Week 9 (parts 1, 2 and 3) Flashcards

Question

what is Hypoxic drive

Answer 1

CO2 is one of the gases that can cross the blood-brain barrier In the cerebrospinal fluid it combines with H2O producing carbonic acid and H⁺ ions H⁺ ions = change to pH So change to arterial CO2 level = change to pH in cerebrospinal fluid Change to pH in cerebrospinal fluid = reaction in the central chemoreceptors near the medulla These receptors are responsible for regulating respiratory function ↑arterial CO2 =↓cerebrospinal pH = ↑ in depth of breathing and RR (and vice versa) However … Some COPD patients have chronically high CO2 levels. For this group, the central chemoreceptors become less sensitive to the changes in CO2 level The stimulus for ventilation is then managed by peripheral chemoreceptors in the carotid bodies and aortic arch – these are stimulated by low O2 levels and then transmit messages to the respiratory centre in the medulla ↓ O2 = ↑ in depth of breathing and RR (and vice versa) ↑ O2 = ?????????? Therefore care must be taken when prescribing oxygen to COPD patients

Answer 2

CPAP (continuous positive airway pressure) CPAP supplies constant fixed positive pressure throughout inspiration and expiration. It, therefore, is not a form of ventilation, but splints the airways open. If delivered with oxygen, it can allow a higher degree of inspired oxygen than other oxygen masks. Helps increase FRC Indications: Hypoxia, Type I RF Pneumonia/acute infection (prior to escalation to ventilator) Pulmonary oedema Obstructive sleep apnoea

Answer 3

BiPAP (Bi-level Positive Airway Pressure). Also known as NIV (Non-invasive ventilation) The key feature of BiPAP is its ability to deliver air at two different pressures: a higher-pressure during inhalation (IPAP) and a lower pressure during exhalation (EPAP) Allows for more complex settings such as setting different pressures, volume support and tidal volumes The machine then automatically selects the lowest IPAP to achieve the target tidal volume Helps reduce risk of barotrauma Good option prior to getting the patient on a ventilator Indications: Type II RF Chronic COPD COPD exacerbations Weaning from ventilator

Answer 4

Recent facial or oesophageal Sx Nausea Vomiting Bullous emphysema

Answer 5

Haemoptysis Inability to protect airway Facial trauma Burns Active untreated TB CVS/haemodynamic instability Undrained pneumothorax Transesophageal fistula

Answer 6

outcome measure in respiratory physiotherapy

Answer 7

There are a large number of outcome measures that can be used within respiratory. The use of outcome measures should be guided by what it is that you specifically want to assess, whether you are looking to measure short term/long term change (e.g. to demonstrate the effectiveness of a chest treatment session, or to evaluate the effect of pulmonary rehabilitation), the particular disease/illness that your patient may have, the availability of equipment, and the validity/reliability of the tool. This presentation looks at a variety of outcome measure used in CVR, but is not exhaustive! The reference list at the end contains many useful papers comparing outcome measures, and look at validity and reliability of many of these outcome measures.

Answer 8

Repeating our respiratory assessment, or components of it, can evaluate the success/effect of treatment, including: Respiratory rate Work of breathing/breathing pattern SpO2% ABGs Oxygen requirements Volume of sputum expectorated Auscultation/palpation/thoracic expansion CXR

Answer 9

Lung function testing (see separate presentation) can measure a range of values e.g. FEV, FVC, VC. It can be used to investigate disease and function, measure disease progression, and response to treatment.

Answer 10

This is a scale rating perceived exertion (RPE) It is often used an outcome measure in pulmonary rehab, to monitor progress during an exercise regime and to help guide patient to exercise at a suitable level of intensity. The original Borg scale measures on a scale of 6-20, the modified Borg scale measures on a scale of 1-10.

Answer 11

The Medical Research Council dyspnea scale (MRC) measures levels of breathlessness during activity. It can be used to identify the impact of breathlessness on functional level, and to compare pre/post treatment course e.g. pulmonary rehab. It is important to know whether the original scale or the modified scale (MMRC) has been used, as the original scale (MRC) is 1-5, and the MMRC is 0-4, and therefore the numbers do not correlate to the same level of breathlessness across the scales.

Answer 12

The six minute walk test (6MWT) is an outcome measure of exercise tolerance that is useful in chronic respiratory disease. It measures the distance walked on a hard flat surface in 6 minutes, back and forth between two points. It is self-paced, and patients can stop and rest if needed. SpO2% can also be measured during this test to identify/monitor any desaturation on exertion. The BORG can also be used pre/post/during certain points in the assessment as an additional outcome measure. It is also measured twice, to account for learning effect.

Answer 13

The incremental shuttle walk test (ISWT) involves the patient walking around cones that are 9 metres apart in time to a set of auditory beeps played on a CD. The walking speed gets increasingly faster at each level. The test continues either when the patient feels they need to stop or if they can no longer keep up with the beeps. The number of shuttles (e.g. each time the patient walks a length to a cone) is measured.

Answer 14

The endurance shuttle walk test (ESWT) involves walking between two cones as per ISWT. The intensity is related to a percentage of each patient's maximum field exercise performance assessed by the ISWT. Patient are to walk at the set pace for as long as possible (max. 20 minutes). Walk distance and walk time are measured. There is also a modified shuttle walk test (MSWT) with 3 further levels than the standard ISWT (usually for younger/fitter patients) Resting/post exercise Sp02% and pre/post walk Borg scores can be recorded for all the above.

