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RET1293 > Test II > Flashcards

Test II Flashcards

1
Q

_________________ is a procedure in which excess fluid accumulation (pleural effusion) is aspirated through a needle inserted through the chest wall.

A

Thoracentesis

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2
Q

A _______________ entails passing a forceps or needle through a bronchoscope to obtain a specimen.

A

Transbronchial lung biopsy

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3
Q

A lung sample can be obtained by means of what?

A
  • Transbronchial needle biopsy
  • Open-lung biopsy
  • Expectoration
  • Tracheal suction
  • Bronchoscopy
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4
Q

Diagnostic thoracentesis may be performed to identify the cause of a _____________.

A

Pleural effusion

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5
Q

Neutrophils make up about _______ of the total number of WBCs.

A

60-70%

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6
Q

What are the smallest of the formed elements in the blood?

A

Platelets, thrombocytes

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7
Q

What is the normal platelet count?

A

150,000 - 350,000/mm3

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8
Q

A platelet count of less than 20,000/mm3 is associated with _________________.

A

Spontaneous bleeding, prolonged bleeding time and poor clot retraction

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9
Q

What is the normal value of glucose?

A

70-110 mg/dL

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10
Q

Increased lymphocytes are typically seen in _______________________.

A

Viral infections

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11
Q

Lymphocytes are divided into what two categories?

A
  • B cells
  • T cells
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12
Q

Increased basophils are primarily associated with what?

A

Certain myeloproliferative disorders

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13
Q

________________ are the second order of cells to arrive at an inflammation site, usually appearing 5 hours or more after the injury.

A

Monocytes

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14
Q

Early (immature) forms of neutrophils are nonsegmented and called ___________.

A

“Band” forms

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15
Q

Gram staining is used for what?

A

To classify bacteria into gram-negative or gram-positive organisms

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16
Q

What is performed to determine the presence of acid-fast bacilli?

A

Acid-fast smear and culture

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17
Q

____________ are commonly performed to evaluate allergic reactions or exposure to tuberculosis bacilli or fungi.

A

Skin tests

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18
Q

A negative skin test may also be seen in patients with a depression of cell-mediated immunity, such as that which develops in ____________.

A

HIV infections

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19
Q

________________ includes the insertion of a scope though a small incision in the suprasternal notch.

A

Mediastinoscopy

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20
Q

What gram-positive organism makes up 80% of all bacterial pneumonias?

A

Streptococcus

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20
Q

What bronchoscopic technique involves injecting a small amount (30mL) of sterile saline through the bronchoscope then withdrawing the fluid for examination of cells?

A

Bronchoalveolar lavage (BAL)

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21
Q

What is performed to prevent the recurrence of a pneumothorax or pleural effusion?

A

Pleurodesis

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22
Q

What are the major functions of the WBCs?

A
  • Fight against infection
  • Defend the body by phagocytosis against foreign substances
  • Produce antibodies in the immune response
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23
Q

The fluid in the lung cavity is classified as either:

A

Exudate or transudate

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24
Q

What is the normal value for Potassium (K+)?

A

3.8-5.0 mEq/L

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25
Q

What is the normal value for Calcium (Ca++)?

A

4.5-5.4 mEq/L

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26
Q

What is the normal value for Sodium (Na+)?

A

136-142 mEq/L

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27
Q

A deficiency of platelets leads to what?

A

Prolonged bleed time and impaired clot retention

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28
Q

A low platelet count (thrombocytopenia) is associated with what?

A
  • Massive blood transfusion
  • Pneumonia
  • Cancer chemotherapy
  • Infection
  • Allergic reactions
  • Toxic effects to certain drugs
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28
Q

A high platelet count (thrombocythemia) is associated with what?

A
  • Cancer
  • Trauma
  • Asphyxiation
  • Rheumatoid arthritis
  • Iron deficiency
  • Acute infections
  • Heart disease
  • TB
  • Polycythemia vera
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29
Q

What is the normal value for Bilirubin?

A

0.1-1.2 mg/dL

Increases are associated with:
- Massive hemolysis
- Hepatitis

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30
Q

What is the normal value for Blood urea nitrogen (BUN)?

A

8-18 mg/dL
Increases are associated with acute or chronic renal failure

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31
Q

What is the normal value for Serum creatinine?

A

0.6-1.2 mg/dL
Increases are associated with renal failure

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32
Q

What are the first WBCs to arrive at the site infection or inflammation, usually appearing within 90 minutes of the injury?

A

Neutrophils

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33
Q

B cells may up _______% of the total lymphocytes.

A

10-30

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34
Q

T cells account for ______% of the total lymphocytes.

A

70-90

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35
Q

Where are B cells formed?

