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Cardiorespiratory Flashcards

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1
Q

define dyspnoea

A

difficult or labored breathing

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2
Q

define tachypnoea

A

increased rate of of respiration

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3
Q

define orthopnoea

A

upright position with extended neck

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4
Q

what is normal respiratory rate when resting?

A

<35 brpm

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5
Q

what is normal respiratory rate when sleeping?

A

<25 brpm

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6
Q

what are the main causes of tachypnoea/dyspnoea?

A

physiological
hypoxaemia
hypercapnia
respiratory disease
cardiac disease

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7
Q

what are the physiological causes of tachypnoea/dyspnoea?

A

stress
pain
excitement
exercise

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8
Q

what is hypoxaemia?

A

not enough oxygen in the blood

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9
Q

what makes up the upper airway?

A

nasal passages
pharynx
larynx
trachea

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10
Q

what type of dyspnoea is associated with upper airway issues?

A

inspiratory dyspnoea

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11
Q

what is inspiratory dyspnoea?

A

hard for the patient to breathe in

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12
Q

what sounds may be heard with inspiratory dyspnoea?

A

stertor
stridor

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13
Q

what is stertor?

A

snoring

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14
Q

what is stridor?

A

harsh, high pitched breathing sounds on inspiration

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15
Q

what conditions are stertor and stridor commonly seen with?

A

stertor - BOAS
stridor - laryngeal paralysis

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16
Q

what are the upper airway causes of dyspnoea?

A

laryngeal paralysis
BOAS
neoplasia
polyps
FB
inflammation
tracheal collapse

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17
Q

how should upper airway causes of dyspnoea be treated?

A

if obstructed: anaesthesia and intubation
decompensation may be rapid

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18
Q

what makes up the lower airway?

A

bronchi
bronchioli

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19
Q

what respiratory pattern is seen with lower airway dyspnoea?

A

quick short inspiration
prolonged expiration

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20
Q

what may be heard on lung auscultation of lower airway dyspnoea patients?

A

harsh lung sounds (wheezing, crackles)

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21
Q

what are harsh lung sound on auscultation caused by?

A

bronchoconstriction
secretions blocking airways causing crackles as air forced past

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22
Q

what are the lower airway causes of dyspnoea?

A

asthma
bronchitis
smoke inhalation
bronchopneumonia
COPD

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23
Q

what dyspnoea type is seen with lung parenchyma disease?

A

inspiratory and expiratory

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24
Q

what are the lung parenchymal causes of dyspnoea?

A

pulmonary oedema (cardiac or non cardiac)
pneumonia
haemorrhage
contusion
neoplasia
thromboembolism
parasites

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25
Q

what are the cardiac causes of pulmonary oedema?

A

CHF

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26
Q

what are the non-cardiac causes of pulmonary oedema?

A

electrocution
strangling

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27
Q

what breathing pattern is seen with pleural space diseases?

A

restrictive pattern
increased rate but reduced depth

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28
Q

why is restrictive dyspnoea seen with pleural space diseases

A

lungs cannot expand due to fluid/air leading to shallower breaths

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29
Q

what are the pleural space causes of dyspnoea?

A

pneumothorax
pleural effusion
masses
diaphragmatic hernia

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30
Q

what are the causes of pleural effusions?

A

haemorrhage
infection (pyothorax)
neoplasia
heart failure
chylothorax

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31
Q

what are the auscultation findings in patients with effusions?

A

if standing: muffled heart and lung sounds ventrally (fluid settling)
normal dorsally

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32
Q

what are the auscultation findings in patients with pneumothorax?

A

muffed heart and lung sounds dorsally as air rises

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33
Q

what is involved in initial assessment of respiratory emergencies?

A

oxygen is crucial
targeted physical exam
check for URT signs
RR rate and effort
MM
heart rate
any arrhythmias
murmurs
check peripheral pulses (defecits)

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34
Q

what is the goal of oxygen supplementation?

A

increase oxygen content in arterial blood and delivery to tissue

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35
Q

what are the determinants of oxygen delivery?

A

haemoglobin concentration
blood oxygenation
cardiac output

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36
Q

how does haemoglobin concentration determine oxygen delivery?

