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C/R THEORY Flashcards

1
Q

What do you observe during OAx

A

EYES
- Anaemia ( not pink enough )
- Jaundice ( Liver and Blood disorders)
- Dropping of the eye (Lung cancer)
- Oedema (Fluid retention)
HANDS
- Nicotine stains (smoking)
- clubbing

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2
Q

What can you feel and observe if someone had crackles?

A

TACTILE FREMITUS
(Palpable vibration of the chest)

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3
Q

why would you ausculate and what are you listening for ?

A

To listen for breath sounds and added sounds.
BREATH SOUNDS (BS)

To find any abnormality / where the sputum is and if there is any consolidation.

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4
Q

What are the different Breath sounds you could hear ?
and how are they created ?

A

a.) NORMAL VESICULAR BS
It’s generated from turbulent Air Flow in the trachea and large AW.
It’s heard as the sound is filtered and transmitted to the chest wall through all matter in the lungs.

b.) DECREASED BREATH SOUNDS
This is due to impaired transmission.
Drop in inspiration AF (blockage / narrowing of AW)
(Obesity / Chest deformities) extra pulmonary factors
(Disruption of the mechanical properties of the lungs)

c.) INCREASED / BRONCHIAL BREATH SOUNDS
This occurs due to the increase in density of the lung tissue/AW and the sound generated by turbulent AF in large AW is transmitted better to the chest wall.
(CONSOLIDATION/COLLAPSED/SECRETIONS)

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5
Q

What are the different ADDED SOUNDS and how are they created ?

A

a.) CRACKLES
- COARSE
They are produced by boluses of gas passing through AW as they open + close intermittently
Heard through expiration and its an indicative of secretions.
(COPD/BRONCHIESCTASIS/PNEUMONIA/SEVERE PULMONARY O)
- FINE
Produced by sudden inspiratory opening of a small Air Way held closed by.

b.) WHEEZES
Inflammation and narrowing of the AW in any location, from your throat out into your lungs.
This is mainly due to an obstructive AW disease
(2 TYPES: monophonic and polyphonic)

c.) STRIDOR
Caused by inhalation of a foreign body/laryngeal tumours etc.
It’s heard in the neck as the turbulent flow passes through a narrow segment in the upper respiratory tract.

d.) PLEURAL RUB
Heard localised to the affected area where pleural surfaces rubbing together.

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6
Q

what is the systematic way of reading an X-ray ?

A

A - alignment
B - bones
C - cardiac muscle
D - Diaphragm (2 hemi diaphragm)
E - Expansion of the Lungs
F - Lung Fields

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7
Q

How can you differentiate the difference between an AP and a PA Xray ?

A

PA X-ray
Scapula protraction will be visible because their arms are leaning on a box.
AP
The heart is enlarged.

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8
Q

When would you use ABG’S ?

A

To assess adequacy of oxygenation and ventilation (removal of CO2 in the lungs).

To assess acid base status.

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9
Q

What are the normal ABG’s value ?

A

PH = 7.35 - 7.45
PaCo2 = 4.7 - 6 kpa
PaO2 = 10 -13.3 kpa
SaO2 = 96 - 100 %
HCO3 = 22 - 26 mmol/l
RR = 12 - 20

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10
Q

What does the PFT (spirometer) measures ?

A

STATIC + DYNAMIC LUNG VOLUMES
(flow of vol of air / lung vol capacities)

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11
Q

Why would you use a SPIROMETER.

A
  • Evaluate signs/symptoms or previous abnormalities.
  • Measure the effect of Disease on pulmonary function.
  • Asses impairment from lung Disease.

If the FVC is less than 80% they may have some restrictive disorder.

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12
Q

When would you not use a Spirometer ?

A
  • Pneumothorax
  • Haemoptysis
  • Aneurysm
  • Recent MI / Surgery
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13
Q

What is Pulmonary Rehab ?

A

Its an intervention for patients with chronic respiratory disease who are symptomatic and often have decreased daily Activities.
This should be offered within a month post discharge from Hospital if relevant.

1.) 6 - 12 week programme
2.) Includes progressive muscle resistance of aerobic training.

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14
Q

What are the Benefits of Exercising ?

A
  • Increased Ventilation Perfusion
  • Increased Circulation
  • Functional Independence
  • Improved O2 uptake & utilisation
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15
Q

What is PERFUSION + VENTILATION

A

PERFUSION
the flow of blood to alveolar capillaries (L/min)
VENTILATION
Fresh air in the alveoli

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16
Q

What is Inspiratory Reserve Volume (IRV)

A

The extra volume of air that can be inspired with maximal effort after reaching the end of a normal.

