LO3 assessment skills, clinical reasoning and evidence base Flashcards
(17 cards)
ABGs: what is PaO2
partial pressure of oxygen in arterial blood (plasma)
normal range: 10-13kPa
PaO2<8 = type 1 respiratory failure
ABGs: what is pH
measures the hydrogen concentration
-by-product of metabolism
normal range: 7.35-7.45
pH<7.35 ACIDOSIS
pH>7.45 ALKALOSIS
ABGs: what is PaCO2
CO2 is acid
-accumulation through sedation, head injury and reduced breaths = ACIDOSIS
-reduction = ALKALOSIS
normal range: 4/7-6.0 KPa
PCO2<4.7 RESPIRATORY ALKALOSIS
PCO2>6.0 RESPIRATORY ACIDOSIS
ABGs: what is HCO3-
bicarbonate is an alkali
normal range: 22-26
HCO3<22 METABOLIC ACIDOSIS
HCO3>26 METABOLIC ALKALOSIS
ABGs: what is base excess
BE= another way of expressing bicarbonate levels
normal range: +2 to -2
LOW BASE - a lot used to neutralise the acid to raise pH
= METABOLIC ACIDOSIS
e.g. if HCO3 = 28 then BE = +4
HIGH BASE - extra alkali in blood
=METABOLIC ALKALOSIS
e.g. if HCO3 = 20 then BE = -4
compensations in ABGs
if ONLY PaCO2 or HCO3 is abnormal = NO COMPENSATION
if pH is abnormal and BOTH CO2 and HCO3 have changed = PATIENT PARTIALLY COMPENSATED
is pH is normal BUT CO2 and HCO3 are not = PATIENT FULLY COMPENSATED
acidosis
RESPIRATORY ACIDOSIS
-reduced lung ventilation causes CO2 retention
-retained CO2 increases acidity
therefore:
pH: low eg 7.25
pCO2: raised eg 7.5
METABOLIC ACIDOSIS
-caused by excessive H-, renal failure, bicarb ion loss
therefore:
pH: low e.g 7.25
HCO3: low eg 16
BE:low eg -8
alkalosis
RESPIRATORY ALKALOSIS
-excessive CO2 blown off
-causes hyperventilation
therefore:
pH: raised eg 7.49
pCO2: low eg 3.8
METABOLIC ALKALOSIS
-caused by excessive acid loss
therefore
pH: raised eg 7.49
HCO3: raised eg 33
respiratory failure
type 1 RF
-affects only oxygen
-PaO2<8
PaO2 <10 and >8 = HYPOXAEMIA
type 2 RF
-affects oxygen and carbon dioxide
-PaO2<8
-PaCO2>6.0
explain the rationale for using ABGs as an objective assessment technique
-identify and monitor deterioration
-acidosis/alkalosis
-metabolic/respiratory
-identify and monitor respiratory failure
-monitor effect of treatment
-outcome measure following physiotherapy intervention
what is the motor relearning programme?
a functional way of assessing, identifying problems and treating patients through a task oriented approach considering all ADLs
what is the first stage of MRP?
analysis of task
-observation
-comparison
-analysis
how should MRP be applied?
-task oriented
-use affected side for movement
-verbal and visual prompts
-discourage compensatory movement
-prevent muscle shortening
-active participation
-functional treatment
how to assess sit to stand
-clear explanation and instructions, consent
-demonstrates procedure and check bp
-general observation (alignment and cog)
-bos
-muscle activity
-tonal changes
stages of sit to stand
☐ flexion momentum – overcome inertia, might include backward rock, trunk moves
forward shifting CoG forwards, with hip flexion and rotation of pelvis to more
anterior, might include change in foot placement to be more underneath trunk
☐ momentum transfer - max power needed in lower limbs, forward translation of
knee and max dorsiflexion, dynamic stability needed in feet
☐ extension – extension of hips and knees, demands high level of
postural control, pelvis moves towards a more neutral alignment whilst
hips and knees extend
☐ stabilisation – AP postural sway, small base of support
☐ Compensatory strategies – can identify when patient uses compensatory strategies
☐ Willingness to move - is there any fear/reluctance to move?
☐ Any evidence of left-sided neglect/inattention?
analysis of sit to stand
-any missing component of task
-graded muscle rsponse
-absence of specific muscle activity
-presence of any excessive or inappropriate muscle activity/tonal
-alignment
-rom and pattern of movement
-timing
-speed
-strength
-task completion
sit to stand clinical reasoning
