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Pulmonology Flashcards

1
Q

Acute respiratory distress syndrome

A

Non-cardiogenic pulmonary edema

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2
Q

Cor pulmonale

A

Right-heart failure

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3
Q

Hemoptysis

A

Coughing up blood

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4
Q

Orthopena

A

Difficulty breathing while lying down

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5
Q

Paroxysmal nocturnal dyspnea

A

Difficulty breathing at night

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6
Q

Positive end-expiratory pressure (PEEP)

A

Extrinsic PEEP uses an impedance valve to increase volume of air remaining in lungs at end of expiration to improve gas exchange

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7
Q

Subcutaneous emphysema

A

Crackling under the skin upon palpitation due to trapped air. Typically found in chest, neck, or face

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8
Q

Tidal volume

A

Volume of air inhaled or exhaled with each breath; normal adult tidal volume is about 500mL

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9
Q

Ventilation

A

Mechanical process that moves air in and out of lungs

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10
Q

Inspiration

A

Active process of ventilation (requires energy)

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11
Q

Exhalation

A

Passive process of ventilation

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12
Q

External respiration

A

Movement of oxygen from the alveoli into the bloodstream and movement of CO2 from the blood stream to the alveoli

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13
Q

Internal respiration

A

The exchange of gasses (O2 & CO2) between the bloodstream and the tissues in the body

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14
Q

Minute volume

A

Respiratory rate x tidal volume

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15
Q

CO2 drive

A

The primary system for monitoring breathing status

Monitors CO2 levels in blood and cerebral spinal fluid

Chemoreceptors in the brain detect increased CO2 and rapidly trigger increased respiratory rate

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16
Q

Hypoxic drive

A

Backup to CO2 drive

Monitors oxygen levels in plasma

Prolonged exposure to high concentration oxygen in hypoxia drive patients can cause respiratory depression

May be present in end-stage COPD patients

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17
Q

Acid-base disorders

A

Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

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18
Q

Respiratory acidosis

A

Low pH and elevated CO2

PaCO2 greater than 45mmHg

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19
Q

Respiratory alkalosis

A

Elevated pH and low CO2

PaCO2 less than 35mmHg

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20
Q

Metabolic acidosis

A

Low pH and low HCO3

HCO3 below 22mmHg

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21
Q

Metabolic alkalosis

A

Elevated pH and elevated HCO3

HCO3 greater than 26mmHg

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22
Q

Normal arterial blood gas values

A
  • pH: 7.35-7.45
  • PaO2: 80-100 mmHg
  • PaCO2: 35-45 mmHg
  • HCO3: 22-26 mEq/L
  • SaO2: 95% or above
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23
Q

Without adequate respiration x

A
  • heart and brain become irritable almost immediately
  • brain damage within 4 min
  • permanent brain damage within 6 minutes
  • irrecoverable brain damage within 10 minutes
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24
Q

Ventilation-perfusion mismatch

V/Q mismatch or V/Q defect

A

*Occurs when lungs receive oxygen,but not adequate blood flow
-or-
when the lungs receive blood flow, but inadequate oxygen

*could be a ventilator problem or perfusion problem

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25
Q

Mallampati score (used for oral intubation)

A

Class I: entire tonsil clear

Class II: upper half of tonsil visible

Class III: soft and hard palate visible

Class IV: only hard palate visible

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26
Q

LEMONS (for difficult airway)

A 
L- look externally
E- evaluate 3-3-2 rule
M- mallampati score
O- obstruction 
N- neck mobility 
S- saturation’s
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27
Q

Oxygen cylinder sizes and contents

A

D cylinder: about 350-L ; 0.16

E cylinder: about 625-L ; 0.28

M cylinder: about 3,000-L ; 1.56

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28
Q

Atonal respiration

A

Slow, shallow, infrequent breaths

Indicates brain anoxia

29
Q

Biot’s respiration

A

Irregular pattern of rate and depth and periodic apnea

Indicates increased ICP

30
Q

Central neurological hyperventilation

A

Deep, rapid respiration’s

Indicates increased ICP

31
Q

Cheyenne-Stokes respiration’s

A

Progressively deeper and faster breaths, changing to slower and shallow breaths

Indicates brain injury

32
Q

Kussmaul respirations

A

Deep, gasping breaths

Indicates possible DKA

33
Q

Rales (crackles)

A

Fine, bubbling sound on inspiration

Indicates fluid in lower airways

34
Q

Rhonchi

A

Coarse sounds on inspiration

Indicates inflammation or mucus in lower airways

35
Q

Wheezes

A

High-pitched sound on inspiration or expiration

Indicates bronchoconstriction

36
Q

Snoring

A

Indicates partial airway obstruction from the tongue

37
Q

Stridor

A

High-pitched sound

Indicating significant upper airway obstruction (ex:foreign body, angioedema, anaphylaxis)

38
Q

Gurgling

A

Indicates fluid in the upper airway

39
Q

Pleural friction rub

A

Sounds like dried pieces of leather rubbing together

40
Q

SpO2

A

Pulse oximetry

41
Q

ETCO2

A

Capnography

42
Q

Continuous Positive Airway Pressure (CPAP)

A
  • Indications: alert and spontaneously breathing patients, at least 12 years, in significant respiratory distress. (Sleep apnea, COPD, pulmonary edema, CHF, pneumonia); tachypnea, SpO2 below 94%, use of accessory muscles
  • Contraindications: apnea, unable to follow verbal commands, suspected pneumothorax, chest trauma, tracheostomy, vomiting, GI bleeding and hypotension
43
Q

