision from spine of 4th vertebrae to 5th or 6th ICS at the anterior axillary line.
Posterolateral thoracotomy
Median sternotomy:
Most common for cardiothoracic surgery.
Sternum closed with stainless steel sutures.
Thoracoabdominal incision:
For diaphragm and other major organs.
Affects the latissimus, serratus, obliques, rectus.
Used for:
Visualization of the bronchia tree.
Diagnostic or therapeutic purposes.
Bronchoscopy
Used to examine chest cavity from with and perform diagnostic and therapeutic procedures.
Video Assisted Thoracoscopy
performed to prevent recurrence of pneumothorax or recurrent pleural effusion
Pleurodesis
The goal of a pleurodesis is to eliminate the pleural space so that fluid can no longer accumulate.
Removal of fluid from the pleural cavity.
Pleurocentesis/Thoracocentesis
OXYGEN THERAPY is done to people because:
- Hypoxemia
- Decreased exercise/activity tolerance for patients who desaturate with exercise/activity.
- Increased work of breathing
- Increased myocardial work
Hyperoxia
oxygen toxicity
Fio
Fraction of inspired oxygen
should be less than 40%
FiO2 level should be at
less than 40%
Hyperoxia in lungs can lead to:
- airway inflammation
- increased alveolar permeability
- pulmonary edema
Hyperoxia effects on the body over time:
- Increased production of free radicals
- Can damage cell membrane, proteins and DNA.
- Can lead to cell death and loss of organ function.
If a pt is at 1 L/min of oxygen in the nasal cannula, what is the percentage of oxygen inspired?
.24 %
If a pt is at 2 L/min of oxygen in the nasal cannula, what is the percentage of oxygen inspired?
.28%
If a pt is at 3 L/min of oxygen in the nasal cannula, what is the percentage of oxygen inspired?
.32 %
If a pt is at 6 L/min of oxygen in the nasal cannula, what is the percentage of oxygen inspired?
.44 %
If a pt is at 5-6 L/min of oxygen in the face mask, what is the percentage of oxygen inspired?
how about 6-7 L/min?
7-10 L/min
.35%
Mixes room air with room air, creates a high flow of a controlled concentration of oxygen
venturi mask
High Flow Oxygen types:
- Aerosol Mask: medications
- Venturi Mask: accurate and constant FiO2
- Non-rebreather: 100 % FiO2
- Manual resuscitator (Ambu bag): 100% FiO2
- Optiflow: Can adjust FiO2 and flow separately.
Aerosol Mask can be used to treat…
cystic fibrosis, asthma
(High Flow Oxygen mask)
Venturi Max
tracheostomy tube
- Inflated: more tight seal.
- Deflated: air can get thru, so the patient may be able to talk.
What is a fenestrated trach?
A fenestrated trach tube is similar to other trach tubes but has one added feature. It has one or more holes in the outer cannula. The holes allow air to pass from your lungs up through your vocal cords and out through your mouth and nose. It lets you: Breathe normally, as if you did not have a trach tube. Speak using your vocal cords Cough out secretions (mucous) through your mouth.
Types of low flow oxygen:
- Nasal cannula (starts at .24% to .44% FiO2 )
- Face mask (starts at .35% to .55% FiO2)
Which type of oxygen delivery allows administration of medications?
Aerosol mask
Which type of oxygen delivery mixes oxygen with room air to create a high flow of a controlled concentration of oxygen?
Venturi Mask
Which type of oxygen delivery has a reservoir which prevents the patient from re-breathing any expired air?
non-rebreather
Which two types of oxygen delivery devices allows FiO2 100%
- Non re-breather
- Manual resucitator
Which type of oxygen delivery can adjust flow and FiO2 separately?
Optiflow mask
Which type of oxygen delivery can be used to ambulate ventilated patients?
- Manul resucitator
- Optiflow
- Ventimask (recommended)
The goal of a ___________ is to eliminate the pleural space so that fluid can no longer accumulate.
pleurodesis
_____________________________is the fraction or percentage of oxygen in the space being measured.
Fraction of inspired oxygen (FiO2)
Medical patients experiencing difficulty breathing are provided with oxygen-enriched air, which means a higher-than-atmospheric FiO2. Natural air includes 20.9% oxygen, which is equivalent to FiO2 of 0.209. Oxygen-enriched air has a higher FiO2 than 0.21; up to 1.00 which means 100% oxygen. FiO2 is typically maintained below 0.5 even with mechanical ventilation, to avoid oxygen toxicity.[1] If a patient is wearing a nasal cannula or a simple face mask, each additional liter/min of oxygen adds about 4 percentage points for the first 3 liters and only 3 Percentage point for every liter thereafter to their FiO2 (for example, a patient with a nasal cannula with 4L/min of oxygen flow would have an FIO2 of 21% + (3 x 4%)+(1 x 3%) =36%).
