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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
Q

define congestion

A

blood not pumped forward fast enough

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26
Q

what the difference between left and right sided congestion?

A

left- lungs

right- systemic

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27
Q

what are signs of left sided congestion?

A

pulmonary oedema
tachypnoea
dyspnoea
cough

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28
Q

what are signs of right sided congestion?

A

distended peripheral veins
ascites
pleural effusion

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29
Q

define ascites

A

fluid in abdomen

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30
Q

define cardiac cachexia

A

loss of lean muscle mass

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31
Q

what blood tests can help diagnose cardiac disease?

A

haematology for systemic disease or anaemia
biochemistry for kidney values and electrolytes
cardiac biomarkers for cardiac cell damage and myocardial stretch

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32
Q

what is the consequence of hypertension in heart disease?

A

increased cardiac workload which can progress the disease

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33
Q

what is significant about hypotension in heart failure?

A

suggests decompensation

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34
Q

what is the purpose of ECG in diagnosing cardiac disease?

A

characterise auscultatory findings
indicate treatment and prognosis
monitor progression or response to treatment

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35
Q

what is the purpose of 24 hour ECG for diagnosing heart disease?

A

investigate intermittent arrhythmia
determine cause of syncope etc
monitor response to antiarrhythmic therapy

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36
Q

when are thoracic radiographs indicated for diagnosing cardiac disease?

A

cough
tachypnoea
dyspnoea

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37
Q

what views are taken for imaging of heart disease diagnosis?

A

right lateral

dorsoventral

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38
Q

what is seen on imaging of congestive heart failure?

A

pulmonary oedema

distended pulmonary veins

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39
Q

what can be seen on radiographs with lung pathology present?

A

pneumonia

neoplasia

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40
Q

what is seen on imaging with cardiomegaly?

A

vertebral heart size in dogs over 10.7 and cats over 8
elevated trachea
increased sternal contact

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41
Q

what is meant by stenosis?

A

narrowing

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42
Q

what are the types of stenosis?

A

subvalvular
valvular
supravalvular

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43
Q

how is stenosis diagnosed?

A

ECG

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44
Q

what type of stenosis is aortic and what are the consequences?

A

subvalvular

left ventricular hypertrophy, left sided congestive heart failure

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45
Q

what type of stenosis is pulmonic and what are the consequences?

A

valvular

right ventricular hypertrophy, left sided congestive heart failure

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46
Q

state clinical signs of stenosis

A 
asymptomatic
arrhythmia
exercise intolerance
syncope
congestive heart failure
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47
Q

how is stenosis treated?

A

beta blockers
balloon valvuloplasty for pulmonic
treat congestive heart failure

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48
Q

describe what is meant by patent ductus arteriosus

A

failure of ductus arteriosus to close when first breaths are taken so blood flows from aorta to pulmonary artery

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49
Q

what should the ductus arteriosus become after birth?

A

ligamentum arteriosum

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50
Q

list signs of patent ductus arteriosus?

A

loud continuous murmur in left heart base
exercise intolerance
pale MM

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51
Q

how is patent ductus arteriosus usually diagnosed?

A

incidental finding
ECG
ultrasound

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52
Q

what is prognosis for patent ductus arteriosus?

A

good if successful closure

can cause congestive heart failure if untreated

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53
Q

how is patent ductus arteriosus treated?

A

interventional closure
surgical ligation
treatment of congestive heart failure
limit stress and exercise

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54
Q

where are ventricular septal defects usually found?

A

upper septum below aortic valve

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55
Q

what are signs of ventricular septal defects?

A

right sided systolic murmur

small defects loud and large defects small

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56
Q

how is ventricular septal defects diagnosed?

A

ECG

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57
Q

what is treatment for ventricular septal defects?

A

none needed usually

heart failure treatment as needed

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58
Q

what is prognosis for ventricular septal defects?

A

normal life if small defect

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59
Q

what is signalment for myxomatous mitral valve disease?

A

hereditary
idiopathic
small breed dogs
adults

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60
Q

which valves are affected by myxomatous mitral valve disease?

A

mitral

tricuspid

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61
Q

how is myxomatous mitral valve disease diagnosed?

A

ECG

look at signalment

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62
Q

describe myxomatous mitral valve disease

A

valves thicken so blood regurgitates
left ventricle and atrium dilate
valves prolapse

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63
Q

what is the sign of myxomatous mitral valve disease?

A

left sided apical systolic heart murmur

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64
Q

how does myxomatous mitral valve disease progress?

