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Cardiorespiratory Physiotherapy > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What is normal blood pressure

A

between 95/60 and 145/90 mmHg

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2
Q

what is hypertension

A

Over 145/90mmHg

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3
Q

normal respiratory rate

A

12-16 breaths a minute

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4
Q

What is Tachypnoea

A

Respiratory rate higher than 20 breaths a minute

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5
Q

What is Bradypneoa

A

Respiratory rate of less than 10 breaths a minute

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6
Q

What is pectus carinatum

A

pigeon chest - sternum protrudes anteriorly

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7
Q

What is pectus excavatum

A

funnel chest- sternum is depressed inwards

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8
Q

Normal temperature

A

36.5-37.5 degrees

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9
Q

What is SpO2

A

oxygen saturation

is an estimate of arterial oxygen saturation, or SaO2, which refers to the amount of oxygenated haemoglobin in the blood. Haemoglobin is a protein that carries oxygen in the blood

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10
Q

what is FiO2

A

Fractional concentration

stands for Fraction of Inspired Oxygen; it is a fraction of the amount of oxygen a patient is inhaling produced by an oxygen device such as a nasal cannula or mask. Different devices deliver different amounts of oxygen to the patient.

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11
Q

What is Dyspnoea

A

shortness of breath

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12
Q

What to include in your checklist for patient interview

A 
Patient main problem
dyspnoea 
cough, sputum, wheezing
pain
PMHx
Function, Mobility
SHx
Specific question
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13
Q

What are the 5 main symptoms of respiratory disease

A 
Dyspnoea
Cough 
Sputum and haemoptysis 
Wheeze
Chest Pain
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14
Q

What should be enquired about in regards to symptoms

A

duration
severity
pattern
associated factors

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15
Q

What can cause dyspnoea (short of breath)

A

anaemia
neuromuscular disorders
metabolic disorders
psychological factors - anxiety

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16
Q

Important information to gain for dyspnoea

A

duration - time since onset or duration of the present symptoms, frequency
severity - relative to the recent and past events, getting better or worse
pattern - seasonal or daily
associated factors- including precipitants, agg factors, eas factors, associated symptoms, positions of ease , distance mobilised, stairs

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17
Q

Characteristics of a cough

A

a cough is a protective reflex that can be caused by inflammation, irritation, habit or excess secretions. Coughing is a difficult symptom for patients to describe due to the fact that they don’t see it’s significance

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18
Q

What to include in your cough checklist

A

frequency

  • daytime
  • nocturnal
  • after eating or drinking
  • acute/chronic

Effectiveness

  • weak/strong
  • productive/non-productive
  • pain affected

Quality

  • wet/dry
  • wheezy, raspy, bark like, tight

COMPARE CURRENT TO USUAL

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19
Q

What is haemoptysis

A

coughing up blood

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20
Q

complications associated with cough

A

fractured ribs
hernias
incontinence
embarrassing

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21
Q

What is sputum

A 
excess tracheobronchial secretions
cleared by huffing or coughing 
may contain
-mucus 
-cellular debris
-microorganisms
-blood
-foreign particles
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22
Q

Sputum checklist

A

quantity

  • small, moderate, copious
  • Tsp, tbls, 1/4 cup etc
Quality - 
consistency 
- thick think, watery plug
colour 
-haemoptysis
Odour
COMPARE CURRENT TO USUAL
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23
Q

What to include in PMHx

A 
Specific questions - 
smoking history
 (pack years)
 (if/when ceased)
Alcohol consumption
previous respiratory condition/infections
 - medication
 - precious Rx - including physio
 - hospitalisation

Incontinence
headaches
peripheral oedema

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24
Q

What special questions to ask

A

Post operatively

  • nausea
  • dizziness
  • drowsy
  • drowsy
  • vomiting
  • Pain

condition specific

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25
Q

Clubbing

A

common in chronic cystic fibrosis**

Note: clubbing disappears in CF patients after lung transplant

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26
Q

What is the Glasgow Coma Scale

A

Used for Neurological Observation

  • Eye opening
  • Best verbal response
  • Best motor response
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27
Q

Which are the 4 ‘class’ of the New York Heart Association (NYHA) classification of breathlessness

A

Class 1 (mild) - No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).