A

Bone marrow

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36
Q

T cells are divided into what four categories?

A
  1. Cytotoxic cells - attack and kill foreign or infected cells
  2. Helper T cells - recognize foreign antigens and help activate cytotoxic T cells and plasma cells
  3. Inducer T cells - stimulate the production of the different T cell subsets
  4. Suppressor T cells - work to suppress the responses of the outer cells and provide feedback information to the system
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37
Q

Which WBC are large wandering cells that attack and engulf foreign antigens?

A

Macrophages

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38
Q

Which WBC represents the primary cellular defense against bacterial organisms through the process of phagocytosis?

A

Neutrophils

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39
Q

The health man has about _______ RBCs in each cubic millimeter (mm3) of blood.

A

5 million

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40
Q

The health woman has about _______ RBCs in each cubic millimeter (mm3) of blood.

A

4 million

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41
Q

What does an elevated number of monocytes suggest?

A

Infection and inflammation

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42
Q

In the healthy man, the Hct is about _______.

A

45 percent

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43
Q

In the healthy woman, the Hct is about _______.

A

42 percent

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44
Q

For both man and woman, normal MCV is ____________.

A

87 to 103 µm3

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45
Q

What entails the collection of a single sputum sample in a special container with fixative solution?

A

Cytology examination

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46
Q

What are some indications for diagnostic bronchoscopy?

A
  • Persistent atelectasis
  • Excessive bronchial secretions
  • Acute smoke inhalation injuries
  • Intubation damage
  • Bronchiectasis
  • Foreign bodies
  • Hemoptysis
  • Lung abscess
  • Major thoracic trauma
  • Stridor or localized wheezing
  • Unexplained cough
  • Abnormal radiographic findings
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47
Q

Bronchoalveolar lavage (BAL) is commonly used to diagnose what?

A

Pneumocystis jiroveci pneumonia

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48
Q

An _____________ may be performed during a bronchoscopy to help establish the stage of lung cancer and, importantly - establish if - and how — the cancer may have spread.

A

Endobronchial ultrasound

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49
Q

What test is used to inspect and perform biopsy of lymph nodes in the anterior mediastinal area?

A

Mediastinoscopy

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50
Q

Eosinophils make up about ________ of the total number of WBCs.

A

2 to 4%

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51
Q

Basophils make up about ________ of the total number of WBCs.

A

0.5 to 1%

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52
Q

Lymphocytes make up about ________ of the total number of WBCs.

A

20 to 25%

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53
Q

Monocytes make up about ________ of the total number of WBCs.

A

3 to 8%

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54
Q

Which WBC have granules that are neutral and therefore do not stain with an acid or a base dye?

A

Neutrophils

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55
Q

An increased neutrophil count is associated with:

A
  • Bacterial infection
  • Physical and emotional stress
  • Tumors
  • Inflammatory or traumatic disorders
  • Some leukemia
  • Myocardial infarction
  • Burns
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56
Q

Normochromic anemia is commonly caused by what?

A

Excessive blood loss

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57
Q

The _______ is a measure of weight of Hb in a single RBC.

A

Mean Cell Hemoglobin (MCH)

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58
Q

What is the normal range for MCH?

A

27 to 32 pg/RBC

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59
Q

Which WBC plays an important role in the breakdown of protein material?

A

Eosinophils

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60
Q

In the healthy subject, the T4/T8 ratio is about _____.

A

2.0

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61
Q

Various clinical procedures such as bronchoscopy or the insertion of an arterial catheter are generally safe when the platelet count is no lower than _____________.

A

50,000/mm3

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62
Q

What test is performed to:
1. Diagnose bacterial infection
2. Select an antibiotic
3. Evaluate the effectiveness of antibiotic therapy?

A

Culture and sensitivity study

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63
Q

What is the turn around time for a culture and sensitivity study?

A

48 to 72 hours

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64
Q

All but the ___________ can be seen on a Gram stain.

A

Viral organisms

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65
Q

With minimal risk to the patient - and without interrupting the patient’s ventilation - the flexible fiberoptic bronchoscope allows direct visualization of the upper airways down to the third or fourth generation.

A

Bronchoscopy

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66
Q

What is considered the first line of defense in the treatment of atelectasis from retained secretions?

A

Routine respiratory therapy modalities at the patient’s bedside:
- CPT
- Intermittent percussive ventilation
- PD
- Deep breathing
- PEP therapy
- Coughing techniques

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67
Q

Clinically, therapeutic bronchoscopy is commonly used in the management of:

A
  • Bronchiectasis
  • Alveolar proteinosis (with lavage)
  • Lung abscess
  • Smoke inhalation
  • Thermal injuries
  • Lung cancer
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68
Q

What may be performed during a bronchoscopy to help establish the stage of lung cancer and how the cancer spread?

