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SEM2 2024 > Cardio > Flashcards

Cardio Flashcards

1
Q

What are the 6 physio problems for Cardio?

A
  • Impaired A/way clearance
  • Impaired Gas exchange
  • Exercise Tolerance
  • Reduced Mobs
  • Low Lung Vol
  • Dyspnoea
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2
Q

What’s the difference b/n asterisk, clinical signs and contributing factors?

A

*- measurable, expect them to change w/ treatment
CS- maybe measurable or not, difficult to reassess e.g. collapse on CXR
CF- assist in explaining * pathophys., e.g. prolonged bed rest explains reduced mobility

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3
Q

Where do you auscultate anteriorly?

A

1- Below clavicle close to midline, ~T1
2- Under armpit level
3- Lower under armpit, mid-axillary line

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4
Q

Where do you auscultate posteriorly?

A

1- T1 level
2- Inside scapular border
3/4- T10 level, one closer to spine

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5
Q

How many breaths at each auscultation point are required?

A

2

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6
Q

How do you measure degree of inspiration in thoracic Xray?

A

Count no. of ribs above diaphragam, should meet at 5-7 along midclavicular line

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7
Q

Which hemidiaphragm sits higher?

A

Right due to liver

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8
Q

What is consolidation and how does it appear on Xray?

A

Air filled spaces replaced by products of disease e.g. water, pus, blood

White opaque appearance, dark worms, loss of demarcated borders

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9
Q

How does atelectasis appear on Xray?

A

Increased whiteness on affected lobe
Affected areas pulled adjacent structures towards them

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10
Q

What does sailsign indicate?

A

Left lower lobe collapse

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11
Q

How does pneumothorax appear on Xray?

A

Thin white lines parallel to chest

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12
Q

What is subcutaneous emphysema and how does it appear on Xray?

A

Presence of air in soft tissues
Blackened fascial planes within soft tissue, striations of muscles appear

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13
Q

What is pleural effusion and how does it appear on Xray?

A

Fluid b/n visceral and parietal pleura layers
Opaque meniscus (think test tube) and blunting of costophrenic angle

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14
Q

How does congestive heart failure appear on Xray?

A

Pulmonary oedema, fair floss appearance

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15
Q

What is the typical approach for a thoracic surgery?

A

Posterolateral

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16
Q

How does general anaesthesia affect the lungs?

A
  • Decreased FRC
  • Reduced lung compliance
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17
Q

How does postop pain affect recovery?

A

Sympathethic responses- tachy and HTN
Impair Respiratory- weak cough, low tidal volumes
Biggest barrier to early mobs

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18
Q

How does general anaesthesia impact mucociliary function?

A

Paralysed cilia, reduced humidification and thus dried airways, increased secretion viscosity as secretions cannot be cleared

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19
Q

How does general anaesthesia impact atelectasis?

A

Usually tidal volume lies above closing capacity, general anesthesia lowers tidal volume causing it to fall below closing capacity and atelectasis

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20
Q

What is PPC?

A

Pulmonary abnormality that produces disease or dysfunction following surgery

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21
Q

What time period does PPC usually occur?

A

First three days postop

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22
Q

How is PPC diagnosed?

A

Melbourne Group Score, 4 or more clininical, diagnostic or other factors in one day
e.g. ausc, sputum, collapse, WCC, pneumonia

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23
Q

What are some risks for PPC pre, peri and postop?

A

Pre- age, smoking, resp disease, fitness, obesity (all increase closing capacity
Peri- haemorrhage, surgery length
Post- delayed mobs

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24
Q

Where is atelectasis the greatest typically?

A

Regions close to diaphragm

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25
Q

What is acute cardiopulmonary dysfunction and how does it occur?

A
  • Impairment in one or more steps of oxygen transport system
  • Impact of acute illness and prolonged bed rest
  • Incl. CV, resp, MSK and other changes (cognitive, metabolic)
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26
Q

What are the CV aspects of acute cardiopulomary dysfunction?

A
  • Fluid moving from periphery to thorax
  • Impaired blood flow regulation
    Risk of DVT
    Blood viscosity
    Increased filling pressure, reduced cardiac output and cardiac stress
    Increased HR
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27
Q

What are the respiratory aspects of acute pulmonary dysfunction?

