Dec 6th Test Flashcards Preview

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Flashcards in Dec 6th Test Deck (160):
1

What kind of disease is cardiogenic pulmonary edema classified as?

restrictive lung disease

2

What is cardiogenic pulmonary edema also called?

hydrostatic pulmonary edema

3

What is cardiogenic pulmonary edema caused by?

-left side heart failure
-fluid overload

4

What is pulmonary edema?

excessive amount of fluid in the lung tissue or alveoli due to an increase in pulmonary capillary pressure (resulting from abnormal left heart function)

5

What is the etiology of cardiogenic pulmonary edema?

-left heart failure (i.e. coronary artery disease)
-aortic stenosis
-mitral valve stenosis
-systemic hypertension
-fluid overload

6

What is the result of cardiogenic pulmonary edema?

backup of fluid from the heart into the pulmonary capillaries, which become engorged

7

What happens when pulmonary capillaries are engorged?

fluid leaks into interstitial space and into the alveoli

8

What is the swam ganz catheter?

-it measures the back pressure from the pulmonary veins
-done from the carotid or subclavian vein and into the right atrium, tricuspid and right ventricle

9

Is it possible to measure the pressure from the left heart?

no

10

Is it possible to measure the pressure from the right heart?

yes

11

What carries the swan ganz?

the right ventricle into the pulmonary artery

12

Where does the swan ganz measure pressure and what should it not exceed what?

only in front of the catheter; 5-8

13

How is the progress of treatment of pulmonary edema measured?

swan ganz catheter

14

How is pulmonary edema treated?

-ionotropic (makes left side work harder: digoxin)
-lasix (gets excess fluid out of the body)

15

What is atrial fibrillation?

atopic phoxi; 350-600/min

16

What is atrial fibrillation caused by?

congestive heart of the left ventricle
-acidemia
-alkalemia
-electrical imbalances

17

What are physical signs of pulmonary edema?

-distended neck veins
-frequent cough
-distended abdomen
-pitting edema
-blue lips

18

What are typical vital signs associated with pulmonary edema?

-BP 100/50
-HR 145
-RR 22
-ABG: 7.56, co2 38, hco3 20, o2 51 spo2 70%

19

What shows up on an xray for pulmonary edema?

-faint opacities in lower lobes bilaterally
-enlarged heart (left ventricle)

20

What treatment is used for pulmonary edema?

-oxygen
-intravenous digitalis (dobutamine)
-furosemide

21

What does digitalis do for pulmonary edema?

-ionotropic
-increases myocardial force of contraction
-increases stroke volume
-antiarrhthmic used to treat atrial flutter and fibrillation

22

What does dobutamine do for pulmonary edema?

-increases myocardial contaction
-increases stroke volume without increasing systemic vascular resistance

23

What does furosemide do for pulmonary edema?

-causes diuresis by inhibiting reabsorption of sodium
-loss of chlorine
-loss of potassium

24

What kind of ABG result can furosemide cause?

metabolic alkalosis

25

What kind of breath sounds are associated with pulmonary edema?

-inspiratory crackles over lower lobes
-expiratory wheezes over lower lobes

26

What kind of shunt is caused by pulmonary edema?

Alveoli filled with fluid

27

What is venous admixture for pulmonary edema?

good lung mixing with bad lung leading to lower PaO2

28

What happens to lung volumes in pulmonary edema?

get smaller

29

In pulmonary edema, what needs to be resupplied so lung volumes can return to normal?

surfactant

30

How is FVC affected with pulmonary edema?

smaller (middle line in picture)

31

How is lung compliance affected with pulmonary edema?

decreased

32

How is WOB affected with pulmonary edema?

increased

33

What is the gold standard treatment for cardiogenic pulmonary edema?

cpap mask

34

What is a pulmonary embolism?

obstruction of the pulmonary artery or one of its branches

35

What is an embolus?

a clot that travels through the bloodstream from its vessel of origin and lodges into a smaller vessel, resulting in flow obstruction

36

What are the possible sources of pulmonary emboli?