A

slowly with long asymptomatic period

can progress to left sided congestive heart failure

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65
Q

how is myxomatous mitral valve disease treated?

A

medication when non-symptomatic
check for progression
treat CHF
diet providing enough calories for prevention of cardiac cachexia

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66
Q

what is signalment for DCM?

A

idiopathic
hereditary
large breed dogs
adults

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67
Q

what are signs of DCM?

A 
left apical systolic murmur
left ventricular dilation
decreased systolic function
arrhythmia
lethargy
coughing
anorexia
tachycardia
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68
Q

how is DCM diagnosed?

A

ECG
BP monitoring
thoracic radiographs

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69
Q

how is DCM treated?

A

pimobendane to increase contractility and vasodilation
low sodium diet
taurine supplements

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70
Q

what is prognosis for DCM?

A

long asymptomatic period
rapid progression to arrhythmia
congestive heart failure
sudden death

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71
Q

state causes of pericardial effusion

A

idiopathic
neoplasia
large breed adult dogs

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72
Q

what is the consequence of pericardial effusions?

A

fluid causes tamponade
decreased CO
right sided heart failure

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73
Q

why does pericardial effusion cause right not left sided heart failure?

A

right is lower pressure than left

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74
Q

what are signs of pericardial effusion?

A

right sided heart failure
lethargy
vomiting
exercise intolerance

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75
Q

how is pericardial effusion diagnosed?

A

ECG

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76
Q

how is pericardial effusion treated?

A

pericardiocentesis

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77
Q

how is pericardiocentesis carried out?

A 
sedation
left lateral recumbency
visualise with ECG
use large catheter
measure amount drained and submit for cytology and culture
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78
Q

what us prognosis for pericardial effusions?

A

idiopathic responds well to treatment

poor if neoplasia

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79
Q

what are causes of hypertrophic cardiomyopathy?

A

genetics

adult onset

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80
Q

what is the consequence of hypertrophic cardiomyopathy?

A

impaired filling as increased myocardial thickness

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81
Q

what are symptoms of hypertrophic cardiomyopathy?

A 
anorexia
lethargy
weak pulses
difficulty breathing
crackles on breathing
exercise intolerance
aortic thromboembolism
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82
Q

how is hypertrophic cardiomyopathy diagnosed?

A

ECG

incidental findings of heart murmur, gallop

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83
Q

what are signs of aortic thromboembolism?

A

sudden lameness
cold leg
peripheral cyanosis
pain

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84
Q

what is prognosis of hypertrophic cardiomyopathy?

A

depends on severity

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85
Q

how is hypertrophic cardiomyopathy treated?

A

medication to manage rhythm and thickening of heart wall

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86
Q

what are causes of heart failure?

A

disease progression
decompensation of stable heart failure
compromised cardiac filling

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87
Q

what are the consequences of heart failure?

A 
reduced CO
tachycardia
slow CRT
hypothermia
bradycardia
easy decompensation
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88
Q

how is heart failure treated?

A 
furosemide
spironolactone
limit stress
oxygen
pimobendan to increase contractility
water to prevent AKI
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89
Q

what is ideal RR and BP for patients with heart failure?

A

RR- less than 40brpm

BP- over 100mmHg systolic

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90
Q

what are signs of improvement for patients with heart failure?

A

decreased RR and HR

improved pulses and CRT

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91
Q

how are arrhythmias assessed?

A 
ECG
HR
sinus complexes
regularity
timings
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92
Q

what heart conditions can cause bradycardia?

A

atrial standstill
AV blocks
sick sinus syndrome

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93
Q

what diseases can cause tachycardia?

A

supraventricular atrial fibrillation
ventricular arrhythmia
ventricular premature complexes
ventricular tachycardia

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94
Q

define fibrillation

A

lack of contraction

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95
Q

what are signs of atrial fibrillation?

A

HR 210
irregular rhythm
no P waves

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96
Q

list components of URT

A 
nasal cavity
tongue
soft palette
oral cavity
pharynx
larynx
trachea
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97
Q

list components of LRT

A

trachea
bronchus
bronchiole
alveoli

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98
Q

what is acute respiratory failure?

A

lungs cant oxygenate blood or exchange CO2

emergency

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99
Q

what are causes of acute respiratory failure?

A 
airway obstruction
ruptured diaphragm
pulmonary oedema
pneumo, heamo, pyo, chylo thorax
neoplasia
infection
intoxication
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100
Q

list signs of acute respiratory failure

A 
cyanosis
dyspnoea
tachypnoea
orthopnoea
tachycardia
collapse
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101
Q

what is orthopnoea?