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17
Q

What is FUNCTIONAL RESIDUAL CAPACITY (FRC)

A

Volume of air that remains in the lungs after a normal tidal exhalation.
(the point at which we begin and end a breath)

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18
Q

Factors affecting Muco-ciliary clearance

A
  • HYPOXIA / HYPERCAPNIA
  • AGE
  • SMOKING
  • HEIGHT OF CILIA
  • DEPTH OF SOL LAYER
  • NARROWED AW
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19
Q

What are the different problems that can occur due to Retained Secretions ?

A
  • Infection / Inflammation
  • Long term persistent mucus stasis
  • Impaired gas exchange
  • Destruction of Airways
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20
Q

What are the negative effects of vigorous / persistent coughing ?

A
  • Rib Fracture
  • Pneumothorax
  • Stroke
  • Seizures
  • Head aches
  • Tracheobronchial Trauma
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21
Q

what are the reasons for the inability to generate a sufficient Expiratory flow ( cough )

A
  • PAIN + FEAR (post op / chest trauma)
  • Respiratory Muscle Dysfunction (reduced strength)
  • Chest wall Disorder ( Kyphoscoliosis / Rib Fracture )
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22
Q

What is Respiratory Failure ?

A

Its when the respiratory system fails to oxygenate the arterial blood adequately causing retention of CO2.

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23
Q

What is O2 Therapy and what are the Indication for O2 Therapy ?

A

its the administration of O2 at concentrations greater than those found in air in order to treat/prevent Hypoxaemia.

  • Evident Hypoxemia
  • To decrease symptoms and workload due to hypoxemia.
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24
Q

What are the complications of O2 Therapy ?

A
  • O2 Toxicity
  • Depression of ventilation
  • Absorption Atelectasis
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25
Q

What does a Humidifier do ?

A

It stops sputum from drying out so that patients can cough it out.

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26
Q

What are the consequence of Chronic Respiratory Failure ?

A

1.) PULMONARY HYPERTENSION
High BP in the blood vessels that supply the lungs via pulmonary artery = Damaging Right side of the Heart.

2.) COR PULMONALE
Right side of the heart fails due to long term High BP in the arteries of the lung.

3.) HYPOXIC DRIVE
Receptors stops responding to CO2 (retention)

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27
Q

What is IPPB (BIRD BOX) ?

A

Its a ventilator to increase inspiratory lung volume and helps with secretion clearance.
(decreasing WOB)
Its pressure limited delivering a flow of gas during inspiration.

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28
Q

what are some contraindications to IPPB

A
  • Undrained Pneumothorax
  • surgical emphysema
  • Bronchial tumour in proximal AW
  • Large Bullae
  • Hypoxic drive patient
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29
Q

What are the effects of General Anaesthesia at the respiratory system ?

A
  • Mucociliary clearance stop working after 90min of GA (leading to atelectasis)
  • Dependant Lung collapse occurs within 15min of induction.
  • Risk of absorption atelectasis
  • Difficult AW clearance due to inhalation of dry cold gas. (increase mucus viscosity)
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30
Q

C/R complications post-op

A

ATELCTASIS
Their position disrupts the FRC as they are imobile due to pain as a result, they would be gurding and Tidal Volume decreases.

HYPOXAEMIA
Decrease Hypoxic vasoconstriction because of anaesthetic gases, patient is o2 hungry.

CHEST INFECTION
48hr Post-op

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31
Q

What are some indications for ventilating patients ?

A
  • Respiratory Failure
  • Inability to protect AW
  • Prolonged post op surgery
  • Altered conscious level
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32
Q

What are the different types of VENTILATION ?

A

VOLUME CONTROLLED VENTILATION
Ventilator delivers a pre set Tidal Vol / RR / Set pause time.
AW pressure rises slowly as ventilator reaches desired vol.
Peak AW pressure will vary from breath to breath.

PRESSURE CONTROLLED VENTILATION
Pressure is constant, its set so that the volume can change from breath to breath depending on Lung Compliance
- pre set RR / Inspiratory time
- pressure controlled reduce risk of Barotrauma in patients with stiff lungs (better lung compliance)

33
Q

What is the aim of suctioning ?

A
  • Removal of secretions
  • Maintain Patent Airway
  • Reduce WOB
  • Improve Ventilation and Oxygenation
34
Q

What are the different methods of Suctioning ?

A

OPEN SUCTIONING
Patient is temporarily disconnected from the ventilator whilst suctioning occurs.

CLOSED SYSTEM SUCTIONING
Patient remains attached to the ventilator.
There’s a permanent attachment of a sterile line suction catheter to the ventilator circuit.

Saline solution can be used to help down break down sputum when suctioning. It has to be warmed up first to prevent Bronchospasm (shock)

35
Q

What complications can occur due to suctioning ?

