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test 1 year 3 > cardio > Flashcards

cardio Flashcards

1
Q

Ms Smith is admitted to the trauma ward due to sustaining a pneumothorax after being assaulted at work. The trauma surgeon inserted an intercostal drain (ICD) at her right chest wall, prescribed analgesia and referred her for physiotherapy.

  1. Define a pneumothorax. (1)
A

is a complete of partial collapse of a lung, which is due to air leaking into the pleural space , the increased intra-thoracic volume due to air occupying the pleural space leads to lung collapse and compression of underlying lung

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2
Q

Ms Smith is admitted to the trauma ward due to sustaining a pneumothorax after being assaulted at work. The trauma surgeon inserted an intercostal drain (ICD) at her right chest wall, prescribed analgesia and referred her for physiotherapy.
2. Document the CXR features that you would anticipate to see with a pneumothorax. (4)

A
  • mediastinal shift away from pneuomothorax
  • Black lung fields with NO lung markings
  • hyperinflated lung
  • edge of lung pulled away from rib cage resulting in lung collapse
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3
Q

Ms Smith is admitted to the trauma ward due to sustaining a pneumothorax after being assaulted at work. The trauma surgeon inserted an intercostal drain (ICD) at her right chest wall, prescribed analgesia and referred her for physiotherapy.
3. Explain the ICD activity that you would observe in the ICD bottle of Ms Smith. (2)

A
  • swing/ oscillation which refelects the changes in pleural pressure on breathing
  • bubbling- reflects the amount of air draining out of the pleural space
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4
Q

Ms Smith is admitted to the trauma ward due to sustaining a pneumothorax after being assaulted at work. The trauma surgeon inserted an intercostal drain (ICD) at her right chest wall, prescribed analgesia and referred her for physiotherapy.
4. Explain four impairments that Ms Smith may present with due to her pathology. (8)

A
  1. sputum retention- due to inability to effectively cough
  2. dyspnoea- due to decreased lung volumes
  3. fatigue- due to reduction v/q mismatch
  4. tachypnoea- due to the decrease in ventilation capacity, body will compensate by increasing RR
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5
Q

Mr Solomon complains of class four breathlessness and is admitted to a medical ward with a diagnosis of pneumocystis jiroveci pneumonia. During your assessment the following is found:
Vital signs: heart rate 115 bpm, respiratory rate 28 breaths/ minute, Sp02 92%.
Apical breathing pattern with increased use of accessory respiratory muscles.
Arterial blood gas (ABG) on FiO2 0.4: pH = 7.33, PaCO2 = 48 mmHg, HCO3 = 24 mmol/l, BE 1.5, PaO2 = 95 mmHg.
Auscultation of his chest wall reveals no added abnormal lung sounds but slight diminished breath sounds bilateral basally (all segments).

2.1 Explain class four breathlessness. (1)

A

symtoms of breathlessnes at rest

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6
Q

Mr Solomon complains of class four breathlessness and is admitted to a medical ward with a diagnosis of pneumocystis jiroveci pneumonia. During your assessment the following is found:
Vital signs: heart rate 115 bpm, respiratory rate 28 breaths/ minute, Sp02 92%.
Apical breathing pattern with increased use of accessory respiratory muscles.
Arterial blood gas (ABG) on FiO2 0.4: pH = 7.33, PaCO2 = 48 mmHg, HCO3 = 24 mmol/l, BE 1.5, PaO2 = 95 mmHg.
Auscultation of his chest wall reveals no added abnormal lung sounds but slight diminished breath sounds bilateral basally (all segments).
2.2 Analyse and interpret the ABG. (4)

A 
PH =7.33 (normal 7.35-7.45) therefore acidotic 
Hco3 = 24 (normal 22-26) normal 
paco2 48 (normal 35-45) high 
therefore respritory acidosis
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7
Q

2.4 Discuss how you will manage Mr Solomon’s breathlessness during your first treatment. (5)

A

Acbt
neb with mucolitic
active coughing
manual chest therapy

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8
Q

2.5 Name an outcome measure that can be used to assess Mr Solomon’s functional status. (1)

A

FSS-ICU

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9
Q

Mrs Viljoen is 70 years old and was admitted to the medical ward due to a complaint of breathlessness and fatigue when performing mild daily activities. Her symptoms have progressively worsened and for the last month she has also started experiencing a chronic non-productive cough and orthopnoea. Her past medical history reveals a history of hypertension and type two diabetes. The medical team ordered a chest X-ray and noted she has cardiomegaly with small bilateral pleural effusions and Kerley B-lines basally.

