Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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 |