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NURS 6413 Advanced Physiology and Pathophysiology > Pulmonary Physiology > Flashcards

Pulmonary Physiology Flashcards

1
Q

OSA: ____________ secondary to reduction in ___________ tone during sleep

A

mechanical obstruction, pharyngeal muscle

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2
Q

OHS: _________________ with no mechanical, neuromuscular, or metabolic etiology

A

obesity/sleep-disordered breathing/daytime hypoventilation

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3
Q

Most significant risk factor

A

Obesity

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4
Q

______ of obese patients and
_______ of patients presenting for bariatric surgery
Increasing prevalence in _________ patients

A

40%, 80%, pediatric

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5
Q

OSA is associated with increased ____________ in hospitalized patients

A

morbidity/mortality

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6
Q

OSA results in chronic _________ leading to an inflammatory state

A

hypoxemia and hypercarbia

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7
Q

OSA inflammatory state promotes the development of:

A

atherosclerosis, hypertension, stroke, insulin resistance/diabetes mellitus, dyslipidemia, etc.

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8
Q

T/F: OSA decreases FRC

A

True- decreased apneic oxygen reserve, contributes to hypoxemia and hypercarbia

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9
Q

Hallmark of OSA

A

daytime somnolence due to habitual snoring and fragmented sleep

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10
Q

_________ provides definitive objective diagnosis and gradation of severity

A

Polysomnography

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11
Q

What is the Apnea Plus Hypopnea (AHI) Index?

A

number of abnormal respiratory events per hour of sleep

READ THIS:
>5 with sleep-related symptoms or >15 without sleep-related symptoms
Moderate OSA: >15
Severe OSA: >30

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12
Q

What does STOP stand for?

A

S- Snoring
T- tiredness
O-observed apnea
P- high blood pressure

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12
Q

What does BANG stand for?

A

B- Body mass index >35 kg/m2
A- Age > 50 years
N- Neck circumference > 40 cm
G- Gender, male

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13
Q

Lifestyle treatment for OSA

A

Weight loss

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14
Q

Medical treatment for OSA

A

CPAP, airway devices, medications (modafinil, methylxanthines, tricyclic antidepressants)

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15
Q

Surgical treatment for OSA

A

adenotonsillectomy, uvulopalatopharyngoplasty, hypoglossal nerve stimulator

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16
Q

Induction considerations for OSA

A
  • Anticipate difficult mask ventilation/laryngoscopy
  • decreased FRC= decreased apneic oxygen time
  • Elevate head and shoulders (ramping)
  • Have airway adjuncts (LMA/videolaryngoscope) available
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16
Q

Preoperative considerations for OSA:

A
  • Bring CPAP on day of surgery
  • Airway examination- anticipate difficult mask ventilation/laryngoscopy
  • Mallampati and neck circumference
  • Consider regional anesthesia or multimodal analgesia (minimize need for meds that produce sedation)
  • Minimize/avoid sedatives (patient with OSA may be more sensitive to sedative effects)
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17
Q

Emergence considerations for OSA

A
  • Consider awake extubation
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18
Q

Postoperative considerations for OSA

A
  • Monitor ventilation and oxygenation
  • Consider CPAP in PACU
  • Consider prolonged monitoring (6 -24 hours)
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19
Q

What is preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases

A

COPD

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20
Q

Chronic bronchitis: ____________ of expiratory airflow by excess ____________.

A

Obstruction, mucous secretion

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21
Q

Chronic bronchitis occurs most days for at least __________ per year for at least ______ successive years

A

3 months, 2

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22
Q

Emphysema is _________ abnormal enlargement of air spaces distal to the terminal bronchioles accompanied by irreversible destruction of _________ ________.

A

permanent, alveolar walls

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23
Q

______lobular: predominantly affects respiratory bronchioles in upper lung lobes

A

Centrilobular

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24
Q

______lobular: widespread destruction of acini

A

Panlobular

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25
Q

What is the most significant risk factor for COPD?