3.1 State the precautions that you will following when treating Mrs Viljoen considering her pathology. (4)

A

monitor vitals before and after
regulary palpate pule during treatment
monitor intensity level of breathlessness
observe patient closely eg coulor and signs of cyanosis
monitor secretions

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10
Q

Mrs Viljoen is 70 years old and was admitted to the medical ward due to a complaint of breathlessness and fatigue when performing mild daily activities. Her symptoms have progressively worsened and for the last month she has also started experiencing a chronic non-productive cough and orthopnoea. Her past medical history reveals a history of hypertension and type two diabetes. The medical team ordered a chest X-ray and noted she has cardiomegaly with small bilateral pleural effusions and Kerley B-lines basally.
3.2 Document four foot care advice tips that you will explain to Mrs Viljoen as a means of preventing diabetic foot ulcers in the long term. (4)

A
  1. wash feet daily in lukewarm water and soap
  2. dry feet effectively
  3. wear clean socks daily
  4. apply hand cream to feet esp dry areas
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11
Q

Question 3
Mrs Viljoen was admitted to the medical ward due to a complaint of breathlessness and fatigue when performing mild daily activities. Her symptoms has progressively worsened and for the last month she has also started experiencing a chronic non-productive cough and orthopnoea. The medical team diagnosed her with left ventricular heart failure.

3.1 Define orthopnoea. (2)

A

orthopnea is the sessation of breathlessness in the recumbent position, which is releaved by sitting or standing

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12
Q

Question 3
Mrs Viljoen was admitted to the medical ward due to a complaint of breathlessness and fatigue when performing mild daily activities. Her symptoms has progressively worsened and for the last month she has also started experiencing a chronic non-productive cough and orthopnoea. The medical team diagnosed her with left ventricular heart failure.
3.2 Name the classification system that is used to classify heart failure according to functional limitations and justify Mrs Viljoen’s classification. (2)

A 
class 4 on the NYHA funtional classfication of hf 
since she complains of breathlessness on mild activities ie less then ordinary activities, she is not comftobale at rest and the activty casues fatigue and breathlessness
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13
Q

Ms Smith is admitted to the trauma ward due to sustaining a haemothorax after being assaulted at work. The trauma surgeon inserted an intercostal drain (ICD) at her right chest wall, prescribed analgesia and referred her for physiotherapy.

  1. Define a haemothorax. (2)
A

blood accumulating in the pleural space

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14
Q

Ms Smith is admitted to the trauma ward due to sustaining a haemothorax after being assaulted at work. The trauma surgeon inserted an intercostal drain (ICD) at her right chest wall, prescribed analgesia and referred her for physiotherapy.
2. Document the chest x-ray features you expect to find with a haemothorax. (4)

A

grey discoloration over lungs in supine
white density over mid-lower lung regions with meniscus sign in sitting
possible mediastinal shift away from haemothorax

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15
Q
  1. Explain the ICD activity that you would observe in the ICD bottle of Ms Smith. (4)
A

swinging where gentle movement of fluid back and forth within the collection tube
drainage of blood

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16
Q
  1. Document the precautions regarding the ICD that you will teach Ms Smith that she should following during treatment and physical activity. (5)
A

Cough with ICD support
• ICD should always be below insertion site.
infection control near insertion site
make sure drain is upright
drains should be on the floor on their stand fro gravity drainage

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17
Q

Mr Solomon complains of breathlessness and is admitted to a medical ward with a diagnosis of pneumocystis jiroveci pneumonia. During your assessment the following is found:
Vital signs: heart rate 115 bpm, respiratory rate 28 breaths/ minute, Sp02 88%.
Apical breathing pattern with increased use of accessory respiratory muscles.
Arterial blood gas (ABG) on room air: pH = 7.33, PaCO2 = 48 mmHg, HCO3 = 24 mmol/l, BE 1.5, PaO2 = 55 mmHg.
Auscultation of his chest wall reveals no added abnormal lung sounds but slight diminished breath sounds bilateral basally (all segments).

