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410 Patho Exam 1 > Vascular Lung Disorders > Flashcards

Vascular Lung Disorders Flashcards

1
Q

What is the definition of pulmonary edema?

A

abnormal accumulation of fluid in alveoli and interstital spaces

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2
Q

what is the difference between pleural effusion and pulmonary edema ?

A

pleural effusion
- abnormal amount of fluid in pleural space
- so fluid is in the chest cavity below the lung and it pushes up the lung, resulting in pneumothorax

pulmonary edema
- fluid is already INSIDE the lung between the alveoli

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3
Q

pulmonary edema usually is a complication of what ?

most common cause of pulmonary edema is what?

A

heart and lung disease

left sided heart failure

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4
Q

what are some common manifestations of pulmonary edema ?

A

dyspnea
crackles
wheezing
chest pain

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5
Q

patients with pulmonary edema have a very specific type of productive cough, what is it ?

A

pink frothy sputum

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6
Q

test question
if you see a patient in respiratory distress what are we doing to do first?
give them oxygen?
raise the rest of the bed ?

A

raise the head of the bed
- this will help with lung expansion

then give them oxygen

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7
Q

what does pulmonary embolism (PE) mean ?

A

blockage of one or more pulmonary arteries by thrombus, fat or air embolus or tumor tissue

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8
Q

what does embolism mean ?

A

a clot, usually from the venous system goes dislodges itself and travels up into the pulmonary circulation then lodges into the small blood vessels and obstructs alveolar perfusion

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9
Q

most of the time, pulmonary embolism is often found and effect what part of the lung ?

A

lower lobes

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10
Q

who are at the most risk of developing a pulmonary embolism?

A

bed ridden patients
trauma patients

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11
Q

what is the mainly the cause of pulmonary embolism, or think about how most of the time it happens ?

A

you already had a clot before hand, typically a DVT and then it dislodged and traveled up into the pulmonary circulation, causing the pe

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12
Q

Where does venous thromboembolism (VTE) originate ?

what are some other forms that VTE can occur ? think of medical procedures

A

deep veins of legs, femoral or iliac veins, right side of the heart

central venous cetherters, IV lines

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13
Q

what is a saddle embolus ?

A

large thrombus at aerial bifurcation
- large clot affecting both lungs

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14
Q

does a pulmonary embolism happen fast or slow ? and explain the patho behind this ?

A

fast
reason why is because it usually comes from the DVT already formed and most of the time patients can’t really tell its in there legs cause the lack of symptoms, but the second it goes into your lungs, you are out of breath almost instant

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15
Q

the bigger the clot the more likely you are to see what within a patient ?

A

the severity of symptoms, so like the complications are going to be more worse

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15
Q

what are some common manifestations you will see with patients who just got a pulmonary embolism, so think of them one second they are fine and now the clot is in their chest? (4)

A

change in mental status
hypotension
impending sense of doom
dyspnea

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16
Q

what are 2 complications that occur from pulmonary embolism ?

A

pulmonary infarction
pulmonary hypertension

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17
Q

what is pulmonary infarction ?

explain to me the patho

A

occlusion of medium or large sized vessel, inadequate collateral blood flow and preexisting lung disease results in alveolar necrosis and hemorrhage which may results in abscess and pleural effusions

so with pulmonary embolism, we have a clot that is preventing proper perfusion and circulation of blood and oxygen, when the body doesn’t receive either of these things, it will begin to die or in other words necrosis, causing your alveoli to usually collapsing and furthering the complications

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18
Q

what is pulmonary hypertension ?
explain the patho behind this for pulmonary embolism

most of the time though, it takes about 50% or more for your body to go through hypertension because of the hypoxemia in your tissues

A

your body is having to work 100x harder to try to get blood and oxygen across this clot, usually resulting in patients to get right ventricular hypertrophy

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19
Q

circulation test
the right side of your heart pumps blood and oxygen to your ?

the left side of your heart pumps blood and oxygen to your ?

