Medical/Surgical Management of Pulmonary Dysfunction Flashcards
(73 cards)
1
Q
What meds are used for smoking cessation? (3)
A
- Nicotine Replacement Therapy—start with higher doses and wean down
- Bupropion (Zyban) – antidepressant that helps cravings and withdrawal SE through binding in the brain
- Varenincline (Chantix) –partial nicotine receptor agonist that could have an effect on the cardiovascular system bc have an affinity for nicotinic cathecholamines
2
Q
Medications to Manage Secretions? (5)
A
- antitussives
- antihistamines
- decongestants
- mucolytics and expectorants
3
Q
How do antitussives work? Name the category and 2 examples
A
- (cough medication)—suppress cough reflex
- Opioids (suppress cough reflex)
- Ex: hydrocodone, codeine
4
Q
How do antihistamines work? (2) Examples? (3) SE? (4)
A
- block histamine receptor
- Some of these meds can cross blood brain barrier, so can see side effects
- Ex: diphenhydramine (benadryl), cetirizine (zyrtec), loratadine (claritin)
- HTN
- Unsteadiness
- Drugged state
- Irritate upper airways
5
Q
Decongestants are classified as? How do they work? Need to be aware of? (2) Examples? (2) SE? (6)
A
- Often classified as alpha receptor agonists
- Vasoconstriction in nasal vasculature
- Method of delivery affects side effects
- Need to be aware of cardiovascular side effects
- Ex: epinephrine (primatene), pseudoephedrine (sudafed)
- HA
- Nausea
- Arrythmias and palpitations bc they target cardiac beta receptors
- HTN
6
Q
How do Mucolytics and Expectorants work? Examples? (3)
A
- Mucolytics—break up mucus in airway
- Expectorants—facilitate mucus secretion and clearance
- Ex: mucomyst, pulmozyme, guaifenesin (mucinex)
7
Q
Most used Bronchodilators are what category? Onset is? Cause? (4) Usually taken how? 2 examples?
A
- Beta2 Agonists (beta-andrenergic agonist)
- Short and long acting
- Cause bronchodilation,
- relaxation of smooth muscle by activating Beta2 receptors
- inhibit respiratory smooth muscle contraction
- maintain size of airways
- Usually taken orally or inhaled (nebulizer, metered dose inhaler)
- Albuterol (Ventolin®, Proventil®)
- Salmeterol (Serevent®)
8
Q
Two other categories of bronchodilators?
A
Theophylline
Anticholinergics
9
Q
How common is theophylline? MOA? (2) Usually taken how? Example?
A
- Relaxes airway smooth muscle, some anti-inflammatory effects
- Usually taken orally, but can be injected
- Xanthine derivative
10
Q
How do anticholinergics work? Limited use why? SE? (3) Two examples?
A
- Decrease acetylcholine activity at various sites in the body, including the lungs -> so, inhibition of this facilitates bronchodilation
- Limited use as not specific to the pulmonary system—may be used in combination with a Beta2 agonist
- tachycardia, blurred vision, jittery
- Atrovent (ipratropium)
- Spiriva (tiotropium)
11
Q
3 types of anti-inflammatory meds?
A
Corticosteroids—glucocorticoids
Leukotriene Modifiers
Cromones
12
Q
2 types of oral corticosteroids? Inhalde? (3) How effective? SEs?(11) Used for? (2) Not good for?
A
- Oral = prednisone, methylprednisolone
- Inhaled = triamcinolone (Azmacort), beclomethasone, fluticasone (Flovent)
- Very effective at treating inflammation
Side effects:
- Steroid myopathy
- HTN,
- gastric ulcers,
- exacerbation of DM,
- steroid induced DM,
- glaucoma,
- adrenal gland suppression,
- osteoporosis,
- skin breakdown
- fluid retention
- May have cushingoid look to face
- Very useful in treatment of asthma, bronchitis
- Not good for diabetics bc it throws sugar out of whack
13
Q
Leukotriene Modifiers impact what? What are they? Example? SE?
A
- Impact how leukotrienes work
- Leukotrienes lipid compound produced w/in cells lining respiratory mucosa that tend to augment the inflammatory response
- Ex: Montelukast (singulair)
- hepatotoxicity
14
Q
Cromones help prevent? Need to take when? Help with? Example?
