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Ontario PCP 2019/2020 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

a disease characterized by a decreased ability of the lungs to perform the function of ventilation

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2
Q

cardiac and circulatory diseases may allow blood to pool in the large veins of the pelvis and lower extremities causing …

A

pulmonary emboli

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3
Q

Processes of Gas Exchange

A

Ventilation
Diffusion
Perfusion

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4
Q

Major function of the respiratory system is to

A

exchange gases with the environment. Oxygen is taken in and carbon dioxide eliminated, a process known as gas exchange.

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5
Q

Ventilation

A

is the mechanical process of moving air in and out of the lungs

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6
Q

Diffusion

A

the movement of molecules through a membrane from an area of greater concentration to an area of lesser concentration

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7
Q

In diffusion the gases move between

A

the alveoli and the pulmonary capillaries.

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8
Q

As the red blood cells moves through the pulmonary capillaries..

A

they become enriched with oxygen. less oxygen will pass into the bloodstream as the gradient between alveolar and capillary oxygen concentration decreases

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9
Q

Perfusion

A

the circulation of blood through the capillaries

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10
Q

lung perfusion is dependent on three conditions

A

Adequate blood volume
intact pulmonary capillaries
efficient pumping of blood by the heart

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11
Q

hemoglobin

A

the transport protein that carries oxygen in the blood

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12
Q

oxygen is transported in the bloodstream in one of two ways

A

bound to hemoglobin

dissolved in the plasma

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13
Q

carbon dioxide is transported from the cells to the lungs in one of three ways

A

as bicarbonate ions
bound to the globin portion of the hemoglobin molecule
dissolved in plasma (measured in PCO2)

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14
Q

respiration

A

the exchange of gases between a living organism and its environment

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15
Q

diseases that affect the upper respiratory tract will result in

A

obstruction of air flow to the lower structures.

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16
Q

upper airway trauma produces

A

both significant hemorrhage and swelling

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17
Q

infections of the upper airway structures can obstruct

A

airflow

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18
Q

lower air obstruction may be caused by

A

trauma, foreign body aspiration, mucus accumulation (asthmatics), smooth muscle constriction (in asthma and COPD) and airway edema produced by infections or burns

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19
Q

traumatic injuries to chest wall/diaphragm will disrupt the normal mechanics causing..

A

negative pressure within the pleural space.

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20
Q

pneumothorax

A

a collection of air in the pleural space, causing a loss of the negative pressure that binds the lung to the chest wall.

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21
Q

open pneumothorax

A

air enters the pleural space through an injury to the chest wall

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22
Q

closed pneumothorax

A

air enters the pleural space through an opening in the pleura that covers the lung

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23
Q

tension pneumothorax

A

develops when air in the pleural space cannot escape, causing buildup of pressure and collapse of the lung

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24
Q

hemothorax

A

a collection of blood in the pleural space

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25
Q

flail chest

A

one or more ribs fractures in two or more places, creating an unattached rib segment

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26
Q

cheyne-stokes respirations description

A

pattern with progressively increasing tidal volume, followed by a declining volume, separated by periods of apnea at the end of expiration

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27
Q

what patient is cheyne-stokes typically seen in

A

older patient with terminal illness

brain injury

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28
Q

Kussmails respirations decription

A

deep, rapid breaths that result as a corrective measure against such conditions as diabetic ketoacidosis that produce metabolic acidosis

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29
Q

apneustic respiration description

A

is characterized by long deep breaths that are stopped during the inspiratory phase and separated by periods of apnea.

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30
Q

when would you see apneustic respirations in a pateint

A

result of stroke or severe central nervous system disease

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31
Q

hypoxia

A

state in which insufficient oxygen is available to meet the oxygen requirements of the cells.

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32
Q

when an area of lung tissue is appropriately ventilated but no capillary perfusion occurs, available oxygen is not moved into the circulatory system … what is this called

A

pulmonary shunting

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33
Q

General Impression of Respiratory Status

A 
position
colour
mental status
ability to speak
respiratory effect
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34
Q

pallor

A

paleness

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35
Q

diaphoresis

A

sweatiness

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36
Q

cyanosis

A

bluish discoloration of the skin. the condition is directly related to poor ventilation

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37
Q

tracheal tugging

A

retraction of the tissues of the neck due to airway obstruction or dyspnea

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38
Q

noisy breathing nearly always means …

A

partial airway obstruction

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39
Q

obstruction breathing is now always..