A

posture to aid breathing

elbows abducted and neck extended

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102
Q

how can oxygen be provided to conscious patients?

A

flow by
nasal prongs
face mask
oxygen tent

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103
Q

how should oxygen be provided to unconscious patients?

A

ETT

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104
Q

how is airway maintained in unconscious patients?

A

ETT
head and neck extended
tracheostomy tube

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105
Q

what are consideration for nursing acute respiratory failure pateints?

A 
oxygen
monitoring
medications
recumbency care
exercise
feeding
barrier nursing if needed
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106
Q

list signs of conditions of URT

A 
nasal discharge
sneezing
stertor
systemic signs
CNS signs
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107
Q

what is assessed in URT physical exam?

A 
noise
nasal discharge
pain
facial deformity
nasal depigmentation
airflow
lymph nodes
dental disease
ophthalmic disease
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108
Q

what are the different causes of nasal diseases?

A 
inflammatory
infectious
neoplasia
trauma
foreign body
systemic causes
other
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109
Q

what are systemic causes of nasal disease?

A

coagulopathy
hyperviscosity syndrome
systemic hypertension

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110
Q

what are other causes of nasal disease?

A 
dental disease
oronasal fistula 
polyps
stenosis
BOAS
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111
Q

what are investigations for nasal disease?

A 
bloods
test for bleeding disorders
serology
viral testing
GA for full oral exam and nasopharyngeal swab
imaging
endoscopy
biopsy
rhinoscopy
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112
Q

what are considerations for rhinoscopy?

A

need GA
painful
bleeding

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113
Q

what is nursing care for nasal disease patients?

A 
treat dyspnoea
remove foreign objects
monitor fluids and food
remove discharges
decongestant therapy
isolate if infectious
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114
Q

what are the two types of aspergillosis?

A

sinonasal

sinoorbital

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115
Q

what type of dogs are predisposed to sinonasal aspergillosis?

A

meso and dolichocephalics

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116
Q

what predisposes to sinoorbital aspergillosis?

A

brachycephalics

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117
Q

what are clinical signs of aspergillosis?

A 
mucopurulent nasal discharge
epistaxis
sneezing
pain
nasal depigmentation
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118
Q

how is aspergillosis diagnosed?

A 
serology
PCR
imaging
rhinoscopy
cytology
histopathology
fungal culture
clinical suspicions
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119
Q

how does imaging help show aspergillosis?

A

see turbinate destruction

increased soft tissue opacity and density

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120
Q

how is aspergillosis treated?

A

endoscopic debridement

topical antifungal

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121
Q

what is meant by BOAS?

A

group of conditions resulting from poor breeding and body conformation of dogs with short noses

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122
Q

what are BOAS abnormalities?

A 
excess soft tissue in skin and airways
stenotic nares
elongated soft palette
hypoplastic trachea
enlarged tonsils
stertor
stridor
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123
Q

how do BOAS patients compensate?

A

harder insiratory pull causing negative pressure in neck and chest

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124
Q

what are potential consequences of BOAS compensatory mechanisms?

A

secondary respiratory and digestive problems
laryngeal collapse
hiatal hernia

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125
Q

how does BOAS present?

A 
loud breathing
snoring
heat and exercise intolerance
sleep deprivation
gagging
vomiting and regurgitation
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126
Q

how is BOAS diagnosed?

A 
physical exam
history
fluroscopy
barium swallow
CT of head and neck
chest xrays
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127
Q

what is nursing considerations for BOAS patients?

A 
owner education
discourage breeding
keep low stress
avoid excess heat
harness not collar
ideal body weight managed
careful exercise
oxygen
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128
Q

how does laryngeal paralysis present?

A 
exercise intolerance
soft cough
inspiratory stridor
can be emergency
dysphonia
dysphagia
cyanosis
collapse
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129
Q

what are causes of laryngeal paralysis?

A

congenital
trauma
nerve infiltration
older large breed dogs

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130
Q

how is laryngeal paralysis diagnosed?

A

laryngeal exam under sedation or GA

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131
Q

what are nursing considerations of laryngeal paralysis patients?

A 
keep calm
nothing around neck
keep cool
oxygen
monitor for aspiration pneumonia, dysphagia, megaoesophagus
steroids to reduce laryngeal oedema
132
Q

what are predispositions for tracheal collapse?

A

small breeds

obesity

133
Q

where do tracheal collapses normally occur?

A

thoracic inlet

134
Q

how does tracheal collapse present?

A

goose honking cough

135
Q

how is tracheal collapse diagnosed?