A

oxygen carrying capcity reduced if haemaglobin reduced (e.g. anaemia)

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37
Q

how does cardiac output determine oxygen delivery?

A

reduced leads to reduced oxygen delivery to tissues

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38
Q

what are the main methods of oxygen supplementation?

A

flow by
mask
nasal prongs
oxygen catheter
collar (not ideal)
oxygen cage
intubation
ventilation

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39
Q

how is pleural effusion / pneumothorax diagnosed?

A

physical exam
thoracic xray
ultrasound

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40
Q

what are the benefits of ultrasound for respiratory patients?

A

less stressful
no need to be in lateral

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41
Q

what can be used to stabilise pleural effusion/pneumothorax patients?

A

thoracocentesis

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42
Q

what is involved in thoracocentesis?

A

sedate animal
prep area
use catheter to drain chest
collect samples for cytology, culture and biochem

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43
Q

what catheters may be used for thoracocentesis?

A

catheters for dogs
butterfly needle for cats

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44
Q

what are the main considerations for oxygen administration?

A

is supplementation indicated
awareness of O2 toxicity
rate of delivery needed (not too much or too little)

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45
Q

what are the aims of oxygen supplementation?

A

resolution of life threatening hypoxaemia
relief of respiratory distress

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46
Q

what are the lungs vulnerable to when patients are on high FiO2?

A

oxygen toxicity

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47
Q

what influences oxygen toxicity?

A

FiO2 and duration

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48
Q

when are patients only likely to receive 100% FiO2?

A

intubated or ventilated

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49
Q

how what FiO2 should patients be on if on long term oxygen?

A

<60%

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50
Q

what can be done to avoid oxygen toxicity?

A

administer to lowest level the patient will tolerate

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51
Q

what are the main patient monitoring methods available for dyspnoeic patients?

A

physical exam
ABG
pulse ox

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52
Q

what is the downside of monitoring patients through physical exam?

A

insensitive

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53
Q

what should be monitored on a clinical exam of respiratory patients?

A

RR and effort
MM
heart rate
peripheral pulses
anxiety levels

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54
Q

what may be indicated by mm colour?

A

dehydration
hypovolaemia
hypotension
vasoconstriction

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55
Q

why may respiratory patients be hypotensive/vasoconstricted?

A

cardiac output reduced

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56
Q

are mucous membranes necessarily a good indicator of respiratory patient status?

A

could be normal

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57
Q

what is measured by ABG?

A

PaO2

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58
Q

what is the gold standard method of evaluation of arterial oxygenation?

A

ABG

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59
Q

where are ABG samples taken from?

A

dorsal metatarsal artery
femoral artery

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60
Q

what is needed for ABG?

A

specific syringe
blood gas analyser

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61
Q

what is crucial about ABG samples to ensure PaO2 is measured accurately?

A

airtight
analysed straight away

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62
Q

what is normal PaO2 on ABG at room air?

A

100 mmHg

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63
Q

what is normal PaO2 on ABG at 100% O2?

A

500mmHg

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64
Q

what does PaO2 depend on?

A

FiO2
barometric pressure

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65
Q

what PaO2 suggests hypoxaemia?

A

<80 mmHg on room air

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66
Q

what O2 saturation suggests hypoxaemia?

A

<95%

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67
Q

what PaO2 is indicated by SpO2 of <90%?

A

<60 mmHg

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68
Q

how much does PaO2 increase by on 100% FiO2?

A

~5x room air

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69
Q

why are venous PaO2 readings less useful?

A

venous PaO2 around 40mmHg once O2 has been delivered to tissues

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70
Q

on room air what PaO2 should you aim for?

A

80-120 mmHg

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71
Q

on room air what SpO2 should you aim for?

A

95-100%

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72
Q

what does pulse oximetry measure?

A

peripheral oxygen saturation

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73
Q

what is calculated by a pulse ox?

A

haemaglobin oxygen saturation

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74
Q

is the reationship between PaO2 and SpO2 linear?

A

no

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75
Q

what is the issue with thoracic radiographs?