A

noisy

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40
Q

the brain can only survive only a few minutes in ..

A

asphyxia

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41
Q

asphyxia

A

a decrease in the amount of oxygen and an increase in the amount of carbon dioxide as a result of some interference with respiration

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42
Q

what breathing signs should suggest a possible life-threatening respiratory problem in adults

A
  • alterations in mental status
  • severe central cyanosis
  • absent breath sounds
  • audible stridor
  • one-two work dyspnea
  • tachycardia
  • pallor or diaphoresis
  • presence of intercostal and sternocleidomastoid retractions
  • use of accessory muscles
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43
Q

orthopnea

A

dyspnea while lying surpine

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44
Q

paroxysmal nocturnal dyspnea

A

short attacks of dyspnea that occur at night and interrupt sleep

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45
Q

hemoptysis

A

expectoration of blood from the respiratory tree

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46
Q

if a patient complains of dyspnea what should you obtain

A

SAMPLE

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47
Q

if the chief complaint suggests respiratory disease what should you ask for

A

OPQRST questions about current symptoms

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48
Q

SOME GOOD QUESTIONS TO ASK FOR OPQRST

A
  • how long has the dyspnea been present
  • was the onset gradual or abrupt
  • is the dyspnea better or worse by position
  • is there associated orthopnea or PNS
  • has the patient been coughing
  • character and colour of the sputum
  • is there any hemptysis
  • is there any chest pain associated with the dyspnea (what is the location of the pain, was the onset of pain sudden or slow, what was the duration of the pain, does the pain radiate to any area, does the pain increase with respiration)
  • are there associated symptoms of fever or chills
  • what is the patients past medical history
  • has the patient experienced wheezing
  • is the patient or close family member or smoker
49
Q

why should you inspect the finger for clubbing

A

any clubbing may indicate chronic respiratory or cardiac disease

50
Q

principles of management for respiratory disorders include….

A

give first priority to the airway and always provide oxygen to patients with respiratory distress or the possibility of hypoxia, including patients with COPD

51
Q

common causes of airway obstruction

A 
tongue
foreign matter
trauma
burns
allergic reaction
infection
52
Q

Management of a conscious adult in an upper airway obstruction

A

1) ask the patient .. are you choking? can you speak? if the patient can speak they should be able to produce a forceful cough to expel the foreign body
2) if the patient has a complete obstruction or poor air exchange (can speak) … perform Heimlich manoeuvre,

53
Q

management of unconscious adult or is loosing conscious in an upper airway obstruction

A

1) head-tilt, chin lift, the jaw thrust to try and open airway
2) insert an NPA and attempt to give 2 ventilation’s via BVM; if attempts fail, repositon head and repeat attempt
3) if step 1&2 fail start chest compressions. three sets of five
4) if step 3 fails, try the tongue-jaw lift and if the object is visual attempt to sweep it out of the way. If successful resume ventilation, if unsuccessful call an ACP

54
Q

Adult respiratory distress syndrome (ARDS)

A

form of pulmonary edema that is caused by fluid accumulation in the interstitial space within the lungs

55
Q

if airway obstruction is caused by laryngeal edema (anaphylactic reactions, angioedeme) .. what do you do?

A

1) head tilt chin lift/jaw thrust manoever
2) administer supplemental oxygen
3) attempt BVM
4) start an IV and administer EPI

56
Q

patients with cardiogenic pulmonary edema have a poorly functioning…..

A

left ventricle

57
Q

Positive end expiratory pressure (PEEP)

A

a method of holding the alveoli open by increasing expiratory pressure.

58
Q

obstructive lung diseases

A

emphysema
chronic bronchitis
asthma

59
Q

if the patient has asthma & chronic bronchitis what do we call that?

A

chronic obstructive pulmonary disease (COPD)

60
Q

Obstructive lung diseases result in obstruction primarily in what?