A

EBUS - Endobronchial Ultrasound

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69
Q

Which procedure is used to diagnose carcinoma, granulomatous infection and sarcoidosis?

A

Mediastinoscopy

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70
Q

After an open-lung biopsy, a chest tube is inserted for drainage and suction for how long?

A

7-14 days

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71
Q

A needle lung biopsy is contraindicated in what patients?

(6)

A
  • Patients with lung bullae
  • Cysts
  • Blood coagulation disorders
  • Severe hypoxia
  • Pulmonary hypertension
  • Cor pulmonale
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72
Q

Where are over two-thirds of lung tumors located?

A

Lung periphery

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73
Q

What are the advantages of the navigational bronchoscopy procedure?

A
  • Minimally invasive
  • Reaches tumors located in the periphery of lungs
  • Requires less time for recovery
  • Can be done on an outpatient basis
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74
Q

Depending on the purpose of a thoracentesis, up to how much can be withdrawn?

A

1500 mL

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75
Q

After a thoracentesis, what is the patient instructed to do?

A

Lie on the puncture site for an hour to allow it to heal

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76
Q

What are some complications of a thoracentesis?

(5)

A
  • Pneumothorax
  • Postaspiration pulmonary edema
  • Infection
  • Bleeding
  • Organ damage
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77
Q

Pleurodesis is achieved by injecting any number of agents into the pleural space through a chest tube. What are the agents called?

A

Sclerosing agents or sclerosants

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78
Q

Although complications of pleurodesis are uncommon, what are some of the risks?

A
  • Superinfection
  • Bleeding
  • ARDS
  • Pneumothorax and respiratory failure
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79
Q

Talc and doxycycline can cause __________.

A

Fever and pain

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80
Q

What can quinacrine cause?

A

Low BP, fever and hallucinations

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81
Q

Bleomycin can cause ___________.

A

Fever, pain and nausea

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82
Q

Pleurodesis may fail due to what complications?

A
  • Trapped lung, the lung is enclosed in scar or tumor tissue
  • Formation of isolated pockets within pleural space
  • Loss of lung flexibility
  • Production of large amounts of pleural fluid
  • Extensive spread of pleural cancer
  • Improper positioning, blockage or kinking of chest tube
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83
Q

What is the most frequent laboratory hematology?

A

Complete Blood Count - CBC

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84
Q

Clinically, what are useful in assessing a patient’s overall oxygen-carrying capacity?

A
  • Total RBCs
  • Red blood cell indices
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85
Q

Because of granulocyte cells have distinctive multilobar nuclei, they’re often referred as ____________.

A

Polymorphonuclear leukocytes

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86
Q

What is the WBC range count?

A

5,000-10,000 cells per cubic millimeter of blood

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87
Q

Band forms almost always signify infection if elevated about ______% of the differential.

A

10

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88
Q

The volume of red blood cells in 100 mL of blood

A

Hematocrit

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89
Q

Hematocrit is also called ___________.

A

Packed cell volume

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90
Q

What is the normal hematocrit in a healthy newborn?

A

45-60%

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91
Q

What is the normal Hb value for men?

A

14-16g

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91
Q

Each RBC contains about ______ Hb molecules

A

280 million

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92
Q

What is the normal Hb value for women?

A

12-15g

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93
Q

Hb constitutes about _____ % of the RBC weight.

A

33

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94
Q

_______ is the actual size of the RBCs and is used to classify anemias.

A

Mean Cell Volume (MCV)

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94
Q

_______ is the measure of weight Hb in a single RBC.

A

Mean Cell Hemoglobin (MCH)

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94
Q

__________ is a measure of the concentration or proportion of Hb in an average (mean) RBC.

A

Mean Corpuscular Hemoglobin Concentration - MCHC

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94
Q

What is the normal MCHC ranges for men and women?

A

32-36%

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94
Q

Macrocytic (large cell anemia) is commonly caused by _________.

A

Folic acid and vitamin B12 deficiencies

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95
Q

What type of anemia is this?
Patient produces fewer RBCs, but the RBCs that are present are larger than normal

A

Macrocytic anemia

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96
Q

Where is hypochromic (decreased Hb) microcytic (small cell size) anemia commonly seen?

A

Patients with:
- Chronic blood loss
- Iron deficiency
- Chronic infections
- Malignancies

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97
Q

Eosinophils are activated by what?

A

Allergies and parasitic infections

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98
Q

The granules of basophil stain blue with a _____.

