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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
what are some of the causes of pleural effusion?
haemorrhage infection (pyothorax) neoplasia heart failure chylothorax
26
what are the usual findings on auscultation of a patient with a pleural effusion?
muffled heart and lung sounds ventrally but normal lung sounds dorsally
27
what is our immediate clinical approach to a patient respiratory distress?
oxygen supplementation straight away physical examination localise - stridor/stertor? RR and effort mucous membrane colour HR, arrhythmias, murmurs, peripheral pulses
28
what is the goal of oxygen supplementation in these patients?
increase oxygen content in arterial blood and delivery to tissues - resolution of life-threatening hypoxaemia relief of respiratory distress
29
what are the main determinants of oxygen delivery?
haemoglobin concentration blood concentration cardiac output
30
what are the main methods of oxygen supplementation?
flow by mask nasal prongs oxygen catheter collar oxygen cage intubation and ventilation
31
what is the normal approach to patients displaying signs of pleural effusion/pneumothorax?
diagnose - examine, thoracic radiographs, U/S stabilise - thoracocentesis
32
what types of samples might we collect via thoracocentesis?
samples for cytology, culture, biochemistry
33
what is a safe fraction of inspired oxygen for long term supplementation?
<60%
34
how can we monitor patients in respiratory distress?
physical examination arterial blood gas analysis pulse oximetry
35
what should we be monitoring during physical examination of patients in respiratory distress?
RR and effort mm colour HR and peripheral pulses anxiety levels
36
what does arterial blood gas analysis measure?
PaO2 - partial pressure of oxygen
37
what is the gold standard for evaluation of arterial oxygenation?
arterial blood gas analysis
38
where should a blood gas sample be taken from?
an artery
39
which arteries are suitable for blood gas sampling?
dorsal metatarsal, femoral artery
40
what is important to remember after taking a blood gas sample?
lots of pressure on punctured vessel analysis should be done ASAP
41
what is PaO2 dependent on?
oxygen barometric pressure
42
what is a normal PaO2 value breathing room air?
100mmHg
43
what is a normal PaO2 value breathing 100% oxygen?
500mmHg
44
what PaO2 value is hypoxaemic?
<80mmHg
45
what does pulse oximetry measure?
peripheral oxygen saturation
46
what is oxygen saturation indicative of?
haemoglobin saturation
47
what are the benefits of pulse oximetry?
continuous and non-invasive measurement
48
what is the relationship between PaO2 and oxyhaemoglobin?
non-linear, S-shaped curve
49
why isn't it deal to take thoracic radiographs of an animal in respiratory distress?
restraint for radiographs can exacerbate stress
50
what side congestive heart failure do dogs commonly get?
can get left and right sided
51
what commonly causes left-sided heart failure in dogs?
small breeds - myxomatous mitral valve disease large breeds - dilated cardiomyopathy
52
what is dilated cardiomyopathy?
weakening of the heart muscle - results in systolic dysfunction
53
what causes right-sided heart failure in dogs?
pericardial effusion
54
what causes congestive heart failure in young dogs?
congenital heart disease
55
what type of heart failure do cats get?
biventricular failure
56
what commonly causes biventricular heart failure in cats
hypertrophic cardiomyopathy
57
what happens in hypertrophic cardiomyopathy?
thickening of the heart muscle - leads to diastolic dysfunction
58
what are the effects of left-sided (backwards) heart failure?
pulmonary oedema tachynpoea/dyspnoea cough
59
what are the effects of right-sided (backwards) heart failure?
effects on body - backs up from pulmonary circulation distended peripheral veins - esp enlarged jugular ascites, pleural effusion
60
how does cardiac ascites/pleural effusion cause tachypnoea/dyspnoea?
presses on diaphragm
61
what is caused by forward failure of the heart?
reduced cardiac output
62
what side of the heart is affected by forward failure?
both
63
what are the effects of forward failure/reduced cardiac output?
weak peripheral pulses due to decreased stroke volume tachycardia (compensatory)
64
how does left-sided heart failure result in a cough?
enlarged heart presses on left main bronchus
65
how does left-sided congestive heart failure present?
heart murmur (not always) tachypnoea, dyspnoea tachycardia pale mm, prolonged CRT arrhythmias (?) weak peripheral pulses, pulse deficits (?)
66
what is the overall clinical approach towards left-sided heart failure?
history physical examination stabilisation of patient before performing diagnostic tests
67
how can we stabilise patients in left-sided congestive heart failure?
minimise stress - consider mild sedation oxygen supplementation furosemide IV for pulmonary oedema pimobendan IV/PO to improve myocardial contractility
68
how does furosemide help reduce pulmonary oedema in left-sided heart failure?
reduces circulating volume
69
what drug can be given to help reduce circulating volume?
furosemide IV
70
which drug can be given to help improve myocardial contractility?
pimobendan (IV/PO)
71
what diagnostic tests can be done to diagnose left-sided congestive heart failure?
echocardiography thoracic radiography ECG blood pressure measurement blood tests
72
what can echocardiography tell us about left-sided heart failure?
diagnosis and severity
73
what can thoracic radiography tell us about left-sided heart failure?
degree of pulmonary oedema, patterns and distribution of fluid, presence of neoplasia
74
what can ECG tell us about left-sided heart failure?
presence of arrhythmias
75
what can BP measurement tell us about left-sided heart failure?
presence of hypotension
76
what can blood tests tell us about left-sided heart failure?
electrolytes, renal parameters
77
what should we be monitoring in patients with left-sided congestive heart failure?
