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Cadiopulmonary Medicine > Test 5 Ch. 21 Pulmonary Vascular Disease > Flashcards

Test 5 Ch. 21 Pulmonary Vascular Disease Flashcards

1
Q

A blood clot that forms and remains in the vein is called a

A

thombus

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2
Q

A blood clot that becomes dislodged and travels to another part of the body is called an

A

embolus (embolism)

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3
Q

A blood clot that went to the lungs

A

Pulmonary Embolism (PE)

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4
Q

When the embolus significantly disrupts pulmonary arterial blood flow…..
Which in turn can cause

A

pulmonary infarction; atelectasis, consolidation, and tissue necrosis

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5
Q

When a large embolus detaches from a thrombus and passes through the right side of the heart, where it may lodge in the bifurcation of the pulmonary artery is referred to as

A

saddle embolus

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6
Q

A large saddle embolus is often quickly _________, b/c it can significantly block ______________ _________ from returning to the left __________ and being pumped out the ___________ ______________

A

fatal
pulmonary blood
ventricle
systemic circulation

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7
Q

Pathologic or structural changes associated with PE

A
  • Pulmonary hypertension
  • Right- heart failure (cor pulmonale)
  • Pulmonary infarction (when severe)
  • Alveolar atelectasis
  • Alveolar consolidation
  • Bronchial smooth muscle constriction (Bronchospasm)
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8
Q

Risk Factors associated with PE: Venous Stasis (not moving) 6

A
  • Inactivity
  • Prolonged bed rest/ immobilization
  • Prolong sitting (car or plane travel)
  • CHF
  • Varicose veins
  • Thrombophlebitis
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9
Q

Risk Factors associated with PE: Surgical Procedures (4)

A
  • Hip surgery
  • Pelvic surgery
  • Knee surgery
  • Certain obstetric or gynecologic procedures
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10
Q

Risk Factors associated with PE: Trauma (5)

A
  • Bone fractures
  • Extensive injury to soft tissue
  • Post op or postpartum states
  • Extensive him or abdominal operations
  • “milk-leg” of pregnancy
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11
Q

Risk Factors associated with PE: Hypercoagulation Disorders (3)

A
  • Oral contraceptives
  • polycythemia
  • multiple myeloma
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12
Q

Risk Factors associated with PE:others

A
  • Obesity
  • Pacemakers or venous catheters
  • Pregnancy or childbirth
  • Supplement estrogen
  • Family history of clots
  • Smoking
  • Malignant neoplasm
  • Burns
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13
Q

Clot that forms in the veins of the lower extremities

A

Deep vein thrombosis (DVT)

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14
Q

Sudden death is often the first symptom in about % of ppl who have a large PE

A

25%

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15
Q

In the U.S about _____ individuals die each year from a PE

A

100,000

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16
Q

There are three primary factors (known as the Virchow triad) associated with the formation if DVT:

A
  1. venous stasis
  2. hypercoagulability (increased tendency of blood to form clot)
  3. injury to the endothelial cells that line the vessels
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17
Q

The diagnosis tests of a PE are (3)

A
  • blood tests
  • venous ultrasonography
  • one or more lung imaging techniques
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18
Q

Common tests done for suspected PE

A
  • Blood test
  • D-Dimer Blood test
  • Ultrasonography
  • Chest x-ray
  • Computed Tomography Pulmonary Angiogram (CTPA)
  • Ventilation-Perfusion Scan
  • Pulmonary Angiogram
  • Magnetic Resonance Imagining
  • Magnetic Resonance Angiography
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19
Q

This test is used to check for an increased level of protein fibrinogen, an integral component of the blood-clotting process

A

D- dimer blood test

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20
Q

D-dimer blood test is also called the

A

fibrinogen test

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21
Q

The d-dimer test is relatively _______ and _____; it entails drawing a blood sample and the results can be available in less than

A

simple and fast; 1 hour

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22
Q

D-dimer values higher than _____ ng/mL are considered ____________, which may suggest the _____________ of blood clots

A

500
positive
possibility

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23
Q

A normal d- dimer level essentially rules out the

A

possibility of blood clots

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24
Q

This test uses high- frequency sound waves to detect blood clots in the thigh veins

A

ultrasonography

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25
Q

The ultrasonography test is ______________ and takes only _____ minutes or less to perform

A

noninvasive
30

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26
Q

Ultrasonography is very accurate for the diagnosis of blood clots behind

A

the knee or thigh

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27
Q

This test can be used to rule out conditions that mimic a PE, such as PNA and pneumothorax

A

Chest Xray

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28
Q

___________ and __________ will be seen in _____% of PE and an elevated _______________ occurs in as many as ___% of cases (when using a chest X-ray)