A
  • Decreased VO2max
  • Increased WOB
  • Risk of pneumonia and atelectasis
  • Decreased exercise tolerance
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28
Q

What are the MSK aspects of acute pulmonary dysfunction?

A

Reduced muscle mass, tone and strength and endurance

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29
Q

What are the other aspects of acute pulmonary dysfunction?

A
  • Lowered immunity
  • Decreased metabolism and appetite
  • Anxiety and depression
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30
Q

What’s the aim of mobs in acute cardiopulmonary dysfunction?

A
  • Increase ventilation and lung volume
  • Mucociliary clearance
  • CV fitness
  • Reduce cognitive issues and improve psychological wellbeing
  • Optimise independence
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31
Q

What is the rationale behind exercise helping low lung volumes?

A

Exercise increases ventilation of atelectatic regions, inflating more alveoli which will in turn pull open adjacent alveoli

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32
Q

What is the rationale behind exercise for airway clearance?

A
  • Increased ventilation to alveoli, with air going through collateral channels to clear obstructions
  • Also an increased lung volume will increase power of cough
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33
Q

What drop in BP indicates postural hypotension?

A

Greater than 20/10 mmHg drop

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34
Q

What are some signs of postural hypotension?

A

Nausea, dizziness, fatigue, sweating

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35
Q

What are some strategies to manage postural hypotension?

A

Daily sitting, dangling legs and standing

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36
Q

What is the normal range of RR?

A

12-16

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37
Q

What is the normal, precaution and contraindication range of Hb?

A

12-18 g/dl
<10
<8

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38
Q

What pain level is okay to mobilize?

A

Below 7

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39
Q

What are the intensity guidelines for mobs?

A

10-20 beats above resting HR
3-5 on Borg exertion, somewhat hard

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40
Q

In ausc, what does reduced or absent sound indicate?

A

Atelectasis, postop

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41
Q

In ausc, what does fine inspiratory crackles indicate?

A

A/ways opening up

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42
Q

In ausc, what does coarse crackles indicate?

A

Secretions/sputum
May be COPD or pneumonia

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43
Q

In ausc, what does wheeze indicate?

A

Brochnospasm e.g. asthma

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44
Q

What are instructions for ausc?

A

SOOB, breathe in and out through mouther slightly deeper and faster than normal, rest if feeling dizzy, 5-6 breaths at a time

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45
Q

What is the dosage for TEEs?

A

6x6 2-3 times a day

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46
Q

What is the dosage for SMI?

A

2-3 reps

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47
Q

What does open heart surgery on pump mean?

A

Cardiopulmonary bypass, blood is removed, oxygenated and then mechanically pumped back into the aorta

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48
Q

What are the pros and cons of open heart surgery off pump?

A

Less operative time and risk of cerebral emboli

Harder to access posterior heart and maintain haemodynamic stability

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49
Q

What is an example of a peripheral procedure and when is it used?

A

Catheter finds occlusion, inflate balloon to allow reperfusion. Done in STEMI with no comorbidities

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50
Q

What are some surgery requirements for coronary artery bypass grafting?

A

Hypothermia: protect myocardium by reducing O2, rewarmed after surgery
Cardioplegia: induced asystole

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51
Q

What are the considerations for postop support in cardio surge?

A
  • Organ perfusion
  • Minimize cardiac demand
  • Maintain gas exchange
  • Reduce PPC
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52
Q

What are some preop, periop and postop risk factors?

A

Pre- fraility, 65+, low PA
Peri- non-elective, intraoperative bleeding, surgery >4-6 hours
Postop- delirium, delay mobs, ICU LOS >5 days

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53
Q

What does the literature say about UL exercises in cardiac surgery?

A

Less sternal pain post discharge

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54
Q

What does the literature say about moderate intensity exercises in cardiac surgery?

A

Higher function (6MWD) at D/C

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55
Q

What are cardiac surgery sternal precautions?

A
  • Do not lift arms above 90
  • No objects 2kg+
  • Do not reach backwards
  • Do not push through arms

4-6 weeks from time of op

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56
Q

What is temporary pacing?

A

Helps heartbeat go back to regular pace after surgery

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57
Q

How to treat low lung volumes?

A

Mobs
Deep breaths
SMI/TEE
Inspiratory Muscle Training
NIV

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58
Q

How to treat excessive secretions?

A

ACBT
Gravity Drainage
PEP
Flutter
Exercise

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59
Q

How to treat dyspnoea?