-fat
-air
-bone marrow
-tumor fragments
-blood clots

37

What is the most common source of emboli?

blood clot

38

Where does an emboli usually originate?

in deep veins of the leg or pelvic area

39

Where does an emboli travel to?

back to the heart through the venous system where it eventually lodges in a pulmonary artery

40

Why does a clot usually form?

-stagnation of blood flow
-prolonged bed rest
-immobility from trauma, surgery, paralysis or pain

41

What are some predisposing factors for emboli?

-long travel
-CHF
-varicose veins
-thromnophlebitis
-traumatic injury

42

What should be looked at carefully in traumatic injuries?

-bone fragments from pelvis
-long bones of lower extremeties
-extensive injury to soft tissue

43

What are some hypercoagulation disorders that cause embolis?

-oral contraceptives
-polycythemia
-multiple myeloma

44

What does a blockage result in?

dead space ventilation (ventilation without perfusion), which causes a high V/Q mismatch

45

What causes a high V/Q mismatch?

dead space

46

What causes a low V/Q mismatch?

shunt

47

What is the initial V/Q ratio response and what does it lead to?

a high initial ratio which leads to a low V/Q mismatch

48

What causes a change from high to low V/Q mismatch?

-activation of serotonin
-histamine
-prostaglandin

49

What is caused by the release of serotonin, histamine and prostaglandin?

-alveolar atelectasis
-alveolar consolidation
-bronchoconstriction
-shunting

50

What causes 10% of pulmonary emboli cases?

infarction

51

What dictates the pathophysiology of pulmonary emboli?

size of thromboembolism

52

What determines the impact of pulmonary emboli on the cardiovascular system?

size and number of pulmonary emboli

53

Where is the reduction of cardiac output seen with pulmonary emboli?

systemic side

54

What heart effects are seen in the pulmonary side with pulmonary emboli?

-pulmonary hypertension
-increased right ventricular work load

55

What heart effects are seen in the systemic side with pulmonary emboli?

-systemic hypertension
-decreased blood flow entering the left ventricle

56

How does the body attempt to compensate for the systemic side?

increased heart rate

57

What are the most common symptoms of pulmonary emboli?

-dyspnea
-tachypnea
-pleuritic chest pain
-cough
-tachycardia
-hypotension

58

What are additional findings of pulmonary emboli?

-abnormal heart sounds
-distended neck veins
-swollen and tender liver
-right ventricular heave or lift
-right ventricular distension

59

What breath sounds are associated with pulmonary emboli?

-inspiratory crackles
-wheezes
-pleural friction rub

60

When is pleural friction rub most common in pulmonary emboli?

when pulmonary infarction involves the pleura

61

What ABG result is commonly seen in mild to moderate pulmonary emboli?

acute alveolar hyperventilation with hypoxemia

62

What ABG result is commonly seen in severe pulmonary emboli with infarction?

acute ventilatory failure with hypoxemia

63

What happens when tissue hypoxia is severe enough to produce lactic acid?

the pH and HCO3 will be lower than expected for a particular PaCO2

64

Does a shunt increase or decrease the qs/qt fraction?

increase

65

Is oxygen delivery increased or decreased in pulmonary emboli?

decreased

66

Is the oxygen extraction ratio increased or decreased in pulmonary emboli?

increased

67

Does the SvO2 increase or decrease in pulmonary emboli?

decrease

68

Is central venous pressure increased or decreased in pulmonary emboli?

increased

69

Is pulmonary arterty pressure increased or decreased in pulmonary emboli?

increased

70

What is normal pulmonary artery pressure?

no greater than 25/10 mmHg

71

What is normal mean pulmonary artery pressure?

15 mmHg

72

What is normal mean pulmonary artery pressure for patients with emboli?

excess of 20 mmHg

73

What are 3 major mechanisms that contribute to pulmonary hypertension?

