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SRNAHealthAssessment > Leo-Pulmonary Assessment > Flashcards

Leo-Pulmonary Assessment Flashcards

(100 cards)

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1
Q

What are the 3 main things to consider for pulmonary Assessment?

A

1.Determine patient’s baseline
2.Recent changes in patient’s pulmonary
status:How would these changes affect the anesthetic
plan
3.Assess risk for pulmonary complications

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2
Q

Length of Surgery – risk

A

Increase after 2-3hrs

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3
Q

What further increases risk of pulmonary complications?

A

Increase Risk when incision approaches diaphragm

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4
Q

What is decrease after long surgery (pulmonary)?

A

FRC and postop VC

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5
Q

Pulmonary assessment

CCC SSSSS REM

A

– Current or Recent upper respiratory infection?
– Cough – productive? Need to be optimized before surgery?
– Coexisting diseases

– Shortness of breath (dypsnea/orthopnea)
– Sleep apnea
– Snoring
– Stridor, wheezing
– Smoking: Tobacco Use
– Recently hospitalized fordisease/infection
– Exercise tolerance
–Medications
■ What meds and their actions
■ Effectiveness for patient
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6
Q

Even in smokers, with no chronic

lung disease, Effect of smoking?

A

Smoking increases carboxyhemoglobin levels, decreases ciliary function, increases sputum production, stimulates CV system

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7
Q

Smoke-free interval of 12-18 hours shows

A

significant declines in carboxyhgb & normalization of

oxygen-HGB dissociation curve

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8
Q

■ 8 wks smoke free:

A

improves ciliary & small airway function; & decreases
risk of post-op pulm. complications.
– Increased reactivity

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9
Q

CXR and anesthetic plan

A

Only 5% had an impact on surgical/anesthetic plan

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10
Q

Physical Pulmonary Assessment (RCASSSWCT)

A 
Respiratory rate (RR)
■ Conversation
■ Auscultation of Lung Sounds
■ Skin color
■ Size/shape of chest
■ Work of breathing
■ Clubbing/ nail color
■ Tongue & Sublingual area
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11
Q

Surgical Physiologic Changes in Pulmonary Function mainly 2 types of surgeries

A

Abdominal and Thoracic surgeries

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12
Q

Surgical Physiologic Changes in Pulmonary Function Diaphragm change?

A

Diaphragmatic dysfunction

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13
Q

Surgical Physiologic Changes in Pulmonary Function TV

A

Decreased

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14
Q

Surgical Physiologic Changes in Pulmonary Function RR

A

Increased

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15
Q

Surgical Physiologic Changes in Pulmonary Function FRC FRC

A

Decreased FRC (up to 60-70%)

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16
Q

Surgical Physiologic Changes in Pulmonary Function TLC

A

Decreased TLC

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17
Q

Surgical Physiologic Changes in Pulmonary Function alveolar -arterial O2 tension

A

Increased Alveolar-to-arterial O2 tension gradient

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18
Q

________should be treated with antibiotics before undergoing surgery

A

■ Infections

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19
Q

How does Chest physiotherapy help–

A

improve sputum clearance & bronchial drainage

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20
Q

Treat cor pulmonale with

A

diuretics, dig, oxygen

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21
Q

Preop Assessment Goals

A 
■ Bronchodilation therapy
■ Stop smoking
■ Steroid therapy
■ Correct hypoxemia
■ Relieve bronchospasm
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22
Q

Other things to consider

A 
Procedure
■ Position
■ Estimated & Allowable Blood loss
■ Pain Control
■ Need for paralysis
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23
Q

General Anesthesia: on airway

A

Provides controlled airway to deliver desired oxygen

concentration

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24
Q

What are the benefits of Volatile Anesthetics

A

– Good bronchodilators
– Can even be used to treat status asthmaticus
– Beta2-adrenergic stimulation

