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Pulm disease exam 3
spc
| Question | Answer |
|---|---|
| Diagnostic Bronchoscopy indications? | Abnormal radio graphic findings, mass lesion, aspiration, pulm infiltrate, for assessment of ET tubes and trachs(tracheal damage, tube placement, obstruction), bronchiectasis, foreign body, hemoptysis, recurrent laryngeal nerve paralysis |
| Therapeutic bronchoscopy indications? | endotracheal intubation, retained secretions or mucus plugs, foreign body aspiration, bronchial strictures, endobronchial malignant obstruction ( removing tumor, brachytherapy) |
| Bronchoscopy contraindications? | absence of informed consent, no experienced bronchoscopist, lack of emergency facilities, inability to adequetly oxygenate the patient, cardiac instability, uncontrolled asthma, coagulopathy, tracheal obstruction, uremia, pulm htn |
| Pneumothorax can be identified on their basis of origin, such as? | traumatic pneumo, spontaneous pneumo, iatrogenic pneumo |
| What is a closed pneumothorax? | gas in the pleural space is not in direct contact with the atmosphere |
| What is an open pneumothorax? | the pleural space is in direct contact with the atmosphere, gas can move freely in and out |
| What is a tension pneumothorax? | the intrapleural pressure exceeds the intra-alveolar (atmospheric) pressure |
| How is a traumatic pneumo caused? | penetrating wounds to the chest wall |
| When this type of traumatic pneumo occurs the pleural space is in direct contact with the atmosphere, gas can move in and out, this is called? | A sucking chest wound and it is also a open chest wound |
| A piercing chest wound may also result in a closed or tension pneumo through a one way valve, this works by? | a ruptured parietal pleura, gas enters the pleural space during inspiration but cannot leave during expiration |
| When a pneumo occurs suddenly without any obvious underlying cause, it is called? | a spontaneous pneumo, can sometimes be cause by the rupture of a small bleb or bulla on the surface of the lung. |
| An iatrogenic pneumo occurs? | during diagnostic or therapeutic procedure, medically caused. |
| What is pendelluft? | a paradoxical movement of gas within the lungs caused by a sucking chest wound, causes the patient to hypoventilate |
| What are chest assessment findings of a pneumothorax? | hyperresonant percussion not over the pneumothorax, diminished breath sounds over pneumo, tracheal shift (away with tension pneumo), displaced heart sounds |
| How do you diagnose a pneumothorax? | chest x-ray |
| When the pneumothorax is relatively small what tx? | 15-20% Pneumo, pt will need bed rest or limited physical activity |
| When the pneumothorax is larger than 20%? | should be evacuated, in less severe cases it can be withdrawn from pleural cavity by needle aspiration, in more severe cases use a chest tube |
| A chest tube is inserted into the? | 2nd intercostal space, midclavicular line |
| Pneumothorax= Restrictive = | Decreased venous return= Decreased BP |
| With bronchoscopy trans bronchial needle aspirations are performed with? | needle catheters |
| Diagnostic brushings are done with bronchoscopy? | bacterial culture, cytology, using a double sheathed protected catheter brush |
| Needle aspiration with bronchoscopy are done for? | cytology, biopsy, culture |
| Biopsy and bronchoalveolar lavage can also be done? | with bronchoscopy |
| The bronchoscope should be cleaned thoroughly following the? | manufacturers instructions, transmission of infectious agents to patients by bronchoscopes is possible ( most important part is cleaning the scope) |
| The bronchoscope requires? | A 45 minute soaking time in glutaraldehyde , ready for use in approximately an hour |
| What is a pleural effusion? | an accumulation of fluid in the pleural cavity, there is normally about 10cc to lubricate breathing |
| What are some surgical complications of a tracheostomy? | hemorrhage, air leaks (pneumo and sub q emphysema), cardiac arrest, airway trouble, fistula |
| Complications while tracheostomy is in place? | injury, perforation, infection, displacement, air leak |
| Complication during and after decannulation? | scar, granuloma, keloid, persistent open stoma, dysphagia, tracheal stenosis, tracheomalacia, web formation |
| A percutaneous tracheostomy is done at the bedside instead of the OR, benefits of this are? | decrease operative time, decrease cost ( do not decrease amount of staff needed) |
| Transtracheal 02 catheters are used for? | patients that need high flows, they conserve 02, reduce 02 flow requirements by 50-75% |
| Complications of transtracheal 02 catheters? | hemoptysis, subcutaneous emphysema, site infection |
| A tension pneumo signs? | tachycardia, low BP, due to decreased venous return |
| What are signs of a pleural effusion? | decreased breath sounds, dull percussion, decreased tactile fremitus, diminished breath sounds |
| A chest x ray must be done to determine pleural effusion, you will see? | blunted costo phrenic angles, and fluid level on the affected side |
| Pleural effusion= | restrictive |
| what is the treatment for bacterial pneumonia caused pleural effusion and empyema? | thoracentesis (drain cavity) and antibiotics.. surgery ONLY when nothing else works |
| Empyema is? | infected pus in the pleural space, begins as bacterial pneumonia |
| You must do a thoracentesis with a pleural effusion too? | determine what caused it and if it is an extrudate or transudate |
| Exudate fluid has a high protein content, transudate? | has a low protein content |
| Common causes of transudative pleural effusion ( not infections) | CHF, nephrotic syndrome, hypoalbuminia, hepatic hydrothorax, peritoneal dialysis, pulmonary embolism or infarction |
| Common causes of exudative effusions? | bacterial pneumonia, cancer (malignant), lymphoma, empyema, tuberculosis, fungal disease |
| Signs of ARDS? | tachypnea, refractory hypoxemia, crackles, intercostal and substernal retractions, tachypnea, decreased compliance (increased ventilatory rate) |
| What happens with ARDS? | pulm capillaries become engorged, AC membrane permeability increases, interstitial and alveolar edema, decreased alveolar surfactant, alveolar collapse, atelectasis |
| Causes of ARDS? | sepsis, aspiration, pneumonia, trauma, massive blood transfusion, drug abuse |
| ARDS will appear as? | ground glass on an x ray |
| Hypoxemia develops with ARDS because of? | alveolar consolidation, atelectasis, increased alveolar capillary thickening |
| Lung expansion measures for ARDS? | peep and cpap are used to offset the alveolar consolidation and atelectasis |
| Vent settings for ARDS? | Low VT, Higher peep, Higher RR's, Diuretics, permissive hercapnia |
| What is the ph for adds? | 7.2 |
| On an X-ray an ards pt will look like? | Ground glass |
Created by:
juialynn92
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