A
- Help prevent inflammation in airway by inhibiting release of inflammatory mediators from cells in respiratory mucosea
- Need to take BEFORE exposure to allergen/irritant
- Help with prevention of an attack
- Ex: Cromolyn (nasalcrom)
15
Q
Therapist should be aware of ? (3)
A
- Therapist should be aware of patients with exercise-induced asthma (pre-medicate if appropriate) : Bring short-acting bronchodilator to PT session, in case an asthmatic attack occurs
- Therapists should be aware of the proper metered dose inhaler technique (hand-breathing coordination)
- Be aware of the side effects of cardiac effects of theophylline and beta-agonists as well as corticosteroid induced thinning of the skin and weakening of bones
16
Q
Define
Wedge Resection
Bullectomy
Lobectomy
Pneumonectomy
Lung volume reduction (LVRS)
A
Wedge Resection: remove triangular slice of tissue
Bullectomy: bullae can rupture and cause PTX
Lobectomy: take part of lobe out
Pneumonectomy: entire lung
Lung volume reduction (LVRS): take 30% of the diseased lung out- shown to improve breathing ability, lung capacity
17
Q
Lung Transplant Candidacy includes? (8)
A
Idiopathic pulmonary fibrosis COPD Cystic fibrosis Emphysema due to alpha-1-antitripsin deficiency Pulmonary arterial hypertension Bronchiolitis obliterans Restrictive lung disease Pulmonary vascular disease
18
Q
Lung Transplant Absolute Criteria? (6)
A
- Normal other organ function
- No malignancy for 2-5 years
- Severe obstructive or restrictive dz
- Limited life expectancy
- No contraindications to immunosuppressants
- Ineffective or unavailable medical therapy
19
Q
Lung Transplant relative Criteria? (7)
A
- No resistant organisms
- Ambulatory with rehabilitation potential
- ## No current alcohol, smoking, substance abuse
20
Q
Lung Transplant Absolute Contraindications? (6)
A
- Recent malignancy
- Active infection with hep B or C
- Active/recent cigarette smoking, drug or alcohol abuse
- Severe psychiatric illness
- Noncompliance with medical care
- Absence of consistent & reliable social network
21
Q
Lung Transplant relative Contraindications? (5)
A
- HIV infection (rel vs abs)
- Significant extrapulmonary organ dysfcn
- Obesity/underweight nutritional status
- Age
- Other co-morbidities
22
Q
When do they do a bilateral lung transplant (BLT)? (3)
A
CF
COPD
PF
23
Q
Lung transplant complications? (5)
A
- Primary Graft Dysfunction
- Airway Complications (ex: bronchial stenosis)
- Infection
- Acute Rejection
- Chronic allograft dysfunction due to bronchiolitis obliterans
24
Q
Lung transplants require a pt take what meds? Examples? (3) Cause?
A
- On anti-rejection medications
Often tacrolimus (prograf), mycophenolate mofetil (MMF), & glucocorticoids
- cause tremors
25
Median sternotomy is most?
Most commonly used for cardiothoracic surgery
26
Thoracoabdominal incision is for? Affects? (4)
- For diaphragm and other major organs
| - Affects the latissimus, serratus, obliques, rectus
27
Chest tubes function? What kind of seals? (2)
- to drain the intrapleural space or the mediastinum
Water seal
Suction seal
28
Pleurodesis is for? How does it work?
pleural effusion or pleural anything; put talc inside to try to fuse pleura together
29
PT Implications of Surgical Procedures - watch? Look at? Thank about? Monitor? Why is it important to get pt moving?
- Watch the tubing/pleurevac/etc
- Look at breathing pattern and what you can do to improve it
- Think about the implication of specific surgeries
- monitor VS
- might develop pneumonia or atlectosis if not moving
30
Indications for Oxygen Therapy? (5)
- Hypoxemia
- Increased work of breathing
- Increased myocardial work
- Decreased exercise/activity tolerance for patients who desaturate with exercise/activity
-
31
Oxygen Toxicity aka? What is it? Can lead to? (5) In the lungs? Keep FiO2 at what %?
