Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/102

Click to flip

102 Cards in this Set

  • Front
  • Back
What will you find when you do a physical exam on an asthmatic?
1)wheezing
2)hyper-resonant
3)tachypnic
4)elevated HR
5)prolonged expiratory phase
6)Accessory muscle use
7)pulsus paradoxis
Pulsus paradoxis
During inspiration, systolic pressure drop by 10, because of increase in negative pressure (pleural cavity)
By the time you hear wheezing, lung volume has decreased by____
25 percent
How do we diagnose asthma?
1)Clinical Hx
2)PFT testing
3)LUng volumes
4)DLCO
Yellow Zone precautions
Oral medications
Peak Flow Variations due to steroids
If the person has undergone a steroid burst, muscle weakness can result
Broncho-provacation tests
1)methylcholine
2)Exercise
3)cold air
4)hyperventilation
5)inhaled histamine
When do we stop the methylcholine challenge
When the FEV1 decreases by greater than 20 percent of the control, or if the person has completed the high doses of methylcholine
Tests we might order on an ashmatic
1)CXR
2)CBCD
3)Allergy tests
Factors which decrease the lumen of the bronchus
Mucus plugging, edema, inflammation, bronchospasm
Airway inflammation causes
Inflammation, and increased permeability of the vessels
Increased permeability causes
Leakage of proteins,fluids, and chemical mediators into the airway
Why young males have a higher incidence of asthma than girls
They have smaller lungs
Prognosis for young females with asthma
1/3 will get better, 1/3 will stay the same, 1/3 will get worse. Same prognosis when asthmatic females give birth,but may develop severe asthma during menopause
Allergens
Dander, dust mites, spores, cockroaches, molds, fungi, respiratory tract infections, air pollution, aspirin, GERD,sulfites, MSG,inflammation, exercise, inflammation
Asthma may be difficult to differentiate from_____
viral bronchiolitis, early CHF, and cystic fibrosis
CHF wheeze caused by
enlargement of the pulmonary capillaries, causing consequent narrowing the airways
Cough variant asthma
Only cough, not wheezing or SOB
Signs of severe obstruction
Pulsus paradoxis, accessory muscle use,retractions,hypoxemia, hypercapnia
Green zone
1)Dypsnea with exertion only
2)able to speak in complete sentences
3)expiratory wheezing
4)peak flow 80-100
Patients with a moderate asthma exacerbation
1)Dypsnea with exertion
2)difficulty speaking complete sentences
3)louder expiratory wheezing
4)peak flow 50-80
Patients with a severe exacerbation
1)dypsnea at rest
2)difficulty speaking a few words
3)anxiety, fatigue, confusion,
4)louder exp. wheeze
5)peak flow less than 50
Mast cell mediators
1)leukotrienes
2)histamine
3)cytokines
Response from mast cell mediators
smooth muscle constriction, blood vessel dilation (early, response to bronchodilators)
attraction of eosinophils, neutrophils, and macrophages (6-8 hours)
Resolution time for a late phase response
12-24 hours
Rescue meds
1)albuterol
2)metaproterenal
3)pirbuterol
4)terbuteraline
5)levalbuterol
Characteristics of rescue meds
1)onset within minutes, peak 30-60 minutes
2)effective for 3-6 hours
3)only for relief from acute bronchospasm
Side effects from rescue meds
1)anxiety
2)tremor
3)tachycardia
4)headache
5)hypokalemia
6)tolerance
7)metabolic acidosis
Maintenance meds
1)long acting beta 2 agonists
2)oral or inhaled steroids
3)mast cell stabilizers
Long acting beta 2 agonists are ____
lipophilic
Salmeterol (serevent)
1)10 minutes to
All patient classified as being beyond__ should be using inhaled steroids
mild intermittant
Inhaled steroids can take___before patients see a benefit, and ___ before patients see full benefit
one month, one year
fluticasone, pulmocort, azmacort,flunisolide,beclomethasone
Can cause--
1)throat irritation
2)thrush/horse
Side effects from oral steroids
1)cataracts
2)osteoporosis
3)diabetes
4)immunosuppresion
5)hypertension
6)psychosis
7)cardiovascular disease
8)fluid retention
9)muscle wasting
10)menstrual irregularites
11)adrenal suppression
examples of mast cell stabilizers
1)cromulyn sodium
2)nedocromil
action of mast cell stabilizers
1)prevent the release of histamine
Action of leukotrienes
1)cause smooth muscle constriction
2)chemoattraction
3)increased vascular permeability
4)increased mucus production
Onset of anticholinergics
30-60 minutes
Drugs that have no immediate effects
1)inhaled steroids
2)long acting beta agonists
3)cromylyn/necromil
4)antileukotrienes
Fatal effects of albuterol
1)lactic acidosis
2)beta one effects on the heart
3)decreased potassium
Individuals who die from asthma
1)older than 55
2)sensitive to aspirin
3)poor perceiver of peak flow less than 150 liters per minute
4)have been intubated
5)2 or more hospitalizations in a year
6)poor access to medical care
nasal polyps and asthma
some asthma patients develop nasal polyps when given aspirin
10 to 15 percent of asthmatics die from ____
occupational exposure
General Approach to asthma
1) determine if the pt. has asthma
--spirometry
--methycholine challenge
--exercise challenge
--chest x ray
2)assess trigger
3)educate
4)establish maximal
5)determine routine
6)emergency phone list, plan
Structural barriers in to the lower airway
nasal turbinates, epiglottis
where is the carina
