Ch. 21

Question 1

What is a thrombus?

Answer 1

A blood clot that forms and remains in a vein

Question 2

What is an embolus?

Answer 2

Blood clot that be becomes dislodged and travels to another part of the body.

Question 3

What is pulmonary infarction?

Answer 3

When the embolus significantly disrupts arterial blood flow.

Question 4

What is saddle embolus?

Answer 4

When a large embolus detaches form a thrombus and passes through the right side of the heart, It may lodge in the bifurcation of the pulmonary artery.

Question 5

Why is a large saddle embolus quickly fatal?

Answer 5

Because it can can significantly block pulmonary blood form returning to the left ventricle and being pumped out to the systemic circulation.

Question 6

What are the major pathologic or structural changes of the lungs?

Answer 6

• Blockage of the pulmonary vascular system
• pulmonale
• pulmonary hypertension
• pulmonary infarction
• altelectasis
• consolidation
• bronchial smooth muscle constriction

Question 7

What are DVT and PE commonly clinically classified as?

Answer 7

Insidious disorders

Question 8

If pulmonary embolism is relatively small will the early signs and symptoms be present?

Answer 8

Yes

Question 9

Sudden death is often the first symptom in about how many percent of people who have PE?

Answer 9

25%

Question 10

The possibility of a blood clot being lodged in the lung is often not considered until autopsy in about what percentage of a patient?

Answer 10

70-80%

Question 11

In the U.S. how many people die each year from a PE?

Answer 11

100,000

Question 12

PE is more common in males than females T or F?

Answer 12

True

Question 13

What is the most common possible source of an PE?

Answer 13

Blood clot

Question 14

Where do most blood clots originate or break away from?

Answer 14

Deep venous thrombosis in the lower part of the body

Question 15

What are the 3 primary factors called associated with a DVT?

Answer 15

The Virchow triad

Question 16

What does the Virchow triad include?

Answer 16

(1) venous stasis (i.e., slowing or stagnation of blood flow through the veins)
(2) hypercoagulability (i.e., the increased tendency of blood to form clots)
(3) injury to the endothelial cells that line the vessels.

Question 17

What are some common risk factors associated with PE? Box 21.1

Answer 17

Question 18

What are some common tests used to to detect a pulmonary embolism?

Answer 18

Blood test
D-dimer test
Ultrasonography
CXR
CPTA
V/Q scan
Pulmonary angiogram
MRI
MRA

Question 19

What are some things looked for in a blood test?

Answer 19

(1) have a family history of blood clots
(2) have had more than one episode of blood clots
(3) have experienced blood clots for no known reason, the doctor may prescribe a series of blood tests to determine if there are any inherited abnormalities in the blood-clotting system.

Question 20

What is another name for the D-dimer test?

Answer 20

Fibrinogen test

Question 21

What is the D dimer test used for?

Answer 21

To check for an increase level of the protein fibrinogen. The test is relatively simple and fast it entails drawing a blood sample.

Question 22

When are the results available for a d-dimer test?

Answer 22

Less than one hour

Question 23

Values higher than what are considered positive?

Answer 23

500 ng/mL

Question 24

What are some conditions that can increase in individuals d-dimer level?

Answer 24

Recent surgery

Question 25

What is an ultrasonography test?

Answer 25

Uses high frequency sound waves to detect blood clots in the thigh veins. The test is not invasive

Question 26

How long does the ultrasonography test take to perform?

Answer 26

30 minutes or less

Question 27

What are some signs of symptoms, associated with pulmonary embolism? Box 21.2

Answer 27

Question 28

True or false a chest x-ray is often normal in a patient with pulmonary embolism?

Answer 28

True

Question 29

What is a chest x-ray used for?

Answer 29

Used to rule out conditions that mimic a pulmonary embolism, such as pneumonia and pneumothorax

Question 30

What percentage of infiltrates or atelectasis will be seen in a chest x-ray for pulmonary embolism?

Answer 30

50%

Question 31

What percentage of an elevated hemidiaphragm occurs in a chest x-ray of pulmonary embolism?

Answer 31

40%

Question 32

What does CTPA stand for?

Answer 32

Computed tomography pulmonary angiogram

Question 33

T or F The CTPA is fast becoming the first line test for diagnosing suspected pulmonary embolism?

Answer 33

True

Question 34

True or false the CTPA is increasingly being referred to previous gold standards for diagnosing, a pulmonary embolism, ventilation perfusion, scanning or direct pulmonary angiography?

Answer 34

True

Question 35

Why is the CTPA preferred over other test?

Answer 35

1. The scan requires only an intravenous line 2. The image resolution is very good 3. The volumetric skating allows the contrast 4. material to be administered more economically and time 5.The entire chess can be scanned in a single 6.breath, hold, or in several successive short breath holds

Question 36

What does VQ scan do?

Answer 36

The test confirms that the lungs are normal, or that there is a high probability of a pulmonary embolism

Question 37

T or F; The V/Q scan is rarely used today to identify a pulmonary embolus. The V/Q is reliable, only at the extremes of interpretation.

Answer 37

True

Question 38

What does a pulmonary angiogram do?