- hyperoxia
- Increased production of ‘free radicals’
- Can damage cell membrane, proteins and DNA
- Can lead to cell death and loss of organ function
In the lungs – this may lead to airway inflammation, increased alveolar permeability, pulmonary edema
Keep FiO2
32
We breath what FiO2 regularly?
~21-23%
33
Aerosol masks are for what? (4)
- CF, asthma, anybody that needs a bronchodilator or steroid
34
Venturi mask mixes what? To create? Used when?
- Mixes oxygen with RA -> creates high-flow enriches O2 of a CONTROLLED concentration
- Used when concerned about CO2 retention
35
3 types of high flow O2?
Non-rebreather
Manual resuscitator (Ambu bag)
Optiflow
36
What is a non-rebreather?
Face mask with a reservoir which prevents patient from re-breathing any expired air FiO2 is 100%
37
A manual resuscitator (Ambu bag) delivers? Can be used to?
- Delivers 100% oxygen
| - Can be used to ambulate ventilated patients or for manual hyperinflation
38
Optiflow can adjust? Can wear for?
- Can adjust flow and FiO2 separately
| - Can wear for transfers, but recommend Venti mask for ambulation
39
3 types of artificial airways?
intubation
endotracheal tubes
tracheostomy
40
Reasons for intubation? (4)
- Airway obstruction
- Inability to protect the lower airway from aspiration
- Inability to clear secretions from the lower airways
- Need for positive pressure ventilation (apnea or ventilatory failure)
41
Endotracheal tube goes from - oral? Nasal?
Oral: from mouth to trachea
Nasal: from nose to trachea
42
Tracheostomy tube goes where? Parts?
- Directly to trachea via tracheostomy just below the vocal cords
- Cuff
- Cap
- Speaking valve (ex: passy muir)
43
When the cuff is inflated what happens to the air? Deflated?
- goes into lungs
| - you can talk over it a little
44
Parts of the tracheostomy tube (trach)?
- Outer cannula: what you see
- Inner cannula: looked together to prevent from being coughed out
- Obturator: window in it that could be used as a trial before trach is moved out, if they can breath normall and clear secretions
45
Positive Pressure Ventilator delivers? This is opposite of? How does one exhale?
- a positive pressure
- This is opposite of normal negative pressure ventilation
- positive pressure pushes air directly in but you have elastic recoil of lungs to come out
46
Neg pressure ventilator aka? What is it?
- Iron lung
| - vacuum pump, creates negative pressure
47
Mechanical Ventilation Terminology - define frequency, flow rate, spontaneous breath, trigger
Frequency: number of breaths per minute
Flow rate: the speed at which the ventilator breath is delivered
Spontaneous breath: breathing through the ventilator circuit without assistance
Trigger: variable that causes a breath to be delivered
48
What is ventilator volume cycled? For what pts?
predetermined air amount based on their needs
| - for pts that are more longer term vent support
49
What is pressure cycled?
Getting certain amount of max pressure to deliver air, pressure reached, inspiration ends and passive recoil
50
Two types of positive pressure ventilator (PPV) modes?
- Controlled Mechanical Ventilation (CMV)
| - Assist/Control (AC)
51
CMV delivers? Usually at set? Pt usually? (2)
- Ventilator delivers all breaths at a preset frequency and flow rate
- Usually at set Volume &/or Pressure
- Patient usually is sedated and paralyzed
- Patient can NOT take a spontaneous breath or trigger the machine
52
AC is based on? (3) Machine senses? If pts doesnt initiate breath, what happens? To breaths in general? Problem with volume modes?
- Volume targeted mode (patient receives a preset volume),
- Pressure targeted mode (patient receives a preset pressure),
- frequency
- Machine senses patient initiated breath by sensing negative pressure and then starts to supply a positive pressure breathe
- If patient does not initiate the breathe, the machine will supply a breathe
- ALL breathes are machine delivered
Problem with volume modes: as lung compliance decreases, need to increase pressure to supply the same volume
53
3 other ventilator modes?
- Intermittent Mandatory Ventilation (IMV)
- Synchronized Intermittent Mandatory Ventilation (SIMV)
- Pressure Support (PS)
54
Intermittent Mandatory Ventilation (IMV) delivers? PT can?
