exam #1 study guide

Question 1

what does dyspnea mean

Answer 1

shortness of breath perceived by patient

Question 2

what does orthopnea mean

Answer 2

difficulty breathing in supine position (flat on back)

Question 3

ABG interpretation

Answer 3

PH- acidosis < 7.35 > alkalosis
CO2- alkalotic <35-45> acidotic
HCO3 acidotic <22-28>
alkalosis

Question 4

what does the sputum color black indicate?

Answer 4

smoke or coal dust

Question 5

what does the sputum color brown indicate?

Answer 5

cigarette smoker

Question 6

what does the sputum color frothy white/pink indicate

Answer 6

pulmonary edema

Question 7

what is overcorrected hypoxemia on O2

Answer 7

> 100mmhg

Question 8

what is corrected hypoxemia on O2

Answer 8

<100-60mmhg

Question 9

what is severe hypoxemia on O2

Answer 9

<60mmhg

Question 10

mild hypoxemia ranges

Answer 10

60-79mmhg

Question 11

moderate hypoxemia ranges

Answer 11

40-59mmhg

Question 12

severe hypoxemia range

Answer 12

<40mmhg severe hypoxemia

Question 13

what is type II respiratory failure, its associated names and symptoms

Answer 13

alveolar ventilation which is inadequate for the patients current metabolic rate
associated names- hypercapnic/ventilatory
symptoms- loss of consciousness and headache

Question 14

what is the relationship between alveolar ventilation and PaCO2

Answer 14

VA and PaCO2 are inversely proportional
increased VA= decreased PaCO2
decreased VA= increased PaCO2

Question 15

what does an ABG look like for acute respiratory failure

Answer 15

low PaO2 and CaO2, a high PaCO2 with acidotic PH, and an increased RBC

Question 16

what is the treatment for acute asthma attack treatment

Answer 16

1. oxygen
   2.fast acting bronchodilators
   3.svn
2. continuous bronchodilator therapy
3. IV/PO corticosteroids
4. monitor peak flow
5. IV ketamine
   8.IV magnesium sulfate
6. heliox therapy
7. NIPPV
8. mechanical ventilation

Question 17

what does the PaCO2 in the different phases of asthma attack

Answer 17

Early asthmatic response- hypocapnia (low CO2)
late asthma response- normal PaCO2 indicates more severe obstructive
Hypercapnia is seen with impending respiratory failure

Question 18

what is the main anatomic alteration seen in asthma?

Answer 18

airway inflammation, airway hyper-responsiveness, expiratory flow limitations

Question 19

what is the definition of inspection (and what are you looking for while inspecting)?

Answer 19

Inspection involves assessment of the patients overall appearance.
1. look for level of consciousness
2. body habitus (general ill health)
3. position
4. respiratory rate
5. breathing pattern
6. speech pattern
7. skin
8. facial expression
9. personal hygiene
10. sensorium (mental health)
11. nose (nose flaring?)
12. lips (cyanosis or pursed lip breathing)
13. jugular veins (distended?)
14. trachea (midline?)
15. thorax (barrel chest indicating COPD?)
16. digits (digital clubbing?)

Question 20

what is the definition of palpation?

Answer 20

applies the sensation of touch to evaluate underlying structure and function. palpation is performed to assess
1. tracheal position
2. evaluation vocal/tactile fremitus
3. estimate thoracic expansion
4. asses the skin and tissues of the chest and extremities
5. identify abdominal distention and tenderness
6. locate the hearts apical impulse

Question 21

what is the definition of percussion?

Answer 21

involves tapping the body surface to evaluate the underlying structure, it produces a sound and a palpable vibration useful in evaluating underlying tissue and the position of the diaphragm and liver.
hyperresonant/hyporesonant

Question 22

what is the definition of vocal fremitus?

Answer 22

it refers to the vibrations created by the vocal cords during speech. These vibrations are transmitted down the tracheobronchial tree and to the chest wall.
increased vocal fremitus occurs when tissue is more solid (pneumonia, lung consolidation)
decreased fremitus- occurs when something is blocking the transmission of sound (pleural effusion, pneumothorax, copd)

Question 23

what is the definition of bradypnea?

Answer 23

a breathing rate less than normal

Question 24

what is the definition of Cheyenne-stokes breathing?

Answer 24

deep rapid breaths followed by apnea, breaths gradually increase and then gradually decrease until apnea period. (indication of CHF and stroke)

Question 25

what are the conditions associated with increased resonance?

