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ARDS Pulm, Pneumo Pleur Guillan > Pulmonary Edema, Emboli, > Flashcards

Pulmonary Edema, Emboli, Flashcards

1
Q

Colloid osmotic pressure is also called

A

colloid oncotic pressure

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2
Q

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

A

increases

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3
Q

In pulmonary edema, increased hydrostatic pressure can be caused by

A

excessive sodium consumption

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4
Q

The normal colloid osmotic pressure in the pulmonary capillaries is

A

25-30 mmHG

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5
Q

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

A

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

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6
Q

What is the normal hydrostatic pressure in the pulmonary capillaries?

A

10-15 mmHg

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7
Q

Causes of cardiogenic pulmonary edema

A 
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
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8
Q

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

A
  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
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9
Q

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

A

pulmonary shunting increases, venus admixture increases, hypoxemia results

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10
Q

Acute pulmonary edema is treated with

A

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

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11
Q

.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.

A

10 to 15 mmHg

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12
Q

.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.

A

out

into

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13
Q

.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.

A

10-15 mmHg

25-30 mmHg

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14
Q

What is the normal oncotic pressure of the blood?

A

25-30 mmHg

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15
Q

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
A

1, 3, and 4 only

LEFT ventricular failure causes cardiogenic pulmonary edema

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16
Q

What abnormal ventilatory pattern is associated with pulmonary edema?

A

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

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17
Q

What are some common CXR findings with pulmonary edema?

A 
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)
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18
Q

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

A

give digitalis

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19
Q 
Which are considered noncardiogenic causes of increased capillary permeability?
1. Head injury
2. Pneumonia
3  Sulfur Dioxide
4  Alveolar hypoxia
A

answer is all 1, 2, 3 & 4

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20
Q

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

A

greater than 25 to 30 mmHg

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21
Q

The MOST common cause of pulmonary edema is

A

left sided heart failure

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22
Q

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

A

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.

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23
Q 
Decreased oncotic pressure can be caused by all of the following EXCEPT:
A. dehydration
B. severe malnutrition
C. excessive intravenous fluids
D. uremia
A

A. dehydration

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

24
Q

Compare and contrast oncotic and hydrostatic pressures

A

a. Oncotic - colloid osmotic pressure

b. Hydrostatic - pressure of nonmoving fluid

25
Q

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

A

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

26
Q

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 ____.

A

a thrombus

an embolus

27
Q

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

A

increased heart rate and increased ventilatory (respiratory) rate

28
Q 
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
A

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

29
Q

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

A

only 2 and 4

30
Q 
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
31
Q

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

A

bronchial constriction

32
Q

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

A

decreased

decreased V/Q ratio

33
Q

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

A

low molecular weight heparin

34
Q

THe ABG level of the pulmonary embolism patient will be:

A

decreased from normal

35
Q

Pulmnary embolism initially results in

A

increased dead space ventilation

36
Q

Name 2 anticoagulant agents

A

warfarin, heprin

37
Q

Name 2 thrombolytic agents

A

urokinase, streptokinase

38
Q

Chest xray findings with PEembolism

A
  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
39
Q

Chest assessment findings with PEmolism can include

A
  1. right ventricular heave or lift

2. crackles, wheezes, pleural friction rub

40
Q

Is chest expansion with PE increased, decreased or normal?

41
Q

Are abnormal heart sounds associated with PE?

A

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

42
Q

Oxygenation indices associated with PE are:

Qs/Qt? Do2? Vo2? C(a-v)? O2ER? SvO2?

A 
Qs/Qt--  increased
Do2 - decreased
Vo2 - normal
 C(a-v) - normal
O2ER -  increased
SvO2 - decreased
43
Q

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

A
  • Interstitial edema
  • alveolar flooding
  • increased surface tension of alveolar fluids
  • alveolar shrinkage and atelectasis
  • frothy white or pink secretions throughout the tracheobronchial tree
44
Q

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.

A

10 - 15 mmHg

45
Q

the other name for colloid osmotic pressure is?

A

oncotic pressure

46
Q

causes of pulmonary edema

A

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

47
Q

abnormal ventilatory patterns and findings associated with cardiogenic pulmonary edema

A
  • cheyne-stokes respiration
  • paroxysmal nocturnal dyspnea
  • orthopnea
48
Q

PFT findings for pulmonary edema

A

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

49
Q

ABG for mild to moderate pulmonary edema

A

acute alveolar hyperventilation w/ hypoxemia

pH - increase, paCO2 - decrease, HCO3 - slightly decrease, PaO2 - decrease

50
Q

ABG for severe pulmonary edema

A

acute ventilatory failure w/ hypoxemia

pH - decrease, PaCO2 - increase, HCO3 - slightly increase, PaO2 - decrease

51
Q

Oxygenation indices for pulmonary edema

A

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

52
Q

hemodynamic indices for pulmonary edema

A

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

53
Q

normal range for PCWP

A

2 - 15 mmHG

54
Q

Patients with cardiogenic pulmonary edema typically present with _______ sputum

A

pink frothy sputum

55
Q

X-Ray findings for pulmonary edema

A
  • bilateral fluffy opacities
  • dilated pulmonary arteries
  • left ventricular hypertrophy
  • kerley A & B lines
  • bat’s wings or butterfly pattern
  • pleural effusion
56
Q

medications for pulmonary edema

A

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

57
Q

effect of CPAP on pulmonary edema

A

offset fluid accumulation and alveolar shrinkage associated with pulmonary edema

ARDS Pulm, Pneumo Pleur Guillan (4 decks)

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