2.1 Name an outcome measure that can be used to quantify Mr Solomon’s breathlessness during functional activities. (1)

A

new york heart association classfircation of breathlessness

18
Q

Mr Solomon complains of breathlessness and is admitted to a medical ward with a diagnosis of pneumocystis jiroveci pneumonia. During your assessment the following is found:
Vital signs: heart rate 115 bpm, respiratory rate 28 breaths/ minute, Sp02 88%.
Apical breathing pattern with increased use of accessory respiratory muscles.
Arterial blood gas (ABG) on room air: pH = 7.33, PaCO2 = 48 mmHg, HCO3 = 24 mmol/l, BE 1.5, PaO2 = 55 mmHg.
Auscultation of his chest wall reveals no added abnormal lung sounds but slight diminished breath sounds bilateral basally (all segments). 2.2 Analyse and interpret the ABG. (4)

A 
PH =7.33 (normal 7.35-7.45) therefore acidotic 
Hco3 = 24 (normal 22-26) normal 
paco2 48 (normal 35-45) high 
therefore respritory acidosis
19
Q

Mr Solomon complains of breathlessness and is admitted to a medical ward with a diagnosis of pneumocystis jiroveci pneumonia. During your assessment the following is found:
Vital signs: heart rate 115 bpm, respiratory rate 28 breaths/ minute, Sp02 88%.
Apical breathing pattern with increased use of accessory respiratory muscles.
Arterial blood gas (ABG) on room air: pH = 7.33, PaCO2 = 48 mmHg, HCO3 = 24 mmol/l, BE 1.5, PaO2 = 55 mmHg.
Auscultation of his chest wall reveals no added abnormal lung sounds but slight diminished breath sounds bilateral basally (all segments). 2.3 Justify whether oxygen therapy is required when managing Mr Solomon. (4)

A

yes the pt has severe hyoxmia pao2 below 60 and spo2 88

20
Q

Mr Solomon complains of breathlessness and is admitted to a medical ward with a diagnosis of pneumocystis jiroveci pneumonia. During your assessment the following is found:
Vital signs: heart rate 115 bpm, respiratory rate 28 breaths/ minute, Sp02 88%.
Apical breathing pattern with increased use of accessory respiratory muscles.
Arterial blood gas (ABG) on room air: pH = 7.33, PaCO2 = 48 mmHg, HCO3 = 24 mmol/l, BE 1.5, PaO2 = 55 mmHg.
Auscultation of his chest wall reveals no added abnormal lung sounds but slight diminished breath sounds bilateral basally (all segments). 2.4 Document the physiotherapy aims for the treatment of Mr Solomon. (6)

A 
prevent secondary complications
reduce breathlessness 
encourage effective ventilation 
increase lung volumes 
effective cough 
increase exercise tolerance
21
Q

Mr Solomon complains of breathlessness and is admitted to a medical ward with a diagnosis of pneumocystis jiroveci pneumonia. During your assessment the following is found:
Vital signs: heart rate 115 bpm, respiratory rate 28 breaths/ minute, Sp02 88%.
Apical breathing pattern with increased use of accessory respiratory muscles.
Arterial blood gas (ABG) on room air: pH = 7.33, PaCO2 = 48 mmHg, HCO3 = 24 mmol/l, BE 1.5, PaO2 = 55 mmHg.
Auscultation of his chest wall reveals no added abnormal lung sounds but slight diminished breath sounds bilateral basally (all segments). 2.5 Explain how you will perform sputum induction with Mr Solomon. (6)

A

hypertonic saline, ultrasonic neb, nil by night, brushing of teeth, ifenction control, 20 min, acbt,in sterile jar

22
Q

Question 1
Mrs Khan was admitted to the medical ward due to a complaint of breathlessness and fatigue when performing mild daily activities. She is a known hypertensive patient and was diagnosed with heart failure with reduced ejection fraction (HFrEF).