A

Relaxation positions
Pursed lip
Breathing control

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60
Q

How to treat exercise tolerance?

A

Prehab, rehab and exercise

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61
Q

How long are SMIs held?

A

3 seconds

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62
Q

What is the physiological explanation of SMI?

A

Expands to TLC, gas enters areas of low lung compliance and re-expand collapsed alveoli
Go through collateral ventilation to clear any secretions

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63
Q

What is the dosage for breathing exercise?

A

5 breaths to TLC/hour

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64
Q

What is the reasoning behind IMT?

A

Strengthen muscles to assist with inspiration

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65
Q

What occurs in respiratory prehab?

A

Education e.g. PPC
Explain postop mobility
Teach ACBT

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66
Q

What is the reasoning behind CPAP?

A

Positive airway pressure on insp and exp, keeping air in lungs and increasing FRC

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67
Q

What does high flow O2 allow?

A

Reduced RR
Increased end expiratory and tidal lung volume
Reduced WOB
Improved mucus clearance

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68
Q

Whats a lobectomy and pneumonectomy?

A

Taking out a lobe and taking out a lung

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69
Q

What are the two thoracotomies?

A

Posterolateral- divides lats
Anterior- muscle sparing

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70
Q

What are the adv and dadv of video assisted thorascopy?

A

A- Minimal trauma, option for higher risk pts, less pain
D- takes longer, higher risk pt

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71
Q

What are the three chambers of UWSD?

A

1st- collects fluids
2nd- underneath level of water, controls air unilaterally
3rd- suction, regulates negative pressure

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72
Q

What 4 things in UWSD are Ax?

A

Swing- no swing = all fluid drained or occlusion
Bubbling- air leak
Volume drained
Suction with balloon, should peak out to show adequate suction

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73
Q

What does 1 pack year mean?

A

1 pack a day for a year

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74
Q

Where does oesophageal cancer appear?

A

Generally appear near gastro oesophageal junction or middle and upper oesophagus
Spreads deeper into layers of stomach and then beyond

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75
Q

How is oesophagus cancer treated?

A

Chemoradiotherapy
Oesophagectomy (always on right)

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76
Q

What is the precautions of oesophagectomy?

A
  • No head tip down
  • Avoid neck extension
  • Avoid suction or high PAP
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77
Q

What are common vascular presentations?

A
  • Ulcers
  • Necrosis
  • AAA
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78
Q

What are common surgeries for vascular issues?

A
  • Revascularization (angioplasty balloon dilate, stenting, bypass)
  • Amputation
  • AAA repair
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79
Q

What are considerations for amputation?

A
  • Healing before mobs
  • Prevent contractures (elevate stump, rigid dressing)
  • Phantom limb
  • Impaired balance/falls risk
  • Stump care
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80
Q

How is amputation managed?

A
  • Preop counselling and education
  • Prosthetic training
  • T/F options, avoid hopping
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81
Q

What is the highest priority for vascular surgery postop?

A

Preserve contralateral limb

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82
Q

What areas are the dermatome tests?

A

L1 Lateral groin
L2 Slightly lower
L3 Medial near knee
L4 Medial calf
L5 Lateral anterior
S1 Heel
S2 Popliteal Fossa

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83
Q

What are potential causes of dyspnoea?

A

Resp- pneumonia, atelectasis, COPD
CV- congestive heart failure
Neurological- resp m. weakness
Psychological- anxiety, depression

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84
Q

What are clinical features of dyspnoea?

A
  • Breathing rate
  • Pursed lips
  • Reduced exercise tolerance and communication
  • Fatigue
  • Overuse of accessory muscles => weight loss
  • Panic and anxiety
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85
Q

How should you behave around dyspnoeic pts?

A

Talk quietly, slowly
Yes/no Q’s
Do not make dyspnoea worse

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86
Q

What is the modified Borg?

A

Measures shortness of breath 1-10

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87
Q

What positions help dyspnoea?

A

Tripod- fix shoulders reverse attachment, employs accessory muscles
Forward lean- hands on either side of table, relax shoulders, contraindicated for back issues
Supported lean- anchor chest to hard surface allows postural muscles to relax, conta for balance
High side lying- push up abdominal content, diaphragm in better position, for sleep

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88
Q

What is the rationale of pursed lip breathing and the dosage?

