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Cadiopulmonary Medicine > Ch. 13 and 14 > Flashcards

Ch. 13 and 14 Flashcards

1
Q

ATS guidelines for COPD is a

A

preventable and treatable disease, characterized as airflow limitation

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2
Q

COPD is primarily caused by

A

cigarette smoke

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3
Q

Chronic productive cough for 3 months and 2 successive years

A

chronic bronchitis

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4
Q

permanent enlargement of the air sacs distal to the terminal bronchioles w. destruction of bronchial walls

A

emphysema

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5
Q

The conducting airway are the primary structures that under go change in

A

chronic bronchitis

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6
Q

As a result _________ inflammation, the __________ walls are narrowed by vasodilation, congestion and mucosal edema

A

chronic; bronchial

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7
Q

Major pathologic associated w/ chronic bronchitis (5)

A
  • thickening of the walls
  • excessive mucous production
  • partial of total mucous plugging
  • smooth muscle constriction
  • air trapping hyperinflation
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8
Q

The weakening and permanent enlargement of the air sacs distal to the terminal bronchioles

A

emphysema

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9
Q

Major pathologic associated w emphysema

A
  • permananet enlargement and destruction of the air spaces
  • destruction of AC membrane
  • Weakening of the distal, primarily respiratory bronchioles
  • air trapping and hyperinflation
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10
Q

2 types of emphysema

A
  • panacinar (panlobular) emphysema
  • centriacinar (centrilobular) emphysema
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11
Q

Most common, emphysema chronic bronchitis, cigarette smoke

A

centrilobular

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12
Q

Less common, more severe, genetic factor Alpha- anti trypsin deficiency

A

panlobular

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13
Q

Chronic bronchitis, abnormal weakening and enlargement of the Respiratory bronchioles and alveoli in the proximal portion of the acinus

A

centrilobular emphysema

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14
Q

Abnormal weakening and enlargement of all air spaces distal to the terminal bronchioles

A

panlobular

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15
Q

How many people in the US have chronic bronchitis, emphysema or both?

A

10- million

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16
Q

Risk factors include (4)

A
  • genetic factors
  • age/ gender
  • lung growth/ development
  • exposure to particles
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17
Q

Diagnosis should be considered at what age, and with pts who experience these symptoms

A

40; dyspnea, chronic cough, sputum production, history of exposure risk factors

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18
Q

3 main spirometry test are to measure the severity of airflow limitation w/ suspected COPD

A
  • FVC
  • FEV1
  • FEV1/FVC ratio
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19
Q

What the primary goals of a COPD assessment (3)

A
  1. Establish the degree of airflow limitation
  2. Determine the effect of COPD on pt’s health
  3. Ascertain the risk for future events( exacerbation of hospitalizations)
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20
Q

GOLD recommended the assessment of the features independently (4 ASEC)

A
  1. Airway limitation
  2. Symptoms
  3. Exacerbation risks
  4. Comorbidities
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21
Q

