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DPS1 > CVR research and Rx > Flashcards

CVR research and Rx Flashcards

(52 cards)

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1
Q

What 6 problems for CVR Mr Khan?

A

Pain, reduced thoracic volume, reduced gas exchange, increased WOB, dyspnea and airway restriction from GORD.

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2
Q

What is his main problem, what shows and why?

A

Atelectasis of the left lung base shown in diminished breath sounds, reduced expansion and dull percussion. Could be from general anaesthesia or mucus.

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3
Q

What two more problems can arise for Mr Khan and why?

A

Sputum retention because he is avoiding coughing due to pain and type 1 respiratory failure as he has hypoxaemia and approaching low pH on 60% oxygen

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4
Q

Give 8 barriers to his recovery…

A

High BMI, Hypertension, GORD, Age, Sedentary lifestyle, Passive smoke, Large family may be a caregiver and pain

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5
Q

What ethics/morals to consider for Mr Khan?

A

Informed consent by explaining treatment and making sure he understands with closed questions and respecting his autonomy and any cultural values

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6
Q

What MDT can be involved for Mr Khan?

A

OT may need to place things in house for safe discharge, GP for wound care or medication, signpost to weight loss advise.

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7
Q

Why encourage exercise after his op?

A

Because improving his exercise will improve lung function and reduce strain on the respiratory system and improve his FRC and TV

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8
Q

What’s the first treatment for Mr Khan and why?

A

Controlling his pain before doing any Rx as pain is 6/10 at rest.

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9
Q

What might be the most concerning thing for Mr Khan and how to deal with this?

A

Dyspnea i.e the fear associated with his SOB and can teach WOB techniques for discharge i.e. calming hand and positions of ease

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10
Q

What will cardiac charge position help?

A

Positioning will reduce WOB, help improve expansion and V/Q in the lower lobe of lungs and increase FRC

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11
Q

Why position side lying on atelectasis down?

A

Placing atelectasis lung down making this the dependent lung will increase V/Q and help expansion, although sats will drop initially and then increase.

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12
Q

Why move over to atelectasis lung up after some time?

A

This will increase the oxygenation in the atelectasis lung and also preferentiate V/Q in the good lung so improving sats.

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13
Q

What research supports side lying atelectasis up and why?

A

RCT by Li et al., 2022 showed lateral positioning and sighing with atelectasis lung up increased trans pulmonary pressure to increase alveolar expansion and recruit collapsed area.

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14
Q

What is the ideal VQ ratio? `

A

1

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15
Q

Why am I using ACBT for MR Khan?

A

Will help work on breathing mechanics and potentially clear mucus if there is any.

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16
Q

Explain breathing control and how many?

A

2 BC and in through nose to encourage reduced turbelence promoting peripheral airflow and diaphragm, pursed lip put to help increase PEP and gas exchange.

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17
Q

Explain TEES?

A

In through nose, hold for 2secs to help promote collateral ventilation and oxygenation and then sniff to help increase PEEP and splint open the airways so reducing closing volume.

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18
Q

Would we do huffs for Mr Khan and how to modify?

A

Could do huffs if there any noticable secretions on CXR no indication so far, could do low volume with a pillow to reduce pain

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19
Q

What two other things can be done for Mr Khan?

A

Encourage hydration as his urine output is low and is on high oxygen and also early mobilisations to naturally increase TV and reduce risk of DVT

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20
Q

What research has been done for ACBT in atelectasis?

A

RCT by Zhong et al., 2021 found ACBT to be an acceptable and tolerable treatment compared to manual techniques after thoracic surgery and helped to increase lung volumes.

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21
Q

What outcome measures can be looked at for both CVR cases?

Study These Flashcards
A

Sats (SP02), auscultation, percussion, CXR, pt subjective opinion and any sputum secretion volumes, MMRC and borg dyspnea.

22
Q

What 2 things can be done if Mr Khan doesn’t improve?

Study These Flashcards
A

IPPB (bird) to increase positive pressure, TV and elastic recoil of lungs or CPAP to help open collapsed alveoli and improve gas exchange.

23
Q

What are the suggestions by NICE 2024 on acute breathlessness in over 18s?

Study These Flashcards
A

Understand the underlying cause of the lobe collapse sit the person up with oxygen adjustments to improve sats to 94-98% controlling RR.

24
Q

What must be considered for Mr Khan discharged including NICE 2020…

Study These Flashcards
A

Wound cleaning with sterile wipes and avoid touching the area for infection control, multi-generational household risks contact.

