Pulmonary Assessment Flashcards
What type of breathing?
shallow and rapid breathing
restrictive
What type of breathing?
slow and deep, pursed lip breathing
(decreased work of breathing)
obstructive
Febrile, ABX, cough – productive?
These can indicate presence of ______ ______ ________
Upper Respiratory Infection (URI)
Dyspnea at rest or with exertion ties directly to the pt.’s ________ __________
functional capacity
General pre-surgery interview questions? (3-4 questions)
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?
Evaluate functional capacity/status questions (2-3 questions)
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?
produces a bluish discoloration, specially noticed on the mucous membranes of the lips, tongue, head and torso.
Central Cyanosis
cyanosis that affects the fingers, toes and skin surrounding the lips, is not noticed around mucous membranes.
Peripheral Cyanosis
___________ 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.
Acrocyanosis
vasospasm of the small vessels of the skin in response to cold
Acrocyanosis
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)
Clubbing of the fingers
Heard in the chest wall where bronchi occur, not over alveoli
Usually clear after coughing.
Rhonchi
Heard in both phases of respiration
Hallmark of chronic bronchitis
Late inspiratory crackles indicative of pneumonia, CHF, or atelectasis.
Crackles (Rales)
Caused by narrowing of the airways: smooth muscle contraction, mucosal edema
Wheezes
Used to assess the presence of symptoms of Obstructive Sleep Apnea (OSA)
STOP-BANG assessment
STOP-BANG assessment high risk if yes to > or = _____ items
If so, refer to sleep testing
> or = 3 items
Recurrent productive cough > 3 months of the year for 2 consecutive years
Chronic Bronchitis
________ is the most common symptom in patients with cardiopulmonary disease
Dyspnea
______ _________ 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.
Pulsus paradoxus
These disorders are associated with what type of dyspnea?
COPD and Asthma
Aspiration syndromes
Vocal cord dysfunction
Intermittent
These disorders are associated with what type of dyspnea?
Endobronchial tumor
Tracheal stenosis
Asthma
Persistent
These disorders are associated with what type of dyspnea?
COPD
Pulmonary tumors and infiltrates
Progressive
Serum albumin <3.5 mg/dL is indicative of ______ disease
Liver disease
Serum albumin <____ mg/dL is indicative of liver disease
<3.5 mg/dL
_______ and ______ _________ surgeries have the highest risk of Postoperative Pulmonary Complications (PPCs)
Thoracic
Upper abdominal
________ and _______ analgesia is protective against post op pulmonary complicationsPPCs
Multimodal
epidural
_________ is the leading cause of preventable morbidity and mortality
Smoking
Avoid ________ anesthesia when safe and appropriate
general anesthesia
If your pt is a smoker, it is important to talk about smoking ________ before surgery
smoking cessation
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
3-4 weeks
4 weeks
(T/F) Quitting smoking 2 weeks before surgery leads to worse outcomes.
False
Quit anytime
Progressive disorder characterized by persistent airflow limitation that is Not fully reversible
COPD
By far the most important risk factor associated with COPD is the amount and duration of _______ _________
cigarette smoking
genetic cause for COPD
α-1 antitrypsin deficiency
chronic productive cough for 3 months in each of 2 successive years and not attributed to other causes (Poor prognosis)
Chronic Bronchitis
pathologic pulmonary structural changes associated with COPD
Emphysema
Main difference btw COPD and Asthma?
COPD is not fully reversible
characterized by nonuniform parenchymal destruction, loss of alveolar attachments and reduced elastic recoil.
Emphysema
“Blue Bloaters”
Chronic Bronchitis
“Pink Puffers”
Emphysema
Dyspneic, pink, thin, noted pursed lip breathing
Normal ABGs (typically)
Increased minute ventilation to maintain PaCO2
Increased work of breathing
Emphysema
Cyanotic, hypercarbic, hypoxemic, usually overweight
Chronic respiratory failure with decreased response to CO2
May have a cough, copious sputum
Cor pulmonale
Chronic Bronchitis
Spirometry (postbronchodilator) FEV1/FVC ratio of < ____
confirms airflow limitation that is Not fully reversible (aka COPD dx)
< 0.7
What ratio defines COPD?
FEV1/FVC ratio of < 0.7
FEV1 >/= 80% predicted
Mild COPD
50% = FEV1 = 80% predicted
Moderate COPD
30% = FEV1 = 50% predicted
Severe COPD
FEV1 < 30% predicted
or
FEV1 < 50% predicted w/ chronic respiratory failure
Very sever COPD
Pharmacotherapy for stable COPD (4 classes)
short- and long-acting inhaled bronchodilators (anticholinergics andβ2agonists),
oral bronchodilators (theophylline),
inhaled glucocorticoids
oral phosphodiesterase-4 inhibitors (e.g., roflumilast).