A

Basic dye

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99
Q

_____________ are short-lived, phagocytic WBCs with a half-life of about 1 day.

A

Monocytes

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100
Q

Monocytes circulate in the bloodstream, from which they move into tissues at which point they mature into long-living macrophages called what?

A

Histiocytes

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101
Q

What happens when foreign material cannot be digested by the macrophages?

A

Macrophages may proliferate to form a capsule that surrounds and encloses the foreign material (e.g fungal spores)

102
Q

What are considered the first lines of cellular inflammatory defense?

A

Macrophages and monocytes

103
Q

Which lymphocyte has a smooth surface?

A

T cells
B cells have projections

104
Q

B cells, which are formed in the bone marrow, further divide into either:

A

Plasma cells or memory cells

105
Q

Where are T cells formed?

A

Thymus

106
Q

What subset consists mainly of cytotoxic and suppressor cells?

A

T8 surface antigen

107
Q

What surface antigen subset makes up 60-70% of circulating T cells?

A

T4 surface antigen

108
Q

In a patient with HIV/AIDS, the T4/T8 ratio is usually _________.

A

0.5 or less

109
Q

Where are platelets formed?

A

Bone marrow and possibly in the lungs

110
Q

What is the normal value for lactic dehydrogenase?

A

80-120 Wacker units

111
Q

What is the normal value for Serum glutamic oxaloacetic transaniminase (SGOT)?

A

8-33 U/mL

112
Q

What is the normal value for Chloride (CI-)?

A

95-103 mEq/L

113
Q

Ch. 10
Of the seven “index conditions” monitored, what are the 5 significant use of respiratory care services?

A
  • Acute pneumonia
  • COPD exacerbation
  • Postoperative infections
  • VAP
  • CHF/Pulmonary edema
  • Myocardial infarction
114
Q

Ch. 10
According to the AARC, what is the purpose of respiratory TDPs?

A
  • Deliver individualized diagnostic and therapeutic respiratory care to patients
  • Assist physician with evaluating patients’ needs and optimize the allocation of respiratory care services
  • Determine the indications for respiratory therapy
  • Empower respiratory therapist to use sign and symptom based algorithms
115
Q

What are the indications for Oxygen Therapy protocol?

A
  • PaO2 less than 60 on room air
  • SaO2 less than 90 room air
  • Acute hypoxemia suspected
  • After severe trauma
  • Intraoperative and postoperative state
  • Acute myocardial infarction
  • Low CO state
  • Hypoxia suggested in sleep study or CPET
  • Hb less than 8.0 g/dL
116
Q

Hypoxemia that develops as a result of consolidation is caused by _____________.

A

Capillary shunting

117
Q

What are the indications for Airway Clearance Therapy protocol?

A
  • Restore mucocilliary blanket
  • Hydrate and remove retained secretions
  • Improve cough effectiveness/expectoration
  • Prevent atelectasis
118
Q

Hypoxemia that results from atelectasis is caused by ____________.

A

Partial or total capillary shunting

119
Q

What are the indications for Lung Expansion Therapy protocol?

A
  • Predisposing conditions for atelectasis
  • Upper abdominal and thoracic surgery
  • Surgery in patients with chronic lung disease (CLD) and CHF
  • Existing pulmonary fibrosis
  • Restrictive lung disorders
  • Patients with excessive secretions
  • Patients with chronic neuromuscular diseases
120
Q

What is the primary indication for aerosolized bronchodilator therapy?

A

Reversible reactive airway diseases

121
Q

Hypoxemia that develops as a result of an increased alveolar-capillary membrane is caused by ____________.

A

Alveolar-capillary diffusion block

122
Q

What is the primary treatment modality used to offset the anatomic alterations of bronchospasm?

A

Aerosolized Medication Therapy Protocol

123
Q

What is the secondary treatment modality used to offset the mild, moderate or severe clinical manifestations associated with bronchospasm?

A
  • Oxygen Therapy Protocol
  • Mechanical Ventilation Protocol
124
Q

What is the primary treatment modality used to offset the anatomic alterations associated with excessive bronchial secretions?

A

Airway Clearance Protocol Therapy

125
Q

What is the general term used to describe the inability of the respiratory system to establish and maintain adequate oxygen uptake and carbon dioxide removal from the body?

A

Respiratory failure (Ventilatory failure)

126
Q

On the basis of the ABG values, respiratory failure is classified as what two things?

A
  • Hypoxemic respiratory failure (type I respiratory failure)
  • Hypercapnic respiratory failure (type II respiratory failure)
127
Q

There a 6 basic anatomic alterations of the lungs, which in turn cause 6 different scenarios that can result in respiratory failure. What are they?

