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Flashcards in Restrictive Lung Disease Deck (27)
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1
Q

➢___ surrounds the lungs includes
-parietal pleura, skeletal structure
-muscles (intercostals, diaphragm, accessory muscles of respiration)
➢___ determine position and mobility of both diaphragm and thoracic cage
➢Disease in any of these locations can reduce the patient’s overall ___
-Create a V/Q mismatch and result in ___

A

Thoracic cage
Abdominal wall and contents
compliance
restrictive disease

2
Q

Restrictive disease is characterized by proportional decreases in?

A

ALL lung volumes

3
Q

Restrictive Lung Disease:
➢Reduction in : •Total lung capacity •Functional Residual Capacity
•Reserve Volume •Vital capacity •Total volume exhaled
•FEV1 (forced expiratory volume 1 second) •FVC (forced vital capacity)
•___ BREATHING
➢___ leads to low lung compliance and arterial hypoxemia due to V/Q mismatch
➢No change in ?

A

RAPID SHALLOW
Reduced FRC
•FEV1/FVC ratio normal

4
Q

Restrictive Disease:
➢___ is limited by the reduced compliance of the lung or chest wall
aka “___”
➢Reduction in lung compliance results in increased ___ and ___
➢Breathing pattern
-Rapid, shallow which increases?
-Lower ___ during apnea

A
Inspiration 
"stiff lungs"
work of breathing and dyspnea 
-dead space ventilation 
-oxygen stores
5
Q
Restrictive Disease:
➢Normal gas exchange exists until advanced disease then:
-increased ?
-decreased ?
-\_\_\_ 
-\_\_\_
A

PaCO2
PaO2
pulmonary HTN
cor pulmonale

6
Q
Restrictive Disease Characterized by: 
➢ Decreased \_\_\_, Increased \_\_\_ and Increased \_\_\_
➢ Vital Capacity LESS than ?
➢ Expiratory flow rate \_\_\_
➢ \_\_\_ NORMAL
➢ Breathing pattern?
➢Decreased \_\_\_
A
TLC
PaCO2, work of breathing 
70 ml/kg
normal 
FEV1/FVC ratio 
Rapid, shallow 
lung compliance
7
Q

Classification of Restrictive Diseases:
➢___ = pulmonary edema, ARDS
➢___ = diseased lung parenchyma - sarcoidosis
➢___ = chest wall, intra-abdominal & neuromuscular diseases
➢Disorders of the Pleura and Mediastinum

A

➢Acute Intrinsic
➢Chronic Intrinsic
➢Chronic Extrinsic

8
Q

Acute Intrinsic Pulmonary Edema:
*Leakage of ___ - Fluid moves from the ___ into the ___ and into ___
•Increased ___ (example: cardiogenic)
•Increased ___ (inflammatory process)
•Seen as ___ on CXR
•If ___ will see accompanying dyspnea, tachypnea SNS activation (hypertension, tachycardia and diaphoresis)

A
*intravascular fluid
pulmonary vasculature into the lung interstitium 
alveoli
capillary/hydrostatic pressure
capillary permeability 
bilateral symmetrical opacity
cardiogenic
9
Q

Acute Intrinsic Aspiration Pneumonitis
➢___ is rapidly distributed through-out
➢Acidic gastric fluid destroys ___ cells & injures the ___ of the capillaries in the lungs
➢Produces capillary permeability with resultant ___ and ___ (like ARDS)
➢S/S = Arterial Hypoxia, Tachypnea, Bronchospasm
-Pulmonary vascular constriction can develop into ___
-CXR changes ___ later – usually ___

A
Aspirate
surfactant-producing
endothelium
atelectasis and edema formation 
pulmonary HTN
6-12 hours later - right lower lobe
10
Q

Treatment of Aspiration Pneumonitis:

  • Treatment is aimed at delivery of ___
  • ___
  • ___ for bronchospasm
  • ___ = if suspected solid material aspirated
  • Evidence does not support prophylactic antibiotics
  • Steroid use is controversial some may give dexamethasone or methylprednisolone
A
  • increased FIO2
  • PEEP
  • B-2 agonists
  • Fiberoptic bronchoscopy
11
Q

Negative Pressure Pulmonary Edema:
➢Occurs minutes to 2-3 hours after ___ in a spontaneously breathing patient
➢Causes: There are 4 start naming betchhhh

A

acute upper airway obstruction

  • Post-extubation laryngospasm
  • Obstructive sleep apnea
  • Epiglotitis
  • Tumors
11
Q

Negative Pressure Pulmonary Edema:
➢Development related to generation of highly negative intrapleural pressures against a ___
➢Highly negative intrapleural pressures cause:
•Decreased ___ •Increased ___ •Increased ___ on left ventricle
•Increased ___ = HTN, central displacement of blood volume
➢Resultant?

A
  • closed glottis/upper airway
  • interstitial hydrostatic pressure
  • venous return
  • afterload
  • SNS outflow
  • Acute Pulmonary Edema
12
Q

Negative-Pressure Pulmonary Edema:

  • Presents with: ___, ___, ___
  • Usually self-limited ___ duration
  • Treatment includes:
  • Supplemental O2
  • Maintenance of ___
  • Occasionally ___ for brief periods
A
  • Tachypnea
  • Cough
  • Failure to maintain SaO2 >95%
  • 12-24 hour
  • patent upper airway
  • mechanical ventilation
13
Q

Systematic granulomatous disorder that changes the intrinsic properties of the lung due to pulmonary fibrosis?

  • Results in ___ and ___
  • Often found in ___ and ___
A

Sarcoidosis (Chronic Intrinsic)

  • cor pulmonale and pulmonary HTN
  • thoracic lymph nodes and lungs
14
Q

Chronic Intrinsic-Sarcoidosis:
➢___ = can interfere with passage of adult sized tubes
➢___ = rare conduction defects (heart block, dysrhythmias, restrictive cardiomyopathy)
➢Liver, spleen, optic, and unilateral facial nerve palsy

A
  • Laryngeal sarcoid

* Myocardial sarcoid

15
Q

Chronic Intrinsic: Sarcoidosis

  • Patients present with ___ and ___
  • Patients present for ___ for diagnosis via lymph node tissue
  • Patients are often treated with ___
  • Consider a stress dose of steroids peri-operatively
A
  • dyspnea and rapid shallow breathing
  • mediastinoscopy
  • corticosteroids
16
Q

Chronic Extrinsic Restrictive Lung Disease:
➢Compressed lungs result in ___
-Decreased lung volumes with corresponding increase in ___
-Abnormal chest wall mechanics
➢___ = Right ventricular dysfunction common with chronic compression of pulmonary vasculature
➢Impaired cough results in ?

A
  • increased work of breathing
  • airway resistance
  • Thoracic deformity
  • chronic infection
17
Q

Neuromuscular Disorders: Review
➢Spinal cord, peripheral nerve, neuromuscular junction, or skeletal muscle pathology that prevents normal respiratory pressures
-Diaphragmatic paralysis -Spinal cord transection
-Guillian-Barre syndrome -Myasthenia gravis
-Myasthenic syndrome -Muscular dystrophy

➢Results in:     
~\_\_\_ cough     
~impaired \_\_\_      
~pneumonia
~respiratory failure may result      
~Very sensitive to ?
A

~ineffective
~clearance of secretions
~CNS depressants

18
Q

Pre-operative Assessment and Optimization for NM Disorders:

  • ___ and baseline ___
  • PFTs, flow-volume loops and ABG may be useful to grade severity
  • **Factors that signal increased risk:
  • Decrease in ___
  • Resting ___
A

-Exercise tolerance and baseline dyspnea
VC less than 15 ml/kg
resting hypercarbia

19
Q

Preoperative Assessment and Optimization for NM Disorders:

  • Treat ___
  • Improve ___
  • Treat cardiac dysfunction
  • Attempt to improve ___ w/ respiratory therapy techniques
  • Smoking cessation
A
  • pulmonary infection
  • sputum clearance
  • respiratory muscle strength
20
Q

Anesthetic Management with Neuromuscular Disorders:
➢___ results in high airway pressures in order to expand stiff lungs
➢Overall mechanical ventilation should combine ___ and ___

A
  • Positive-pressure ventilation
  • lower tidal volumes
  • rapid rates
21
Q

Anesthetic Management for Neuromuscular Disorders:
➢Pre-Induction = Titrate pre-medications carefully to reduce ___ – very little reserve
➢Regional anesthesia = at ___ level, pt will have a loss of accessory respiratory muscles which may be crucial to spontaneous ventilation in these patients
➢___ = must be used w/caution s/t risk of barotrauma (pneumothorax)
➢IV/maintenance agents =shorter acting agents preferred to minimize?
➢Volatile Agents = ___ (decreased FRC and often increased RR)

A
ventilatory depression 
>T10 level 
N2O
post-operative respiratory depression
accelerated uptake
22
Q

Anesthetic Management NM Disease: Ventilation

  • ___ will help maintain optimal oxygenation and ventilation
  • Pre-oxygenation very important = decreased ___-lower ___
  • ___ drops quickly with apnea
  • Expect increased __ as poorly compliant lungs ventilated mechanically -Decrease ___(?) -Increase ___(?) -Consider the risk for ?
  • Attempt to keep end-inspiratory plateau pressure ?
A
  • Mechanical ventilation w/ETT
  • FRC-lower oxygen stores
  • SaO2
  • Peak airway pressures
  • Decrease volume (4-8 ml/kg)
  • Increase rate (14-18 breaths per minute)
  • Barotrauma
  • less than 30 cm of water
23
Q

Post -Anesthetic Management of Patient with NM Disease:
➢Post-op Pulmonary problems are primarily ___
-Decreased ?
-Consider abdominal impingement on movement of ___
-Abnormal resp pattern with ?
-Consider ___ = this is an important risk factor for development of Post-operative pulmonary complications

A
  • Restrictive
  • lung volumes
  • diaphragm
  • shallow breathing with rapid respirations
  • surgical site
24
Q

Post-Anesthetic Management of the Patient with NM Disorders:
➢Decreased lung volumes and impaired cough put patient at risk for post-operative ___
➢Supplemental O2 for transport
➢Treat pain adequately but avoid excessive respiratory depression
➢Low threshold for - ?
-Monitored post-operative bed

A
  • respiratory failure

- Post-op mechanical ventilation

25
Q

Anesthetic Management-Acute Restrictive Disease: Critically Ill Patients
➢Elective surgery should be canceled if ? (ARDS, pulmonary edema)
➢If Emergency surgery is indicated = -___ for fluid overload
-___ and ___ for cardiac failure
-Consider drainage of pleural effusions/ascites pre-op
-May require ___
-Aggressive hemodynamic monitoring (a-line, CVP, pulm art cath)

A

acute intrinsic restrictive disease

  • Diuretic therapy
  • Vasodilators and inotropes
  • ICU ventilator
26
Q

Anesthetic Management Neuromuscular Disorders: Extubation criteria
Adequate PaO2? PaCO2? RR? TV? VC?
*Adequate LOC and muscle strength - head lift for greater than 5 secs
*Full reversal of neuromuscular blockade

A
greater than 60 mmHg
less than 50 mmHg
less than 30 bpm
greater than 300 mL
greater than 10-15 ml/kg