A

Cigarette smoking (Others: Environmental pollutants, genetics)

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26
Q

COPD is ______ leading cause of death; ~___% of American adults

A

3rd, 5
Death may be secondary to respiratory failure or related comorbidities (e.g., heart disease, lung cancer)

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27
Q

COPD pathophysiology:
* _________ in intrinsic size of bronchial lumina
* _________ in collapsibility of bronchial walls
* __________ in elastic recoil of the lungs

A

Decrease, increase, decrease

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28
Q

COPD pathophysiology:

A
  1. Increased size of acini/alveoli causes compression of adjacent small airways, thereby increasing resistance to airflow
  2. Consolidation of alveoli leads to loss of alveolar surface area and impaired gas diffusion
  3. Mismatched ventilation/perfusion due to heterogeneity of the disease
  4. Loss of alveolar walls decreases the number of pulmonary capillaries, which increases right ventricular workload
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29
Q

Hallmark for COPD

A

chronic productive cough and progressive exercise limitations

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30
Q

Clinical manifestations for COPD

A

dyspnea, wheezing

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31
Q

Pulmonary Function Testing (i.e., GOLD Classification)
FEV1 >80%(or equal to) = ________
FEV1 50%-79% = ________
FEV1 30%-49% = ________
FEV1 <30% = ________

A

mild, moderate, severe, very severe

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32
Q

ABG of someone with COPD

A

PaO2 <60 mm Hg
PaCO2 >45 mm Hg

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33
Q

Lifestyle treatment for COPD

A

smoking cessation, influenza vaccination

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34
Q

Medical treatment for COPD

A

bronchodilation: B2-agonists, anticholinergics, corticosteroids

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35
Q

Surgical treatment for COPD

A

bullectomy, lung volume reduction surgery (LVRS), lung transplantation

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36
Q

Preoperative considerations for COPD

A
  • Assess symptoms, severity of airflow limitation, history of exacerbations, and comorbidities
  • Cough, dyspnea, chest discomfort, and fatigue are signs/symptoms of acute exacerbation
  • Consider regional anesthesia
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36
Q

Maintainence for COPD

A
  • Volatile anesthetics promote bronchodilation
  • Consider humidification of inspired gas
  • Ventilation
  • Maintain adequate oxygenation
  • Eliminate CO2
  • Avoid barotrauma (high PIP)
  • Avoid alveolar injury secondary to atelectasis
  • Avoid volutrauma secondary to high Vt or auto-PEEP
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37
Q

Postoperative Considerations

A
  • Consider postoperative mechanical ventilation
  • Incentive spirometry
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38
Q

Chronic inflammatory disorder of the airways in which many cells and cellular elements play a role… In susceptible individuals, this inflammation causes recurrent episodes of coughing (particularly at night or in the early morning), wheezing, breathlessness, and chest tightness. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.”

A

Asthma

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39
Q

What are the four pathophysiological alterations of asthma?

A
  1. Bronchoconstriction – bronchial smooth muscle contraction that narrows airways in response to variety of stimuli
  2. Airway hyperresponsiveness – exaggerated bronchoconstrictor response to stimuli
  3. Mucous secretion – hypersecretion of mucin
  4. Airway edema
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40
Q

Allergic asthma is triggered by

A

presentation of antigens

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41
Q

(Asthma) Antigens provoke

A

T-lymphocytes to generate an IgE-mediated immune response

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42
Q

(Asthma) Proinflammatory cascade results in

A

proliferation of eosinophils, neutrophils, mast cells, and macrophages

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43
Q

(Asthma) results in

A
  1. increased smooth airway muscle tone (bronchoconstriction)
  2. increased mucous secretion
  3. submucosal edema
  4. pulmonary vasoconstriction and increased vascular permeability
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44
Q

Type of asthma that may be related to high minute ventilation or low temperature/humidity of inspired gas

A

Exercise

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45
Q

Type of asthma that causes inhaled irritants to stimulate vagal nerve endings in the airway epithelium