Answer 15

Cardiopulmonary exercise testing (CPET) GOLD standard test to measure exercise capacity across all age groups Also used to predict outcomes, QoL and mortality risk in cardiovascular disease especially CAD, HF and chronic CVR conditions Maximal exercise test so provides the most accurate insight into the patient’s exercise tolerance, capacity and risk CPET involves measurements of respiratory oxygen uptake (Vo2), carbon dioxide production (Vco2), cardiac rhythm (ECG) and ventilatory measures during a symptom‐limited exercise test Helps clearly differentiate between cardiac vs pulmonary limitations Test conducted using either cycle ergometry or treadmill Cycle ergometry is preferred in patients Treadmill more commonly used for athletes or normal healthy individuals

Answer 16

The CRQ is a self reported questionnaire that looks at the patient's health status and health related quality of life (HRQoL) It made up of 20 questions, split across four dimensions relating to dyspnoea, emotional function, fatigue, and mastery. Scores are recorded from 1-7. Patients identify everyday activities that make them breathless and then select, rank and score the 5 most important activities to them on the 1-7 scales. Each patient will therefore have a list of activities unique to them The lower the score in each dimension, the greater the impact on their function.

Answer 17

This questionnaire is designed for patients with an obstructive respiratory disease, and measures health related quality of life, impact of the disease and perceived health status. There are 50 questions , with questions looking at symptoms, activity and impacts. Scores range from 0-100, higher scores indicate more limitations.

Answer 18

The LCQ is a a self-completed HRQoL measure of chronic cough. It has 19 questions across 3 dimensions (physical, social and psychological) and it assesses the impact of symptoms in the last 2 weeks. The lower the score, the greater the limitation due to cough.

Answer 19

The COPD Assessment Tool (CAT) is a questionnaire that measures the impact of COPD symptoms on HRQoL and health status/function. It is an 8 point questionnaire, with a scale of 1-5 for each answer depending on the effect/severity of symptoms. The higher the score, the greater the impact of COPD symptoms on the patient's daily life.

Answer 20

International Physical Activity Questionnaire The IPAQ is a standardized questionnaire that estimates how much physical activity people do It is a self reported measure of physical activity, measuring sedentary time, time spent standing, time spent in low, moderate and high intensity physical activity Suitable for individuals aged 18-69.

Answer 21

Acute Lung Disease

Answer 22

- Umbrella term for infection of the lung parenchyma - Caused by several different organisms - Pneumonia is a type of chest infection which has infiltrated the alveoli. Most chest infections are viral whereas most cases of pneumonia are bacterial

Answer 23

CAP = community acquired pneumonia a pneumonia that is acquired outside a hospital setting HAP = hospital acquired pneumonia a pneumonia that is acquired > 48hrs after being admitted to hospital VAP = ventilator acquired pneumonia a pneumonia that is acquired > 48 hours after intubation

Answer 24

Bacterial – e.g. pneumococcus, haemophilus influenzae, streptococcus pneumoniae Viral – e.g. influenza virus, respiratory syncytial virus, parainfluenza virus, COVID-19 Fungal – more usually found in patients who are immunocompromised, e.g. transplant patients, HIV Risk factors include: age, weakened immune system, diabetes, long-term conditions e.g. heart disease, lung disease, smoking, excess ETOH

Answer 25

0.5 – 1% of population have CAP every year in UK Mortality during hospitalisation – 6.5% Mortality at 1 year 30.6% Leading cause of death in children < 5 yrs old worldwide

Answer 26

Pathogens find their way through to lower respiratory tract Alveoli become inflamed – full of exudate Neutrophils sent to alveoli to fight infection – also fill alveoli Mucosal swelling occurs – partial occlusion of bronchi Reduced oxygen transfer Problems: - V/Q mismatch - Hypoxaemia - Breathlessness - Secretion retention

Answer 27

Cough Shortness of breath Increased temperature Chest pain Fatigue Wheeze Increased sputum production Hypoxia Tachycardia ↑ Respiratory rate

Answer 28

Occurs when air accumulates in the pleural space Can be primary spontaneous (occurs without any trauma or known resp illness) or secondary spontaneous (known resp illness) Can also be related to trauma or medical intervention (iatrogenic) If air enters the pleural space and cannot escape this causes a tension pneumothorax – this is a medical emergency

Answer 29

Unilateral chest pain Absent breath sounds on auscultation over collapsed lung  HR  RR Shortness of breath (SOB) Cyanosis (i.e. blue lips, nails, skin) Reduced chest wall movement on side of collapsed lung Excessive sweating (tends to be tension pneumothorax) May have CV instability as pneumothorax progresses

Answer 30

Known chronic lung disease, e.g. COPD, cystic fibrosis, pulmonary fibrosis Trauma e.g. RTA, gunshot wound, stab wound Mechanical ventilation Flying Scuba diving Inhaling drugs Smoking Marfan’s syndrome Tall, thin, male Pregnancy Family history or previous pneumothorax

Answer 31

Minor – may just watch and wait for it to resolve Oxygen therapy Thoracentesis - fine needle between ribs to decompress air Chest drain – tube placed into pleural space, usually left for a few days until lung has re-expanded Pleurodesis – chemical or surgical, sticks lung to chest cavity. Makes any future lung surgery more difficult, e.g. lung transplant

Answer 32

Oxygen therapy Breathlessness management Avoid positive pressure until pneumothorax has been drained or is draining Pain management Supported cough Airway clearance techniques (especially important in chronic lung disease) Mobilising - will prevent secondary complications such as DVT

Week 9 (parts 1, 2 and 3) Flashcards

(58 cards)