-decreased cross sectional area of the pulmonary vascular system
-vasoconstriction induced by humoral agents
-vasoconstriction induced by alveolar hypoxia

74

What is seen on an xray that has infarction?

increased alveolar density in infarcted areas, which appear similar to pneumonia

75

What is seen on a xray when there is a cardiovascular response?

-dilation of pulmonary artery
-ventricular enlargement may cause it to appear similar to pulmonary edema

76

What is a ventilation test?

patient breathes in xenon gas to test ventilation

77

What is a perfusion test?

intravenous injection of radiolabeled particles that goes into the pulmonary vascular system. if blood flow is decreased or absent past emboli, fewer particles are present in the area

78

What gold standard is used to confirm the presence of pulmonary embolism?

pulmonary angiography

79

What is pulmonary angiography?

a catheter is advanced into the right heart and a radiopaque dye is injected into an artery

80

How is pulmonary embolism confirmed with pulmonary angiography?

dark area appears on the angiogram distal to the emboli (radiopaque material is prevented from flowing past obstruction)

81

Does pulmonary angiography have risks?

none unless patient has severe pulmonary hypertension about 45 mmHg, is in shock, or has an allergic reaction to contrast medium

82

What is the best treatment for pulmonary emboli?

avoiding venous stasis

83

Besides prevention, what are other ways to treat pulmonary emboli?

-low dose heparin given subcutaneously
-tight fitting socks
-pneumatic stockings or boots
-active or passive leg movements

84

When are fibronolytic agents used and why?

only used when hemodynamic instability is severe due to excessive risk of bleeding

85

What are the respiratory care treatment protocols associated with pulmonary emboli?

-oxygen therapy
-aerosolized medications
-mechanical ventilation

86

What is pleural effusion?

fluid accumulation in the pleural space

87

What anatomic alterations of the lungs are associated with pleural effusion?

-separation of the visceral and parietal pleura
-compress the lungs
-atelectasis
-great veins may be compressed
-cardiac venous return may be diminished

88

What kind of disorder does pleural effusion produce?

restrictive lung disorder

89

What are the two classifications of pleural effusion?

-transudative
-exudative

90

What is a transudate pleural effusion?

-develops when fluid from pulmonary capillaries moves into pleural space
-the fluid is thin and watery and contains a few blood cells and very little protein

91

True/False: a pleural disease causes a transudate

false

92

What is an exudate pleural effusion?

-develops when the pleural surfaces are diseased
-fluid has high protein content
-great deal of cellular debris

93

True/False: exudates are usually caused by inflammation

true

94

What are the major causes of transudative pleural effusion?

-CHF
-liver disease
-kidney disease
-pulmonary embolus

95

What are the major causes of exudative pleural effusion?

-cancer
-pneumonias
-fungal diseases
-disease of the GI system

96

In addition to transudate and exudate, there are other pathologic fluids that can separate the ___ pleura from the ___ pleura

parietal; visceral

97

What are the other pathologic pleural fluids?

-empyema
-chylothorax
-hemothorax

98

What is empyema?

the accumulation of pus in the pleural cavity

99

Empyema commonly develops as a result of what?

-infection
-inflammation

100

How is empyema removed?

chest tube drainage

101

What is used to confirm a diagnosis of empyema and determine the specific causative organism?

thoracentesis

102

What is chylothorax?

chyle in the pleural cavity

103

What is chyle?

-a milky liquid produced from the food in the small intestine during digestion
-consists mainly of fat particles in a stable emulsion

104

How is chyle transported?

from intestinal lymphatics through the thoracic duct (in the neck) into the venous circulation and mixed with blood

105

What results in chylothorax?

-trauma to the neck or thorax
-tumor that occludes the thoracic duct

106

What is hemothorax?

the presence of blood in the pleural space

107

What are the causes of hemothorax?