A
  • Atelectasis
  • Alveolar consolidation
  • Increased alveolar-capillary membrane thickness
  • Bronchospasm
  • Excessive bronchial secretions
  • Distal airway and alveolar thickening
128
Q

What is the ABG criteria in a patient with respiratory failure?

A
  • PaO2 less than 60 mmHg
  • CO2 greater than 50 mmHg
  • A mixture of both
129
Q

What are some subjective findings of respiratory failure?

A
  • Dyspnea
  • Anxiety
  • Restlessness
  • Rapid and shallow breathing
130
Q

What are some objective findings of respiratory failure?

A
  • Cardiac arrythmias
  • Hypertension and preterminally hypotension
  • Coma
  • Death
131
Q

The term hypoxemic respiratory failure is when the primary problem is ____________________.

A

Inadequate oxygenation between the alveoli and the pulmonary capillary system, which results in a decreased PaO2.

132
Q

The term hypercapnic respiratory failure is when the primary problem is ____________________.

A

Alveolar hyperventilation, which results in an increased PaCO2, and without supplemental oxygen, a decreased PaO2.

133
Q

Hypercapnic respiratory failure is commonly called what?

A

Ventilatory failure

134
Q

What are some clinical indicators of hypoxemic respiratory failure?

A
  • Decreased PaO2
  • Increased alveolar-arterial oxygen tension gradient
  • Decreased arterial oxygen tension to fractional inspired oxygen ratio (PaO2/FIO2)
135
Q

What are the major pathophysiologic causes of hypoxemic respiratory failure?

A
  • Alveolar hypoventilation
  • Pulmonary shunting
  • Ventilation-perfusion mismatch
  • Less common: Decrease in inspired oxygen pressure
136
Q

What are some common causes of alveolar hypoventilation?

A
  • CNS depressants
  • Head trauma
  • Chronic obstructive pulmonary disease
  • Obesity
  • Sleep apnea
  • NMDs
137
Q

When does alveolar hypoventilation develop?

A

When the minute volume of alveolar ventilation is not adequate for the body’s metabolic needs

138
Q

The results of alveolar hypoventilation are _______________.

A
  • Hypoxia
  • Hypercapnia
  • Respiratory acidosis
  • In severe cases, pulmonary hypertension with cor pulmonale
139
Q

Treatment of alveolar hypoventilation primarily consists of _________________.

A

Ventilatory support

140
Q

Define pulmonary shunting.

A

The portion of the cardiac output that moves from the right side to the left side of the heart without being exposed to alveolar oxygen.

141
Q

Pulmonary shunting is divided into what two categories?

A
  • Absolute shunt
  • Relative shunt
142
Q

Which type of shunt responds poorly to oxygen?

A

Absolute shunts

143
Q

Absolute shunts are either classified as ____________ or _______________.

A

Anatomic shunt or capillary shunt

144
Q

Anatomic shunts occur when ___________________.

A

Blood flows from the right side of the heart to the left side without coming in contact with an alveolus for gas exchange

145
Q

In a healthy lung, what is the normal anatomic shunt of the cardiac output?

A

3 percent

146
Q

What is the normal P(A-a)O2 difference?

A

7 to 15 mmHg

147
Q

What are common abnormal causes of anatomic shunts?

A
  • Congenital heart disease
  • Intrapulmonary fistula
  • Vascular lung tumors
148
Q

Capillary shunts are caused by _______________.

A
  • Alveolar collapse or atelectasis
  • Alveolar fluid accumulation
  • Alveolar consolidation or pneumonia
149
Q

The sum of __________________ makes up the absolute (also called the true shunt)

A

Anatomic shunt and capillary shunt

150
Q

What are some common respiratory disorders that cause airway obstruction?

A
  • Emphysema
  • Chronic bronchitis
  • Asthma
  • CF
151
Q

Define relative shunt.

A

When pulmonary capillary perfusion is in excess of alveolar ventilation.

152
Q

A relative shunt can be caused by ____________.

A

An airway obstruction, an alveolar-capillary diffusion defect or both

153
Q

Under normal conditions, the overall alveolar ventilation is _________.

A

4 L/min

154
Q

Under normal conditions, the pulmonary capillary blood flow is _________.

A

About 5 L/min

155
Q

In an ____________ the alveolar oxygen does not come in direct contact with the shunted blood - the nonoxygenated blood completely bypasses the ventilated alveoli and mixes downstream with the oxygenated blood.

A

Anatomic shunt

156
Q

What is the VD/VT ratio in a normal spontaneously breathing adult?

A

20-40%

157
Q

What is the VD/VT ratio in a patient receiving mechanical ventilation?

A

40-60%, because of the mechanical dead space added by the ETT.

