Pulmonary Assessment Flashcards by Cooper Hewett

What type of breathing?

shallow and rapid breathing

restrictive

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What type of breathing?

slow and deep, pursed lip breathing
(decreased work of breathing)

obstructive

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Febrile, ABX, cough – productive?

These can indicate presence of ______ ______ ________

Upper Respiratory Infection (URI)

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Dyspnea at rest or with exertion ties directly to the pt.’s ________ __________

functional capacity

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General pre-surgery interview questions? (3-4 questions)

Do you have any problems with your breathing?

Do you have asthma, COPD (emphysema, chronic bronchitis), or cough?

Do you smoke? If yes, how much per day and how many years?

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Evaluate functional capacity/status questions (2-3 questions)

Can you walk a city block or a flight of stairs without stopping?

If no, are you limited by your heart and breathing? What makes you stop?

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produces a bluish discoloration, specially noticed on the mucous membranes of the lips, tongue, head and torso.

Central Cyanosis

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cyanosis that affects the fingers, toes and skin surrounding the lips, is not noticed around mucous membranes.

Peripheral Cyanosis

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___________ is a functional peripheral vascular disorder characterized by cyanosis, of the hands, feet, and sometimes the face caused byvasospasm of the small vessels of the skin in response to cold.Normal in newborns.

Acrocyanosis

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vasospasm of the small vessels of the skin in response to cold

Acrocyanosis

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associated with chronically low PaO2, differential should include chronic lung diseases such as COPD, malignancy, and Rt-Lt cardiac shunting (Tetralogy of Fallot or transposition of great vessels)

Clubbing of the fingers

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Heard in the chest wall where bronchi occur, not over alveoli
Usually clear after coughing.

Rhonchi

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Heard in both phases of respiration

Hallmark of chronic bronchitis

Late inspiratory crackles indicative of pneumonia, CHF, or atelectasis.

Crackles (Rales)

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Caused by narrowing of the airways: smooth muscle contraction, mucosal edema

Wheezes

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Used to assess the presence of symptoms of Obstructive Sleep Apnea (OSA)

STOP-BANG assessment

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STOP-BANG assessment high risk if yes to > or = _____ items

If so, refer to sleep testing

> or = 3 items

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Recurrent productive cough > 3 months of the year for 2 consecutive years

Chronic Bronchitis

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________ is the most common symptom in patients with cardiopulmonary disease

Dyspnea

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______ _________ isan exaggerated drop in blood pressure when you take a deep breath. Seen in conditions such as severe acute asthma or exacerbations of chronic obstructive pulmonary disease (COPD) and cardiac tamponade.

Pulsus paradoxus

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These disorders are associated with what type of dyspnea?

COPD and Asthma
Aspiration syndromes
Vocal cord dysfunction

Intermittent

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These disorders are associated with what type of dyspnea?

Endobronchial tumor
Tracheal stenosis
Asthma

Persistent

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These disorders are associated with what type of dyspnea?

COPD
Pulmonary tumors and infiltrates

Progressive

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Serum albumin <3.5 mg/dL is indicative of ______ disease

Liver disease

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Serum albumin <____ mg/dL is indicative of liver disease

<3.5 mg/dL

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_______ and ______ _________ surgeries have the highest risk of Postoperative Pulmonary Complications (PPCs)

Thoracic Upper abdominal

________ and _______ analgesia is protective against post op pulmonary complicationsPPCs

Multimodal epidural

_________ is the leading cause of preventable morbidity and mortality

Smoking

Avoid ________ anesthesia when safe and appropriate

general anesthesia

If your pt is a smoker, it is important to talk about smoking ________ before surgery

smoking cessation

systematic reviews of previous studies concluded that at least __ to __ weeks of preoperative abstinence reduced surgical site infections, and abstinence of at least __ weeks decreased respiratory complication

3-4 weeks 4 weeks

(T/F) Quitting smoking 2 weeks before surgery leads to worse outcomes.

False Quit anytime

Progressive disorder characterized by persistent airflow limitation that is Not fully reversible

COPD

By far the most important risk factor associated with COPD is the amount and duration of _______ _________

cigarette smoking

genetic cause for COPD

α-1 antitrypsin deficiency

chronic productive cough for 3 months in each of 2 successive years and not attributed to other causes (Poor prognosis)

Chronic Bronchitis

pathologic pulmonary structural changes associated with COPD

Emphysema

Main difference btw COPD and Asthma?

COPD is not fully reversible

characterized by nonuniform parenchymal destruction, loss of alveolar attachments and reduced elastic recoil.

Emphysema

“Blue Bloaters”

Chronic Bronchitis

“Pink Puffers”

Emphysema

Dyspneic, pink, thin, noted pursed lip breathing Normal ABGs (typically) Increased minute ventilation to maintain PaCO2 Increased work of breathing

Emphysema

Cyanotic, hypercarbic, hypoxemic, usually overweight Chronic respiratory failure with decreased response to CO2 May have a cough, copious sputum Cor pulmonale

Chronic Bronchitis

Spirometry (postbronchodilator) FEV1/FVC ratio of < ____ confirms airflow limitation that is Not fully reversible (aka COPD dx)

< 0.7

What ratio defines COPD?

FEV1/FVC ratio of < 0.7

FEV1 >/= 80% predicted

Mild COPD

50% = FEV1 = 80% predicted

Moderate COPD

30% = FEV1 = 50% predicted

Severe COPD

FEV1 < 30% predicted or FEV1 < 50% predicted w/ chronic respiratory failure

Very sever COPD

Pharmacotherapy for stable COPD (4 classes)

short- and long-acting inhaled bronchodilators (anticholinergics and β2 agonists), oral bronchodilators (theophylline), inhaled glucocorticoids oral phosphodiesterase-4 inhibitors (e.g., roflumilast).

