Pulmonary Edema, Emboli,

Question 1

Colloid osmotic pressure is also called

Answer 1

colloid oncotic pressure

Question 2

During acute pulmonary edema, alveolar surface tension (increases/decreases)

Answer 2

increases

Question 3

In pulmonary edema, increased hydrostatic pressure can be caused by

Answer 3

excessive sodium consumption

Question 4

The normal colloid osmotic pressure in the pulmonary capillaries is

Answer 4

25-30 mmHG

Question 5

Which of the following are considered noncardiogenic causes of increased capillary permeability?

Answer 5

head injury, pneumonia, noxious fumes like sulfur dioxide, alveolar hypoxia

Question 6

What is the normal hydrostatic pressure in the pulmonary capillaries?

Answer 6

10-15 mmHg

Question 7

Causes of cardiogenic pulmonary edema

Answer 7

excessive fluid administration
CHF (left sided heart failure)
arrhythmias
systemic hypertension
congenital heart defects
mitral or aortic valve disease
renal failure
pulmonary embolus
myocardial infarction/cardiac tamponade
myocarditis (rheumatic heart disease)
viral cardiomyopathies

Question 8

The major pathologic/structural changes of the lungs associated with pulmonary edema:

Answer 8

1. interstitial edema including engorgement of the perivascular and peribronchial spaces and alveolar wall interstitium
   2 alveolar flooding
   3 increased surface tension of alveolar fluids
   4 alveolar shrinkage and atelectasis
   5 frothy pink secretions

Question 9

What happens when pulmonary hydrostatic pressure rises? (as when a patient with pul edema lies down)

Answer 9

pulmonary shunting increases, venus admixture increases, hypoxemia results

Question 10

Acute pulmonary edema is treated with

Answer 10

O2, diurectics such as lasix, inotrophic drugs such as digoxin

Question 11

.Pulmonary edema hydrostatic pressure -
ordinarily, hydrostatic pressure is about ____ and tends to move fluid out of the pulmonary capillaries into the interstitial space. This force is normally offset by colloid osmotic forces of about 25-30 mmHg.

Answer 11

10 to 15 mmHg

Question 12

.Pulmonary edema hydrostatic pressure -
ordinarily, hydrostatic pressure is about 10-15 mmHg and tends to move fluid ____ of the pulmonary capillaries and ____the interstitial space. This force is normally offset by colloid osmotic forces of about 25-30 mmHg.

Answer 12

out

into

Question 13

.Pulmonary edema hydrostatic pressure -
ordinarily, hydrostatic pressure is about ____ and tends to move fluid out of the pulmonary capillaries into the interstitial space. This force is normally offset by colloid osmotic forces of about _____ mmHg.

Answer 13

10-15 mmHg

25-30 mmHg

Question 14

What is the normal oncotic pressure of the blood?

Answer 14

25-30 mmHg

Question 15

Which of the following are causes of cardiogenic pulmonary edema?

1. Excessive fluid administration
2. Right ventricular failure
3. Mitral valve disease
4. Pulmonary embolus

Answer 15

1, 3, and 4 only

LEFT ventricular failure causes cardiogenic pulmonary edema

Question 16

What abnormal ventilatory pattern is associated with pulmonary edema?

Answer 16

cheyne-stokes (progressively deeper, faster then decreasing to apnea)

Question 17

What are some common CXR findings with pulmonary edema?

Answer 17

cardiomegaly, hilar prominence, Bat wing or butterfly pattern
Kerley lines (A lines do not reach the pleura and are prevalent in the middle and upper lung- B lines are short, thin, horizontal extending inward from the pleural surface commonly seen in the bases)

Question 18

When a patient has left sided heart failure, what is usually done to increase cardiac output?

