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Clinical Nursing May Exam > Cardiorespiratory > Flashcards

Cardiorespiratory Flashcards

1
Q

state the function of the heart

A

pump blood around the body

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2
Q

list the phases of heart contraction

A

systole

diastole

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3
Q

what is sytsole?

A

relaxed phase

filling of the heart

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4
Q

what is diastole?

A

contracted phase

pumping out blood

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5
Q

state normal dog HR

A

60-180bpm

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6
Q

state normal cat HR

A

120-240bpm

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7
Q

what are congenital heart diseases?

A

abnormalities of heart development

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8
Q

list some congenital heart diseases

A

aortic stenosis
patent ductus arteriosus
pulmonic stenosis
ventricular septal defect

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9
Q

list some acquired heart diseases in dogs

A

myxomatous mitral valve disease
dilated cardiomyopathy
pericardial effusion

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10
Q

state an acquired heart diseases in cats

A

hypertrophic cardiomyopathy

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11
Q

define arrhythmia

A

heart rhythm abnormality

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12
Q

how can history help diagnose cardiac disease?

A 
incidental findings of murmurs or arrhythmia
exercise intolerance
syncope
weakness
heart failure
sudden death
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13
Q

define syncope

A

fainting

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14
Q

what are signs of left sided heart failure?

A

tachypnoea

dyspnoea

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15
Q

what are signs of right sided heart failure?

A

difficulty breathing

distended abdomen

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16
Q

what is assessed in physical exam for cardiac assessment?

A 
body condition
MM
CRT
jugular veins- if visible or pulsing
peripheral pulses
RR
HR
murmur grade
lung sounds
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17
Q

what is RR in CHF?

A

35-40brpm

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18
Q

what is seen in grade 1 heart murmur?

A

quiet

needs time to localise

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19
Q

what is seen in grade 2 heart murmur?

A

quieter than heart sounds

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20
Q

what is seen in grade 3 heart murmur?

A

as loud as heart sounds

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21
Q

what is seen in grade 4 heart murmur?

A

louder than heart sounds

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22
Q

what is seen in grade 5 heart murmur?

A

very loud with precordial thrill

feel with hand

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23
Q

what is seen in grade 6 heart murmur?

