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Cardiopulmonary I > Pulmonary MedSurg Management > Flashcards

Pulmonary MedSurg Management Flashcards

1
Q

what are 4 medical management options for pulmonary dysfunction

A

medications
supplemental O2
monitoring vitals and diagnostics
adjustments to physical activity

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2
Q

true or false. any device can be used in any setting

A

false
certain devices can only be used in a medical setting

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3
Q

what is the typical upper limit of flow rate of a portable O2 tanks? where do we see these?

A

< 12/15 L/min
can be found anywhere

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4
Q

what happens if a device needs more than the standard flow rate (> 12-15 L/min) of a portable O2 tank?

A

the device will be seen in a medical setting with centralized O2 only! (not found outside the hospital)

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5
Q

what is non-invasive ventilation (NIV)?

A

method of breathing support that delivers pressure and volume without the use of an advanced airway (ETT or trach)

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6
Q

what 4 conditions is NIV used as the first line of treatment?

A
  1. COPD exacerbation w/ hypercapnia
  2. cardiogenic pulmonary edema
  3. pulmonary infiltrates (PNA) for immunocompromised patients
  4. weaning O2 in extubated COPD patients with hypercapnia
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7
Q

why is NIV used as the first line therapy in the following acute conditions:
– COPD exacerbation with hypercapnia (inc. CO2)
– cardiogenic pulmonary edema
– pulmonary infiltrates (PNA) for immunocompromised patients
– weaning O2 in extubated COPD patients with hypercapnia

A

– helps supplement pts breathing to get rid of CO2
– pressure on inhalation helps “push” excess fluid out of alveoli (used with HF patients)
– risk of infection is higher with mechanical ventilation
– used as a transition from MV to other supplemental O2

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8
Q

NIV:
heated high flow nasal cannula:
– up to _____ and ____% FiO2
– _____ _______ helps protect airways and keep secretions __(thin/thick)__
– provides some _____ on inhalation and exhalation
– most beneficial pressure is on ______

A

– 60L/min and 100%
– heated humidification ; thin
– pressure
– exhalation –> device helps keep alveoli inflated at the end of exhalation

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9
Q

NIV:
continuous positive airway pressure (CPAP):
– gives pressure on ______ only
– used for _____ breathing patterns that cause sleep apnea
– not effective enough to breathe off excess ____, but is able to keep _____ levels from climbing

A

– inhalation
– obstructive
– CO2 ; CO2

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10
Q

NIV:
BiLevel Positive Airway Pressure: (BiPAP)
– gives one pressure on ______ and one pressure on _____
– used to help rid body of _____
– used for protecting ______ in attempt to avoid ______

A

– inhalation ; exhalation (can be different pressures)
– excess CO2 build up
– airway ; mechanical ventilation

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11
Q

indications for lung surgery

A

slide 13 (9 things)

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12
Q

what is a thoracotomy?

A

incision cut along the borders of ribs or muscles to access thoracic cavity or lungs

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13
Q

which thoracotomy approach is most common and exposes the most amount of space?

A

posterolateral

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14
Q

when would a thoracotomy anterolateral approach be used?

A

if anterior structures involved
need accesss to heart or esophagus

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15
Q

a clamshell thoracotomy approach is used exclusively for?

A

lung transplant
bilateral incisions

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16
Q

what is video assisted thoracic surgery? (VATS)

A

minimally-invasive approach that doesn’t require separating ribs - may have mini-thoracotomy

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17
Q

what are the benefits of performing VATS vs open thoracotomy?

A

more delicate handling and precision of instruments
decreased blood loss
less incisional pain
less negatively-affected pulmonary functions
decreased inflammatory cytokine reaction to surgery
decreased inflammatory cytokine reaction to surgery
earlier post op mobility
reduced hospital LOS

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18
Q

what are thoracotomy precautions?

A

no lifting > 5 pounds
no twisting or rotational activities
no strenuous activity with surgical side
ROM encouraged as tolerated below 90-90
splinted coughing

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19
Q

how long are precautions in place after thoracotomy?

A

6-8 weeks

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20
Q

what is decortication?

A

removing fibrous visceral pleura from the lung to allow the underlying lung tissue expand

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21
Q

when are decortications commonly performed?

A

lung cancer
empyema
radiation induced pleural fibrosis

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22
Q

how are decortications performed?

A

via VATs or thoracotomy

23
Q

what is pleurodesis?

A

adheres the pleura together to eliminate the pleural space to prevent air/fluid buildup and entrapment

24
Q

what are the two options for a pleurodesis to be adhered?

A

surgically or chemically

25
Q

when are pleurodesis commonly performed?

A

to treat recurrent or malignant pleural effusion
recurrent pneumothorax

26
Q

how do we keep the pleural space drained post op?

A

post op drain or chest tube

27
Q

what is a wedge resection?

A

removal of a wedge-shaped portion of the lung

28
Q

when are wedge resections commonly used?

A

removal of lung tumors that are close to the periphery
remove granulomas or isolated areas of lung damage from various diseases

29
Q

how are wedge resections performed?

A

VATS

30
Q

lobectomy =
pneumonectomy =

A

removal of entire lobe of the lung
removal of entire lung

31
Q

when are lobectomy/pneumonectomy performed?

A

advanced lung cancer if other surgical removal is not possible

32
Q

lobectomy/pneumonectomy:
– the larger the tissue removed, the _____

A

higher the likelihood a full thoracotomy will be used

33
Q

what is lung reduction?

A

procedure to reduce lung volume due to hyperinflation from COPD/emphysema

34
Q

_________ has an increased risk of worsening and creating a tension PNX

A

subpleural emphysema

35
Q

what surgical management technique is used as a last resort and after less-invasive measures have failed?

A

lung reduction

36
Q

avg time on lung transplant list for:
– single lung transplant:
– double lung transplant:

A

– 2 years
– 3 years

37
Q

when was the first human lung transplant in US?

A

1963

38
Q

first successful long term lung transplant?

A

1980s

39
Q

use of ECMO in adults help patients survive to transplant:

A

1990s

40
Q

what are medical management protocols for patients who are candidates for a lung transplant?

A

severe functional deficits
limited life expectancy
some must remain hospitalized until transplant becomes available

41
Q

indications of lung transplants:
** put in order of # of transplants performed

A

IPF
CF
sarcoidosis/amyloidosis
COPD

42
Q

contraindications for lung transplant:

A

age > 72
severe mental/psychological instability
drug, tobacco, ETOH use within 6mo
BMI > 35
malnourishment
uncontrolled DM
PVD
hepatitis B/C
renal failure
autoimmune disease with multisystem involvement
AIDS
current/recent malignant cancer
other systemic illness with shortened life expectancy

43
Q

a lung transplant evaluation includes:

A

CVP imaging
PFTs
VQ scan
exercise testing

44
Q

what is the process of getting a lung transplant?

A

evaluation
put on wait list after being deemed candidate
when organ becomes available, it is matched to the patient
preserved and transported to recipient

45
Q

what do the following medications that are used for lung transplants do?
– immunosuppressants
– corticosteroids
– antibiotics/antivirals
– anti-hypertensives
– insulin
– bronchodilators
– mucolytics

A

– prevents organ rejection
– reduces inflammation, reduces risk of rejection
– prevention of bacterial or viral illnesses in the setting of immunosuppression
– counteracts side effects of SLT/DLT meds that cause HTN ; prevents pulmonary hypertension
– counteracts side effects of SLT/DLT medications that cause hyperglycemia
– prevents bronchoconstriction/bronchospasm in donor lung airways
– ensures secretion clearance

46
Q

what are two common complications of a SLT/DLT?

A
  1. infection –> highest risk 12 months post op
  2. rejection –> 20-50% in first 12 months
47
Q

what are symptoms of organ rejection?

A

fever
fatigue
N/V
myalgias

48
Q

when are chest tubes often placed?
where?

A

during thoracic surgical procedures
inserted at optimal intercostal space to target the accumulated fluid/air and then advanced several inches into the pleural space

49
Q

what does a chest tube do?

A

evacuate fluid or air that can impede breathing and cause the lung collapse

50
Q

chest tubes are usually connected to:
– what does this help tell us?

A

three-chamber water seal drainage devices
– provides a mean to verify presence of an air leak and monitor amount of drainage and intrathoracic blood loss

51
Q

post-surgery, where is the chest tube attached?

A

to wall suction initially
progressed to gravity only as the air leak reduces in size or the drainage amount subsides

52
Q

what is a PleurX Drain?

A

indwelling drain that continously drains pleural space

53
Q

when are PleurX drain’s indicated?

A

recurrent pleural effusions, done in place of repeated thoracentesis procedures

54
Q

where are PleurX drains’ commonly seen?

A

palliative or hospice situations – can be manageed at home

Cardiopulmonary I (25 decks)

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