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PCE > CardioResp class notes > Flashcards

CardioResp class notes Flashcards

1
Q

What factors dictate the Partial pressure of O2 in arterial blood?

A
  • Alveolar ventilation
  • Ventilation/ perfusion
  • FiO2
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2
Q

What is the driving force for saturating hemoglobin with O2?

A

PO2 = partial pressure of oxygen in any blood

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3
Q

What are the ways that H+ is removed from the blood?

A
  • respiration

- renal (metabolic) mechanism

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4
Q

Normal ABG ranges?

A 
pH: 7.35-7.45
PaC02: 35-45
HCO3: 22-28
PaO2: 80-100mmHg
SaO2: 95-100%
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5
Q

What is respiratory acidosis?

A

pH decrease
PaCO2 increase
HC03 normal

Ex: lactic acidosis, keteacidosis

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6
Q

What is respiratory alkalosis?

A

PpH increase
CO2 decrease
HCO3 normal

Ex: potassium depletion, Cushing’s syndrome

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7
Q

What is metabolic acidosis?

A

pH decrease
CO2 normal
HCO3 decrease

Ex: hypoventilation, COPD

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8
Q

What is metabolic alkalosis?

A

pH increase
CO2 normal
HCO3 increase

Ex: anxiety, hyperventilation

Respiratory compensation= min- hrs
Renal compensation= 1-5 days

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9
Q

What factors cause impaired oxygenation?

A

aka: low PaO2

  • hypoventilation
  • decreased inspired O2
  • diffusion impairment
  • shunt
  • ventilation perfusion mismatch
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10
Q

NG tube precaution

A

Turn Off if HOB is less than 30 degrees

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11
Q

List effects of Anesthetics

A

Decreases:
- deep breathing, tidal volume, coughing, FRC, increased RR, increased need for appropriate closing volume.

Causes increased:
- infections, secretion retention, atelectasis, WOB, immobility, LOS, but decreased vital capacity

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12
Q

What reflex can be inhibited from Anesthetics?

A

Hypoxic pulmonary vasoconstriction reflex:

- shunting of blood from poor to well ventilated areas, causing V/Q mismatch

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13
Q

Indications for O2 therapy

A
  • SpO2
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14
Q

When to involved an RT?

A
  • O2 >40%

- SaO2

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15
Q

What is a nebulizer?

A

Delivers drug into the airway by a vapor mist

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16
Q

What is FiO2? How does it vary?

A
  • proportion of inspired oxygen
  • room air = 21%
  • varies with breathing pattern, rate and TV
  • 1L/m = FiO2 = 24% (add 4 % per litre)
  • 5L/m = FiO2 = 40 %
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17
Q

What flow rate do you use a simple mask?

A

5-10L/min

FiO2 25-50%

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18
Q

What % of inspiration is controlled by the diaphragm?

A

40%

- two parts: lower 6 ribs + upper 3 Lspine to central tendon

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19
Q

What are the accessory inspiratory muscles?

A
  • SCM
  • Scalenes
  • Pec Minor
  • Parastenal intercostal
  • external intercostal
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20
Q

Expiratory muscles:

A
  • internal intercostals

- all abdominals but mostly TA

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21
Q

Adaptation from inspiratory muscle training

A

Improves:

  • inspiratory mm strength
  • exercise tolerance / decreases dyspnea
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22
Q

Pathophysiology of COPD and results.

A
  • Parenchymal inflammation (emphysema) & decreased recoil
  • Airway inflammation & remodelling

Results in:
- decreased expiratory flow, hyperinflation, gas exchange abnormalities

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23
Q

Signs and symptoms of COPD

A

Signs:

  • airway obstruction
  • Hx of toxin exposure
  • impaired diffusion capacity
  • increased lung volume
  • hypoxemia
  • Anorexia

Symptoms:
- Dyspnea, chronic productive cough, wheeze, fatigue/ weakness

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24
Q

How to test for COPD?

A

Spirometry w/ bronchodilator
- FEV1 decrease
Lung volume and diffusion capacity
CT Scan

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25
Q

COPD management

A
  • smooth mm relaxation: SA & LA beta agonist
  • oral Cortico steroid to reduce airway inflammation
  • exercise
  • O2 therapy
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26
Q

Positioning for respiratory distress

A
  • Head, shoulders down breath in/out of mouth : pursed lip
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27
Q

Differentiate b/w hypoxia and hypoxemia

A

Hypoxia: cells not getting enough O2

Hypoxemia: not enough O2 in blood

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28
Q

Discuss V/Q matching in lung

A 
Apex:
- Large alveoli with poor blood flow = V/Q >1
- PA>Pa>Pv
Mid zone:
- V/Q = 1------ Pa>PA>Pv

Base:
V/Q PvP>PA

29
Q

To optimize V/Q how do u position a patient in unilateral lung disease?

