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Flashcards in Unit 9 Deck (96):
1

pulm edema

pulm congestion in vessels, fluid accum in lungs/alveoli

2

what causes pulm edema

inc HCP

3

et pulm edema

usually LS CHF
non CV issues

4

which non CV issues may cause pulm edema

FVE
smoke inhalation
aspiratin
iv drug abuse

5

why FVE cause pulm edema

inc blood vol lt inc HCP

6

why may smoke inhalation from a fire cause pulm edema

inhalation of toxic fumes -> inflm -> altered perm -> fluid shift

7

why may iv drug use cause pulm edema

inc vessel perm, CNS depression -> issue with fluid exch

8

path of fluid movement in pulm edema

fluid moves from blood to IS spae to alveoli

9

what does accumulation of fluid in avleoli do to gas exchange

increases the distance req for GE + expands SA lt dec GE and dec lung fx

10

mnfts of pulm edema

productive frothy cough
dec lung compliance
wet crackles on ausc

11

why do pts w pulm edema have a prod frothy cough

mix of air and fluid causing frothy sputum

12

why do lungs have dec compliance in pulm edema

rt inc in fluid in lungs

13

tx for pulm edema

treat cause , resp support via O2 and ventilation

14

embolism

process of formation for an emboli

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how does pulm embolism occur

clot in DV dislodges -> RA -> RV pulm circuit

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where are thrombi in pulm ebolism usually located

arterial pulm v

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what percent of pulm emboli are lethal

33%

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where do majority of pulm emboli arise from

DVTs

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which veins have inc incidence for emb fomration

iliac, popliteal, femoral

20

other causes of pulm emb

fat, air, amniotic fluid

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how may fat cause a pulm emb

fat from bone marrow if bone is fractured, as bones are highly vascularized

22

how may amniotic fluid cause a pulm emb

if rupture of membs coincideds with rupture of vessels during birth. fluid contains some partiular matter

23

where do large pulm emboli usually lay

in the bifurcation of main pulm a.

24

what variable does pulm emboli change in the PV ration

P and V

25

if a pulm emboli begins as dvt, what happens next ...

breaks off -> embolus -> thrombus in a. bed -> impaired perf

26

what do platlets do when they interact with an embolis

begin to degranulate

27

what happens when platelets degranulate in pulm embolism

rls of mediators

28

what does mediator rls in pulm emb cause

constr of brachial and pulm a

29

why is V affected in VP in pulm emb

bronchial constr

30

what does hemodynamic instability

blood vol, BP, blood flow

31

what type of broncho constr occurs in pulm emb

reflexive

32

what causes reflexive broncho constr

n. reflex by SNS

33

what is the benefit of reflexive broncho constr

no benefit

34

why does CO dec in pulm emb

dec blood flow to LS of heart dt obstr-> dec circulation

35

what happens to surfactant prod in pulm emb. why

dec bc adeq perf is needed for surfactant to form

36

what happens when there is dec surfactant

atelectasis

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mechanism of dec surfactant prod

ischemia rt dec perf -> tissue damage -> dec surf

38

why does RS HF occur in pulm embol

RS is pumping against resistance -> hypertrophy of RV

39

what are mnfts of pulm emboli based on

location of embolis and size

40

mfnts of pulm embolism

chest pain
tachypnea
dyspnea
tachycardia

41

why may chest pain occur in pulm embolism

rt ischemia

42

why may tachypnea occur in pulm embolism

rt bronchospasm??

43

when does dyspnea occur in pulm embolism

if there is tissue damage

44

why does dyspea occur in pulm ebolism

dec sa for GE

45

why does tachycardia occur in pulm embolism

rt dec CO

46

is inc HR in pulm ebol compesnatory

YES

47

dx for pulm embolism

hx, px
ABG
LDH3
Lungscan
CXR, CT
angiogram

48

which dx test for pulm embolism is most affectve

angiogram, but it is also the most invasive

49

LDH3

lactase dehydrogenase

50

fx of LDH3

ez that is released when there is tissue damage in lung damage (serum marker) 3 is lung spec

51

what is the complete name for lung scan

lung scan 131 I-HSA, IV

52

"HSA" in lung scan 131 I-HSA

stands for human serum albumin

53

what is HSA labeled with when doing lung scan

With iodine 131, an isotope.