A

physical exam
x-ray
fluroscopy

136
Q

what are nursing considerations for tracheal collapse patients?

A 
sedation
corticosteroids
bronchodilators
restricted exercise
harness
oxygen 
intubate if needed
weight loss
137
Q

how is tracheal collapse treated?

A

surgery to place stent

138
Q

define hyperpnoea

A

increased respiratory effort without dyspnoea

139
Q

define cough

A

sudden expiratory effort against closed glottis resulting in noisy expulsion of air from lungs

140
Q

what is the aim of coughing?

A

protective reflex to clear excess secretions or foreign materials

141
Q

where are cough receptors found?

A 
large airways
nose
sinuses
pharynx
pleura
142
Q

describe the cough reflex arc

A

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
Q

what are harmful effects of coughing?

A

excacerbate airway inflammation and irritation
emphysema
pneumothorax
weakness

144
Q

what are clinical signs of LRT disease?

A 
cough
tachypnoea
dyspnoea
exercise intolerance
weakness
cyanosis
syncope
145
Q

define dyspnoea

A

difficulty breathing

increased respiratory effort

146
Q

what are URT causes of cough and dyspnoea?

A

BOAS
laryngeal paralysis
kennel cough
neoplasia

147
Q

what are LRT causes of cough and dyspnoea?

A 
tracheitis
tracheal collapse
neoplasia
bronchitis
asthma
foreign body
pneumonia
lung worm
pneumothorax
pleural effusion
148
Q

how are LRT conditions diagnosed?

A

physical exam
thoracic auscultation
further investigations

149
Q

what is looked for in physical exam for LRT disease patients?

A

posture
RR effort and rhythm
URT noise
HR

150
Q

what may be seen on thoracic auscultation for LRT disease patients?

A

crackles
wheezing
murmurs

151
Q

what further investigations may be done for LRT disease patients?

A 
pathology
oxygenation assessment
laryngeal exam
imaging 
bronchoscopy
BALs
152
Q

what equipment should be prepared for LRT disease patients?

A 
endoscope
sterile saline
collection pots
mouth gag
urinary catheter
emergency box
153
Q

what are nursing considerations of LRT disease pateints?

A

coupage to clear lungs
careful monitoring
observe for complications
access to emergency equipment

154
Q

what is canine chronic bronchitis?

A

chronic bronchial inflammation with over secretion of mucus

155
Q

what are comorbidities to canine chronic bronchitis?

A

tracheal/bronchial collapse
mitral valve disease
pulmonary hypertension

156
Q

what predisposes to canine chronic bronchitis?

A

kennel cough
irritants
allergens
parasites

157
Q

what are the effects of canine chronic bronchitis?

A

airways obstructed by mucus
inflammation of airways
bronchomalacia
bronchiectasis

158
Q

define brochomalacia

A

weakened cartilage

159
Q

define bronchiectasis

A

end stage branchial change

160
Q

list clinical signs of canine chronic bronchitis

A 
chronic cough
dyspnoea
tachypnoea
gagging
pyrexia if pneumonia
crackles and wheezing
161
Q

how is canine chronic bronchitis diagnosed?

A

imaging
bronchoscopy
BAL

162
Q

what are nursing considerations for canine chronic bronchitis patients?

A 
weight management
harness
avoid irritants to airway
glucocorticoids
bronchodilators
antibiotics if needed
inhalational therapy
163
Q

what is prognosis for chronic canine bronchitis?

A

progressive
years if well managed
can have mitral valve disease or pulmonary hypertension

164
Q

what diseases are on the spectrum of FLAD?

A

feline asthma

feline bronchitis

165
Q

what is FLAD?

A

chronic bronchial inflammation with mucus hypersecretion causing bronchoconstriction

166
Q

what is signalment for FLAD?

A

young to middle aged cats

siamese

167
Q

what are causes of FLAD?

A

infections
allergens and hypersensitivity
bronchus obstruction

168
Q

what are clinical signs of FLAD?

A 
none
cough
tachypnoea
open mouth breathing
cyanosis
asthmatic crisis
169
Q

how is FLAD investigated?

A

chest imaging
bronchoscopy
BAL

170
Q

how is FLAD treated?

A 
keep stress free
oxygen
bronchodilators
corticosteroids
sedation
inhalational therapy
171
Q

how is FLAD managed long term?

A

dust free litter
no smoking
medication- glucocorticoids and bronchodilators

172
Q

what is prognosis for acute and chronic FLAD?

A

chronic- good when treated well

acute- fatal if not quickly managed

173
Q

what are some pulmonary parasites?