Healthy pt needs chest X-ray pre op?

Delay elective surgery for __ weeks with Hx recent URI

6 weeks

Recent pulmonary function testing is warranted with changes in baseline and undergoing _________ surgery

intrathoracic

Preoperative ______ may be useful with known/suspected hypoxemia or hypercapnia

ABG

______ is a chronic inflammatory disease affecting the airways characterized by bronchial hyperresponsiveness and airflow obstruction.

Asthma

4 symptoms of Asthma related bronchoconstriction

intermittent cough wheezing chest tightness SOB

Meds that can trigger asthma symptoms

ASA NSAIDS B-blockers

With asthma, post-bronchodilator spirometry should show significant improvement (>___% and _____ mL increase) in FEV1.

>12% 200 mL

normal spirometry does not exclude the diagnosis of asthma and bronchoprovocation testing. The __________ challenge may be needed for confirmation, particularly in patients with atypical presentation

methacholine

Study PP slide 38

Study it bro

For pharmacologic asthma tx., use ______ therapy (i.e., __________) for patients with allergic sensitivity

anti-IgE omalizumab

For pharmacologic asthma tx., use ________ antibodies for patients with eosinophilic asthma

anti–IL-5

You suspect a pt may have poorly controlled asthma. What should you do?

Refer to pulmonologist/consult surgical team

List 3 pt. presentations that are evidence to poor asthma control

Symptoms >2 days/wk (Mild persistent or more severe) Weekly nighttime awakening Limitation in normal daily activity Use of short-acting bronchodilators for symptom control >2 days/wk (Acute exacerbation) FEV1 or peak expiratory flow rate <80% of predicted or personal best ≥ 2 exacerbations requiring systemic glucocorticoids in the last year

(T/F) Ketamine is a bronchodilator

true

With asthma, the Risk of ____________ is Low, but Potentially Life Threatening!!!

Bronchospasm

What should you resort to when asthma pt is bronchospasming and you can't ventilate and all other tx. methods are exhausted?

Extubate and mask ventilate with sevo and consider higher dose epi

Avoid _______ meds w/ asthma pts

NSAID

W/ asthma pts, avoid medications releasing ________ (MSO4)!!!

histamine

Induction technique for asthma pts

RSI (rapid sequence induction)

Increased Peak Inspiratory Pressures (PIP) Wheezing, decreased or absent breath sounds

Bronchospasm

List the 8 sequence of tx for bronchospasm (know this well and be able to answer <20 seconds!!!)

Remove from ventilator, hand ventilate with FiO2 1.0 Remove/correct trigger Deepen anesthetic (Increase [ ] volatile inhalation agent) B2 agonist Metered Dose Inhaler Corticosteroid IV Epinephrine 10mcg IV, repeat as necessary Magnesium or Heliox ABG monitoring

Restrictive or obstructive? Decreased Total Lung Capacity (TLC) FEV1 and FVC reduced proportionally FEV1 / FVC ratio is normal or increased

Restrictive Lung Disease

PFT stands for _______ _______ __________

Pulmonary Function Testing

Pathophysiologic process causing Reduced Lung Compliance

Restrictive Lung Disease

_______ lung parenchymal diseases are referred to as interstitial lung diseases (ILDs);

Intrinsic

Regarding restrictive lung disease, _________ diseases involve the pleura, pleural cavity, diaphragm, or chest wall (e.g., pleural effusions, ankylosing spondylitis, kyphoscoliosis, obesity);

extrinsic

List 3 neuromuscular disorders causing respiratory muscle weakness

myasthenia gravis Guillain–Barré syndrome muscular dystrophies Spinal cord injury (Quadriplegia) Phrenic nerve neuropathy (diaphragm)

Compared to extrapulmonary restrictive lung diseases, interstitial lung diseases (ILDs) are usually associated with impaired ______ ______ ______ _______ ________ (DLCO) on pulmonary function test (PFTs).

diffusing capacity for carbon monoxide

Patients with interstitial lung disease (ILDs) typically present with progressive ________ _____ __________ or __________ __________

dyspnea on exertion nonproductive cough

There is no strong evidence for any preoperative interventions to improve perioperative outcomes in patients with ______ specifically.

ILDs (interstitial lung diseases)

Autosomal recessive disorder caused by mutation of CFTR protein on chromosome 7

Cystic Fibrosis (CF)

CFTR functions as a _______ channel of epithelial cells lining most exocrine glands

chloride

Dx for cystic fibrosis - elevated sweat chloride > ___ mmol/L

60 mmol/L

Changes in cellular electrolytes and water transport resulting in thickened secretions multiple organ systems

Cystic Fibrosis (CF)

Repetitive upper airway collapses leading to cessation of breathing during sleep lasting 10 seconds or more

Obstructive Sleep Apnea (OSA)

Most prevalent sleep-breathing disorder

Obstructive Sleep Apnea (OSA)

Dx test for OSA is __________ __________ (PSG). This determines the _____-_______ ______ (AHI)

Overnight polysomnography (PSG) apnea-hypopnea index (AHI)

Know the STOP-BANG questionairre

Know it

This tx for OSA can: Significantly reduces apnea hypopnea index (AHI), providing better quality of sleep Attenuates symptoms of OSA: daytime sleepiness, fatigue, memory loss Long-term associated with decrease in CV morbidity and mortality

Positive airway pressure (PAP)

Try to limit _______ meds with OSA pts

opioid

Pulmonary Assessment Flashcards

(90 cards)