158
Q

The VD/VT ratio increases with diseases that cause significant dead space, such as ____________.

A

Pulmonary embolism

159
Q

Where is the PeCO2 derived?

A

Capnometer

160
Q

What is the normal overall pulmonary ventilation-perfusion ratio?

A

4:5 or 0.8

161
Q

The volume of gas in the conducting airways: the nose, mouth, pharynx and larynx and lower portions of the airways down to but not including the respiratory bronchioles.

A

Anatomic dead space

162
Q

The sum of the anatomic and alveolar dead space.

A

Physiological dead space

163
Q

The volume of anatomic dead space is approx. equal to ____________ of normal body weight.

A

1 mL/lb (2.2 mL/kg)

164
Q

When the alveolus is ventilated but not perfused with capillary blood. What is this called?

A

Alveolar dead space

165
Q

_______________ is used clinically to identify the primary cause of hypoxemic respiratory failure.

A

Alveolar-arterial oxygen tension difference

166
Q

What is the normal range for P(A-a) O2?

A

7-15 mmHg and should not exceed 30 mmHg

167
Q

P(A-a) O2 increases at _____________.

A

High oxygen concentrations

168
Q

The normal P(A-a) O2 for an FiO2 of 1.0 is ___________________.

A

25-65 mmHg

169
Q

What is the critical value of P(A-a) O2 on the 100% oxygen is __________.

A

Greater than 350 mmHg

170
Q

When ___________ is the primary cause of hypoxemic respiratory failure, the P(A-a) O2 is elevated.

A
  • V/Q mismatch
  • Pulmonary shunting
  • Diffusion blockade
171
Q

What is the phrase used when the primary problem is alveolar hypoventilation?

A

Hypercapnic respiratory failure (type II)

172
Q

What are the major pathophysiologic mechanisms that result in hypercapnic respiratory failure?

A
  • Alveolar hypoventilation
  • Increased dead space disease
  • Severe V/Q mismatch
173
Q

A condition in which the lungs are unable to meet the metabolic demands of the body in terms of CO2 removal.

A

Acute ventilatory failure - acute respiratory acidosis

174
Q

What are the four standard criteria for mechanical ventilation?

A
  • Apnea
  • Acute ventilatory failure
  • Impending ventilatory failure
  • Severe refractory hypoxemia
175
Q

Is apnea an indication of invasive or noninvasive mechanical ventilation?

A

Invasive mechanical ventilation

176
Q

_________ occurs when the patient demonstrates a significant increase in the work of breathing with borderline acceptable ABG values.

A

Impending ventilatory failure

177
Q

Severe refractory hypoxemia is seen _______________.

A

In cases of severe pneumonia, ILDs, ARDS

178
Q

What is the primary indication for NIV?

A

Hypercapnic respiratory failure secondary to COPD exacerbation

179
Q

What are some benefits of noninvasive ventilation?

A
  • Avoids ET intubation
  • Reduces airway trauma, risk for aspiration, nosocomial pneumonia
  • Maximizes patient effort
  • Decrease mortality
  • Increases alveolar ventilation
  • Decreases muscle fatigue
  • Decreases O2 consumption
180
Q

About _____% of ventilated patients need a more systemic approach to discontinuing the ventilatory support.

A

15-20

181
Q

About _____% of patients require days or weeks to be weaned off MV.

A

5

182
Q

What are some common used tools to assess the patient’s readiness for ventilator weaning?

A
  • PaO2/FiO2 ratio
  • P(A-a)O2
  • MIP
  • Airway occlusion pressure at 0.1 second
  • P0.1/MIP ratio
  • VC
  • VEsp
  • MVV
  • Pressure Time Index (PTI)
  • RSBI
  • Cuff leak test
183
Q

Term used when it can be proved the mechanical ventilation caused an acute lung injury.

A

VILI - Ventilator Induced Lung Injury

184
Q

What are the most common forms of VALI?

A
  • Barotrauma
  • Volutrauma
185
Q

What is the normal range for PaO2/PAO2 ratio?

A

0.75 to 0.95

186
Q

What is the normal range for PaO2/FiO2 ratio?

A

350-450

187
Q

What is the normal range for Qs/Qt?

A

<5

188
Q

What is the normal PTI range?

A

0.5 to 1.2.

Criteria for successful weaning are less than 0.15-0.18

189
Q

________________ is defined as the overexpansion of the alveolar structure, alveolar rupture and air leakage caused by high ventilator volumes and pressure.

A

Barotrauma

189
Q

How is volutrauma different from barotrauma?

A

Alveolar rupture does not occur

190
Q

Studies have suggested that ____________ is the most reliable single measurement to assess the risk for barotrauma in ventilated patients.

