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NP School > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

A pleural effusion makes a ____ sound upon percussion?

A

Dull

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2
Q

A pneumothorax makes a ________ sound upon percussion?

A

hyper-resonant

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3
Q

What is pulsus paradoxus?

A

a drop in systolic blood pressure of 10mmHg or more during inspiration

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4
Q

What is the term for a drop in systolic blood pressure of 10mmHg or more during inspiration?

A

pulsus paradoxus: caused by
- cardiac tamponade
- pericarditis
- tension pneumothorax
- CHF
- acute asthma exacerbation
- COPD exacerbation

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5
Q

What is the normal pulmonary flow rate?

A

6 L/min

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6
Q

What is the normal mean pulmonary arterial pressure?

A

12-15 mmHg

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7
Q

What is the normal PaCO2 value?

A

35-45 mmHg

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8
Q

What is the normal PaO2 value?

A

75-100 mmHg
- partial pressure of oxygen in arterial blood

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9
Q

What is the normal SaO2?

A

95-100%
- percentage of O2 binding sites on hemoglobin that are bound to O2
- arterial O2
- low percentage means high number of empty O2 binding sites on hgb

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10
Q

What value shows the percentage of O2 binding sites on hemoglobin that are bound to O2?

A

SaO2

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11
Q

What is the difference between PaO2 and SaO2?

A
  • PaO2 = O2 in plasma
  • SaO2 = 02 bound to hemoglobin
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12
Q

What 2 conditions can cause a shift to the left on the oxyhemoglobin dissociation curve?

A
  • shift to the left = increased affinity of Hgb for O2
  • alkalosis
  • hypothermia
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13
Q

What does a shift to the left on the oxyhemoglobin dissociation curve mean?

A

means that hemoglobin has a higher affinity for O2, doesn’t release it to the tissues and binds to O2 in the lungs easily
- can lead to tissue hypoxia

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14
Q

What does a shift to the right on the oxyhemoglobin dissociation curve?

A

means that hemoglobin has a weak affinity for O2
- hemoglobin readily dissociates from or releases O2 to tissues
- caused by hypercapnia (high CO2) which creates an acidic environment

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15
Q

What conditions can cause a shift to the right on the oxyhemoglobin dissociation curve?

A
  • acidosis
  • increased tissue metabolism
  • increased anaerobic metabolism
  • hyperthermia
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16
Q

What is the normal Svo2 value (O2 in venous blood returned to heart)?

A

60-80%

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17
Q

An SvO2 < 60% is indicative of what?

A
  • amnt of O2 returning to heart
  • normal: 60-80%
  • increased O2 demand (fever, shivering, increased WOB, pain)
  • decreased O2 Supply (may not be oxygenating or may be alkalotic)
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18
Q

An SvO2 < 40% indicates?

A
  • anaerobic metabolism leading to organ dysfunction
  • increased O2 demand or decreased oxygenation
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19
Q

An SvO2 > 80% implies?

A
  • decreased tissue extraction of O2
    • less O2 demand (sleep, hypothermic)
    • decreased O2 delivery and cell uptake (sepsis, shift of curve to the left)
    • increased O2 supply (polycythemia, FIO2 > need)
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20
Q

What does PEEP on ventilator stand for?

A

Positive End Expiratory Pressure
- pressure at end of expiration to keep alveoli from collapsing

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21
Q

What is PEEP in ventilation?

A
  • Positive End Expiratory Pressure
  • pressure applied by the ventilator at the end of each breath to prevent alveoli collapse
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22
Q

Which part of the brain controls the involuntary act of breathing?

A

Brainstem (medulla and pons)

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23
Q

Why should O2 be administered at low flow rates and titrated carefully in patients with chronically high PaCO2?

A
  • patients have lost the normal hypercapnic drive and respond only to changes in PaO2
  • increased PaO2 may result in suppression of ventilation
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24
Q

What is the ratio of CO2 to O2 exchange between the alveolus and capillaries?

A
  • 20:1
  • 20 CO2 cross from capillaries for every 1 O2
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25
Q

What does FIO2 stand for?

A

Fraction of Inspired Oxygen

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26
Q

What does the SaO2 measure?

