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PTY EXAM > PTY2031 > Flashcards

PTY2031 Flashcards

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1
Q

What is Stridor?

A

Abnormal, high pitched musical sound with breathing
Due to obstruction in trachea or larynx

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2
Q

Most common cause of wheeze

A

bronchospasm secondary to asthma

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3
Q

In subjective Cardio Ax, why would asking about gastro-oesophageal reflux be relevant?

A

aggravated by some airway clearance techniques (cystic fibrosis, COPD, bronchiectasis)

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4
Q

Indications for Abdominal surgery (6)

A
  • Cancer
  • Inflammatory Bowel Disease (Chron’s, Ulcerative colitis)
  • Trauma
  • Bowel obstruction (carcinoma, diverticular, volvulus)
  • Biliary Obtruction/Jaundice
  • Vascular tears/Bleeding
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5
Q

5 common types of abdominal surgery

A

Colorectal resection
Liver resection (Hepatectoy)
Whipples (pancreaticodiodenectomy)
Gastrectomy
Cholecystectomy

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6
Q

Post-operative complications (5)

A

Atelectasis/pneumonia/PPC
Pain
Wound infection
Nausea/Vom
Anaemi/Blood loss

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7
Q

Example of peripheral line and function

A

Intravenous drip
Injected in vein to prevent dehydration

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8
Q

Purpose of Nasogastric tube?

A

A tube that is inserted through the nose, down the throat and esophagus, and into the stomach
carries food and medicine to the stomach

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9
Q

Central venous catheter function (CVC)

A

ube that doctors place in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly.

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10
Q

Tube that drains the air or fluid from the pleural space

A

Intercostal catheter

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11
Q

What restriction is common post abdominal surgery?

A

nil by mouth

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12
Q

Device that allows air or fluid to be removed from the pleural cavity, while also preventing backflow of air or fluid into the pleural space

A

Underwater seal drain

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13
Q

PT contraindications/precautions post oesophageal surgery

A

Treat with head up ~30° (2 pillows)
No CPAP/BiPAP – unless NGT and no air leak
Avoid suctioning the lungs
Avoid manual techniques
Avoid neck extension

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14
Q

Considerations for Oesophageal surgery?

A

Often malnourished, marked weight loss, dysphagia
-Associated with poor survival - usually palliative

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15
Q

Indication for oesophageal surgery?

A

Cancer

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16
Q

Indications for vascular surgery

A

-aneurysm
-Trauma
-Embolism
- Peripheral vascular disease
-Chronic limb ischaemia

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17
Q

Post-op vascular surgery complications

A

Haemorrhage
Reduced blood supply
Gangrene
 Hypotension
 Cardiac dysfunction
 Renal impairment
 Wound infection

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18
Q

Post-op management for vascular surgery?

A

Short period immobilisation
Reduced WBing (limb surgery

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19
Q

Post-op complications of transplant operations?

A

Rejection
 Immunosuppression
 Infection
 Haemorrhage
 Non-function of transplanted organ  Osteoporosis
 PPC / pneumonia
 Reduced exercise tolerance

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20
Q

PT treatment post UAS?

A

Early mobilisations/positioning
Re-enforcement of pre-op regimine/edu
Respiratory techniques (TEE, DB & C, SMI, ACBT, PEP)
O2 therapy, humidificaiton, nebulisation
NIV-CPAP

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21
Q

According to evidence, is there beneficial effect of adding DBEs to early mobilisation to reduce PPCs?

A

NO. Early mobilisation can reduce PPC if pts exerted at moderate level of exertion.

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22
Q

What surgery is there no current PT research for incidence of ppc?

A

LAPAROSCOPIC SURGERY

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23
Q

What are common types of transplants?

A

Kidney
Liver
Heart
Lung
Pancreas

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24
Q

Post-op complication of laryngectomy?