where the manubrium meets the body of the sternum, 2nd intercostal space, and aortic knob
if the carina is blunted____
There may be a tumor located underneath it
Airway integtrity is maintained by
Elastic properties of alveoli
Most common indication for bronchoscopy
lung cancer
Fever and bronchoscopy
24 hour fever a complication, because the scope must bypass a sterile airway
Before a bronchoscopy, patient must be NPO for
6-8 hours
30-90 minutes before a bronchscopy____
Patient is given atropine, narcotics, and a benzodiazepine
Atropine is given before a bronchscopy
To counteract the vagal reflex, as well as the drying effect of secretions
Just before a bronchoscopy
1)lidocaine neb and/or atomizer
2)versed iv
3)neosynephrine to open the airway
4)oxygen is applied to the less open nare
when starting the procedure
lidocaine in the nose, then pushed into the airway
What needs to be monitored during a bronchoscopy
1)ECg
2)Sat
3)BP
4) RR
How much saline is used for a lavage
20-60 cc's. Procedure repeated 4-5 times, 40 cc's returned through a trap
Lavage is used to diagnose____
1)Pneumonia
2)malignancy
3)Interstital disease
4)alveolar hemm
After the bronchoscopy
1)monitored until sedation wears off
2)NPO two hours
3)CXR for pneumothorax if biopsies were performed
Benzidiazepines
versed,ativan-aniolxic, amnesiac effects
narcotics
Morphine,fentanyl--suppress cough, relax the pt.
wheeze heard over only one area of the body
is most likely a tumor or a foreign body
Pts. have peripheral edema
may have CHF and the global wheeze
Allergic aspergilliosis
Is a fungal infection that may present as asthma
Cough variant asthma people
will have a positive methycholine challenge
puebescent males and asthma
males with mild asthma tend to get better, while those with severe asthma tend not to change
Why do asthmatics need a CXR
To rule out fibrosis, pneumothorax, pleural effusion, CHF
CHF could cause ___ and ___
SOB and wheeze
Side effects of resecue meds
1)anxiety
2)tremor
3)tachycardia
4)hypokalemia
5)headache
6)metabolic acidosis
Maintenance meds
1)salmeterol
Airway responsiveness manifests as
1)wheezing
2)SOB
3)chest tightness
4)cough
immune cells which affect asthma
1)mast cells
2)macrophages
3)neutrophils
4)eosinphils
5)lymphocytes
A post operative complication
pulpmary abnnormality that produce idenitifiable disease or dysfunction, aversely affecting a patient's clinical course
Most common post op complication
Atalectasis
Highest risks of pulmonary complications
upper abdominal or thoracic surgery
What decreases after upper abdominal or thoracic surgery
1)VC, Vt, FRC will decrease
2)A-a gradient will increase
(post op days 1-3)
The patient who stops smoking ___ weeks before the surgery is at the least risk of developing pulmonary complications
Eight
Morphine
can cause increased histamine release, which could exacerbate bronchspasm in the surgical pt.
One of the best predictors of post-op complications
PCO2 greater than 45, also a greater than 9 second blowout
Percent of asthmatics who acquire asthma from occupational exposure
10-15 percent
In the supine position, pts will have a ____ FRC
decreased, because abdominal contents move against the diaphragm
RAW is defined as_____
The pressure required to move 1 L/S in and out of the airways
Phases of the single breath nitrogen washout
1)deadspace exhalation
2)transition from deadspace to alveolar ventilation
3)Alveolar plateau
4)closing volumes
Factors determining DLCO
1)area of the alveolar capillary membrane
2)driving pressure of the Co
3)thickness of scarring of the alveolar capillary membrane
4)V/Q mismatch
Contraindications to Spirometry
1)respiratory isolation
2)aneuryisms
3)acute illness
4)chest pain
5)current tracheostomy
Anticholingerics blocks
vagal or parasypathetic tone
Anticholingerics work better in ____ patients
COPD
Theophylline is used with _____ medications and ______
1)B2
2) steroids
Airway inflammation contributes to
1)airway hyperresponsiveness
2)airway limitation
3)respiratory symptoms
4)disease chronicity
)
Varieties of airway limitation
1)bronchospasm
2)mucus plug
2)airway remodeling
4)aiway edema
Atopy
the genetic predisposition for the devleopment of igE medizated response to common aeroallergens
Fibroblasts, endothelial cells, and epithelial cells
release cytokines and chemokines
B and T cells
are triggered by cytokines, and signal neutrophils (mast cells alert)
Macrophages
signal eosinophils, and other macrophages
IN adult onset asthma
IGE response to allergens, and family hx not detected
Risk Factors for asthma
1)genetics
2)age
3)race
4)gender
5)environmental/occupational exposure
6)weight
7)Dietary antioxidants
Mild Intermittant asthma
1)Less than 2 days a week, 2 nights a month with symptoms
2)PEF or FEV1 80 percent
3)less than 20 percent variability
Mild Persistent
1)3-6 days a week with symptoms, 3-4 nights a month
2)less than 80 percent PEF ir FEV1
3)variability 20-30 percent
Moderate Persistent
1)daily sx., more than 5 nights a month
2)60-80 percent PEF or FEV1
3)greater than 30 percent variability
Severe Persistent
1)continous sx., frequent nighttime interruption, less than 60 percent PEF or FEVI.,
3)Greater than 30 percent variability
Not recommended for asthma
1)methylxanthines
2)antibiotics
3)aggresive hydration
4)CPT