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RET1293 > Test 4 - Ch. 20. Pulmonary Edema > Flashcards

Test 4 - Ch. 20. Pulmonary Edema Flashcards

1
Q

Question from back of the book:
Which of the following is an afterload reducer?

A

Nitroprusside

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2
Q

Question from back of the book:
What is the normal hydrostatic pressure in the pulmonary capillaries?

A

10 to 15 mm Hg

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3
Q

Question from back of the book:
What is the normal oncotic pressure of the blood?

A

25-30 mm Hg

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4
Q

Question from back of the book:
The left ventricular ejection:

A
  • Correlates well with the brain natriuretic peptide values
  • Provides a noninvasive measurement of cardiac contractility
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5
Q

Question from back of the book:
Which of the following are causes of cardiogenic pulmonary edema?

A
  • Excessive fluid administration
  • Mitral valve disease
  • Pulmonary embolus
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6
Q

Question from back of the book:
As a result of pulmonary edema, the patient’s:

A

RV is decreased

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7
Q

Kerley B lines are suggestive of what?

A

Congestive Heart Failure - CHF

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8
Q

Pulmonary edema results from _______________.

A

Excessive movement of fluid from the pulmonary vascular system to the extravascular system and air spaces of the lungs.

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9
Q

As a result of the fluid movement, what happens to the alveolar walls and interstitial spaces?

A

They swell, as the swelling intensifies, the alveolar space tension increases and causes alveolar shrinkage and atelectasis.

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10
Q

The abundance of fluid in the interstitial spaces causes _____________________.

A

The lymphatic vessels to widen and the lymph flow to increase.

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11
Q

Pulmonary edema produces what type of pulmonary disorder?

A

Restrictive

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12
Q

What are the major pathologic or structural changes of the lungs associated with pulmonary edema?

A
  • Interstitial edema
  • Alveolar flooding
  • Increased surface tension of alveolar fluids
  • Alveolar shrinkage and atelectasis
  • Frothy white (or pink) secretions throughout the tracheobronchial tree
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13
Q

The causes of pulmonary edema can be divided into what two major categories?

A
  • Cardiogenic
  • Noncardiogenic
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14
Q

According to the American Heart Association (AHA) 2018 Heart Disease and Stroke Statistic Update, what remains the no. 1 cause of death in the US?

A

Heart disease

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15
Q

Coronary heart disease accounts for ________ deaths in the US, killing over 366,800 people a year.

A

1 in 7

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16
Q

What is the overall prevalence for a myocardial infarction in the US in adults?

A

7.9 million, or 3%

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17
Q

In 2015, heart attacks claimed _______ lives in the US.

A

114,023

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18
Q

What is the estimated annual incidence of heart attacks in the US?

A

720,000 new attacks and 335,000 recurrent attacks

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19
Q

What is the average age of the first heart attack of a male and female?

A

Male: 65.6
Female: 72.0

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20
Q

Approximately every _______, an American will have a heart attack.

A

40 seconds

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21
Q

What was the estimated direct and indirect cost of heart disease in 2013 to 2014?

A

204.8 billion

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22
Q

What were the two out of ten most expensive conditions treated in the US hospitals in 2013?

A

- Heart attacks (12 billion)
- Coronary Heart Disease (9.0 billion)

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23
Q

Between 2013 and 2023, medical costs of coronary heart disease are projected to increase by ___________.

A

About 100%

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24
Q

Cardiac pulmonary edema occurs when _______________________.

A

The left ventricle is unable to pump out a sufficient amount of blood during each ventricular contraction.

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25
Q

The ability of the left ventricle to pump blood can be determined by the means of the _____________.

A

Left Ventricular Ejection Fraction (LVEF), with a noninvasive cardiac imaging procedure echocardiogram that reflects the patient’s left ventricular systolic contractility.

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26
Q

Poor ventricular function can also be caused by _________________.

A
  • Increased ventricular stiffness
  • Impaired myocardial relaxation

Called diastolic dysfunction and is associated with a relatively normal LVEF

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27
Q

Normal values for the LVEF range between __________.