Answer 25

COPD, Pneumothorax (heard in the presence of excessive air)

Question 26

what are the indications of pleural effusion (TD, PALP, PERC, BS)

Answer 26

tracheal deviation- shifted away from the affected area (push) palpation- decrease in vibrations (decreased fremitus) percussion_ hyporesonant dull sound associated with increased density Breath sounds- diminished or absent due to fluid accumulation preventing lung expansion and sound transmission

Question 27

what are the normal and abnormal percussion notes and there causes?

Answer 27

Resonant- are normal percussion notes, clear, low-pitches and hollow quality like the sound of tapping on a drum. Hyperresonant- are louder and lower pitched heard in the presence of excessive air seen in patients with COPD and pneumothorax.(tympanic) Hyporesonant- dull sound associated with increased density, seen in patients with pneumonia, atelectasis, and pleural effusion. (flat)

Question 28

what are the causes of tracheal deviation (shifting)

Answer 28

tracheal deviation shifts away from the affected area (Push) seen in pneumothorax, and pleural effusion patients. tracheal deviation shifts towards the affected area (pull) seen in atelectasis and fibrosis patients

Question 29

what does retractions indicate?

Answer 29

Indicates inward sinking on or around the chest all and occur due to increased WOB. (intercostal, subcostal, and substernal/suprasternal effected)

Question 30

what causes unilateral lung expansion and what is it

Answer 30

occurs when one lung expands more than the other, it can be caused by pneumonia, pneumothorax, and rib fractures)

Question 31

what are the two chest cavity abnormalities

Answer 31

Pectus carinatum- outward sternal profusion(pigeon breast) pectus excavatum- funnel shaped depression over the sternum (funnel chest)

Question 32

what are all the indicating factors of a pneumothorax

Answer 32

chest inspection- unequal/unilateral expansion may be a sign of pneumothorax tracheal deviation- shifts away from the affected area (push) chest palpitations- decreased fremitus (decrease in vibrations) crepitus- subcutaneous emphysema (small gas bubbles under the skin, feels like crackling when palpated) hyperresonant- lower pitch heard in the presence of excessive air

Question 33

what are the 2 diseases that make up COPD

Answer 33

emphysema and chronic bronchitis

Question 34

what are the PFT findings in patients with COPD

Answer 34

They have increased residual volumes, total lung capacity, and functional residual capacity They have decreased values for peak expiratory flow rate, forced vital capacity and forced expiratory volume in 1 second(FEV1) FEV1/FVC <0.7 confirms the presence of non-reversible airflow obstruction

Question 35

how do you calculate pack years?

Answer 35

years smoking X number of packs/day= pack yers EX: 30 years X 2 1/2 packs/day = 75 pack years

Question 36

what is the pathophysiology of emphysema?

Answer 36

emphysema- condition that is characterized by abnormal, permanent enlargement of the alveoli and destruction of the alveolar walls. 1. dilation and destruction of lung parenchyma 2. tissue destruction decreasing surface area of alveoli 3.terminal bronchioles lose elastic fibers and collapse during exhalation 4. results in air trapping and poor gas exchange

Question 37

what is pathophysiology of chronic bronchitis

Answer 37

chronic bronchitis- condition that is characterized by a chronic productive cough for at least 3 months/year for at least 2 consecutive years 1. inflammation leds to mucus glands growing larger, which leads to increased ,mucus production 2. excessive mucus production and inflammation in smaller airways impairs airflow to alveoli

Question 38

what are the X-Ray findings in patients with COPD

Answer 38

1. hyperinflation 2. flattened diaphragm 3. elongated (vertical) heart 4. Bullae (blebs)- air that filled spaces within the lung parenchyma that form because of the destruction of alveolar tissue

Question 39

what is the treatment for Alpha 1 anti-trypsin deficiency?

Answer 39

given Prolastin (alpha 1-proteinase inhibitor-human) given by IV and weekly administered (for life) associated with slowed rate of decline of lung function and improved survival

Question 40

what are the COPD symptoms upon inspection?