Answer 18

give digitalis

Question 19

Which are considered noncardiogenic causes of increased capillary permeability?
1. Head injury
2. Pneumonia
3  Sulfur Dioxide
4  Alveolar hypoxia

Answer 19

answer is all 1, 2, 3 & 4

Question 20

Pulmonary edema can occur when the hydrostatic pressure within the pulmonary vascular system (also called wedge pressure) is

Answer 20

greater than 25 to 30 mmHg

Question 21

The MOST common cause of pulmonary edema is

Answer 21

left sided heart failure

Question 22

Pulmonary edema involves:
A. fluid moving from the pulmonary vascular system to the air spaces
B. fluid moving from the air spaces to the pulmonary vascular system
C. fluid moving from the pulmonary vascular system to the pleural spaces
D. fluid moving from the systemic vascular system to the air spaces

Answer 22

A. fluid moving from the pulmonary vascular system to the air spaces

Pulmonary edema involves fluid moving from the pulmonary vascular system to the air spaces of the lungs. With drowning, fluid can move from the air spaces to the pulmonary vascular system. A pleural effusion involves fluid moving from the pulmonary vascular system to the pleural spaces.

Question 23

Decreased oncotic pressure can be caused by all of the following EXCEPT:
A. dehydration
B. severe malnutrition
C. excessive intravenous fluids
D. uremia

Answer 23

A. dehydration

Dehydration would increase the oncotic pressure. All of the other listed options, and others, can result in decreased oncotic pressure.

Question 24

Compare and contrast oncotic and hydrostatic pressures

Answer 24

a. Oncotic - colloid osmotic pressure

b. Hydrostatic - pressure of nonmoving fluid

Question 25

What happens in the Oxygenation Indices of a patient with pulmonary edema?

Answer 25

Increased Qs/Qt; Decreased D02; Normal V02; Normal C(a-v) O2, Increased O2 ER, Decreased Sv02

Question 26

A blood clot that forms and remains in a vein is called _____. A blood clot that becomes dislodged and travels to another part of the body is called ____.

Answer 26

a thrombus an embolus

Question 27

The aortic and carotid sinus baroreceptors initiate what in response to a decreased systemic blood pressure?

Answer 27

increased heart rate and increased ventilatory (respiratory) rate

Question 28

``` What is the upper limit of the normal MEAN pulmonary artery pressure? A. 5 mmHg B. 10 mm Hg C. 15 mm Hg D. 20 mm HG ```

Answer 28

15 mmHg is the upper limit of the normal MEAN pulmonary artery pressure

Question 29

Pulmonary hypertension develops in pulmonary embolism because of: 1. Increased cross sectional area of the pulmonary vascular system 2. Vasoconstriction caused by humoral agent release 3. Vasoconstriction induced by decreased arterial oxygen pressure (PaO2) 4. Vasoconstriction induced by decreased alveolar oxygen pressure (PAO2) 1 and 3 only 2 and 4 only 1,2,3 only 2,3,4 only 1234

Answer 29

only 2 and 4

Question 30

``` In severe pulmonary embolism, which of the following hemodynamic indices are commonly seen? 1. Decreased PVR 2. Increased PA 3. Decreased CVP 4. Increased PCWP 2 only 3 only 4 only 1 and 2 only ```

Answer 30

2 only

Question 31

Emboli activate teh release of humoral agents such as seratonin histamine and prostaglandins into pulmonary circulation. These cause which: bronchoconstriction or bronchodilation?

Answer 31

bronchial constriction

Question 32

Bronchial constriction, alveolar atelectasis, and consolidation lead to _____ alveolar ventilation relative to perfusion causing the V/Q ratio to do what?

Answer 32

decreased | decreased V/Q ratio

Question 33

The safest most effective class of fast acting anticoagulant medication to prevent PE is:

Answer 33

low molecular weight heparin

Question 34

THe ABG level of the pulmonary embolism patient will be:

Answer 34

decreased from normal

Question 35

Pulmnary embolism initially results in

Answer 35

increased dead space ventilation

Question 36

Name 2 anticoagulant agents

Answer 36

warfarin, heprin

Question 37

Name 2 thrombolytic agents

Answer 37

urokinase, streptokinase

Question 38

Chest xray findings with PEembolism

Answer 38

1. often there are no CXR signs 2. can see increased areas of density in infarcted areas 3. dilation of the pulmonary arteries 4. right ventricular cardiomegaly (cor pulmonale) 5. small pleural effusion

Question 39

Chest assessment findings with PEmolism can include

Answer 39

1. right ventricular heave or lift | 2. crackles, wheezes, pleural friction rub

Question 40

Is chest expansion with PE increased, decreased or normal?

