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CardioResp > (5) Resp Management in Neuromuscular Disease > Flashcards

(5) Resp Management in Neuromuscular Disease Flashcards

1
Q

What is Motor Neuron Disease (MND)?

A

progressive neuro condition that attacks the motor neurones or nerves in the brain or sc meaning messages sto reaching the muscles

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2
Q

What 3 major sites are damaged in a degenerative neurological condition?

A
  • Anterior horn cell (LMN symptoms)
  • Corticospinal tract (UMN symptoms)
  • Motor nuclei in brain stem (bulbar palsy)
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3
Q

What are UMN signs (3)?

A
  • weakness
  • spasticity
  • brisk reflexes
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4
Q

What are LMN signs (5)?

A
  • weakness
  • muscle wasting
  • fasciculations
  • cramping
  • decreased reflexes
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5
Q

What are bulbar signs (6)?

A
  • dysphagia
  • slurred/loss speech
  • breathing difficulty
  • weak cough
  • problems managing saliva
  • aspiration
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6
Q

What are 4 types of MND?

A
  • Amyotrophic Lateral Sclerosis (ALS)
  • Progressive Bulbar Palsy (PBP)
  • Progressive Muscular Atrophy (PMA)
  • Primary Lateral Sclerosis (PLS)
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7
Q

Where is the breathing rate controlled?

A

medulla oblongata (resp centre)

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8
Q

What are the muscles of ventilation?

A
  • diaphragm (C3-5)
  • intercostals (T1-11)
  • Abdominals (T5-12)
  • Accessory Muscles
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9
Q

What are the inspiratory muscles responsible for?

A

ventilation

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10
Q

What are the expiratory muscles responsible for?

A

coughing

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11
Q

What are the bulbar muscles responsible for?

A

protecting the airway

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12
Q

What are the factors in restrictive lung disease?

A

_ total lung volume too low
- stiffness in chest wall
- reduced FVC

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13
Q

What are the factors in obstructive lung disease?

A
  • difficulty exhaling air from lungs
  • smaller airways partially blocked
  • results decreased FEV1 & FEV1/FVC ratio
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14
Q

What are different types of resp complications?

A
  • paradoxical breathing patterns
  • underdeveloped lungs
  • hypercapnia
  • weak/ineffective cough
  • recurrent RTI
  • sleep disordered breathing
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15
Q

What causes respiratory failure in MND (5)?

A
  • resp muscle weakness
  • reduced chest compliance
  • increased resistive load
  • upper airway muscle weakness
  • impaired control of breathing
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16
Q

What is involved in the subjective Ax of the resp system in NMD patients?

A
  • Full MHx
  • complaints SOB?
  • Sleep quality
  • Ax for hypoventilation
  • change in appetite
17
Q

What is involved in the objective Ax of the resp system in a NMD patient?

A
  • Increased RR
  • Accessory muscle recruitment
  • Overnight oximetry
  • early morning ABG
  • PFTs - FVC
  • peak cough
  • SNIP & MIP
18
Q

What do MIP & SNIP measure?

A

inspiratory muscle strength

19
Q

How is MIP performed?

A
  • patient inhale against occluded airway
  • maximal pressure generated recorded by pressure transducer
  • < -60cm significant muscle weakness
20
Q

How is the SNIP test performed?

A
  • insert pressure transducer into nostril
  • patient sniffing action
  • <40cm predictor of nocturnal hypoxemia
21
Q

What does a face mask and stand peak flow meter measure?

A

Cough flow

22
Q

What is the technique for using a face mask and stand peak flow meter?

A
  • place mask over patients mouth
  • inhale deeply and cough strong as possible
  • repeat 3-5 times
  • record highest score
23
Q

What is the focus for physios for low cough efficacy?

A
  • monitor signs and symptoms of resp insufficiency
  • manage secretions
  • manually assist cough
24
Q

What are manual assisted cough techniques used for?

A

Producing a increase in velocity of expiratory flow sufficient to mobilise secretions from the airways, when patient no longer able generate this force

25
Q

What are three types of manual assisted cough techniques?

A
  1. Abdominal thrust
  2. Lateral Costal Compression
  3. Anterior chest wall compression
26
Q

How does a cough assist machine work?

A
  • delivers a preset positive pressure into the airways for a set duration inspiration
  • followed by abrupt change to a preset negative exsufflation
  • simulates a cough
27
Q

How does breath stacking work?

A
  • pt take deep breath
  • pt try take another breath on top
  • squeeze bag
  • pt breath out or cough
28
Q

What is glossopharyngeal (frog) breathing?

A

Lips, larynx, pharynx, tongue “GUP sound”

29
Q

What does frog breathing do?

A
  • improves VC
  • maintains chest wall ROM
  • improves pulmonary compliance
30
Q

What are indications for tracheostomy?

A
  • bulbar dysfunction leading to aspiration
  • failure control ventilation with NIV
  • failure wean onto NIV following acute decompensation
  • vocal cord dysfunction/upper airway problems
31
Q

What is palliative care?

A

seeks to prevent, relieve, reduce or soothe the symptoms of disease or disorder without effecting a cure

32
Q

What is end of life care?

A

care concerning the final stages of life and focuses on care of the dying person and their family

33
Q

Where does the physio fit into end of life care?

A
  • use of transferrable skills
  • honest, positive
  • problem solving approach
  • changes in goals
  • maximise patients potential at end of life
34
Q

What are considerations for suctioning at end of life?

A
  • Patient too weak
  • conscious?
  • distressing for pt & family
  • NEVER routinely done
35
Q

What are barriers to Palliative Care in COPD?

A
  • Misperception
  • Difficulty determining disease prognosis
  • impaired comms
  • lack practice guidelines

CardioResp (9 decks)

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