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PAtho > Unit 9 > Flashcards

Unit 9 Flashcards

1
Q

pulm edema

A

pulm congestion in vessels, fluid accum in lungs/alveoli

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2
Q

what causes pulm edema

A

inc HCP

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3
Q

et pulm edema

A

usually LS CHF

non CV issues

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4
Q

which non CV issues may cause pulm edema

A

FVE
smoke inhalation
aspiratin
iv drug abuse

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5
Q

why FVE cause pulm edema

A

inc blood vol lt inc HCP

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6
Q

why may smoke inhalation from a fire cause pulm edema

A

inhalation of toxic fumes -> inflm -> altered perm -> fluid shift

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7
Q

why may iv drug use cause pulm edema

A

inc vessel perm, CNS depression -> issue with fluid exch

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8
Q

path of fluid movement in pulm edema

A

fluid moves from blood to IS spae to alveoli

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9
Q

what does accumulation of fluid in avleoli do to gas exchange

A

increases the distance req for GE + expands SA lt dec GE and dec lung fx

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10
Q

mnfts of pulm edema

A

productive frothy cough
dec lung compliance
wet crackles on ausc

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11
Q

why do pts w pulm edema have a prod frothy cough

A

mix of air and fluid causing frothy sputum

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12
Q

why do lungs have dec compliance in pulm edema

A

rt inc in fluid in lungs

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13
Q

tx for pulm edema

A

treat cause , resp support via O2 and ventilation

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14
Q

embolism

A

process of formation for an emboli

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15
Q

how does pulm embolism occur

A

clot in DV dislodges -> RA -> RV pulm circuit

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16
Q

where are thrombi in pulm ebolism usually located

A

arterial pulm v

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17
Q

what percent of pulm emboli are lethal

A

33%

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18
Q

where do majority of pulm emboli arise from

A

DVTs

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19
Q

which veins have inc incidence for emb fomration

A

iliac, popliteal, femoral

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20
Q

other causes of pulm emb

A

fat, air, amniotic fluid

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21
Q

how may fat cause a pulm emb

A

fat from bone marrow if bone is fractured, as bones are highly vascularized

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22
Q

how may amniotic fluid cause a pulm emb

A

if rupture of membs coincideds with rupture of vessels during birth. fluid contains some partiular matter

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23
Q

where do large pulm emboli usually lay

A

in the bifurcation of main pulm a.

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24
Q

what variable does pulm emboli change in the PV ration

A

P and V

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25
Q

if a pulm emboli begins as dvt, what happens next …

A

breaks off -> embolus -> thrombus in a. bed -> impaired perf

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26
Q

what do platlets do when they interact with an embolis

A

begin to degranulate

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27
Q

what happens when platelets degranulate in pulm embolism

A

rls of mediators

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28
Q

what does mediator rls in pulm emb cause

A

constr of brachial and pulm a

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29
Q

why is V affected in VP in pulm emb

A

bronchial constr

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30
Q

what does hemodynamic instability

A

blood vol, BP, blood flow

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31
Q

what type of broncho constr occurs in pulm emb

A

reflexive

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32
Q

what causes reflexive broncho constr

A

n. reflex by SNS

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33
Q

what is the benefit of reflexive broncho constr

A

no benefit

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34
Q

why does CO dec in pulm emb

A

dec blood flow to LS of heart dt obstr-> dec circulation

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35
Q

what happens to surfactant prod in pulm emb. why

A

dec bc adeq perf is needed for surfactant to form

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36
Q

what happens when there is dec surfactant

A

atelectasis

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37
Q

mechanism of dec surfactant prod

A

ischemia rt dec perf -> tissue damage -> dec surf

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38
Q

why does RS HF occur in pulm embol

A

RS is pumping against resistance -> hypertrophy of RV

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39
Q

what are mnfts of pulm emboli based on

A

location of embolis and size

40
Q

mfnts of pulm embolism

A

chest pain
tachypnea
dyspnea
tachycardia

41
Q

why may chest pain occur in pulm embolism

A

rt ischemia

42
Q

why may tachypnea occur in pulm embolism

A

rt bronchospasm??

43
Q

when does dyspnea occur in pulm embolism

A

if there is tissue damage

44
Q

why does dyspea occur in pulm ebolism

A

dec sa for GE

45
Q

why does tachycardia occur in pulm embolism

A

rt dec CO

46
Q

is inc HR in pulm ebol compesnatory

A

YES

47
Q

dx for pulm embolism

A 
hx, px
ABG
LDH3
Lungscan
CXR, CT
angiogram
48
Q

which dx test for pulm embolism is most affectve

A

angiogram, but it is also the most invasive

49
Q

LDH3

A

lactase dehydrogenase

50
Q

fx of LDH3

A

ez that is released when there is tissue damage in lung damage (serum marker) 3 is lung spec

51
Q

what is the complete name for lung scan

A

lung scan 131 I-HSA, IV

52
Q

“HSA” in lung scan 131 I-HSA

A

stands for human serum albumin

53
Q

what is HSA labeled with when doing lung scan

A

With iodine 131, an isotope.

