exam Flashcards
(55 cards)
1
Q
What are the areas for auscultation
A
apices, superior lobes, middle lobes/lingula, inferior lobes
back - apices, superior lobes, inferior lobes, base of lungs
2
Q
Why and when do we auscultate
A
to assess the lungs, and to identify pathologies of the lungs thru sounds
3
Q
What are all the ABG values
A
pH. 7.35-7.45
PaCO2. 4.5-6
hco3. 22-26
PaO2. 9.3-13.3
SpO2. 95-100, 88-92 in COPD
4
Q
What is type 1 resp failure
A
Normal pCO2/pH, but low O2 (hypoxic), treatment is often oxygen therapy
5
Q
WHat is type 2 resp failure
A
Hypoxic O2 AND high PaCO2, treatment is often ventilation
6
Q
A
7
Q
What are indications to use positive pressure breathing
A
- improve lung expansion in the presence of atelectasis when other forms of therapy have been unsuccessful (incentive spirometry, chest physio, deep breathing exercises, positive airway pressure adjuncts)
- hypercapnia
- hypoxemia
- circulatory failure
8
Q
What are the contraindications for positive pressure breathing
A
- need for intubation
- encephalopathy
- hemodynamic instability (unstable blood flow)
- facial trauma or facial defects
- airway obstruction secondary to a mass
- anticipated need for prolonged mechanical ventilation
- gastrointestinal bleeding
- undrained pneumothorax
- frank haemoptysis
- raised ICP
- recent upper GI surgery
- lung abscess
9
Q
What is the indication for a CPAP?
A
- type 1 respiratory failure
- atelectasis
- rib fractures - to splint rib cage open - stabilise fracture and prevent lung damage
- congestive heart failure
- cardiogenic pulmonary edema
- OSA
- pneumonia
10
Q
what is the indication for a BIPAP?
A
- type 2 respiratory failure
- acidotic exacerbation of COPD
- ventilatory failure - increased WOB, hypercapnia, fatigue or neuromuscular disorder
- weaning from tracheal intubation
11
Q
What does suctioning/cough assist do?
A
removes mucus and secretions in patients with a weak cough
cough assist - offers oscillatory insufflations/exsufflations
12
Q
What are the indications to cough assist/suctioning
A
- weak or ineffective cough
- mucus retention
- hypoxemia
- distress from secretions
- visible/audible secretions
- poor inspiratory effort
- Peak cough flows of <180 L/min are unlikely to be effective at clearing secretions
13
Q
What are the contraindications to cough assist/suctioning
A
- bronchospasm
- undrained pneumothorax
- active haemoptysis
- facial fracture
- CV instability
- combative patient
- deranged clotting
- recent upper GI surgery
- lung abscess
- vomiting
- raised ICP
14
Q
What is the technique for suctioning
A
gloves on and consent, test suction and set to 150mmhg, open catheter, connect nozzle and put under armpit, put on a new glove, and only touch catheter with that glove. push til resistance and then hold suction, and then slowly pull out with a small twisting motion
15
Q
whats the technique for cough assist
A
consent, 20mmh20 setting, ask pt to breath in/out w mask with insufflation pressure, then after 5 breaths on last one do forceful out and cough with exiflation pressure
16
Q
What does OPEP do
A
- provides resistance on expiration 10 - 20cmH20
- provides oscillations to mobilise secretions
- prevents airway collapse
- maintains patency
- requires breathing control
- increase lung volume by increase FRC (air in lungs after passive expiration) and VT (amount of air moved out of the lung during a normal breath)
-opens up collateral airways to create backpressure to mobilize secretions
17
Q
Indications for OPEP
A
- mucus retention
- improve airway clearance in CF, bronchitis, bronchiectasis
- reduce hyperinflation in, enphysema, bronchitis, asthma
- increase lung volume by increase FRC (air in lungs after passive expiration) and VT (amount of air moved out of the lung during a normal breath)
18
Q
Contraindications for OPEP
A
- haemodynamic instability
- undrained pneumothorax
- frank haemoptysis
- high ICP >20mmhg
- facial trauma
- acute asthma or COPD attack
- inner ear pathology
- nausea
- inability to follow instructions
19
Q
OPEP technique?