A

very loud

audible thrill without stethescope

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24
Q

list typical findings in heart failure

A 
weak peripheral pulses
tachycardia
pale MM
long CRT
weakness
murmur
exercise intolerance
arrhythmia
right or left sided congestion
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25
define congestion
blood not pumped forward fast enough
26
what the difference between left and right sided congestion?
left- lungs | right- systemic
27
what are signs of left sided congestion?
pulmonary oedema tachypnoea dyspnoea cough
28
what are signs of right sided congestion?
distended peripheral veins ascites pleural effusion
29
define ascites
fluid in abdomen
30
define cardiac cachexia
loss of lean muscle mass
31
what blood tests can help diagnose cardiac disease?
haematology for systemic disease or anaemia biochemistry for kidney values and electrolytes cardiac biomarkers for cardiac cell damage and myocardial stretch
32
what is the consequence of hypertension in heart disease?
increased cardiac workload which can progress the disease
33
what is significant about hypotension in heart failure?
suggests decompensation
34
what is the purpose of ECG in diagnosing cardiac disease?
characterise auscultatory findings indicate treatment and prognosis monitor progression or response to treatment
35
what is the purpose of 24 hour ECG for diagnosing heart disease?
investigate intermittent arrhythmia determine cause of syncope etc monitor response to antiarrhythmic therapy
36
when are thoracic radiographs indicated for diagnosing cardiac disease?
cough tachypnoea dyspnoea
37
what views are taken for imaging of heart disease diagnosis?
right lateral | dorsoventral
38
what is seen on imaging of congestive heart failure?
pulmonary oedema | distended pulmonary veins
39
what can be seen on radiographs with lung pathology present?
pneumonia | neoplasia
40
what is seen on imaging with cardiomegaly?
vertebral heart size in dogs over 10.7 and cats over 8 elevated trachea increased sternal contact
41
what is meant by stenosis?
narrowing
42
what are the types of stenosis?
subvalvular valvular supravalvular
43
how is stenosis diagnosed?
ECG
44
what type of stenosis is aortic and what are the consequences?
subvalvular | left ventricular hypertrophy, left sided congestive heart failure
45
what type of stenosis is pulmonic and what are the consequences?
valvular | right ventricular hypertrophy, left sided congestive heart failure
46
state clinical signs of stenosis
``` asymptomatic arrhythmia exercise intolerance syncope congestive heart failure ```
47
how is stenosis treated?
beta blockers balloon valvuloplasty for pulmonic treat congestive heart failure
48
describe what is meant by patent ductus arteriosus
failure of ductus arteriosus to close when first breaths are taken so blood flows from aorta to pulmonary artery
49
what should the ductus arteriosus become after birth?
ligamentum arteriosum
50
list signs of patent ductus arteriosus?
loud continuous murmur in left heart base exercise intolerance pale MM
51
how is patent ductus arteriosus usually diagnosed?
incidental finding ECG ultrasound
52
what is prognosis for patent ductus arteriosus?
good if successful closure | can cause congestive heart failure if untreated
53
how is patent ductus arteriosus treated?
interventional closure surgical ligation treatment of congestive heart failure limit stress and exercise
54
where are ventricular septal defects usually found?
upper septum below aortic valve
55
what are signs of ventricular septal defects?
right sided systolic murmur | small defects loud and large defects small
56
how is ventricular septal defects diagnosed?
ECG
57
what is treatment for ventricular septal defects?
none needed usually | heart failure treatment as needed
58
what is prognosis for ventricular septal defects?
normal life if small defect
59
what is signalment for myxomatous mitral valve disease?
hereditary idiopathic small breed dogs adults
60
which valves are affected by myxomatous mitral valve disease?
mitral | tricuspid
61
how is myxomatous mitral valve disease diagnosed?
ECG | look at signalment
62
describe myxomatous mitral valve disease
valves thicken so blood regurgitates left ventricle and atrium dilate valves prolapse
63
what is the sign of myxomatous mitral valve disease?
left sided apical systolic heart murmur
64
how does myxomatous mitral valve disease progress?
slowly with long asymptomatic period | can progress to left sided congestive heart failure
65
how is myxomatous mitral valve disease treated?
medication when non-symptomatic check for progression treat CHF diet providing enough calories for prevention of cardiac cachexia
66
what is signalment for DCM?
idiopathic hereditary large breed dogs adults
67
what are signs of DCM?
``` left apical systolic murmur left ventricular dilation decreased systolic function arrhythmia lethargy coughing anorexia tachycardia ```
68
how is DCM diagnosed?
ECG BP monitoring thoracic radiographs
69
how is DCM treated?
pimobendane to increase contractility and vasodilation low sodium diet taurine supplements
70
what is prognosis for DCM?
long asymptomatic period rapid progression to arrhythmia congestive heart failure sudden death
71
state causes of pericardial effusion