A
  • Bronchospasm
  • Infection
  • Arrythmias
  • Tissue trauma
  • Pneumothorax
  • Psychological effects
36
Q

How do you minimise the risk of complications during Suctioning ?

A
  • Limit procedure
  • Use sterile Technique and Equipment
  • No Trombone / Twist / Twirling
  • Suction only when necessary
  • Choose correct catheter size (-2 / x2)
37
Q

What are the complication that can occur due to manual hyperinflation ?

A
  • Barotrauma
  • Undrained Pneumothorax
  • Emphysematous Bullae
  • Severe Bronchospasm
38
Q

When would you use Ventilators ?

A
  • Respiratory Failure
  • Post op
  • AW obstruction
  • Spinal injury
39
Q

What are some complications of Ventilators ?

A
  • Baro Trauma
  • V / Q Mismatch
  • Discomfort
  • Complication of high O2
  • Weakened Respiratory Muscles.
40
Q

What are the possible use of CPAP ?

CPAP comes along with PEEP
AIDS OXYGENATION ONLY.

A
  • To improve gas exchange between alveoli
  • Type 1 Respiratory Failure
  • Pneumonia
  • Recruits Alveoli
41
Q

What is NIV ?

A

Non-invasive ventilation is the use of breathing support administered through a face mask, nasal mask, or a helmet. Air, usually with added oxygen, is given through the mask under positive pressure; generally the amount of pressure is alternated depending on whether someone is breathing in or out.

42
Q

What are the Possible use of NIV ?

A
  • Type 2 Respiratory Failure
  • Increase Tidal Volume and Decrease CO2
  • Pneumonia
  • COPD
  • Post extubation
43
Q

What are the possible causes of Increase WOB ?

A
  • Increase Metabolic rate (^ Ventilation / fever)
  • Cardiovascular Issues (Anaemmia)
  • Deconditioning (lactate accumulates)
  • Respiratory muscle Dysfunction
  • Perfusion Limitation
44
Q

What are the different features of Increase WOB ?

A
  • Use of accessory muscles
  • Disturbed/Inability to complete sentences
  • Pursed Lip Breathing
  • Paradoxical Breathing
45
Q

What are the possible Treatment options for EXCESS SECRETIONS ?

A
  • ACBT
  • Positioning
  • Manual Technique
  • ADJUNCTS (autogenic drainage / bubble pep)
  • NIPPY CLEARWAY
46
Q

What are the possible Treatment options for INCREASED WOB ?

A
  • Positioning of Eases
  • Breathing ReEd
  • Fan Therapy
  • Pursed Lip breathing
  • Education / relaxation
  • NIPPY CLEARWAY
  • Pacing / Planning / Prioritising
47
Q

What are the possible Treatment options for LOSS OF LUNG VOLUME ? (atelectasis)

A
  • NIPPY CLEARWAY
  • Positioning
  • Breathing Exercise (TEE)
  • Incentive Spirometry
  • IPPB (Lung expansion therapy)
  • CPAP w/ PEEP
  • Clearway Cough Assist
48
Q

What are the possible Treatment options for SOBAR ?

A
  • Positioning
  • Breathing ReEd
  • Fan Therapy (Trigeminal nerve )
  • Pursed Lip Breathing
  • NIV
49
Q

What are the different Breathing Re-Education technique ?

A

DIAPHRAGMATIC BREATHING
- Hands on tummy while breathing in and out.

BREATHING RECTANGLE (VISUAL)
- Short breath in / Long breath out

CALMING HANDS
Thumb = recognise Breathing
1 = sigh out (release tension)
2 = Breath out
3 = Relax

RELAXATION
- breathing control (mindfulness app / calm )

50
Q

What is IPPB ?
(Intermittent Positive Pressure Breathing)

A

Its a NIV whereby it gives a positive pressure during inspiration and gives patient atmospheric pressure during expiration.

51
Q

What is the purpose of using IPPB ?

A
  • To make patients take Deeper Breaths
  • To stimulate a cough
  • Prevent / Decreases ATELECTASIS
  • Increase Oxygenation
  • Improve Vital Capacity
52
Q

What causes HYPOXAEMIA ?

A

A reduced in O2 in arterial blood
- Reduced FiO2
- Hypoventilation
- Dead Space / PE ( wasted ventilation )

53
Q

What Causes HYPOXIA ?

A

When there is an O2 deficit at tissue level.

54
Q

What is HYPOXAEMIA ?

A

Respiratory system fails to oxygenate arterial blood adequately.

55
Q

What is HYPOXIA ?

A

Failure to provide the body adequate amounts of O2.

56
Q

What is HYPERCAPNOEA ?

A

Person fails to ventilate well enough to eliminate CO2.