A
loosen mucus
-take a deep breath
form tight seal around mouth
hold for 2-3 seconds
breath out through acapella with a non forceful, sustained exhalation
repeat 8-10 times and include breathing control
cough at the end and bring up mucus
- take a deep breath in and perform 3 huffs to elicit cough
- can also perform ACBT cycle
continue cycle for 10-20 minutes or until mucus is cleared
20
Q
A
21
Q
What does ACBT do
A
- increases expiratory flow
- works on collateral ventilation
- breathing control
- forced expiratory technique
- adjuncts
- improve ventilation
- mobilise secretions
22
Q
Indications for ACBT
A
sputum retension
poor expansion
CF
Bronchiectasis
atelectasis
respiratory muscle weakness
mechanical ventilation
asthma
increased breathing rate/effort
23
Q
Contraindications for ACBT
A
- bronchospasm
- head, neck or spinal injury
- unconscious patient
- confused or agitated
- unable to follow instructions
- not spontaneously breathing
24
Q
Technique for ACBT
A
- breathing control 20-30 seconds to relax airways
- 3-4 deep breaths
- breathing control 10 seconds
- 3-4 deep breaths
- breathing control
- deep breath followed by huff for cough
repeat cycle for up to 10 mins or until mucus is cleared
25
What are manual techniques for
mechanically dislodges mucus
26
What are the indications for manual techniques
- increased mucus production
- prolonged bed rest
- painful incisions that restrict deep breathing and coughing
- ventilator but stable enough to tolerate treatment
- weak or elderly patients
- patients with artificial airways
27
What are the contraindications for manual techniques
- severe osteoperosis
- haemoptysis
- fractures ribs
- chest inuries
- hyper-reactive airways
- severe bronchospasm
28
How is percussion performed
- performed with cupped hand over the lung segment being drained
- cover area with thin cloth or towel - avoid tapping spine - breastbone - stomach - lower ribs and back
- cup hands like holding water palm down
- tap chest with a steady beat and moderate force making hollow sound
- movement should come from wrist with arm relaxed
- duration dependant on assessment findings and symptoms.
29
How is vibration performed
- used in conjunction with percussion to help move secretions to larger airways
- applied on expiratory phase as patient is deep breathing
- apply vibration directly on the skin and gently compress and rapidly vibrate chest wall as patient breathes out
- small amplitude
30
How are shakes performed
- more vigorous form of vibration applied during exhalation
- high frequency large amplitude
31
What is postural drainage
- remove secretions from the lungs via gravity
- prevent accumulation of secretions in patients at risk of pulmonary complications
32
What are the indications to posteral drainage
- increased mucus production
- prolonged bed rest
- painful incisions that restrict deep breathing and coughing
- ventilator but stable enough to tolerate treatment
- weak or elderly patients
- patients with artificial airways
33
What are the contraindications to posteral drainage
- severe haemoptysis
- untreated acute conditions
- pulmonary edema
- congestive heart failure
- large pleural effusion
- pneumothorax
- cardiovascular instability
- cardiac arrythmia
- hypertension - hypotension
- recent myocardial infarction
- unstable angina
- recent neurosurgery
- head down posture may increase ICP
34
What are the positions of relaxed breathing
attempts to disengage accessory muscles, thus decreasing work of breathing
provides a stretch onto the diaphragm fibres and encourages dome shape
use pressure from abdominal contents to support the dome shape for fibres to work effectively
35
What are the indications for using positions of relaxed breathing
- Dyspnoea
- low Sp02
- patients with flat diaphragm - they benefit from positions that use pressure from abdominal contents to support the dome shape for fibres to work effectively.
36
What are the contraindications for using positions of relaxed breathing
- ability to follow instructions
- fractures preventing positioning
- aneurysms
- active haemoptysis
- increase oxygen requirements hypoxaemia
- haemodynamic instability
- heavy sedation -unable to maintain airway
- increased pain from positioning
37
What are the positions of relaxed breahting
high side lying
forward lean on table
forward lean no table
standing forward lean
standing with back support
38
how does high sitting/side lying improve breathing and who for?
- patients with flat diaphragm
they benefit from positions that use pressure from abdominal contents to support the dome shape for fibres to work effectively.
39
how does forward lean sitting improve breathing?
- provides a stretch onto the diaphragm fibres and encourages dome shape.
- attempts to disengage accessory muscles, thus decreasing work of breathing.
40
what should the physios focus be when trying to improve breathing and deliver care?
- aim to reduce work of breathing
- improve efficiency of ventilation
- need education to understand normal breathing mechanics
- constant reassurance to calm patient down
- feedback to the patient.