-trauma (i.e. penetrating or blunt chest trauma, chest wall, diaphragm, lung or mediastinum)
-rupture of small blood vessels
-iatrogenic hemothorax (trauma causes by the insertion of a central venous catheter)

108

What are the cardiopulmonary symptoms of pleural effusion?

-symptoms vary according to the size of the effusion
-decree of lung compression

109

What are the lung volume and capacity changes associated with pleural effusion?

-restrictive lung defects
-decreased lung volumes

110

What chest assessment findings are associated with pleural effusion?

-chest pain
-decreased chest expansion
-cough (dry, nonproductive)
-tracheal shift
-decreased tactile and vocal fremitus
-dull percussion note
-diminished breath sounds
-displaced heart sounds

111

What are the radiologic findings associated with pleural effusion?

-opacity (white)
-blunting of costophrenic angle
-depressed diaphragm
-possible mediastinal shift to unaffected side
-atelectasis

112

What is the diagnosis of pleural effusion generally based on?

chest xray film

113

Pleural effusion chest xray facts

-fluid first accumulates posteriorly in the most dependent part of the thoracic cavity, between the inferior surface of the lower lobe and diaphragm
-as the fluid volume increases, it extends upward around the anterior, lateral and posterior thoracic walls
-on the typical radiograph, the lateral costophrenic angle is obliterated and the outline of the diaphragm on the affected side is lost

114

Pleural effusion chest xray facts cont'd

-in severe cases, the weight of the fluid may cause the diaphragm to become inverted (concave)
-first identified with a posteroanterior (PA) or lateral chest radiograph
-confirmed with a lateral decubitus radiograph
-free fluid gravitates along the horizontal plane to the lowest level

115

What is the treatment of pleural effusion?

-thoracentesis
-chest tube insertion (for larger pleural effusions)
-oxygen therapy
-hyperinflation therapy

116

What is thoracentesis?

removal of pleural fluid

117

When is hyperinflation therapy used and how does it treat pleural effusion?

after the removal of pleural fluid; inflates the compressed lung

118

What should you monitor post thoracentesis?

watch for signs of hemothorax and pneumothorax associated with accidental puncture of the lung

119

What is guillain-barre syndrome described as?

a relatively rare disorder of the peripheral nervous system in which flaccid paralysis of the skeletal muscles and loss of the reflexes develop in a previously healthy patient

120

What are the pathologic changes of the peripheral nerves associated with guillain-barre syndrome?

-microscopically the nerves show: demyelination, inflammation, edema
-nerved impulse transmission decreases leading to paralysis

121

What is the etiology of guillain-barre syndrome?

-probably an autoimmune disorder
-lymphocytes and macrophages attack and strip off the myelin sheath of the peripheral nerves

122

What are four facts about autoimmune disorders associated with guillain-barre?

-studies show high serum antibody titers in the early stages of the syndrome
-elevated levels of lgM and complement activating antibodies against human peripheral nerve myelin
-anti-PMN antibody
-antibodies reduced rapidly during the recovery phase

123

What is the onset of guillain-barre?

-occurs one to four weeks after a febrile episode
-upper respiratory
-gastrointestinal
-bacterial and viral
-vaccinations

124

What bacterial and viral causes are associated with guillain-barre?

infectious mononucleosis associated with as many as 25 percent of cases

125

What vaccinations are associated with guillain-barre?

in 1976 40 million people were vaccinated for swine flu. 500 of which developed guillain-barre and 25 died from it

126

What are the early symptoms of guillain-barre?

-fever, malaise, nausea, prostration
-tingling sensation and numbness in the extremities (distal paresthesia)
-skeletal muscle paralysis and loss of deep tendon reflexes in the feet and lower portions of the leg

127

What are the progressive symptoms of guillain-barre?

the muscle paralysis moves upward (ascending paralysis):
-to the arms, neck, pharyngeal and facial muscles (cranial nerves IX and X)
-the patient's gag reflex is generally decreased or absent and swallowing is difficult (dysphagia)
-aspiration is likely unless the airway is protected

128

What are the common non-cardiopulmonary manifestations associated with guillain-barre?

