Quiz 11

Question 1

COPD: smoking history?

Answer 1

Always 2 questions:
-Do you smoke?
-Have you ever smoked / when did you quit?
PPD and duration?

Question 2

COPD: Dyspnea?

Answer 2

• presence
• severity
• exercise tolerance*
• home O2 requirement*
• baseline SpO2 on room air*

Question 3

Chronic Bronchitis: Problems? Causes?

Answer 3

Cough
Sputum production
Recurrent infections

Smoking, occupational exposure (radon, coal, asbestosis)

Question 4

Emphysema: key characteristic? Causes?

Answer 4

Progressive dyspnea

Smoking
coal miners
alpha-1 antitrypsin deficiency = autodigestion of pulmonary tissue by proteases

Question 5

what is specific to asthmatic bronchitis?

Answer 5

Only partially reversible – some degree of obstruction will always remain

Question 6

Nicotine stimulates ________ ganglia – ____________ released from adrenal medulla – increasing HR, BP, and SVR – persists ____ minutes after last cigarette

Answer 6

sympathetic

catecholamines

30

Question 7

Precaution in smokers?

Answer 7

Pre-O2 well and avoid instrumentation of airway until deep level of anesthesia

Question 8

pre-op smoking cessation?

Answer 8

-Advise stopping at least 12 hours prior to surgery
Stopped night before surgery (12-24 hrs) – will reduce COHb and nicotine levels to that of nonsmokers

• Airway reactivity decreases after 2 days of cessation and is near the level of a nonsmoker after 10 days of cessation
• Cessation of > 8 weeks will reduce post-op pulmonary complications
• Cessation of > 2 years will reduces risk of MI to that of nonsmoking population

Question 9

What to avoid in COPD pts? What can it cause? prevention?

Answer 9

• Histamine releasing drugs (Pentothal, Morphine, Atracurium, Mivacurium, Neostigmine)
• Bronchospasm
• treat with albuterol neb esp before extubation

Question 10

Characteristics of asthmatics?

Answer 10

• Airway hyperreactivity
• bronchial wall inflammation
• variable degrees of reversible airflow obstruction