Ch. 25 & 26 - Kyphoscoliosis & Pleural Effusion/Empyema

23. Kyphoscoliosis affects ______% of people in the USA, mostly ______ undergoing _____ ______

1-2%; kids undergoing growth spurts

5. An adult patient with a large pleural effusion requires placement of a thoracostomy tube. Which of the following statements are true regarding thoracostomy tube placement? 1. The tube is placed in the 2nd to 3rd intercostal space. 2. The tube is placed in the 4th to 5th intercostal space. 3. The tube is placed in the midclavicular line. 4. The tube is placed in the midaxillary line.

2 & 4

Roughly _____ of malignant pleural effusions occur in women, and are highly associated with ______ ______

2/3; breast cancer

19. Infantile Scoliosis occurs during the first _____ years of life, Juvenile Scoliosis occurs from ____ years old to ________, and adolescent scoliosis is classified after a person is _____ years old.

3 years; 4 years old - adolescence; 10 years old

Around ___-____% of patients with pulmonary emboli develop pleural effusions

30-50%

6. Scoliosis is defined as a spinal curvature of _____ degrees.

>10 degrees

A pleural effusion is exudative when pleural fluid protein is _______, fluid cholesterol is _______, and/or when pleural fluid lactate dehydrogenase _______ for serum

>2.9 g/dL (29 g/L), >45 mg/dL, and/or >60% of upper limit

7. Bracing is the primary form of treatment for what type of scoliosis?

Adolescent idiopathic scoliosis (AIS)

4. Which age group is most likely to develop idiopathic scoliosis?

Adolescents

A patient with nephrotic syndrome usually has a ______ pleural effusion

Bilateral pleural effusion

11. What are the chest radiograph findings associated with a large pleural effusion?

Blunting of costophrenic angle, fluid level on the affected side, depressed diaphragm, mediastinal shift to unaffected side, atelectasis

15. What orthotic brace are used in the management of scoliosis?

Boston Brace, Charleston Bending Brace, SpineCor Brace, Milwaukee Brace

3. What is associated with a Transudative pleural effusion?

CHF, hepatic hydrothorax, peritoneal dialysis, nephrotic syndrome, &/or pulmonary embolism/infarction

18. Neuromuscular Scoliosis is caused from other diseases such as:

Cerebral palsy, muscular dystrophy, spina bifida, or poliomyelitis

14. What is the name for the degree of lateral spinal curvature calculated from a radiograph?

Cobb Angle

17. Congenital Scoliosis

Formation of the spine or fused ribs during fetal development

5. Positive risk factor(s) for the development of kyphoscoliosis include:

Gender, Age, Angle of the curve, location, height, & spinal problems at birth

Common fungal diseases that cause pleural effusions:

Histoplasmosis, coccidioidomycosis, & blastomycosis

20. 80-85% of cases of kyphoscoliosis are classified as __________

Idiopathic

12. A patient with severe kyphoscoliosis and chronic ventilatory failure with hypoxemia will have what laboratory findings?

Increased hematocrit and hemoglobin (aka polycythemia), hypochloremia (Cl), hypernatremia (Na)

8. The Charleston bending brace is preferred over other braces because it:

It is only worn 8-10 hours at night when human growth hormone levels are highest

1. The anatomic alteration caused by a pleural effusion is:

It's a restrictive lung disorder; fluid accumulates in the pleural space, separating visceral and parietal pleura

1. Posterior curvature of the spine best describes:

Kyphosis

21. ________ can be caused by Scheuermann's Disease; Scheuermann's disease is the _____ together of several bones of vertebrae in a row.

Kyphosis; wedging

A decrease in the rate of pleural fluid absorption through visceral pleura and movement of fluid through the visceral pleura into the pleural space is caused by:

Left-sided heart failure

2. The major pathologic and structural changes associated with a significant pleural effusion are?

Lung compression, atelectasis, compression of great veins and decreased cardiac venous return

3. The major pathologic and structural changes of the lungs found with kyphoscoliosis include:

Lung restriction and compression, mediastinal shift, mucous accumulation throughout tracheobronchial tree, atelectasis

10. While reviewing an upright chest radiograph of a patient with a pleural effusion, the respiratory therapist observes a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called?

Meniscus sign

8. A respiratory therapist is assisting a physician who is performing a thoracentesis. It is suspected that the patient has a chylothorax. How would the pleural effusion be described?

Milky liquid

24. Respiratory care treatment protocols for Kyphoscoliosis

Oxygen therapy, bronchopulmonary hygiene therapy, lung expansion therapy.

Respiratory care treatment protocols used for Pleural effusions / Empyema

Oxygen therapy, lung expansion, mechanical ventilation protocols

7. A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for analysis. To help identify the cause of the effusion, what tests should be performed?

PFT results, ABG results, X-ray findings, vital signs/HR/BP, auscultation/chest assessment

Hepatic Hydrothorax

Pleural effusion with >500mL in patients with cirrhosis and no primary cardiac, pulmonary or pleural disease.

If a patient has a recurring pleural effusion, a _______ can be done to adhere the outer surface of the lung to the chest cavity

Pleurodesis

13. In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most likely signify?

Pulmonary embolism/infarction, malignant disease

11. What pulmonary function results are likely to be found in a patient with kyphoscoliosis?

RV/TLC ratio will be normal, FEV1/FVC ratio will be normal or increased, and all others can either be normal or decreased

________-sided heart failure can increase the rate of pleural fluid formation, as well as decrease lymphatic drainage from the pleural space due to elevated systemic venous pressure

Right-sided heart failure

2. What would be expected to appear on the chest radiograph of a patient with scoliosis?

Spine curve to one side, either as an S or C shape.

9. A patient has a 45-degree curvature of her spine. The physician is most likely to recommend what treatments?

Surgery via spinal fusion or rod instrumentation

13. In a case of severe kyphoscoliosis, what chest radiograph findings would be expected?

Thoracic deformity, mediastinal shift, increased lung opacity, atelectasis in areas of compressed lungs, cor pulmonale (enlarged heart)

9. During a chest assessment on a patient with a large pleural effusion, what would be expected?

Tracheal shift, decreased tactile and vocal fremitus, dull percussion note, diminished breath sounds, displaced heart sound, pleural friction rub

10. What chest assessment findings are associated with kyphoscoliosis?

Tracheal shift, obvious thoracic deformity, dull percussion note, bronchial breath sounds, whispered pectoriloquy, crackles and wheezing, increased tactile and vocal fremitus

14. What is the most common cause of a chylothorax?

Trauma to the neck or thorax, or by cancer occluding thoracic duct

6. Treatment of an empyema usually includes:

Treating the cause of empyema, along with use of thoracotomy drainage if needed

22. True or False: There is no definitive proof that electrical stimulation, exercise, chiropractic manipulation, or prophylactic deep breathing and coughing exercises have any long term effect on scoliosis treatment.

True

True or False: Ascitic fluid that is present in the abdomen is indicative of cirrhosis, which can cause hepatic hydrothorax

True

True or False: Left-sided heart failure is more likely to produce pleural effusion than right-sided heart failure.

True

4. A patient has malignant mesothelioma related to chronic asbestos exposure. What would his pleural effusion fluid likely show on laboratory analysis?

Will contain a mixture of normal mesothelial cells, & varying number of lymphocytes + polymorphonuclear leukocytes.

16. For best results, how many hours per day should a SpineCor brace be worn?

~20 hours a day, or off for less than 2 hours at a time

12. What percentage of patients with bacterial pneumonia are likely to develop pleural effusion?

~40%