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PY1103 - Intro to Cardiorespiratory Physiotherapy > Week 6 (parts 1,2 and 3) > Flashcards

Week 6 (parts 1,2 and 3) Flashcards

(59 cards)

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1
Q

Part 1

A

ABGs

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2
Q

what is an ABG (arterial blood gas)

A

‘…An Arterial Blood Gas (ABG) is a blood test that measures the acidity, or pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery. The test is used to check the function of the patient’s lungs and how well they are able to move oxygen and remove carbon dioxide….’ Nurse.org

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3
Q

what do ABGs measure

A

 pH
 PaO₂ (partial pressure of oxygen in the arterial blood)
 PaCO₂ (partial pressure of carbon dioxide in the arterial blood)
 HCO₃- (bicarbonate – a base/alkali)
 Base excess (measurement of bases/alkali)

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4
Q

what is partial pressure

A

 Air is a mixture of gases; in the body the “concentration” of each gas is described using the term partial pressure
 Partial pressures are measured in kilopascals (kPa) or millimetres of mercury (mmHg) (0.133kPa = 1mmHg)

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5
Q

what does PO2/ PCO2 stand for

A

partial pressure of oxygen / carbon dioxide in the air

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6
Q

what does PaO2 stand for

A

partial pressure of oxygen dissolved in plasma of arterial blood

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7
Q

what does PvCO2 stand for

A

partial pressure of carbon dioxide dissolved in plasma of venous blood

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8
Q

what is the partial pressure of respiratory gases (in atmosphere)

A

 PO2 = 21.1kPa (159mmHg)
 PCO2 = 0.04kPa (0.3mmHg)
 However, in alveolar air:
 PO2 = 13.8kPa (104mmHg)
 PCO2 = 5.3kPa (40mmHg) (high&raquo_space; low pressure)

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9
Q

what are the normal ABG values

A

pH 7.35-7.45
PaO₂ 10.7 – 13.3 kPa
PaCO₂ 4.7 – 6.0 kPa
HCO₃- 22-26 mmol/l
Base excess -2 to +2

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10
Q

what is Hypoxia

A

Hypoxia occurs when oxygen is insufficient at the tissue level to maintain adequate homeostasis

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11
Q

what is Hypoxaemia

A

Low oxygen in arterial blood/abnormally low concentration of O2 in the blood where PaO2 is less than 80mm Hg or 10.6 kPa

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12
Q

what is Hypercapnia

A

condition characterised by increased CO2 concentration in the blood/ increase in partial pressure of carbon dioxide (PaCO2) above 45 mm Hg or 6.0 kPa

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13
Q

what is Cyanosis

A

Abnormal blue (blue-ish-purple) discolouration of the skin, nail beds and mucous membranes caused by a shortage of oxygenation of the blood

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14
Q

who needs an ABG

A

 All critically ill patients
 Stable patient who suddenly drops their oxygen saturations
 Stable patient who requires an increase on FiO2 to maintain oxygenation and keep within their target range

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15
Q

what are the 2 ways you can interpret ABGs

A
  • Acid – base balance
  • Respiratory failure
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16
Q

ways to interpret ABGs (acid balance or respiratory Failure)

A

 Respiratory acidosis = increase in PaCO₂
 Respiratory alkalosis = decrease in PaCO₂
 Metabolic acidosis = decrease in HCO₃- or BE
 Metabolic alkalosis = increase in HCO₃- or BE
Remember PaO₂ does not affect pH
Respiratory Failure:
‘failure of the respiratory system to provide adequate gas exchange for metabolic requirements’

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17
Q

how does RF clinically manifest

A

 Marked dyspnoea, tachypnoea
 Purse lip breathing
 Use of accessory muscles at rest
 Acute confusion
 Cyanosis & peripheral oedema
 Inability to speak
 Unwillingness to lie flat (orthopnoea)
 Agitation, restlessness,
 ↓ consciousness
 Asynchronous breathing pattern
 Tachycardia
 Sweating

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18
Q

how would you medically assess RF

A
  • Arterial blood gases (ABGs) for diagnosis of respiratory failure
  • Chest X-ray
  • Physical examination
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19
Q

what is Type 1 and Type 2 RF

A

 Type I Respiratory Failure (hypoxaemic) – failure of oxygenation
 Type I = failure of oxygenation – usually acute
 PaO2 <8kPa but PaCO2 is normal
 Type I respiratory failure is the result of only one problem … low PaO2

