pathologies Flashcards
1
Q
COPD meds
A
- Saba - Albuterol, Xopenex, Ipratropium bromide
- Laba- Salmetero, spiriva
- Steroids for inflammation - Fluticasone, budesonid
- MDI - Advair, Symbicort
2
Q
COPD
hospital management for exacerbagtion
A
- meds: SABA and antibiotics
- oxygen - 24 -28% for hypoxemian
- NPPV (pH <7.35 and Paco2 >45)
- INtubate (pH <7.30 and Paco2 >50)
3
Q
COPD
When do you intuate?
A
pH is , 7.30 and Paco2 >50
for pts with acute hypercapnic resp. failure and server hypoxemia
4
Q
Short- acting beta agonis
A
Albuterol, Xopenex, Ipratropium bromide
5
Q
Long acting beta agonist
A
Salmetero, spiriva
6
Q
Emphysema / c. Bronchitis
Patient assesment
apperance and respiratory pattern
A
- appearance: barrel chest, increased A-P diameter, clubbing and cyanosid
- resp. pattern: dyspnea, accessory muscle use, pursed-lip breathing
7
Q
Ephysema / C. Bronchitis
COPD breath sounds
A
diminished aeration with bilateral expiratory wheeze
8
Q
Ephysema / Chronic Bronchitis
chest percussion and cough assessment
A
Percussion : tympanic or hyperresonant
cough: congested, productive or thich sputum
9
Q
Emphysema / Chronic Bronchitis
Pulmonary funtion testing
A
decreased flows (FEV1, FEV1/FVC, FEFn25-75)
10
Q
Terminology used to describe COPD
A
Chronic ventilatory failure, increased lung compliance, chronic hypercapnia, loss of elastic recoil, Chronic CO2 retention
11
Q
Treatment for CB / ephysema
A
- low o2 spo2 is 88-92%
- aerosolized bronchodilators
- bronchial hygiene
- corticosteroids
- antibiotics if indicated by sputum culture
- smoking cessation
- pulmonary rehabilitation
- proper nutrition
12
Q
Asthma
Patient assessment : Appearance of the chest and Resp pattern:
A
Chest: increased A-P diameter during episode
RP: accessory muscle usage, retractions
13
Q
Asthma severity PEFR or FEV1
A
Mild > 80%
Moderate 60-70%
Severe >60
14
Q
med given for status asthmaticus
A
Amoline
15
Q
Asthma medications
SABA
A
albuterol, Xopenex, Ipratropium
16
Q
Asthma medications
Corticosteroids for inflamation
A
prednisone
methylprednisolone
17
Q
Asthma Assessment
Resp. pattern
Chest percussion
A
RP: accessory muscle use, retractions (in children)
CP: Hyperresonant / tympanic note
18
Q
Asthma assessment
breath sounds
A
- Diffuse wheezing
- diminished
- prolonged expiration
19
Q
asthma assesment
physical appearance
A
Diaphoresis
20
Q
Asthma assessment
Vital signs
A
- Tachycardia
- tachypnea
- pulsus paradoxus
21
Q
Astham chest x-ray
A
- increased A-P diameter
- translucent lungs fields
- depressed/ flattened diaphragms
22
Q
Asthma PFT and post-bronchodilator spirometry
A
- reduced flowrates (peak flow, FEV1, FEV1/FVC)
- Post-bronchodialator: considered a significant response if FEV1 increases at least 12% and 200mL
23
Q
Asthma management of acute episodes
A
- O2
- SABA and anticholinergic agents
- Corticosteroids
- intubate if ventilatory failure or resp. arrest occurs
- considere: heliox, magnesium sulfate, subcutaneous epinephrine
24
Q
Asthma Long term control
A
control meds:
* LABA
* inhaled corticosteroids
* mast cell stanbilizers
* leukotrine inhibitos
Asthma action plan
25
Green
Asthma cation plan
| Peak Flow ?
Action plan?
Stable
Peak Flow 80 -100 %
| continue with med in daily treatment plan , use Preventative medicine
26
Yellow
asthma action plan
increase in symptoms
Peak Flow 50-80%
* Give Preventative (anti-inflammatory) inhalor
* ADD: quick relief inhalor (albuterol)
* begin / increase oral steroids
* call doctor
* return to level 1 when symptos improve
27
Red
asthma action plan
| peak flow?
no improvement after increasing treatment after yellow zone
Peak flow <50%
* Quick relief bronchodilator inhaker
* Begin/ increase treatment with oral steroids
* call doctor!