A

bronchioles

61
Q

cor pulmonale

A

hypertrophy of the right ventricle resulting from disorders of the lung

62
Q

polycythemia

A

an excess of red blood cells

63
Q

Emphysema is rarely associated with….

A

a cough except in the morning

64
Q

how does emphysema result?

A

destruction of the alveolar walls distal to the terminal bronchioles.

65
Q

continued exposure in emphysema can lead to…

A

hypertension which can lead to cor pulmonale, right heart failure or death

66
Q

why does emphysema turn into hypertension

A

diffusion defects, the number of pulmonary capillaries in the lung is decreased, thus increasing resistance to pulmonary blood flow.

67
Q

what are the signs and symptoms a patient may have with emphysema

A

report a history of recent weight loss, increased dyspnea with exertion, well developed accessory muscles and progressive limitation of physical activity. Rarely has a cough only in the morning, a barrel chest, clubbing of the fingers, hypertension and pink skin.

68
Q

Chronic bronchitis

A

results from an increase in the number of the goblet cells in the respiratory tree.

69
Q

how is chronic bronchitis characterized

A

characterized by the production of a large quantity of sputum.

70
Q

unlike emphysema… in chronic bronchitis the aveoli are….

A

not severely affected, and diffusion remains normal

71
Q

hypoxia may increase red blood cell production which in turn leads to

A

polycythemia

72
Q

chronic bronchitis is usually associated with…

A

productive cough and copious sputum production
patients tend to be overweight and are often cyanotic
usually a smoker

73
Q

what is the first step in treating a patient suffering an exacerbation of emphysema or chronic bronchitis

A

establish an airway

74
Q

What are the steps to managing emphysema and chronic bronchitis

A

establish an airway
place patient in a seated or semi seated position
apply pulse oximeter
administer supplemental oxygen at low-flow rate
** may have to BVM
establish an IV and you may have to administer and bronchodilator medication.

75
Q

emphysema and chronic bronchitis management goals

A

relieve hypoxia

reverse bronchoconstriction

76
Q

Common signs of asthma

A

dyspnea
wheezing
cough

77
Q

what happens in the body when someone takes an asthma attack

A

a two phase reaction occurs.
the first phase: characterized by a release of chemical mediators such as histamine. these mediators cause contraction of the bronchial smooth muscle and leakage of fluid from peribronchial capillaries. this results in both bronchoconstriction and bronchial edema. the two factors can decrease expiratory airflow.
the second phase: will typically not respond to inhaled beta-agonist drugs. will need anti-inflammatory agents, such as corticosteroid’s will be required.

78
Q

asthma management goals

A

correct hypoxia - give oxygen
reverse bronchospam - give a beta-agonist
reduce inflammation

remember to always to monitor the patient and be prepared to provide airway and respiratory support.

79
Q

status asthmaticus

A

is a severe, prolonged asthma attack that cannot be broken even by repeated doses of bronchodilator’s.

this patient will be exhausted, severely acidotic, and dehydrated.
TRANSPORT IMMEDIATELY

80
Q

pleuritic

A

sharp or tearing, as a description of pain

81
Q

pneumonia

A

is an infection of the lungs.

82
Q

what happens in pneumonia within the body

A

the infection begins in one part of the lung and often spreads to nearby alveoli. as the diseases progresses fluid and inflammatory cells collect in the alveoli, and alveolar collapse may occur. if the infection gets into the blood stream to more distant sites in the body this may lead to SEPTIC SHOCK

83
Q

assessing a patient with pneumonia

A
  • may have had a recent history of chills and fever
  • complain of deep, productive cough that may expel yellow to brown sputum often streaked with blood
  • many cases involve pleuritic chest pain (may be upper abdominal pain since pneumonia affect lower lobes of the lung)
  • secondary assessment will commonly reveal fever, trachypnea, tachycardia, and a cough. Auscultation of the check demonstrates crackles.
84
Q

managing pneumonia

A

place patient in comfortable position and administer high flow oxygen.
if wheezing is present you can administer a beta-agonist for some symptomatic relief.

