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CardioPulm 2 > 9] NIV, Transplant, Apnea ADD article questions- make sure all the info is on here > Flashcards

9] NIV, Transplant, Apnea ADD article questions- make sure all the info is on here Flashcards

1
Q

What is sleep apnea?

A

Significant daytime sleepiness with other Sx

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2
Q

Hallmark of sleep apnea

A

Airway narrowing/obstruction at night

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3
Q

3 types of sleep apnea

A

Central
Obstructive
Mixed

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4
Q

What does obstructive sleep apnea mean? (OSAS)

A

Periods that last 10 sec or more where you have hypopnea or apnea of breathing

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5
Q

Patho of OSAS

A

Partial or complete pharyngeal collapse during sleep- relaxed pharynx during sleep obstructs ventilation

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6
Q

What’s dampened during sleep?

A

Reflex

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7
Q

What else gets dampened during sleep worsening the loss of airway tone?

A

Chemoreceptors

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8
Q

Results of narrow airway in OSAS

A

Low oxygen and increased CO2

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9
Q

Healthy breathing

A 
Negative intrathoracic pressures pull air in —> 
⦿ Pharyngeal dilator muscles fight the 
inward pull to keep airways patent
⦿ Slow air movement is laminar and aids 
in keeping airway dilated
⦿ During sleep, pharyngeal dilator 
muscles relax increasing airway 
resistance
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10
Q

Severe sleep apnea

A

More than 30 episodes per night of loss of breathing

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11
Q

Moderate sleep apnea

A

15-30 episodes/night

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12
Q

Mild sleep apnea

A

5-14 episodes/night

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13
Q

Gender risk factor for SA

A

Mor emen

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14
Q

Race for SA

A

African America, Hispanic, Pacific Islanders

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15
Q

Elevated BMI as risk factor in sleep apnea

A

40% obese have it and 70% of people with sleep apnea are obese; neck circumference more than 16 inches for women, more than 17 for men

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16
Q

Anatomy as risk factor for SA

A

Small airways, cervical extension, FHP

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17
Q

Sleep apnea is seen a lot in kids with?

A

Down syndrome

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18
Q

Signs and Sx in adults for SA

A 
Wifey complains
Sleep disturb
Tired and groggy even tho they got 8 hours sleep
Morning headaches (b/c of alterations in CO2 and O2 levels)
Irritable
Memory loss
Dry mouth
Car accidents (they fall asleep)
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19
Q

Signs and Sx of sleep apnea in kids

A

Hyperactivity- primary Sx
Can’t concentrate
Bad school performance (detention)

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20
Q

Long term consequences of SA

A 
HTN
CAD
HF
Dysrhytthmias 
CVA disorders 
Impairs growth in kids
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21
Q

The death rate for ppl with ? SA is ? Than for those who dont have OSAS

A

Untreated

3x higher

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22
Q

Define obesity hypoventilation syndrome

A

BMI more than 30
PaCO2 more than 45
Sleep disordered breathing
CHRONIC HYPOventilation

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23
Q

Altered breathing in obesity HYpovent syndrome results in

A

Daytime LOW PaO2
Daytime elevation PCO2
(Differentiates OHS from OSA)

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24
Q

Risk factor for OHS

A

Obesity

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25
Q

What does OHS stand for

A

Obesity hypoventilation syndrome

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26
Q

Signs and Sx of OHS

A 
Sleepy
Depression
SOB with activity
Irritable
Signs of cor pulmonale
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27
Q

Risks of OHS

A 
HTN
Cor pulmonale
Sexual dysfunction
Dysrhytmia
Polycythemia
CVA
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28
Q

Treatment for SA and OHS

A

NIV, Masks with CPAP and BiPAP which all aim to increase alveolar ventilation and stent airways

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29
Q

Goal of NIV

A

Airway stunting

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30
Q

Goal os NIV is to increase

A

FRC = ERV + RV

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31
Q

What is FRC

A

Volume in lungs after a normal expiration

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32
Q

Increasing the FRC does what

A

Limits “de-recruitment” of alveoli

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33
Q

What is CPAP

A

Pressure during exhale to stent open airways

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34
Q

How does patient breathe on CPAP

A

Spontaneously

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35
Q

What’s another common intervention for SA

A

BIPAP- NIV

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36
Q

What’s different of BiPAP

A

It’s a type of CPAP with two diff pressures during inhale (high pressure) and exhale (low pressure)