A

55-70%

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28
Q

An LVEF less than _____% may confirm heart failure.

A

40

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29
Q

An LVEF less than ____% is life-threatening and cardiac arrhythmias are likely.

A

35

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30
Q

When the patient’s LVEF is low, the blood pressure inside the pulmonary veins and capillaries __________ as a result.

Increases or decreases?

A

Increases

This action causes fluid to be pushed through the capillary walls and into the alveoli in the form of a transudate.

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31
Q

Ordinarily, hydrostatic pressure of about ________ tends to move fluid out of the pulmonary capillaries into the interstitial space.

A

10-15 mm Hg

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32
Q

Ordinarily, hydrostatic pressure tends to move fluid out of the pulmonary capillaries into the interstitial space. This force is normally offset by colloid osmotic forces of about __________.

A

25-30 mm Hg

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33
Q

The colloid pressure is referred to as __________.

A

Oncotic pressure

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34
Q

What is oncotic pressure produced by?

A

Albumin and globulin in the blood.

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35
Q

The stability of fluid within the pulmonary capillaries is determined by what?

A

The balance between hydrostatic and oncotic pressures.

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36
Q

Movement of fluid in and of the capillaries is expressed by the _______________.

A

Starling equation

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37
Q

Of the four pressures, which are the only two that can be measured without any certainty?

A

Oncotic and hydrostatic pressures of the blood in the pulmonary capillaries

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38
Q

The oncotic and hydrostatic pressures within the ___________ cannot be readily determined.

A

Interstitial compartments

39
Q

What happens when the hydrostatic pressure within the pulmonary capillaries rises to more than 25-30 mm Hg?

A

The oncotic pressure loses its holding force over the fluid within the vessels. Consequently, fluid starts to spill into the interstitial spaces and alveoli of the lungs.

40
Q

Clinically, the patient with left ventricular failure often has what?

A
  • Activity intolerance
  • Weight gain
  • Anxiety
  • Delirium
  • Dyspnea
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Cough
  • Fatigue
  • Cardiac arrythmias (A-fib)
  • Adventitious breath sounds
41
Q

Because of poor circulation patients with left ventricular failure often has:

A
  • Cool skin
  • Diaphoresis
  • Cyanosis of the digits
  • Peripheral pallor
42
Q

Major organ failure of the brain and kidney may be the result of ___________.

A

Hypoperfusion

43
Q

What is the most common cause of pulmonary edema?

A

Increased pulmonary capillary hydrostatic pressure

44
Q

State some common causes of cardiogenic pulmonary edema.

A
  • Arrythmias (PVCs or bradycardia producing low cardiac output)
  • Systemic hypertension
  • Congenital heart defects
  • Coronary heart disease
  • Excessive fluid administration
  • Left ventricular failure
  • Mitral or aortic valve disease
  • Myocardial infarction
  • Cardiac tamponade
  • Pulmonary embolus
  • Renal failure
  • Rheumatic heart disease
  • Cardiomyopathies
45
Q

What are some risk factors for coronary heart disease?
Pg. 313 (List isn’t finished)

A
  • Age
  • Males older than 45
  • Females older than 55
  • Family history of CHD
  • Male relative with CHD: Younger than 55 years old
  • Female relative with CHD: Younger than 65 years old
  • Obesity
  • Cigarette smoking
  • Hypertension: Blood pressure >140/90 mm Hg or on antihypertensive agents
  • High level of low-density-lipoprotein cholesterol
46
Q

Noncardiogenic pulmonary edema is less common and develops as a results of what?

Left off at bottom of pg. 313

A

Damage to the lungs!

47
Q

Describe noncardiogenic pulmonary edema.

A

Lung tissues become inflated and swollen and fluid can readily leak from the pulmonary capillaries into the alveoli.

48
Q

What are some common causes of noncardiogenic pulmonary edema?