A

dangerous if patient is unstable
requires lateral recumbancy
could lead to rapid decompensation

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76
Q

what is congestive heart failure caused by?

A

increased pressure in the heart leading to increased pressure in veins returning to the heart
this creates increased pressure in the capillaries which prevents fluid from being reabsorbed from the tissues

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77
Q

what types of CHF are seen in dogs?

A

left sided
right sided
congenital

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78
Q

what signs are seen with left sided CHF?

A

pulmonary veins
pulmonary oedema

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79
Q

what can lead to left sided CHF in small dogs?

A

myxomatous mitral valve disease

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80
Q

what can lead to left sided CHF in large dogs?

A

DCM

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81
Q

what happens to the heart muscle during DCM?

A

muscle becomes weakened

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82
Q

what part of the cardiac cycle is affected by DCM?

A

systolic failure - heart not strong enough to pump

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83
Q

what signs are seen with right sided CHF?

A

systemic veins affected
effusions / ascites seen

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84
Q

what can right sided CHF lead to?

A

pericardial effusion

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85
Q

what are the sings of CHF in cats?

A

both left and right sided can be seen

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86
Q

what side of the heart is commonly more affected in cats?

A

left

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87
Q

what is the most common heart disease in cats?

A

hypertrophic cardiomyopathy

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88
Q

what is the effect of hypertrophic cardiomyopathy on the cardiac cycle?

A

diastolic dysfunction due to thickening of heart muscle - heart cannot fill

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89
Q

what are the two types of backward CHF?

A

left sided
right sided

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90
Q

what organ is most affected by left sided CHF?

A

lungs

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91
Q

what are the signs seen in the lungs of left sided CHF?

A

pulmonary oedema
tachypnoea
dyspnoea
cough

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92
Q

how does left sided CHF lead to cough?

A

cough receptors are in large airways and so unlikely affected by pulmonary oedema
more likely that enlarged heart is triggering receptors

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93
Q

what area is most affected by right sided CHF?

A

body

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94
Q

what signs are seen with right sided CHF?

A

distended peripheral veins
ascites
pleural effusion

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95
Q

what are the respiratory effects seen as a result of pleural effusion / ascites?

A

tachypnoea / dyspnoea due to restriction of breathing

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96
Q

what is forward CHF?

A

reduction in cardiac output

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97
Q

when is forward CHF often seen?

A

endstage disease - especially DCM

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98
Q

what side of the heart can be affected by forward failure?

A

left or right

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99
Q

what are the signs of forward CHF?

A

weak peripheral pulses
tachycardia

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100
Q

why does forward CHF lead to weak peripheral pulses and tachycardia?

A

reduction in stroke volume leads to increased heart rate in an attempt to increase cardiac output

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101
Q

how do patients with left sided CHF present?

A

heart murmur
tachypnoea
dyspnoea
tachycardia
pale
prolonged capillary refill time
arrhythmias
weak peripheral pulses
pulse defecits

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102
Q

are heart murmurs always seen with left sided CHF?

A

most but not all
can have murmur and no CHF but can have CHF with no murmur

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103
Q

what sort of heart failure are pale mm more commonly seen with?

A

forward failure

104
Q

what is involved in initial assessment of left sided CHF patients?

A

history
targeted physical exam
stabilisation before diagnostic testing

105
Q

why must CHF patients be stabilised before diagnostic tests are performed?

A

patients often fragile and may decompensate

106
Q

how can left sided CHF patients be stabilised?

A

minimise stress
consider mild sedation
O2

107
Q

what may CHF patients be given for mild sedation?

A

butorphanol - reduce RR and calm

108
Q

what drugs may be given to stabilise left sided CHF patients?

A

furosemide IV
pimobendan PO or IV

109
Q

what is the purpose of furosemide?

A

reduces circulating volume and so work of the heart

110
Q

what can furosemide reduce in LHS CHF patients?

A

pulmonary oedema

111
Q

what is the rol of pimobendan in the stabilisation of left sided CHF patients?

A

improve myocardial contractility to increase stroke volume and cardiac output

112
Q

via what route should pimobendan be given?

