Cardiorespiratory Practical Skills Flashcards
What are the indications for O2 therapy?
- Acute respiratory failure
- Low cardiac output states
- Increased metabolic demands
- Post-surgical
What is Type I and Type II respiratory failure?
Type I = hypoxia without hypercapnia
Type II = hypoxia with hypercapnia
Precautions for O2 therapy?
- Hypoxic drive
- Oxygen toxicity (lung damage resulting from too much supplementary oxygen)
- Retrolental fibroplasia (disease of the premature eye)
- Fire
What is the percentage of oxygen delivered via nasal specs for the following:
a) 1L/min
b) 2L/min
c) 3L/min
d) 4L/min
* *over 6L can cause dryness/discomfort
a) 1L/min = 22%
b) 2L/min = 24%
c) 3L/min = 26%
d) 4L/min = 28%
What is anatomical dead space?
The volume of conducting airways. This does not change.
What is the normal tidal volume of an adult?
How much of this is anatomical dead space?
450-600ml
150ml of dead space
What is physiological dead space?
When a disease or condition obstructs the alveolar space (anatomical areas of diffusion)
What is spirometry?
A physiological test that measures the maximal volume of air that an individual can inspire and expire with maximal effort.
What is:
a) FVC
b) FEV1
a) FVC = volume delivered during a forceful expiration (from full inspiration)
b) FEV1 = expiratory volume in the first second of an FVC manoeuvre
What are the instructions for teaching the patient how to do a spirometry test?
1) Attach nose clip
2) Take a maximum inspiration, steady pace, “more, more, more”
3) Seal mouth tightly around mouthpiece
4) Expire; “blast as hard, fast & for as long as possible”, “keep going, keep going”
5) Rest & then re-test
How to check if a spirometry test is good quality?
3x ‘satisfactory tests’
Two largest FVC values must be <0.150L
Two largest FEV1 values must be <0.150L
When you achieve 3 reproducible spirometry results, what data is recorded?
The best result of 3.
What is the FEV1 : FVC ratio important for?
Gives diagnostic information regarding the classification of pulmonary disease.
What are the FEV1:FVC values for the following classifications:
a) Normal
b) Obstructive
c) Restrictive
a) Normal = 75-85%
b) Obstructive = <70% (reduced FEV1 due to obstruction)
c) Restrictive = 75-85% (FEV1 and FVC reduced)
If an obstructive disease is identified, what are the following severities rated by? (FEV1)
a) MILD
b) MODERATE
c) SEVERE
d) VERY SEVERE
a) MILD = FEV1 > / = 80% of predicted
b) MODERATE = FEV1 50-80% of predicted
c) SEVERE = FEV1 30-50% of predicted
d) VERY SEVERE = FEV1 < 30% of predicted
What is a peak expiratory flow meter?
A monitoring device for peak expiratory flow rate.
What are the instructions for a peak flow meter test?
1) Hold device horizontally and clear fingers from scale.
2) Take maximal breath in.
3) Breath out as HARD and FAST as you can.
A peak flow drop below __% of a patients best PEF means they should consult their asthma action plan.
80%
What is the V/Q matching at each lung region:
a) Apex
b) Middle
c) Lower
a) Apex = V > Q
b) Middle = V = Q
c) Lower = V < Q
The diaphragm provides __% of inspiratory effort and has a major effect on ventilation.
*thus, those with impaired diaphragm movements should be encouraged to perform diaphragmatic movements eg. post-abdo Sx
70
What are TEEs?
What are they used for?
Thoracic Expansion Exercises
They are used to try to increase lung volumes, reduce atelectasis/lobar collapse, remove secretions & assist with cough.
What are the mechanisms of action for TEEs/SMIs?
1) Collateral airflow via collateral channels: air movements from areas of high pressure to low, expanding collapse alveoli
2) Interdependence theory: inflating alveoli pulls on the adjacent alveoli
Instructions for a TEE set:
1) Relax shoulders and upper chest
2) Take in a slow, deep breath (6 seconds), expanding ribs against hands
3) Hold for 1-2 seconds
4) Breath out slowly
5) *optional squeeze at the end of expiration to facilitate next inspiration
What is the usual prescription for TEEs?
3-4x consecutive TEE breaths
Rest
Repeat until 10-12 breath total eg. 3x sets with 4x reps
Can repeat hourly whilst awake.
What is an SMI?
What is it used for?
Sustained maximal inspiration; TEE + a sniff at maximal inspiration
Uses as per TEE
What is the usual prescription of SMI’s?
2x TEE’s followed by 1xSMI
Break
Repeat to achieve 10-12 breaths
Can be hourly whilst awake
What is incentive spirometry?
Examples?
A device which encourages patients to take a sustained maximal inspiration through visual feedback.
Eg. Triflow, Voldyne
Explain the procedure for using a Voldyne.
1) Slow, deep inspiration through mouthpiece
2) Aim to get marker as high as possible
* Can set target
* Left chamber has ‘good, better. best’ ranges to cue SLOW inspiration
* make sure marker returns to bottom before second breath to avoid ‘stacking’
What is the usual prescription for Voldyne or Triflow?
10-12 breaths (3-4sets), hourly
with sufficient rests
Explain the technique for using a Triflow?
1) Slowly and deeply inspire
2) Aim to get first 2x balls up to top for a couple of seconds
3) Third ball should NOT be raised, if so the breath is too fast
What are the main secretion clearance techniques?
1) Cough
2) Huff & FETs
3) ACBTs
What is a cough?
A deep inspiration followed by a forced expiratory manoeuvre performed against a closed glottis
Expiratory flow needs to be at least __% greater than inspiratory flow to get secretion clearance by annular flow.
10
A cough may be assisted by:
- Upright positioning
- Increasing inspiratory capacity
- Manual overpressure/support
- Sip of water
How to describe a cough?
- Strong/weak
- Dry/moist
- Effect/ineffective
- Productive/non-productive
High vs Low volume huff?
High = clears secretions from trachea and larger airways Low = clears secretions from smaller periphery airways
What is the procedure for FETs?
1) Position patient upright or in well supported GAP
2) Teach LVH
3) 30sec-1min breathing control
4) 1-2 LVHs
5) BC
6) LVH or HVH (may cause cough)
7) BC
8) Continue until FETs sound ‘dry’
What is the procedure for ACBT?
1) Position in sitting or GAP
2) 30sec-1min BC
3) 3-4x TEEs (1-2sec hold)
4) BC
5) FET; start with LVH, later may choose HVH, and then cough
6) BC
Repeat