 Type II Respiratory Failure (hypercapnic) – failure of ventilation
 Type II = failure of ventilation – may be acute, chronic or acute on chronic
 PaO2 <8kPa and PaCO2 >6.0kPa
 Type II respiratory failure is the result of two problems … low PaO2 and high PaCO2

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20
Q

how can respiratory failure be classified

A

 Respiratory failure may be
 Acute
 Chronic
 Acute on chronic
 E.g acute exacerbation of advance COPD

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21
Q

how can RF progress

A

 Uncorrected Type I RF will develop into Type II RF.
 This can occur acutely with infection or injury or over an extended period of time such as with COPD

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22
Q

what are the COPD problems that can lead to RF

A

 Lung hyperinflation and/or fatigue
 Shallow ineffective breathing
 Reduced ventilation
 Incomplete lung emptying
 Increased VQ mismatch
 Decreased responsiveness to hypoxia
 Increased dead space

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23
Q

how are the mechanical properties of the lungs affected

A

By the disease process, resulting in:
 loss of elasticity
 hyperinflation
 increased sputum production
 loss of alveolar gas exchange surface
This causes:
 VQ mismatch
 inability to overcome increased work of breathing
 failure to compensate for increased dead space

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24
Q

what is dead space

Study These Flashcards
A

‘the volume of ventilated air that does not participate in gas exchange’
Volume of air located in the respiratory tract segments that are responsible for conducting air to the alveoli and respiratory bronchioles but do not take part in the process of gas exchange itself.

