Optimising Function - CARDIORESP Flashcards

Question

Describe respiratory compensation

Answer 1

In metabolic ACIDOSIS - hyperventilation occurs to ‘blow off’ CO2 and reduce hydrogen ions returning pH back towards normal In metabolic ALKALOSIS - Hypoventilation occurs to retain CO2 and increase hydrogen ions returning pH back towards normal.

Answer 2

In respiratory ACIDOSIS - the kidneys excrete less HCO3 into the urine, allowing more hydrogen ions to be ‘mopped up’, and returning the pH In respiratory ALKALOSIS - the kidneys excrete more HCO3 into the urine, reducing circulating levels in the blood.

Answer 3

The % saturation of O2 at various partial pressures of oxygen.

Answer 4

A term used to describe a chronic condition where atherosclerotic obstruction (narrowing or occlusion) of the peripheral arteries affects the blood supply to the lower limbs.

Answer 5

Limitation of blood flow to the affected limb Less common causes: inflammatory disorders (eg vasculitis) and non-inflammatory arteriopathies (eg fibromuscular dysplasia).

Answer 6

Mostly caused by atherosclerosis Peripheral arterial disease Non inflammatory arteriopathies Adventital cystic disease Buergers disease Thromboembolism Popliteal entrapment syndrome Arterial dissection

Answer 7

Aortic dissection or embolisation Hypercoagulable states Graft thrombosis Iotragenic complications of vascular interventions Cardiac ambolisation

Answer 8

Smoking Diabetes mellitus Hypertension Hypercholesterolaemia

Answer 9

Impairment of quality of life due to mobility limitations Severe pain Psychological complications such as depression Tissue loss (ulceration and gangrene) Risk of amputation Infection Procedural complications in people undergoing invasive treatments for peripheral arterial disease

Answer 10

The 6 Ps: Pain - constantly present and persistent Pallor - or cyanosis or mottling Pulselessness - ankle pulses are always absent Poikilothermia - perishing with cold Paresthesia - or reduced sensation or numbness Paralysis - or power loss

Answer 11

Embolus: onset is acute, limb appears mottled, vascular examination of the other leg is usually normal. Thrombosis: onset is more gradual (due to increased collateral circulation with pre-existing peripheral artery disease). The leg may be bluish, and there is no distinct demarcation. Presentation is usually with worsening claudication. Pulses in the other leg may be abnormal.

Answer 12

Has an obstructed upper airway Likely to need prolonged artificial ventilation Patient is unable to mainta8in an airway independently The p[atients bronchial secretions cannot be cleared normally The patient is having surgery to the orafacial region and might affect the upper airway (eg due to swelling).

Answer 13

Avoids damage to the larynx and pharynx, mouth care is improved More comfortable than a ET tube (endotracheal tube), less sedation required The patient can eat and drink if they can swallow Facilitates ventilator weaning by reducing anatomical dead space by 25-30%. Reduction in resistance to airflow.

Answer 14

Single and dual cannula tubes - single often used with children, but a double lumen is safer in case of blockage (outer and inner cannula). Fenestrated tubes - little holes in the tube, so the patient also aids the breathing with their upper airway. Placed in in advance but with a non fenstrated inner tube, so reduce changing the tubes often. Good for weaning. Final stage of weaning would be using the decanulation cap, with a DOUBLE FENESTRATED tube so the patient uses their upper airways. Cuffed tubes - needed when ventilating patients, a closed system. Uncuffled tubed - allows the patients to breath some air in and out of their upper airway, but there is resistance. Long length/adjustable tubes - used if the patient has a large neck, eg obese or burns patients with swelling. Tube can be adjusted as swelling goes down, without changing the whole tube. Subglotic line - you can aspirate using this, putting a syringe into the line to remove the secretions that are sitting on top of the cuff. This allows you to deflate the cuff, without letting the secretions drop into the lungs causing the patient to struggle.

Answer 15

Humidification - tracheostomy bypasses the natural de-humidification processes in the upper airway. Needed to prevent secretions and the bronchitracheal tree from drying. Use a BUCANNON BIB (long term use) or a SWEDISH NOSE. Checking cuff pressure - cuff remains inflated when patient requires long term ventilation, patient has reduced conscious level, patient has excessive oral secretions. Patients can develop tracheal stenosis after the tracheostomy has been removed as the trachea gets subject to high pressures from the cuff. Complications can occur from an under or over inflated cuff. Should be between 15-25 cmH2O. If pt can make a sound then cuff is not inflated enough. Suctioning and tube hygiene - need to use a non-fenestrated inner tube when suctioning. Communication needs to be- cannot talk with an inflated cuff. Might use alphabet or picture boards, lip reading, iPads, notepads. Always have a call bell. Involve speech and language therapists. Ensuring safety - signs by the bed side “This patient has a tracheostomy”.

Answer 16

Recruitment of accessory muscles, paradoxical breathing Cyanosis Oxygen stats low, respiratory rate high Bleeding, dislodged tracheostomy.

Answer 17

- the patient is able to maintain adequate gas exchange self-ventilating positive and negative supplemental oxygen (not more the 40% supplemental oxygen) - there are no signs of deteriorating broncho pulmonary infection or excessive pulmonary secretions (requiring lots of suction). - the patient has a stable lung status with oxygen therapy less than 40% - the initial reason for the insertion of the tracheostomy has been resolved and/or been considered - the patient is cardiovascularly stable.