A

lungs
the rest of the body

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20
Q

what is the first and most effective method of testing out if the patient has pulmonary embolism ?

A

D-dimer tests

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21
Q

what are the other 2 forms of testing other than the D-dimer we use to test for a pulmonary embolism?

A

Spiral (Helical)
V/Q scan

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22
Q

how does a d-dimer help us rule out if there is a pulmonary embolism effecting our patient ?

A

elevated d-dimer in the body

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23
Q

what if there is a negative d-dimer, what do we do as nurses?

A

try doing other exams and rule out anything else unless proven otherwise

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24
Q

what does a spiral helical ct scan do to help us find out a pulmonary embolism?

A

we give patients IV contrast media and take a 3d picture of the pulmonary vasculature to see any clots present, but we try not to do this anymore because some clots can be very small and go unnoticed

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25
Q

what does v/q contrast help us identify a pulmonary embolism?

A

perfusion scanning - pulmonary circulation
ventilation scanning - distribution of gas in lungs

usually it will be mismatched and uneven

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26
Q

notes
some other form of assessments we can do that aren’t those tests mentioned previously are like
abgs - artieral blood gas
chest x-ray
electrocardiogram

A
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27
Q

why are Abg Importance in helping us figure out pulmonary embolism ?

A

ABG measure the amount fo carbon dioxide in the patient, so if the patient isn’t perfusing well, we can find it here

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28
Q

why do we do troponin levels for patients who have pulmonary embolism?

A

normally we do this for patients who are having heart attack but with pulmonary embolism, we can see a slight increase as time continues with the pe

29
Q

Additional information
why do we use b-natriuretic peptide ?

A

testing out for heart failure

30
Q

what is the goal of treatment for patients who are having a pulmonary embolism?

A

to have adequate tissue perfusion and respiratory function

31
Q

what are some intern-profession care we are trying to prevent with patients who have a PE? dont over think it

A

further growth of the clot
prevent embolization from upper or lower extremities
prevent further recurrence of pe

32
Q

What are the 5 ways we are going to support cardiopulmonary status ?

PH &FV

A

oxygen
pulmonary hygiene
fluids/vasopressores
diuretics
opioids

33
Q

how is oxygen going to help support cardiopulmonary status for patients with pe??

A

They are going to be struggling to breathe, so we need to give them some oxygen to help that

34
Q

how is pulmonary hygiene going to help us support cardiopulmonary status for patients with PE?

A

by teaching them to use incentive spirometer, coughing and ambulation techs to avoid getting atelectasis

35
Q

how is fluid and vasopressers going to help us support cardiopulmonary status for patients with PE?

A

to try to keep the volume up from where the blood clot is preventing blood and oxygen from passing

36
Q

how is diuretics going to help us support cardiopulmonary status for patients with PE?

A

most of the time patients will end up getting heart failure, and that results in pulmonary edema because the blood just accumulates in one area, so we need to flush that part out

37
Q

how is opioids going to help us support cardiopulmonary status for patients with PE?

A

pain will be reduced causing the patient to feel less anxious and need to breathe so hard

38
Q

remember pulmonary embolism not a ___issue its a ___issue

A

gas exchange issue
perfusion issue

39
Q

can you explain why pulmonary embolism is a perfusion issue ?

A

the reason is because gas exchange is happening to the rest of the body, like oxygen and carbon are leaving and staying, however the blood, the perfusion is not being met and moved

40
Q

what are the 2 types of drug therapy we are going to be giving these patients who have pulmonary embolism ?

A

anticoagulation
fibrinolytic agents

41
Q

what does anticoagulants do ?

A

they dont dissolve the clot, they simply prevent from clots from forming

42
Q

if you have a clot already is an anticoagulant going to do anything to it ?

A

nope

43
Q

what are the 3 anticoauglaties we need to know to help with pulmonary embolism?

A

heparin
unfrationated iv heparin
warfarin ( Coumadin )

44
Q

what does fibrinolytic agents do for pulmonary embolism?

