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Acute Care > Cardiorespiratory Practical Skills > Flashcards

Cardiorespiratory Practical Skills Flashcards

1
Q

What are the indications for O2 therapy?

A
  • Acute respiratory failure
  • Low cardiac output states
  • Increased metabolic demands
  • Post-surgical
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2
Q

What is Type I and Type II respiratory failure?

A

Type I = hypoxia without hypercapnia

Type II = hypoxia with hypercapnia

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3
Q

Precautions for O2 therapy?

A
  • Hypoxic drive
  • Oxygen toxicity (lung damage resulting from too much supplementary oxygen)
  • Retrolental fibroplasia (disease of the premature eye)
  • Fire
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4
Q

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

a) 1L/min = 22%
b) 2L/min = 24%
c) 3L/min = 26%
d) 4L/min = 28%

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5
Q

What is anatomical dead space?

A

The volume of conducting airways. This does not change.

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6
Q

What is the normal tidal volume of an adult?

How much of this is anatomical dead space?

A

450-600ml

150ml of dead space

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7
Q

What is physiological dead space?

A

When a disease or condition obstructs the alveolar space (anatomical areas of diffusion)

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8
Q

What is spirometry?

A

A physiological test that measures the maximal volume of air that an individual can inspire and expire with maximal effort.

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9
Q

What is:

a) FVC
b) FEV1

A

a) FVC = volume delivered during a forceful expiration (from full inspiration)
b) FEV1 = expiratory volume in the first second of an FVC manoeuvre

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10
Q

What are the instructions for teaching the patient how to do a spirometry test?

A

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

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11
Q

How to check if a spirometry test is good quality?

A

3x ‘satisfactory tests’
Two largest FVC values must be <0.150L
Two largest FEV1 values must be <0.150L

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12
Q

When you achieve 3 reproducible spirometry results, what data is recorded?

A

The best result of 3.

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13
Q

What is the FEV1 : FVC ratio important for?

A

Gives diagnostic information regarding the classification of pulmonary disease.

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14
Q

What are the FEV1:FVC values for the following classifications:

a) Normal
b) Obstructive
c) Restrictive

A

a) Normal = 75-85%
b) Obstructive = <70% (reduced FEV1 due to obstruction)
c) Restrictive = 75-85% (FEV1 and FVC reduced)

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15
Q

If an obstructive disease is identified, what are the following severities rated by? (FEV1)

a) MILD
b) MODERATE
c) SEVERE
d) VERY SEVERE

A

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

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16
Q

What is a peak expiratory flow meter?

A

A monitoring device for peak expiratory flow rate.

17
Q

What are the instructions for a peak flow meter test?

A

1) Hold device horizontally and clear fingers from scale.
2) Take maximal breath in.
3) Breath out as HARD and FAST as you can.

18
Q

A peak flow drop below __% of a patients best PEF means they should consult their asthma action plan.

A

80%

19
Q

What is the V/Q matching at each lung region:

a) Apex
b) Middle
c) Lower

A

a) Apex = V > Q
b) Middle = V = Q
c) Lower = V < Q

20
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

A

70

21
Q

What are TEEs?

What are they used for?

A

Thoracic Expansion Exercises

They are used to try to increase lung volumes, reduce atelectasis/lobar collapse, remove secretions & assist with cough.

22
Q

What are the mechanisms of action for TEEs/SMIs?

A

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

23
Q

Instructions for a TEE set:

A

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

24
Q

What is the usual prescription for TEEs?

A

3-4x consecutive TEE breaths
Rest
Repeat until 10-12 breath total eg. 3x sets with 4x reps
Can repeat hourly whilst awake.

25
Q

What is an SMI?

What is it used for?

A

Sustained maximal inspiration; TEE + a sniff at maximal inspiration
Uses as per TEE

26
Q

What is the usual prescription of SMI’s?

A

2x TEE’s followed by 1xSMI
Break
Repeat to achieve 10-12 breaths
Can be hourly whilst awake

27
Q

What is incentive spirometry?

Examples?

A

A device which encourages patients to take a sustained maximal inspiration through visual feedback.
Eg. Triflow, Voldyne

28
Q

Explain the procedure for using a Voldyne.

A

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’

29
Q

What is the usual prescription for Voldyne or Triflow?

A

10-12 breaths (3-4sets), hourly

with sufficient rests

30
Q

Explain the technique for using a Triflow?

A

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

31
Q

What are the main secretion clearance techniques?

A

1) Cough
2) Huff & FETs
3) ACBTs

32
Q

What is a cough?

A

A deep inspiration followed by a forced expiratory manoeuvre performed against a closed glottis

33
Q

Expiratory flow needs to be at least __% greater than inspiratory flow to get secretion clearance by annular flow.

A

10

34
Q

A cough may be assisted by:

A
  • Upright positioning
  • Increasing inspiratory capacity
  • Manual overpressure/support
  • Sip of water
35
Q

How to describe a cough?

A
  • Strong/weak
  • Dry/moist
  • Effect/ineffective
  • Productive/non-productive
36
Q

High vs Low volume huff?

A 
High = clears secretions from trachea and larger airways 
Low = clears secretions from smaller periphery airways
37
Q

What is the procedure for FETs?

A

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’

38
Q

What is the procedure for ACBT?

A

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

Acute Care (6 decks)

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