54

fx of a lung scan

to label :HSA and visualize its movement thru the pulm circulation.

55

how is a lung scan done

injected IV and then visualized. non invasive

56

Tx for pulm embol (stat)

size dependent
anticoagulants and thrombolytics
maintain CV fx

57

when do we use caution with anticoag and thrombolytics

in pts who are at risk for bleeding

58

why do we maintain CV fx when txing pulm embol

to avoid shock

59

pulm htn

htn within pulm circuit that is pathologic and is sustained a

60

what measurement indicates pulm htn

>25mmHg

61

normal mmhg for pulm circuit

~15mmhg

62

what allows the pulm circuit to handle inc CO

low P, low resistance circuit, where blood is distributed over extensive vasculature

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when is inc CO a problem for the pulm circuit

when there is resistance in the ciruit

64

3 cats of et for pulm htn

inc pulm vol (rt septum defect)
hypoxemia
inc pulm venous p

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et for pulm htn: inc pulm vol

fetal septum between RA and LA doesnt fully close, so blood can move into RA from LA and go into pulm circuit again, inc Co

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et for pulm htn: hypoxemia

hypoxic lung tissue vaso constricts to prevent mass rls of CO2 causing inc resistance

67

what does hypoxic peripheral tissue do

vasodilates vessels to remove excess CO2

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what may cause inc in pulm venous P

LV dysfx -> LSHF

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top 3 mnfts of pulm htm

dyspnea, syncope, chestpain on excertion

70

what other mfnts occur in pulm htn

those of RSHF rt RV pumping against resistance
fatigue

71

what do you see on a cxr of a pt with pulm htn

RS v hypertrophy prior to HF

72

tx of pulm htn

tx cause
dec progression
vasodilation w CA channel blocker

73

ARDS

str damage to cap wall and alveoli rt trauma of lung. gross, fatal, and rapid damage with acute onset

74

mortality in ards

40-60%

75

et of ards

aspiration (near drowning/GI content)
drugs (recreational)
inhaled gas or smoke
infc (septic)
trauma/shock (burns, fat embolism, chest trauma)
inc blood transfusions

76

why is there and inc in perm in ards

rt pathologic accum of cells lt mediator rls

77

what mediators are rlsed inards

proteases, PAF

78

what type of exudate is rls in ards

protein rich

79

what does the protein rich exudate rlsed in ards cause

non permiable membraine forms on alveoli wall, no exch occurs

80

what does inc perm in ards allow

fluid, protein, cellular debris, platlets, blood cells to move out of vasculature and enter alveoli

81

what happens to neutrolphils in ards

rls free radicals, phospholipids, proteases

82

what happens when free radicals, phospholipids and proteases are rlsd in ards

endothelial and alveolar damage, imfl

83

how/why do proteins, cells and fluids enter alveoli in ards

inc permeability rt inflm creates larger cell junctions, allowing entrance of larger components

84

what type of edema occurs in ards

large vol with variety of components

85

what does large vol edema do in ards

dec compliance, vent, and GE

86

hyaline memb

imprevious layer that forms in ards blocking all GE

87

why is the term hyaline used in hyaline memb

because the memb has a shiny appearance

88

why does atelec occur in ards

def and inactivated surfactanct

89

what is detected in abg in ards

profound hypoxemia

90

when do mnfts for ards appear

within minutes

91

5 earliest mfnts of ards

dyspnea
hypoxemia on abg
tahcypnea
resp alkilosis
late metb acidosis

92

why does tachypnea occur in ards

compensatory response in attempt to deliver more air to lungs

93

why does resp alkilosis occur in ards

inc RR lt dec CO2. bicarbonate inbody picks up more H to make CO2, causing alkilosis

94

why does late metb acidosis occur in ards

inc lactic acid prod lt inc H+ in blood, rt anaerobic resp dt hypoxemia

95

6th mnft of ards

diffuse consolodation

96

tx of ards

complex
early detection has better prognosis
reverse cause
resp support
avoid complications