A

Occupational

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46
Q

(Asthma) Secondary to acute inflammation due to viral/bacterial/mycoplasmal infection

A

Infection (I know this is redundant lol)

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47
Q

Type of asthma that results in inhibition of cyclooxygenase results in greater production of leukotrienes

A

Aspirin

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48
Q

Clinical manifestations of asthma

A

Recurrent wheezing, dyspnea, cough, tachypnea, chest tightness, fatigue

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49
Q

Asthma attacks are short-lived, lasting ______ long symptom-free periods between attacks

A

minutes to hours

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49
Q

Airflow obstruction that is refractory to bronchodilator therapy is known as

A

Status asthmaticus

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50
Q

During exacerbations, airflow obstruction is indicated by

A

decreased FEF25-75%

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51
Q

Asthma preoperative considerations

A
  • Review symptom control prior to surgery (pulmonary function, medication use)
  • Consider canceling the procedure if optimization is necessary
  • Consider regional anesthesia
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52
Q

Asthma induction considerations:

A
  • Avoid endotracheal intubation if possible; consider supraglottic airway if appropriate
  • Ketamine> Propofol > Etomidate/Barbiturates
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53
Q

Asthma maintenance considerations

A
  • Consider use of sevoflurane, least irritating volatile anesthetic
  • Avoid atracurium, mivacurium, morphine, B-antagonists, Hemabate, NSAIDs
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54
Q

Asthma emergence considerations

A
  • Consider deep extubation
  • Consider use of Sugammadex; anticholinesterase reversal agents have risk of bronchospasm
  • Verify adequate reversal of neuromuscular blockade
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55
Q

Intraoperative Bronchospasm: (Way to remember- a1b2eca)

A
  1. Administer additional anesthetic agents
  2. Increase FiO2 to 1.0 (100%)
  3. Administer short acting B2-agonist (albuterol)
  4. Consider administering epinephrine 10 mcg/kg
  5. Administer a corticosteroid (hydrocortisone 2-4 mg/kg)
  6. Consider administering aminophylline
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56
Q

PH is defined as:

A

Mean Pulmonary Artery Pressure >25 mm Hg

57
Q

PH has Rapid disease progression; _______ mortality rate is 79%

A

5-year
Mortality is primarily related to the integrity of the right ventricle, which is in turn related to the degree of increase in pressure in the pulmonary circulation

58
Q

PH: Factors predictive of perioperative mortality include

A

major surgery, emergency surgery, long operative time, use of general anesthesia, and increased NYHA functional class

(May be caused by COPD, connective tissue disorders, sarcoidosis, drug effects, and genetics/idiopathic)

59
Q

PH Patho:
* __________ vascular tone
* Growth and proliferation of _________________
* Irreversible increase in PVR/PAP
* Right ventricular overload culminating in cor pulmonale

A

Increased, pulmonary vascular smooth muscle

60
Q

Hallmark for PH

A

dyspnea/ exercise intolerance

61
Q

PH Induction considerations

A
  • Consider ECG, echocardiogram, chest x-ray and ABG
  • Continue medications for PAH
  • Consider regional anesthesia
61
Q

Diagnosis for PH
(Studies)

A
  • Doppler echocardiography- velocity of tricuspid regurgitation correlates with invasive PAP measurements
  • Cardiac catheterization- provides information about pressures in the pulmonary system and heart
  • Vasodilator challenge- administration of pulmonary vasodilator (nitroglycerin, isoproterenol) to assess reversibility of PAH
62
Q

PH Maintenance considerations

A
  • Neuraxial anesthesia may cause significant hemodynamic alterations
  • Etomidate or high-dose opioids may be preferable to minimize cardiac depression
  • Consider arterial blood pressure monitoring
  • Consider central venous catheter for major procedures
63
Q