A

PEP splints open airways, prevents gas tapping
2 s inhale, 4 s exhale

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89
Q

What’s the rationale behind pulmonary rehab?

A
  • Less ventilation for same work
  • Reduced hyperinflation
  • Improved overall body funcitoning
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90
Q

What are normal values for ABG?

A

pH 7.35-7.45
CO2 35-45
O2 80-100
HCO3 22-26

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91
Q

What distinguishes respiratory and metabolic acidosis/alkalosis?

A

Acidosis- resp acidotic CO2
metabolic acidotic HCO3

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92
Q

When is O2 therapy required?

A
  • Hypoxaemia/hypoxia
  • Resp distress
  • Cardiac arrest
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93
Q

Distinguish between hypoxaemia and hypoxia?

A

Hypoxaemia- low O2 in blood
Hypoxia- low O2 in tissue

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94
Q

Distinguish between Flow and FiO2

A

FiO2- concentration of O2 that a person inhales
Flow- steady continuous supply

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95
Q

What is peak inspiratory flow demand?

A

Maximal inspiratory flow required during tidal breathing
Normal 25-35 L/min

96
Q

How do you work out average FiO2?

A

Av FiO2 = FiO2/PIFD

97
Q

What does high flow mean?

A

Matching or exceeding PIFD

98
Q

Distinguish between variable and fixed performance devices

A

Variable- flow less than patients minute volume, vary with rate and volume of breath
Fixed- known concentration of O2 at a higher flow rate

99
Q

What is a standard variable O2 therapy?

A

Nasal prongs
Hudson mask- min 6L/min

100
Q

What is a standard fixed O2 therapy?

A

Venturi- humidified, <15L/min

101
Q

What is a fixed high flow O2 therapy?

A

AIRVO- humidified, 2-60 L/min

102
Q

What are signs of COPD?

A

Barrel chest
Wheeze
High RR
Tachycardia
Fatigue

103
Q

What is a physios’ role in COPD?

A
  • Pulmonary rehab
  • Breathing exercise
  • A/way clearance
  • Manage exacerbation
104
Q

What are causes of ILD?

A

Infection/virus
Occupation exposure
Radiation
Mostly idiopathic

105
Q

What are features of ILD?

A

Dypsnoea on exertion
Dry cough
Fatigue

106
Q

How is ILD treated?

A
  • Pulmonary rehab
  • Anti-fibrotics
  • Smoking cessation
  • Breathing exercise
107
Q

What is Equal Pressure Point and why is it relevant?

A

Point at which pressure in pleura is higher than that in alveoli, compressing airways
This is the rationale for FET moving secretions

108
Q

When is each phase of AD progressed?

A

3 breaths, 3 huffs
ERV, move when crackles at end of expiration
TV, prolonged crackles
IRV, coughing

109
Q

What are contra for GAD?

A

Post eating
Reflux
Head or neck surgery

110
Q

What is the rationale behind high flow?

A

Reduce physiological dead space
Reduced WOB
Humidification

111
Q

Why is humidification needed in high flow?

A
  • Inhalation of dry gas reduces humidity
  • Prevents drying of sputum
112
Q

What is type I and II respiratory failure?

A

I- Hypoxaemia PaO2 <60
II- Hypoxaemia and hypercapnia PaCO2 >45 PaO2 <60

113
Q

What is the rationale of CPAP?

A

Treats Type I respiratory failure, positive pressure on insp and exp
Collateral ventilation, opens alveoli, increasing FRC, increased gas exchange

114
Q

Who should receive CPAP?

A

Postop
Immobilized
Chest wall abnormalities

115
Q

What are precautions/contra of CPAP and BiPAP?

A

Oesophageal surgery
Vomiting
Prescence or risk of pneumothorax
Facial trauma/burns
Facial Fracture

116
Q

What is the rationale of BiPAP?

A

Treat Type II respiratory failure, PAP throughout but different levels of pressure with exp lower than insp
Lower PaCO2 by increasing tidal volume
Lower WOB
Lower RR, longer expiration

117
Q

Who should receive BiPAP?

A

Hypercapnic- COPD, bronchiectasis, CF

118
Q

What are the three types of bronchiectasis?

A

Cylindrical- enlarged and cylindrical
Irregular- some dilated some constricted
Saccular- clusters or cysts

119
Q

What is the pathophys of bronchiectasis?

