MIDTERM FOR PATHO

Therapist driven protocols~

  • Oxygen therapy protocol

  • Bronchopulmonary hygiene protocol

  • Aerosolized medication therapy protocol

  • Lung expansion therapy protocol- used for atelectasis

  • Mechanical ventilation protocol

  • Mechanical ventilation weaning protocol

When are aerosolized medications appropriate? When a rapid, targeted treatment of the airways in needed

Protocol options for post-op patients with low SpO2 and poor cough- optimizing oxygenation, expanding lungs, and clearing secretions {high growlers position}

SOAP~ what specific information goes in each part of the SOAP form?

S: Subject~ data that is provided by the patient

O: Object~ data that can be observed directly by clinician

A: Assessment~ looking at patients vital signs and what state they are in

P: Plan~ coming up with a treatment for patient that will help them

4 types of hypoxias~

Hypoxic Hypoxia~ inadequate oxygen in tissue cells caused by low PaO2 [causes: hypoventilation & high altitude, pulmonary edema, interstitial lung disease, pulmonary shunting]

Anemic Hypoxia~ PaO2 is normal, but oxygen-carrying capacity of HB is inadequate [causes: anemia, hemorrhage, methemoglobin]

Circulatory Hypoxia~ blood flow to tissue cells are inadequate; oxygen is not adequate enough to meet tissue needs [causes: slow/stagnant peripheral blood flow, arterial-venous shunts]

Histotoxic Hypoxia~ impaired ability of the tissue cells to metabolize oxygen [causes: cyanide poisoning]

Carbon monoxide poisoning- what happens to the hemoglobin? CO is inhaled and passes from the lungs to the blood where it binds with hemoglobin [produces carboxyhemoglobin, affinity to HB is greater than 200 x”s that of O2 , reduces O2 carrying capacity of blood, alters release of remaining oxygen to cells]

What’s normal CO and what considered poisoning? Normal CO is 1-3% and poisoning is >20%

ABG interpretation, normal values, levels of hypoxemia?

pH: 7.35-7.45

PCO2: 35-45

HCO3: 22-26

PaCO2: 80-100mmHg (none) 60-80mmHg (mild) 40-60mmHg (mod) <40 (severe)

Blood flow through the heart~ SVC, Right A, Tricuspid valve, Right Vent, Pulmonary A, Lungs, Pulmonary Veins, Left A, Mitral Valve, Left Vent, Aorta, Body

Bronchoscopy- indications for, therapeutic bronchoscopy vs diagnostic, rigid vs flex bronchoscope- persistent cough, hemoptysis, abnormal chest imaging, persistent atelectasis…Therapuetic enables doctors to treat conditions like removing foreign bodies, clearing mucus plugs/blood clots, while diagnostic identifies coughing, diagnose infections, and sample tissues—Flex uses a thin bendable tube for diagnosing, sampling, and accessing small peripheral airways under sedation, while ridged utilizes a straight, ridged metal tube under anesthesia

Chest x-ray- PA vs AP- posterior view is the most used x-ray view it helps get a clearer reading

Steeple sign indications, thumb sign indication- on an anterior-posterior X-ray you can see steeple sign which indicates a subglottic tracheal narrowing, appears as inverted V shape associated with croup

Thumb sign refers to a swollen epiglottis on a lateral X-ray view appearing like a thumb indicating severe life-threatening airway inflammation

Management of COPD, x-ray findings- reducing symptoms, exacerbations, smoking cessation, bronchodilators, rehab

CXR findings= hyperinflation, emphysema (lungs darker on X-ray air trapping) small vertical heart

Management of Asthma, x-ray findings, lab tests that appear abnormal- abnormal lab tests— sputum examination [eosinophilia, casts of mucus from small airways]…cxr findings [barrel chest, translucent lung fields, flattened diaphragm…management [develop patient/doctor partnership, identify and reduce exposure to risk factors, assess, treat, and monitor asthma]

Emphysema- characteristics of, diagnostic tests, x-ray findings- high CO retention, pursed lip breathing, dyspnea, hyper resonance chest percussion, barrel chest, othopneic, thin appearance— X-ray findings hyperinflation, narrow mediastinum, flat diaphragm, DLCO is decreased… Diagnostic tests spirometry test, ct scan, and ABG test

Chronic bronchitis- definition of, characteristics, signs and symptoms- chronic productive cough for 3 months in 2 successive years, cyanotic, high sputum production, hypoxia, hypercapnia (high pCO2), respiratory acidosis, high Hbg, high RR, digital clubbing, cardiac enlargement; crackles, wheezes,

Lung cancer- Staging, signs, and symptoms-

TNM classification~

T represents the extent of the primary tumor

N denotes the lymph node involvement

M indicated the extent of metastasis

Roman numerals are used to indentify stages ~

0 being least advanced

IV being most advanced

Atelectasis, alveolar consolidation, excessive bronchial secretions

Tachypnea, Tachycardia, hypertension, cyanosis, cough sputum production, hempotysis, crackles, rhonchi, wheezing

Tuberculosis- clinical manifestations associated with: treatment, CRX, presentation, initial presentation-

CXR findings [increased tactile, vocal fremitus, dull percussion, bronchial breath sounds, crackles, rhonchi, wheezing,


What are cultures and sensitivities lab blood tests? Diagnostic procedures used to detect, identify, and determine the treatment for bacterial or fungal infections in the bloodstream

PFT lung volumes and capacities. Why would a PFT be ordered? DLCO study?