A

infiltrates and atelectasis; 50%
hemidiaphragm; 40%

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29
Q

The spiral (helical) volumetric……….. w/ intravenous contrast is fast becoming the first-line test for diagnosis suspected PE

A

computed tomography pulmonary angiogram (CTPA)

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30
Q

computed tomography pulmonary angiogram (CTPA) is also called

A

CT pulmonary angiography

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31
Q

The CTPA is increasingly being preferred as the gold standard for diagnosing PE over V/Q scanning or direct pulmonary angiogram b/c (4)

A
  1. the scan requires only an iv line
  2. the imaging resolution is very good
  3. the volumetric scanning allows the contrast material to be administered more economically and timed more precisely
  4. the entire chest can be scanned in a single breath hold or in several successive short breath holds
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32
Q

This scan is rarely used to identify a PE

A

V/Q scan

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33
Q

This test provides a clear image of the blood flow in the lung’s arteries

A

pulmonary angiogram

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34
Q

This test may be used on individual’s whose kidneys may be harmed by dyes used in x-ray tests and for women who are pregnant

A

MRI

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35
Q

This test may be used to differentiate among blood (usual) thromboemboli, and tumor emboli in pts w/ malignacy

A

MRA

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36
Q

Signs and symptoms Commonly Associated w/ PE

A

sudden SOB
cardiac arrhythmias
- sinus tachycardia
- atrial arrhythmias
- atrial tachycardia
- atrial flutter
weak pulse
lightheadednesss or fainting
anxiety
excessive sweating
cyanosis
Chest pain. that resembles a heart attack
cough
blood-streaked sputum
wheezing
leg swelling

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37
Q

Clinical manifestation of PE (2)

A
  • atelectasis
  • bronchospasm
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38
Q

Vital signs for PE

A
  • Increased RR
  • Increased HR
  • Decreased BP
39
Q

When blood flow is reduced or completely absent distal to the obstruction, the alveolar ventilation and no carbon- dioxide- oxygen exchange. The V/Q ratio distal to the PE is high and may even be infinite if there is no perfusion

A

Increased Physiologic (Alveolar) Dead Space

40
Q

What is the normal pulmonary hydrostatic pressure

A

15 mm Hg

41
Q

What is the normal oncotic pressure

A

25 mm Hg

42
Q

When the pulmonary hydrostatic becomes higher than the Pulmonary oncotic pressure, what does this result in?

A

pulmonary hypertension

43
Q

The increase in the hydrostatic pressure permits plasma and RBC to move across the alveolar-capillary membrane and into alveolar spaces in a process similar seen in

A

cariogenic pulmonary edema

44
Q

If the process continues will result in

A

stimulation and a cough reflex and the expectoration of blood-tinged Sputum

45
Q

Peripheral Edema and Venous Distention (4)

A
  • Distended neck veins
  • Swollen and tender liver
  • Ankle and feet swelling
  • Pitting edema
46
Q

This is frequently noted in pts w/ PE. The origin of the pain is unknown. It may be cardiac or pleuritic, but it is one of the common early findings in all forms of PE (2)

A
  • Chest pain
  • Decreased Chest Expansion
47
Q

Chest assessment findings (3)

A
  • crackles
  • wheezes
  • Pleural friction rub (especially when pulmonary infarction involves the pleura)
48
Q

Abnormal EKGs (2)

A
  • Sinus tachycardia
  • Atrial arrhythmia
49
Q

Chest Xray

A
  • Increased density
  • Hyperradiolucency
  • Dilation of the pulmonary Arties
  • Right ventricular cardiomegaly (cor pulmonale)
  • Pleural effusions (usually small)
50
Q

An increased in mean pulmonary artery pressure greater than 25 mm Hg at rest is called

A

Pulmonary hypertension (PH)

51
Q

Normal range for mean pulmonary artery pressure

A

10 to 20 mm Hg

52
Q

PH is a frequent complication of a

A

chronic pulmonary disease

53
Q

PH is more common in
With a ratio of

A

women than men
3:1

54
Q

W.H.O divided PH into

A

five different group classifications based on the cause and tx options

55
Q

PH can be very ________, the pt may have mild to moderate PH for years w/ no remarkable signs and symptoms

A

insidious

56
Q

The diagnosis of PH is based on the pt’s (3)

A
  • medical and fam history
  • physical examination
  • and the results from variety of test and procedures
57
Q

What test may be used to diagnose PH? (4)

A
  • echocardiography
  • chest x-ray
  • electrocardiograms
  • right- heart catherization
58
Q

Which sided heart failure is more commonly the cause of PH?