28
Assess severity of asthma with __ or __
| Mild, Moderate, Sever
PEFR or FEV1
Mild >80 %
Moderate 60-70%
Severe <60%
29
Give for status asthmaticus
Amoline
30
Asthma Medications
| In Hospital
* SABA - Albutero, Xopenex, Ipratropium
* Corticosteroids - Prednisone, methylprednisolone
* oxygen for hypoxdemia
| After 3 nebs of albuterol, if wheezing continues give corticosteroids
31
Asthma medication
(home care, rehab)
| ICS, SABA, LABA, MDI
* Inhaled corticosteroids - Fluticasone, Pulmicort, Azmacort, Singulair
* Albuterol
* LABA - seravent, only use with ICS
* MDI - Advair, Symbicort
32
Bronchiectasis
| definition
Chronic dilation and distortion of one or more bronchi as a result of excessive inflammation and destructionon bronchial walls, blood vessels, elastic tissu, and smooth muscle
33
Bronchiectasis
| Patient assessment
* hx of pulmonary infections and cystic fibrosis
* cyanosis, barrel chest, clubbing
* Tachypnea, dyspnea, accessory muscle use
34
Bronchiectaisis
| Diagnostic chest percussion and cough
CP: Hyperresonant or tympanic
Cough: Pruductive of purulent, fould smellin secretions , hemoptysis, sputus separete into 3 layers
35
Bronchiectasis treatment
* oxygen therapy
* bronchopulmonary hygiene
* Lung expansion therapy
* Antibiotics
* expectorants
* aeroslized SABA and anticholinergic
36
Cystic Fibrosis
An inherited, genetic disorder involving the exocrine glands. Results in thick viscous mucus accumulation in the lungs and prohibits enzymes from reaching the intestines leading to inhibition of digestion of protein and fat and deficencies of Vitamins A,D,E and K.
37
CF
assessment
| general apperance
breath sounds
GA: Barrel chest, cyanosis, clubing, small for age, malnutrition, poor body development, peripheral edema
BS: diminished, crackles, wheezing
38
CF
assessment
| Respiratory pattern
Chest percussion
Rp: tachypnea, dyspnea on exertion, use of accessory muscles of inspiration and expiration, cough productive of large amount of thick purulent secretions
CP: hyperresonant or tympanic note
39
CF
x-ray
Translucent (dark) lung fields, depressed or flattened diaphragm, right ventricular enlargement, areas of atelectasis and fibrosis.
40
Cystic Fibrosis
CBC
elevated Hb and Hct concentration.
41
Cystic Fibrosis
sputum culture
Opften positive for *Staphylococcus aureus, Haemophilius influenza, Pseudomonas aeroginosa*
42
Cystic Fibrosis
Special test
* New born - screening by immunoreactive trypsin level (IRT)
* Sweat Chloride Test (>60 mEq/L)
* Genetic testing of CFTR mutation
43
Positive CF Sweat Chloride test
> 60mEq/L
44
Cystic Fibrosis
mediactions
* Bronchodilators
* Expectorants for mobilizing secretions
* Mucolytics - Pulmozyme
* Antibiotics for infection (TOBI)
* CFTR modulators (Orkambi, Symdeko, Kalydeco)
45
How frequently do you give TOBI for CF
nebulized twice a day every other month to reduce bronchiectic exacerbations.
46
Do you use NPPV for CF?
Yes, for impending ventilatory failure (pH<7.30)
47
" Caftors "
Orkambi
Sumdeko
Kalydeco
| Given to cystic Fibrosis pt
48
Treatment for CF
* Chest percussion and postural drainage
* Exercise
* PEP therapy
* High Frequency chest wall compression
* O2 therapy
49
Inhaled antibiotics
| 3
* Tobramycin (TOBI)
* Colistin
* Amikacin
50
name a mucolytic for CF
dornase alpha (Pulmozyme)
51
Apnea is diagnosed in pt who..