85
Q

lung cancer management goals

A

administer oxygen
support ventilation
be aware of any DNR order
provide emotional support

86
Q

toxic inhalation management sequence

A

ensure safety or rescue personnel
remove patient from toxic environment
maintain an open airway
provide humidified, high-concentration oxygen

87
Q

pulmonary embolism

A

a blood clot or some other particle that lodges in a pulmonary artery, effectively blocking blood flow through that vessel.

88
Q

what happens when a pulmonary embolism occurs

A

the blockage of blood flow through the affected artery causes the right heart to pump against increased resistance. this results in an increase in pulmonary capillary pressure. the area of the lung supplied by the occluded pulmonary vessel can no longer effectively function in gas exchange, since it receives no effective blood supply.

89
Q

a patient with acute pulmonary embolism may have a sudden onset of …

A

severe unexplained dyspnea with or without pleuritic chest pain

90
Q

a large pulmonary embolism may lead to …

A

cardiac arrest

91
Q

spontaneous pneumothorax

A

a pneumothorax that occurs spontaneously, in the absence of blunt or penetrating trauma.

92
Q

what is a spontaneous pneumothorax

A

the primary derangement is one of ventilation as the negative pressure that normally exists in the pleural space is lost. this prevents proper expansion of the lung in concert with the chest wall.

93
Q

Assessing a patient with a spontaneous pneumothorax

A

presents with a sudden onset of sharp, pleuritic chest or shoulder pain.

94
Q

management of a spontaneous pneumothorax

A

supplemental oxygen

95
Q

what should you be careful of when managing a spontaneous pneumothorax

A

too much pressure may result in a tension pneumothorax

96
Q

what should you consider hyperventilation

A

indicative or a serious medical problem until proven otherwise

97
Q

central nervous system (CNS) dysfunction pathophysiology

A

can be a causative factor in respiratory depression and arrest. causes include head trauma, stroke, brain tumours and various drugs.

98
Q

Managing CNS dysfunction

A

establish and maintain an open airway. if respiratory depression is noted or respiration’s are absent, initiate mechanical ventilation with supplemental oxygen and establish an IV or normal saline at a “to-keep-open” rate

99
Q

extubation

A

removing a tube from a body opening

100
Q

paradoxical breathing

A

assymetrical chest wall movement that lessens respiratory efficiency

101
Q

anoxia

A

the absence or near absence of oxygen

102
Q

pulses paradoxus

A

drop in blood pressure of greater than 10mmHg during inspiration

103
Q

Kussmaul’s respirations

A

deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis

104
Q

cheyne-stokes respiration’s

A

progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indicating brain stem injury

105
Q

Biot’s respiration’s

A

irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure

106
Q

central neurogenic hyperventilation respiration’s

A

deep, rapid respirations, indicating increased intracranial pressure

107
Q

agonal respiration’s

A

shallow, slow, or infrequent breathing, indicating brain anoxia

108
Q

snoring sound’s

A

results from partial obstruction of the upper airway by the tongue (airflow compromise)

109
Q

gurgling sound’s

A

results from the accumulation of blood, vomitus, or other secretions in the upper airway (airflow compromise)

110
Q

stridor sound’s

A

a harsh, high-pitched sound heard on inhalation, associated with laryngeal edema or constriction (airflow compromise)

111
Q

wheezing sound’s

A

a musical, squeaking, or whistling sound heard on inspiration and/or expiration. Associated with bronchiolar constriction (airflow compromise)

112
Q

Quiet sound’s

A

diminished or absent breath sounds are ominous finding and indicate a serious problem with the airway, breathing or both. (airflow compromise)

113
Q

crackle sound’s

A

a fine bubbling sound heard on inspiration associated with fluid in the smaller bronchioles (compromise gas exchange)

114
Q

rhonchi sound’s

A

a coarse, rattling noise heard on inspiration, associated with inflammation, mucus or fluid in the bronchioles (compromise gas exchange)

115
Q

compliance

A

the stiffness or flexibility of the lung tissue

116
Q

tachycardia usually accompanies…

A

hypoxia in an adult

117
Q

bradycardia hints at…

A

anoxia with imminent cardiac arrest

118
Q

tank life in minutes formula is…

A

gauge pressure - safe residual pressure/oxygen delivered in litres per minute x constant

Ontario PCP 2019/2020 (8 decks)

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