A
  • the amount of O2 bound to hemoglobin
  • norm: 95-100%
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27
Q

What ventilator adjustments would be done to treat a patient with respiratory acidosis?

A
  • increase resp rate
  • increase tidal volume
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28
Q

How do you increase the tidal volume on a ventilator when in assist control mode?

A

directly increase the tidal volume

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29
Q

How do you increase the tidal volume on a ventilator when in pressure control or pressure support mode?

A

increase the inspiratory pressure

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30
Q

What is the goal of treatment for a patient with respiratory acidosis?

A

to decrease the PaCO2

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31
Q

What is the goal of treatment for a patient with respiratory alkalosis?

A

to increase the PaCO2

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32
Q

What ventilator adjustments would be done to treat a patient with respiratory alkalosis?

A
  • decrease the resp rate
  • decrease the tidal volume
  • unless the patient is breathing faster than the vent, need another strategy
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33
Q

What ventilator adjustments would be done to treat a patient who is hypoxic?

A
  • increase the FIO2
  • increase Positive End Expiratory Pressure (PEEP)
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34
Q

What information/values are measured in an arterial blood gas (ABG)?

A
  • pH (7.35-7.45)
  • PaO2 (80-100 mmHg)
  • PaCO2 (35-45 mmHg)
  • HCO3 (22-26 mEq/L)
  • Base excess (-3 to +3 mEq/L)
  • SaO2 (> 98%)
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35
Q

What is the normal PaO2/FiO2 (P/F ratio) ratio range?

A
  • 300-500
  • < 300 indicates impaired O2 exchang
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36
Q

A P/F ratio between 200-300 is indicative of what?

A

impaired O2 exchange

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37
Q

A P/F ratio between < 200 is indicative of what?

A

severe hypoxemia

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38
Q

Every 10 mmHg shift in PaCO2 has what effect on blood pH?

A
  • produces an opposite shift in the pH
    (ex: 10 mmHg shift up = 0.08 shift down in pH = more acidic)
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39
Q

An SpO2 of 90% = PaO2 of _?__

A

60 mmHg

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40
Q

An SpO2 of 75% = PaO2 of _?__

A

40 mmHg

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41
Q

An SpO2 of 50% = PaO2 of _?__

A

27mmHg

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42
Q

What are the indications for a pulmonary artery catheterization (PA Cath)

A
  • differentiate between cardiogenic and pulmogenic cause of pulmonary edema
  • to measure CO, CI, SVR, pulmonary vascular resistance, SvO2
  • to titrate therapy
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43
Q

How does placement of pulmonary arterial catheter help differentiate between cardiogenic and pulmogenic cause of pulmonary edema?

A
  • cardiogenic = high pulmonary capillary wedge pressures (PCWP) with normal PAP
  • pulmogenic = normal PCWP with high PAP
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44
Q

What does the Pulmonary Capillary Wedge Pressure measures?

A

LV end-diastolic filling pressure or LV preload
- elevated is indicative of left heart failure or mitral valve stenosis
- norm: 4–12 mmHg

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45
Q

What urine output is indicative of low intravascular volume?

A

< 0.5mL/kg/hr

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46
Q

What is the normal Pulmonary Capillary Wedge Pressure range?

A

4-12 mmHg

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47
Q

What is the normal Central Venous Pressure range (CVP)?

A

2-8mmhg (pressure in vena cavae)
- measures
- venous return
- fluid status
- indirect measurement of CO

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48
Q

What is the name for the loss of defined borders on an CXR?

A

Silhoutte Sign
- sign of fluid builidup
- shows up white, should be black

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49
Q

A displaced trachea that is not midline on XR is indicative of?

A
  • thyroid enlargement
  • increased pressure in chest
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50
Q

What is the term for the location of the bifurcation of the left and right bronchi?

A

carina

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51
Q

What is the carina and where should it be located on a CXR?

A
  • point of bifurcation of the left and right bronchi
  • between T4 and T6
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52
Q

Aspiration pneumonia should be suspected when consolidation or fluid is seen in the which lobes?

A

right middle or lower lobes

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53
Q

How much higher is the right diaphragm when compared to the left?

