Exam 2: Pulmonary

Question 1

Observation pieces of pulmonary assessment:

Answer 1

Rate/pattern/effort of breathing
Tracheal position
Thorax expansion
Skin/soft tissue appearance
Trach scar/stoma

Question 2

Bronchial breath sounds are normally heard:

Answer 2

In the tracheobronchial tree

Trachea, R sternoclavicular

Question 3

Characteristics of bronchial breath sounds:

Answer 3

I/E components equal with a pause between

Higher pitch, louder

Question 4

Vesicular breath sounds are normally heard:

Answer 4

In the lung tissue

Question 5

Characteristics of vesicular breath sounds:

Answer 5

Lower pitched and softer

Expiration shorter than inspiration without a pause between breath sounds

Question 6

Consolidation sounds like:

Answer 6

Low pitched bronchial breathing

Question 7

Cavitary disease sounds like:

Answer 7

High pitched bronchial breathing

Question 8

Three adventitious sounds:

Answer 8

Wheeze
Stridor
Crackles

Question 9

Seven appropriate candidates for PFTs:

Answer 9

COPD
Smokers with persistent cough
Wheezing/dyspnea on exertion
Morbid obesity
Thoracic surgery
Open upper abdominal surgery
> 70 y/o

Question 10

Two categories of PFT:

Answer 10

Abnormalities of gas exchange (ABG, pulse ox, capnography)

Mechanical dysfunction of lungs/chest wall (spirometry)

Question 11

Normal %s of volume & flow in spirometry:

Answer 11

Volume: 80-120% of predicted
Flow: 80% of predicted

Question 12

Examples of obstructive lung disease:

Answer 12

COPD

Asthma

Question 13

Examples of restrictive lung disease:

Answer 13

Pregnancy
NM disease
Obesity

Question 14

Normal vital capacity result:

Answer 14

> 80% of predicted value

Question 15

Type of disease that affects VC:

Answer 15

Restrictive diseases ↓ VC

Question 16

Interpretation of FVC results:

Answer 16

80-120% Normal
70-79% Mild
50-69% Moderate

Question 17

FVC measures:

Answer 17

Resistance to flow; max inspiration with forced expiration

Question 18

FEV1 measures:

Answer 18

Volume of air forcefully expired from full inspiration in the 1st second

Question 19

Interpretation of % FEV1/FVC:

Answer 19

> 75% Normal
60-75% Mild
50-59% Moderate

Question 20

Type of disease that affects FEV1/FVC:

Answer 20

Obstructive disease will ↓ ratio

Question 21

FEF25-75 measures:

Answer 21

The effort independent middle portion of expiration and the status of the smaller airways

Question 22

Interpretation of % FEF25-75:

Answer 22

> 60% Normal
40-60% Mild
20-40% Moderate

Question 23

Type of disease that affects FEF25-75:

Answer 23

Obstructive disease, even in early stages

Question 24

FRC is measured by:

Answer 24

Nitrogen wash-out with an analyzer on spirometer; end-point is when alveolar nitrogen concentration falls below 7%

Question 25

Relative PA, Pa, and Pv in Zone 1:

Answer 25

PA > Pa > Pv

Question 26

Relative PA, Pa, and Pv in Zone 2:

Answer 26

Pa > PA > Pv

Question 27

Relative PA, Pa, and Pv in Zone 3:

Answer 27

Pa > Pv > PA

Question 28

Best V/Q match is in Zone:

Answer 28

Zone 2

Question 29

Describe Zone 1:

Answer 29

Arterial pressure falls below alveolar pressure so capillaries are compressed, alveoli are enlarged; does not happen under normal circumstances, only when BP drops below alveolar pressure; more ventilation than perfusion.

Question 30

Describe Zone 2:

Answer 30

Pulmonary artery pressure exceeds both venous pressure and alveolar pressure, so good flow past alveoli and good V/Q match

Question 31

Describe Zone 3:

Answer 31

Venous pressure exceeds alveolar pressure, so capillaries are engorged and crushing alveoli; more perfusion than ventilation.

Question 32

Distribution of pulmonary blood flow upright/supine:

Answer 32

Upright: flow strongest bases --> apex Supine: flow equal bases to apex, but strongest in posterior/weakest anterior

Question 33

Pulmonary effects of PPV:

Answer 33

``` Increases in: Zone 1 Blood flow to dependent lung Ventilation to independent lung Dead space ```

Question 34

CV effects of PPV:

Answer 34

Decreased preload and BP | Can increase R to L shunt with atrial septal defect

Question 35

Counteracting CV effects of PPV:

Answer 35

``` Positioning TED hose Fluid administration to ↑ volume load/preload ɑ/β agonists Inotropic support ```

Question 36

Effects of smoking cessation at 12-14 hours:

Answer 36

↓ carboxyhemoglobin levels to normal

Question 37

Effects of smoking cessation at 2-3 weeks:

Answer 37

Mucociliary function returns | ↑ secretions!!

Question 38

Effects of smoking cessation at 4 weeks:

Answer 38

Reduced secretions

Question 39

Effects of smoking cessation at 8 weeks:

Answer 39

↓ rate of post-op pulmonary complications

Question 40

Tx for bronchospasm:

Answer 40

β-agonists Anticholinergics Methylxanthines Corticosteroids (for inflammation)

Question 41

Restrictive pulmonary disease and anesthetics:

Answer 41

Titrate sedation carefully d/t ↓ FRC Careful with NO and sats Inhaled agents have accelerated uptake d/t ↓ FRC SaO2 will drop quickly due to lower stores

Question 42

Restrictive disease and regional anesthesia:

Answer 42

Regional anesthesia > T10 may impair ventilation (accessory muscles)

Question 43

Restrictive disease and mechanical ventilation:

Answer 43

``` ↑ PAP ↓ volumes (4-8 ml/kg) ↑ respiratory rate (14-18) Use PEEP Pressure control mode better than volume ```

Question 44

FRC change in supine position:

Answer 44

10-15% ↓

Question 45

FRC change with GA:

Answer 45

5-10% ↓ additional

Question 46

VC changes after upper abdominal procedure:

Answer 46

Up to 40% ↓ and up to 14 days to recover

Question 47

Strategies for obstructive pulmonary disease and anesthesia:

Answer 47

Reduce airway reactivity Avoid spontaneous ventilation under GA Keep regional anesthesia low-level Careful with NO

Question 48

Strategies for reducing airway reactivity:

Answer 48

Bronchodilator therapy High alveolar concentrations of inhalation agents IV opioids/lidocaine prior to airway manipulation Single dose corticosteroids

Question 49

PPV for obstructive disease:

Answer 49

Large TV Slower rate to allow full expiration Low I:E ratio Keep PIP below 40