Cause of acute cor pulmonale

A

PE

63
Q

What is Cor Pulmonale

A

Right heart failure secondary to pulmonary pathology

64
Q

Cor pulmonale is ______ most common cardiac disorder in people greater than 50 years of age

A

third
(Five times more prevalent in males)

65
Q

Cause of chronic cor pulmonale

A

COPD

66
Q

Clinical manifestations of cor pulmonale

A

Cough, dyspnea, weakness, fatigue, hemoptysis, jugular venous distension, S3 gallop, S4 heart sound, murmur, hepatomegaly, ascites, dependent edema

67
Q

Preoperative considerations for cor pulmonale

A

Consider regional anesthesia

67
Q

(PH) Doppler echocardiography and cardiac catheterization

A

velocity of tricuspid regurgitation correlates with invasive PAP measurements

provides information about pressures in the pulmonary system and heart

68
Q

Medical and surgical treatment for cor pulmonale

A

Administer O2, Medications (prostanoids, endothelin receptor antagonists, phosphodiesterase inhibitors, diuretics)

heart/lung transplant

69
Q

Maintenance for cor pulmonale

A
  • Maintain adequate oxygenation
  • Avoid acidosis
  • Avoid stimuli that increase sympathetic tone
  • Avoid hypothermia
70
Q

Pulmonary Embolism (PE)

A

Occlusion of pulmonary blood flow by embolic material, resulting in obstruction of pulmonary blood flow and resultant mismatch of ventilation and perfusion

71
Q

PE Occurs in ____% of surgical patients

A

1%

72
Q

PE occurs in ___% of orthopedic surgical patients

A

30%

73
Q

PE is usually caused by a DVT from the __________ vessels

A

PE is usually caused by a DVT from the ileofemoral vessels

74
Q

Causes of PE

A
  1. DVT
  2. Air
  3. CO2
  4. Tumor
  5. Bone
  6. Fat
  7. Amniotic fluid
  8. catheter fragments
75
Q

Virchow’s Triad

A
  1. Venous stasis
  2. Venous Injury
  3. Hypercoaguable state
76
Q

List the stepwise pathophysiology of PE:

A
  1. thrombus formation
  2. release of thrombus into circulation
  3. Occlusion of pulmonary circulation
  4. Increased PVR proximal to occlusion, decreased perfusion distal to occlusion
  5. V/Q mismatch
  6. Alveolar Damage
77
Q

Hallmark signs of PE:

A
  1. sudden onset of dyspnea
  2. sudden decrease in EtCO2
78
Q

Clinical manifestations of PE

A
  1. hypotension
  2. tachycardia
  3. hypoxemia
  4. wheezing
  5. tachypnea
79
Q

PE clinical presentation is primarily determined by […]

A

PE clinical presentation is primarily determined by the size of the embolus

80
Q

Treatment of PE:

A
  1. Medical: thrombolytic agents; anticoagulation
  2. embolectomy; IVC filter insertion
81
Q

Anesthetic Management of PE:
Induction: _______ (cardiac stable)
Avoid _____ & _____ (increase PVR)
Maintenance: high _____ monitor ____ & ____

A

Anesthetic Management of PE:
Induction: Etomidate (cardiac stable)
Avoid Ketamine & N2O (increase PVR)
Maintenance: high Fio2; monitor CVP/PAP

82
Q

Treatment for Intraoperative PE:
1. Increase _____
2. Discontinue _____
3. Administer ___ & ___ as needed
4. Administer ___ & ____ for ventricular dysrhythmias
5. Prepare for ____ or _____
6. Consider ____ as a temporizing measure

A

Treatment for Intraoperative PE:
1. Increase Fio2
2. Discontinue anesthetic agents
3. Administer sympathomimetics & IVF/blood as needed
4. Administer lidocaine & amiodarone for ventricular dysrhythmias
5. Prepare for thrombolysis or pulmonary embolectomy
6. Consider CPB as a temporizing measure

83
Q

Restrictive Pulmonary Disease (Pulmonary Edema):