A

Infection (potentially from COPD or CF) -> Inflammation -> Airway Damage (elastic and muscular tissue, high mucus production) -> Impaired Clearance -> Infection

120
Q

What are features of bronchiectasis?

A

Fatigue
Cough
Chest pain
Dyspnoea

121
Q

How is bronchiectasis Ax?

A

Spirometry
Sputum
ABG
Imaging

122
Q

How is bronchiectasis Mx?

A
  • Antibiotics, bronchodilators, mucolytics
  • A/way clearance lit
  • Pulmonary rehab lit
123
Q

What is the rationale of PEP?

A
  • Breath towards a resistor, positive pressure
  • Increase FRC, slightly larger insp volumes
  • Elastic recoil increases and uses collateral ventilation to get behind secretions
124
Q

What is dosage of PEP?

A

6x6, 6 breaths followed by FET and cough
2-3 s in, hold 1-2, out 3-4s

125
Q

What are precautions for PEP?

A

Facial #
Pneumothorax
Post lung lobectomy

126
Q

What is Hi PEP?

A

Same equipment with mask but 8-10 breaths, FET against mask

127
Q

What benefit does OPEP have?

A

Creates vibrations, further mobs of secretions

128
Q

How is bottle PEP set up?

A

10-12 cm deep (threshold resistance), tube cannot touch bottom

Water discarded after each treatment, wash bottle

129
Q

How can exercise act as an ACT?

A
  • Increases RR, recruitment of lung units
  • Increase flow speed, more sheering
130
Q

How does CF occur?

A

CFTR mutation

131
Q

What is the pathophys of CF?

A
  • Mucociliary escalator impaired, cannot clear mucus
  • Infection
  • A/way damage
  • Further impaired cilia Fx and destruction
132
Q

What are the features of CF?

A
  • Chronic cough
  • Dyspnoea
  • Haemoptysis
  • Coarse insp crackles
  • Reflux
  • MSK pain
133
Q

How is CF managed?

A
  • ACBT, PEP, AD, GAD
  • Exercise, strength, fitness, spinal mobility
  • MSK Mx, posture advice, weight bearing activity
  • Mucolytics
  • Pelvic floor strength/endurance for continence
134
Q

How can you adapt Rx in CF children?

A
  • Less percs and vibes
  • Assisted AD
  • Creative to keep engaged
135
Q

What is dosage of IMT?

A

2 X 15
Aim 20mmHg

136
Q

What is the pathophys of diastolic and systolic heart failure?

A

Diastolic- too little blood into stiff ventricles, barely filled thus little blood pumped out, stretch stimulus encourages hypertrophy
Systolic- filling enlarged ventricles, not enough pressure to pump out blood

137
Q

How is heart failure Mx?

A
  • Pharmaco, ACE, beta blockers
  • Life style, salt intake, weight, diet
  • Pacemaker
  • Exercise, no guidelines, early ambulation in stable pts, reduced LOS and readmission
138
Q

Describe the phases of cardiac rehab

A

Phase 1: inpatient, 1-3 times daily 5-20 min, resting HR +20, 3-4/10 Borg
Walking, stationary cycling, prevent PPC

Phase 2: outpatient 4-12/52,
5-7 times/week, moderate intensity, 60 min
Max exercise capacity
Ax, education, nutrition

Phase 3: LT maintenance, behaviour change

139
Q

What are the benefits of HF exercise?

A
  • Improve QoL
  • Increase VO2 Max (associated with survival
  • Reduce fatigue
  • Improve dyspnoea
140
Q

How do you prescribe aerobic intensity for walking?

A

80% x (6MWT distance/ 6x prescribed duration)
e.g. 220m 6MWT, 36.7m in 1min
30 min distance 1101m
80% of 1101m = 881 m in 30 min

141
Q

How do you prescribe aerobic intensity for treadmill speed?

A

Speed= 80% 6MWT average speed

e.g. 300 m in 6min, 0.3 km in 0.1 hr = 3km/hr
80% of 3= 2.4km/hr

142
Q

What is the dosage for resistance training 0-4 weeks post surgery/HF and 4+ weeks?

A

0-4: 12-15 reps, 1-3 RPE
4+: 8-12 reps, <5 RPE

143
Q

How do you determine target HR?

A

THR = ((max HR - resting HR) x intensity) + resting HR

Max HR 220-age

THR = ((197- 50) x 50%) + 50
THR = (147 x 50%) + 50
= 73.5 + 50 = 123.5

144
Q

What are indications to stop exercise?