A

Atelectasis / pneumonia / PPC
 Wound infection
 Haematoma
 Airway obstruction
 Aspiration / swallowing difficulties  Cosmetic deformity

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25
Post-op management of laryngectomy?
-Humidification -No pressure over wounds / grafts - Head up 30° - Dietitian (Restricted oral intake)( Alternative feeding options: NGT, PEG) - Speech Therapy (Communication, Swallowing)
26
What are low lung volumes?
Reduced functional residual capacity and alveolar ventilation
27
What is FRC and why is it important?
volume remaining in the lungs after normal, passive exhalation (~3L) - keeps the small airways open, prevents complete emptying of the lungs
28
Conditions assoc. w/ low lung volumes? (6)
Post-surgery (thoracic, cardiac, abdominal) Rib/Sternal #s Chest wall abnormalities Supine position (bed rest) Pleural effusion Lung fibrosis
29
Aims of breathing exercises/strategies?
Increase lung volume, redistribute ventilation, improve gas exchange -Increase thoracic wall mobility - aid secretion clearance - increase strength, endurance and efficiency of breathing
30
Main types of breathing exercises to increase lung volumes (3)
Bilat./Unilat. basal expansion (thoracic expansion) Sustained maximal inspiration (SMI) Incentive spirometry
31
What is the rationale for breathing exercises?
Distention of lungs (increase transpulmonary pressure) to inflate alveoli Increase lung volumes therefore increase sputum movement
32
2 positions for breathing exercises?
Sidelying or sitting upright
33
Sustained maximal inspiration How does it work?
3 s breath hold at maximal inspiration (TLC) -Redistribution of gas into areas of low lung compliance using collateral ventilation pathways and lung interdependance to re-expand collapsed alveoli
34
What does the evidence say about incentive spirometry for PPC?
Evidence does not support the use of IS for reducing incidence
35
What and when is IS used?
incentive device to perform deep breathing exercise mostly used in paediatrics post surgery
36
What is CPAP?
Continuous Positive Airways Pressure
37
What does CPAP involve?
positive pressure to the airways throughout inspiration and expiration during spontaneous breathing can be delivered cont. or intermittently.
38
Clinical effects of CPAP
splinting of airways (prevents closure) -FRC (collateral ventilation) - increased lung compliance - reduced V/Q mismatch and WOB - increased tidal volume for same amount of effort
39
What is vital capacity?
total amount of air exhaled after maximal inhalation
40
tidal volume
the amount of air you move through your lungs each time you inhale and exhale while you're at res
41
Indications for CPAP
Low lung volumes Obstructive sleep apnoea Acute pulmonary oedema Hypoxaemic respiratory failure (Type 1 respiratory failure)
41
Indications for CPAP in PT
Second line intervention, used when conventional treatment has failed Management of moderate-severe hypoxaemia (resulting from low lung volumes or excessive sputum)
42
Hypoxaemia (Type 1 respiratory failure) is seen where?
Seen postoperatively (UAS, cardiac surgery) Chest wall deformity (# ribs), obesity
43
Evidence for chest PT in cardiac surgery?
No strong evidence for routine postoperative chest physiotherapy to reduce the incidence of PPC
44
What factors affect FRC?
-Body size (decreased w/ obesity, inc. w/ height) - Gender (F>M) - Posture (dec. supine) - Diaphragmatic muscle tone - Lung disease
45
The volume of the lung at which small airways in the dependent region begin to close is called?
Closing capacity
46
How does GA affect FRC?
- reduces due to reduced abdominal muscle tone diaphragmatic dysfunction reduced lung/chest wall compliance reduced phrenic nerve activity
47
What percentage does FRC remain reduced by at 24hrs post surgery?
30%
48
Effects of Anaesthesia + supine pos. on FRC and how it results in atelectasis
reduced FRC - FRC < CC - Small airway closure in dependent regions -> reduced ventilation -> V/Q mismatch -> hypoxaemia + atelectasis
49
How GA affects sputum
Mucociliary clearance ceases 90mins after anaesthesia - Increases musus viscosity - Decreased velocity of mucus clearance
50
How GA and surgery affect cough?
Cough reflex dampened (sedation/opiated + surgical wound) -strength of cough reduced (low lung vol. reduced ability to generate intra abdominal pressure)
51
Post-op, where is atelectasis most common in lung?
Areas closest to diaphragm
52
Post operative pulmonary complications - effect on LOS and hosp. resources