A
  • Bad lung up b/c perfusion is better in the dependent part of the lung.
30
Q

What is ventilation like in restrictive diseases

A

Reduced compliance:

- decrease lung volume causing increase RR + WOB

31
Q

What is the ventilation in obstructive diseases

A

Increased resistance to airflow:
- higher intra pleural pressures are needed to overcome the high airway resistance due to loss of elastic recoil and alveoli destruction

32
Q

What determines the amount of O2 in the blood?

A
  • Hb saturation: Carrying capacity

- SO2: Saturation of Hb with O2 (how much of the carrying capacity is being used)

33
Q

Name 13 secretion techniques

A
  • Cough +/- splint
  • Huffing (forced expiratory technique): 2 reps followed by 3 DB
  • Assisted cough: manual force to xyphoid
  • Active cycle breathing: relax breath, big with hold, relax, huff
  • Vibrations
  • Percussions: see precaution list
  • Rib springing
  • PEP mask: positive expiratory pressure
  • Autogenic drainage: unsticking, collecting, evacuating
  • Postural drainage: special positions
  • exercise:
  • suction:
34
Q

Postural drainage position for: Left upper lobe

A 
Apical segment:
- sitting at 80 degrees
Posterior segment: 
- Incline prone w/ left side partially up
Left lingua:
- decline, supine, left side up a bit
35
Q

Postural drainage position for: Left lower lobe

A 
Superior (apical) segment:
- Flat, prone, pillow under belly
Anterior segment:
- Decline, supine
Posterior segment:
- decline prone, pillows under hips
Lateral segment:
- decline, side lying
36
Q

Postural drainage position for: Right upper lobe

A 
Apical:
- sitting at 80 degrees
Anterior:
- flat supine, hips ER
Posterior:
- flat, prone, pillow under chest
37
Q

Postural drainage position for: Right middle lobe

A

Middle lobe:

- decline, supine, right side up a bit

38
Q

Postural drainage position for: right lower lobe

A 
Superior:
- flat, prone, pillow under belly
Anterior segment:
- decline supine
Posterior:
- decline, prone, pillow under hips
Lateral segment:
- decline, side lying
39
Q

What are the pressure requirements for suctioning

A

Adults: 120-150 mmHg
Children: 80-120 mmHg
Infant: 60-80 mmHg

40
Q

What are the indications for suctioning

A
  • unable to clear secretion
  • loss of airway control
  • lung pathologies
  • need a sputum sample
41
Q

Contraindications to nasopharyngeal suctioning

A

Bleeding

  • epiglottis or croup
  • acute head or facial injury
  • CSF leakage
  • Nasal stenosis/ infection/ polyps
42
Q

Define lung compliance

A

Ability of lung to stretch during a change in volume

43
Q

What is atmospheric pressure

A

At sea level 760 mmHg

44
Q

What is intrapulmonary pressure

A
  • pressure in the alveoli of the lungs

- Rises and falls with patterns of breathing but always equalizes itself with atmospheric pressure

45
Q

Define Intrapleural pressure

A
  • pressure within pleural cavity

- fluctuates with breath but always ~ 4 mmHg

46
Q

What is transpulmonary pressure

A

Difference between intrapulmonary and intra pleural pressure
- keeps the lungs from collapsing

47
Q

List different breathing exercises

A
  • Diaphragmatic: belly breathing
  • Diaphragmatic plus hold: prevents atelectasis, increases diffusion time
  • lateral costal breathing: lower lung zones, cue with hands
  • pursed lip breathing: expiration 2x inspiration
  • Segmental breathing: use tactile and pressure cues
  • Incentive Spirometry: sustain for 3 seconds, no evidence
  • breath stacking: when deep breathing is too painful
  • SOS for SOB
  • Rib springing:
48
Q

How does a BODE index score relate to COPD

A 
Score of 7+ = very poor prognosis
- FEV1
- Distance walked in 6 min (m)
- MMRC dyspnea scale
- BMI
-
49
Q

Aerobic FITT for pulmonary rehab

A

F: 1-2x/day (3-7days/week)

I: Borg 3-5/10 (SpO2 >88%), 50-80 % of 6MWT avg speed

T: intervals

T: large mm groups

50
Q

Resistance FITT for pulmonary rehab

A

KISS: more reps before weights

51
Q

What is EIB

A

Increase in airway resistance following rigorous exercise

- >10% decrease in FEV1 or peak expiratory flow rate occuring maximally at 3-15 to mins after exercise