25
what to do when interpreting ABGs
 First check the pH. Is it normal, acidosis or alkalosis?  Look at the PaCO2. Is it within range, too high or too low?  If it is abnormal check to see if this has caused the change in pH. If so, then this is likely to be a respiratory acidosis/alkalosis.  If it hasn’t caused the pH to change, it could be a metabolic disturbance compensated for by the respiratory system or a respiratory disturbance compensated for by the metabolic system.  Now look at the HCO3. Is it within range, too high or too low?  Is the change in keeping with the pH? If it is, then it is likely to be an uncompensated metabolic acidosis/alkalosis.  Nb: changes in bicarbonate ions (HCO3) take at least a couple of days to occur after the initial cause /event  Check PaO2 and PaCO2. Is this Type 1 or Type 2 Respiratory Failure?  Check Base Excess and pH – has compensation occurred? Is this a partial compensation (ie: pH is not within normal range) or fully compensated (ie: pH is within normal range)?
26
Part 2
Identifying the deteriorating patient
27
what is the normal respiratory rate
Respiratory Rate: 12-16bpm (often omitted)
28
how could you increase the respiratory rate
* Chronic respiratory conditions * Acute respiratory conditions * Cardiac causes * Anxiety * Pain * Sepsis * Increased temp * Compensation
29
what could decrease the respiratory rate
* Sedatives/narcotics * Altered consciousness * Extreme fatigue * Metabolic/neurological disorders Often omitted on obs charts/inaccurately recorded- it is an early and extremely good indicator of deterioration, not just from a respiratory point of view
30
what is the normal Spo2%
97-99%
31
how could you increase the Spo2%
Excessive O2
32
how could you decrease Spo2%
* Chronic respiratory disease * Acute respiratory disease * Cardiac/circulatory issues * Neuromuscular disease * Respiratory depression
33
what is considered as a normal Heart rate
60-100bpm
34
how could you increase Heart rate
* Hypoxaemia * Hypotension * Anxiety * Sepsis * Pain * Fever * Medication
35
how could you decrease Heart rate
* Arrythmias * Cardiac disease * Hypothermia * Medication * Vagal stimulation
36
what is the normal range for Blood pressure
120/80 mmhg
37
how can you increase BP
* Renal/endocrine disease * Anxiety * Pain * Head injury * Medication * Medication withdrawal/omission * Atherosclerosis
38
how could you decrease BP
* Arrythmias * Medication * Cardiac disease * Blood loss * Dehydration * Sepsis
39
what is a normal body temperature
36.7C
40
how can you increase body temperature
* Medication * Exposure/exertion * Infection * Malignancy * Inflammatory Disease
41
how could you decrease body temperature
* Exposure * Metabolic issues * Burns * Medication * Sepsis * Neurological disease/impairment * Malnutrition * Trauma * Shock
42
what are the AVCPU/GCS - level of consciousness
Alert Confusion Voice Pain Unresponsive
43
who are high risk patients
* Poor previous functional status * Smoking/alcohol history * Co-morbidities (and multi co-morbidities) e.g * Chronic lung disease * Chronic heart disease * Renal disease * Liver disease * Obesity * Metabolic disorders * Malignancy * Neurological disease
44
what are other causes for concern in terms of deterioration
* Fluid balance changes * Abnormal/ worsening bloods * Abnormal/ worsening ABGs * Retained secretions and weak cough/ inability to DBE * Uncontrolled post op pain * Increasing medications/support to maintain obs
45
what teatments should you consider deterioration and high risk patients early for
* Prioritisation * Involvement of other MDT members * Escalation
46
how may early intervention impact a patients life
* Length of stay * Quality of life * Need for high care * Mortality * Functional status on D/C
47
Part 3
Breathlessness
48
what is breathlessness
NICE defines breathlessness as “a highly subjective, uncomfortable or distressing sensation that occurs when actual ventilation is perceived not to satisfy demand”   Also known as dyspnoea (pronounced diss-nee-a) Can be: acute – develops suddenly/within minutes subacute – develops over hours/days chronic – develops over weeks/months
49
what does breathlessness feel like
Feeling unable to breath Cannot get your words out Chest feeling tight/heavy Can’t get enough air in Feel anxious Feel scared
50
what causes acute breathlessness
Acute asthma/COPD/bronchiectasis exacerbation Pleural effusion Pneumothorax Pulmonary embolism Foreign body in the upper airway (e.g. penny, lego block) – known as stridor Pneumonia Acute deterioration of cardiac failure Hyperventilation Neuromuscular disease, e.g. Guillan-Barré syndrome Sudden onset cardiac arrhythmia Cardiac tamponade
51
what causes chronic breathless ness
Chronic respiratory disease, e.g. cystic fibrosis, COPD Anxiety Congenital heart disease Cardiac arrhythmia Ischaemic heart disease Anaemia Chest wall deformity Obesity Diaphragmatic splinting, e.g. in pregnancy, ascites Hypoventilation, e.g. motor neurone disease
52
how can you help patients who are breathless
Many different techniques we can use Will depend on a)cause of breathlessness and b)what works for the patient – everyone is different Try to be calm around the patient, e.g. don’t speak quickly or loudly, don’t rush around. If you are calm it will help your patient to be calmer
53
what is the length-tension relationship of diaphragm
In general as muscles shorten they produce more tension up to a certain level. Beyond this level there is no benefit to increasing the tension In some respiratory conditions e.g. COPD, the diaphragm is flattened because the lungs are hyperinflated. This affects the length/tension relationship so the diaphragm cannot work as effectively Forward-lean sitting etc. will help to dome the diaphragm
54
what is rectangular breathing
Aim is to increase time spent exhaling When breathless you tend to speed up your breathing in a panic to get more air in This can lead to gas trapping as the exhalation breath is not long enough to allow air out Remember that inspiration is “active” (i.e. we contract muscles) but exhalation is “passive” (i.e. it happens as we relax are respiratory muscles). So exhalation will take longer Trace a rectangle as you breathe in and out (e.g. a window) and try to gradually slow the speed of your breathing Breathe out for twice as long as you breath in (rectangular shape)
55
what is the 54321 anxiety management technique
Notice 5 things you can see Notice 4 things you can feel/touch Notice 3 things you can hear Notice 2 things you can smell Notice 1 thing you can taste
56
what is pacing
Aim to avoid “boom” and “bust”, i.e. doing as much as you can when you feel good and then running out of energy/breath and crashing Take things slower – tortoise not hare Break bigger tasks into smaller tasks and take regular breaks Remember that some days are better than others and that’s ok Don’t get other people to do everything for them – this will lead to deconditioning and  breathlessness
57
how can using a hand-held fan help breathlessness
Handheld fan – thought to stimulate the trigeminal nerve which is responsible for facial sensations. Sends message to the brain and reduces the perception of breathlessness
58
how can pursed lip breathing help to manage breathlessness
Pursed lip breathing – creates some back pressure (PEEP) which splints open airways and allows greater airflow on exhalation, reducing gas trapping and hyperinflation
59
what is fan therapy
A cool draft of air from a handheld fan may help reduce the sensation of dyspnoea Can be combines with positioning and breathing techniques (breathing control or pursed lip breathing) Hold the fan approx. 15cm away from face Aim the draft of air towards the central part of face Benefit may be felt after a few minutes

PY1103 - Intro to Cardiorespiratory Physiotherapy (11 decks)

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