Infarct

A

Area of necrosis or death

44
Q

Pulse CO-oximetry (SpCO)

A

Non-invasive measurement of carbon monoxide saturation of hemoglobin

45
Q

Pulse oximetry (SpO2)

A

Non-invasive measurement of oxygen saturation of hemoglobin

46
Q

Capnography

A

Measure or monitoring of exhaled CO2

48
Q

Sudden drop of ETCO2 to zero

A
  • esophageal intubation
  • ventilation defect or disconnect
  • defect in CO2 analyzer
49
Q

Sudden decrease of ETCO2 (not to zero)

A
  • leak in ventilator; obstruction
  • partial disconnect in ventilator circuits
  • partial airway obstruction (secretions)
50
Q

Exponential decrease of ETCO2

A
  • pulmonary embolism
  • cardiac arrest
  • sudden hypotension
  • severe hyperventilation
51
Q

Change in CO2 baseline

A
  • calibration error
  • water droplet in analyzer
  • mechanical failure (ventilator)
52
Q

Sudden increase in ETCO2

A
  • accessing an area of lung previously obstructed
  • release of tourniquet
  • sudden increase in BP
53
Q

Gradual lowering of ETCO2

A
  • hypovolemia
  • decreasing cardiac output
  • decreasing body temp; hypothermia; drop in metabolism
54
Q

FBAO

A

BLS: Conscious - Abdominal thrusts, alt back blows & chest thrust

Unconscious - CPR

ALS: *attempt to remove foreign body with laryngoscope and McGill forecps

*Attempt ETT insertion to try passing tube through obstruction or forcing it into right mainstem

55
Q

ARDS - Acute Respiratory Distress Syndrome

A
  • a form of pulmonary edema NOT caused by poor left ventricle function
  • causes: sepsis, trauma, OD, drowning, toxic inhalation
  • s/s: decline in respiratory status; tachypnea, tachycardia, decrease in SpO2
  • mgmt: monitor SpO2, sit pt upright with legs dangling, CPAP, PEEP
56
Q

COPD

A
  • cause: smoking and environmental toxins
    * incl emphysema & chronic bronchitis, increased mortality

-s/s: hx of smoking, cough with increased mucus, right heart failure, JVD & pedal edema, decrease SpO2, clubbing, Ronchhi lung sounds

57
Q

Asthma

A
  • cause: chronic inflammatory airway disease
  • s/s: dyspnea, wheezing, cough, tachypnea, tachycardia, decrease SpO2, pulses paradoxus (decrease in systolic BP of at least 10mmHg during inspiration
  • mgmt: monitor expiratory flow rates (PEFR), aggressive use of bronchodilators to reverse bronchospasm
  • status asthmaticus: not reversible with bronchodilator medications, may have absent lung sounds, respiratory arrest is eminent
58
Q

Pneumonia

A

*lung infection

  • s/s: patients with a history of CP with associated fever, chills, cough
    • weakness, dyspnea, pleuritic CP, abnormal lung sounds

-mgmt: dehydration is common, consider use in IV fluids

59
Q

Pulmonary embolism

A

-patho: blockage in pulmonary artery that decreases blood flow

  • s/s: possible indications of DVT (warm, swollen,lower extremity with pain upon palpitation)
    • tachypnea, tachycardia, acute unexplained dyspnea, cough, pleuritic CP

-mgmt: O2 therapy, prepare for sudden cardiac arrest & rapid transport

60
Q

Spontaneous pneumothorax

A
  • patho: not related to blunt or penetrating trauma, reoccurrence rate high (50%); common in male smokers
  • s/s:acute onset of sharp pleuritic CP or shoulder pain, localized diminished lung sounds, tachypnea, possible subcutaneous emphysema
  • mgmt: monitor SpO2, O2, transport in a position of comfort
61
Q

Hyperventilation syndrome

A
  • hyperventilation considered significant until confirmed otherwise
  • s/s: tachypnea, CP, anxiety, possible carpal pedal spasms due to alkalosis & hypocalcemia
  • causes: anxiety, metabolic & respiratory disorders, pulmonary embolism, cardiac & CNS disorders, medication (aspirin)
  • mgmt: monitor SpO2, O2, transport
62
Q

Gradual increase in ETCO2

A
  • rising body temp
  • hypoventilation
  • CO2 absorption
  • partial airway obstruction (fbao); reactive airway disease
63
Q

Processes of gas exchange

A
  • ventilation
  • diffusion
  • perfusion
64
Q

Residual volume

A

Air that remains in the lungs at all times maintaining the patency of the alveoli

65
Q

Inspiratory reserve volume

A

Additional volume of air beyond the volume inspired during quiet respiration

66
Q

Expiratory reserve volume

A

Amount of air that can be forcibly expired out of the lung after a normal breath

67
Q

Diffusion

A

Process by which gases move between the alveoli and the pulmonary capillaries

68
Q

Most important determinant of the ventilatory rate

A

Arterial PCO2

*Increase in arterial PCO2 results in a decrease in the pH of the blood

69
Q

Perfusion

A

Circulation of blood through the lungs (pulmonary capillaries)

70
Q

Lung perfusion is dependent on three conditions:

A
  • adequate blood volume
  • Intact pulmonary capillaries
  • Efficient pumping of blood by the heart

pulmonology (1 decks)

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