A

intestinal worms
lungworms
heartworms

174
Q

what are clinical signs of angiostrongylus infection?

A

respiratory disease
increased bleeding
neurological signs

175
Q

how is angiostrongylus diagnosed?

A

chest imaging
antigen detection
PCR
faecal smear

176
Q

how is angiostrongylus treated?

A

moxidection 30 days apart

fenbendazole for 10-20 days

177
Q

what can be reactions following angiostrongylus treatment?

A

dyspnoea
ascites
sudden death

178
Q

what is prognosis for angiostrongylus?

A

depends on clinical signs

179
Q

what are associations with bacterial pneumonia?

A

abscesses
pleural effusions
pneumothorax

180
Q

what predisposes to bacterial pneumonia?

A

chronic bronchitis
immunosuppression
foreign body
aspiration

181
Q

what are clinical signs of bacterial pneumonia?

A 
cough
dyspnoea
tachypnoea
exercise intolerance
pyrexia
lethargy
182
Q

how can you diagnose bacterial pneumonia?

A

neutrophillia
neutropenia
hypoxia
chest imaging

183
Q

how is bacterial pneumonia treated?

A 
antibiotics
oxygen
IVFT
nebulisation
bronchodilators
may need lung lobectomy
184
Q

what is prognosis of bacterial pneumonia?

A

depends on clinical sign severity

185
Q

how do pleural space diseases present?

A 
tachypnoea
dyspnoea
paradoxical breathing
muffled lung sounds with effusion
absent lung sounds with pneumothorax
186
Q

describe how pleural effusions happen

A

gradual collapse of lungs causes negative intrathoracic pressure to become positive

187
Q

what can be consequences of resolving pleural effusion?

A

inflammation

pneumothorax

188
Q

what is the result of not treating pleural space disease?

A

low CO

cardiac arrest

189
Q

list signs of respiratory distress

A 
orthopnoea
mouth breathing
tachypnoea
respiratory noises
cyanosis
restrictive dyspnoea
190
Q

list the types of dyspnoea

A

inspiratory
expiratory
mixed pattern

191
Q

what causes inspiratory dyspnoea?

A 
dynamic upper airway obstruction
BOAS
polyp
foreign body
tumour
laryngeal paralysis or collapse
192
Q

what are signs of inspiratory dyspnoea?

A

stertor

stridor

193
Q

what causes expiratory dyspnoea?

A

dynamic lower airway obstruction
tracheal collapse
bronchial collapse
asthma

194
Q

what are signs of expiratory dyspnoea?

195
Q

what causes mixed pattern dyspnoea?

A 
airway obstruction
plueral space disease
mass
tracheal collapse
pneumonia
pulmonary oedema
196
Q

what are signs of mixed pattern dyspnoea?

A

shallow breathing
reduced lung sounds
laboured breathing

197
Q

how is respiratory distress diagnosed?

A

chest radiographs
thoracic ultrasound
thoracocentesis
fluid analysis

198
Q

define thoracocentesis

A

aspiration of air or fluid from pleural cavity

199
Q

describe how thoracocentesis are carried out?

A

clip and scrub around 8th rib

place butterfly needle in cranial aspect of rib

200
Q

why is cranial rib space used for thoracocentesis?

A

caudal side has nerves and vessels

201
Q

what are complications from thoracocentesis?

A

pyothorax

pneumothorax

202
Q

how can you treat respiratory distress?

A

thoracocentesis
antibiotics
surgery

203
Q

define pneumothorax

A

air accumulation in pleural space

204
Q

what causes pneumothorax?

A 
trauma
blebs
bullae
chronic airway disease
iatrogenic
205
Q

define bleb

A

small collection of air between lung and visceral pleura

206
Q

define bullae

A

lesion on lung that can spontaneously rupture

207
Q

what is seen on physical exam of patients with pneumothorax?

A

no dorsal lung sounds

hyper resonant percussion

208
Q

how is pneumothorax diagnosed?

A

radiography

ultrasound

209
Q

how is pneumothorax treated?

A

rest
thoracocentesis
oxygen
exploratory thoracotomy

210
Q

list nursing considerations for initial treatment of pneumothorax

A 
delay diagnosing until stable
keep calm or sedate
oxygen
monitor oxygen saturation
prepare for thoracoentesis
211
Q

what is general care for patients with pneumothorax?

A 
care for drains
oxygen
monitoring
analgesia
IVFT
treat shock
recumbency care
212
Q

what are the main issues of BOAS patients?