idiopathic neoplasia large breed adult dogs
72
what is the consequence of pericardial effusions?
fluid causes tamponade decreased CO right sided heart failure
73
why does pericardial effusion cause right not left sided heart failure?
right is lower pressure than left
74
what are signs of pericardial effusion?
right sided heart failure lethargy vomiting exercise intolerance
75
how is pericardial effusion diagnosed?
ECG
76
how is pericardial effusion treated?
pericardiocentesis
77
how is pericardiocentesis carried out?
``` sedation left lateral recumbency visualise with ECG use large catheter measure amount drained and submit for cytology and culture ```
78
what us prognosis for pericardial effusions?
idiopathic responds well to treatment | poor if neoplasia
79
what are causes of hypertrophic cardiomyopathy?
genetics | adult onset
80
what is the consequence of hypertrophic cardiomyopathy?
impaired filling as increased myocardial thickness
81
what are symptoms of hypertrophic cardiomyopathy?
``` anorexia lethargy weak pulses difficulty breathing crackles on breathing exercise intolerance aortic thromboembolism ```
82
how is hypertrophic cardiomyopathy diagnosed?
ECG | incidental findings of heart murmur, gallop
83
what are signs of aortic thromboembolism?
sudden lameness cold leg peripheral cyanosis pain
84
what is prognosis of hypertrophic cardiomyopathy?
depends on severity
85
how is hypertrophic cardiomyopathy treated?
medication to manage rhythm and thickening of heart wall
86
what are causes of heart failure?
disease progression decompensation of stable heart failure compromised cardiac filling
87
what are the consequences of heart failure?
``` reduced CO tachycardia slow CRT hypothermia bradycardia easy decompensation ```
88
how is heart failure treated?
``` furosemide spironolactone limit stress oxygen pimobendan to increase contractility water to prevent AKI ```
89
what is ideal RR and BP for patients with heart failure?
RR- less than 40brpm | BP- over 100mmHg systolic
90
what are signs of improvement for patients with heart failure?
decreased RR and HR | improved pulses and CRT
91
how are arrhythmias assessed?
``` ECG HR sinus complexes regularity timings ```
92
what heart conditions can cause bradycardia?
atrial standstill AV blocks sick sinus syndrome
93
what diseases can cause tachycardia?
supraventricular atrial fibrillation ventricular arrhythmia ventricular premature complexes ventricular tachycardia
94
define fibrillation
lack of contraction
95
what are signs of atrial fibrillation?
HR 210 irregular rhythm no P waves
96
list components of URT
``` nasal cavity tongue soft palette oral cavity pharynx larynx trachea ```
97
list components of LRT
trachea bronchus bronchiole alveoli
98
what is acute respiratory failure?
lungs cant oxygenate blood or exchange CO2 | emergency
99
what are causes of acute respiratory failure?
``` airway obstruction ruptured diaphragm pulmonary oedema pneumo, heamo, pyo, chylo thorax neoplasia infection intoxication ```
100
list signs of acute respiratory failure
``` cyanosis dyspnoea tachypnoea orthopnoea tachycardia collapse ```
101
what is orthopnoea?
posture to aid breathing | elbows abducted and neck extended
102
how can oxygen be provided to conscious patients?
flow by nasal prongs face mask oxygen tent
103
how should oxygen be provided to unconscious patients?
ETT
104
how is airway maintained in unconscious patients?
ETT head and neck extended tracheostomy tube
105
what are consideration for nursing acute respiratory failure pateints?
``` oxygen monitoring medications recumbency care exercise feeding barrier nursing if needed ```
106
list signs of conditions of URT
``` nasal discharge sneezing stertor systemic signs CNS signs ```
107
what is assessed in URT physical exam?
``` noise nasal discharge pain facial deformity nasal depigmentation airflow lymph nodes dental disease ophthalmic disease ```
108
what are the different causes of nasal diseases?
``` inflammatory infectious neoplasia trauma foreign body systemic causes other ```
109
what are systemic causes of nasal disease?
coagulopathy hyperviscosity syndrome systemic hypertension
110
what are other causes of nasal disease?
``` dental disease oronasal fistula polyps stenosis BOAS ```
111
what are investigations for nasal disease?
``` bloods test for bleeding disorders serology viral testing GA for full oral exam and nasopharyngeal swab imaging endoscopy biopsy rhinoscopy ```
112
what are considerations for rhinoscopy?
need GA painful bleeding
113
what is nursing care for nasal disease patients?
``` treat dyspnoea remove foreign objects monitor fluids and food remove discharges decongestant therapy isolate if infectious ```
114
what are the two types of aspergillosis?
sinonasal | sinoorbital
115
what type of dogs are predisposed to sinonasal aspergillosis?
meso and dolichocephalics
116
what predisposes to sinoorbital aspergillosis?
brachycephalics
117
what are clinical signs of aspergillosis?
``` mucopurulent nasal discharge epistaxis sneezing pain nasal depigmentation ```
118
how is aspergillosis diagnosed?
``` serology PCR imaging rhinoscopy cytology histopathology fungal culture clinical suspicions ```
119
how does imaging help show aspergillosis?
see turbinate destruction | increased soft tissue opacity and density