Answer 40

1. barrel chest 2. accessory muscle use 3. tri-pod position 4. cyanosis 5. digital clubbing 6. dyspnea 7. JVD (sign of HF)

Question 41

what are the COPD symptoms upon palpation

Answer 41

1. decreased fremitus 2. decreased chest expansion

Question 42

COPD symptom upon percussion

Answer 42

hyperresonance

Question 43

COPD symptoms upon auscultation

Answer 43

1. decreased breath sounds with prolonged expiration due to reduced airflow 2. wheezing can occur due to bronchospasm 3. coarse crackles/rhonchi can occur when secretions are present

Question 44

COPD symptoms related to cough

Answer 44

1. frequent, productive cough 2. alteration in color is indicative of infection

Question 45

COPD symptoms in relation to ABG's

Answer 45

1. acute ventilatory/hypoxemic failure 2. chronic ventilatory/hypoxemic failure 3. acute on chronic respiratory failure

Question 46

COPD symptoms related to labs (CBC)

Answer 46

increased RBC, HB, HCT due to chronic hypoxemia WBC is increased when infection/fever present

Question 47

what is the etiology of COPD

Answer 47

1. smoking- 80-90% of COPD related deaths 2. environmental/occupational exposures (air pollution, biomass fuels, ad chemicals) 3. genetic- Alpha-1 antitrypsin deficiency

Question 48

what are the effects of cigarettes

Answer 48

80-90% of COPD related deaths, cigarette smoking kills more than 480,000 Americans each year

Question 49

what is the treatment for acute exacerbations?

Answer 49

* Inhaled bronchodilators SABA: Albuterol SAMA: Ipratropium bromide * Inhaled steroids Budesonide * IV steroids Solu-medrol * Antibiotics If infection is suspected * Oxygen therapy Nasal cannula (most used) Maintain SpO2 that is appropriate for individual patient * NIPPV Has shown to decrease morbidity and mortality Intubation and mechanical ventilation * Secretion mobilization Chest physiotherapy (CPT) or postural drainage and percussion (PD&P) Vibratory PEP or HFCWO therapy

Question 50

how is COPD classified?

Answer 50

* Patients can be categorized by severity of symptoms and frequency of exacerbations * COPD assessment test (CAT) score or mMRC dyspnea scale can be used to assess symptom severity *Scored ABCD- class A is less symptomatic and 0-1 exacerbations a year Class B- frequent symptoms but not a lot of exacerbations Class C- greater or equal to 2 exacerbations a year but less daily symptoms (unicorn) Class D-two or more exacerbations a year and high symptom burdens

Question 51

COPD treatment based on classification ACUTE TREATMENT

Answer 51

* Inhaled bronchodilators SABA: Albuterol SAMA: Ipratropium bromide * Inhaled steroids Budesonide * IV steroids Solu-medrol * Antibiotics If infection is suspected * Oxygen therapy Nasal cannula (most used) Maintain SpO2 that is appropriate for individual patient * NIPPV Has shown to decrease morbidity and mortality Intubation and mechanical ventilation * Secretion mobilization Chest physiotherapy (CPT) or postural drainage and percussion (PD&P) Vibratory PEP or HFCWO therapy

Question 52

COPD treatment based on classification CHRONIC MANAGEMENT

Answer 52

* Inhaled bronchodilators LABA: formoterol LAMA: tiotropium Variety of combo inhalers available * Inhaled steroids Budesonide, fluticasone Variety of combo inhalers available * Vaccination Influenza, pneumococcal, covid-19, pertussis Helps prevent secondary infections * Oxygen therapy Long term administration in patients with severe hypoxemia has shown to increase survival rates * NIPPV or CPAP Home use of NIPPV has been shown to decrease hospital readmissions for exacerbations CPAP may be preferred in patients with known obstructive sleep apnea * Pulmonary rehab Exercise training Education Managing symptoms Typically, 6-8 weeks in length Associated with significant reduction in hospital length of stay * Prevention Identifying and reducing exposure to risk factors Smoking cessation Avoid exposure to occupation irritants Avoid exposure to environmental irritants

Question 53

COPD based on classification ADVANCED TREATMENT

Answer 53

* Lung volume reduction surgery Areas of the lung with the most hyperinflation are resected Improves lung mechanics of remaining tissue Higher mortality rates are associated in patients with severe emphysema * Endobronchial valves Less invasive approach to lung reduction Valve opens during exhalation and allows air to escape During inhalation, the valves close and prevents air from entering the treated lobe Patients tend to have lower number of exacerbations post treatment * Lung transplantation Considered for patients who are not candidates for LVRS Very severe COPD patients (FEV1 <20%) Limited availability due to cost and shortage of donor organs