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25
■ Good choice for respiratory compromised patient
Local / Regional Anesthesia
26
Good choice when trying to avoid possibility | of bronchospasm d/t instrumentation
Local / Regional Anesthesia
27
High levels of blockade can produce
severe anxiety & initiate bronchospasm
28
LA Can block sympathetic input to lungs leading
even leading to increased airway resistance
29
Patients at Increased Risk for Pulmonary Complications | COUPLES
``` COPD /Cardiac disease Obese Upper abdominal surgery Prolonged bed rest Long surgery Elderly Smokers ```
30
Patients at greatest risk for complications are | those with
preop pulmonary function measurements less than 50% of predicted
31
Vesicular | ■ NORMAL
– inspiration/expiratory ratio of 3 to 1 (I:E of 3:1)
32
Over most of both lungs Which bronchial sounds
Vesicular
33
■ Inspiratory sounds last longer then expiratory
Vesicular
34
Soft sound with relatively low pitch
Vesicular
35
Distinct pause between I/E
Bronchial
36
Expiratory sounds last longer than inspiratory (1:3)
Bronchial
37
Bronchial breath sounds other than close to the trachea | may indicate
pneumonia, atelectasis, pleural effusions
38
High pitch
Bronchial
39
Breath sounds with high intensity
Bronchial
40
Abnormal in the lung periphery and may indicate an early infiltrate or partial atelectasis
Bronchovesicular
41
Inspiratory & expiratory almost Equal
Bronchovesicular
42
Mixture of the pitch of the bronchial breath sounds | heard near the trachea and the alveoli with the vesicular sound
Bronchovesicular
43
Medium intensity
Bronchovesicular
44
Medium Pitch
Bronchovesicular
45
Heard between scapula & in 1st & 2nd interspaces | anteriorly
Bronchovesicular
46
Signs of Inadequate Airway pediatric
Stridor ■ Noisy respirations ■ Flaring of nares ■ Labored breathing with use of accessory muscles (Supraclavicular& intercostalretractions
47
Signs of Inadequate Gas Exchange
``` Tachypnea ■ Decreased PaO2 ■ Increased dead space ■ Central cyanosis ■ Chest infiltrates on x-ray evaluation ```
48
Inadequate Ventilation manifestations of
Obstructed airway
49
Chest wall and inadequate ventilation
Paradoxical motion involving significant portion of chest | wall
50
PaO2, PaCo2, pH
PaO2 decreased PaCo2 increased pH decreased
51
Central cyanosis associated with
inadequate ventilation
52
Normal FRC =
30 mL/Kg (2-2.5L inaverage person)
53
Associated with decreased FRC
FRC ↓ in supine position during general anesthesia & ARDS
54
PEEP: How does it help in supine position
↑ FRC & ↓ airway closure
55
Preoxygenate/ denitrogenate to keep Expired oxygen
>90%
56
After general anesthesia, how long does it take for FRC to return to normal
FRC can take 2 weeks to return to baseline after GETA
57
Asthma is a
Chronic airway inflammation characterized by exacerbations & remissions
58
Can cause bronchospasm
Manipulation &/or intubation of airway can cause | Bronchospasm
59
Asthma and CO2 retention
CO2 retention is late finding in these patients – May be hypocarbic with respiratory alkalosis d/t hyperventilation
60
Solubility of CO2 vs O2
– 20X more soluble than O2
61
Asthma : What is universal finding during attack
hypoxemia
62
During interview for asthma; Determine?
``` Inciting factors o Severity o Reversibility o Current status o Last attack (May be hyperreactive for weeks!) ```
63
For asthma know the last time they
Hospitalizations, bronchodilator use, systemic | steroid use
64
What are the 3 Early signs of an asthma attack under general anesthesia
1. Increased peak airway pressure 2. Alteration of expiratory plateau on capnography 3. Hypoxemia occurs as the attack progresses and worsens
65
COPD Criteria to postpone surgery
``` Elective surgery is postponed: – Severe dyspnea – Wheezing – Pulmonary congestion – Hypercarbia (paCO2>50 mm Hg) ```