120
how is aspergillosis treated?
endoscopic debridement | topical antifungal
121
what is meant by BOAS?
group of conditions resulting from poor breeding and body conformation of dogs with short noses
122
what are BOAS abnormalities?
``` excess soft tissue in skin and airways stenotic nares elongated soft palette hypoplastic trachea enlarged tonsils stertor stridor ```
123
how do BOAS patients compensate?
harder insiratory pull causing negative pressure in neck and chest
124
what are potential consequences of BOAS compensatory mechanisms?
secondary respiratory and digestive problems laryngeal collapse hiatal hernia
125
how does BOAS present?
``` loud breathing snoring heat and exercise intolerance sleep deprivation gagging vomiting and regurgitation ```
126
how is BOAS diagnosed?
``` physical exam history fluroscopy barium swallow CT of head and neck chest xrays ```
127
what is nursing considerations for BOAS patients?
``` owner education discourage breeding keep low stress avoid excess heat harness not collar ideal body weight managed careful exercise oxygen ```
128
how does laryngeal paralysis present?
``` exercise intolerance soft cough inspiratory stridor can be emergency dysphonia dysphagia cyanosis collapse ```
129
what are causes of laryngeal paralysis?
congenital trauma nerve infiltration older large breed dogs
130
how is laryngeal paralysis diagnosed?
laryngeal exam under sedation or GA
131
what are nursing considerations of laryngeal paralysis patients?
``` keep calm nothing around neck keep cool oxygen monitor for aspiration pneumonia, dysphagia, megaoesophagus steroids to reduce laryngeal oedema ```
132
what are predispositions for tracheal collapse?
small breeds | obesity
133
where do tracheal collapses normally occur?
thoracic inlet
134
how does tracheal collapse present?
goose honking cough
135
how is tracheal collapse diagnosed?
physical exam x-ray fluroscopy
136
what are nursing considerations for tracheal collapse patients?
``` sedation corticosteroids bronchodilators restricted exercise harness oxygen intubate if needed weight loss ```
137
how is tracheal collapse treated?
surgery to place stent
138
define hyperpnoea
increased respiratory effort without dyspnoea
139
define cough
sudden expiratory effort against closed glottis resulting in noisy expulsion of air from lungs
140
what is the aim of coughing?
protective reflex to clear excess secretions or foreign materials
141
where are cough receptors found?
``` large airways nose sinuses pharynx pleura ```
142
describe the cough reflex arc
afferent pathway via vagus nerve to cough centre in medulla | efferent pathway via vagus and phrenic nerve to spinal motor nerves to diaphragm, abdominal walls and muscles
143
what are harmful effects of coughing?
excacerbate airway inflammation and irritation emphysema pneumothorax weakness
144
what are clinical signs of LRT disease?
``` cough tachypnoea dyspnoea exercise intolerance weakness cyanosis syncope ```
145
define dyspnoea
difficulty breathing | increased respiratory effort
146
what are URT causes of cough and dyspnoea?
BOAS laryngeal paralysis kennel cough neoplasia
147
what are LRT causes of cough and dyspnoea?
``` tracheitis tracheal collapse neoplasia bronchitis asthma foreign body pneumonia lung worm pneumothorax pleural effusion ```
148
how are LRT conditions diagnosed?
physical exam thoracic auscultation further investigations
149
what is looked for in physical exam for LRT disease patients?
posture RR effort and rhythm URT noise HR
150
what may be seen on thoracic auscultation for LRT disease patients?
crackles wheezing murmurs
151
what further investigations may be done for LRT disease patients?
``` pathology oxygenation assessment laryngeal exam imaging bronchoscopy BALs ```
152
what equipment should be prepared for LRT disease patients?
``` endoscope sterile saline collection pots mouth gag urinary catheter emergency box ```
153
what are nursing considerations of LRT disease pateints?
coupage to clear lungs careful monitoring observe for complications access to emergency equipment
154
what is canine chronic bronchitis?
chronic bronchial inflammation with over secretion of mucus
155
what are comorbidities to canine chronic bronchitis?
tracheal/bronchial collapse mitral valve disease pulmonary hypertension
156
what predisposes to canine chronic bronchitis?
kennel cough irritants allergens parasites
157
what are the effects of canine chronic bronchitis?
airways obstructed by mucus inflammation of airways bronchomalacia bronchiectasis
158
define brochomalacia
weakened cartilage
159
define bronchiectasis
end stage branchial change
160
list clinical signs of canine chronic bronchitis
``` chronic cough dyspnoea tachypnoea gagging pyrexia if pneumonia crackles and wheezing ```
161
how is canine chronic bronchitis diagnosed?
imaging bronchoscopy BAL
162
what are nursing considerations for canine chronic bronchitis patients?
``` weight management harness avoid irritants to airway glucocorticoids bronchodilators antibiotics if needed inhalational therapy ```
163
what is prognosis for chronic canine bronchitis?
progressive years if well managed can have mitral valve disease or pulmonary hypertension
164
what diseases are on the spectrum of FLAD?