GOLD 1 = MILD=

A

FEV1 Greater than or equal to 80% predicated

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22
Q

GOLD 2= MODERATE =

A

FEV1 50% - 79% predicted

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23
Q

GOLD 3 = SEVERE=

A

FEV1 30%-49% predicated

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24
Q

GOLD 4 = VERY SEVERE =

A

FEV1 Less than or equal to 29% or less than predicated

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25
Characteristics of Emphysema (pink puffers)
- barrel chest - dyspnea - reddish skin - decreased breath sounds - hyper resonance - accessory muscle used - diminished respiratory drive
26
Characteristics of Chronic Bronchitis (blue bloaters)
- digital clubbing - hypercapnic state - cyanosis - peripheral edema - polycythemia - cor pulmonale wheezes, crackles, rhonchi
27
The heart appears long in narrow as a result being drawn downward by the descending diaphragm in which disease process
emphysema
28
Translucent (dark) lung fields at the bases, depressed diaphragms and long and narrow heart appears in which disease process
chronic bronchitis
29
In the PFT's all of the tests are
decreased
30
Mild to moderate stages 1 and 2 (Acute alveolar hypoventilation w/ hypoxemia) pH is...... paco2 is...... hco3- is ...... pao2 is.... sao2 is.....
pH increased paco2 decreased hco3- decreased pao2 decreased sao2 decreased
31
Severe stages 3 and 4 (Chronic vent failure w/ hypoxemia) pH is...... paco2 is...... hco3- is ...... pao2 is.... sao2 is.....
pH normal paco2 increased hco3- increased pao2 decreased sao2 decreased
32
lung volume and capacity findings: CB and emphysema vT is or normal; IRV is normal or; RV is normal or; VC is; IC is normal or; FRC is; TLC is normal or; RV/TLC is normal or
Increased Decreased Increased Decreased Decreased Increased Increased Increased
33
Chronic airway inflammation, history of respiratory symptoms like wheezing, SOB, chest tightening and cough
Asthma
34
Asthma is also described as heterogenous disease that commonly has a set of observable characteristics that result from the interaction of the pt’s genotype w/ environment called
asthma phenotype
35
The more common asthma phenotypes include
- allergic or atopic asthma - nonallergic asthma - late onset asthma - asthma w/ fixed airflow limitation - asthma w/ obesity
36
Most easily to identify , typically appears in childhood
allergic or atopic asthma
37
seen in some adults who do not have allergies
nonallergic asthma
38
develop asthma for the first time in adult life (especially in women)
late onset asthma
39
long history of asthma develop a fixed airflow limitation caused by **airway wall remodeling**
asthma w/ fixed airflow limitation
40
BMI greater that 30 , asthma is difficult to control
asthma w/ obesity
41
NAEPP guidelines under 4 components (APCT)
1. Assessment and monitoring 2. Pt education 3. Control factors contributing to asthma severity 4. treatment medications
42
Asthma is described as lung disorder characterized by (3)
1. Reversible bronchial smooth muscle constriction 2. Airway Inflammation 3. Increased airway responsive to an assortment
43
Pathologic changes during an asthma attack (6)
- Smooth muscle constriction of bronchial airways (bronchospasm) (wheezing breath sound typically reversable) - Excessive production of thick, whitish bronchial secretions - Mucous plugging - Hyperinflation of the alveoli (air trapping) - In severe cases atelectasis caused by mucous plugging - Bronchial wall inflammation leading to fibrosis (in severe cases, caused by remodeling)
44
How many adults and children suffer from asthma in the US
18.4 million(7.6%) and 6.2 million (8.4%) total 25 million
45
how many people suffer from asthma worldwide
235 million
46
Risk factors for asthma (3)
- genetics - obesity - sex
47
What are GINA 2 guidelines to help clinical diagnosis of asthma
1. history of variable Respiratory symptoms 2. the evidence of variable expiratory airflow limitation
48
what test helps to induce asthma attacks
bronchial provocation test (methacoline challenge)
49
Allergy test measures the level of specific _____ via RAST (eosinophils)
IgE
50
Measures fractional concentration of exhaled nitric oxide (FeNO)
Exhaled Nitric Oxide
51
Chest assessment findings during asthma attacks (6)
- Expiratory prolonged (I/E >1:3) - decreased tactile and vocal fremitus - Hypersonanate percussion note (b/c of air) - diminished breath sounds - wheezing (bronchospasm) - crackles
52
PFT Moderate to Severe Asthma episode
ALL PFT's are decreased
53
Lung volumes and capacity
54
GINA long term goals for asthma are (2)
- symptom control - risk reduction of future exacerbation (removal of potential risk factors)
55
Used for regular maintenance treatment
Controller medications
56
Used for as needed relief of asthma symptoms
Reliever (rescue) medications
57
Pt continues to have symptoms despite optimized treatment. Possibly adding on corticosteroids
Add- on therapies for pts w/ severe asthma
58
In obesity, GERD, anxiety and depression, food allergy and anaphylaxis asthma is
difficult to treat
59
Aerosolized Medication protocol for asthma
- Bronchodilators - LABA'S - ICS
60
Treat hypoxemia to decrease WOB, what protocol would you use?
Oxygen Therapy protocol
61
Excessive mucous production and secretions, PEP therapy or Acapella may be used to mobilize secretions. What protocol would be used
Airway clearance therapy
62
When a pt is **status asthmatics** (will not respond to therapy) and continue MV may be required what protocol may be used
Mechanical Ventilation Protocol

Cadiopulmonary Medicine (24 decks)

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