A
  • Excessive sweating
  • Palpitations
  • Dizziness, breathlessness
  • Physical inability to continue
145
Q

What are the five malignancy types?

A

Carcinomas- epithelial
Sarcinomas- muscle/bone
Melanomas- skin
Lymphoma/leukemias- blood cells
Germ cell tumours

146
Q

What are the side effects of cancer surgery?

A
  • Pain
  • Low mobility/Fx
  • PPC
147
Q

What is radiotherapy and its side effects?

A

Electron radiation, free radicals damage cancer cell DNA

Damage to healthy cells and inflammatory response causes
- Fatigue
- Flulike symptoms
- Joint stiffness

148
Q

What is chemo and its side effects?

A

Chemical substances that interfere with mitosis
- Anaemia
- Fatigue
- Nausea
- Cognitive problems

149
Q

What are cancer guidelines?

A

Moderate intensity 3 times a week for at least 30 min
Resistance at least 2 times a week

150
Q

What are the benefits of exercise in cancer?

A
  • Reduce fatigue, anxiety, depression
  • Prevent deconditioning
  • Increase tolerance to treatment
  • Higher recovery profile

Lit

151
Q

What are precautions for exercise in cancer pts?

A
  • Avoid activities with significant balance and coordination
  • Mild intensity
  • Fatigable pts, break down into smaller parts
152
Q

What are some prehab for cancer exercises and their dosage?

A

Walking, cycling, STS, resistance, inspiratory muscle
4-6 RPE, at least 2 weeks, 4 weeks best

153
Q

What are the aims of pulmonary rehab?

A
  • Reduce symptom burden
  • Increase participation
  • QOL
  • Promote autonomy
153
Q

What are considerations for pulmonary rehab with COPD pts?

A
  • Limited due to dyspnoea, dynamic hyperinflation, resp load, may be deconditioned
  • Improve oxidative capacity, reduce ventilation requirement, reduce hypercapnoea
154
Q

What is the dosage for Phase 2 Pulmonary Rehab?

A

6-12/52
4-5 x week
60 mins
Moderate intensity
Endurance + resistance

155
Q

What are some resistance exercises in pulmonary rehab?

A
  • Leg extension, squat, step ups
  • Abduction, rows
156
Q

What is the dosage for Phase 1 Pulmonary rehab?

A

1-3 x day
5-20 min
Light intensity
Walking, cycling, functional

157
Q

What is a common problem for axilla node dissection pts?

A

MSK dysfunction, pain and numbness

158
Q

What is 1’ and 2’ lymphoedema?

A

1’ excessive accumulation of lymph fluid due to genetic malformation
2’ same but due to damage or destructions of lymph nodes (surgery or cancer)

159
Q

What are some dissection precautions?

A

Limit ROM and WB for LL

160
Q

Why is neuropathic pain seen in neck lymph node dissection?

A

Spinal accessory nerve may have to be sacrificed

161
Q

What are the greatest risk factors for ENT cancer?

A

Tobacco and alcohol

162
Q

What are some complications of flap reconstruction?

A

Ischaemia, haemotoma, infection, wound healing failure

163
Q

What are some considerations for surgeries around the face?

A

Vestibular issues
Facial nerve palsy
Tracheostomy
CSF leak

164
Q

What are some considerations for laryngectomy?

A

Humidification and coughing issues due to absent glottis
Communication

165
Q

What are the 4 categories in the gen med ward?

A

Palliative care- no longer responsive to curative treatment
Acute reversible conditions e.g. pneumonia
Non-acute patients with urgent needs e.g. falls
Exacerbation of chronic disease e.g. COPD

166
Q

What is the main aim in palliative care?

A

Maximize QOL and manage symptoms

167
Q

What are common symptoms in UTIs?

A
  • Dysuria
  • Increase urgency
  • Haematuria
  • Fever
  • Confusion, drowsy, agitated
168
Q

How can physios manage UTI pts?

A
  • Education on IDC (in dwelling catheter)
  • Pelvic floor retraining
169
Q

What are the most common comorbidities?

A

HTN and T2D

170
Q

How are exacerbations managed by physio?

A
  • May alter Fx
  • Smoking cessation
  • Prevent readmission
171
Q

Where does oedema occur in LHF and RHF?

