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Anesthesia Principles > COPD > Flashcards

COPD Flashcards

1
Q

What is lost in COPD?

A

alveolar tissue

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2
Q

Is COPD reversible

A

no

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3
Q

COPD presents with progressive airflow ____.

A

obstruction

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4
Q

With bronchiloar and alveolar destruction, what is lost?

A

Pulmonary elastic recoil

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5
Q

What is the main risk factor for COPD?

A

inhalation of toxic chemicals from cigarettes

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6
Q

What is a risk factor for COPD that is r/t childhood?

A

Low birth weight & alpha1-antitrypsin deficiency

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7
Q

What work environments contribute to COPD?

A

coal mining, gold mining, and textile b/c of exposure to dust and chemicals

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8
Q

What normally maintains the airways in an open position?

A

elasticity of the lung parenchyma

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9
Q

COPD ___ the rigidity of the bronchilaor wall.

A

decreases

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10
Q

B/c COPD decreases the rigidity of bronchiolar walls, the lungs are more likely to do what?

A

collapse during exhalation

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11
Q

Increased gas flow in narrowed bronchioli leads to a ____ pressure. What does this cause?

A

decreased

airway collapse

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12
Q

Increased pulmonary secretions with COPD causes what 2 things:

A

active bronchospasm

obstruction

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13
Q

Air sacs will ____ in size with COPD

A

enlarge

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14
Q

What eventually develops with COPD

A

emphysema

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15
Q

COPD destroys lung ____

A

parenchyma

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16
Q

the 3 main s/s of COPD

A

DOE or at rest
chronic cough
chronic sputum production

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17
Q

As expiratory flow obstruction increases in severe COPD, RR ____ and a ____ expiratory time are evident.

A

increases

prolonged

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18
Q

BS are ____ in COPD

A

decreased

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19
Q

What adventitious BS is common in OCPD

A

expiratory wheezes

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20
Q

What is needed to definitively dx COPD?

A

Spirometry

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21
Q

What is PFT result in COPD

A

decrease FEV1:FVC ratio

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22
Q

An FEV1:FVC ratio <___ of predicated that is not _____ confirms COPD dx.

A

70%

reversible w/ bronchodilators

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23
Q

COPD - FRC

A

increased

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24
Q

COPD - TLC

A

increased

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25
Q

CXray is senstive test for COPD T/F

A

false

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26
Q

When will ABGs show COPD?

A

w/ severe dx

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27
Q

The PaO2 in a pt with COPD usually does not decrease until the FEV1 is <____

A

50%

28
Q

What are two therapeutic interventions that may alter history of COPD?

A

smoking cessation

long-term O2 admin

29
Q

Home O2 therapy is recommended if PaO2 is <___ in COPD patients

A

55

30
Q

For COPD, home O2 therapy is recommended if Hct is ____

A

above 55%

31
Q

For COPD, home o2 is recommended if there is evidence of what disease?

A

cor pulmonale

32
Q

For COPD, the goal of O2 is to achieve a PaO2 of ___

A

> 60

33
Q

What 3 drug clasess are often used in combination for COPD?

A

long acting B2 agonist
inhaled corticosteroid
Long-acting anticholinergic

34
Q

During COPD exacerbations what 3 meds might be necessary?

A

Abx
Systemic corticosteroids
Theophylline

35
Q

Exacerbations of COPD are always infective. T/F

A

False - can be noninfective or infective

36
Q

Diuretics can cause ____ depletion

A

chloride

37
Q

Chloride depletion can cause what ABG

A

hypochloremic metabolic acidosis

38
Q

Diuretic-induced chloride depletion may produce a hypochloremic metabolic alkalosis that _____ the ventilatory drive and may aggravate chronic carbon dioxide retention.

A

depresses

39
Q

Further pulmonary evaluation is indicated with hypoxemia at ___

A

RA

40
Q

Further pulmonary evaluation is indicated with a bicarb of ___

A

> 33

41
Q

Further pulmonary evaluation is indicated with a PCO ____

A

> 50

42
Q

Further pulmonary evaluation is indicated with a history of _____

A

respiratory failure

43
Q

Further pulmonary evaluation is indicated with severe _____

A

SOB attributed to dx

44
Q

Further pulmonary evaluation is indicated with a planned _____ procedure

A

pneumonectomy

45
Q

Further pulmonary evaluation is indicated with difficulty in assessing _____ by just clinical signs

A

pulmonary function

46
Q

Further pulmonary evaluation is indicated with need to determine resposne to ?

A

bronchodilation

47
Q

Further pulmonary evaluation is indicated with supstected ____

A

PHTN

48
Q

Encourage smoking cessation for _____

A

6 weeks

49
Q

Intraoperative suggestions for COPD

A

minimally invasive techniques
regional
shorter surgeries

50
Q

COPD - avoid surgical procedures likley to last longer than ______

A

3 hours

51
Q

Poor nutritional statue w/ a low ______ <3.5 is a powerful predictor of post op pulmonary complications in COPD

A

albumin

52
Q

COPD - regional anesthesia is suitable for operations that do not invade ___ or are performed on ____.

A

peritoneum; extremities

53
Q

COPD - Use of regional anesthetic techniques that produce sensory anesthesia above ___ is not recommended.

A

T6

54
Q

In COPD a high block can impair ventilatory functions requiring active ____.

A

exhalation

55
Q

In COPD, active exhalation can affect ERV, PEFR, and _____

A

max minute ventilation.

56
Q

Emergence from anesthesia with inhaled agents is ____ in COPD patients.

A

prolonged significantly

57
Q

Why is inhaled emergence prolonged in COPD patients?

A

Air trapping also traps the agent as they try to flood out of the various body compartments into the lungs

58
Q

At ETT bypassess most of the natural airway ___ system

A

humidification

59
Q

T/F: patients with copd are at a decreased risk of lung injry

A

false -increase risk

60
Q

The goal of mechanical ventilation in COPD patients is to prevent _____ and avoid ____.

A

development of auto-PEEP;

dynamic hyperinflation of lungs

61
Q

When does auto-PEEP occur?

A

Positive pressure ventilation is applied and insufficient expiratory time is allowed

62
Q

Auto Peep increases ______

A

intrathoracic pressure

63
Q

Auto peep impeded ______ return

A

venous

64
Q

With auto peep, the elevated intrathoracic pressure is transmited where?

A

to the pulmonary artery

65
Q

What capnography signs indicate air-trapping in COPD patients that are mechanically ventilated?

A

CO2 concentration does not plateau but is still upsloping at the time of the next breath.

66
Q

An upsloping ETCO2 in COPD indicates what?

A

there is still admixture of air from dead space reducing the ETCO2

Anesthesia Principles (10 decks)

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