Answer 40

decreased

Question 41

Are abnormal heart sounds associated with PE?

Answer 41

yes, increased second heart sound, splitting of second heart sound and 3rd heart sound of ventricular gallop

Question 42

Oxygenation indices associated with PE are: | Qs/Qt? Do2? Vo2? C(a-v)? O2ER? SvO2?

Answer 42

``` Qs/Qt-- increased Do2 - decreased Vo2 - normal C(a-v) - normal O2ER - increased SvO2 - decreased ```

Question 43

What are the major pathologic or structural change of the lungs associated with cardiogenic pulmonary edema?

Answer 43

- Interstitial edema - alveolar flooding - increased surface tension of alveolar fluids - alveolar shrinkage and atelectasis - frothy white or pink secretions throughout the tracheobronchial tree

Question 44

pulmonary edema hydrostatic pressure ordinarily, hydrostatic pressure is about _______ and tends to move fluid out of the pulmonary capillaries into the interstitial space. This force is normally offset by colloid osmotic forces.

Answer 44

10 - 15 mmHg

Question 45

the other name for colloid osmotic pressure is?

Answer 45

oncotic pressure

Question 46

causes of pulmonary edema

Answer 46

cardiogenic: arrhythmias, systemic hypertension, congenital heart defects, excessive fluid administration, left ventricular failure, mitral or aortic valve disease, myocardial infarction, cardiac tamponade pulmonary embolus renal failure, rheumatic heart disease, cardiomyopathies non-cardiogenic: allergic reaction to drugs, excessive sodium consumption, drug overdose, metal poisoning, chronic alcoholic ingestion, aspiration, cns stimulation, encephalitis, high altitudes

Question 47

abnormal ventilatory patterns and findings associated with cardiogenic pulmonary edema

Answer 47

- cheyne-stokes respiration - paroxysmal nocturnal dyspnea - orthopnea

Question 48

PFT findings for pulmonary edema

Answer 48

VT - normal or increase, IRV - decrease, ERV - decrease, RV - decrease, VC - decrease, IC - decrease, FRC - decrease, TLC - decrease, RV/TLC ratio - normal

Question 49

ABG for mild to moderate pulmonary edema

Answer 49

acute alveolar hyperventilation w/ hypoxemia | pH - increase, paCO2 - decrease, HCO3 - slightly decrease, PaO2 - decrease

Question 50

ABG for severe pulmonary edema

Answer 50

acute ventilatory failure w/ hypoxemia | pH - decrease, PaCO2 - increase, HCO3 - slightly increase, PaO2 - decrease

Question 51

Oxygenation indices for pulmonary edema

Answer 51

QS/QT - increase, DO2 - decrease, VO2 - normal, C(a-V)O2 - normal, O2ER - increase, SVO2 - decrease

Question 52

hemodynamic indices for pulmonary edema

Answer 52

CVP - increase, RAP - increase, PA - increase, PCWP - increase, CO - decrease, SV - decrease, SVI - decrease, CI -decrease, RVSWI - increase, LVSWI - decrease, PVR - increase , SVR - increase

Question 53

normal range for PCWP

Answer 53

2 - 15 mmHG

Question 54

Patients with cardiogenic pulmonary edema typically present with _______ sputum

Answer 54

pink frothy sputum

Question 55

X-Ray findings for pulmonary edema

Answer 55

- bilateral fluffy opacities - dilated pulmonary arteries - left ventricular hypertrophy - kerley A & B lines - bat's wings or butterfly pattern - pleural effusion

Question 56

medications for pulmonary edema

Answer 56

Antidyshythmic agents - prevent cardiac dysrhythmias positive inotropic agents - improve cardiac output cardiac workload reduction - afterload reduction sodium and fluid retention therapy albumin and mannitol - offset increase hydrostatic pressure

Question 57

effect of CPAP on pulmonary edema

Answer 57

offset fluid accumulation and alveolar shrinkage associated with pulmonary edema