feline asthma | feline bronchitis
165
what is FLAD?
chronic bronchial inflammation with mucus hypersecretion causing bronchoconstriction
166
what is signalment for FLAD?
young to middle aged cats | siamese
167
what are causes of FLAD?
infections allergens and hypersensitivity bronchus obstruction
168
what are clinical signs of FLAD?
``` none cough tachypnoea open mouth breathing cyanosis asthmatic crisis ```
169
how is FLAD investigated?
chest imaging bronchoscopy BAL
170
how is FLAD treated?
``` keep stress free oxygen bronchodilators corticosteroids sedation inhalational therapy ```
171
how is FLAD managed long term?
dust free litter no smoking medication- glucocorticoids and bronchodilators
172
what is prognosis for acute and chronic FLAD?
chronic- good when treated well | acute- fatal if not quickly managed
173
what are some pulmonary parasites?
intestinal worms lungworms heartworms
174
what are clinical signs of angiostrongylus infection?
respiratory disease increased bleeding neurological signs
175
how is angiostrongylus diagnosed?
chest imaging antigen detection PCR faecal smear
176
how is angiostrongylus treated?
moxidection 30 days apart | fenbendazole for 10-20 days
177
what can be reactions following angiostrongylus treatment?
dyspnoea ascites sudden death
178
what is prognosis for angiostrongylus?
depends on clinical signs
179
what are associations with bacterial pneumonia?
abscesses pleural effusions pneumothorax
180
what predisposes to bacterial pneumonia?
chronic bronchitis immunosuppression foreign body aspiration
181
what are clinical signs of bacterial pneumonia?
``` cough dyspnoea tachypnoea exercise intolerance pyrexia lethargy ```
182
how can you diagnose bacterial pneumonia?
neutrophillia neutropenia hypoxia chest imaging
183
how is bacterial pneumonia treated?
``` antibiotics oxygen IVFT nebulisation bronchodilators may need lung lobectomy ```
184
what is prognosis of bacterial pneumonia?
depends on clinical sign severity
185
how do pleural space diseases present?
``` tachypnoea dyspnoea paradoxical breathing muffled lung sounds with effusion absent lung sounds with pneumothorax ```
186
describe how pleural effusions happen
gradual collapse of lungs causes negative intrathoracic pressure to become positive
187
what can be consequences of resolving pleural effusion?
inflammation | pneumothorax
188
what is the result of not treating pleural space disease?
low CO | cardiac arrest
189
list signs of respiratory distress
``` orthopnoea mouth breathing tachypnoea respiratory noises cyanosis restrictive dyspnoea ```
190
list the types of dyspnoea
inspiratory expiratory mixed pattern
191
what causes inspiratory dyspnoea?
``` dynamic upper airway obstruction BOAS polyp foreign body tumour laryngeal paralysis or collapse ```
192
what are signs of inspiratory dyspnoea?
stertor | stridor
193
what causes expiratory dyspnoea?
dynamic lower airway obstruction tracheal collapse bronchial collapse asthma
194
what are signs of expiratory dyspnoea?
wheezes
195
what causes mixed pattern dyspnoea?
``` airway obstruction plueral space disease mass tracheal collapse pneumonia pulmonary oedema ```
196
what are signs of mixed pattern dyspnoea?
shallow breathing reduced lung sounds laboured breathing
197
how is respiratory distress diagnosed?
chest radiographs thoracic ultrasound thoracocentesis fluid analysis
198
define thoracocentesis
aspiration of air or fluid from pleural cavity
199
describe how thoracocentesis are carried out?
clip and scrub around 8th rib | place butterfly needle in cranial aspect of rib
200
why is cranial rib space used for thoracocentesis?
caudal side has nerves and vessels
201
what are complications from thoracocentesis?
pyothorax | pneumothorax
202
how can you treat respiratory distress?
thoracocentesis antibiotics surgery
203
define pneumothorax
air accumulation in pleural space
204
what causes pneumothorax?
``` trauma blebs bullae chronic airway disease iatrogenic ```
205
define bleb
small collection of air between lung and visceral pleura
206
define bullae
lesion on lung that can spontaneously rupture
207
what is seen on physical exam of patients with pneumothorax?
no dorsal lung sounds | hyper resonant percussion
208
how is pneumothorax diagnosed?
radiography | ultrasound
209
how is pneumothorax treated?
rest thoracocentesis oxygen exploratory thoracotomy
210
list nursing considerations for initial treatment of pneumothorax
``` delay diagnosing until stable keep calm or sedate oxygen monitor oxygen saturation prepare for thoracoentesis ```
211
what is general care for patients with pneumothorax?
``` care for drains oxygen monitoring analgesia IVFT treat shock recumbency care ```
212
what are the main issues of BOAS patients?
resistance to airflow in nose laryngeal collapse obstructed or narrowed trachea
213
how are BOAS patients assessed?
``` TPR MM SPO2 clinical signs of BOAS ASA grading ```
214
what are the aims of surgical treatment of BOAS?
increase airway to reduce resistance to airflow
215
what surgical procedures can treat BOAS?
soft palette resection tonsil resection removal of everted laryngeal saccules nostril resection
216
what is pre-surgical prep for BOAS surgery?
