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Health Assessment > Obstructive Lung Disease > Flashcards

Obstructive Lung Disease Flashcards

1
Q

the age 25-44 experience the “common cold” at what rate per year

A

19%

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2
Q

the age 45-65 experience the “common cold” at what rate per year

A

16%

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3
Q

T/F a fraction of scheduled surgery patients will have an active URI

A

true

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4
Q

what accounts for 95% of all URIs

A

infectious nasopharyngitis

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5
Q

associated viral pathogens in the URI

A

rhinovirus
coronavirus
influenza
parainfluenza
RSV

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6
Q

noninfectious nasopharygitis can be of what 2 origins

A

allergic or vasomotor

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7
Q

T/F viral culture and lab tests are sensitve, tho time consuming

A

false, viral culture and lab tests lack sensitivity

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8
Q

children with URIs have a higher risk of what perioperative adverse events

A

laryngospasm
coughing
breath holding
transient hypoxemia

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9
Q

a patient has had a URI for _____ and is ____ and improving can be safely managed without postponing surgery

A

weeks; stable

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10
Q

if surgery is cancelled due to active URI, it should be rescheduled within

A

6 weeks due to airway hyperreactivity

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11
Q

the COLDS scoring system takes into account what 5 things

A

current symptoms
onset of symptoms
presence of lung disease
airway device present
type of surgery

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12
Q

anesthetic management of patients with URI includes

A

adequate hydration, reducing secretions, and limiting airway manipulation

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13
Q

what can be done to reduce upper airway sensitivity

A

inhaleed or topical local anesthetics on the vocal cords

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14
Q

as far as airway/ventilation management what can be done to reduce risk of laryngospasm

A

use of LMA over ETT

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15
Q

when there are no contraindications; what can be done for a smoother emergence

A

deep extubation

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16
Q

adverse respiratory events in patients with URI

A

bronchospasm
laryngospasm
airway obstruction
postintubation croup
desaturation
atelectasis

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17
Q

intraoperative and postoperative hypoxemia are common and treated with

A

supplemental O2

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18
Q

what is astham

A

chronic inflammation of the mucosa of the lower airways

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19
Q

with asthma activation of the inflammatory cascade leads to

A

infilitration of airway mucosa with eosinophils, neutrophils, mast cells, T cells, B cells, and leukotrienes

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20
Q

the inflammatory cascade involving eosinophils, neutrophils, mast cells, T cells, B cells and leurkotrienes causes what

A

airway edema; especially in the bronchi

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21
Q

what kind of airway remodeling occurs with asthma

A

thickening of the basement membrane and smooth muscle mass

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22
Q

the main inflammatory mediatiors implicated in asthma include

A

histamine
prostaglandin D2
leukotrienes

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23
Q

what can provoke asthma

A

allergens
ASA, NSAIDs, sulfiting drugs
infections
exercise
emotional stress

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24
Q

T/F excersie induce asthma occurs after the exertion

A

true

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25
Q

asthma is an episodic disease with _________ _______ and ______ _______

A

acute exacerbations and asymptomatic periods

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26
Q

symptoms of asthma include

A

expiratory wheeze,
productive/nonproductive cough
dyspea
chest tightness
eosinophilia

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27
Q

what is status asthmaticus

A

dangerous, life threathening bronchospasm that persists despite treatment

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28
Q

when the history is obtained from an asthma patients- what is ur focus of assessment

A

intubation for asthma
ICU admission for asthma
2+ hospitalizations for astham in the past year
and presence of coexisting disease

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29
Q

diagnosis of asthma depends on

A

clincal history, symotoms, objective measurements of airway obstruction

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30
Q

astham is diagnosed when

A

pt reports wheezing, chest tightness, or SOB, and demonstrates airflow obstruction on PFT (that is at least partially reversible by bronchodilators

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31
Q

FEV1 normal values

A

80-120%

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32
Q

lung tests used with asthma

A

FEV1
FVC
FEV1:FVC
FEF 25-75
Diffusing Capaity (DCLO)

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33
Q

FVC normal values male/female

A

male - 4.8L
female - 3.7L

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34
Q

normal FEV1/FVC ratio in adults

A

75-90%

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35
Q

maximum ventilatory ventilation is a test that examines

A

the maximum amount of air that can inhaled and exhaled within 1 min
for patient comfort it is measured over 15 sec time period

36
Q

what PFTs are a direct measure of the severity of the expiratory obstruction

A

FEV1
FEF
midexpiratory phase flow

37
Q

what is the FEV1 of a symptomatic asthmatic patient

A

FEV1 <35%

38
Q

during moderate to severe astham attacks what effects are seen on TLC and FRC

A

FRC increases but TLC is unchanged

39
Q

with expriatory obstruction and relief f obstruction after administration of bronchodilator suggests

A

asthma

40
Q

t/f abnormal PFTs may persist for several days after an attack despite absence of symptoms

A

true

since asthma is episodic, diagnosis can be suspected with normal PFTs

41
Q

mild asthma attack is accompanied by what ABG findings`

A

normal PaO2 and PaCO2

42
Q

during an asthma attack tachypnea and hyperventilation is caused by

A

neural reflexes of the lung not hypoxemia

43
Q

what ABG findings might you see in sytmptomatic asthma patient

A

hypocarbia and respiratory alkalosis

44
Q

as the severity of expiratory obstruction increases, the associated VQ mismatching results in a PaO2 of