A

P plat - Ventilator plateau pressures

and monitoring peak airway pressures

191
Q

The generally accepted lung protective strategies to avoid and treat VALI are:

A

Low tidal volumes, low peak and plateau pressures and permissive hypercapnia

192
Q

What is characterized by a weakening and permanent enlargement of the air spaces distal to the terminal bronchioles and by destruction of the alveolar walls?

A

Emphysema

193
Q

What are the two major types of emphysema?

A

Panacinar (panlobular) and Centriacinar (centrilobular)

194
Q

Chronic bronchitis is defined clinically as…..

A

Chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded

195
Q

In patients with COPD, both _______ and _______ are present.

A

Chronic bronchitis and emphysema

196
Q

Whose definition is this?
Chronic obstructive pulmonary disease is a preventable and treatable disease state caused by airflow limitation that is not fully reversible.

A

The American Thoracic Society

197
Q

Whose definition is this?
Chronic obstructive pulmonary disease is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is caused by airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gas

A

GOLD - Global Initiative for Chronic Obstructive Lung Disease

198
Q

The ___________ are the primary structures that undergo change in chronic bronchitis.

A

Conducting airways (particularly the bronchi)

199
Q

What are the major pathologic or structural changes associated with chronic bronchitis?

A
  • Chronic inflammation and thickening of the walls of the peripheral airways
  • Excessive mucous production and accumulation
  • Partial or total mucous plugging of the airways
  • Smooth muscle constriction of bronchial airways
  • Air trapping or hyperinflation of alveoli may occur in late stages
200
Q

With emphysema, the weakened distal airways tend to collapse during _______________ in response to increased ICP.

A

Expiration

201
Q

Where is panlobular emphysema commonly found?

A

Lower parts of the lungs and is sometimes associated with a deficiency of the protease inhibitor alpha1-antitrypsin

202
Q

Which type of emphysema is more severe?

A

Panlobular emphysema

203
Q

In centrilobular emphysema, the pathologic issues involve the ___________.

A

Respiratory bronchioles in proximal (central) portion of the acinus

204
Q

What is centriacinar emphysema strongly associated with?

A

Smoking and chronic bronchitis

205
Q

It is estimated that _______ people in the US have chronic bronchitis, emphysema or both

A

10-15 million

206
Q

COPD-related deaths claim more than _______ Americans each year

A

138,000

207
Q

More people have chronic bronchitis than emphysema.

A

CB - 9.5 million
Emphysema - 4.1 million

208
Q

Alpha1-antitrypsin is made in the _____________.

A

Liver. One of its functions is to protect the lungs from neutrophil elastase, an enzyme that can break down connective tissue

209
Q

The premature development of emphysema is the hallmark of __________________________

A

Alpha1-antitrypsin

210
Q

What is the normal level of alpha1-antitrypsin?

A

150-350 mg/dL when measure via radial immunodiffusion.

211
Q

A spirometry test is required to confirm the diagnosis of COPD, showing the presence of a postbronchodilator FEV1/FVC of ___________.

A

Less than 0.70

212
Q

What are three main spirometric tests used to measure the severity of airflow limitation in a patient with suspected COPD?

A
  • FVC
  • FEV1
  • FEV1/FVC ratio
213
Q

What are the primary goals of COPD assessment?

A
  • Establish degree of airflow limitation
  • Determine the effect of the COPD on the patient’s health status
  • Ascertain the risk for future events
214
Q

An mMMR greater than _____ is considered a high risk patient.

A

2

215
Q

A CAT score less than ____ is classified as a low risk patient.

A

10

216
Q

According to GOLD, a COPD exacerbation is defined as ______________________.

A

“acute worsening of respiratory symptoms that result in additional therapy”

217
Q

What is the best predictor for the risk of exacerbation?

A

Patient’s history of exacerbations, including hospitalizations

218
Q

A history of _____________ per year is considered a high risk for more exacerbations.

A

Two or more exacerbations

219
Q

The inward movement of the lower lateral chest wall during each inspiration - indicates severe hyperinflation.

A

Hoover sign.

220
Q

Palpation of the chest: Chronic bronchitis

A

Normal

221
Q

Percussion of the chest: Chronic bronchitis

A

Normal

222
Q

Percussion of the chest: Emphysema

A
  • Hyperresonance
  • Decreased diaphragmatic excursion
223
Q

Auscultation of the chest: Emphysema

A
  • Diminished breath and heart sounds
  • Prolonged expirations
224
Q

Peripheral edema and venous distention: CB and Emphysema

A

Emphysema - end stage
CB - COMMON!