Class 2 (mild) - Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).

Class 3 (moderate) - Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.

Class 4 (severe) - Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

28
Q

What is the Borg Scale

A

RPE Scale Method
0-10 used for respiratory conditions

6-20 used for cardiac conditions - coincides with heartbeat (60-200)

29
Q

What is a wheeze

A

A whistling or musical sound produced by turbulent airflow through narrowed airways.

30
Q

What is Bradycardia

A

Heartrate

31
Q

What is Tachycardia

A

Heartrate >100 beats/min

32
Q

What is normal heart rate

A

60-­‐100 beats/min

33
Q

Chest pain in respiratory patients usually originates from

A

Musculoskeletal, pleural or tracheal inflammation

34
Q

Cause of clubbing

A

Lung disease
Cardiac Disease
Other - like familial

35
Q

What is cyanosis

A

Bluish discolouration of the skin caused by hypoxemia

- Increased haemoglobin not bound to oxygen

36
Q

How to calculate Pack Year History

A

(cigarettes per day x years smoked) / 20 = # pack years

37
Q

What is Subcutaneous emphysema

A

When gas or air is in the layer under the skin of chest wall

38
Q

What is percussion

A

an assessment technique which produces sounds by the examiner tapping on the patient’s chest wall.

Normal aerated lung gives ‘resonance’
Consolidated lung sounds ‘dull’

39
Q

What is fremitus

A

Vibratory tremors that can be felt through the chest by palpation.

40
Q

What is Auscultation

A

The process of listening to and interpreting sounds produced in the thorax

41
Q

Common causes of crackles heard through auscultation

A 
Coarse, early inspiratory
- Bronchiectasis
- Bronchitis
***Coarse = when bronchioles open
–Thought to represent the passage of a bolus of gas through a lightly closed, fluid filled airway, which opens intermitently when the upstream gas pressure rises

Fine, late inspiratory
- Pulmonary odema
- Pulmonary fibrosis
***Fine = when alveoli and respiratory bronchioles open
–Generated at the alveolar level by the sudden equalisation of gas pressure between 2 compartments – when a closed section of the airway suddenly opens

42
Q

Causes of increased breath sounds

A

-Bronchial Breathing

43
Q

Cause of decreased breath sounds

A 
–Pneumothorax/haemothorax
–Pleural effusions 
–Atelectasis 
–Hyperinflated
–Decreased air entry
–obesity
44
Q

Expiratory wheezes only

A
  • bronchospasm

- actue asthma

45
Q

Inspiratory and expiratory wheezes

A

from airway obstructions ie oedema, foreign objects, mucous, tumours.

46
Q

What to include in Ax

A

background information Medical chart
Bed chart
Subjective assessment
Physical assessment

47
Q

What’s included in the meds chart

A 
Important to ensure you have the correct paCents chart
•  This informaCon will guide assessment and treatment •  Checklist
–  PresenCng condiCon –  Past medical Hx
–  Social Hx
–  FuncConal Hx
–  InvesCgaCons
–  Medical Management
–  +/- Surgical notes or Special orders
48
Q

What is included in bed chart

A

Busy chart •
Includes:
– Observation Chart – Medication chart – Pain chart
– Fluid balance
– Neurological – GCS
– Blood glucose sliding scale – normal 4-8mmol/L – Falls risk Ax
– Nursing care plans

49
Q

what to consider with meds

A 
MedicaCons
•  Lots of different medicaCons •  Examples
–  Cardiac
–  Respiratory –  Analgesic –  AnCemeCc
•  Consider –  Timing
– Side effects
50
Q

what to explore with pain

A 
Checklist
–  At rest, with movement/cough –  Area
–  Type
•  Sharp, dull, blunt –  Severity
•  VAS –  History
51
Q

PMHx

A 
Specific Questions – ask were relevant
•  Smoking History
–  Pack years
–  If/when ceased
•  Alcohol consumption
•  Previous respiratory conditions/infections
–  If any
–  MedicaCon
–  Previous Rx – including physio –  Hospitalisation previously
•  Incontinence
•  Headaches
•  Peripheral oedema
52
Q

pack year Hx

A

1 pack = 20 cigarettes
• Number of pack years = packs per day x years
• 1 pack smoked per day for 40 years = 40 pack yrs
• Or
• (cigarettes per day x yrs) / 20
• (15cigsx40yrs)/20=30packyears

