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Test 4 Health Assessment (Mordecai) > Exam 4 Obstructive lung disease Part II (Ash) > Flashcards

Exam 4 Obstructive lung disease Part II (Ash) Flashcards

1
Q

What 3 things may improve reversible componenets of asthma pre-operatively?

A

chest physiotherapy, antibiotics, and a bronchodilator

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2
Q

What is indicated when we are concerned about the adequacy of ventilation or oxygenation?

A

ABG

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3
Q

____ and ____ therapy should be continued until induction.

A

Anti-inflammatory and bronchodilator

Slide 22

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4
Q

T/F
Patients on systemic steroids within the last 6 months may need a stress dose of hydrocortisone or methylprednisolone

A

True

Slide 22

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5
Q

Asthma patients should be ____ and have a PEFR ____% of predicted or their personal best value before surgery

A

free of wheezing
>80%

Slide 22

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6
Q

COPD is a disease of ____ ____ ____

A

chronic airflow obstruction

Slide 24

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7
Q

COPD Sx include:
____ characterized by lung parenchymal destruction
____ chracterized by cough and sputum production and ____

A

emphysema, chronic bronchitis, and small airway obstruction

Slide 24

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8
Q

Pulmonary elastic recoil is lost d/t ____ destruction

A

bronchio-alveolar

Slide 24

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9
Q

COPD has a worldwide prevalence of ____ and is the ____ leading cause of death

A

10%
3rd

Slide 24

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10
Q

3 common Sx of COPD

A

dyspnea at rest or exertion
chronic cough
chronic sputum production

Slide 26

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11
Q

T/F
COPD exacerbations are c/b chronic worsening in airflow obstruction.

A

FALSE!
it is an acute worsening in airflow obstruction

Slide 26

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12
Q

as expiratory airflow obstruction increases, ____ and ____ ____ ____ become evident

A

tachypnea
prolonged expiratory times

Slide 26

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13
Q

As COPD progresses, exacerbations become more frequent and are often triggered by ____

A

Bacterial respiratory infections

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14
Q

in COPD breath sounds are ____ and a ____ wheeze is common

A

decreased
expiratory

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15
Q

providers should have a high degree of suspicion and low threshold to test for COPD in pts with ____ and ____ or ____

A

dyspnea
chronic cough
environmental exposures

Slide 27

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16
Q

What test gives us a definitive diagnosis of COPD?

A

Spirometry

Slide 27

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17
Q

PFTs in COPD show a ____ in FEV1:FVC ratio and an even greater ____ in the FEF 25-75% of VC.
FEV1:FVC is usually ____%, FRC and TLC are ____, and the DLCO (diffusing capacity for CO is ____

A

Decrease
Decrease
<70%
increased
reduced

Slide 27

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18
Q

What is responsible for the increase in RV in COPD? (2 things)

A

slowing of expiratory airflow and gas trapping being pramturely closed airways

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19
Q

What is the advantage of an increased RV and FRC in pts with COPD related to?
What is the cost?

A

enlarged airway diameter
Cost is a greater work of breathing at higher lung volumes

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20
Q

GOLD spirometric criteria for COPD severity is based on ____ measurement.
What are the stages and characteristics at each stage?

A

FEV1

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21
Q

What does a Chest X-ray look like in COPD patients?
What suggests emphysema? What confirms it?

A

abnormalities minimal even w/ severe COPD
-hyperlucency in the lung periphery suggests emphysema
-bullae confirms emphysema, although only a small percentage of pts with emphysema have bullae

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22
Q

____ is much more sensitive at diagnosing COPD than ____

A

CT, CXR

Slide 30

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23
Q

what symptoms are suggestive of multi-organ loss of tissue (MOLT) COPD phenotype?
What is it associated with?

A

airspace enalrgement and alveolar destruction
loss of bone, muscle and fat
associated with higher rates of lung cancer

Slide 30

24
Q

what symptoms indicate bronchitic phenotype? What is it usually accompanied by?

A

bronchiolar narrowing and wall thickening
metabolic syndrome and high rates of cardiac disease

Slide 30

25
Q

what factors does the BODE index look at?

A

BMI, degree of obstruction, level of dyspnea, exercise tolerance

all used to assess prognosis

Slide 31

26
Q

Higher BODE scores indicate greater risk of what?

A

COPD exacerbations, hospitalizations, and death c/b pulmonary complications

Slide 31

27
Q

____ deficiency is an inherited disorder associated w/ premature development of COPD
in blood testing, a low level indicates ____ and need for lifelong replacement therapy

A

alpha1-antitrypsin
genetic disease

Slide 31

28
Q

Which lab should be measured in pts w/ uncontrolled COPD despite adequate bronchodilator treatment?
What do high levels indicate?
Low levels are associated with?