A

PO if possible and safe, if not IV

113
Q

what are the main diagnostic tests used for left sided CHF?

A

echocardiography
thoracic xray
ECG
BP
blood tests

114
Q

what is the role of echocardiography in left sided congestive heart failure?

A

diagnosis
assessment of severity

115
Q

what is the role of thoracic xray in left sided congestive heart failure?

A

assess for pulmonary oedema or other potential causes of respiratory distress

116
Q

is thoracic xray always indicated?

A

not if in resp distress due to risk of decompensation
may be used later once more stable

117
Q

what is the role of ECG in left sided congestive heart failure?

A

detection of arrhythmia

118
Q

what is the role of BP measurement in left sided congestive heart failure?

A

assess for hypotension

119
Q

what is the role of blood tests in left sided congestive heart failure?

A

check electrolytes and renal function (due to diuretics)

120
Q

what may be seen on xray of a patient in left sided CHF?

A

pulmonary oedema - lungs compressed ‘floating’ on fluid
enlarged heart

121
Q

what is normal sleeping RR?

A

<25 brpm

122
Q

what is normal resting RR?

A

<30 brpm

123
Q

what should be monitored about a left sided CHF patient?

A

RR and effort
BP
HR and pulse quality
ECG

124
Q

how can patient improvement when stabilising in left sided CHF be shown?

A

RR and HR decrease

125
Q

what is the RR goal for patients in left sided CHF?

A

<40 brpm

126
Q

when should you be concerned about left sided CHF patients BP?

A

systolic <80 mmHg

127
Q

what should you do if arrhythmias are detected on ECG?

A

telemetry

128
Q

when may thoracic radiographs be used in an unstable CHF patient?

A

if patient isnt improving as rapidly as expected

129
Q

how should left sided CHF patients be treated once stabilised?

A

optimise therapy
start feeding ASAP
book revisits for blood tests, echo etc

130
Q

what must be explained to owners about managing left sided CHF?

A

therapy is life long

131
Q

why should CHF patients be fed as soon as possible?

A

cardiac cachexia leading to loss of muscle mass and body weight

132
Q

how often may blood tests be needed for CHF patients?

A

~3 monthly

133
Q

what are the causes of right sided CHF?

A

pulmonic stenosis
tricuspid dysplasia
pericardial effusion

134
Q

how is right sided CHF diagnosed?

A

history and physical exam
clip neck
echocardiography
thoracic xray
ECG
CT

135
Q

why should the neck be clipped on all suspected right sided CHF patients?

A

look for jugular pulsation

136
Q

what may be found on auscultation of right sided CHF patients?

A

muffled heart sounds due to effusion

137
Q

what is the role of echocardiography in right sided congestive heart failure?

A

diagnosis
detection of neoplasia

138
Q

what is the role of thoracic xray in right sided congestive heart failure?

A

assess heart size

139
Q

what is the disadvantage of using thoracic xray to assess heart size?

A

pericardial effusion may appear like an enlarged heart

140
Q

what is the role of ECG in right sided congestive heart failure?

A

arrythmia

141
Q

what is the role of CT in right sided congestive heart failure?

A

neoplasia detection - primary or metastasis

142
Q

what is a pericardial effusion?

A

increased fluid in the pericardium

143
Q

what is cardiac tamponade?

A

right atrium is lowest pressure chamber and so collapses due to the increased external pressure from the effusion - this impairs filling of the right side of the heart and in trun decreases cardiac output

144
Q

what is the effect of pericardial effusion?

A

due to increased fluid and collapse of the right atrium filling of the right side of the heart is impaired leading to decreased cardiac output and reduced left sided heart filling

145
Q

what are the causes of pericardial effusion?

A

idiopathic
neoplastic

146
Q

what animals mainly present with pericardial effusion?

A

large breed adult dogs

147
Q

how is pericardial effusion treated?

A

stabilisation through pericardiocentesis and IVFT

148
Q

why is IVFT indicated for pericardial effusion?

A

pressure in heart is reduced as is venous return
IVFT can increase systemic volume and so increase pressure in heart and hopefully cardiac output

149
Q

what drugs are not indicated for pericardial effusion?