Total lung capacity- volume of gas contained in the lungs after maximal inspiration

Tidal volume- the volume of gas moved in and out of the lungs with each breath

Expiratory reserve volume- largest volume of gas that can be expired from the resting end-expiratory level

Residual volume- volume of gas remaining in the lungs at the ends of a maximal expiraton regardless 0f lung volume at which exhalation was started

Inspiratory reserve volume- subdivision of vital capacity, the volume of gas measured from a slow complete expiration after maximal inspiration without forced effort

Vital capacity- the largest amount of air that can be forced from the lungs after maximal inspiration

Functional residual capacity- the volume of gas remaining in the lungs at the end of a quiet breath

PFTs play a major role in assessment of lung disease and any pulmonary symptoms

DLCO study- measures how well oxygen passes from the alveoli in the lungs into the blood, it is crucial for diagnosing and staging diseases like pulmonary fibrosis, emphysema, pulmonary hypertension

EKGs- what is the function of the SA node? AV node? PQRST waves, what is happening to the heart in each wave? How many leads in a 12 lead? SA node generates impulse in normal heartbeat primary pacemaker,

P wave= depolarization of the atria

QRS wave= depolarization of ventricles

T wave= reploarization of ventricles

Av node a critical component of hearts electrical conduction system located in right atrium

How does a heart attack present on a EKG? Asystole? Asystole is complete abscence of heart beat, cardiac output stops and bp goes 0 this is when flatline happens; A heart attack shows an elevated ST segment myocardial tissue has reduced blood and oxygen supply

Lub(s1) dub (s2) heart sounds what is happening in each sound? In s1 ventricular contractions happen while tricuspid and mitral valves are closing and s2 ventricles relax while pulmonic and aortic valves close

Wet vs Dry drowning- Dry drowning when water doesn’t aspirate into the lungs because laryngospasm happens

Smoke inhalation and thermal injury- Anatomical Alterations of the lungs [early, intermediate, and late stages] Thermal injury is caused by hot gases confined to upper airway {blistering, mucosal edema, vascular congestion, epithelial sloughing, thick secretions, acute upper airway obstruction

Smoke inhalation injury~

  • Inflammation of tracheobronchial tree

  • Bronchospasm

  • Mucous plugging

  • Atelectasis

  • Alveolar edema and frothy secretions (pulmonary edema)

  • ARDS

Early stages 0-24 hours after inhalation: tracheobronchial tree becomes more inflamed bronchospasm occurs, bronchial secretions, toxic effects of smoke slow activity of mucosal ciliary, smoke inhalation may cause ARDS, overhydration

Intermediate stage 2-5 days after inhalation: mucus production continues to increase, mucosal ciliary transport decreases, mucosa of trcheobronchial tree becomes necrotic and sloughs (at 3-4 day mark), necrotic debris, excessive mucous production lead to mucous plugging and atelectasis, the mucous accumulation leads to bacterial colonization, bronchitis, and pneumonia,, acute respiratory distress syndrome (ARDS) may occur anytime, when chest wall (thorax) burns happen may cause inability for patient to breathe deeply and cough

Late stage 5 or more days after inhalation: major concern during this period is the burn wounds on patient body, infections are often led to sepsis and multi-organ failure which is the primary cause of death pneumonia is also a major problem in this period, Pulmonary embolism may develop 2 weeks after serious body burns, long-term effects of smoke inhalation result in restrictive and obstructive lung disorders, a restrictive lung disorder develops from alveolar fibrosis and chronic atelectasis, obstructive is generally caused by increased chronic bronchial secretions [anything bronchial]

Orthopnea- What does this indicate? Breathless while laying down; COPD or heart failure

Polycythemia, what is embolism? Blood disorder characterized by increased volume of red blood cells that thickens the blood, slows circulation, and clot risks caused by genetic mutations; embolism occurs when a clot breaks free travels through bloodstream, and lodges in a blood vessel blocking blood flow- causing pulmonary embolism

Status asthmaticus~ A severe asthma attack without medication

A patient with emphysema has increased or decreased lung compliance? Increased

What’s the difference between PAO2 vs PaO2? Big A is alveolar and little a is arterial with a 5-10mmHg difference

Definition of ventilation? The process of oxygen moving in and out of your lungs (gas exchange in and out of the lungs)

An example of dead space ventilation- ventilation with no perfusion

Which ABG pattern is common in near drowning- all their levels would be decreased except CO2 because they aren’t breathing right which would cause constriction

Why would you give someone PEEP for a drowning patient? To reopen collapsed alveoli

Which structure in your body is most commonly affected when you have thermal injury? Upper airway, nose, nasal cavity, pharynx and larynx

Hallmark sign for upper airway thermal injury? Inspiratory stridor [there airway is swelling]

What pulmonary disorder is seen in smoke inhalation cases? Multi organ failure, ARDS [acute respiratory distress syndrome] lungs shutdown, infection develop

Chronic bronchitis is clinically diagnosed how? 3 months for 2 consecutive years

What is the difference between a normal vs unhealthy person when doing a PFT? Decreased

Mucous plugging and severe asthma leads to what pulmonary disorder? Atelectasis

2 CRX findings for COPD? Hyperinflation, hyper resonance

Most common cause of lung abscess? Aspiration, pneumonia

3 ways to check for tuberculosis sputum? CRX, acid-fast, quantin-farin test(24hr test most common) [crx findings cavity formation]

What are treatments for a patient with lung abscess? Surgical draining and antibiotics

On EKG the P wave represents? Depolarization of the atria

Reploarization happens on which wave? T wave