225
Q

Palpation of the chest: Emphysema

A
  • Decreased tactile fremitus
  • Decreased chest expansion
  • PMI often shifts to epigastric area
226
Q

Hoover sign is common in CB or emphysema?

A

Pink puffers! Emphysema

227
Q

Patients in Group C should be given _____________.

A

A single LAMA.

228
Q

What is the initial tx for group B patients?

A

LAMA or LABA

229
Q

Patients in group D should be stated on ________________.

A

LABA + LAMA

230
Q

Initially, supplemental oxygen should be administered with a target SaO2 of _________.

A

88-92%

231
Q

Oxygen therapy is used to:

A
  • Treat hypoxemia
  • Decrease WOB
  • Decrease myocardial work
232
Q

Which phenotype is associated with the lowest serum concentration of alpha1- antitrypsin?

A

ZZ phenotype

233
Q

Patients with allergic asthma usually respond well to therapy with ____________.

A

ICSs

234
Q

What type of medication is Beclomethasone?

A

ICS
Brand name: QVAR

235
Q

What type of medication is Tiotropium?

A

LAMA
Brand name: Spiriva HandiHaler
Spirivia Respimat

236
Q

What is sameterol’s brand name?

A

Serevent Diskus (LABA)

237
Q

What is CICLESONIDE’s brand name?

A

Inhaled Corticosteroids
Alvesco

238
Q

What is FLUTICASONE’s brand name and drug class?

A

Inhaled Corticosteroids
- Flovent HFA
- Flovent Diskus
- Arnuity Ellipta

239
Q

What is HYRDOCORTISONE’s brand name and drug class?

A

Oral Corticosteroids
Solu-Cortef

240
Q

What is MOMETASONE’s brand name and drug class?

A

Inhaled Corticosteroids
Asmanex Twisthaler
Asmanex HFA

241
Q

What is FLUNISOLIDE’s brand name and drug class?

A

Inhaled Corticosteroids
Aerospan HFA

242
Q

What is Dulera?

A

ICS and LABA combined
Mometasone and formoterol

243
Q

What is METHYLPREDNISOLONE’s brand name and drug class?

A

Oral Corticosteroid
- Medrol
- Solu-Medrol

244
Q

What is Advair Diskus?

A

ICS and LABA
Fluticasone and salmeterol

245
Q

What is Symbicort?

A

ICS and LABA
Budesonide and formoterol

246
Q

What is Budesonide?

A

Inhaled Corticosteroid
Pulmicort Flexhaler

247
Q

What are the LAMAs?

A

Tiotropium - Spiriva HandiHaler and Spiriva Respimat
Aclidinium - Tudorza Pressair
Umeclidinium - Incruse Ellipta

248
Q

What are the Leukotriene Inhibitors?

A

Zafirlukast - Accolate
Montelukast - Singulair
Zileuton - Zyflo, Zyflo CR

249
Q

What are the Xanthine Derivatives?

A

Theophylline - Theochron, Elixphyllin, Theo-24
Oxtriphylline - Choledyl SA
Aminophylline - Generic
Dyphylline - Lufyllin

250
Q

What are the agents used to reduce inflammation in allergic diseases?

A

Anti-interleukin-5
- Mepolizumab (subc.)
- Reslizumab (IV)

251
Q

Antiimmunoglobulin E (Anti-IgE)

A

Omalizumab - Xolair

252
Q

Combined SABAs and Anticholinergic agent

A

Ipratropium and Albuterol - DuoNeb, Combivent Respimat

253
Q

Combined LABAs and Anticholinergic agent

A

Umeclidinium and Vilanterol - Anora Ellipta

254
Q

What classification is Albuterol?

A

Classification: SABA
Brand name: Proventil HFA, Ventolin HFA, ProAir HFA

255
Q

What is Ipratropium classified as and what is the brand name?

A

Classification: SAMA
Brand name: Atrovent HFA

256
Q

What are all the LABAs?

A
  • Salmeterol: Servent Diskus
  • Formoterol: Performist, Foradil Aerolizer
  • Arformoterol: Brovana
  • Indacater: Arcapta Neohaler
  • Olodaterol: Striverdi Respimat
257
Q

What is fluticasone and salmeterol?

A

COMBINED LABA AND ICS
Advair Diskus (250/50 mcg only)

258
Q

What is budesonide and formoterol?

A

COMBINED LABA AND ICS
Symbicort (60/4.5 mcg only)

259
Q

What is fluticasone and vilanterol?

A

COMBINED LABA AND ICS
Breo Ellipta

260
Q

What is a phosphodiesterase-4 inhibitor?

A

Generic: Roflumilast
Brand name: Daliresp

RET1293 (10 decks)

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