A

diuretics due to risk of reducing venous return even more

150
Q

what is the only heart failure condition that IVFT is indicated for?

A

pericardial effusion

151
Q

how does fluid drained from the pericardium typically appear?

A

looks like blood

152
Q

how can you check fluid drained from the pericardium is actually not being drained from the heart itself?

A

pericardial fluid will not clot - blood will - plain serum tube to watch for clotting
ECG to check for arrhythmia if heart is being prodded

153
Q

what should be seen following pericardiocentesis?

A

visible improvement in HR, pulse strength and demenour

154
Q

how long should patients be hospitalised for following pericardial effusion?

A

12-24 hours

155
Q

what should be monitored for following pericardial effusion and pericardiocentesis?

A

arrhythmias
recurrence

156
Q

what should owners be warned about following pericardial effusion?

A

signs to look out for
that it may recur

157
Q

what is the most common cause of feline cardiac emergencies?

A

hypertrophic cardiomyopathy

158
Q

what can heart failure in cats be precipitated by?

A

stress
anaesthesia
IVFT

159
Q

how do cats in heart failure commonly present?

A

murmur
gallop sounds
tachypnoea
dyspnoea
open-mouth breathing
tachy or brady cardia
weak peripheral pulses
hypothermia

160
Q

what signs indicate a cat is more sick with CHF?

A

gallop sounds
bradycardia

161
Q

what is a significant feline cardiac emergency?

A

arterial thromboembolism

162
Q

where does the thrombus develop from in feline arterial thromboembolism?

A

L atrium

163
Q

what are the signs of arterial thromboembolism?

A

sudden onset hindlimb paresis / paralysis
pain
pallor/cyanosis of pads and nail beds
pulselessness
cold leg

164
Q

what are the 5 Ps of arterial thromboembolism?

A

pain
pallor
paresis/paralysis
pulselessness
poikilothermy

165
Q

why does paralysis/paresis, poikilothermy and pulselessness result from arterial thromboembolism?

A

blockage of distal aorta

166
Q

what is the initial approach to feline cardiac emergancies?

A

history
physical exam
stabilisation
further tests once stable as cats are so fragile

167
Q

how should feline cardiac patients be stabilised?

A

AVOID STRESS
O2
furosemide
drain pleural effusion
gentle warming
analgesia and soft bedding if arterial thromboembolism

168
Q

how can feline cardiac emergencies be diagnosed?

A

echocardiagraphy for diagnosis
thoracic xrays (avoid if possible)
ECG - arrhythmia
BP measurement - hypotension
blood tests - electrolytes and renal parameters

169
Q

how should feline patients be managed once stabilised?

A

adjust drug therapy to lowest effective dose
life long treatment
warm soft bedding
physio if ATE
Home ASAP
encourage eating
minimise stress including vet visits
revisit for bloods and echo

170
Q

what must owners be informed about cats with cardiac issues?

A

monitor sleeping resp rate and respiratory effort for signs of worsening CHF
look for signs of ATE (5 Ps)
warn them that cats may die suddenly

171
Q

what is the normal heart rate of a dog?

A

60-160 bpm

172
Q

what is the normal heart rate of a cat?

A

160-220 bpm

173
Q

what is classed as a brady arrhythmia in a dog?

A

<60 bpm

174
Q

what is classed as a brady arrhythmia in a cat?

A

<120 bpm

175
Q

what is classed as a tachy arrhythmia in a dog?

A

> 160 bpm

176
Q

what is classed as a tachy arrhythmia in a cat?

A

> 240 bpm

177
Q

how may patients with arrhythmias present?

A

syncope/ collapse
weakness
exercise intolerance
signs of CHF
abnormal heart rhythm (irregular/brady/tachy)
weak peripheral pulses
pulse defecits

178
Q

how can arrhythmia be diagnosed?

A

ECG

179
Q

what is a severe type of brady arrhythmia?

A

3rd degree AV block

180
Q

what HR is associated with 3rd degree AV block?

A

40 bpm

181
Q

what is occuring during 3rd degree AV block?