1.1 Document three chest X-ray features of HFrEF. (3)

A

kerely b lines fluid fills and distends the interlobular septa
kerelly b lines (septal lines) visible in costophrenic angles (horizontal lines)
enlarged heart
billateral pleural effusion
interstitialpulmary oedema
as the left atrial pressure rises blood is shunted to the upper zones

23
Q

Mrs Khan was admitted to the medical ward due to a complaint of breathlessness and fatigue when performing mild daily activities. She is a known hypertensive patient and was diagnosed with heart failure with reduced ejection fraction (HFrEF).
1.2 Define her breathlessness according to the New York Heart Association Scale. (1)

A

class 3

24
Q

1.3 Define orthopnoea. (2)

A

deacresed breathlesness sensation in the recumbent postion and is relieved with sitting up or standing

25
Q

1.4 List the precautions that you will follow when treating Mrs Khan considering she has heart failure. (5)

A

monitor vitals before and after treatment
palpate pulse troughout treatment
watch patient to see facial expression for cyanosis
monitor level of breathlessness
monitor secretions

26
Q

1.5 Explain the treatment that you will implement to address Mrs Khan’s breathlessness. (4)

A

acbt with focus of bc
relaxation breathing exercises
exercise persciption

27
Q

1.5 Explain the treatment that you will implement to address Mrs Khan’s breathlessness. (4)

A

acbt with focus of bc
relaxation breathing exercises
exercise persciption
thoracic mobilzation

28
Q

Mr Smit was admitted to the medical ward due to a complaint of fever and expectorating foul smelling green sputum. The medical team diagnosed him with a lung abscess in his right middle lobe. During your assessment you note the following:
ABG: pH 7.34, PaCO2 47mmHg, HCO3 25mmol/L, BE 1.8, SaO2 94%, PaO2 75mmHg
Oxygen therapy: Nasal cannula at 3L/min
Auscultation findings of his chest wall: coarse crackles over his right middle lobe with diminished breath sounds over his right posterior basal lung segment.

2.2 Analyse and interpret Mr Smit’s ABG. (5)

A

PH- 7.34 slight acidosis
paco2 slight increase
hco3 N
pao2- decreased moderate hypoxia (on o2)

29
Q

2.1 Define a lung abscess. (2)

A

A localized collection of pus within necrotic lesion in the lung paraenchyma which leads to a cavity and after formation of a bronchopulmonary fistula and air fluid level inside the cavity

30
Q

Mr Smit was admitted to the medical ward due to a complaint of fever and expectorating foul smelling green sputum. The medical team diagnosed him with a lung abscess in his right middle lobe. During your assessment you note the following:
ABG: pH 7.34, PaCO2 47mmHg, HCO3 25mmol/L, BE 1.8, SaO2 94%, PaO2 75mmHg
Oxygen therapy: Nasal cannula at 3L/min
Auscultation findings of his chest wall: coarse crackles over his right middle lobe with diminished breath sounds over his right posterior basal lung segment.2.3 Document the oxygen percentage that Mr Smit is receiving with the oxygen therapy device. (1)

A

3 l/min provides 32% oxygen

31
Q

2.4 Explain the process that you will follow to perform sputum induction with Mr Smit. (5)

A

hyperonic saline in ulrasonic neb 20 min,nil by night, good cleaning, rinse saline, acbt with fet cough and expectoration, pd mt, steril jar, infection control, monitor for side affects

32
Q

2.5 Describe the postural drainage position of the right middle lobe. (4)

A

bed at 15, pt in supine with 1/4 tilt towards left, right arm and upper torso are supported with a pillow and the head with another pillow

33
Q

Mr Ndlovu was admitted to the trauma ward following a motor vehicle accident during which he sustained blunt chest trauma. He was diagnosed with the following injuries: rib fractures (right 6-10 on the lateral side of his chest wall), right pneumothorax and pulmonary contusions of the right basal lung segments. His medical management included Tramadol prescription for analgesia, the insertion of an intercostal drain at his chest wall and oxygen therapy.