-progressive paralysis of the ascending skeletal muscles
-tingling sensation and numbness (distal paresthesia)
-loss of deep tendon reflexes
-sensory nerves impairment
-peripheral facial weakness
-decreased gag reflex
-decreased ability to swallow

129

What is the progress and recovery time for guillain-barre?

-paralysis generally peaks in less than 10 days
-after paralysis reaches its maximum it usually remains unchanged for a few days or weeks
-recovery generally begins spontaneously and continues for weeks or in rare cases months

130

Describe open pneumothorax

air can go in and out of the chest cavity freely

131

What is pendelluft?

air moves from one lung into the other lung and then all back out. it is seen in open pneumothorax

132

Describe closed pneumothorax

air moves into the lungs then out of the lung into the pleural space

133

Describe open tension pneumothorax

air moves into the lung area with an open wound but when air tries to move back out, the wound closes

134

What do you seen on inspection of pneumothorax?

one chest wall is moving higher than the other

135

What do you hear on percussion of pneumothorax?

hyperresonance

136

What breath sounds do you hear for pneumothorax?

diminished breath sounds

137

What happens to the alveoli that are affected by pneumothorax?

it becomes hypoventilated and creates a venous admixture in the blood

138

What is the most severe form of ARDS?

pulmonary edema

139

What is the mortality rate of pulmonary edema?

40-90%

140

What type of respiratory failure occurs with pulmonary edema?

acute hypoxic respiratory failure

141

What is the cause of ARDS?

-increased capillary permeability
-fluid leak
-inflammation mediators

142

What is ARDS also called?

acute lung injury

143

What are the primary risk factors for ARDS?

-toxic inhalation
-near drowning
-lung contusion
-gastric aspiration
-pneumonia

144

What are the secondary risk factors for ARDS?

-burn injuries
-sepsis
-pancreatitis
-shock
-prolonged systemic hypotension
-multiple blood transfusions
-drug overdose
-fulminant hepatic failure
-multiple trauma
-sickle cell crisis

145

What are the other risk factors for ARDS?

-prolonged cardiopulmonary bypass
-fat emboli
-immunologic reactions (goodpastures syndrome)
-increased ICP
-CNS disorders
-pulmonary ischemia
-intravascular coagulation
-radiation-induced lung injury
-drug overdose

146

How long is the exudative phase?

1-3 days

147

How are the alveoli damaged in ARDS?

destruction of type 1 pneumocytes

148

How do microvascular injuries in ARDS happen?

destruction of capillaries

149

In ARDS, where is there an influx of inflammatory fluids?

interstitial space and alveoli

150

What membrane forms in ARDS?

hyaline membrane

151

How does a patient present with ARDS?

-severe dyspnea
-tachypnea
-refractory hypoxemia

152

How long is the proliferative phase in ARDS?

3-7 days

153

What does the fribroproliferative phase begin after?

inflammatory injury is controlled

154

During the fibroproliferative phase, which cells experience hyperplasia (increase of cells)?

-type 2 pneumocytes
-fibroblasts (interstitial alveolar fibrosis)

155

What is SOAP?

getting objective information

156

What breath sounds are heard in ARDS?

crackles

157

What is seen on xray in ARDS?

bilateral fluffy infiltrates

158

What is a typical ABG for a patient with ARDS?

pH 7.51
PaCO2 29
PaO2 52
HCO3 22

159

What would you seen on a hemoglobin curve with ARDS?

acute alveolar hyperventilation with moderate hypoxemia

160

What are the pulmonary mechanics of ARDS?

-all lung volumes decreased
-compliance is decreased
-resistance is increased
-WOB is increased