A

AV node not functioning
impulse from SA node not transmitted
ventricular rhythm with atrial tachycardia

182
Q

what is seen on ECG with 3rd degree AV block?

A

P and QRS complexes are not associated as SA node not triggering ventricular depolarisation

183
Q

describe this cardiac rhythm

A

3rd degree AV block - P unrelated to QRS

184
Q

what HR is associated with ventricular tachycardia?

A

300 bpm

185
Q

how does ventricular tachycardia appear on ECG?

A

wide and bizarre complexes

186
Q

what cardiac rhythm is this?

A

ventricular tachycardia

187
Q

where does fluid collect in left sided CHF?

A

lungs - pulmonary oedema

188
Q

where does fluid collect in right sided CHF?

A

body - ascites, pleural effusion, jugular pulsation

189
Q

how should all cardiac patients be managed?

A

with care
low stress
very fragile

190
Q

what is echocardiography used to diagnose?

A

cardiac disease

191
Q

what is thoracic xray used to diagnose?

A

heart failure

192
Q

what are ECGs used to diagnose?

A

arrhythmias

193
Q

what are the signs of respiratory distress in cats?

A

tachypnoea
orthopnoea
dyspnoea
open mouth breathing

194
Q

when triaging a patient what is crucial?

A

assess the most life threatening concerns even if distracting wounds/fractures

195
Q

what body systems are assessed as a priority during triage?

A

respiratory
CVS
neuro (head trauma etc)

196
Q

what is key when managing respiratory patients?

A

fragile!
low stress environment
O2

197
Q

when examining a respiratory patient what areas should you look at?

A

observe rate, effort and pattern
auscultate
purcussion
check cranial rib spring
assess oxygenation

198
Q

what is cranial rib spring?

A

palpation of cranial ribs to assess for potential masses
ribs should compress slightly and spring back

199
Q

what is indicted by inspiratory dyspnoea?

A

extrathoracic upper airway obstruction

200
Q

what is indicted by expiratory dyspnoea?

A

intrathoracic upper airway obstruction
lower airway disease

201
Q

what is indicated by rapid shallow breathing or slow laboured breathing?

A

pleural space disease
parenchymal disease

202
Q

what are adventitious lung sounds?

A

abnormal respiratory noises

203
Q

what sort of adventitious lung sounds may be heard on auscultation?

A

wheezes
crackles

204
Q

how else can the chest be assessed during examinaton aside from auscultation?

A

palpation (cranial rib spring)
percussion

205
Q

what is a valuable tool for monitoring oxygen delivery?

A

pulse ox

206
Q

what are the 4 main causes of dyspnoea?

A

URT obstruction
LRT disease
pleural space disease
parenchymal disease

207
Q

what are the common URT causes of dyspnoea?

A

FB
nasopharyngeal polyps
tumours

208
Q

what are the common LRT causes of dyspnoea?

A

feline asthma
bronchitis

209
Q

what are the common pleural space causes of dyspnoea?

A

pneumothorax
pleural effusion
haemothorax
diaphragmatic rupture

210
Q

what are the common parenchymal causes of dyspnoea?

A

pulmonary oedema
haemorrhage
infection
neoplasia
fibrosis

211
Q

what is indicated by inspiratory noise and dyspnoea?

A

URT disease

212
Q

what area of the URT may be affected if stridor is heard?

A

larynx

213
Q

what are the potential causes of laryngeal disease?

A

neoplasia
oedema
FB
spasm
paralysis
abscess
granuloma

214
Q

what must be done if a URT patient is unable to breathe effectively?

A

intubation
may need ucath

215
Q

what is indicted by expiratory dyspnoea with no URT noise?

A

lower airway disease

216
Q

what may indicate chronic lower airway disease on auscultation?

A

expiratory wheezes
increased resonance

217
Q

what are the common causes of feline lower airway disease?

A

asthma
chronic bronchitis
bacterial infection
lungworm
FB
neoplasia

218
Q

what is feline asthma caused by?

A

type 1 hypersensitivity response to an allergen

219
Q

what is caused by hypersensitivity in feline asthma?

A

airway hyper-responsiveness
reversible bronchoconstriction
secondary inflammatin

220
Q

what is seen with chronic bronchitis?

