pulm Patho

Question 1

pulm questions

Answer 1

any resp/lung problems- severity, tx? 
do you see a pulmonologist?
recent hospitalizations
recent exacerbations? 
recent URI
exercise tolerance: can you walk up a flight o stairs?
SOB, Wheezing- last exacerbation, tx
Smoking
OSA- snoring, pillows, HA, wake up SOB, daytime tiredness 
previous lung surg
position--how it will effect V/Q

Question 2

pulm meds

Answer 2

abx
steroids
beta agonist
Mucolytics (anticholinergics)

Question 3

meds to mobilize secretions

Answer 3

mucolytics
hydration
Aerosol therapy
mechanical therapy
abx

Question 4

Meds for bronchospasms

Answer 4

B2
anticholinergics
methylxanthines
corticosteroids

Question 5

Pulm tests

Answer 5

PFT
Abg
O2sat
PaCO2

Question 6

PFT included 6

Answer 6

VC
FVC- forced vital capacity
FEV1- forced expiratory volume in 1sec
FEV1/FVC
FEF25-75- the mean forced expiratory flow 
MVV: max voluntary vent
what are the results-mild mod severe 
are there trends?
improvement with tx?

Question 7

Not included in PFT

Answer 7

FRC

need nitrogen washout to measure

Question 8

who needs PFT 8

Answer 8

COPD
smokers with cough
Wheezing or DOE
morbid obesity
thoracic surg
open upper abd
>70yo
chest wall or spinal deformities

Question 9

tests for gas exchange

Answer 9

Abg
SaO2
capnography

Question 10

assesses mechanical dysfunction of lungs and chest wall

Answer 10

IS

Spirometry

Question 11

Pulm Labs

Answer 11

CBC for WBC

Question 12

Pulm physical assessment:

Answer 12

observe and inspect

Question 13

Pulm observe and inspect

Answer 13

breathing rate, pattern, effort, accessory muscle use
SOB
wheezing 
Cough 
Tracheal position
expansion of thorax: barrel chest 
goiter/mass
Skin: color, nails, clubbing of fingers

Question 14

auscultate

Answer 14

anterior posterior (better) lateral each side
*Tracheobronchial tree: bronchial sounds
trachea, R sc joint and R post is space
high pitch, louder, e=i, pause
*Vesicular: over lung tissue
lower pitch, softer, exp shorter NO pause

Question 15

maximize pulm function

Answer 15

smoking cessation
mobilization of secretions
bronchospasm tx
improve motivation

Question 16

Pulm prevent

Answer 16

atelectiasis
barotrauma
worsening VQ-PPV
increased dead space- by provided adequate BP

Question 17

Smoking cessation

Answer 17

ideal 8 weeks
12-24hr preop: able to better oxygenate bc carboxyhemoglobin levels back to normal
2-3 weeks: increased secretions bc mucociliary function returned
4 weeks: decreased secretions
8 weeks: decreased post op pulm complication

Question 18

Restrictive pulm disease
sedation
regional
inhaled agents

Answer 18

dec FRC: careful with sedation
Regional: >T10…not good if they rely on accessory muscles?
Inhaled agents: accelerated uptake bc dec FRC

Question 19

Restrictive: mech vent

Answer 19

Expect increased airway pressures 
dec TV: 4-8ml/kg
inc rate 14-18
PEEP
Pressure control

Question 20

Restrictive anesthesia effects on FRC

Answer 20

dec: supine
dec: GA
plateau develops after 10 mins
may take 3-7 days to recover after abd procedure
VC dec 40% takes up to 14 days to recover

Question 21

Restrictive: mech vent

Answer 21

can't get IN
Expect increased airway pressures 
dec TV: 4-8ml/kg
inc rate 14-18
PEEP
Pressure control

Question 22

Obstructive Pulm disease

Answer 22

can’t get OUT
avoid spont vent on GA
hyper vent can cause air trapping

Question 23

Obstructive reduce airway reactivity

Answer 23

bronchodilator therapy
inc alveolar [ ] of IA
IV opioids prior to airway manipulation
Steroids

Question 24

Obstructive vent settings

Answer 24

large TV
slow RR
keep PIP below 40cmH20
goal=balance
avoid high peak airway pressure
allow longest possible exp time

Question 25

PFTs in detail LOOK in NOTES: back side of hand written

Answer 25

lung

Question 26

Abnormal breath sounds

Answer 26

bronchial: anywhere other than expected
Absent
Consolidation: low pitch bronchial 
Cavitary: high pitch bronchial 
Adventitious: wheezing, stridor, crackles