A

LHF- pulmonary
RHF- LL

172
Q

What are some symptoms of cardiac failure?

A
  • Dyspnoea
  • Fine crackless
  • Peripheral oedema
  • Pink, frothy sputum
173
Q

How is cardiac failure managed?

A
  • Diuresis (more urine) and fluid restrictions to lower volume for heart to pu,p
  • Oxygen therapy and NIV to treat hypoxia
174
Q

What is the age that falls risk is significant?

A

65

175
Q

What is functional decline?

A

Decrease in physical/cognitive Fx, less likely to be able to complete ADLs

176
Q

What are adverse outcomes of functional decline?

A
  • Decreased indep
  • Pressure areas
  • Falls
  • Delirium
177
Q

What are the four aspects of functional decline maintenance program?

A

Physical- exercise, mobs
Nutrition
Cognitive- stimulation, prevent decline
Occupational performance- ADLs e.g. showering, feeding

178
Q

What is delirium?

A

Disturbance of consciousness, attention, cognition and perception often caused by trigger

179
Q

How is delirium diagnosed?

A

CAM ICU

180
Q

How can delirium be managed?

A
  • Regular mobs
  • Family visits
  • Reorientation (e.g. room with window for time orientation), reassurance
  • Reduce stimulation and noise
181
Q

What are some outcome measures used in gen med?

A
  • DEMMI
  • mILOA
  • 5x STS
  • SPPB
  • Berg Balance Scale
182
Q

What is PAC?

A

Therapy in home, 1-2 sessions over 4 weeks
Achieve ST goal or gap until community therapy

183
Q

What is rehab in the home?

A

2-5 times per week, 4-12 weeks
ST and LT goals

184
Q

What is commonwealth home support program?

A

65+, low level support
Meals, allied health, domestic assistance, transport

185
Q

What is hospital in the home?

A

Daily visits 2-4 weeks medical and nursing

186
Q

What is subacute@home?

A

Home based alternative to inpatient rehab, daily input but non-intensive therapy

187
Q

What is inpatient rehab?

A

MDT goals, 2 sessions of PT daily, any age

188
Q

What is GEM?

A

MDT goals, slower stream than IPR, 2-5 days a week

189
Q

What is residential care and respite?

A

Resi: high care needs, PT mostly for maintenance
Respite: aims to return home after period of high care need

190
Q

How do neural pathologies affect the respiratory system?

A

Degeneration of neurons may affect diaphragm for inspiration, or glottis and abdominals for cough

191
Q

What is spinal shock?

A

Temporary areflexic state with impaired autonomic control and muscle tone below level of injury

192
Q

What is neurogenic shock?

A

Reduction of thoracic sympathetic innervation resulting in bradycardia and vasodilation

193
Q

What is paradoxical breathing?

A

Flaccid intercostals allow chest wall depression and flaccid abdominals expands stomach out and reduces expiratory force

194
Q

How does a cough assistance machine (in/exsufllator) help resp issues?

A

Positive pressure on insp, volume restoration
Negative pressure on exp, increase exp, sucks out
Begin with low pressure and progress
Expiratory flow can create sheer forces

195
Q

What are precautions for cough assistance machine?

A

Pneumothorax, contra without drain
Bronchospasm
Thoracic, gastric or oesophageal surgery
Contra- active airway obstruction, emphesema

196
Q

What is a nippy?

A

Similar to cough assistance machine, volume restoration and aids sputum clearance

197
Q

What is the positioning for manual assisted cough?

A

Hands over abdomen and chest wall, time compression with exp

198
Q

What are precautions for manual assisted cough?

A

Spinal cord injury, #s, pregnancy, recently eaten

199
Q

What is the carina?

A

Area of nerve fibre in trachea that stimulates cough

200
Q

What are the implications of traches?

A

No air through upper airways
- Loss of voice
- Impaired cough
- Impaired swallow

201
Q

What are indications for suction?

A
  • Moist cough or sounds gurgly
  • Difficulty coughing
  • Decrease in sats
202
Q

When is nasopharyngeal indicated and contraindicated?

A

Central palpable fremitus
Contra- #s, facial trauma, burns

203
Q

How is manual hyperinflation applied?

A

Bag inflates
Compress to coincide with insp
6x6

204
Q

When is ventilatory hyperinflation used over MHI?