increased LOS and resources used
53
Where are PPC most common in?
Upper abdominal surgery
54
Clinical signs of PPC?
Reduced SpO2 < 90% RA CXR changes (atelectasis/consolidation)  Fever (> 38C)  Altered sputum quantity or quality  Sputum microbiology changes  Raised white cell count (WCC) or administration of antibiotics  Medical diagnosis of pneumonia  Readmission to ICU/HDU with respiratory issues
55
Pre-operative Risk factors for PPC
Co-morbidities (respiratory and cardiac) ASA status (class 3-5) Obesity Age Smoking (current) Pre-Morbid Physical Function Immune Status Emergency vs Elective Surgery
56
Perioperative risk factors for PPC
Type of Surgery Length of anaesthesia Pain Immobility Surgical complications Lack of education about preventative measures ICU admission
57
Role of PT in surgery
Reversal of adverse pulmonary changes produced by anaesthesia and surgery Prevent post-op complications
58
Pre-op PT may include...
Edu (mob, self-direct DB)
59
Ratio of inspiration to Expiration
1:2
60
Outcome measures for Dyspnoea
Modified Borg scale/RPE VAS MRC (Medical research Council) Dyspnoea scale
61
QoL measures for Dyspnoea
Chronic Respiratory Disease Questionnaire (CRDQ) St. Georges questionnaire AQOL (Australian)
62
Moderate score on Mod. Borg
3/4
63
3 step management for Dyspnoea
1. Pharmalogical (bronchodilaters) 2. Positioning (fwd lean, high sidelying) 3. PLB /RCB
64
What MDT member would be helpful for energy conservation advice for patients with dyspnoea?
OT
65
Rationale for forward lean 2
- decreases accesory muscle use - optimal length-tension of diaphram
66
Gait aids to support fwd lean?
4WD, Gutter fram, 2WF
67
PLB rationale
- expiratory time to prevent airway collapse
68
Reassess if treatment has work for dyspnoea?
RR SpO2, Borg, RPE, symptom reporting, exercise capacity
69
Indications for airway clearance
excessive sputum production sputum retention (impaired cough)
70
Aim of ACTs?
mobility and clear excess bronchial secretions
71
Types of ACT (8)
ACBT Positive Expiratory Pressure Therapy (PEP) Oscillating PEP Exercise Autogenic Drainage Postural/Gravity assisted drainage Manual:percussion/vibration Inhalation therapy
72
How to do ACBT?
1. Relaxed breathing (normal breathing) 2. Thoracic expansion (DB + SMI, 4-6 breaths) 3. Forced Expiration technique (1 or 2 huffs)
73
Rationale of TEE in ACBT?
Increases lung volume, air flows via collateral channels -air behind secretions assist in mobilising them
74
Rationale for FET?
squeezing effect of EPP to push mucus centrally
75
PEP rationale
Increasing gas pressure behind mucus through collateral ventilation (pushes mucus out of the lungs and opens up regions that would otherwise be closed off) – Stabilises airways by splinting them open during expiration
76
How to do PEP therapy?
mask/Hi-PEP/mouthpiece, 6-10 breath followed by FET
77
Oscillating PEP action
Oscillating positive pressure – Vibration of the airway wall – Loosens mucus from airway wall – Decreases the viscosity of sputum
78
PEP for children
Bubble/bottle PEP (hydraPEP, TheraBubble)
79
Inhalation therapy?
Long term inhalation of hypertonic saline (7%)
80
Normal Blood Ph range
7.35-7.45
81
Normal PaCO2 (partial pressure of CO2 in arterial blood)
35-45mmHg
82
Normal PaO2
80-100 mmHg
83
normal HCO3 (Plasma conc. of bicarbonate)
22-26mmHg
84
Be/Bd range
-2-2+
85
order of ABG recording?
blood pH/PaCO2/PaO2/HCO3/BEorBD
86
Causes of acidosis pH <7.35? Resp and Metabolic?
Resp: HYPOventilation- COPD, Airway obstruction, weakness of resp. muscles Meta: diabetic ketoacidocis, renal failure, lactic acidosis (shock)
87
Causes of Alkalosis pH >7.45?
Resp: HYPER ventilation- anxiety, asthma, pneumothorax Meta: vomiting, diuretic therapy
88
Indications for O2 therapy
V/Q mismatching and/or shunt Decreased alveolar ventilation ◦ Diffusion interference ◦ Low FiO2
89
Limit of flow for nasal prongs
0.25 to 4L/min
90
Min flow on Huson mask?
6L/min- 15
91
Alternative for NP?
High flow nasal prongs- 2-60L/min
92
SpO2 for COPD
88-92%
93
Which type of spina bifida may a tuft of hair overlie non fusion?
spina bifida occulta
94
What type of paralysis is more common in SB, flaccid or spastic
Flaccid
95
How many SB pts also have learning disabilities?
80%
96
How many SB pts also have learning disabilities?
80%
97
Talipes equinovarus is does to lesion at
L4/L5
98
Around what day as an embryo does meningomyelocele (SB) occur?
B 21 days

PTY EXAM (6 decks)

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