A

1-3 cm higher

54
Q

An elevated diaphragm is indicative of?

A
  • diaphragmatic paralysis
  • phrenic nerve injury
55
Q

What are the types of COPD?

A
  • emphysema
  • chronic bronchitis
  • bronchospastic airway disease (asthma, reactive airway disease)
56
Q

What are the cardinal symptoms of COPD?

A
  • dyspnea with exertion
  • chronic cough
  • increased sputum production
57
Q

What is the term for the loss of fat body mass or weight loss in patients with advanced lung disease?

A

Pulmonary cachexia

58
Q

How long does a patient have to have a chronic cough for to to defined as having chronic bronchitis?

A

3 consecutive month in 2 consecutive years

59
Q

What condition is defined as a chronic cough lasting 3 or more consecutive months in 2 consecutive years?

A

Chronic Bronchitis

60
Q

What condition describes structural changes associated with COPD that include abnormal and permanent air space enlargements distal to the terminal bronchioles along with destruction of airspace walls without overt fibrosis?

A

Emphysema

61
Q

What are the indications for ordering a Pulmonary Function Test (PFT)?

A
  • unexplained dyspnea/cough
  • assess severity of pulmonary dysfunction
  • to trend pulmonary dysfunction
62
Q

Spirometry is used to determine which two pulmonary values?

A
  • forced vital capacity (FVC)
  • forced expiratory volume (FEV)
63
Q

What is the gold standard test to diagnose obstructive lung disease?

A

Forced expiratory volume in one second (FEV1) over Forced vital capacity (FVC)
- FEV1/FVC < 70% = obstructive disease

64
Q

What FEV1/FVC ratio is indicative of airflow obstruction or an airway obstructive disorder?

A

< 70%

65
Q

What is the term for the max amount of air a pt can forcibly exhale from the lungs?

A

Forced Vital Capacity

66
Q

What is the normal value for the Forced Vital Capacity?

A
  • max amnt of air that can be forcibly exhaled
  • approx 80% of total lung capacity
  • males: 4.75-5.5 liters
  • females: 3.25-3.75 liters
67
Q

What is the term for the amount of air that is inhaled and exhaled during a normal respiratory cycle?

A

Tidal Volume
- 400-500 mL

68
Q

What are the s/s of COPD?

A
  • dyspnea w/ exertion
  • chronic cough
  • sputum production
  • chest tightness
  • pulmonary cachexia
  • tripod posture
  • normal RR or tachypnea
  • mental status changes
  • pursed lip breathing
69
Q

What are the causes of chest tightness felt by patients with COPD?

A
  • increased anteroposterior (AP) chest diameter or “barrel” chest
  • acute air retention within the thorax
70
Q

Hyperresonance upon percussion of the chest is indicative of?

A

increased air present within the lung tissueW

71
Q

What diagnostic test(s) are done if COPD is suspected?

A
  • spirometry
  • ABG
  • pulse oximetry
  • H/H
  • CXR
72
Q

In a patient with COPD, oxygenation is deemed adequate when the SaO2 is _______ and the hemoglobin is ________?

A
  • SaO2 > 88%
  • Hgb > 10g/dl
73
Q

What class of drug is Bupropion?

A

norepinephrine/dopamine reuptake inhibitor
- used to treat depression and quit smoking

74
Q

Bupropion is used to treat what conditions?

A
  • NE and dopamine reuptake inhibitor
  • major depressive disorder
  • seasonal affective disorder
  • smoking cessation aid
75
Q

A COPD patient with what FEV1 needs to have an inhaled corticosteroid ordered?

A

FEV1 < 60
- fluticasone
- budesonide

76
Q

A patient with an FEV1 < 60 should be prescribed what medication?

A

an inhaled corticosteroid
- fluticasone
- budesonide

77
Q

What is used to treat a mild COPD exacerbation?

A

short acting beta agonist
- albuterol

78
Q

What is used to treat a moderate COPD exacerbation?

A
  • short acting beta agonist plus:
    • ABX and/or
    • oral corticosteroids
79
Q

\What is used to treat a severe COPD exacerbation?