54
Q

fx of a lung scan

A

to label :HSA and visualize its movement thru the pulm circulation.

55
Q

how is a lung scan done

A

injected IV and then visualized. non invasive

56
Q

Tx for pulm embol (stat)

A

size dependent
anticoagulants and thrombolytics
maintain CV fx

57
Q

when do we use caution with anticoag and thrombolytics

A

in pts who are at risk for bleeding

58
Q

why do we maintain CV fx when txing pulm embol

A

to avoid shock

59
Q

pulm htn

A

htn within pulm circuit that is pathologic and is sustained a

60
Q

what measurement indicates pulm htn

A

> 25mmHg

61
Q

normal mmhg for pulm circuit

A

~15mmhg

62
Q

what allows the pulm circuit to handle inc CO

A

low P, low resistance circuit, where blood is distributed over extensive vasculature

63
Q

when is inc CO a problem for the pulm circuit

A

when there is resistance in the ciruit

64
Q

3 cats of et for pulm htn

A

inc pulm vol (rt septum defect)
hypoxemia
inc pulm venous p

65
Q

et for pulm htn: inc pulm vol

A

fetal septum between RA and LA doesnt fully close, so blood can move into RA from LA and go into pulm circuit again, inc Co

66
Q

et for pulm htn: hypoxemia

A

hypoxic lung tissue vaso constricts to prevent mass rls of CO2 causing inc resistance

67
Q

what does hypoxic peripheral tissue do

A

vasodilates vessels to remove excess CO2

68
Q

what may cause inc in pulm venous P

A

LV dysfx -> LSHF

69
Q

top 3 mnfts of pulm htm

A

dyspnea, syncope, chestpain on excertion

70
Q

what other mfnts occur in pulm htn

A

those of RSHF rt RV pumping against resistance

fatigue

71
Q

what do you see on a cxr of a pt with pulm htn

A

RS v hypertrophy prior to HF

72
Q

tx of pulm htn

A

tx cause
dec progression
vasodilation w CA channel blocker

73
Q

ARDS

A

str damage to cap wall and alveoli rt trauma of lung. gross, fatal, and rapid damage with acute onset

74
Q

mortality in ards

A

40-60%

75
Q

et of ards

A 
aspiration (near drowning/GI content)
drugs (recreational)
inhaled gas or smoke
infc (septic)
trauma/shock (burns, fat embolism, chest trauma)
inc blood transfusions
76
Q

why is there and inc in perm in ards

A

rt pathologic accum of cells lt mediator rls

77
Q

what mediators are rlsed inards

A

proteases, PAF

78
Q

what type of exudate is rls in ards

A

protein rich

79
Q

what does the protein rich exudate rlsed in ards cause

A

non permiable membraine forms on alveoli wall, no exch occurs

80
Q

what does inc perm in ards allow

A

fluid, protein, cellular debris, platlets, blood cells to move out of vasculature and enter alveoli

81
Q

what happens to neutrolphils in ards

A

rls free radicals, phospholipids, proteases

82
Q

what happens when free radicals, phospholipids and proteases are rlsd in ards

A

endothelial and alveolar damage, imfl

83
Q

how/why do proteins, cells and fluids enter alveoli in ards

A

inc permeability rt inflm creates larger cell junctions, allowing entrance of larger components

84
Q

what type of edema occurs in ards

A

large vol with variety of components

85
Q

what does large vol edema do in ards

A

dec compliance, vent, and GE

86
Q

hyaline memb

A

imprevious layer that forms in ards blocking all GE

87
Q

why is the term hyaline used in hyaline memb

A

because the memb has a shiny appearance

88
Q

why does atelec occur in ards

A

def and inactivated surfactanct

89
Q

what is detected in abg in ards

A

profound hypoxemia

90
Q

when do mnfts for ards appear

A

within minutes

91
Q

5 earliest mfnts of ards

A 
dyspnea
hypoxemia on abg
tahcypnea
resp alkilosis
late metb acidosis
92
Q

why does tachypnea occur in ards

A

compensatory response in attempt to deliver more air to lungs

93
Q

why does resp alkilosis occur in ards

A

inc RR lt dec CO2. bicarbonate inbody picks up more H to make CO2, causing alkilosis

94
Q

why does late metb acidosis occur in ards

A

inc lactic acid prod lt inc H+ in blood, rt anaerobic resp dt hypoxemia

95
Q

6th mnft of ards

A

diffuse consolodation

96
Q

tx of ards

A 
complex
early detection has better prognosis
reverse cause
resp support
avoid complications

PAtho (31 decks)

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