9] NIV, Transplant, Apnea ADD article questions- make sure all the info is on here Flashcards
(109 cards)
1
Q
What is sleep apnea?
A
Significant daytime sleepiness with other Sx
2
Q
Hallmark of sleep apnea
A
Airway narrowing/obstruction at night
3
Q
3 types of sleep apnea
A
Central
Obstructive
Mixed
4
Q
What does obstructive sleep apnea mean? (OSAS)
A
Periods that last 10 sec or more where you have hypopnea or apnea of breathing
5
Q
Patho of OSAS
A
Partial or complete pharyngeal collapse during sleep- relaxed pharynx during sleep obstructs ventilation
6
Q
What’s dampened during sleep?
A
Reflex
7
Q
What else gets dampened during sleep worsening the loss of airway tone?
A
Chemoreceptors
8
Q
Results of narrow airway in OSAS
A
Low oxygen and increased CO2
9
Q
Healthy breathing
A
Negative intrathoracic pressures pull air in —> ⦿ Pharyngeal dilator muscles fight the inward pull to keep airways patent ⦿ Slow air movement is laminar and aids in keeping airway dilated ⦿ During sleep, pharyngeal dilator muscles relax increasing airway resistance
10
Q
Severe sleep apnea
A
More than 30 episodes per night of loss of breathing
11
Q
Moderate sleep apnea
A
15-30 episodes/night
12
Q
Mild sleep apnea
A
5-14 episodes/night
13
Q
Gender risk factor for SA
A
Mor emen
14
Q
Race for SA
A
African America, Hispanic, Pacific Islanders
15
Q
Elevated BMI as risk factor in sleep apnea
A
40% obese have it and 70% of people with sleep apnea are obese; neck circumference more than 16 inches for women, more than 17 for men
16
Q
Anatomy as risk factor for SA
A
Small airways, cervical extension, FHP
17
Q
Sleep apnea is seen a lot in kids with?
A
Down syndrome
18
Q
Signs and Sx in adults for SA
A
Wifey complains Sleep disturb Tired and groggy even tho they got 8 hours sleep Morning headaches (b/c of alterations in CO2 and O2 levels) Irritable Memory loss Dry mouth Car accidents (they fall asleep)
19
Q
Signs and Sx of sleep apnea in kids
A
Hyperactivity- primary Sx
Can’t concentrate
Bad school performance (detention)
20
Q
Long term consequences of SA
A
HTN CAD HF Dysrhytthmias CVA disorders Impairs growth in kids
21
Q
The death rate for ppl with ? SA is ? Than for those who dont have OSAS
A
Untreated
3x higher
22
Q
Define obesity hypoventilation syndrome
A
BMI more than 30
PaCO2 more than 45
Sleep disordered breathing
CHRONIC HYPOventilation
23
Q
Altered breathing in obesity HYpovent syndrome results in
A
Daytime LOW PaO2
Daytime elevation PCO2
(Differentiates OHS from OSA)
24
Q
Risk factor for OHS
A
Obesity
25
What does OHS stand for
Obesity hypoventilation syndrome
26
Signs and Sx of OHS
```
Sleepy
Depression
SOB with activity
Irritable
Signs of cor pulmonale
```
27
Risks of OHS
```
HTN
Cor pulmonale
Sexual dysfunction
Dysrhytmia
Polycythemia
CVA
```
28
Treatment for SA and OHS
NIV, Masks with CPAP and BiPAP which all aim to increase alveolar ventilation and stent airways
29
Goal of NIV
Airway stunting
30
Goal os NIV is to increase
FRC = ERV + RV
31
What is FRC
Volume in lungs after a normal expiration
32
Increasing the FRC does what
Limits “de-recruitment” of alveoli
33
What is CPAP
Pressure during exhale to stent open airways
34
How does patient breathe on CPAP
Spontaneously
35
What’s another common intervention for SA
BIPAP- NIV
36
What’s different of BiPAP
It’s a type of CPAP with two diff pressures during inhale (high pressure) and exhale (low pressure)
37
High pressure in BiPAP during inhale for
Stenting
38
Low pressure of BiPAP during exhale for
Helps blow off CO2
39
PT implications for SA
Take a thorough sleep history, look at ADHD in kids, weight, sleep hygiene, exercise, sleep positioning
