case 3

Question 1

management of possible pnuemonia

Answer 1

management of respiratory failure
management of airway secretions
reduction of increase work of breathing
management of co morbilidites
recovery of illness

Question 2

what would you hear on ascultation if the patient has pnemonia or pulmonary odema

Answer 2

coarse crackles- sound of walking on snow

Question 3

what would fine crackles on ascultation indicate

Answer 3

pulmonary fibrosis - rubbing fingers along a balloon

Question 4

postural management of breathlessness

Answer 4

forward kneeing - children, lying on pillows
relxed standing
forward leaning standing on window seal
high side lying
breathing control in sitting

Question 5

what is the term given to low heart rate

Answer 5

bradycardia
normal heart rate 60-100 bpm

Question 6

major cause of desaturation

Answer 6

loss of lung volume
confirmed with cardio resp assessment
ascultation and palpation

Question 7

outcome measures

Answer 7

ascultation
dysponea rating score
palpation
functional test, time up and go
6 min walk test
Lars quesitonnaire score

Question 8

What is COPD

Answer 8

chronic obstructive pulmonary disorder
chronic inflammatory lung disease - causes obstructive airflow from the lungs

Question 9

symptoms of COPD

Answer 9

breathing difficulties
shortness of breath during physical activities
cough
mucus production
wheezing
chest tightness
frequent respiratory infections- case
lack of energy- difficulty coping at home, using Zimmer frame , is she leaning over the zimmer frame
unintended weight loss
swelling in ankles and feet

Question 10

common conditions that contribute to COPD

Answer 10

emphysema
chronic bronchitis

Question 11

what is chronic bronchitis

Answer 11

inflammation of the lining of bronchial tubes

Question 12

test for COPD diagnosis

Answer 12

spirometry

Question 13

treatment for infection in COPD

Answer 13

emphysema during an infection episode
bronchitis - always do postural drainage

Question 14

outcome measures for COPD

Answer 14

lung volumes and exercise capacity
cardiopulmonary exercise testing
bleep test
6- minute walk test

Question 15

purpose of inhalers in COPD

Answer 15

relaxing the muscles in the airway
reducing swelling

Question 16

benefit of NIV

Answer 16

reduces the work of breathing
improving gas exchange

Question 17

how does NIV work

Answer 17

create a positive airway pressure - make the pressure outside the lung greater than the pressure inside the lungs

Boyles law- gas will move from a place of high concentration to low concentration, hence air rushes inside the lungs and keeps the airway open for longer. - Air Force into the lung down the pressure gradient

keeps the chest and lungs expanding by increasing the residual capacity

Question 18

types of NIV

Answer 18

non invasive positive pressure
negative pressure ventilation

Question 19

what is non NIPP

Answer 19

non invasive positive pressure breathing
delivery of oxygen at either constant or variable pressure

Question 20

two types of pressures in non invasive positive pressure

Answer 20

Bi-level positive pressure breathing
constant positive pressure CPAP

Question 21

what is CPAP

Answer 21

a type of NIV but a non invasive positive pressure breathing non rebreathing mask
provides constant fixed pressure throughout expiration and inspiration - constant C
causes the airway to remain open - results in a higher degree of inspired oxygen
usually for patients with sleep apnea
eg type 1 respiratory failure , acute pulmonary oedema - by recruiting collapse alveoli

Question 22

how does CPAP work with pulmonary oedema

Answer 22

recruits collapse alveoli

Question 23

indications for CPAP

Answer 23

patient remains hypoxic after intervention
atlectesis complete or partial collapse of the lung
rib fractures
type 1 respiratory failure
congestive heart failure
cardio pulmonary oedema
obstructive sleep apnea
pneumonia

Question 24

which respiratory failure would you use CPAP

Answer 24

type 1

Question 25

what is BIPAP

Answer 25

biPAP
provides different airway pressure depending on inspiration and expiration
composed of iPAP and ePAP
inspiration positive airway pressure - is higher than the expiration positive airway pressure
ventilation is recruited mainly by IPAP
ePAP- recruits under ventilated or collapse alveoli - allows for the removal of exhaled gas