Healthy pt needs chest X-ray pre op?
NO
Delay elective surgery for __ weeks with Hx recent URI
6 weeks
Recent pulmonary function testing is warranted with changes in baseline and undergoing _________ surgery
intrathoracic
Preoperative ______ may be useful with known/suspected hypoxemia or hypercapnia
ABG
______ is a chronic inflammatory disease affecting the airways characterized by bronchial hyperresponsiveness and airflow obstruction.
Asthma
4 symptoms of Asthma related bronchoconstriction
intermittent cough
wheezing
chest tightness
SOB
Meds that can trigger asthma symptoms
ASA
NSAIDS
B-blockers
With asthma, post-bronchodilator spirometry should show significant improvement (>___% and _____ mL increase) in FEV1.
> 12%
200 mL
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
methacholine
Study PP slide 38
Study it bro
For pharmacologic asthma tx., use ______ therapy (i.e., __________) for patients with allergic sensitivity
anti-IgE
omalizumab
For pharmacologic asthma tx., use ________ antibodies for patients with eosinophilic asthma
anti–IL-5
You suspect a pt may have poorly controlled asthma. What should you do?
Refer to pulmonologist/consult surgical team
List 3 pt. presentations that are evidence to poor asthma control
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
(T/F) Ketamine is a bronchodilator
true
With asthma, the Risk of ____________ is Low, but Potentially Life Threatening!!!
Bronchospasm
What should you resort to when asthma pt is bronchospasming and you can’t ventilate and all other tx. methods are exhausted?
Extubate and mask ventilate with sevo and consider higher dose epi
Avoid _______ meds w/ asthma pts
NSAID
W/ asthma pts, avoid medications releasing ________ (MSO4)!!!
histamine
Induction technique for asthma pts
RSI (rapid sequence induction)
Increased Peak Inspiratory Pressures (PIP)
Wheezing, decreased or absent breath sounds
Bronchospasm
List the 8 sequence of tx for bronchospasm (know this well and be able to answer <20 seconds!!!)
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
Restrictive or obstructive?
Decreased Total Lung Capacity (TLC)
FEV1 and FVC reduced proportionally
FEV1 / FVC ratio is normal or increased
Restrictive Lung Disease
PFT stands for _______ _______ __________
Pulmonary Function Testing
Pathophysiologic process causing Reduced Lung Compliance
Restrictive Lung Disease
_______ lung parenchymal diseases are referred to as interstitial lung diseases (ILDs);
Intrinsic
Regarding restrictive lung disease, _________ diseases involve the pleura, pleural cavity, diaphragm, or chest wall (e.g., pleural effusions, ankylosing spondylitis, kyphoscoliosis, obesity);
extrinsic
List 3 neuromuscular disorders causing respiratory muscle weakness
myasthenia gravis
Guillain–Barré syndrome
muscular dystrophies
Spinal cord injury (Quadriplegia)
Phrenic nerve neuropathy (diaphragm)
Compared to extrapulmonary restrictive lung diseases, interstitial lung diseases (ILDs) are usually associated with impaired ______ ______ ______ _______ ________ (DLCO) on pulmonary function test (PFTs).
diffusing capacity for carbon monoxide
Patients with interstitial lung disease (ILDs) typically present with progressive ________ _____ __________ or __________ __________
dyspnea on exertion
nonproductive cough
There is no strong evidence for any preoperative interventions to improve perioperative outcomes in patients with ______ specifically.
ILDs (interstitial lung diseases)
Autosomal recessive disorder caused by mutation of CFTR protein on chromosome 7
Cystic Fibrosis (CF)
CFTR functions as a _______ channel of epithelial cells lining most exocrine glands
chloride
Dx for cystic fibrosis - elevated sweat chloride > ___ mmol/L
60 mmol/L
Changes in cellular electrolytes and water transport resulting in thickened secretions multiple organ systems
Cystic Fibrosis (CF)
Repetitive upper airway collapses leading to cessation of breathing during sleep lasting 10 seconds or more
Obstructive Sleep Apnea (OSA)
Most prevalent sleep-breathing disorder
Obstructive Sleep Apnea (OSA)
Dx test for OSA is __________ __________ (PSG). This
determines the _____-_______ ______ (AHI)
Overnight polysomnography (PSG)
apnea-hypopnea index (AHI)
Know the STOP-BANG questionairre
Know it
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
Positive airway pressure (PAP)
Try to limit _______ meds with OSA pts
opioid