40
Indications for lung transplant
```
Advanced lung disease- class II or IV
Progressive lung disease that needs max intervention
Survival chance less than 50 in 2 years without transplant
Pt understands risks
```
41
Contraindications for lung transplant
```
Active cancer in last 2-5 years
Untreatable or advanced disease of another organ
Uncurable infection
Chest wall/Spine deformity
Not compliant with therapy
Psych conditions untreatable
No social support
Substance addition like smoking
```
42
RELATIVE contraindications for lung transplant
```
More than 75 years old
Poor functional status
Colonization
BMI more than 30
Severe osteoporosis- mechanical vent
```
43
What does LAS stand for
Lung allocation score
44
What does LAS predict
The probability of surviving next year without transplant and length of survival post-transplant
45
6MWT for LAS
In adults, less than 400 m (1312 feet) is correlated with higher mortality
46
Determination of eligibility and “place in line” for lung transplant depends on:
LAS
| Distance from organ
47
Lung transplant listing for kids
Priority 1- urgent
| Priority 2
48
Kids under 12 cannot?
Get adult lungs
49
6MWT for kids
More than 1000 feet is correlated with shorter ICU stay and fewer days of vent
50
2 types of lung transplants
Single- 5-9 hours
| Double- 7-9 hours
51
Lateral thoracotomy cuts through
Serratus and lats
52
Which intercostal space with transplants?
5th Intercostal space
53
Aerobic capacity for pre-txp eval
6MWT
Incremental shuttle walk
GXT
54
Pulmonary endurance and strength for pre-txp
MIP
| MVV
55
Short physical performance battery
Marker for frailty in pre-lung txp and predicts disability and waitlist mortality
56
Pre-txp Ex presc
F: 2-5x/week
I: 50-80% HRR or 3-5 on dyspnea scale or 60-80% 6MWT speed
TT: continuous training 15-30 minutes or
Intermittent training 5-10 minutes;
2-3 bouts Interval training: 30 seconds exercise;
30 seconds rest for 12-26 minutes
57
Main med they use to prevent rejection episodes
CALI nursing inhibitors (tacrolimus and cyclosporine)
58
Main side effects of calcination inhibitors
HTN
Tremor
Electrolyte abnormalities (low Mg and high K)
59
Side dish meds
Mycophenelate
| Imuran
60
Salads med examples
Sirolimus and everolimus
61
Mg and K affect?
Cardiac muscle function
62
What are side dishes
Things they add onto pts regimen to help prevent rejections
63
Mycophenelate can cause
N/V, diarrhea, Leuko and sytopenia, anemia
64
What’s the cutoff for platelets for them to use weights?
Above 50,000 ****
65
How do salads work with meds?
If they are having too many Side effects, salads can replace main dishes
66
Salads can be used for what?
Also if they have mild or mod rejections that help
67
Bread and butter for rejection episodes
Steroids
Methyprednosolone and
Prednisone
68
Side effects of steroids
Muscle atrophy
Bone loss
GI irritability
69
With steroids, people gain
Weight in weird places- abdomen and buffalo hump
70
Before txp they have likely had what
COPD or etc
71
Premorbid disease and muscle changes
COPD:
Atrophy type I fibers
More fatigue
Lower lactic acid threshold
72
It’s usually what that limits the pt after txp?
Peripheral issues- not lungs
73
Acute care s/p LTXP
```
Chest PT
Postural drainage every 4-6 hours
Early mob
Training cough
Secretion clearance techniques
```
74
What is a a-line
Direct measurement of arterial BP
75
PT precautions with A-line
Dont pull it out
| No wrist ROM
76
How to interpret A line readings
Transducer has to be at level of right atrium for accurate readings
77
If a-line alarm goes off, what do you do?