A

less than 60 mmHg

45
Q

when is the PaCO2 likely to increase in an asthmatic patient

A

when FEV1<25% of predicted value

46
Q

what can cotnribute to the hypercarbia during an asthamtic attack

A

fatigue of skeletal muscles

47
Q

EKG findings of severe asthma patietns

A

hyperinflation and hilar vascular congestion due to mucous plugging and pulmonary HTN

48
Q

what can EKG reveal during an asthma attack

A

R heart strain or ventricular irritability

49
Q

differiental diagnosis of asthma includes

A

viral tracheobronchitis
sarcoidosis
rhematoid arthritis with brnchotis
extrinsic/intrinsic AW compression
vocal cord dysfunction
tracheal stenosis
chronic bronchitis, COPD, and foriegn body aspiration

50
Q

treatment for asthma aims to

A

control symptoms and reduce exacerbation

51
Q

1st line treatment for mild asthmatic patients

A

short acting inhaled B2 agonist

recommended in those with <2 exacerbations a month

52
Q

what can be added to asthmatic therapy to reduce exacerbations adn decrease risk of hospitalization

A

inhaled corticosteroid

53
Q

if asthma symptoms remain uncontrolled what is added to therapy

A

daily B2 agonist

54
Q

other therapy options for asthma

A

inhaled muscarinic atagonists, leukotriene modifiers, and mast cell stabilizers

55
Q

when are systemic corticosteroids used for asthmatic therapy

A

severe asthma uncontrolled with inhaled medications

56
Q

what therapy can be used in asthma treatment to decrease long term use of medications and improve quality of life

A

SQ immunotherapy

57
Q

what is bronchial thermoplasty and why is it used in asthma therpay

A

bronchscopy delivers radiofrequency ablation of smooth muscles to all lung fields except the right middle lobe
loss of airway smooth muscle is thought to reduce bronchoconstriction

58
Q

with bronchial thermplasty what lobe of the lung is not targeted

A

right middle lobe

59
Q

how many sessions of bronchial thermoplasty is recommended

A

3 sessions
risk for airway fire

60
Q

with bronchial thermoplasty when the FEV1 improves how much of normal - do patients have minimal or no symoptoms

A

about 50%

61
Q

acute severe asthma (status asthmaticus)

A

bronchocspasm that doesnt resolve despite usual therapy

considered life threatening

62
Q

treatment for acute severe asthma

A

high dose, short acting B2 agonist and systemic corticosteroids

63
Q

inhaled b2 agonist can be used in treatment of acute severe asthma every

A

15-20 min for several doses without hemodynamic effects

although pts may experience unpleasant sensations due to adrenegic stim

64
Q

2 most commonly administered corticosteroids for acute severe asthma

A

methyprednisone
hydrocortisone

65
Q

with acute severe asthma, when is supplemental O2 given

A

to maintain saturations > 90%

66
Q

other drug therapies for acute severe asthma

A

magneisum, oral leukotriene inhibitors

67
Q

when is tracheal intubation warranted for acute severe asthma

A

PaCO > 50 mmhg

68
Q

MV parameters in acute severe asthma

A

high gas flows permit short inspiriation timesand longer expiration
expiration time must be prolonged to avoid air trapping “auto-peep”
permissive hypercarbia

69
Q

what is the likelihood of bronchospasm in asthmatics undergoing GA

A

0.2-4.2%

70
Q

risk of bronchoscopasm is correlated with the type of surgery - what surgeries increase the risk

A

upper abdominal and oncologic surgery

71
Q

GA mechanisms that increase airway resistance

A

depression of cough reflex
impairment of mucocilliary funciton, reduction of palatopharyngeal muscle tone
depression of diaphragmatic function
increaed fluid in the airway walll

72
Q

other factors increasing airway resistance in asthamtic patietns undergoing GA

A

airway stim (intubation)
PNS activation and or release of neurotransmiters (Substance P and neurokinins)

73
Q

preop assessment of asthmatic patient includes

A

notes of symptom control
frequency of exacerbations
need for hospitalization or intubation
previous anesthesia tolerance

74
Q

what physcial assessment might you note of your asthmatic patient preop

A

use of accessory muscles
wheezing/creptitis

75
Q

t/f eosinophil count mirrors the degree of inflammation

A

true

76
Q

what PFTs might you want before heading back to surgery with an asthma patient

A

FEV1 before and after bronchodilator

77
Q

what PFT findings prdict the risk of periop respiratory complications

A

FEV1 or FVC < 70% predicted
FEV1:FVC ratio < 65% predicted

78
Q

what can improve reversible components of asthma

A

chest physiotherapy, antibiotics, and bronchodilators

79
Q

how long do you continue preop anti-inflammatories and bronchodilators

A

until induction

q

80
Q

if patients are on systemic corticosteroids for asthma within the past 6 months, what is indicated

A

stress dose hydrocortisone or methylprednisone

81
Q

ideally patietns should be free of ______ and have a PEFR of > _____ % of predicted or their personal best before surgery

A

free of wheezing
PEFR > 80%

82
Q

COPD is a disease of

A

chronic airflow obstruction

83
Q

symptoms of COPD include

A

emphysema - lung parynchema destruction, chronic bronchitis, productive cough and small airway disease

84
Q

COPD prevalence and rank in leading cause of death

A

10%
3rd leading cause of death

85
Q

risk factors for COPD

A

cigarette smoke, occupational exposure to dust and chemicals, absetos, gold mining, biomass fuel, air pollution. genetic factors, age, female, poor lung development during gestation, low birth weight

Health Assessment (16 decks)

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