have more than 5 episodes of apnea per hour that may occur in REM and/or non-REM sleep over a 6 hour period
52
Hypopnea
shallow or slow breathing
53
Central sleep apnea
caused by failure of the respiratory center of the brain to send signals to the reps. muscles
54
Polysomnography: If both nasal flow and resp effort decrease then desaturation
| CSA or OSA
Central Sleep Apnea
55
Polysomnography: If nasal flow decreases with an increase in respiratory effort then desaturation
Obstructive sleep apnea
56
the average number of apneas and hypopneas per hour of sleep
AHI
| apnea-hypopnea index
57
Normal AHI
| apnea-hypopnea index
<5 episodes/ hour
58
AHI
* Mild
* Mod
* Severfe
* mild 5-15
* mod 16-30
* Severe >30
59
Treatment for Central sleep apnea
NPPV
60
Treatment for Obstructive apena
* nasal CPAP
* weight loss
* sleep posture (lateral or upright)
* oxygen therapy
* surgery (UPPP, trach)
* oral appliances
* neck collar
61
Chest Trauma / Flail Chest
| General apperance & Resp pattern
GA: Anxious, cuanosis, bruising over area
RP: shallow, rapid respirations, paradoxical chest movement (flail chest)
62
Diagnostic chest precussion for flail chest/ chest trauma
May have sign and symptosm of penumothorax ( hyperresonant/ tympanic note)
63
Chest Trauma / Flail Chest
Breath Sounds
diminished breath sounds over affected area
64
Treatment for Chest Trauma / Flail Chest
| Mild/ Severe
* Mild - Pain medication, lung expansion therapy and bronchial hygiene (IS and deep breathing and coughing, IPPV)
* Severe - Stabilization of chest (NPPV, VC/AC with peep for acute ven failure)
65
Pneumothorax
General assessment
Possible diaphoresis, cyanosis, tracheal or mediastinal shift away from the affected side, bruising over affected area
66
Pneumothorax
Resp. pattern
Tachypnea reduced movement on affected side
67
Pneumothorax
* Breath sounds
* Chest percussion
* BS: diminished or absent on affected side
* CP: Hyperresonant/ tympanic note over affected side
68
Pneumothorax
Vital signs
Tachycardia, pulsus paraxoxus, hypertension
69
Pneumothorax
Chest X-ray
Hyperlucency with absence of vascular markings on the affected side, tracheal shift to the unaffected side, depressed diaphragm, lung collapse
70
Treatment for Pneumothorax less than 20% of lung collapse
may only require bed rest and limited physical activity
| absorption occurs withing 30 days
71
Treatment for Pneumothorax greater than 20% lung collapse
should be evacuated by chest tube or needle if patient is unstable ( bradycardia, hypotension, cyanosis)
* Give Hyperinflation therapy (IS/SMI, IPPV) after chest tube insertion
72
Hemothorax
general appearance
* Cyanosis,
* tracheal or mediastinal shift away from the affected side
73
Hemothorax
* Resp. patterns
* Breath sounds
* RP: tachypnea, productive cough (hemoptysis)
* BS: diminished or absent on affected side
74
Treatment for Hemothorax
* thoracentesis or chest tune
* Hyperinfaltion therapy (IS,/SMI, IPPB)
* mechanical ventilation
75
Carbon monoxide poisoning is present when...
COHb > 20%
76
Carbon Monoxide Poisoning
General appearance
* Anxious
* surface burns
* singed facial hair
* black soot marks
* Cyanosis or cherry red color
77
Carbon Monoxide Poisoning
Breath sounds
Normal in early stages, may present with wheezing, crackles or rhonchi inspiratory Stridor
78
Pulmonary Function of Carbon Monoxide Poisoning
Decreased volumes and flowrates (Vt,VC,FEV...)