``` ASA grading full clinical assessment client discussion full biochemistry and haematology for further risks pre oxygenate before induction IV after pre-med to minimise stress ocular lube intense monitoring thoracic radiographs ```
217
what equipment should be prepared for BOAS surgery?
laryngoscope urinary catheter and rescue ETT to aid intubation ETT suction
218
describe typical positioning of BOAS surgery
sternal with ties to keep mouth open | table tilted in case of regurgitation
219
how is BOAS surgery patients monitored through surgery?
``` SPO2 over 98% capnography for ETCO2 over 35-45mmHg IPPV or mechanical ventilation as needed IVFT if MAP below60mmHg lube throughout ```
220
what are complications following BOAS surgery?
airway swelling vomiting and regurgitation aspiration pneumonia
221
describe considerations when extubating BOAS patients?
``` high risk leave until wont tolerate ETT monitor SPO2 supplement oxygen keep in sternal with head elevated suction available constant monitoring ```
222
what is immediate post op care for BOAS surgery pateints?
quiet environment thermoregulate environment sedate if stressed
223
what is general post op care for owners to know for BOAS surgery patients?
``` harness 6 weeks restricted exercise routine post op checks wet solid food for 6 weeks clear discharge information ```
224
what is laryngeal paralysis?
inability for vocal cords to open in response to exercise and respiratory demands
225
define dysphonia
change or loss of vocal sounds
226
define dysphagia
difficulty eating
227
how are mild cases of laryngeal paralysis treated?
``` anti-inflammatories antibiotics sedatives raised feeding exercise management ```
228
how are severe cases of laryngeal paralysis treated?
unilateral arytenoid lateralisation to tie open left arytenoid cartilage permanently
229
what are post op considerations following unilateral arytenoid lateralisation?
``` soft meals avoid dust raised food and water wound management change in phonation no swimming as aspiration risk ```
230
what is prognosis following unilateral arytenoid lateralisation?
good unless caused by systemic neuromuscular disorder
231
what is an example of congenital palette defects?
clefts to palettes or lips
232
what are signs of congenital palette defects?
difficulty feeding | nasal discharge
233
how are congenital palette defects treated?
surgery to close tissues separating oral and nasal passages
234
what causes and how are acquired palette defects treated?
trauma | primary or secondary closure
235
what causes tracheal collpase?
degeneration of tracheal cartilage rings causing DV collapse
236
state signalment of tracheal collapse
middle aged | small or toy breeds
237
what are signs of tracheal collapse?
dry harsh loud cough stridor build up over time
238
how is tracheal collapse diagnosed?
radiography bronchoscopy fluroscopy
239
how are tracheal collapses graded during bronchoscopy?
I- 25% loss of lumen II- 50% loss of lumen III- 75% loss of lumen IV- 100% loss of lumen
240
list non-surgical management of tracheal collapse
``` weight loss controlled exercise harness avoid smoke corticosteroids if grade 1-2 and young cough suppressants antibiotics steroids bronchodilators ```
241
what is the prognosis following surgery for tracheal collapse?
improved airflow better if less than 6 years old need management after surgery
242
what surgery can be done to treat tracheal collapse?
extraluminal ring prosthesis | intraluminal stenting
243
what are complications of extraluminal ring prosthesis?
laryngeal paralysis dyspnoea vascular damage tracheal ring migration
244
what can be downsides to intraluminal tracheal stenting?
less long lasting if coughing | can get inflammation around trachea
245
how are patients prepared for extraluminal ring prosthesis and intraluminal stenting?
pre-oxygenate careful handling stress free ERP- ventral neck prepared, dorsal recumbency ILS- lateral recumbency, fluoroscopic guidance
246
what is post op care for tracheal collapse surgery?
``` calm quiet cool analgesia oxygen soft food monitoring harness ```
247
what is lateral thoracotomy?
surgical incision between ribs to view one side of thorax
248
when is lateral thoracotomy indicated?
lung lobectomy when torsion, neoplasia, abscessation
249
what is median sternotomy?
surgical incision through sternum to view bilateral thorax
250
when is median sternotomy indicated?
pyothorax mediastinal mass heart surgery
251
what is a tracheostomy?
emergency procedure to bypass nares, pharynx, larynx and proximal trachea when obstructed
252
what are indications for tracheostomy?
``` compromised airway provide airway until obstruction removed laryngeal paralysis BOAS foreign body laryngeal trauma ```
253
what is care for tracheostomies?
24/7 monitoring for issues asepsis maintain airway regular prevention of secretion build up
254
when do tracheostomy tubes need to be checked?
initially every 15 minutes | every 4-6 hours
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when are tracheostomy tubes suctioned?
routinely | if blocked
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how do you suction tracheostomy tubes?
pre-oxygenate use premeasured sterile soft catheter no longer than tip of trach tube once placed turn on suction and move in circular motion withdrawing over 15 seconds
257
when do tracheostomy tubes need to be changed?