A

airway inflammation
excess mucus production
airway narrowing

221
Q

what can be developed secondary to feline asthma and chronic bronchitis?

A

pneumothorax

222
Q

how should feline lower airway disease be treated?

A

stress free
O2
bronchodilators

223
Q

what bronchodilators may be used to treat feline lower airway disease?

A

terbutaline
salbutamol

224
Q

how is terbutaline administered?

A

IM/sC
q4

225
Q

how is salbutamol administered?

A

1-2 puffs of inhaler for effect

226
Q

what may be seen on xray of a patient with chronic bronchitis?

A

lungs over expanded due to ongoing inflammation

227
Q

what disease types are indicated by rapid shallow breathing with no URT noise?

A

parenchymal disease
pleural space disease

228
Q

what disease types are indicated by rapid shallow breathing with no URT noise and no muffling of heart or lung sounds?

A

parenchymal disease

229
Q

what are the main causes of parenchymal disease?

A

haemorrhage
pneumonia
oedema (cardiogenic or non-cardiogenic)
neoplasia
fibrosis

230
Q

how should cardiogenic pulmonary oedema be treated?

A

cage rest
oxygen
sedation with butorphanol if necessary
furosemide I/M if needed

231
Q

what disease types are indicated by inspiratory dyspnoes, rapid shallow breathing with no URT noise and muffling of heart or lung sounds?

A

pleural space disease

232
Q

what is seen on chest percussion with pleural space diseases?

A

dullness

233
Q

what are the main causes of pleural space diseases?

A

pleural effusion
pneumothorax
neoplasia
diaphragmatic rupture

234
Q

what is heard on auscultation and percussion of patients with pneumothorax?

A

hyper-resonance dorsally
reduced lung sounds

235
Q

what should be done if pleural effusion seen/suspected?

A

drain
sample

236
Q

what types of fluid may be seen in pleural effusion?

A

transudate
modified transudate
exudate

237
Q

what is indicated by pleural effusion of transudate?

A

hypoalbuminaemia

238
Q

what is indicated by pleural effusion of modified transudate?

A

CHF
neoplasia

239
Q

what is indicated by pleural effusion of septic exudate?

A

pyothorax

240
Q

what is indicated by pleural effusion of non-septic exudate?

A

neoplasia
FIP

241
Q

what is indicated by pleural effusion of chyle exudate?

A

CHF
trauma
idiopathic

242
Q

what is indicated by pleural effusion of blood exudate?

A

trauma
coagulopathy
neoplasia

243
Q

what equipment is needed for thoracocentesis?

A

clippers
sterile prep
gloves
catheter
3 way tap
EDTA
plain tube
20ml syringe

244
Q

where should the needle be placed for thoracocentesis?

A

7th to 8th intercostal space

245
Q

whereabouts in relation to the rib should thoracocentesis needles be placed?

A

cranial - nerves and blood vessels run along caudal boarder

246
Q

what tubes are needed for thoracocentesis sampling?

A

EDTA for cytology
plain for biochem, culture and sensitivity

247
Q

what should the patient be started on following thoracocentesis?

A

IV antibiotics pending culture results

248
Q

what are the main considerations for emergency care of respiratory patients?

A

stress free
sedation if needed
O2
equipment needed for thoracocentesis, intubation and tracheostomy
U/S preferred
xray if safe
meds

249
Q

what are the main bronchodilators used?

A

terbutaline IM
salbutamol inhaler

250
Q

what are the main emergency drugs used for respiratory patients?

A

bronchodilators
glucocorticoids
furosemide (IV or IM)

251
Q

what glucocorticoids may be used in respiratory patients?

A

dexamethasone IV or IM
fluticasone inhaler

252
Q

when will furosemide be given to patients?

A

if CHF expected

253
Q

what is the common management for URT disease?

A

intubate

254
Q

what is the common management for LRT disease?

A

bronchodilators

255
Q

what is the common management for CHF?

A

frusemide

256
Q

what is the common management for pleural space disease?

A

thoracocentesis

Advanced Clinical Nursing Theory (36 decks)

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