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AFN Health Assessment > Pulmonary Assessment > Flashcards

Pulmonary Assessment Flashcards

1
Q

What type of breathing?

shallow and rapid breathing

A

restrictive

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2
Q

What type of breathing?

slow and deep, pursed lip breathing
(decreased work of breathing)

A

obstructive

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3
Q

Febrile, ABX, cough – productive?

These can indicate presence of ______ ______ ________

A

Upper Respiratory Infection (URI)

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4
Q

Dyspnea at rest or with exertion ties directly to the pt.’s ________ __________

A

functional capacity

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5
Q

General pre-surgery interview questions? (3-4 questions)

A

Do you have any problems with your breathing?

Do you have asthma, COPD (emphysema, chronic bronchitis), or cough?

Do you smoke? If yes, how much per day and how many years?

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6
Q

Evaluate functional capacity/status questions (2-3 questions)

A

Can you walk a city block or a flight of stairs without stopping?

If no, are you limited by your heart and breathing? What makes you stop?

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7
Q

produces a bluish discoloration, specially noticed on the mucous membranes of the lips, tongue, head and torso.

A

Central Cyanosis

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8
Q

cyanosis that affects the fingers, toes and skin surrounding the lips, is not noticed around mucous membranes.

A

Peripheral Cyanosis

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9
Q

___________ is a functional peripheral vascular disorder characterized by cyanosis, of the hands, feet, and sometimes the face caused byvasospasm of the small vessels of the skin in response to cold.Normal in newborns.

A

Acrocyanosis

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10
Q

vasospasm of the small vessels of the skin in response to cold

A

Acrocyanosis

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11
Q

associated with chronically low PaO2, differential should include chronic lung diseases such as COPD, malignancy, and Rt-Lt cardiac shunting (Tetralogy of Fallot or transposition of great vessels)

A

Clubbing of the fingers

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12
Q

Heard in the chest wall where bronchi occur, not over alveoli
Usually clear after coughing.

A

Rhonchi

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13
Q

Heard in both phases of respiration

Hallmark of chronic bronchitis

Late inspiratory crackles indicative of pneumonia, CHF, or atelectasis.

A

Crackles (Rales)

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14
Q

Caused by narrowing of the airways: smooth muscle contraction, mucosal edema

A

Wheezes

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15
Q

Used to assess the presence of symptoms of Obstructive Sleep Apnea (OSA)

A

STOP-BANG assessment

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16
Q

STOP-BANG assessment high risk if yes to > or = _____ items

If so, refer to sleep testing

A

> or = 3 items

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17
Q

Recurrent productive cough > 3 months of the year for 2 consecutive years

A

Chronic Bronchitis

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18
Q

________ is the most common symptom in patients with cardiopulmonary disease

A

Dyspnea

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19
Q

______ _________ isan exaggerated drop in blood pressure when you take a deep breath. Seen in conditions such as severe acute asthma or exacerbations of chronic obstructive pulmonary disease (COPD) and cardiac tamponade.

A

Pulsus paradoxus

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20
Q

These disorders are associated with what type of dyspnea?

COPD and Asthma
Aspiration syndromes
Vocal cord dysfunction

A

Intermittent

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21
Q

These disorders are associated with what type of dyspnea?

Endobronchial tumor
Tracheal stenosis
Asthma

A

Persistent

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22
Q

These disorders are associated with what type of dyspnea?

COPD
Pulmonary tumors and infiltrates

A

Progressive

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23
Q

Serum albumin <3.5 mg/dL is indicative of ______ disease

A

Liver disease

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24
Q

Serum albumin <____ mg/dL is indicative of liver disease

A

<3.5 mg/dL

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25
Q

_______ and ______ _________ surgeries have the highest risk of Postoperative Pulmonary Complications (PPCs)

A

Thoracic

Upper abdominal

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26
Q

________ and _______ analgesia is protective against post op pulmonary complicationsPPCs

A

Multimodal

epidural

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27
Q

_________ is the leading cause of preventable morbidity and mortality

A

Smoking

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28
Q

Avoid ________ anesthesia when safe and appropriate

A

general anesthesia

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29
Q

If your pt is a smoker, it is important to talk about smoking ________ before surgery

A

smoking cessation

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30
Q

systematic reviews of previous studies concluded that at least __ to __ weeks of preoperative abstinence reduced surgical site infections, and abstinence of at least __ weeks decreased respiratory complication

A

3-4 weeks

4 weeks

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31
Q

(T/F) Quitting smoking 2 weeks before surgery leads to worse outcomes.