Answer 38

Provides a clear image of the blood flow in the lungs arteries. it is an extremely accurate test for a diagnosis of pulmonary embolism

Question 39

How long is a pulmonary angiogram usually take?

Answer 39

It is an invasive procedure that takes about one hour

Question 40

True or false a pulmonary angiogram is usually perform only when other test have failed to provide a definitive diagnosis?

Answer 40

True

Question 41

What does an MRI do?

Answer 41

It is used for individuals whose kidneys may be harmed by dyes used an x-ray test and for women who are pregnant.

Question 42

What is an MRA and what does it do?

Answer 42

Magnetic Renaissance angiography; used to differentiate among blood, thromboemboli, and tumor emboli in patients with malignancy.

Question 43

What is the general management of a pulmonary embolism?

Answer 43

Fast acting, anti-coagulants Thrombolytic agents preventative measures

Question 44

What are some fast acting anticoagulants and what do they do? And the two classifications?

Answer 44

Heparin; prevents existing blood clots from growing and prevent the formation of new ones. •High molecular weight heparin •low molecular weight heparin

Question 45

How is heparin administered?

Answer 45

IV

Question 46

What is high molecular weight heparin (unfractionated heparin)?

Answer 46

The unfractionated heparin dosing must be governed by frequent monitoring of the activated partial thromboplastin time (APTT). This is because bleeding from unfractionated heparin can develop.

Question 47

What is low molecular weight heparin?

Answer 47

They are more cost-effective and do not necessitate APTT monitor- ing. Doctors strive to achieve a full anticoagulant effect within the first 24 hours of treatment.

Question 48

What is a slow acting anticoagulant?

Answer 48

Warfarin

Question 49

What is the timeframe that warfarin and heparin are given together?

Answer 49

5 to 7 days until blood test show that the warfarin is effectively preventing clotting

Question 50

If a pulmonary embolism is caused by a temporary respecter. How long is treatment given?

Answer 50

2 to 3 months

Question 51

If pulmonary embolism is caused by long-term condition how long is treatment given?

Answer 51

3 to 6 months

Question 52

What are some thrombolytic agents?

Answer 52

Streptokinase urokinase alteplase Reteplase

Question 53

What do thrombolytic agents do?

Answer 53

Dissolve blood clots (clot busters)

Question 54

What are thrombolytic agents sometimes used in conjunction with?

Answer 54

Heparin

Question 55

What are some preventative measures?

Answer 55

Walking Exercise while seated Drink fluids Where graduated compression stockings

Question 56

What is the inferior vena cava (greenfield) vein filter?

Answer 56

It is surgically placed in the inferior vena cava to prevent clots being carried into the pulmonary circulation

Question 57

What is pneumatic compression?

Answer 57

Uses thigh- high cuffs, and automatically Inslee every few minutes to massage and compress the veins in the patient’s legs

Question 58

What is pulmonary and embolectomy?

Answer 58

Surgical removal of blood clots from pulmonary circulation.

Question 59

What protocols do you use for pulmonary embolism?

Answer 59

Oxygen therapy protocol Aerosolized medication protocol Lung expansion protocol

Question 60

What does oxygen therapy protocol do?

Answer 60

Treats hypoxemia decreases WOB Decrease myocardial work

Question 61

What does the aerosolized medication protocol do?

Answer 61

Both sympathetic and para sympathetic agents may be used to induce bronchial smooth muscle?

Question 62

What is pulmonary hypertension?

Answer 62

An increase in mean arterial pressure greater than 25 mmHg.

Question 63

What is the normal range for pulmonary hypertension?

Answer 63

10 to 20 mmHg at rest

Question 64

Is pulmonary hypertension, more common among men or women? What is the ratio?

Answer 64

Woman; 3:1

Question 65

What are the five different group classifications for pulmonary hypertension?

Answer 65

Pulmonary arterial hypertension (PAH) Pulmonary hypertension because of left heart disease Pulmonary hypertension because of lung disease and or hypoxia Chronic thromboembolic pulmonary hypertension another pulmonary artery obstructions pulmonary hypertension, with unclear and or multifactorial mechanisms

Question 66

What are some common signs and symptoms of PH?

Answer 66

Question 67

What is the diagnosis of PH based on?

Answer 67

based on the patient’s medical and family histories, physical examination, and the results from a variety of tests and procedures.

Question 68

What are some different tests and procedures used to diagnose pulmonary hypertension?

Answer 68

Question 69

What are the causes of right sided heart failure?

Answer 69

COPD, coronary artery disease, pulmonic stenosis, tricuspid stenosis, and tricuspid regurgitation

Question 70

What is the most common cause of PH?

Answer 70

left-sided heart failure (congestive heart failure)

Question 71

What is biventricular failure?

Answer 71

Both left and right sided heart failure

Question 72

What are some therapies used to treat PH?

Answer 72

Diuretics Phosphodiesterase inhibitors Blood thinning medication Cardiac glycosides Oxygen therapy Physical activity inhaled nitric oxide ***riocugat***

Question 73

Common signs of both left and right sided heart failure?

Answer 73