A

Conditions that interfere with normal lung expansion during inspiration

84
Q

Acute intrinsic causes of restrictive pulmonary disease

A
  1. pulmonary edema
  2. aspiration pneumonitis
  3. ARDS
85
Q

Chronic intrinsic causes of restrictive pulmonary disease

A
  1. idiopathic pulmonary
  2. fibrosis
  3. sarcoidosis
  4. radiation injury
86
Q

Chronic extrinsic causes of restrictive pulmonary disease

A
  1. flail chest
  2. pneumothorax
  3. pleural effusion
87
Q

Pulmonary edema refers to […]

A

Pulmonary edema refers to accumulation of excess fluid in interstitium and alveoli

88
Q

in pulmonary edema, Accumulation of excess fluid is usually caused by

A
  1. increased pulmonary capillary hydrostatic pressure
  2. decreased intravascular colloid oncotic pressure
89
Q

Negative-pressure pulmonary edema may result from

A

acute airway obstruction

90
Q

Risk Factors for negative pressure pulmonary edema:

A
  1. young patients
  2. male gender
  3. delayed recognition/prolonged treatment of airway obstruction
  4. excessive administration of intravenous fluids
91
Q

Pathophysiology of pulmonary edema:

A
  1. Imbalance of Starling’s forces leads to pulmonary edema
92
Q

Cardiogenic pulmonary edema pathophysiology

A

Cardiogenic - high pulmonary capillary pressure
(i.e. CAD, HTN, cardiomyopathy, mitral valvular disease)

93
Q

Non-cardiogenic pulmonary edema pathophysiology

A

Non-cardiogenic - increased permeability of the alveolar-capillary membrane (i.e. Sepsis, ARDS)

94
Q

hallmark sign of pulmonary edema:

A

pink frothy sputum

95
Q

Clinical Manifestations of Pulmonary Edema

A
  1. tachypnea
  2. accessory muscle use’
  3. tachycardia
  4. hypertension
  5. diaphoresis
  6. basilar crackles on auscultation
96
Q

Pulmonary edema CXR:

A
  • Enlargement of cardiac silhouette
  • ‘White-out’ appearance
97
Q

Treatment for pulmonary edema:

A

Medical: administer O2, consider CPAP or mechanical ventilation, restrict fluid administration, medications (morphine, nitroprusside, inotropes)

98
Q

Aspiration Pneumonitis

A

Movement of gastric contents from the stomach to the lungs that results in chemical injury to the lung tissue

99
Q

Overall incidence of aspiration pneumonitits

A

~1/3000 anesthetics
~1/1500 emergency anesthetics or cesarean deliveries

100
Q

Aspiration pneumonitis Occurs when protective _____ _______ are inhibited; usually occurs after ______ or gastroesophageal reflux

A

Occurs when protective airway reflexes are inhibited; usually occurs after vomiting or gastroesophageal reflux

101
Q

Risk factors for aspiration pneumonitis:

A
  1. emergency surgery with a full stomach
  2. bowel obstruction
  3. pregnancy
  4. acute trauma
102
Q

List the stepwise pathophysiology of aspiration pneumonitis:

A
  1. Immediate damage to lung parenchyma by caustic aspirate
  2. Atelectasis develops within minutes, leading to airway closure and decreased compliance
  3. Alveolar macrophages release inflammatory cytokines (IL-8, TNF-alpha), which attract neutrophils that in turn release oxygen radicals and proteases
  4. Secondary injury results from fibrin deposition and alveolar necrosis
103
Q

Aspiration Pneumonitis causes:

A

Damage to alveolar-capillary membrane
* Impaired gas exchange
* Hypoxemia
* Initial hypocarbia due to hyperventilation
* Subsequent hypercarbia
* Capillary leak
* Flooding of interstitium and alveoli with protein rich fluid
* Protein-rich fluid may inactivate surfactant, further contributing to decreased compliance

