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Applied Clinical Veterinary Nursing > Cardiorespiratory > Flashcards

Cardiorespiratory Flashcards

1
Q

which lung areas can we localised dyspnoea and tachypnoea to?

A

upper airway

lower airway

lung parenchyma

pleural space

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2
Q

what does dyspnoea mean?

A

difficult or laboured breathing

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3
Q

what does tachypnoea mean?

A

increased rate of respiration

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4
Q

what is orthopnoea?

A

upright position, extended neck

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5
Q

what is a normal respiratory rate?

A

<35 breaths per minute at rest

<25/min when asleep

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6
Q

what are the possible causes of tachypnoea and dyspnoea?

A

physiological cause

hypoxaemia, hypercapnia

respiratory disease

cardiac disease

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7
Q

what physiological factors might contribute to tachypnoea/dyspnoea?

A

stress, pain, excitement, exercise

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8
Q

what structures form the upper airway?

A

nasal passages, pharynx, larynx, trachea

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9
Q

what type of dyspnoea usually affects the upper airway?

A

inspiratory dyspnoea

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10
Q

what type of respiratory noises affect the upper airway?

A

stertor or stridor

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11
Q

what are some of the upper airway causes of dyspnoea?

A

laryngeal paralysis

brachycephalic syndrome

neoplasia

polyps

foreign bodies

inflammation

tracheal collapse

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12
Q

what is the immediate treatment for upper airway obstruction?

A

anaesthesia and intubation

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13
Q

why should patients with upper airway compromise be monitored closely?

A

decompensation can be rapid

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14
Q

what structures make up the lower airway?

A

bronchi and bronchioli

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15
Q

what breathing pattern is typical of lower airway obstruction?

A

quick short inspiration and prolonged expiration

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16
Q

what type of respiratory issues does quick short inspiration and prolonged expiration indicate?

A

lower airway obstruction

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17
Q

what can we hear on auscultation with lower airway obstruction?

A

harsh lung sounds - wheezes, crackles

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18
Q

why might wheezes and crackles be heard on auscultation?

A

bronchoconstriction

secretions blocking airways

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19
Q

what are some of the lower airways causes of dyspoea?

A

asthma

bronchitis

smoke inhalation

bronchopneumonia

chronic obstructive pulmonary disease

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20
Q

what type of respiratory components can be affected by issues with the lung parenchyma?

A

inspiratory and expiratory components

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21
Q

what are some of the lung parenchymal causes of dyspnoea?

A

pulmonary oedema

pneumonia

haemorrhage

contusion

neoplasia

thromboembolism

parasites

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22
Q

what type of breathing pattern is seen with pleural space disease?

A

restrictive pattern - increased rate but reduced depth of inspiration

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23
Q

why does pleural space disease cause a restrictive breathing pattern?

A

lungs cannot expand as they should

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24
Q

what are some of the pleural space causes of dyspnoea?

A

pneumothorax

pleural effusion

masses

diaphragmatic hernia

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25
Q

what are some of the causes of pleural effusion?

A

haemorrhage

infection (pyothorax)

neoplasia

heart failure

chylothorax

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26
Q

what are the usual findings on auscultation of a patient with a pleural effusion?

A

muffled heart and lung sounds ventrally but normal lung sounds dorsally

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27
Q

what is our immediate clinical approach to a patient respiratory distress?

A

oxygen supplementation straight away

physical examination

localise - stridor/stertor?

RR and effort

mucous membrane colour

HR, arrhythmias, murmurs, peripheral pulses

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28
Q

what is the goal of oxygen supplementation in these patients?

A

increase oxygen content in arterial blood and delivery to tissues - resolution of life-threatening hypoxaemia

relief of respiratory distress

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29
Q

what are the main determinants of oxygen delivery?

A

haemoglobin concentration

blood concentration

cardiac output

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30
Q

what are the main methods of oxygen supplementation?

A

flow by
mask
nasal prongs
oxygen catheter
collar
oxygen cage
intubation and ventilation

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31
Q

what is the normal approach to patients displaying signs of pleural effusion/pneumothorax?

A

diagnose - examine, thoracic radiographs, U/S

stabilise - thoracocentesis

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32
Q

what types of samples might we collect via thoracocentesis?

A

samples for cytology, culture, biochemistry

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33
Q

what is a safe fraction of inspired oxygen for long term supplementation?

A

<60%

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34
Q

how can we monitor patients in respiratory distress?

A

physical examination

arterial blood gas analysis

pulse oximetry

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35
Q

what should we be monitoring during physical examination of patients in respiratory distress?

A

RR and effort

mm colour

HR and peripheral pulses

anxiety levels

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36
Q

what does arterial blood gas analysis measure?

A

PaO2 - partial pressure of oxygen

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37
Q

what is the gold standard for evaluation of arterial oxygenation?

A

arterial blood gas analysis

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38
Q

where should a blood gas sample be taken from?

A

an artery

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39
Q

which arteries are suitable for blood gas sampling?

A

dorsal metatarsal, femoral artery

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40
Q

what is important to remember after taking a blood gas sample?