Answer 18

Cuff deflation - double fenestration Gloved finger occlusion - you yourself cover the airway and check for stridorous noises (if they struggle, remove finger and they are not ready). One way speaking valve - opens as pt breathes in, closes and they breathe out. Gradually build up time, always start in the morning. Decannulation cap. DOUBLE FENESTRATION WHEN WEANING.

Answer 19

Able to obey commands Adequate cough and ability to clear secretions effectively and independently. Cardiovascularly stable No new lung infiltrates on x ray. Tolerates cuff deflation for 24 hours. Tolerates speaking valve 12 hours or more (usually during day time) or decannulation cap for up to 4 hours. MDT agreement for decannulation.

Answer 20

- Call for airway expert expert help - Look, listen and feel at the mouth and tracheostomy - Use waveform capnography (if available) - Apply oxygen to the tracheostomy - Apply oxygen to the face - Remove speaking valve or cap - Remove inner tube - Reassess breathing - Attempt to pass a suction catheter - If the tube as a cuff, deflate this now - Reassess the patient - If the patient is still deteriorating then remove the tracheostomy tube - Reassess again - If the patient is still not breathing ventilated by upper airways - Cover the stomach to stop gas escaping - If unsuccessful, attempt ventilation via the stoma - Use a paediatric face mask or a supra-glottis airway (such as a laryngeal mask). If no improvement secondary emergency oxygenation options include: - Oral intubation - Intubation of the stomach with a 6.0mm tracheostomy or tracheal tube - Use of bronchoscope/Aintree catheter/Bougie/Airway Exchange Catheter.

Answer 21

Indications are for secretion clearance and lung atelectysis (part of the lung collapses). Contraindications - untrained tension pneumothorax Precautions - Bullae, surgical emphysema, recent lung surgery, rib fractures and flail segments, frank haemoptysis, raises intercranial pressure, cardiovascular instability, high PEEP settings.

Answer 22

Claudication is pain caused by too little blood flow to muscles during exercise. Most often this pain occurs in the legs after walking at a certain pace and for a certain amount of time - Fatigue, discomfort or pain in the muscles of lower extremities after walking, that is relived by rest and reproduced by walking the same distance again. - May be described as aching or burning - Symptoms usually occur in the distal proximity before the proximal extremity, the calves are usually affected than the thigh, buttocks and hips. - Symptoms may be unilateral or bilateral. - Some people present with atypical symptoms, and may use terminology such as ‘tired’, ‘giving way’, ‘sore’ and ‘hurts’, rather than describing cramp.

Answer 23

- chronic rest pain may be worsening at night because of the decrease in blood pressure when asleep and the loss of beneficial gravitational effects on lower limb circulation - many people do not have a history of intermittent claudication (may not be apparent in people with limited mobility, or who don’t walk far enough to cause symptoms). - dependent rubor, pallor on elevation of the extremity. - skin changes including non-healing foot wounds, ischaemic ulcers and tissue loss (usually over pressure areas), and gangrene (usually of the toes). - absent foot pulses.

Answer 24

Skin observation and palpation Pulse palpation (femoral pulses, popliteal pulses, dorsalis pedis pulse, posterior tibial pulses). Plantar flexion test 6 minute walking test Ankle - brachial index Blood pressure in toe Toe - brachial index

Answer 25

Bounding or weak, fast or slow, irregular or regular, equal or unequal bilaterally. 1. Intensity graded 1 - 4. 1 = barely detectable, 2 = slightly diminished, 3 = normal pulse, 4 = bounding (stronger than normal). 2. Rhythm, to be certain that variation in rhythm is not due to minor fluctuations that occur in the respiratory cycle. 3. Rate, counting the total number of palpable beats that occur during a minimum of 15 seconds. 4. Can ascultate the heart whilst palpating to ascertain is every pulse gets transmitted as a palpable beat.

Answer 26

Pt is asked to perform 50 sequential, symptom-limited calf raises. Pts with PAD frequently report pain that does not allow them to continue after a low number of repetitions.

Answer 27

Non-invasive test for assessing a peripheral vascular disease. The ABI assesses the severity of arterial insufficiency. A - ultrasound device amplifies the sound of arterial blood flow B - systolic pressure recorded in the brachial artery of the arm C - sound of arterial blood flow located in the ankle D - systolic pressure sequentially recorded in the arteries of the ankle after each arterial flow is located.

Answer 28

An alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms that may be respiratory and/or non-respiratory. 3 drivers: physiological, psychological and biomechanical

Answer 29

Observation of posture and breathing pattern: - mouth or nose breathing - forward head position - audible breath sounds - pattern of breathing (apical, breath stacking) - abnormal inspiration-to-expiration ratio - increased minute volume (rate or volume increases) - frequent sighs, yawns or coughs? - altered speech pattern

Answer 30

Nijumen questionnaire Breath hold test Ventilators parameters BPAT

Answer 31

Education: - rationale for symptoms - reassurance - stress management - total body relaxation - rescue treatment Breathing re-education: - awareness of faulty breathing patterns - relaxation of jaw, upper chest, shoulders and accessory muscles - abdominal breathing pattern re-education - awareness of ‘normal breathing’ rates and rhythms (rest, speech, activity).