A

hospitalization/ED

80
Q

How do anticholinergics/antimuscarinic drugs reduce COPD symptoms?

A

reduce airway secretions and relax airway muscle tone

81
Q

Ipratropium bromide (atrovent) is what class of medication?

A

Short acting muscarinic antagonist or anticholinergic

82
Q

Tiotropium bromide (Spiriva) is what class of medication?

A

Long acting muscarinic antagonist or anticholinergic

83
Q

What is the drug class of choice to treat stable COPD?

A

short and/or long acting anticholinergics (SAMA, LAMA)

84
Q

What are the drugs are used to treat COPD patients?

A
  • anticholinergics (SAMA, LAMA)
  • bronchodilators (SABA, LABA)
  • Corticosteroids
  • Phosphodiesterase 4 inhibitors
  • guaifenesin (thins mucus)
  • acetylcysteine (reduces sputum viscosity)
  • O2
85
Q

Hyperresonance with chest percussion is indicative of what?

A

increased air within the lung tissue

86
Q

A hematocrit > 55 ml/dl in a COPD patient is indicative of what?

A

Secondary Polycythemia d/t chronic hypoxemia
- an increase in all blood cells, especially RBC’s

87
Q

What might be seen on the CXR of a patient with COPD?

A
  • air trapping
  • blebs and bullae
  • flattened diaphragm
  • hyperinflation
  • retrosternal air on lateral view
88
Q

What are blister like, air filled spaces within the lung that are < 1cm in diameter?

A

blebs

89
Q

What are blister like, air filled spaces within the lung that are > 1cm in diameter?

A

bullae

90
Q

What would be the impression of a CXR that shows hyperlucency in the upper lung zones, widening of the the intercostal spaces, and 10 or more ribs id’d above the diaphragm?

A

hyperinflation of the lungs

91
Q

What research study is the standard for staging and treatment of COPD?

A

the GOLD study

92
Q

What are the 3 major categories of respiratory diseases?

A
  • obstructive disease
  • restrictive disease
  • vascular disease
93
Q

What are examples of obstructive airway diseases?

A
  • asthma
  • COPD
  • bronchiectasis
  • bronchiolitis
94
Q

What is the term for a chronic lung disease that causes the airways of the lungs to permanently widen and weaken

A

bronchiectasis

95
Q

Chronic rhonchi is associated with what respiratory diseases?

A
  • bronchiectasis
  • COPD
96
Q

Crackles, or rales are common sign of what respiratory disease?

A

alveolar disease

97
Q

What is Egophony?

A
  • hearing “AH” when the patient says “EEE”, which is an abnormal sound transmission through consolidated/fluid filled parenchym
  • present in PNA
98
Q

A total lung capacity < 80% of the patient’s predicted value is diagnostic for which type of airway disease?

A

restrictive
- parenchymal disease
- neuromuscular weakness
- chest wall/pleural diseases

99
Q

Airway restriction with impaired gas exchange, as indicated by a decreased diffusion capacity of the lung for carbon dioxide (DLCO), suggests which lung disease?

A

parenchymal lung disease

100
Q

normal spirometry, normal lung volumes, and a low diffusion capacity of the lung for carbon dioxide (DLCO) should prompt further evaluation for which type of pulmonary disease?

A

pulmonary vascular disease
- pulmonary embolism
- pulmonary arterial HTN
- pulmonary venoocclusive disease
- vasculitis

101
Q

An ultrasound of the chest can rapidly diagnose which pulmonary diseaseas?

A
  • pneumothorax
  • pleural effusion
  • consolidation of lung parenchyma
102
Q

What is the term for the percutaneous aspiration of fluid from the pleural space?

A

thoracentesis

103
Q

What is a thoracentesis?

A

the percutaneous aspiration of fluid from the pleural space

104
Q

What is the gold standard method for obtaining respiratory secretions for hematologic, biochemical, microbiological, and/or cytologic analyses?

A

Bronchoalveolar lavage (BAL)

105
Q

What action does interleukin 13 have on the body?

A

Induces:
- airway hyperresponsivenes
- mucus secretion
- goblet cell metaplasia

106
Q

What are the make interlinking associated with asthma?