- Machine delivers set frequency & volume or pressure
| - The patient can take spontaneous breaths in between
55
Synchronized Intermittent Mandatory Ventilation (SIMV) delivers? Available in what modes? Used for?
- Mechanical and spontaneous breaths
- Available in volume or pressure modes
- Used for weaning
56
Pressure Support (PS) - pressure is? Pt determines? Machine will not?
- Pressure stays constant, but the volume needed to reach the pressure may vary depending on lung compliance, resistance, and patient effort
- Patient determines rate of breathing
- Machine will NOT deliver a breathe without a patient trigger
57
Positive Airway Pressure terms - define recruitment, derecruitment, function of Positive End Expiratory Pressure (PEEP)?
Recruitment
Opening of previously collapsed airway (alveoli); helps with ease of breathing
Derecruitment
Collapsing of previously opened alveoli
Positive End Expiratory Pressure (PEEP)
Maintains set pressure at the end of expiration to prevent airway collapse
58
Function of Continuous Positive Airway Pressure (CPAP)? (3)
- Spontaneous breathing with an elevated baseline airway pressure -> helps keep airway open
- Indicated for oxygenation
- Tells you mode/pressure/FiO2
59
What is plateau pressure?
Moment btwn insp and exp; it can tell you how sick the lung is = peak pressure
60
What is NIPPV?
noninvasive positive pressure ventilation
61
What is BiPAP? Indicated for? Can set? (2)
- (bilevel positive airway pressure)
- Indicated for ventilation (helps to blow off CO2)
- Can set inspiratory and expiratory pressures
- Can set FiO2 and PEEP
62
CPAP does what?
Prevents lungs from collapsing
63
On both NIPPV and BiPAP you can do what? Both require?
- On both of these you can mobilize patients, BUT source of O2 may limit distance Have RT around when mobilizing
- Both require tight fitting mask
64
Who isn't indicated for positive pressure intervention? (2)
thoracic pts, esophagectomy pts
65
Assist Control (old CMV) - control what? Has a set? (6) Can set? May see?
- Control volume going in regardless of trigger
- Has a set RR, TV, flow, CPAP, FiO2, and PEEP
- Can set trigger so easier or harder to trigger breath
- May see dys-synchronous breathing (pt fighting vent)
66
SIMV (synchronous intermittent minute ventilation) has a? (6)
Has a set rate, TV, flow, pressure support, FiO2, PEEP
67
Can look on ventilator screen to see? (6)
```
TV
Type of breath (“C” = control vs “S” = spontaneous)
RR
Pressure Support
FiO2
Alarms
```
68
If don't see a set RR rate, that means?
If don’t see a set rate, that means the patient is breathing on his/her own and is most likely on CPAP mode
69
Ventilator alarms for? (5)
```
high pressure
low pressure
apnea
disconnection
volume
```
70
Check for what if high pressure alarm goes off? May need? Low pressure - may be? Apnea alarm can go off? Disconnection usually? Volume goes off if? (2)
```
- High pressure
Check for secretions or airflow obstruction
May need to suction or use Ambu bag
- Low pressure
May be a leak in the circuitry or poor connection to patient
- Apnea – no breathe
Pt did not trigger the machine to deliver a breath
- Disconnection
Usually low pressure alarm
- Volume
If not maintaining minute ventilation
Pt may be fatiguing
```
71
What to do if vent isn't working properly?
Disconnect pt from ventilator and start ambu bagging while calling for help
72
PT with a Patient on Mechanical Ventilation - PT roles? (5)
- positional rotation to maintain airway clearance
- breathing retraining and proper posture
- exercise to prevent immobility
- assist w weaning by identifying optimal positions for ventilation function
- adaptive devices to improve function
- Suggestions for t-piece (regular air comes in, no longer ventilator)
73
Suctioning - need to maintain? What kind of setting? Insert? Apply suction how? Do not? How long? May suction how? (3)
- Need to maintain a sterile field
- Low vacuum setting (below 120mm Hg)
- Insert catheter gently until cough is stimulated by contact with the carina
- Apply suction while REMOVING catheter from airway
- DO NOT suction while inserting catheter
- Only 5-15 seconds
- May suction orally, via trach, or nasally