104
Q

Aspiration Pneumonitis hemodynamic changes

A
  • Myocardial ischemia and acidosis secondary to hypoxemia
  • Reduced CO and hypotension
105
Q

Hallmark of aspiration pneumonitis:

A

arterial hypoxemia

106
Q

Clinical Manifestations of aspiration pneumonitis:

A
  1. tachypnea
  2. dyspnea
  3. cyanosis
  4. tachycardia
  5. hypertension
107
Q

Diagnosis of aspiration pneumonitis is made by ____ and ______

A

Diagnosis is made by ABG and chest radiography
* Chest radiography demonstrates aspirate in perihilar and dependent lung regions

108
Q

Differential Diagnosis for aspiration pneumonitis:

A

have high concern in an otherwise healthy patient who develops unexplained/sudden hypoxemia intra- or postoperatively

109
Q

Treatment for aspiration pneumonitis:

A

Medical- ventilation (consider low FiO2, consider PEEP), consider steroids, consider lidocaine 1.5 mg/kg, avoid routine administration of antibiotics, avoid routine use of deep tracheal suctioning/bronchoscopy

110
Q

Preoperative considerations for aspiration pneumonitis:

A
  • NPO
  • Recognize risk factors
  • Pharmacologic prophylaxis
    • Nonparticulate antacid (sodium citrate with citric acid)
    • H2 receptor antagonist (famotidine)
    • PPI (pantoprazole)
    • antiemetics (ondansetron)
111
Q

Induction for aspiration pneumonitis:

A

Induction
* Consider RSI with cricoid pressure
* Consider videolaryngoscopy
* If vomiting, reflux, or aspiration occur during induction
* Tilt the patient’s head downward or turn the patient to the left side
* Suction the oropharynx/ETT
* Consider applying PEEP
* Consider postponing surgery

112
Q

Maintenance for aspiration pneumonitis:

A

Maintenance
* Avoid excessive administration of sedating medication
* Evacuate the stomach

113
Q

Emergence for aspiration pneumonitis:

A
  • Awake extubation
  • Verify adequate reversal of neuromuscular blockade
114
Q

Acute Respiratory Distress Syndrome (ARDS)

A

Condition occurring in critically ill patients in which fluid accumulates in the alveoli, resulting in a mismatch of ventilation and perfusion

115
Q
  • Risk for developing ARDS is additive
    1 risk factor- __%
    2 risk factors- __%
    3 risk factors- ___%
A
  • Risk for developing ARDS is additive
    1 risk factor- 25%
    2 risk factors- 42%
    3 risk factors- 85%
116
Q

Major Risk Factors for ARDs

A
  1. sepsis
  2. bacterial pneumonia
  3. trauma
  4. aspiration pneumonitis
117
Q

Other risk factors for ARDs:

A

Miscellaneous- disease of the central nervous system, pancreatitis, uremia, DIC, anaphylaxis, coronary artery bypass grafting, transfusion reactions

118
Q

ARDS has a mortality rate of ___ %

A

ARDS has a mortality rate of ~50%

119
Q

List the stepwise pathophysiology of ARDs:

A
  1. Damage to the alveolar-capillary membrane leads to diffuse inflammatory response
  2. Capillary endothelium- releases cytokines and membrane-bound phospholipids, complement system- activates leukocytes and macrophages, produces microemboli
  3. Pulmonary vasoconstriction, bronchoconstriction, altered vascular reactivity/permeability
  4. Increased PVR with possible development of cor pulmonale
120
Q

Hallmark feature of ARDs:

A

noncardiogenic pulmonary edema

121
Q

Clinical Manifestations of ARDs:

A
  1. dyspnea, hypoxemia
  2. diffuse bilateral pulmonary infiltrates
  3. decreased pulmonary compliance
122
Q

ARDS is precipitated by […]

A

ARDS is precipitated by a noxious event (e.g., trauma, bacterial pneumonia)

123
Q

Treatment for ARDs:

A

Medical-
1. Lung protective ventilation (supplemental O2)
2. afterload reduction/inotropic support, 3. prone positioning
4. iNO

124
Q

Anesthetic Management for ARDs:

A

Maintenance
* Ventilation
* Consider Vt 6-8 mL/kg IBW
* Consider PEEP
* Avoid PIPs >30 cm H2O
* Avoid excessive administration of IV fluids
* Consider monitoring arterial blood pressure, central venous pressure, cardiac output, urinary output

125
Q

Simple Pneumothorax- define

A

accumulation of air in pleural space; no communication between plural space and atmosphere

treatment: catheter aspiration & tube thoracostomy

126
Q

Tension Pneumothorax- define

A

progressive accumulation of air in pleural space that results in mediastinal shift

Tx: * needle thoracostomy
* tube thoracostomy

126
Q

Communicating Pneumothorax- define

A

accumulation of air in pleural space due to communication between pleural space and atmosphere

tx: * semi-occlusive dressing
* supplemental O2
* tube thoracostomy

127
Q

Hemothorax- define

A

accumulation of blood in pleural space

Tx: * tube thoracostomy
* consider blood transfusion

128
Q

Hallmark signs of Tension Pneumothorax:

A
  1. decreased SpO2
  2. increased peak inspiratory pressures
  3. tachypnea
  4. hypotension
  5. tachycardia
129
Q

Clinical Manifestions of Tension Pneumothorax:

A
  1. asymmetric chest wall movement
  2. tracheal shift
  3. hyperresonance
130
Q

Differential diagnosis for tension pneumothorax:

A

have high concern in patient with history of chest trauma who develops acute decrease in pulmonary compliance

131
Q

Atelectasis:

A

Pathologic condition characterized by abnormal alveolar gas exchange due to airway collapse

132
Q

Atelectasis occurs in ~___% of patients who receive general anesthesia

A

Atelectasis occurs in 90% of patients who receive general anesthesia

Develops within minutes; may persist for hours or days
* Usually subclinical and resolves within 24-48 hours

133
Q

Ateletasis is most common after _____/______ surgery
Most common cause of postoperative ______ ________

A

Most common after thoracic/upper abdominal surgery
Most common cause of postoperative respiratory dysfunction

134
Q

List the stepwise pathophysiology of atelectasis:

A
  1. Blockage or obstruction of airways results in:
  2. closure of small airways,
  3. with absorption of alveolar oxygen,
  4. eading to alveolar collapse
  5. which prevents alveolar gas exchange
    V/Q mismatch
135
Q

In atelectasis, blockage or obstruction of airways may result from:

A
  1. compression of lung tissue
  2. impaired surfactant,
  3. absorption of oxygen from nitrogen-free alveoli
136
Q

Anesthetic Management of atelectasis:

A

Ventilation
* Conside Vt 6-8 mL/kg IBW
* Consider PEEP
* Consider low FiO2
* Consider vital capacity maneuver
* Consider open-lung ventilation

137
Q

Postoperative Considerations for atlectasis:

A
  • Incentive spirometry
  • Consider CPAP in PACU
137
Q

Pleural Effusion

A

Accumulation of excess pleural fluid within the pleural space, secondary to disease or pathology of adjacent structures

138
Q

List the stepwise pathophysiology of pleural effusion:

A
  1. Blockage of lymphatic drainage from the pleural cavity
  2. Increased pulmonary capillary pressure (secondary to cardiac failure) with eventful transudation of fluid into pleural cavity
  3. Decreased plasma colloid osmotic pressure
  4. Infection/inflammation of pleura resulting in altered capillary membrane permeability
139
Q

Treatment of pleural effusion:

A

Surgical- tube thoracostomy, thoracentesis, pleurodesis

140
Q

NPO guidelines:
1. Clear liquids
2. Breast milk
3. Nonhuman Milk/ infant formula
4. Light meal
5. Fried food/Fatty meal or meat

A

NURS 6413 Advanced Physiology and Pathophysiology (4 decks)

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