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
what are the main signs of patient improvement with left-sided heart failure?
respiratory and heart rate decrease
79
how should left-sided heart failure be managed one the patient is stabilised?
optimise therapy - life-long start feeding ASAP to minimise cardiac cachexia r/v for blood tests, repeat exam and echo etc
80
why should patients with left-sided heart failure be fed well ASAP?
to minimise cardiac cachexia
81
what is cardiac cachexia?
loss of body weight and muscle condition due to heart failure
82
what are some of the causes of right-sided congestive heart failure?
pulmonic stenosis tricuspid dysplasia pericardial effusion
83
how can right-sided heart failure be diagnosed?
history and physical exam echocardiography thoracic radiography ECG CT
84
what is heard on auscultation of a patient with right-sided heart failure?
muffled heart sounds
85
what can echocardiography tell us about right-sided heart failure?
diagnosis and presence of neoplasia
86
why is it important not to do radiographs alone if right-sided heart failure is suspected?
can be easy to mistake pericardial effusion for enlargement of the heart of radiographs
87
why might we CT patients with right-sided heart failure?
to determine if cause is neoplastic
88
what is pericardial effusion?
increased fluid in the pericardium
89
what is the result of pericardial effusion on the heart?
right atrium collapses due to increased external pressure - filling is impaired and CO is decreased
90
what is compression of the heart due to pericardial effusion called?
cardiac tamponade
91
what is cardiac tamponade?
compression of the heart due to pericardial effusion
92
what are the causes of pericardiac effusion?
can be idiopathic or neoplastic
93
what is the typical signalment for pericardial effusion?
large-breed adult dogs
94
what is the first line treatment for pericardial effusion?
pericardiocentesis IVFT
95
why are IV fluids given to patients with pericardial effusion?
obstruction to venous return caused by external pressure - fluid can help increase venous return thereby increasing CO
96
why is it difficult to tell whether the correct area is being drained during thoracocentesis?
pericardial fluid typically looks like blood
97
how can you tell if fluid drained during pericardiocentesis is pericardial fluid or blood?
wait and see if fluid clots - blood will clot but pericardial fluid won't
98
what should we see in the patient post-pericardiocentesis?
improvement of CVS parameters - HR, pulse strength, demeanour
99
how long should patients be hospitalised after pericardiocentesis? why?
12-24 hours - monitor for arrhythmias and/or recurrence
100
what is the most common cause of feline cardiac emergency?
hypertrophic cardiomyopathy
101
what is the typical presentation of hypertrophic cardiomyopathy?
murmur, gallop sound tachypnoea, dyspnoea, open-mouth breathing tachy or bradycardia weak peripheral pulses hypothermia
102
where does arterial thromboembolism commonly occur in cats?
distal aorta
103
what is the most obvious sign of aortic thromboembolism in cats?
sudden-onset hindlimb paresis/paralysis
104
what are the symptoms of aortic thromboembolism?
pain pallor/cyanosis (purple) of pads and nail beds paresis/paralysis pulselessness poikilothermy (cold leg)
105
what is the typical clinical approach to feline cardiac emergencies?
history physical examination stabilisation - before further testing!
106
how can we help stabilise cats in cardiac emergency?
avoid stress!! oxygen supplementation furosemide IV/IM for pulmonary oedema drain pleural effusion gentle warming analgesia (for arterial thromboembolism)
107
what is involved in the diagnostic approach for feline cardiac emergencies?
history and PE stabilisation echo and ECG BP measurements blood tests
108
what can echo tell us about feline cardiac emergency?
diagnosis, severity
109
what can thoracic radiography tell us about feline cardiac emergency?
presence of pulmonary oedema (avoid until patient stable)
110
what can ECG tell us about feline cardiac emergency?
presence of arrhythmias
111
what can BP measurement tell us about feline cardiac emergency?
presence of hypotension
112
what can blood tests tell us about feline cardiac emergency?
electrolytes, renal parameters
113
how should cats be managed after stabilisation of cardiac emergency?
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
how should cats be monitored after cardiac emergency?
re-visit for blood tests, exam, echo owner to monitor SRR and respiratory effort for signs of thromboembolism
115
what should cat owners be warned of after cardiac emergency?
some cats can die suddenly
116
what is the prognosis of feline cardiac emergency?
guarded - can do well
117
what is a normal HR for a cat/dog?
dog 60-160bpm cat 160-220bpm
118
what is classed as bradyarrhythmia?
dog <60bpm cat <120bpm
119
what is classed as tachyarrhythmia?
dog >160bpm cat >240bpm
120
what is the typical presentation of a patient with an arrhythymia?
syncope/collapse weakness/exercise intolerance signs of congestive heart failure abnormal heart rhythm - irregular, too fast/slow weak peripheral pulses, pulse deficits
121
how can we test for arrhythmias?
ECG
122
what is 3rd degree AV block?
HR 40/min, P and QRS not associated
123
what is ventricular tachycardia?
HR 300/min, wide and bizarre complexes
124

Applied Clinical Veterinary Nursing (31 decks)

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