41
When would you assess for coordination
when assessing cerebellar function
42
What are the 3 types of coordination disorders
ataxia - general uncoordination
Dysmetria - uncoordinated timing
dysdiachokinesia - inability to perform rapidly alternating movements
43
How do you assess for coordination
finger to nose
heel to shin
alternating clapping on thighs
44
What are the two phases of the gait cycle
swing and stance phase
45
How would you assess gait
normal walking
heel toe walking - ataxic assessment
walking on heels - dorsiflexors/tibial nerve
walking on toes - plantarflexors/deep peroneal nerve
46
What are some pathological gaits to look out for
- hemiplegic gait from stroke - circumduction of hip
- diplegic gait cerebral palsy- high adductor tone and plantar flexing
- neuropathy gait - footdrop
- myopathathy gait- hyper lordotic waddling
- parkinsonian gait - bradykinesia, shuffle gait, hunched over posture
- cerebellar ataxic gait - wide stance poor coordination
- sensory cerebellar ataxic gait - stomping to feel vibrations to understand body positioning
- chorea gait - jerky irregular movements of trunk and arms, rhythmic and irregular
47
What is scapulohumeral rhythm
coordinated movement of the scapula - humerus and clavicle to achieve full abduction or elevation
48
how does scapulohumeral rhythm change with neuro disorders
abnormal tone can influence muscle activity
- dyskinetic movement which can lead to scapula winging
impaired arm elevation
- without scapular rotation, the glenohumeral joint reaches its limit early
altered proprioception
- scapulohumeral rhythm relies on proprioceptive input which can influence movement
compensation
- patients may compensate with trunk movement or excessive scapular elevation due to deficits
- causing improper mechanics
49
What are the 3 phases of scapulohumeral rhythm
- phase 1
- phase 1 - 30 degree elevation -
- after the first degrees the humerus and scapula moves into a 2-1 ratio
- humerus 30 degrees
- scapula slight medial move
- clavicle 0-5 degree elevation
- phase 2
- phase 2 - 90 degree elevation -
- humerus 40 degrees-
- scapula 20 degrees lateral rotation -
- clavicle 15 degrees
- phase 3
- phase 3 - 90 - 180 degrees -
- humerus 60 abduction, 90 degree lateral rotation -
- scapula 30-40 degree lateral rotation,
- clavicle 30-50 posterior rotation, 15 degree elevation
50
How do you perform a sensory assessment ??
- touch - cotton swab on both sides of body compare
- pain - pin prick test, sharp vs blunt
- temperature - hot or cold test
- vibration - apply vibration to bony landmark
- joint movement sense - ask what position joint is moving in
- joint position sense - place joint in a position and ask if its facing up or down.
51
What do you assess for with a motor assessment
- observation
involuntary movements
- muscle strength
- assess strength across myotomes - resisted movement
- muscle tone
assess tone via passive range of motion
- muscle bulk
assess muscle size and any bilateral differences
- reflexes
- Deep tendon reflexes
- triceps reflex - C7
- Brachioradialis reflex - C6
- Knee jerk reflex - L2-L4
- Achilles reflex - S1
- UMN reflexes
- Babinski sign
- Clonus
52
Describe a full upper limb assessment
- Assessment of any pain - passive - active
- Tone - test through passive movement of limb - looking for contractures or stiffness
- altered voluntary movement - inability to sustain, maintain, stop and sequence movement
- abnormal muscle synergies
- strength testing
- functional assessment
- involuntary movements - dyskinesia, dystonia, chorea
- sensation - light touch eyes closed with cotton swab dorsal column - pain (sharp vs blunt) spinothalamic tract
- proprioception - joint position sense - joint movement sense
- coordination
- reflexes
53
what is the trunk control test?
- assess impairments in motor function after patient has suffered a stroke
- 0 points if patient is unable to complete without assistance
- 12 points with non muscular help or abnormal style - needs arms to stable when sitting
- 25 points if patient can complete item individually
54
How is the trunk control test performed
- ask patient to role to weakside - score accordingly
- role to strong side - score accordingly
- patient sitting on edge of plinth without arms - score accordingly (ideally patient has feet of ground)
- sit up from supine lying position - score accordingly
- score of 50 or less after 6 weeks post stroke is an indication of poor recovery
55
What is the 4 stage balance test
Stand with your feet side-by-side
2.Place the instep of one foot so it is touching the big toe of the other foot.
3.Tandem stance Place one foot in front of the other, heel touching toes
4. Stand on one foot
if patient is able to hold for 10s, move onto next position
failing test 3 or before is linked to high fall risk