A

False

Quit anytime

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32
Q

Progressive disorder characterized by persistent airflow limitation that is Not fully reversible

A

COPD

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33
Q

By far the most important risk factor associated with COPD is the amount and duration of _______ _________

A

cigarette smoking

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34
Q

genetic cause for COPD

A

α-1 antitrypsin deficiency

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35
Q

chronic productive cough for 3 months in each of 2 successive years and not attributed to other causes (Poor prognosis)

A

Chronic Bronchitis

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36
Q

pathologic pulmonary structural changes associated with COPD

A

Emphysema

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37
Q

Main difference btw COPD and Asthma?

A

COPD is not fully reversible

38
Q

characterized by nonuniform parenchymal destruction, loss of alveolar attachments and reduced elastic recoil.

A

Emphysema

39
Q

“Blue Bloaters”

A

Chronic Bronchitis

40
Q

“Pink Puffers”

A

Emphysema

41
Q

Dyspneic, pink, thin, noted pursed lip breathing
Normal ABGs (typically)
Increased minute ventilation to maintain PaCO2
Increased work of breathing

A

Emphysema

42
Q

Cyanotic, hypercarbic, hypoxemic, usually overweight
Chronic respiratory failure with decreased response to CO2
May have a cough, copious sputum
Cor pulmonale

A

Chronic Bronchitis

43
Q

Spirometry (postbronchodilator) FEV1/FVC ratio of < ____
confirms airflow limitation that is Not fully reversible (aka COPD dx)

A

< 0.7

44
Q

What ratio defines COPD?

A

FEV1/FVC ratio of < 0.7

45
Q

FEV1 >/= 80% predicted

A

Mild COPD

46
Q

50% = FEV1 = 80% predicted

A

Moderate COPD

47
Q

30% = FEV1 = 50% predicted

A

Severe COPD

48
Q

FEV1 < 30% predicted

or

FEV1 < 50% predicted w/ chronic respiratory failure

A

Very sever COPD

49
Q

Pharmacotherapy for stable COPD (4 classes)

A

short- and long-acting inhaled bronchodilators (anticholinergics andβ2agonists),

oral bronchodilators (theophylline),

inhaled glucocorticoids

oral phosphodiesterase-4 inhibitors (e.g., roflumilast).

50
Q

Healthy pt needs chest X-ray pre op?

A

NO

51
Q

Delay elective surgery for __ weeks with Hx recent URI

A

6 weeks

52
Q

Recent pulmonary function testing is warranted with changes in baseline and undergoing _________ surgery

A

intrathoracic

53
Q

Preoperative ______ may be useful with known/suspected hypoxemia or hypercapnia

A

ABG

54
Q

______ is a chronic inflammatory disease affecting the airways characterized by bronchial hyperresponsiveness and airflow obstruction.

A

Asthma

55
Q

4 symptoms of Asthma related bronchoconstriction

A

intermittent cough
wheezing
chest tightness
SOB

56
Q

Meds that can trigger asthma symptoms

A

ASA
NSAIDS
B-blockers

57
Q

With asthma, post-bronchodilator spirometry should show significant improvement (>___% and _____ mL increase) in FEV1.

A

> 12%
200 mL

58
Q

normal spirometry does not exclude the diagnosis of asthma and bronchoprovocation testing. The __________ challenge may be needed for confirmation, particularly in patients with atypical presentation

A

methacholine

59
Q

Study PP slide 38

A

Study it bro

60
Q

For pharmacologic asthma tx., use ______ therapy (i.e., __________) for patients with allergic sensitivity

A

anti-IgE
omalizumab

61
Q

For pharmacologic asthma tx., use ________ antibodies for patients with eosinophilic asthma

A

anti–IL-5

62
Q

You suspect a pt may have poorly controlled asthma. What should you do?

A

Refer to pulmonologist/consult surgical team

63
Q

List 3 pt. presentations that are evidence to poor asthma control

A

Symptoms >2 days/wk (Mild persistent or more severe)

Weekly nighttime awakening

Limitation in normal daily activity

Use of short-acting bronchodilators for symptom control >2 days/wk (Acute exacerbation)

FEV1or peak expiratory flow rate <80% of predicted or personal best

≥ 2 exacerbations requiring systemic glucocorticoids in the last year

64
Q

(T/F) Ketamine is a bronchodilator

A

true

65
Q

With asthma, the Risk of ____________ is Low, but Potentially Life Threatening!!!

A

Bronchospasm

66
Q

What should you resort to when asthma pt is bronchospasming and you can’t ventilate and all other tx. methods are exhausted?

A

Extubate and mask ventilate with sevo and consider higher dose epi

67
Q

Avoid _______ meds w/ asthma pts

A

NSAID

68
Q

W/ asthma pts, avoid medications releasing ________ (MSO4)!!!

A

histamine

69
Q

Induction technique for asthma pts

A

RSI (rapid sequence induction)

70
Q

Increased Peak Inspiratory Pressures (PIP)
Wheezing, decreased or absent breath sounds

A

Bronchospasm

71
Q

List the 8 sequence of tx for bronchospasm (know this well and be able to answer <20 seconds!!!)

A

Remove from ventilator, hand ventilate with FiO2 1.0

Remove/correct trigger

Deepen anesthetic (Increase [ ] volatile inhalation agent)

B2 agonist Metered Dose Inhaler

Corticosteroid IV

Epinephrine 10mcg IV, repeat as necessary

Magnesium or Heliox

ABG monitoring

72
Q

Restrictive or obstructive?

Decreased Total Lung Capacity (TLC)
FEV1 and FVC reduced proportionally
FEV1 / FVC ratio is normal or increased

A

Restrictive Lung Disease

73
Q

PFT stands for _______ _______ __________

A

Pulmonary Function Testing

74
Q

Pathophysiologic process causing Reduced Lung Compliance

A

Restrictive Lung Disease

75
Q

_______ lung parenchymal diseases are referred to as interstitial lung diseases (ILDs);

A

Intrinsic

76
Q

Regarding restrictive lung disease, _________ diseases involve the pleura, pleural cavity, diaphragm, or chest wall (e.g., pleural effusions, ankylosing spondylitis, kyphoscoliosis, obesity);

A

extrinsic

77
Q

List 3 neuromuscular disorders causing respiratory muscle weakness

A

myasthenia gravis

Guillain–Barré syndrome

muscular dystrophies

Spinal cord injury (Quadriplegia)

Phrenic nerve neuropathy (diaphragm)

78
Q

Compared to extrapulmonary restrictive lung diseases, interstitial lung diseases (ILDs) are usually associated with impaired ______ ______ ______ _______ ________ (DLCO) on pulmonary function test (PFTs).

A

diffusing capacity for carbon monoxide

79
Q

Patients with interstitial lung disease (ILDs) typically present with progressive ________ _____ __________ or __________ __________

A

dyspnea on exertion
nonproductive cough

80
Q

There is no strong evidence for any preoperative interventions to improve perioperative outcomes in patients with ______ specifically.

A

ILDs (interstitial lung diseases)

81
Q

Autosomal recessive disorder caused by mutation of CFTR protein on chromosome 7

A

Cystic Fibrosis (CF)

82
Q

CFTR functions as a _______ channel of epithelial cells lining most exocrine glands

A

chloride

83
Q

Dx for cystic fibrosis - elevated sweat chloride > ___ mmol/L

A

60 mmol/L

84
Q

Changes in cellular electrolytes and water transport resulting in thickened secretions multiple organ systems

A

Cystic Fibrosis (CF)

85
Q

Repetitive upper airway collapses leading to cessation of breathing during sleep lasting 10 seconds or more

A

Obstructive Sleep Apnea (OSA)

86
Q

Most prevalent sleep-breathing disorder

A

Obstructive Sleep Apnea (OSA)

87
Q

Dx test for OSA is __________ __________ (PSG). This
determines the _____-_______ ______ (AHI)

A

Overnight polysomnography (PSG)

apnea-hypopnea index (AHI)

88
Q

Know the STOP-BANG questionairre

A

Know it

89
Q

This tx for OSA can:

Significantly reduces apnea hypopnea index (AHI), providing better quality of sleep

Attenuates symptoms of OSA: daytime sleepiness, fatigue, memory loss

Long-term associated with decrease in CV morbidity and mortality

A

Positive airway pressure (PAP)

90
Q

Try to limit _______ meds with OSA pts

A

opioid

AFN Health Assessment (12 decks)

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