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37
Q

High pressure in BiPAP during inhale for

A

Stenting

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38
Q

Low pressure of BiPAP during exhale for

A

Helps blow off CO2

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39
Q

PT implications for SA

A

Take a thorough sleep history, look at ADHD in kids, weight, sleep hygiene, exercise, sleep positioning

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40
Q

Indications for lung transplant

A 
Advanced lung disease- class II or IV
Progressive lung disease that needs max intervention
Survival chance less than 50 in 2 years without transplant 
Pt understands risks
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41
Q

Contraindications for lung transplant

A 
Active cancer in last 2-5 years
Untreatable or advanced disease of another organ
Uncurable infection
Chest wall/Spine deformity
Not compliant with therapy
Psych conditions untreatable 
No social support
Substance addition like smoking
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42
Q

RELATIVE contraindications for lung transplant

A 
More than 75 years old
Poor functional status
Colonization
BMI more than 30
Severe osteoporosis- mechanical vent
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43
Q

What does LAS stand for

A

Lung allocation score

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44
Q

What does LAS predict

A

The probability of surviving next year without transplant and length of survival post-transplant

45
Q

6MWT for LAS

A

In adults, less than 400 m (1312 feet) is correlated with higher mortality

46
Q

Determination of eligibility and “place in line” for lung transplant depends on:

A

LAS

Distance from organ

47
Q

Lung transplant listing for kids

A

Priority 1- urgent

Priority 2

48
Q

Kids under 12 cannot?

A

Get adult lungs

49
Q

6MWT for kids

A

More than 1000 feet is correlated with shorter ICU stay and fewer days of vent

50
Q

2 types of lung transplants

A

Single- 5-9 hours

Double- 7-9 hours

51
Q

Lateral thoracotomy cuts through

A

Serratus and lats

52
Q

Which intercostal space with transplants?

A

5th Intercostal space

53
Q

Aerobic capacity for pre-txp eval

A

6MWT
Incremental shuttle walk
GXT

54
Q

Pulmonary endurance and strength for pre-txp

A

MIP

MVV

55
Q

Short physical performance battery

A

Marker for frailty in pre-lung txp and predicts disability and waitlist mortality

56
Q

Pre-txp Ex presc

A

F: 2-5x/week
I: 50-80% HRR or 3-5 on dyspnea scale or 60-80% 6MWT speed
TT: continuous training 15-30 minutes or
Intermittent training 5-10 minutes;
2-3 bouts Interval training: 30 seconds exercise;
30 seconds rest for 12-26 minutes

57
Q

Main med they use to prevent rejection episodes

A

CALI nursing inhibitors (tacrolimus and cyclosporine)

58
Q

Main side effects of calcination inhibitors

A

HTN
Tremor
Electrolyte abnormalities (low Mg and high K)

59
Q

Side dish meds

A

Mycophenelate

Imuran

60
Q

Salads med examples

A

Sirolimus and everolimus

61
Q

Mg and K affect?

A

Cardiac muscle function

62
Q

What are side dishes

A

Things they add onto pts regimen to help prevent rejections

63
Q

Mycophenelate can cause

A

N/V, diarrhea, Leuko and sytopenia, anemia

64
Q

What’s the cutoff for platelets for them to use weights?

A

Above 50,000 **

65
Q

How do salads work with meds?

A

If they are having too many Side effects, salads can replace main dishes

66
Q

Salads can be used for what?

A

Also if they have mild or mod rejections that help

67
Q

Bread and butter for rejection episodes

A

Steroids
Methyprednosolone and
Prednisone

68
Q

Side effects of steroids

A

Muscle atrophy
Bone loss
GI irritability

69
Q

With steroids, people gain

A

Weight in weird places- abdomen and buffalo hump

70
Q

Before txp they have likely had what

A

COPD or etc

71
Q

Premorbid disease and muscle changes

A

COPD:
Atrophy type I fibers
More fatigue
Lower lactic acid threshold

72
Q

It’s usually what that limits the pt after txp?

A

Peripheral issues- not lungs

73
Q

Acute care s/p LTXP

A 
Chest PT
Postural drainage every 4-6 hours 
Early mob 
Training cough
Secretion clearance techniques
74
Q

What is a a-line

A

Direct measurement of arterial BP

75
Q

PT precautions with A-line

A

Dont pull it out

No wrist ROM

76
Q

How to interpret A line readings

A

Transducer has to be at level of right atrium for accurate readings

77
Q

If a-line alarm goes off, what do you do?