53
Q

functional ability

A

Important • Checklist
– ADL’s
– Employment/Hobbies – Exercise Tolerance
• Regular exercise
• Distance mobilised – Flat, incline, stairs
• Use of aides
– Inside home
– Community ambulaCon • Use of supplemental O2
– DuraCon of use – Mode of delivery

54
Q

Special questions

A

• Post operaCvely – Nausea
– Dizziness – Drowsy – VomiCng – Pain
• CondiCon specific

55
Q

Subjective Ax should include

A 
patient's main problems 
dyspnoea 
Cough, sputum, wheeze 
pain 
PMHx
function, mobility
SHx
Specific Questions
56
Q

Objective

A

observation
auscultation
palpation
cough and sputum

57
Q

what to include in observation - environment

A 
environment 
-–  Attachments
•  Oxygen – mode of delivery and concentration
•  IV lines and medications
•  Analgesia (PCA, epidural)
•  Indwelling catheter (IDC)
•  Nasogastric tube (NG tube)
•  Intercostal Catheter (ICC)
•  Wound drains
58
Q

Oxygen

A
  • Nasal prongs
  • Hudson mask
  • Non-rebreather mask
  • Venturi mask
  • High flow humidified oxygen • Endotracheal tube (ETT)
  • Tracheostomy
59
Q

Observation on the patient

A 
–  Posture – in bed/siTng
–  Facial expression – fa/gue, pain etc –  Speech paEern (SOB)
–  Level of consciousness (GCS)
–  Body Shape
–  Muscle tone
–  Colour – cyanosed, flushed, pallor –  Peripheral – clubbing, oedema
–  Jugular venous pressure (JVP)
–  Respiratory Rate (RR)
–  Pursed lip breathing
60
Q

Observations - chest

A

– Shape

– Breathing pattern – Chest movement – Accessory muscle use – Paradoxical movements

61
Q

What to include on palpation

A 
•  Hand placement
– Bilaterally at ribs 7-10
– Antero-posterior at sternum and thoracic spine
•  Palpa/ng for:
– Movement (quality, quan/ty, symmetry)
•  Bibasal expansion
•  Apical
–  Temperature
–  Fremitus
– Subcutaneous emphysema
62
Q

Auscultation

A
  • Process of listening to and interpreting the sounds produced within the thorax
  • Use to verify observed and palpated findings before and after treatment.
  • “Breathe in and out through your mouth, slightly deeper than usual”
  • Position – high sittng
  • Stethoscope to skin contact
63
Q

decreased breath sounds could be the result of

A 
–  Pneumothorax/ haemothorax
–  Pleural effusions
–  Atelectasis
–  Hyperinflated
–  Decreased air entry –  obesity
64
Q

added sounds include

A
  • Wheezes
  • Crackles (fine or coarse) • Stridor
  • Rubs
  • Transmitted sounds
  • Surgical emphysema
65
Q

Wheezes

A
  • Generated by the vibration of the walls of a narrowed airway.
  • Pitch is determined by the diameter and elasticity of the airway
  • Expiratory wheezes – bronchospasm
  • Inspiration and expiration wheezes – from airway obstructions ie oedema, foreign objects, mucous, tumours.
66
Q

Crackles

A

• Discon/nuous, short, explosive sounds • Fine
– Generated at the alveolar level by the sudden equalisa/on of gas pressure between 2 compartments – when a closed sec/on of the airway suddenly opens
• Coarse
– Thought to represent the passage of a bolus of gas
through a lightly closed, fluid filled airway, which opens intermittently when the upstream gas pressure rises

67
Q

cough and sputum

A 
•  Strength
– Weak, fair, strong
•  Wet / Dry
•  Effective / non-effective
•  Productive / non-productive
–  Sputum expectorated (table 1.1 Pryor and Prasad page 4) 
•  Quality
•  Quantity

Cardiorespiratory Physiotherapy (7 decks)

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