A

left-sided heart failure (CHF)

59
Q

left-sided and right-sided heart failure combined is called

A

biventricular failure

60
Q

What is the role fast acting anticoagulants?

A

To prevent existing blood clots from growing and prevent the formation of new ones

61
Q

This has been used until recently to tx pts with acute PE, and bleeding can occur with this

A

High- molecular-weight heparin (unfractionated heparin)

62
Q

This has become widely available and have been shown to be safer and more effective than unfractionated heparin. More cost effective

A

low-molecular-weight heparins

63
Q

Example of a High- molecular-weight heparin

A

Heparin

64
Q

Example meds of low-molecular-weight heparins ( EDT)

A
  • enoxaparin
  • dalteparin
  • tinzaparin
65
Q

Heparin can be given thru an

A

IV

66
Q

slow-acting, oral anticoagulant

A

warfarin

67
Q

Warfarin is also called (2)

A
  • Coumadin
  • Panwarfarin
68
Q

Warfarin can be given

A

orally

69
Q

These actually dissolve the clots

A

thrombolytic agents

70
Q

What are some thrombolytic agents (4)

A
  • streptokinase (Streptase)
  • urokinase (Abbokinase)
  • altreplase (Activase)
  • reteplase (Retavase)
71
Q

thrombolytic agents are commonly referred to as

A

“clot- blusters”

72
Q

Thrombolytics agents are sometimes used in

A

conjunction w/ heparin

73
Q

Preventive measures fo PE: (4)

A
  • Walking
  • Exercise while seated
  • Drink fluids
  • Wear graduated compression stockings
74
Q

This may be surgically placed in the inferior vena cava to prevent clots being carried into the pulmonary circulation

A

inferior vena cava (Greenfield) vein filter

75
Q

IVC is recommended only in

A

high risk pts

76
Q

This tx uses thigh high cuffs that automatically inflate every few minutes to massage and compress the veins in the pt’s legs

A

Pnuematic Compression (SCD)

77
Q

Surgically removal of blood clots is generally the last resort in treating PE b/c f the mortality rate

A

Pulmonary embolectomy

78
Q

Protools (3)

A
  • Oxygen therapy
  • Aerosolized Medication
  • Lung Expansion
79
Q

PH has no

A

cure, tx may help reduce symptoms

80
Q

Therapies commonly used to treat all types of PH:

A
  • Diuretics
  • Phosphodiesterase inhibitors
  • Blood- thinning medications
  • Cardiac glycosides (digoxin)
  • o2 therapy
  • Inhaled nitric oxide (iNO)
81
Q

Common signs and symptoms of PH: General Findings

A
  • Dyspnea
  • Lightheaded, dizziness, confusion
  • Fatigue
  • Nonproductive cough
  • Hemoptysis
  • Chest pain/ decreased chest excursion
  • Cyanosis
82
Q

Common signs and symptoms of PH: Test and Procedure Findings

A
  • Abnormal heart sounds
  • Palpable right ventricle heave or lift
  • sinus tachycardia
  • atrial arrhythmia
83
Q

Signs and symptoms of Right sided heart failure (cor pulmonale)

A
  • SOB
  • Irregular fast heart rate
  • Distended neck vein
  • Swollen and tender liver
  • Ankle and feet swelling
  • Pitting edema
  • Heart palpitations
  • Nausea
  • Weight gain
84
Q

Signs and symptoms of Left-sided heart failure (CHF)

A
  • SOB
  • Frothy, blood-tinged sputum
  • Crackles
  • Cough and hemoptysis
  • Weak pulse
  • Decreased urine production
  • Cyanosis
  • Excessive sweating
85
Q

Questions from the back
Most pulmonary emboli originate from thrombi in the

A

Leg and pelvic veins

86
Q

The aortic and carotid sinus baroreceptors initiate which of the following in response to a decreased systemic BP (2) (vitals)

A

Increased HR
Increased ventilatory rate

87
Q

What is the upper limit of the normal mean pulmonary artery pressure?

A

15 mm Hg

88
Q

PH develops in PE b/c of

A
  • Vasconstriction caused by humoral agent release
  • Vasoconstriction induced by decrease PaO2`
89
Q

In severe PE what hemodynamic indices is commonly seen?

A
  • Increased mean pulmonary artery pressure
90
Q

Which of the following are thrombolytic agents

A
  • Urokinase
  • Streptokinase
91
Q

Which of the following is most prominent source of PE

A

blood clots

92
Q

PH is defined as an increase in mean pulmonary pressure greater than

A

25 mm Hg

93
Q

What are the cardiac arrhythmias for PE (4)

A
  • sinus tachycardia
  • atrial arrhythmias
  • atrial tachycardia
  • atrial flutter

Cadiopulmonary Medicine (24 decks)

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