52
Q

How is EIB diagnosed

A
  • FEV1, PEFR tests
  • incremental exercise
  • saline or mannitol challenge
  • escaping voluntary hyperventilation
53
Q

Signs and symptoms of EIB

A

SOB, dry cough, wheeze, chest congestion/discomfort, fatigue, decreased exercise tolerance

54
Q

What is hyperosmolarity theory for EIB

A

Water loss in the airways causes narrowing of airways and creates a wheeze:
- evaporation of water causes increased osmolarit pay of airway and results in mast cell degranulation and release of brochoconstrictor mediators

  • with colder air there is less H2O which is why it’s more prevalent
55
Q

What are the 3 stages of EIB

A

1) Early:
- most severe, cough ++, after 80% VO2max 3-8 mins

2) refractory period:
- the chemicals that cause EIB get depleted after being released
- allow the inflammation to subside, then u have 3 hrs where no brochospasm will occur.

3) Late phase:
- less severe symptoms may reoccur hours later.

56
Q

Exercise advice for EIB

A
  • Warm up, intervals/ built in rest periods.
  • cover mouth and nose
  • self monitor
  • try baseball, golf, wrestling, avoid swimming and skiing.
57
Q

How to test inspiratory muscles

A

Strength: MIP
Endurance: Threshold trainer

58
Q

IMT FITT prescription

A

F: 4-5 days/week
I: start 9 cm H20 or 25% MIP, progress 5%/week
T: 5-15 min/day, add 1-3min up to ~ 30min
T: threshold type trainer

Monitor: fatigue, HR, BP, dyspnea, SpO2

59
Q

What is bronchopulmonary dysphasia

A
  • chronic lung disease in children

- — Crackles, wheeze, cyanosis, hypoxemia, LRTI, abnormal CXRay

60
Q

What is croup and bronchiolitis

A

Virus produces inflammation and edema of upper airway (croup) and lower (bronchiolitis)
- harsh barking cough, hoarse voice, stridor

61
Q

Common respiratory patterns for ppl with CP

A
  • poorly developed chest or scoliosis
  • diaphragm for breathing and posture
  • chronic hypoventilation
  • inability to take DB
  • ineffective cough
  • low energy/ fatigue
  • risk of aspiration
62
Q

What does respiratory distress look like in kids

A
  • > RR, cyanosis, nasal flaring, grunting, head bob, apnea/ bradycardia, breathing pattern, structural deformities ( pectins excavatum, carinatum [pidgeon chest], scoliosis)
63
Q

Anatomical differences of adult and new born

A
  • different chest shape and structure
  • immature alveoli structure and function
  • Narrow airways
  • nose breathers
  • diaphragmatic breathing only
  • lower TV, higher RR: new born TV= 18-29 mL, adult = 500mL
  • increased WOB
  • infection risk
64
Q

Changes in body and breathing for 6-12 month child

A
  • ribs move downward from intercostal activity / efficient diaphragm
  • increased mm
  • larger lung volumes and airway size: increase TV/ RRdecrease
65
Q

Heart SA

A

Point 1) 5th interspace, 9 cm L of midline
Point 2) 5th rib (SC articulation)
Point 3) between the 2nd interspace at the level of sternum

66
Q

What is IPPA?

A

Inspection:
Palpation:
- chest expansion, tactile fremitis, trachea position, vitals
Percussion:
- normal = resonant, fluid = dull, air = hyper-resonant
Auscultation:
- 6 anterior, 10 posterior
- bronchial = hollow breath/ short pause. Normal over large airways
- Adventitious:
— crackles early = obstruction, late = edema/fibrosis
— wheezes: musical snoring
— stridor: laryngeal/ tracheal obstruction
—Pleural rubs: creaking leather

67
Q

11 steps of reading a CXRay

A

1) is it PA or AP?
2) over or under exposed?
3) satisfactory inspiration (9 ribs post, 6 ant)
4) is patient rotated:
5) is heart enlarged: A/B ratio should be smaller than 50%
6) Silhouette signs:
7) position of mediastinum
8) landmarks of the mediasternum
9) Hila/ fissures normal
10) How are the bones
11) clinical reasoning skills

68
Q

What does atelectasis/ collapse look like on CXRay

A
  • shift of landmarks
  • silhouette signs
  • collapse can look white because there is no air
69
Q

Respiratory mm innervations

A

Inspiration:

  • accessories: C2-4
  • diaphragm : C3-5
  • intercostals : T1-11

Muscles of expiration:
- intercostals: t1-11
Abdominals t6- L1

PCE (9 decks)

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