A

lots of pressure on punctured vessel

analysis should be done ASAP

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41
Q

what is PaO2 dependent on?

A

oxygen
barometric pressure

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42
Q

what is a normal PaO2 value breathing room air?

A

100mmHg

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43
Q

what is a normal PaO2 value breathing 100% oxygen?

A

500mmHg

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44
Q

what PaO2 value is hypoxaemic?

A

<80mmHg

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45
Q

what does pulse oximetry measure?

A

peripheral oxygen saturation

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46
Q

what is oxygen saturation indicative of?

A

haemoglobin saturation

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47
Q

what are the benefits of pulse oximetry?

A

continuous and non-invasive measurement

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48
Q

what is the relationship between PaO2 and oxyhaemoglobin?

A

non-linear, S-shaped curve

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49
Q

why isn’t it deal to take thoracic radiographs of an animal in respiratory distress?

A

restraint for radiographs can exacerbate stress

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50
Q

what side congestive heart failure do dogs commonly get?

A

can get left and right sided

51
Q

what commonly causes left-sided heart failure in dogs?

A

small breeds - myxomatous mitral valve disease

large breeds - dilated cardiomyopathy

52
Q

what is dilated cardiomyopathy?

A

weakening of the heart muscle - results in systolic dysfunction

53
Q

what causes right-sided heart failure in dogs?

A

pericardial effusion

54
Q

what causes congestive heart failure in young dogs?

A

congenital heart disease

55
Q

what type of heart failure do cats get?

A

biventricular failure

56
Q

what commonly causes biventricular heart failure in cats

A

hypertrophic cardiomyopathy

57
Q

what happens in hypertrophic cardiomyopathy?

A

thickening of the heart muscle - leads to diastolic dysfunction

58
Q

what are the effects of left-sided (backwards) heart failure?

A

pulmonary oedema
tachynpoea/dyspnoea
cough

59
Q

what are the effects of right-sided (backwards) heart failure?

A

effects on body - backs up from pulmonary circulation

distended peripheral veins - esp enlarged jugular

ascites, pleural effusion

60
Q

how does cardiac ascites/pleural effusion cause tachypnoea/dyspnoea?

A

presses on diaphragm

61
Q

what is caused by forward failure of the heart?

A

reduced cardiac output

62
Q

what side of the heart is affected by forward failure?

63
Q

what are the effects of forward failure/reduced cardiac output?

A

weak peripheral pulses due to decreased stroke volume

tachycardia (compensatory)

64
Q

how does left-sided heart failure result in a cough?

A

enlarged heart presses on left main bronchus

65
Q

how does left-sided congestive heart failure present?

A

heart murmur (not always)

tachypnoea, dyspnoea

tachycardia

pale mm, prolonged CRT

arrhythmias (?)

weak peripheral pulses, pulse deficits (?)

66
Q

what is the overall clinical approach towards left-sided heart failure?

A

history

physical examination

stabilisation of patient before performing diagnostic tests

67
Q

how can we stabilise patients in left-sided congestive heart failure?

A

minimise stress - consider mild sedation

oxygen supplementation

furosemide IV for pulmonary oedema

pimobendan IV/PO to improve myocardial contractility

68
Q

how does furosemide help reduce pulmonary oedema in left-sided heart failure?

A

reduces circulating volume

69
Q

what drug can be given to help reduce circulating volume?

A

furosemide IV

70
Q

which drug can be given to help improve myocardial contractility?

A

pimobendan (IV/PO)

71
Q

what diagnostic tests can be done to diagnose left-sided congestive heart failure?

A

echocardiography

thoracic radiography

ECG

blood pressure measurement

blood tests

72
Q

what can echocardiography tell us about left-sided heart failure?

A

diagnosis and severity

73
Q

what can thoracic radiography tell us about left-sided heart failure?

A

degree of pulmonary oedema, patterns and distribution of fluid, presence of neoplasia

74
Q

what can ECG tell us about left-sided heart failure?

A

presence of arrhythmias

75
Q

what can BP measurement tell us about left-sided heart failure?

A

presence of hypotension

76
Q

what can blood tests tell us about left-sided heart failure?

A

electrolytes, renal parameters

77
Q

what should we be monitoring in patients with left-sided congestive heart failure?

A

RR and effort (goal <40 brpm)

blood pressure (goal >80mmHg systolic)

HR and pulse quality

ECG if known arrhythmias

thoracic radiographs for pulmonary oedema

78
Q

what are the main signs of patient improvement with left-sided heart failure?

A

respiratory and heart rate decrease

79
Q

how should left-sided heart failure be managed one the patient is stabilised?

A

optimise therapy - life-long

start feeding ASAP to minimise cardiac cachexia

r/v for blood tests, repeat exam and echo etc

80
Q

why should patients with left-sided heart failure be fed well ASAP?

A

to minimise cardiac cachexia

81
Q

what is cardiac cachexia?

A

loss of body weight and muscle condition due to heart failure

82
Q

what are some of the causes of right-sided congestive heart failure?

A

pulmonic stenosis

tricuspid dysplasia

pericardial effusion

83
Q

how can right-sided heart failure be diagnosed?