if blocked
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why do patients with tracheostomy tubes need humidification?
normal humidification in URT is bypassed | drying can damage mucosa
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how can you provide humidification to tracheostomy tube patietns?
humidification filters on tube | nebulisation
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how can age affect respiratory disease in horses?
congenital at birth infections usually in young asthma if middle aged exercise induced affects in performance horses
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what history can be taken to assess respiratory disease in horses?
``` environment local infections vaccination history prior illness current illnesses and onset ```
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list features of physical exam for assessing horses respiratory system
``` demeanour nasal discharge RR and effort heave line due to rectus abdominus hypertrophy chest auscultation rebreathing test ```
263
what sampling can be done to assess horses respiration?
nasal and naso-pharyngeal swabs for culture and PCR tracheal wash BAL
264
what imaging can help assess equine respiration?
``` endoscopy to examine URT sinoscopy head or thoracic x ray head CT ultrasound ```
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how are BAL done?
``` sedate enter endoscope inflate cuff when in lung instil up to 500ml saline then draw back 50-80% froth shows surfactant and good sample ```
266
what is DDSP in horses?
dorsal displacement of soft palette
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what are the common presentations of larynx and pharynx disorders in horses?
abnormal respiratory noise on exercise poor performance exercise intolerance
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how is DDSP diagnosed in horses?
exercising endoscopy
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how is equine DDSP treated?
rest | soft palette cautery or laryngeal tie forward to prevent displacement
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what causes arytenoid cartilage collapse in horses?
left recurrent laryngeal nerve is long and end dies off | cricoarytenoideus dorsalis muscle which abducts arytenoid cartilage no longer innervated
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how is arytenoid cartilage collapse diagnosed in horses?
exercise or resting endoscopy
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how is arytenoid cartilage collapse treated in horses?
ventriculocordectomy to remove noise | prosthetic laryngoplasty to hold open cartilage but risk aspiration pneumonia
273
what is sinusitis in horses?
accumulation of exudate in sinus cavities
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what causes primary and secondary sinusitis in horses?
primary- viral or bacterial URT infection | secondary- dental disease
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what are signs of sinusitis in horses?
nasal discharge
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how is sinusitis diagnosed in horses?
endoscopy to rule out other causes imaging sinoscopy
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how is sinusitis treated in horses?
sinus lavage | treat underlying cause
278
what is guttural pouch mycosis in horses?
fungal infection of guttural pouch
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what are clinical signs of GP mycosis in horses?
epistaxis | cranial nerve dysfunction
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when can GP mycosis in horses be fatal?
if carotid artery wall gets eroded away
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how is GP mycosis diagnosed in horses?
GP endoscopy
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how is guttural pouch mycosis treated in horses?
surgical occlusion of vessels | topical antifungal
283
what is strangles in horses?
contagious URT bacterial infection at junction of back of jaw and top of neck
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state clinical signs of strangles in horses
dullness fever purulent nasal discharge enlarged abscessing submandibular and retropharyngeal LNs
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what complications are caused by strangles in horses?
difficulty breathing abscesses seeding around body immune mediated complications
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how is strangles in horses treated?
isolation culture or PCR of abscess endoscopy and GP lavage
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how are horses with strangles treated?
penicillin | drain abscessed lymphnodes
288
how does equine influenza spread?
inhalational through common air spaces | replicates in RTs
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what are symptoms of equine influenza?
``` coughing pyrexia serous nasal discharge inappetence depression ```
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how is equine influenza diagnosed?
virus detection by ELISA or PCR from swabs | serology
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how is equine influenza treated?
rest | NSAIDs
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how can equine influenza be prevented?