A

resistance to airflow in nose
laryngeal collapse
obstructed or narrowed trachea

213
Q

how are BOAS patients assessed?

A 
TPR
MM
SPO2
clinical signs of BOAS
ASA grading
214
Q

what are the aims of surgical treatment of BOAS?

A

increase airway to reduce resistance to airflow

215
Q

what surgical procedures can treat BOAS?

A

soft palette resection
tonsil resection
removal of everted laryngeal saccules
nostril resection

216
Q

what is pre-surgical prep for BOAS surgery?

A 
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
Q

what equipment should be prepared for BOAS surgery?

A

laryngoscope
urinary catheter and rescue ETT to aid intubation
ETT
suction

218
Q

describe typical positioning of BOAS surgery

A

sternal with ties to keep mouth open

table tilted in case of regurgitation

219
Q

how is BOAS surgery patients monitored through surgery?

A 
SPO2 over 98%
capnography for ETCO2 over 35-45mmHg
IPPV or mechanical ventilation as needed
IVFT if MAP below60mmHg
lube throughout
220
Q

what are complications following BOAS surgery?

A

airway swelling
vomiting and regurgitation
aspiration pneumonia

221
Q

describe considerations when extubating BOAS patients?

A 
high risk
leave until wont tolerate ETT
monitor SPO2
supplement oxygen
keep in sternal with head elevated
suction available
constant monitoring
222
Q

what is immediate post op care for BOAS surgery pateints?

A

quiet environment
thermoregulate environment
sedate if stressed

223
Q

what is general post op care for owners to know for BOAS surgery patients?

A 
harness
6 weeks restricted exercise
routine post op checks
wet solid food for 6 weeks
clear discharge information
224
Q

what is laryngeal paralysis?

A

inability for vocal cords to open in response to exercise and respiratory demands

225
Q

define dysphonia

A

change or loss of vocal sounds

226
Q

define dysphagia

A

difficulty eating

227
Q

how are mild cases of laryngeal paralysis treated?

A 
anti-inflammatories
antibiotics
sedatives
raised feeding
exercise management
228
Q

how are severe cases of laryngeal paralysis treated?

A

unilateral arytenoid lateralisation to tie open left arytenoid cartilage permanently

229
Q

what are post op considerations following unilateral arytenoid lateralisation?

A 
soft meals
avoid dust
raised food and water
wound management
change in phonation
no swimming as aspiration risk
230
Q

what is prognosis following unilateral arytenoid lateralisation?

A

good unless caused by systemic neuromuscular disorder

231
Q

what is an example of congenital palette defects?

A

clefts to palettes or lips

232
Q

what are signs of congenital palette defects?

A

difficulty feeding

nasal discharge

233
Q

how are congenital palette defects treated?

A

surgery to close tissues separating oral and nasal passages

234
Q

what causes and how are acquired palette defects treated?

A

trauma

primary or secondary closure

235
Q

what causes tracheal collpase?

A

degeneration of tracheal cartilage rings causing DV collapse

236
Q

state signalment of tracheal collapse

A

middle aged

small or toy breeds

237
Q

what are signs of tracheal collapse?

A

dry harsh loud cough
stridor
build up over time

238
Q

how is tracheal collapse diagnosed?

A

radiography
bronchoscopy
fluroscopy

239
Q

how are tracheal collapses graded during bronchoscopy?

A

I- 25% loss of lumen
II- 50% loss of lumen
III- 75% loss of lumen
IV- 100% loss of lumen

240
Q

list non-surgical management of tracheal collapse

A 
weight loss
controlled exercise
harness
avoid smoke
corticosteroids if grade 1-2 and young
cough suppressants
antibiotics
steroids
bronchodilators
241
Q

what is the prognosis following surgery for tracheal collapse?

A

improved airflow
better if less than 6 years old
need management after surgery

242
Q

what surgery can be done to treat tracheal collapse?

A

extraluminal ring prosthesis

intraluminal stenting

243
Q

what are complications of extraluminal ring prosthesis?

A

laryngeal paralysis
dyspnoea
vascular damage
tracheal ring migration

244
Q

what can be downsides to intraluminal tracheal stenting?

A

less long lasting if coughing

can get inflammation around trachea

245
Q

how are patients prepared for extraluminal ring prosthesis and intraluminal stenting?

A

pre-oxygenate
careful handling
stress free
ERP- ventral neck prepared, dorsal recumbency
ILS- lateral recumbency, fluoroscopic guidance

246
Q

what is post op care for tracheal collapse surgery?