A

history and physical exam

echocardiography

thoracic radiography

ECG

CT

84
Q

what is heard on auscultation of a patient with right-sided heart failure?

A

muffled heart sounds

85
Q

what can echocardiography tell us about right-sided heart failure?

A

diagnosis and presence of neoplasia

86
Q

why is it important not to do radiographs alone if right-sided heart failure is suspected?

A

can be easy to mistake pericardial effusion for enlargement of the heart of radiographs

87
Q

why might we CT patients with right-sided heart failure?

A

to determine if cause is neoplastic

88
Q

what is pericardial effusion?

A

increased fluid in the pericardium

89
Q

what is the result of pericardial effusion on the heart?

A

right atrium collapses due to increased external pressure - filling is impaired and CO is decreased

90
Q

what is compression of the heart due to pericardial effusion called?

A

cardiac tamponade

91
Q

what is cardiac tamponade?

A

compression of the heart due to pericardial effusion

92
Q

what are the causes of pericardiac effusion?

A

can be idiopathic or neoplastic

93
Q

what is the typical signalment for pericardial effusion?

A

large-breed adult dogs

94
Q

what is the first line treatment for pericardial effusion?

A

pericardiocentesis

IVFT

95
Q

why are IV fluids given to patients with pericardial effusion?

A

obstruction to venous return caused by external pressure - fluid can help increase venous return thereby increasing CO

96
Q

why is it difficult to tell whether the correct area is being drained during thoracocentesis?

A

pericardial fluid typically looks like blood

97
Q

how can you tell if fluid drained during pericardiocentesis is pericardial fluid or blood?

A

wait and see if fluid clots - blood will clot but pericardial fluid won’t

98
Q

what should we see in the patient post-pericardiocentesis?

A

improvement of CVS parameters - HR, pulse strength, demeanour

99
Q

how long should patients be hospitalised after pericardiocentesis? why?

A

12-24 hours - monitor for arrhythmias and/or recurrence

100
Q

what is the most common cause of feline cardiac emergency?

A

hypertrophic cardiomyopathy

101
Q

what is the typical presentation of hypertrophic cardiomyopathy?

A

murmur, gallop sound

tachypnoea, dyspnoea, open-mouth breathing

tachy or bradycardia

weak peripheral pulses

hypothermia

102
Q

where does arterial thromboembolism commonly occur in cats?

A

distal aorta

103
Q

what is the most obvious sign of aortic thromboembolism in cats?

A

sudden-onset hindlimb paresis/paralysis

104
Q

what are the symptoms of aortic thromboembolism?

A

pain

pallor/cyanosis (purple) of pads and nail beds

paresis/paralysis

pulselessness

poikilothermy (cold leg)

105
Q

what is the typical clinical approach to feline cardiac emergencies?

A

history

physical examination

stabilisation - before further testing!

106
Q

how can we help stabilise cats in cardiac emergency?

A

avoid stress!!

oxygen supplementation

furosemide IV/IM for pulmonary oedema

drain pleural effusion

gentle warming

analgesia (for arterial thromboembolism)

107
Q

what is involved in the diagnostic approach for feline cardiac emergencies?

A

history and PE

stabilisation

echo and ECG

BP measurements

blood tests

108
Q

what can echo tell us about feline cardiac emergency?

A

diagnosis, severity

109
Q

what can thoracic radiography tell us about feline cardiac emergency?

A

presence of pulmonary oedema (avoid until patient stable)

110
Q

what can ECG tell us about feline cardiac emergency?

A

presence of arrhythmias

111
Q

what can BP measurement tell us about feline cardiac emergency?

A

presence of hypotension

112
Q

what can blood tests tell us about feline cardiac emergency?

A

electrolytes, renal parameters

113
Q

how should cats be managed after stabilisation of cardiac emergency?

A

adjust therapy, offer food - important to get sufficient caloric intake

warm soft bedding and physio for thromboembolism

home ASAP - minimisation of stress (ongoing once home)

114
Q

how should cats be monitored after cardiac emergency?

A

re-visit for blood tests, exam, echo

owner to monitor SRR and respiratory effort for signs of thromboembolism

115
Q

what should cat owners be warned of after cardiac emergency?

A

some cats can die suddenly

116
Q

what is the prognosis of feline cardiac emergency?

A

guarded - can do well

117
Q

what is a normal HR for a cat/dog?

A

dog 60-160bpm

cat 160-220bpm

118
Q

what is classed as bradyarrhythmia?

A

dog <60bpm

cat <120bpm

119
Q

what is classed as tachyarrhythmia?

A

dog >160bpm

cat >240bpm

120
Q

what is the typical presentation of a patient with an arrhythymia?

A

syncope/collapse

weakness/exercise intolerance

signs of congestive heart failure

abnormal heart rhythm - irregular, too fast/slow

weak peripheral pulses, pulse deficits

121
Q

how can we test for arrhythmias?

122
Q

what is 3rd degree AV block?

A

HR 40/min, P and QRS not associated

123
Q

what is ventricular tachycardia?

A

HR 300/min, wide and bizarre complexes

Applied Clinical Veterinary Nursing (31 decks)

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