25
What 6 factors are pre-risk before his op?
GORD, Age, BMI, hypertension, functional status being sedentary and passive smoke exposure.
26
What 5 factors put him at risk during op?
Emergency or planned op, length of operation, site being more at risk, mechanical ventilation, anaesthesia or opioid use.
27
What 4 post-op factors are affecting Khan?
Pain, reduced cough ability, dehydration and altered mental state with fatigue.
28
What 6 problems exist for Mrs Field?
Sputum retention in right lower lobe and maybe upper both, reduced gas exchange as type 2 resp, increased WOB, dyspnea, airway restriction from bronchiectasis and reduced thoracic volume.
29
What is Mrs Fields main 2 problems?
She has a lower respiratory tract which is likely to be pneumonia with type 2 respiratory failure with compensation i.e. respiratory acidosis.
30
What should normal ABG's be?
pH 7.35-7.45, Pa02 10.6-13.3, PaC02 4.7-6, HC03 22-24 and BE -2 to +2
31
What holistic factors to consider for Mrs fields?
She needs good sats and to be eating again before discharge, home support as she's a caregiver, flu jabs.
32
What ethics should be considered for Mrs Field?
Patient autonomy and gaining informed consent despite inability to speak in full sentences.
33
What barriers may affect her recovery?
Her chronic bronchiectasis, 20 pack year smoking, looking after husband, mulitple hospital admissions with infections, type 2 diabetes and hypertension.
34
What can she do with discharge to improve health backed by CSP 2019?
She is eligible for pulmonary rehab classes due to her chronic condition and 3 on MMRC as CSP shown it to reduce hospital admissions by 26000 hence improving QoL.
35
Mrs field What 3 treatments can be utilised before starting physio?
Relaxation techniques as dyspnea is going to be most concerning for her, hydration and saline nebs to improve mucus clearance.
36
What positioning and why for Mrs Field?
Side lying with her left (bad) lung up to help postural drainage of secretions into central airways by gravity assisted and optimise V/Q in dependent good lung.
37
Can we turn her over so bad lung down and why?
We could to help improve expansion.
38
What is the evidence for postural drainage and manual techniques?
A review by Belli et al., 2021 showed postural drainage position with vibs and percussions facilitated movement of secretions.
39
How does manual techniques help clear Mrs Fields sputum retention?
The oscillations from percussions and vibs the rhythm helps loosen mucus and dislodge it from the lower lobe into central airways.
40
What are the risks of MT for Mrs Field?
Due to her age she may be more frail and if she uses corticosteroid can increase risk of osteoporosis.
41
Explain BC and TEES ACBT for Mrs Field...
Breathing control to reduce tachypnea and expiratory flow with purse lips behind the mucus, through nose in inhalation reduces resistance to improve oxygen uptake, thoracic expansion to increase volume with a hold to improve collateral ventilation and oxygenation in the Pores of Kohn, channels of Martin and canals of Lambert.
42
Explain huffs for Mrs Field?
Start with low volume huffs as lower lobes so moves it to more central by having equal pressure point lower to alveoli and then high volume to move from central airways.
43
How many of each in ACBT?
2 BC, 2 Tees, back to 2 BC, 1 huff then back to BC. Repeat 3-4 times.
44
What is the evidence to support ACBT for secretions?
A systematic review by Zisi et al., 2022 found ACBT to cause short term improvements in RTI sputum clearance as had increase volume of expectoration and less viscous sputum.
45
What can be used by NICE 2025 on community acquired pneumonia?
Suggests to advise smoking cessation, arrange a chest x-ray for 6weeks time if symptoms still persist.
46
What are the suggestions by NICE 2023 on pneumonia in adults for safe discharge?
In the last 24hours should have... temperature no higher than 37.5, RR lower than 24, HR lower than 100 and sats of above 90% on room air.
47
What can be done if Mrs Field doesn't improve?
Use BiPAP as she's in type 2 respiratory failure, IPAP to support CO2 removal and PEEP to improve oxygenation/collateral ventilation, cough assist to clear sputum and increase oxygen to 4L or venturi 35%. Flutter devices.
48
Can the bird be used for Mrs Field?
Yes as it will improve lung volume and help to loosen mucus into larger airways.
49
What MDT can be used for Mrs Field?
Signpost to help stop smoking, use of carers to look after husband, OT for home adaptations to improve fatigue and ADLS or use walking aids, psychological support and family involvement for dog walks.
50
What does CXR show?
Increased opacity in the right lower lobe showing consolidation and some mild reduction in right costophrenic angle.
51
What factors could have caused her infection?
Missed flu vaccine, diabetes impairing immunity, smoking, time of year with cold exposure, previous infection and physical stress from caring and retirement.
52
Where can she go next and why based on suspicions from NEWS scores 12 i.e. why she can't mobilise?
Mrs Field is acutely unwell with a NEWS score approaching risk of sepsis so as she is too ill to get up she may need to go to ICU.

DPS1 (3 decks)

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