vaccination but not fully effective as always changing
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what are signs of equine herpes virus?
respiratory signs neurological signs abortion
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how does equine herpes virus spread?
inhalational
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how can you prevent equine herpes virus?
vaccination against EHV1 and 4
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what causes pleuropneumonia in horses?
horses travelling long distances becoming susceptible to opportunistic infections from pharynx to lungs
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what are signs of pleuropneumonia in horses?
``` fever dullness nasal discharge difficulty breathing weight loss ```
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how is pleuropneumonia diagnosed in horses?
clinical exam chest imaging tracheal wash or pleural sample for culture and cytology
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how is pleuropneumonia treated in horses?
aggressive penicillin | chest drain
300
what usually causes asthma in horses?
dust in stables
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what is the effect of equine asthma?
increased mucus production | bronchoconstriction
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what are signs of equine asthma?
coughing wheezing increased respiratory effort heave line
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how is equine asthma diagnosed?
endoscope TW BAL
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how is equine asthma treated?
environmental management | inhaled steroid and bronchodilator
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what is the purpose of diagnostic endoscopies in horses?
examine larynx and pharynx in exercise
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list elective surgical procedures of equine URT
``` ventriculocordectomy/hobday aryepiglottic fold resection prosthetic laryngoplasty/tie back laryngeal advancement/tie forwards soft palette cautery epiglottic entrapment release arytenoid chondritis excision sinus surgery tracheostomy ```
307
list emergency surgical prcedures of equine URT
emergency tracheostomy occlusion of artery for GP mycosis trauma thoracic drain placement
308
what are pre-op consideration for patient undergoing equine URT surgery?
behaviour if standing surgery pathologies present whole body clinical exam 2 hours starving
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what needs to be planned for equine URT surgery?
``` equipment positioning GA or standing plan if things go wrong recovery plan airway management post op plan ```
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what are advantages of standing sedation for equine URT surgery?
no GA cheaper easier access less haemorrhage as above heart
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what are disadvantages of standing sedation for equine URT surgery?
``` temperament may not be suitable less control over complications full environmental control needs to be fast may still need GA ```
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what are advantages of GA for equine URT surgery?
``` more control of horse safer if unpredictable horse good access less time pressure oxygen available ```
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what are disadvantages of GA for equine URT surgery?
``` more expensive longer need the facilities risk of GA constant airway supervision needed ```
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what needs considering during URT surgery in horses?
patent airway protect from aspiration aware of obstruction
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what needs considering post equine URT surgery?
``` swellings compromising airway inhalational pneumonia feed moist hay feed high for tie forward to prevent pressure on sutures feed low for rest for drainage analgesia ```
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what safety is needed for laser surgery?
goggles signs NO fire hazard with laser suction for toxic gases produced
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what are lasers and scalpels used for?
lasers- excision | scalpel- repair and reconstruction
318
what are indications for sinus flap surgery in horses?
sinus emphysema sinus cysts ethmoid haematoma maxillary tooth repulsion
319
what is post op care for soft palette cautery in horses?
analgesia | monitoring eating
320
what is post op care for hobdays?
leave larynx open for drainage laryngostomy tube placed for recovery and overnight occlude before removal to check can breathe
321
where are chest drains placed in horses?
fluid- ventral thorax gas- dorsal thorax bilateral if needed as little communication between pleural spaces
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describe how to prepare for thoracoscopy
standing sedation | suction and oxygen
323
what is thoracoscopy used for?
investigate and treat pleural and pulmonic disease
324
when are tracheotomy tubes used?
emergency
325
when are tracheostomy tubes used?
long term use for surgery or beyond

Clinical Nursing May Exam (22 decks)

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