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
when are pleurodesis commonly performed?
to treat recurrent or malignant pleural effusion recurrent pneumothorax
26
how do we keep the pleural space drained post op?
post op drain or chest tube
27
what is a wedge resection?
removal of a wedge-shaped portion of the lung
28
when are wedge resections commonly used?
removal of lung tumors that are close to the periphery remove granulomas or isolated areas of lung damage from various diseases
29
how are wedge resections performed?
VATS
30
lobectomy = pneumonectomy =
removal of entire lobe of the lung removal of entire lung
31
when are lobectomy/pneumonectomy performed?
advanced lung cancer if other surgical removal is not possible
32
lobectomy/pneumonectomy: -- the larger the tissue removed, the _____
higher the likelihood a full thoracotomy will be used
33
what is lung reduction?
procedure to reduce lung volume due to hyperinflation from COPD/emphysema
34
_________ has an increased risk of worsening and creating a tension PNX
subpleural emphysema
35
what surgical management technique is used as a last resort and after less-invasive measures have failed?
lung reduction
36
avg time on lung transplant list for: -- single lung transplant: -- double lung transplant:
-- 2 years -- 3 years
37
when was the first human lung transplant in US?
1963
38
first successful long term lung transplant?
1980s
39
use of ECMO in adults help patients survive to transplant:
1990s
40
what are medical management protocols for patients who are candidates for a lung transplant?
severe functional deficits limited life expectancy some must remain hospitalized until transplant becomes available
41
indications of lung transplants: ** put in order of # of transplants performed
IPF CF sarcoidosis/amyloidosis COPD
42
contraindications for lung transplant:
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
a lung transplant evaluation includes:
CVP imaging PFTs VQ scan exercise testing
44
what is the process of getting a lung transplant?
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
what do the following medications that are used for lung transplants do? -- immunosuppressants -- corticosteroids -- antibiotics/antivirals -- anti-hypertensives -- insulin -- bronchodilators -- mucolytics
-- 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
what are two common complications of a SLT/DLT?
1. infection --> highest risk 12 months post op 2. rejection --> 20-50% in first 12 months
47
what are symptoms of organ rejection?
fever fatigue N/V myalgias
48
when are chest tubes often placed? where?
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
what does a chest tube do?
evacuate fluid or air that can impede breathing and cause the lung collapse
50
chest tubes are usually connected to: -- what does this help tell us?
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
post-surgery, where is the chest tube attached?
to wall suction initially progressed to gravity only as the air leak reduces in size or the drainage amount subsides
52
what is a PleurX Drain?
indwelling drain that continously drains pleural space
53
when are PleurX drain's indicated?
recurrent pleural effusions, done in place of repeated thoracentesis procedures
54
where are PleurX drains' commonly seen?
palliative or hospice situations -- can be manageed at home