A 
calm
quiet
cool
analgesia
oxygen
soft food
monitoring
harness
247
Q

what is lateral thoracotomy?

A

surgical incision between ribs to view one side of thorax

248
Q

when is lateral thoracotomy indicated?

A

lung lobectomy when torsion, neoplasia, abscessation

249
Q

what is median sternotomy?

A

surgical incision through sternum to view bilateral thorax

250
Q

when is median sternotomy indicated?

A

pyothorax
mediastinal mass
heart surgery

251
Q

what is a tracheostomy?

A

emergency procedure to bypass nares, pharynx, larynx and proximal trachea when obstructed

252
Q

what are indications for tracheostomy?

A 
compromised airway
provide airway until obstruction removed
laryngeal paralysis
BOAS
foreign body
laryngeal trauma
253
Q

what is care for tracheostomies?

A

24/7 monitoring for issues
asepsis
maintain airway
regular prevention of secretion build up

254
Q

when do tracheostomy tubes need to be checked?

A

initially every 15 minutes

every 4-6 hours

255
Q

when are tracheostomy tubes suctioned?

A

routinely

if blocked

256
Q

how do you suction tracheostomy tubes?

A

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
Q

when do tracheostomy tubes need to be changed?

A

if blocked

258
Q

why do patients with tracheostomy tubes need humidification?

A

normal humidification in URT is bypassed

drying can damage mucosa

259
Q

how can you provide humidification to tracheostomy tube patietns?

A

humidification filters on tube

nebulisation

260
Q

how can age affect respiratory disease in horses?

A

congenital at birth
infections usually in young
asthma if middle aged
exercise induced affects in performance horses

261
Q

what history can be taken to assess respiratory disease in horses?

A 
environment
local infections
vaccination history
prior illness
current illnesses and onset
262
Q

list features of physical exam for assessing horses respiratory system

A 
demeanour
nasal discharge
RR and effort
heave line due to rectus abdominus hypertrophy
chest auscultation
rebreathing test
263
Q

what sampling can be done to assess horses respiration?

A

nasal and naso-pharyngeal swabs for culture and PCR
tracheal wash
BAL

264
Q

what imaging can help assess equine respiration?

A 
endoscopy to examine URT
sinoscopy
head or thoracic x ray
head CT
ultrasound
265
Q

how are BAL done?

A 
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
Q

what is DDSP in horses?

A

dorsal displacement of soft palette

267
Q

what are the common presentations of larynx and pharynx disorders in horses?

A

abnormal respiratory noise on exercise
poor performance
exercise intolerance

268
Q

how is DDSP diagnosed in horses?

A

exercising endoscopy

269
Q

how is equine DDSP treated?

A

rest

soft palette cautery or laryngeal tie forward to prevent displacement

270
Q

what causes arytenoid cartilage collapse in horses?

A

left recurrent laryngeal nerve is long and end dies off

cricoarytenoideus dorsalis muscle which abducts arytenoid cartilage no longer innervated

271
Q

how is arytenoid cartilage collapse diagnosed in horses?

A

exercise or resting endoscopy

272
Q

how is arytenoid cartilage collapse treated in horses?

A

ventriculocordectomy to remove noise

prosthetic laryngoplasty to hold open cartilage but risk aspiration pneumonia

273
Q

what is sinusitis in horses?

A

accumulation of exudate in sinus cavities

274
Q

what causes primary and secondary sinusitis in horses?

A

primary- viral or bacterial URT infection

secondary- dental disease

275
Q

what are signs of sinusitis in horses?

A

nasal discharge

276
Q

how is sinusitis diagnosed in horses?

A

endoscopy to rule out other causes
imaging
sinoscopy

277
Q

how is sinusitis treated in horses?

A

sinus lavage

treat underlying cause

278
Q

what is guttural pouch mycosis in horses?

A

fungal infection of guttural pouch

279
Q

what are clinical signs of GP mycosis in horses?

A

epistaxis

cranial nerve dysfunction

280
Q

when can GP mycosis in horses be fatal?

A

if carotid artery wall gets eroded away

281
Q

how is GP mycosis diagnosed in horses?

A

GP endoscopy

282
Q

how is guttural pouch mycosis treated in horses?

A

surgical occlusion of vessels

topical antifungal

283
Q

what is strangles in horses?

A

contagious URT bacterial infection at junction of back of jaw and top of neck

284
Q

state clinical signs of strangles in horses

A

dullness
fever
purulent nasal discharge
enlarged abscessing submandibular and retropharyngeal LNs

285
Q

what complications are caused by strangles in horses?