A

eosinophils
high: need for inhaled glucocorticoids
low: poor response and increased risk of pneumonia

Slide 31

29
Q

____ often remains normal until COPD is severe.
____ doesnt usually decrease until FEV1 is ____ and PaCO2 may not increase until the FEV1 is ____

A

ABG
PaO2, <50%
PaCO2, even lower

Slide 31

30
Q

what is the 1st step in treating COPD?

A

reduce exposure to smoking and environmental pollutants

Slide 32

31
Q

smoking cessation can decrease disease progression and lower mortality by up to ____
What else may diminish or disappear as well?

A

18%
chronic bronchitis and lung degeneration

Slide 32

32
Q

Pharmacologic Treatment of COPD often begins with ____.
What is added if dyspnea persists?
the 3rd treatment, ____, is most effective with associated ____, ____, ____ and ____

A

long acting muscarinic antagonist inhaler
long acting beta 2 agonist
glucocorticoids, asthma, rhinitis, elevated eosinophils, and history of exacerbations

slide 32

33
Q

What are some other treatments for COPD not including the inhaled medications?

A

flu and pneumonia vaccines
diuretics (when RHF or CHF has developed)

Slide 33

34
Q

During exacerbations of COPD, what 3 types of medications may be necessary?

A

abx, corticosteroids, and theophylline

Slide 33

35
Q

What kind of COPD treatment can increase exercise capacity?

A

pulmonary rehab progreams

Slide 33

36
Q

long term home ____ is recommended when the ____ is < 55mmHg, ____ is >55%, or ther is evidence of ____ in order to decrease the risk of death

A

O2
PaO2
Hct
Cor pulmonale

Slide 34

37
Q

what is the goal of supplemental O2 in COPD patients?
What is usually needed to accomplish this?

A

PaO2>60mmHg
NC @2L/min

Slide 34

38
Q

How is the O2 flow rate titrated in COPD patients?

A

ABG or SpO2

Slide 34

39
Q

what kind of surgery may be indicated in pts w/severe COPD, unresponsive to medical therapy who have overdistended, poorly functioning lung tissue

A

lung volume reduction surgery

Slide 36

40
Q

What does surgical removal of overdistended areas of the lung allow for?

A

areas of normal lung to expand and and improves lung function

Slide 36

41
Q

How is lung volume reduction surgery most commonly performed?

A

Median sternotomy
or
Video-Assisted Thoracoscopic Surgery (VATS)

Slide 36

42
Q

What mechanisms improve lung function in COPD?

A

1) increased elastic recoil, which increases expiratory airflow
2) decreased hyperinflation, which improves diaphragmatic and chest wall mechanics
3) decreased ventilation/perfusion mismatch, improving alveolar gas exchange

Slide 36

43
Q

What is included in anesthesia management of a patient have lung volume reduction surgery?

A

a double-lumen ETT
avoidance of nitrous oxide
minimizing excessive airway pressure

Slide 36

44
Q

What measurement is an unreliable guide for fluid management in COPD? Why?

A

CVP
d/t surgical alterations that will affect intrathoracic pressures

Slide 36

45
Q

Any previous need for ____ or ____ should be determined pre-operatively in COPD patients

A

NIPPV- Noninvasive positive pressure ventilation
or
Mechanical ventilation

Slide 37

46
Q

Becuase smoking & COPD are associated w/ multiple comorbidities, pts should also be questioned on what>

A

Presence of other diseases such as DM, HTN, PVD, ischemic heart disease, heart failure, dysrhythmias, and lung cancer

Slide 37

47
Q

If a patient has pulmonary disease, ____ function should be assessed by ____ and ____

A

RV
clinical exam and echocardiogram

Slide 37

48
Q

which therapies should be continued until the morning of the surgery in COPD?

A

inhalation therapies

Slide 37

49
Q

What pre-operative therapies can reduce post-op pulmonary complications?

A

chest physiotherapy such as deep breathing, coughing, incentive spirometry, and pulmonary PT

Slide 37

50
Q

What findings are more predictive of pulmonary complications that spirometric tests?

A

clinical findings such as smoking, wheezing, and productive cough

Slide 37

51
Q

Do COPD patients undergoing peripheral surgery require preop PFT’s?
when in doubt, what is sufficient to assess lung disease?

A

no
spirometry with FEV1

Slide 38

52
Q

Ventilatory function can also be assessed under ____ by measuring airflow related to lung volume

A

dynamic conditions

Slide 39

53
Q

Expiratory flow rates can be plotted against ____ to produce ____

A

lung volumes
flow volume curves

Slide 39

54
Q

when flow rates during inspiration are added to flow volume curves, what do you get?

A

Flow Volume Loops

Slide 39

55
Q

Why is the RV increased in COPD?

A

Air trapping

Slide 39

Test 4 Health Assessment (Mordecai) (13 decks)

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