A

dissolve the clots

45
Q

what are the 2 fibrinolytic agents we need to know for pulmonary embolism?

A

tissue plasminogen activator (tpa)
alteplase (activase)

46
Q

what’s the last Resort for a patient who can’t take a fibrinolytic agent or anticoagulted ?

A

surgery to remove the clot

47
Q

heparin is ___
warfarin is __

A

PTT&APTT
PT & INR

48
Q

what is warfarin normal range ?
what happens if its higher than that
what happens if its lower than that
what happen if its normal

A

2-3
bleeding
clotting
give them the medication

49
Q

what is the surgery called for patients with pulmonary embolismism ?

A

pulmonary embolectomy
- catheter enters and removes it

most of the time we also insert a IVC filter to catch any other clots that could form if a patient is at high risk of making more clots

50
Q

what are some prevention methods we are going to tell patients to do to prevent PE?

A

ambulation
compression devices
anticoagulation
signs and symptoms

51
Q

what the immediate treatment for PE?

A

bed rest in semi-fowlers position
administration oxygen and fluids
assesses cardiopulmonary status
coagulation and complications

52
Q

notes
patent support
- anxiety, pain, dyspnea, fear of death

patient education
- regarding long term-anticoagulant therpay
-measures to prevent VTE
- importance of follow up exams

A
53
Q

how long are people on anticoagulation medications ?

A

6-9 months then get off of it

54
Q

if patients are in critical care, what do we want to do ?

A

have 2 big bore ivs inside them

55
Q

can patients be on warfarin and heparin at the same time ?

A

yes

56
Q

heparin usually is the better options patients are on rather than warfarin because what?

A

because it has a shorter half life

57
Q

if someone is on an anticoaulagate, what do we tell them ?

A

careful of bruising, falls, using electric razor and soft toothbrush

58
Q

what is pulmonary hypertension ?

A

elevated pulmonary artery pressure due to an increase in resistance to blood flow through the pulmonary ciruculation

59
Q

what does pulmonary hypertension do to the body ?

A

mainly affects your body, right side of your heart to do more effort to try to push blood and oxygen in your lungs

60
Q

what is idiopathic pulmonary arterial hypertension (IPAH)?

A

pulmonary hypertension without cause results in right HF and death if untreated

61
Q

what are some clinical manifestations behind pulmonary hypertension ?

A

dyspnea on exertion and fatigue
chest pain
dizziness
abnormal heart sounds

62
Q

most of the time, people with pulmonary hypertension have what?

A

another underlying condition causing it

63
Q

what are some diagnostic studies to test for pulmonary hypertension ?

A

right side heart catheriation
ecg
chest x-ray

64
Q

most of the time its really hard to treat pulmonary hypertension, so early recognition is the best way to stop progression, so go to the doctors if any ___happens?

A

change in breatihing
chest discomfort
edema

65
Q

notes
drug therapy
pulmonary vasodilation, reduce right ventricular overload, and reverse remolding
manage the edema
prevent thrombi
prevent hypoxic

surgical interventions
Artial septostomy
lung transplant
pulmonary thromboendarterectomy

A
66
Q

what is secondary pulmonary arterial hypertension (SPAH)?

A

chronic increase in pulmonary artery pressure from another disease

67
Q

treatment behind SPAH?

A

treat underlying cause and same as IPAH

68
Q

what is cor pulmonale ?

A

enlarged right ventricle secondary to disorder of respiratory system
- COPD

heart failure because it started with a problem with your lungs

69
Q

what are some heart failure manifestions ?

A

edema
weight gain
distend neck veins
full bounding pulse

70
Q

most of the time patients who are diagnosed with for pulmonale usually have to be on long term what?

A

oxygen

71
Q

cor pulmonale notes
early identification is crucial as irreversible heart changes can happen

want to determine and treat underlying cause

manifestations are the same as any other before
- exertion dyspnea, tachypnea,cough , fatigue

A

410 Patho Exam 1 (5 decks)

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