  1. 1 Document two precautions that you will observe when you treat Mr Ndlovu if you consider his pulmonary contusion diagnosis. (2)
  2. 2 Justify whether the active cycle of breathing technique is an appropriate physiotherapy modality to drain the pneumothorax. (6)
A

review secretions with every treatment
no manual therapy
montor hb and platlet levles for signs of active bleeding

34
Q

3.2 Justify whether the active cycle of breathing technique is an appropriate physiotherapy modality to drain the pneumothorax. * (6)

A

ACBT is used to normalize a pt breathing pattern, normalize lung volumes, clear exessive bronchial secreations from the patients trachebronchial tree,
thus it will be intacted as in a pneumo the pt has an abnormal breathing, decreased lung volumes and secretions due to

35
Q

Ms Singh was admitted to the medical ward due to a complaint of class 4 breathlessness. The medical team diagnosed her as having an acute asthma attack. During your assessment you note the following:
She is receiving oxygen therapy with a Venturi facemask at FiO2 0.4.
Vital signs: heart rate 95bpm, respiratory rate 24 breaths per minute, blood pressure 95/65mmHg
ABG: ph7.34, PaCO2 46mmHg, PaO2 75mmHg, HCO3 24mmol/L, BE 0.5, SaO2 85%
Auscultation of her chest wall reveals a high pitched-wheeze over all lung segments.

1.2 Analyse and interpret the ABG of Ms Singh. (5)

A

ph slight acidosis
paco2 46 slight increase
hco3 N
pao2 75 on o2 moderate hypoxia

36
Q

1.1 Define class 4 breathlessness. (1)

A

symtoms of brealthesness at rest

37
Q

1.4 Document the CXR features that is associate with hyperinflation. (3)

A

-flattened hemidiaphragmatic contours
-air trapping
presence of air below the heart
increased ap diameter of the chest barrel chest

38
Q

Ms Singh was admitted to the medical ward due to a complaint of class 4 breathlessness. The medical team diagnosed her as having an acute asthma attack. During your assessment you note the following:
She is receiving oxygen therapy with a Venturi facemask at FiO2 0.4.
Vital signs: heart rate 95bpm, respiratory rate 24 breaths per minute, blood pressure 95/65mmHg
ABG: ph7.34, PaCO2 46mmHg, PaO2 75mmHg, HCO3 24mmol/L, BE 0.5, SaO2 85%
Auscultation of her chest wall reveals a high pitched-wheeze over all lung segments.1.5 Explain the treatment that you will implement to address Ms Singh’s breathlessness. (8)

A
  1. breathing retraining exercises- to normalize breathing patterns by stabilising respiratory rate and increasing expirory airflow,= breathing control using diaphragmatic breathing
    2-relaxed breathing positions
    3.physical training to increase cadriorespiratory performance and increase fittness
    4.resp muscle training
  2. removal of secreations
    6.education
39
Q

Ms Singh was admitted to the medical ward due to a complaint of class 4 breathlessness. The medical team diagnosed her as having an acute asthma attack. During your assessment you note the following:
She is receiving oxygen therapy with a Venturi facemask at FiO2 0.4.
Vital signs: heart rate 95bpm, respiratory rate 24 breaths per minute, blood pressure 95/65mmHg
ABG: ph7.34, PaCO2 46mmHg, PaO2 75mmHg, HCO3 24mmol/L, BE 0.5, SaO2 85%
Auscultation of her chest wall reveals a high pitched-wheeze over all lung segments.
1.3 Explain her auscultation findings. (3)

A

she has high pitched wheezing which inticate a bronchospasm, since there is tubulent airflow through the narrowed airways and the high pitch indicates near toatal obstruction

40
Q

Mr Wes was admitted to the surgical ward following a posterior lateral thoracotomy at his right chest wall. The thoracotomy was performed to stabilise a flail rib segment with internal fixation. Mr Wes is now day one post-operatively and the surgeon has requested that the patient should be mobilised out of bed.

2.1 Define a flail segment of the chest wall. (4)

A

flail chest= mutliple adjacent ribs are fractures in multiple places seprating a segment which is fee-floating and moves indepently
paradoxical breathing could be observed at the flail seg during breathing
will have pulmary contutions

41
Q

Ms Swanepoel was referred for pre-operative assessment at the out-patient physiotherapy department at CMJAH. She will be undergoing a partial mastectomy in two week time.

Document the parameters to be assessed and outcome measures used to evaluate her baseline upper limb function. (6)

A

shoulder ROM- goniometer to measure active and passive forward flex, ab,ir,er,hr
upper limb strength- manual muscle testing, dynamometry, repetition max method
arm function- pt reporeted outcome measure such as disabilities of the arm shoulder hand scale or upperextrimy funtional index

test 1 year 3 (3 decks)

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