A
  • Increased capillary permeability
  • Lymphatic insufficiency
  • Decreased intrapleural pressure
  • High altitude pulmonary edema
  • Decreased oncotic pressure
49
Q

Pulmonary edema may develop as a result of increased capillary permeability stemming from ________________.

A

Infectious, inflammatory and other processes.
Other causes include:
- Alveolar hypoxia (E.g high altitude)
- ARDS
- Inhalation of toxic agents like chlorine, sulfur dioxide, nitrogen dioxides, ammonia and phosgene
- Pulmonary infections (certain pneumonias)
- Therapeutic radiation of the lungs
- Acute head injury (also known as cephalogenic pulmonary edema)

50
Q

What happens should the normal lymphatic drainage of the lungs be decreased?

A

Intravascular and extravascular fluid begins to pool and pulmonary edema ensues.

51
Q

Lymphatic drainage may be slowed because of _______________.

A

Obliteration or distortion of lymphatic vessels.

52
Q

The lymphatic vessels may be obstructed by tumor cells in ________________.

A

Lymphangitic carcinomatosis

53
Q

Why may increased systemic venous pressure slow lymphatic drainage?

A

Because lymphatic vessels empty into the systemic veins

54
Q

Lymphatic insufficiency has also been observed after ___________.

A

Lung transplantation

55
Q

The sudden removal of a pleural effusion can cause what type of edema?

A

Decompression pulmonary edema

56
Q

High-altitude pulmonary edema (HADE) can occur in people who exercise at altitudes about ___________ without having first acclimated to the high altitude.

A

8000 ft.

Often affects recreational hikers and skiers.

57
Q

Decreased oncotic pressure may be caused by what?

A
  • Overtransfusion and/or rapid transfusion of hypotonic or normotonic intravenous fluids.
  • Uremia
  • Hypoproteinemia (E.g severe malnutrition)
  • Acute nephritis
  • Polyarteritis nodosa
58
Q

Other causes of noncardiogenic pulmonary edema:

A
  • Allergic reaction to drugs
  • Excessive sodium consumption
  • Drug overdose
  • Metal poisoning
  • Chronic alcohol ingestion
  • Aspiration (E.g near drowning)
  • CNS stimulation
  • Encephalitis
  • High altitudes (Greater than 8,000-10,000 ft)
  • Pulmonary embolism
  • Eclampsia
  • Transfusion-related acute lung injury
59
Q

The treatment of pulmonary edema is based on ______________.

A

The cause and severity.

60
Q

The treatment of noncardiogenic pulmonary edema is largely supportive and aimed at ________________.

A

Ensuring adequate ventilation and oxygenation.

61
Q

For cardiogenic pulmonary edema, what is the initial management?

A
  • Directed at the use of digitalis
  • Supplemental oxygen
  • Assisted ventilation if necessary
  • Loop diuretics for volume overload
62
Q

The therapeutic intervention to address the patient’s circulatory system has what following three main goals?

A
  • Reduction of pulmonary venous return (preload reduction)
  • Reduction of systemic vascular resistance (afterload reduction)
  • Inotropic support (treatment of reduced cardiac contractility)
63
Q

Reduction of the preload increases/decreases pulmonary capillary hydrostatic pressure and reduces fluid transudation in the pulmonary interstitium and alveoli.

A

Increases

64
Q

Inotropic agents are used to treat what?

A

Hypotension or signs of organ hypoperfusion

65
Q

Reduction of afterload increases ________ and improves renal perfusion, which in turn allows for diuresis in the patient with fluid overload.

A

Cardiac output

66
Q

What are some preload reducers?

A
  • Nitroglycerin (Nitro-bid, Minitran, Nitrostat)
  • Loop diuretics (e.g furosemide)
  • Morphine sulfate
67
Q

What are some afterload reducers?

A
  • Captopril
  • Enalapril
  • Nitroprusside
68
Q

A competitive angiotension-converting enzyme (ACE inhibitor and reduces angiotension II levels.

A

Enalapril (Vasotec)

69
Q

Which drugs prevents the conversion angiotensin I and angiotensin II and is a potent vasodilator?