66
“Pink-puffers” - ________appearance
acyanotic
67
Exhale thru pursed lips (PEEP)
Pink Puffers
68
Pink puffers are COPD with
– Advanced disease, yet preserved arterial O2 tension until very late in disease
69
What is the hallmark of chronic air flow obstruction?
Decrease in Forced Expiratory Volume (FEV1)/Forced Vital Capacity ratio
70
In COPD there is diminished flow in
Diminished airflow at all lung volumes
71
May have hyperinflation & gas trapping
COPD
72
CXR- COPD changed
flat diaphragms, hyperlucent lung fields, heart appears | small, decreased pulm. vasculature
73
COPD patients May have pulm. bullae which put them at risk
– high risk of pneumothoraxes intraop, especially with positive pressure
74
Characteristics of Blue Bloaters
“Blue-Bloaters” – cyanotic – Arterial O2 desaturation (even early in disease) – Bloated appearance
75
Chronic Bronchitis
Copious secretions → occlude airways – d/t proliferation & hypertrophy of bronchial goblet cells; hyperreactivity of bronchial smooth muscle – Chronic productive cough/wheeze
76
Blue bloaters may have RHF with
Possible right-sided failure, cor pulmonale – Peripheral edema – Increased hepatojugular reflux
77
In chronic Bronchitis: Lung volume
– Near normal in chronic bronchitis (except acute | exacerbation)
78
In emphysema :lung volume
Increased TLC, Increased FRC, Increased RV in | emphysema
79
Beware of too much oxygen for COPD why?
– Can dangerously elevate PaO2 if pts are CO2 retainers ■ Depend on chemoreceptors to make them breathe when hypoxic – Elevating PaO2 above 60 mmHg can lead to respiratory failure
80
Acute Intrinsic Pulmonary Disorders
– Pulmonary edema – ARDS – Infectious pneumonia – Aspiration pneumonitis
81
Chronic Intrinsic Pulmonary Disorders
– Interstitial lung disease – Chronic inflammation of alveolar walls, & progressive pulmonary fibrosis.
82
Acute Intrinsic Pulmonary Disorders: surgery
no, postpone elective
83
Preop treatment of:
``` – Heart failure – Fluid overload – Optimize oxygenation & ventilation – Decompress abdomen, drain ascites – Use PEEP (helps c/restrictive airway disease) ```
84
Chronic Intrinsic pulmonary disorders you will see on CXR
– CXR –”Ground-glass to honeycomb”
85
Late stage of chronic intrinsic pulmonary disorders
In late stages, signs of right ventricular failure/cor pulmonale
86
Extrinsic Restrictive Pulmonary Disorders
``` –Pleural effusions – Pneumothorax – Mediastinal mass – Kyphoscoliosis – Pectus excavatum – Neuromuscular disorders – Marked obesity – Increased intraabdominal pressure ■ Ascites, pregnancy, bleeding, pneumoperitoneum ```
87
FEV1: What is it?
forced expiratory volume in one second | – total volume of air a patient can exhale in the first second during maximal effort
88
FVC: What is it
forced vital capacity: total volume of air a patient can exhale for the total duration of the test during maximal effort
89
The percentage of the FVC expired in one second
FEV1/FVC ratio
90
FEF25–75%:
forced expiratory flow over the middle one-half of the FVC
91
FEF25–75%: is the average flow from the point at which
– Average flow from the point at which 25% of the FVC has been exhaled to the point at which 75% of the FVC has been exhale
92
Determine If the FEV1/FVC Ratio Is Low Obstructive? National Asthma Education and Prevention Program
Gold Criteria <0.70 (70% obstructive) | < 85% (0.85)
93
What is the best test for early stage COPD
■ FEF25-75% Decreased
94
Obstructive: VC is
Normal or Decreased
95
Restrictive what is decreased
VC, TLC, RV
96
Obstructive: RV is
Increased
97
FEV1/FVC in obstructive
Decreased
98
FEV1/FVC in Restrictive
normal or INCREASED
99
TLC in obstructive
Normal or increased
100
Restrictive Disease
TLC - < 80% of predicted in age

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