A

1- observe the patient first!!

2- take manual BP

78
Q

Signs and Sx of intolerance- lower intensity (7)

A 
HR increases more than 20-30 above resting HR
SBP increases more than 20-30
RR more than 30 
Increased accessory muscle use
DNV- dizzy, nausea, vomit
Pain
Agitation
79
Q

Ventilator specific alarms (5)

A 
It alarms for disconnect
FiO2 more or equal to 0.6 
PEEP more than 10
Mode changed to assist-control
Tenuous airway
80
Q

Aerobic training goal of outpatient PT

A

30 min most days of the week if not all

81
Q

Strength training in outpatient PT

A

UE strength training after MD clearance

6-9 weeks

82
Q

TERMINATE EXERCISE (10)

A 
RR more than 40
More than 20% increase in resting HR
HR less than 40 or more than 130
MAP less than 65 or more than 110
OH
Severe agitation (RASS more than 2)
Sedation or coma RASS (less or equal to 3)
EKG changes, chest pain, diaphoresis
SpO2 decreases 4% or less than 88%
patient discomfort or refusal
83
Q

Post transplant rehab Ex Prescription

A 
F: 3-5 x/week
I: 50-80% HRR
3-4/10 on dyspnea scale
75-100% 6MWT speed
T: continuous 20 min

*Keep sats above 88%

84
Q

Strength training ex prescription for post txp

A

F: 2-3x/week
I: 60-80% of 1 RM
1-3 sets of 8-15 reps
(Higher sets, lower reps)

85
Q

Because of steroids you want to focus on what durign strength

A

Focus on proximal strength

86
Q

Mechanical changes in thoracic cage

A

Increased collagen

Loss of disc height

87
Q

The mechanical changes in the thoracic cage results in

A

Greater pressure needed to inflate lungs

88
Q

Lung parenchyma changes with age

A

Decreased compliance in small airways
Increased size and production of muscles glands
Decreased elastic recoil of lungs

89
Q

Alveoli changes

A

Decreased available surface area for gas exchange
Decreased diffusion capacity (DLCO)
Decreased number of pulmonary capillaries

90
Q

Respiratory muscle changes

A

Less type I and type II, less # of motor units, slowing at NMJ, lose optimal L-T

91
Q

Muscles have to work harder to?

A

Create negative pressure

92
Q

Lung volumes and capacities with age

A

⦿Decreased FVC
⦿Decreased FEV1
⦿Increased RV
⦿No change in TLC

93
Q

FEV1

A

Amount of air exhaled during 1st second of FVC

94
Q

FEV1 indicates

A

Flow in larger airways

95
Q

Post bronchodilator FEV1/FVC less than what indicates what

A

Less than 70% predicted = COPD

96
Q

GOLD 1

A

Mild

FEV1 more than 80% or = to 80

97
Q

Gold 2

A

Moderate

Between 50-80

98
Q

Gold 3

A

Severe

Between 30-less than 50

99
Q

Gold 4

A

Very severe

Less than 30%

100
Q

Goals of medical assessment (3)

A

Determine level of airflow limitation
Determine impact on health status
Determine risk of future events
(hospitalizations, death, exacerbation)

101
Q

COPD is a common, preventable and treatable disease characterized by ? Respiratory Sx and ? That is due to ? Usually caused by significant ?

A

Persistent
Airflow limitation
Airway and alveolar abnormalities
Exposure to noxious particles or gases

102
Q

Goals of phase III

A

Independent self-minoring

Exercises as life long approach- prevent relapse

103
Q

The minimal increase that is clinically meaningful in 6MW distance is?

A

54-84 m (177 - 275) feet for COPD

104
Q

St George repsiratory questionnaire is ?

A

Disease specific

105
Q

Precontemplation

A

No intention to take action in next 6 months

106
Q

Contemplation

A

Intends to take action in next 6 months

107
Q

Intention to take action in next 30d and has taken behavioral steps to initiate change

A

Preparation

108
Q

Behavior has changed for less than 6 months

A

Action

109
Q

Behavior has changed for more than 6 months

A

Maintenance

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