A

Avoiding disconnection of ventilation

205
Q

What is a STUMBL score?

A

Predicts outcomes in those with rib #s
Age, number of #s etc.

206
Q

What is flail chest?

A

Floating segment of thoracic cage due to fractures, sucked in during insp, blown out during exp

Reduces TV, increases RR and WOB

207
Q

How is rib # managed?

A
  • Analgesia
  • Fixation
  • Oxygen therapy
  • Mobs
208
Q

What is a pulmonary contusion and its consequences?

A

Injury to lung parenchyma in absence of any lung tissue or vascular laceration
- atelectasis, bronchial obstruction, decreased compliance and FRC, increased WOB

209
Q

What is pneumothorax?

A

Air in pleural space
Can decrease lung volume and collapse lung impair gas exchange

210
Q

How is PTx managed?

A
  • ICC
  • Pleuroextomy
211
Q

What is pleural effusion and how is it managed?

A
  • Fluid in pleural space, decreases chest movement, decreased breath sounds
  • ICC, surgery
212
Q

How does spinal cord injury affect resp?

A

Decreased ability to breathe deeply and cough forcefully, paradoxical breathing

213
Q

What are treatments for spinal cord injury resp pts?

A
  • Manual assisted cough and insufflation-exsufflation
  • NIV
  • Abdominal binders
  • Resp muscle training
213
Q

What is shock?

A

Imbalance between oxygen supply and demand

214
Q

What is sepsis?

A

Vigorous inflammatory response to infection, can progress to septic shock where blood pressure drops and lactate rises which is life threatening

215
Q

What is ARDS?

A

Collection of symptoms involving refractory hypoxemia and pulmonary oedema

216
Q

What is ECMO?

A

Life support, external pump and oxygenator

217
Q

What is continuous renal replacement therapy?

A

Dialysis, filters blood

218
Q

What is evidence for hyperinflation?

A

Helps atelectasis, lung compliance and gas exchange

219
Q

What is a MET call and when is it called?

A

Pt fulfils one or more predefined criteria
e.g. HR <40, >130, RR <8, >30

220
Q

Why is proning performed in the ICU?

A

Gets air into posterior of lungs

221
Q

What is the RIKER scale and what does it measure?

A

1-7- unarousable to dangerous agitated
4- calm, cooperative
Agitation and alertness

222
Q

What is the RASS scale and what does it measure?

A

+4 Combative to -5 Unarousable
0 Alert and calm
Agitation and alertness

223
Q

What are the 5 commands of De Jonghe and what does it measure?

A

Open (close) eyes
Look at me
Open mouth stick out tongue
Nod
Raise eyebrows when I reach 5

Alertness

224
Q

When is the day of awakening?

A

When pt responds to 3/5 of De Jonghe on 2 consecutive tests in 6hour period

225
Q

What are the 4 aspects of CAM ICU?

A
  • Any changes from baseline, no, no delirium
  • SAVEAHAART, squeeze hand when I say ‘A’, 0-2 errors no delirium
  • RASS, other than 0, no delirium
  • Disorganized thinking , 0-1 error, no delirium
226
Q

What are the 4 questions of disorganized thinking in the CAMICU?

A
  • Does a stone float on water
  • Are there fish in the sea
  • Does one pound weigh more than two pounds
  • Can you use a hammer to pound a nail
227
Q

What are the aspects of PFIT?

A

Assistance STS
Cadence
Sh F Grade
Kn E Grade

ACSK

228
Q

What is ICU acquired weakness?

A

Detectable weakness developed in critical pt with no indentifiable cause

229
Q

What is a sign of ICU AW?

A

<11 kg male grip strength
<7 kg female grip strength
<48/60 MMT

230
Q

What movements are assessed in ICU AW MMT?

A

Sh Ab
Eb F
Wr F
Hp F
Kn E
DF

231
Q

What is Post Intensive Care Syndrome?

A

Series of health problems following ICU stay

232
Q

What are risk factors for PICS?

A
  • Prolonged MV
  • Sepsis
  • Prolonged bed rest
  • ARDS
  • Delirium
  • 50+
  • Trauma
  • HTN
233
Q

What is the % of ICU survivors who experience PICS?

A

80%

234
Q

What are recommendations for ICU exercise?

A

Early mobs, <72 hours of ICU admission
Break up sedentary time
Bed exercise

SEM2 2024 (4 decks)

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