1- observe the patient first!!
| 2- take manual BP
78
Signs and Sx of intolerance- lower intensity (7)
```
HR increases more than 20-30 above resting HR
SBP increases more than 20-30
RR more than 30
Increased accessory muscle use
DNV- dizzy, nausea, vomit
Pain
Agitation
```
79
Ventilator specific alarms (5)
```
It alarms for disconnect
FiO2 more or equal to 0.6
PEEP more than 10
Mode changed to assist-control
Tenuous airway
```
80
Aerobic training goal of outpatient PT
30 min most days of the week if not all
81
Strength training in outpatient PT
UE strength training after MD clearance
| 6-9 weeks
82
TERMINATE EXERCISE (10)
```
RR more than 40
More than 20% increase in resting HR
HR less than 40 or more than 130
MAP less than 65 or more than 110
OH
Severe agitation (RASS more than 2)
Sedation or coma RASS (less or equal to 3)
EKG changes, chest pain, diaphoresis
SpO2 decreases 4% or less than 88%
patient discomfort or refusal
```
83
Post transplant rehab Ex Prescription
```
F: 3-5 x/week
I: 50-80% HRR
3-4/10 on dyspnea scale
75-100% 6MWT speed
T: continuous 20 min
```
*Keep sats above 88%
84
Strength training ex prescription for post txp
F: 2-3x/week
I: 60-80% of 1 RM
1-3 sets of 8-15 reps
(Higher sets, lower reps)
85
Because of steroids you want to focus on what durign strength
Focus on proximal strength
86
Mechanical changes in thoracic cage
Increased collagen
| Loss of disc height
87
The mechanical changes in the thoracic cage results in
Greater pressure needed to inflate lungs
88
Lung parenchyma changes with age
Decreased compliance in small airways
Increased size and production of muscles glands
Decreased elastic recoil of lungs
89
Alveoli changes
Decreased available surface area for gas exchange
Decreased diffusion capacity (DLCO)
Decreased number of pulmonary capillaries
90
Respiratory muscle changes
Less type I and type II, less # of motor units, slowing at NMJ, lose optimal L-T
91
Muscles have to work harder to?
Create negative pressure
92
Lung volumes and capacities with age
⦿Decreased FVC
⦿Decreased FEV1
⦿Increased RV
⦿No change in TLC
93
FEV1
Amount of air exhaled during 1st second of FVC
94
FEV1 indicates
Flow in larger airways
95
Post bronchodilator FEV1/FVC less than what indicates what
Less than 70% predicted = COPD
96
GOLD 1
Mild
| FEV1 more than 80% or = to 80
97
Gold 2
Moderate
| Between 50-80
98
Gold 3
Severe
| Between 30-less than 50
99
Gold 4
Very severe
| Less than 30%
100
Goals of medical assessment (3)
Determine level of airflow limitation
Determine impact on health status
Determine risk of future events
(hospitalizations, death, exacerbation)
101
COPD is a common, preventable and treatable disease characterized by ? Respiratory Sx and ? That is due to ? Usually caused by significant ?
Persistent
Airflow limitation
Airway and alveolar abnormalities
Exposure to noxious particles or gases
102
Goals of phase III
Independent self-minoring
| Exercises as life long approach- prevent relapse
103
The minimal increase that is clinically meaningful in 6MW distance is?
54-84 m (177 - 275) feet for COPD
104
St George repsiratory questionnaire is ?
Disease specific
105
Precontemplation
No intention to take action in next 6 months
106
Contemplation
Intends to take action in next 6 months
107
Intention to take action in next 30d and has taken behavioral steps to initiate change
Preparation
108
Behavior has changed for less than 6 months
Action
109
Behavior has changed for more than 6 months
Maintenance