* decreased DLco
79
Treatment of Carbon Monoxide Poisoning
* marked or severe distress/ stridor - intubate
* Oxygen therapy 100%
* Hyperbaric oxygen therapy - for severe poisoning
* Mechanica ventialtion for ventilatory failure
* Pulmonary hygiene
* Hyperinflation therapy
80
Carbon Monoxide Poisoning
aerosolized Medication
* Bronchodilators ( Albuterol , Xopenex)
* Mucolytics and expectorants
* Corticosteroids
* Analgesics for pain
* Antiniotics for infection
81
In Carbon Monoxide Poisoning use ___ to diagnose burn injury to upper airway
bronchoscopy
82
Congestive Heart Failure
Abnormal condition that reflects impaired cardia pumping. Caused by myocardial infarction, Ischemic heart disease or cardiomyopathy
83
Pulmonary Edema
Excessive movement of fluid from the pulmonary vascular system to the extravascular system and air spaces of the lungs (alveoli). Most commonly caused by CHF
84
Most common cause of Pulmonary Edema
CHF
85
CHF / P. Edema
general appearance
Peripheral / pedal edema
Diaphoresis
Cyanosis
86
CHF / P. Edema
Respiratory Pattern
Tachypnea, orthopnea, paroxysmal nocturnal dyspnea
| orthopnea - elevate at 30 -35 degrees so they can breath
87
CHF / P. Edema
cough & diagnostic percussion
cough: pink frothy secretions
Percussion: flat or dull percussion note
other: increased tactile and vocal fremitus
88
CHF / P. Edema
Chest x-ray
* bilateral fluffy opacities
* dilated pulm. arteries
* Left ventricular hypertrophy (cardiomegaly)
* butterflu or bat wing pattern
* Kerley A&B lines
89
CHF / P. Edema
PFT
rexuced volumes and capacities
* Normal FEV1/FVC ratio
90
CHF / P. Edema
* hemodynamics
* cardiac enzymes
* Hemo: Increased PCWP, PAP
* CE: elevated brain natriuretic peeptide (BNP)
91
CHF / P. Edema
Treatment
* High flow oxygen therapy via non-rebreather , HFNC
* place in Fowler's position
* Hyperinfaltion therapy (IPPB, IPV)
* Diuretics -furosemide
* Positive inotropic agents - digitalis, dogoxin docutamine, dopamine
* Analgesic - morphine (slow down breathing)
* Preload reduction agens - nitroglycering, nitroprusside, morphine
* CPAP - not for hypercapnia
* Antidysrhytmic agents Atropine (brady), procainamide or metoprolol (tachy)
92
Positive inotropic agents
for CHF
digitalis, dogoxin docutamine, dopamine
93
Analgesic
for CHF
* Analgesic - morphine (slow down breathing)
94
Preload reduction agents for CHF?
| and pulmonary edema
nitroglycering, nitroprusside, morphine
95
Antidysrhytjmic agents for CHF / P. edema
Bradycardia : atropine
Tachycardia : procainamide, metoprolol
96
Arrhythmias etiology
Hopoxemia
Ischemia
Electrolyte imbalance
conduction disorders
97
List a few medications for CHF
* Digitalis - to increase muscle contractility
* Lasix to promote fluid excretion
* Nipride (vasodialtor) to reduce impedance of blood flow
98
Do you give lasix for small or mild edema ?
no
99
Left heart failure
pulmonary edema
100
right heart failure
peripheral edema
101
what do you give for cardiogenic shock
* Anticoagulants (warfarin) and antiplatelets
* Thrombolytics (activase)
* Diuretics
102
Meds for P. edema
* Digitalis / dobutamine to increase cardiac output
* Lasix for fluid excretion
* Vasodilators - morphine and Nipride to decrease vascular resistance and improve cardiac output
| If diuretics dont work, intubate and MV for acute ventilatory failure
103
treatment for Premature Ventricular Contraction
| PVC
Treat with oxygen, lidocaine and consider causes
104
Treatment for Ventricular fibrillation and pulseless ventricular tachycardia ?
defibrillation
105
For Atrial flutter, fibrillation and ventricular tachycardia WITH pulse consider ...
synchronized cardioversion
106
What is a frequen complication of COPD and interstitial lung disease
Pulmonary hypertension
107
An increase in mean pulmonary artery pressure greater than 25mmHg at rest.