57
Q

What are the difference between TYPE 1 and TYPE 2 RESPIRATORY FAILURE ?

A

TYPE 1 (HYPOXAEMIA )
Inability to maintain an adequate PO2 but CO2 is normal.

TYPE 2 (ventilatory failure)
Issue with oxygenation and Co2
Reduced CO2 / Increased O2

58
Q

Manual Technique Precautions.

A
  • Haemophysis
  • Severe clotting Disorder
  • Uncontrolled Thoracic Pain
  • Rib Fracture
  • Incisions / Burns
59
Q

What are some possible complications of suctioning ?

A
  • Cardiac Arrest
  • Tissue Trauma to Tracheal
  • Psychological Effect
  • Pneumothorax
60
Q

How do you assess for o2 for O2 therapy ?

A
  • PULSE OXIMETRY
  • ABG’S
61
Q

What are the 2 different O2 delivery methods for O2 therapy ?

A

VARIABLE PERFORMANCE DEVICE (nasal cannula/face mask)
Amount of O2 delivered is dependant on:
- O2 flow rate
- RR and patients Inspiratory volume

FIXED FLOW DEVICES (VENTURI)
Its already calibrated meaning there is a delivery of fixed proportion of air and O2 ensuring an accurate concentration of O2 regardless of patient inspiratory volume/rate

62
Q

What is CPAP ?
(continuous positive airway pressure)

A

CPAP reduces WOB and manage breathlessness.

It delivers the same flow of gas through out Inspiration/Expiration, which help increase FRC, splits open alveoli improving gas exchange for type 1 resp failure.

63
Q

What are the Respiratory Adjuncts for secretion management?

A

ACAPELLA
- Alter dial on the bottom but start at a low frequency.
- take normal 6 - 10 tidal volumes
- Huff or cough to move secretion = to be cleared
- complete cycle 3x

FLUTTER
BUBBLE PEP
THRESHOLD PEP

64
Q

What is the theory behind Positive expiratory Pressure (PEP) ?

A

It creates a back positive pressure to keep airway open because when you breath out there is a slow drop on the positive pressure.

The positive pressure:
- stabilise AW
- prevent premature AW closure
- less tiring than ACBT (for some)

65
Q

What are the possible complication that can occur due to SUCTIONING ?

A
  • HYPOXEMIA / HYPOXIA
  • Cardiac arrest
  • Atelectasis
  • Pneumothorax
  • Psychological effect
66
Q

what are the contraindication and precautions of Suctioning ?

A
  • Nasal Fractures
  • Stridor
  • Severe Bronchospasm
  • unstable CVS
  • Pulmonary oedema
67
Q

What causes Lung Volume Loss ?

A
  • ATELECTASIS
  • Anything that reduces lung complinace
68
Q

What are the factors that affect IRV ?

A
  • Sufficiency of Inspiratory muscle strength to cause expansion.
  • THORACIC MOBILITY
  • DEGREE OF LUNG COMPLIANCE
69
Q

Loss of Lung volume can cause IRV.
What are the consequence of a Reduced IRV ?

A

Patient will take deep breath and atelectasis occur in dependant region (below the heart).
Rx = V/Q matching

70
Q

What are the factors affecting FRC ?

A
  • Inward recoil of the lungs is increased
  • Outward expansion is reduced
71
Q

What happen when FRC falls ?

A

WIDESPREAD VOLUME LOSS
- small dependant AW begins to close
- AW remains closed during normal tidal breathing
- Gas become trapped in proximal AW = Atelectasis

72
Q

What causes Atelectasis ?

A
  • Immobility / Bed rest / Poor Positioning
  • High O2 (absorption atelectasis)
  • shallow breathing pattern
73
Q

In critical care, how much Ventilation would be given ?

A

Its based on weight.
6 - 10 L/kg

74
Q

When using a spirometer, what is the normal FEV1/FEV ratio for a normal and affected lung ?

A

Normal = 70 - 85 %
Abnormal / COPD = 40 %

75
Q

What is Forced Vital Capacity ?

A

The volume of air expired forcefully until a residual volume is reached.

76
Q

What is FEV1 ?

A

Volume of air the subject exhale in the first second of a maximal breath out.

77
Q

What is the CLOSING CAPACITY ?
(related to FRC)

A

Its the volume of lungs at which its smallest AW, the respiratory bronchioles, collapse.

78
Q

What are the complications of using a PEP ADJUNCT ?
(flutter)

A
  • Barotrauma in the lungs
  • Increased Intracranial pressure
  • Increased WOB
  • It can lead to nausea
79
Q

What is Vital Capacity ?

A

The greatest volume of air that can be expelled from the lungs after taking the deepest possible breath.

CS THEORY (6 decks)

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