A

difficulty breathing
abscesses seeding around body
immune mediated complications

286
Q

how is strangles in horses treated?

A

isolation
culture or PCR of abscess
endoscopy and GP lavage

287
Q

how are horses with strangles treated?

A

penicillin

drain abscessed lymphnodes

288
Q

how does equine influenza spread?

A

inhalational through common air spaces

replicates in RTs

289
Q

what are symptoms of equine influenza?

A 
coughing 
pyrexia
serous nasal discharge
inappetence
depression
290
Q

how is equine influenza diagnosed?

A

virus detection by ELISA or PCR from swabs

serology

291
Q

how is equine influenza treated?

A

rest

NSAIDs

292
Q

how can equine influenza be prevented?

A

vaccination but not fully effective as always changing

293
Q

what are signs of equine herpes virus?

A

respiratory signs
neurological signs
abortion

294
Q

how does equine herpes virus spread?

A

inhalational

295
Q

how can you prevent equine herpes virus?

A

vaccination against EHV1 and 4

296
Q

what causes pleuropneumonia in horses?

A

horses travelling long distances becoming susceptible to opportunistic infections from pharynx to lungs

297
Q

what are signs of pleuropneumonia in horses?

A 
fever
dullness
nasal discharge
difficulty breathing
weight loss
298
Q

how is pleuropneumonia diagnosed in horses?

A

clinical exam
chest imaging
tracheal wash or pleural sample for culture and cytology

299
Q

how is pleuropneumonia treated in horses?

A

aggressive penicillin

chest drain

300
Q

what usually causes asthma in horses?

A

dust in stables

301
Q

what is the effect of equine asthma?

A

increased mucus production

bronchoconstriction

302
Q

what are signs of equine asthma?

A

coughing
wheezing
increased respiratory effort
heave line

303
Q

how is equine asthma diagnosed?

A

endoscope
TW
BAL

304
Q

how is equine asthma treated?

A

environmental management

inhaled steroid and bronchodilator

305
Q

what is the purpose of diagnostic endoscopies in horses?

A

examine larynx and pharynx in exercise

306
Q

list elective surgical procedures of equine URT

A 
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
Q

list emergency surgical prcedures of equine URT

A

emergency tracheostomy
occlusion of artery for GP mycosis
trauma
thoracic drain placement

308
Q

what are pre-op consideration for patient undergoing equine URT surgery?

A

behaviour if standing surgery
pathologies present
whole body clinical exam
2 hours starving

309
Q

what needs to be planned for equine URT surgery?

A 
equipment
positioning
GA or standing
plan if things go wrong
recovery plan
airway management
post op plan
310
Q

what are advantages of standing sedation for equine URT surgery?

A

no GA
cheaper
easier access
less haemorrhage as above heart

311
Q

what are disadvantages of standing sedation for equine URT surgery?

A 
temperament may not be suitable
less control over complications
full environmental control
needs to be fast
may still need GA
312
Q

what are advantages of GA for equine URT surgery?

A 
more control of horse
safer if unpredictable horse
good access
less time pressure
oxygen available
313
Q

what are disadvantages of GA for equine URT surgery?

A 
more expensive
longer
need the facilities
risk of GA
constant airway supervision needed
314
Q

what needs considering during URT surgery in horses?

A

patent airway
protect from aspiration
aware of obstruction

315
Q

what needs considering post equine URT surgery?

A 
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
316
Q

what safety is needed for laser surgery?

A

goggles
signs
NO fire hazard with laser
suction for toxic gases produced

317
Q

what are lasers and scalpels used for?

A

lasers- excision

scalpel- repair and reconstruction

318
Q

what are indications for sinus flap surgery in horses?

A

sinus emphysema
sinus cysts
ethmoid haematoma
maxillary tooth repulsion

319
Q

what is post op care for soft palette cautery in horses?

A

analgesia

monitoring eating

320
Q

what is post op care for hobdays?

A

leave larynx open for drainage
laryngostomy tube placed for recovery and overnight
occlude before removal to check can breathe

321
Q

where are chest drains placed in horses?

A

fluid- ventral thorax
gas- dorsal thorax
bilateral if needed as little communication between pleural spaces

322
Q

describe how to prepare for thoracoscopy

A

standing sedation

suction and oxygen

323
Q

what is thoracoscopy used for?

A

investigate and treat pleural and pulmonic disease

324
Q

when are tracheotomy tubes used?

325
Q

when are tracheostomy tubes used?

A

long term use for surgery or beyond

Clinical Nursing May Exam (22 decks)

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