Pulmonary Hypertension
108
Pulm. Hypertension
general appearance
anxious
diaphoretic
cyanotic
peripheral edema
jugular venous distension
109
Pulm. Hypertension
Resp. pattern
* RP : dispnea, shortness of breath during routine activity tachypnea
110
Pulm. Hypertension
* breath sounds
* cough
* wheezing
crackles
pleural friction rub
* cough : non-pruductive
111
Pulm. Hypertension
Chest x-ray
underluing lung disease
enlarged pulmonary arteries
112
Hemodynamics for Pulm. Hypertension
increased PAP
113
treatment for Pulm. Hypertension
* Diuretics to reduce fluid buildup
* Blood thining meds
* Inotropic agents (digitalis)
* Warfarin (Coumadin)
* O2 therapy
* nitric oxide for severe cases
114
Pulm. Hypertension
blood thining medications
1. Apixaban (Eliquis)
2. Fondaparinux (Arixtra)
3. Heparin (Levenox)
4. Rivaroxaban (Xarelto)
5. Warfarin (Coumadin)
115
Interruption of coronary blood flow for an extended period of time causing potentially irreversile damage to the heart muscle, potentially leading to sudden cardiac arrest
Myocardial Ischemia / Infarction
116
Myocardial Ischemia / Infarction
* general appearance
diaphoretic,
anxious
c/o chest pain
possible cyanosis
117
Myocardial Ischemia / Infarction
*Diagnostic testing*
* ABG
* Electrolytes
* electrocardiogram
* Cardiac enzynes
* ABG: Hypoxemia
* Electrolytes: Hyperkalemia or hypokalemia
* Electrocardiogram: inverted T waves, elevated S-T segment
* Cardiac enzymes: Elevated troponin level
118
Electrocardiogram for Myocardial Ishemia
Inverted T waves, elevated S-T segment
119
treatment for Myocardial Ischemia / Infarction
* 100% oxygen (priority)
* Aspirin
* Morphine
* Anti-arrhythnmic agents as indicated (amiodarone, Procainamide, atropine)
* Nitrates for chest pain
* Maintain blood pressure with fluids or vasopressors (dopamine)
* Defibrillate for pulseless ventricular tachycardia or venticular fibrillation
120
Blood clots develop in peripheral blood vessels becase of..
* Venous stasis ( inactivity, prolonged bed rest or sitting)
* Fat/ air emboli
* Trauma, fractures
* recent surgery
* Obesity
* Pregnancy / child birth
121
Pulmonary Embolism
general appearance
* Anxious
* diaphoretic
* cyanotic
* cool or clammy skin
122
Pulmonary Embolism
respiratory pattern
shortness of breath, tachypnea
123
Pulmonary Embolism
Breath sound:
cough:
BS: wheezing, crackles, pleural friction rub
cough: Possible hmoptysis
124
Pulmonary Embolism
chest x-ray
increased density in infarcted area, dilation of pulmonary arteries, wedfe-sahped infiltrate
125
Pulmonary Embolism
Hmodynamics
increase PAP
126
Pulmonary Embolism
Capnography
PECO2 : decreasing PECO2 with normal PaCO2
127
Pulmonary Embolism
Vd/Vt ratio
| decrease or increased?
increased
128
Pulmonary Embolism
treatment / Prevention
* Anticoagulants ( heparin )
* Anti-embolisn (compression) stockings
* Pneumatic compression device
* Early ambulation
129
Pulmonary Embolism
management / treatment
* Oxygen therapy ( PaO2 >80 torr )
* Anticoagulants ( Heparin )
* Analgesics to relieve chest pain
* Digitalis , digoxin to maintan circulation
* Thrombolytic agent - urokinase, strephtokinase, tPA
130
Thrombolytic agents for PE
urokinase, streptokinase, tPA
131
consist of right ventricular enlargement (hypertrophy, dilation or both) and is secondary to pulmonary hypertension from disorders of the chest wall or lungs
Cor Pulmonare
132
increased right ventricular workload as a result of pulmonary hypertension causing hypertrophy of the right ventricle. Often caused by COPD
Cor Pulmonale
133
Cor Pulmonale
physical appearance
distended neck veins, chest pain, peripheral edema
134
Cor Pulmonale
appearance of the chest
increased AP diameter with obstructive lung disease
135
Cor Pulmonale
hemodynamics
increased CVP, decreased QT with exercise
136
Chronic disorder of the neuromuscular junction that interferes with chemical transmission of acetylcholine
Myasthenia Gravis
| Moves from Mind to Ground
137
Myasthenia Gravis
general appearance
general weakness that improves with rest, drooping eyelids (ptosis), double vision (diplopia), difficulty swallowing (dysphagia)
138
drooping eyelids
ptosis
139
double vision
diplopia
140
dysphagia
difficulty swallowing
141
Myasthenia Gravis
* respiratory pattern
* Breath sounds
Rp: shallow breathing
Bs: diminished with crackles
142
Specail test for Myasthenia Gravis
* Edophonium Test (Tensilon challenge test)
* electromyography (muscles test movement)
* Blood test for Ach recfeptor antibodies
143