A

Captopril

70
Q

With Captopril, afterload and cardiac output usually improve in _______________.

A

10 to 15 minutes

71
Q

What is this drug?
A potent, direct smooth-muscle relaxing agent that primarily reduces afterload. It may also mildly reduce preload.

A

Nitroprusside (Nitropress)

72
Q

Name some positive inotropic agents.

A
  • Dobutamine
  • Dopamine
  • Norepinephrine
  • Milrinone
73
Q

A natural occuring catecholamine with potent alpha-receptor and mild beat-receptor activity. It stimulates beta1-adrenergic and alpha-adrenergic receptor, increasing myocardial contractility, heart rate, and vasoconstriction.

A

Norepinephrine

74
Q

______________ is a naturally occurring catecholamine that acts as a precursor to norepinephrine.

A

Dopamine

75
Q

What is considered a cornerstone in the treatment of cardiogenic pulmonary edema?

A

Loop diuretics (E.g furosemide)

76
Q

A very effective, predictable and rapid-acting medication for preload.

A

Nitroglycerin (Nitro-bid, Minitran, Nitrostat)

77
Q

_______________ are presumed to decreased preload through diuresis and direct vasodilation.

A

Loop diuretics (E.g furosemide)

78
Q

Name this medication.
A synthetic catecholamine that mainly has beta1-receptor activity but also has some beta2-receptor and alpha-receptor activity. Commonly used for patients with mild hypotension.

A

Dobutamine

79
Q

List the physical examination associated with pulmonary edema.

A
  • Tachypnea
  • Hypertension
  • Tachyacardia
80
Q

Cheyne-Stokes breathing may be seen in what type of pulmonary edema patients?

A

Patients with severe left-sided heart failure and pulmonary edema.

81
Q

A patient is said to have ______ when dyspnea increases while the patient is lying in a recumbent position.

A

Orthopnea

82
Q

What is the physical examination of a patient with pulmonary edema?

A
  • Increased RR
  • Increased HR and BP
  • Cheyne-Stokes Respirations
  • Paroxysmal Nocturnal Breathing
  • Orthopnea
  • Cyanosis
  • Cough and Sputum (Frothy & Pink)
  • Increased tactile and vocal fremitus
  • Crackles and wheezing
83
Q

What are some radiological findings associated with pulmonary edema?

A
  • Kerley A & B lines
  • “Bat wing” or “butterfly” pattern
  • Left ventricular hypertrophy
  • Dilated pulmonary arteries
  • Transudate pleural effusion
  • Bilateral fluffy opacities with a predominant central position in the chest
84
Q

BNP levels below 100 mg/mL indicate _______________.

A

No heart failure

85
Q

BNP levels of 100 to 300 mg/mL indicate _______________.

A

Heart failure may be present

86
Q

BNP levels above 300 mg/mL indicate _______________.

A

Mild heart failure

87
Q

BNP levels above 600 mg/mL indicate _______________.

A

Moderate heart failure

88
Q

BNP levels above 900 mg/mL indicate _______________.

A

Severe heart failure

89
Q

Norepinephrine is usually reserved for patients with ___________.

A

Severe hypotension (Systolic BP less than 70 mm Hg)

90
Q

Examples of antidysrhythmic agents.

A
  • Digitalis
  • Procainamide
  • Metoprolol
91
Q

What is sometimes administered to increase the patient’s oncotic pressure in an effort to offset increased hydrostatic forces of cardiogenic edema, if the patient’s osmotic pressure is extremely low?

A

Albumin

92
Q

What are some abnormal tests and procedures of pulmonary edema?

A
  • Low serum potassium
  • Low serum sodium
  • Low serum chloride
93
Q

What are the preload reducers?

A
  • Nitroglycerin
  • Loop diuretics (Furosemide)
  • Morphine sulfate
94
Q

What are the afterload reducers?

A
  • Captopril
  • Enalapril (Vasotec)
  • Nitropurusside

RET1293 (10 decks)

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