A

Interleukin-4
Interleukin-5
Interleukin-13

107
Q

What can trigger airway narrowing in a patient with asthma?

A
  • allergens
  • irritants
  • viral infections
  • exercise and cold dry air
  • air pollution
  • drugs
  • hormonal changes
  • pregnancy
108
Q

During a PFT to test asthma, what is/are the requirements needed to prove reversibility?

A
  • a 12% or greater increase in the FEV1 and absolute increase of >200 mL at least 15 mins after administration of a beta-2-agonist or after several weeks of corticosteroid therapy
109
Q

What is Methacholine?

A
  • cholinergic agonist used to confirm the diagnosis of asthma if PFT is nonconfirmatory
110
Q

Which WBC will be elevated in an asthma patient during an exacerbation ?

A
  • eosinophil > 300 cells/microL
111
Q

If the eosinophil count is greater than 300 in an asthmatic patient, what type of meds should be given?

A

medications that target the type 2 inflammatory process

112
Q

Which antibody will be elevated in an asthmatic patient?

A

IgE

113
Q

Albuterol is what class of medication?

A

short acting beta-2 agonist
- aka salbutamol

114
Q

What is the onset of action for albuterol?

A

3-5 mins after inhalation

115
Q

What is the duration of albuterol?

A

4-6 hours

116
Q

Salmeterol and Formoterol are what class of medication?

A

long acting beta-2 agonist

117
Q

What is the duration of effects for Salmeterol and Formoterol?

A
  • long acting beta-2 agonists
  • duration is about 12 hours
118
Q

What affect do Beta-2 agonists have on potassium?

A

promotes entry of potassium into the cell
- may cause hyokalemia

119
Q

what are the major cytokines associated with type two inflammation related to asthma?

A

Interleukin-4
Interleukin-5
Interleukin-13

120
Q

what are the most common symptoms associated with asthma?

A

After exposure to an allergen or trigger:
- Wheezing
- Shortness of breath
- Chest tightness
- increased mucus production
- Cough

121
Q

what are the goals of asthma therapy?

A
  • Reduction of symptom frequency to 2 or less a week
  • Reduction of nighttime awakenings to 2 or less times/month
  • reduction of rescue inhaler use to 2 or less times a week
  • Maintenance of normal daily activities
122
Q

what medication classes/types are used in the treatment of asthma?

A
  • short acting beta-2 agonist
  • Long acting beta-2 agonist
  • Ultra acting beta-2 agonist
  • anticholinergics (SAMA, LAMA)
  • theophylline
  • corticosteroids
  • leukotriene modifiers
123
Q

what is the time of onset for albuterol and how long does it last?

A

Onset 3 to 5 minutes
Lasts 4 to 6 hours

124
Q

Formoterol class/type of medication?

A
  • Long acting, beta 2 agonist
  • Affect last about 12 hours
125
Q

which oral cortical steroid should be given a treat and as exacerbation and what dose/frequency?

A

Prednisone 40 to 60 mg a day for one to two weeks

126
Q

what is the definition of bronchi ectasis?

A

The irreversible dilation of the bronchi
- Can be focal/localized or diffuse

127
Q

what is the main cause of focal bronchi ectasis?

A

An obstruction of the airway

128
Q

what is the imaging study of choice to confirm the diagnosis of bronchiectasis?

A

Chest CT - will dilated airways
- tram tracks: look like worms
- signet ring sing: circle/oval shape

129
Q

What is a normal cause of death for a patient diagnosed with cystic fibrosis?

A

pulmonary compromise by copious, hyper and sticky, secretions, obstruct, smaller medium sized airways

130
Q

what are the three most common organisms cultured from sputum of a patient with cystic fibrosis?

A
  • staphylococcus aureus
  • haemophilus influenza
  • pseudomonas aeruginosa
131
Q

what effect does cystic fibrosis have on the pancreas?

A
  • called cystic fibrosis of the pancreas
  • secretions obstruct pancreatic ducts & impair production and flow digestive enzymes to the duodenum
  • Pancreatic insufficiency leads to:
    • chronic absorption
    • poor growth
    • fat soluble vitamins efficiency
    • diabetes

NP School (19 decks)

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