Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Acute Rehab > Case study 2 - Bronchiectasis > Flashcards

Case study 2 - Bronchiectasis Flashcards

1
Q

What is bronchiectasis?

A
  • irreversible airway dilation (of bronchi) associated with chronic airway inflammation and infection.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

why may haeomoptisis occur in patients with bronchiectasis

A
  • blood vessels damaged causing bleed
  • due to chronic coughing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Coles Viscious Cycle?

A
  • shows that there is a decrease in cilia, mucocilary clearance (hairs in airways helping to remove secretions).
  • This results in a colonization (increase) of bacteria, leading to chronic inflammation and frequent infection.
  • This increase in mucus leading to infection, becomes the cycle (Chandrasekaran et al, 2018)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the risk factors of bronchiectasis?

A
  • repeated infections
  • immunodefiency
  • cystic fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the symptoms of bronchiectasis?

A
  • increase sputum production
  • shortness of breath
  • chronic cough
  • fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do NICE guidelines say about bronciectasis

A
  • sputum sample should be taken to be tested
  • first choice of antibiotics is Amoxicilin
  • comprise self management plan where possible ACBT can be given.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is pneumonia?

A

infection in alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of pneumonia?

A
  • Bacterial
  • Hospital acquired
  • Legionnaires’ disease
  • community acquired
  • fungal pneumonia
  • aspiration pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is virus + bacteria?

A

Bacteria are single cells that can survive on their own, inside or outside the body.
- Viruses cause infections by entering and multiplying inside the host’s healthy cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the accessory muscles used in respiration?

A
  • scalenes
  • sternocleidomastoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the lobes of the lungs?

A
  • right upper lobe
  • right middle lobe
  • right lower lobe
  • left upper lobe
  • left lower lobe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what fissures are there in the lungs?

A
  • horizontal fissure (seperating the RUL + RML)
  • oblique fissure (seperating the RML + RLL)
    -oblique fissure (seperating LUL + LLL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Explain the structure of the lungs

A
  • mouth/nose, trachea, bronchi (primary, secondary + tertiary), bronchioles, alveoli
  • left + right lobes of lungs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens in gaseous exchange?

A
  • oxygen diffuses into capillaries down concentration gradient
  • forms oxy-haemoglobin
  • has large surface area due to capillaries
  • is very thin so lots of diffusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain bacterial pneumonia

A
  • caused by various bacteria.
  • most common is Streptococcus pneumoniae.
  • in this case the patient has bronchiectasis, with lower cilia more sputum is retained causing increased infection risk.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does lethargic mean

A

increased fatigue levels

17
Q

what must you take into consideration when treating Amiel

A

he is feeling lethargic, therefore may be a risk of hypotension, so ensure you take it slowly and check on patient (maybe place pulse oximeter or bp on)

18
Q

what is the normal value for ph levels in ABG

A
  • 7.35-7.45
  • if too low = acidosis
  • if too high = alkanosis
19
Q

what is the normal value for HC03 (bicarbonate) levels in ABG

A
  • 22-26 mmol/L
    -if lower then PaCO2 then respiratory
  • if higher then PacO2 then metabolic
20
Q

what is the normal value for PaCO2 (partial pressure of carbon dioxide) levels in ABG

A
  • 35-45 mmHg
  • if higher then bicarbonate then respiratory
21
Q

what is respiratory acidosis?

A
  • likely that Amiels ph levels are below 7.35 and PaCO2 levels are higher then bicarbonate levels in blood.
  • increased carbon dioxide in blood
  • the body is unable to remove enough carbon dioxide through breathing
  • medulla oblangata in brain and chemoreceptors detect decrease PH and try to level it leading to hypoventilation
22
Q

what are symptoms of respiratory acidosis?

A
  • shortness of breath
  • cyanosis
  • headaches
  • fatigue
  • lethargic
  • anxiety
23
Q

what are normal spo2 levels in people with bronchiectasis

A
  • appropriate to maintain a saturation of >92%.
24
Q

what do you look for in a chest x-ray?

A
  • trachea position
  • white is solid (bones or blockages)
  • black is air
  • diaphragm
  • check if it is anterior supine or posterior image
  • clavicle location
25
Q

What would you do for assessment of secretion retention?

A
  • sputum sample which links to NICE guidelines
  • auscultation of lungs listening for affected area, likely to be lower lobes due to atelectasis
  • assess cough strength
  • tactile fremitus
26
Q

What would you do for treatment of secretion retention?

A
  • teach ACBT techniques (forced expiratory, thoracic expansion and diaphragmatic breathing)
  • if they are unable to clear use yanker suction?
  • postual drainage for affected lobes (lie Amiel on left side to drain secretions).
  • chest percussion
  • nebuliser if secretions are thick
  • re-position patient in bed
27
Q

What evidence is there for treating secretion retention right lower lobe using ACBT

A
  • Zisi et al 2022
  • explain aim, method, findings, conclusion
  • ACBT is effective in increasing the expectorated sputum volume, in reducing viscoelasticity of the secretion.
  • Amiel will therefore be able to clear secretions
28
Q

What evidence is there for treating secretion retention using postural drainage

A
  • Bott et al 2009, British Thoracic Society
  • Recommend postural drainage being aware of precautions
  • side-lying of lobes affected
29
Q

What would you do for assessment of decreased chest expansion

A
  • tactile fremitus feeling for equal chest epansion (likely to feel decreased in anterior + posterior lower lobes due to atelectasis)
  • palpation of accessory muscles feeling for hypertorphy
  • observe respiratory rate, likely to be decreased due to respiratory acidosis (hypoventilation)
  • use dyspnoea scale (rate of perceived exertion)
30
Q

what would you do for treatment of decreased chest expansion?

A
  • ACBT (forced expiratory, thoracic expansion and diaphragmatic breathing) Reduce sputum retention and in turn reduce dyspnoea, shown from the systematic review.
  • Thoracic expansion technique and diaphragmatic breathing has been shown to have a positive impact compared to other methods such as flutter device, which is also expensive.
31
Q

What evidence is there for treating decreased chest expansion using ACBT

A
  • Zisi et al 2022
  • explain aim, method, findings, conclusion
  • ACBT is effective in increasing the expectorated sputum volume, in reducing viscoelasticity of the secretion and in relieving symptoms such as dyspnoea.
  • will help to increase chest expansion and decrease dyspnoea.
32
Q

How would you assess decreased exercise tolerance?

A
  • use dyspnoea scale/rate of percieved exertion
  • respiratory rate
  • 30 second sit to stand - for his age 58 should be able to do 18. (use borg scale before and after or dyspneoa (breathlessness) scale)
33
Q

How would you treat decreased exercise tolerance?

A
  • marches on spot, sit and rest
  • progress to mobilise patient with WZF to sit on in chair
  • Teach ACBT to ensure breathing pattern is maintained and risk of pulmonary complication decreased
  • outcome measure using dyspnoea scale used.
34
Q

What evidence is there for mobilzing patient with respiratory acidosis?

A
  • Bailey et al 2007
  • explain aim, method, findings, conclusion
  • early activity is feasible and safe in respiratory failure patients.
  • therefore, mobilising Amiel is important to help increase exercise tolerance and decrease risk of muscle weakness
35
Q

types of mechanical ventilation

A
  • Volume-limited assist control ventilation (VAC)
  • Pressure-limited assist control ventilation (PAC)
  • Synchronized intermittent mandatory ventilation with
  • pressure support ventilation (SIMV-PSV)

Acute Rehab (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions