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Seanos epic Acute > Important values and stuff for 1st assessment > Flashcards

Important values and stuff for 1st assessment Flashcards

1
Q

Special questions to ask for respiratory presentations

A

Cough
Sputum
Dyspnea (Shortness of breath)
Wheeze
Hemoptysis (coughing up blood)
Smoking history
Home oxygen
Chest pain
Falls
Previous physio intervention

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2
Q

What is dyspnea

A

shortness of breath

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3
Q

What is hemoptysis

A

coughing up blood

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4
Q

What are the important vital signs?

A

Respiratory rate
Heart rate
Blood pressure
Temperature
Oxygen Saturation (SpO2)
Consciousness

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5
Q

What is respiratory rate and what are the normal values

A

Number of breaths a person breathes per minute
Normal: 12-20 breaths/minute

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6
Q

What is tachypnoea and bradypnoea

A

Tachypnoea: rapid breathing
Bradypnoea: slow breathing

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7
Q

What is heart rate and what are normal values?

A

How many times the heart beats per minute
Normal: 60-100bpm

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8
Q

What is tachycardia and bradycardia?

A

Tachycardia: fast heart rate (>100 bpm)
Bradycardia: slow heart rate (<60bpm)

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9
Q

What is blood pressure and what are normal values?

A

indicates the pressure of blood moving through the arteries as the heart pumps blood throughout the body
Normal: 120/80 or 130/85

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10
Q

What is hypertension

A

Increase in blood pressure which may mean your heart is working hard to deliver oxygenated blood to key organs

> 140/90

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11
Q

What is hypotension?

A

decrease in blood pressure which may mean the pumping pressure of the heart is not sufficient to deliver key organs with oxygenated blood

<90/60

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12
Q

What is temperature and what is a normal value?

A

Temperature measures how well the body can make and remove heat

Normal: 36.5-37.2

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13
Q

What is Oxygen saturation and what are normal values?

A

Provides an indication of the amount of oxygen in a patient’s blood

Normal: 95-100%

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14
Q

What does ACVPU check and what are the steps

A

Checks level of consciousness

Alert
Confusion
Voice
Pain
Unresponsive

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15
Q

Goals of the vital signs

A

To be within ‘the flags’
White = normal
Yellow = patient condition deteriorating
Red = emergency scenario

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16
Q

4 cardiorespiratory impairments

A

Oxygen (O2) movement
Carbon Dioxide (CO2) movement
Secretion clearance
Mobility

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17
Q

Treatment for O2 movement impairment

A

Positioning, breathing exercises, walking

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18
Q

Treatment for CO2 movement impairment

A

relaxation, breathing techniques

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19
Q

Treatment for secretion clearance impairment

A

breathing exercises (ACBT), devices, manual percussions/vibrations, walking

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20
Q

Treatment for mobility impairment

A

strength exercises, functional retraining and walking

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21
Q

What do antibiotics do?

A

Help to fight infections

e.g. Penicillin, ceftriaxone

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22
Q

What do anti-inflammatories/steroids do?

A

reduce the inflammatory response

e.g. hydrocortisone

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23
Q

What do inotropes do?

A

Increases blood pressure either by enhancing contractility of the heart or causing widespread vasoconstriction

e.g. noradrenaline, dobutamine, adrenaline

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24
Q

What do anti-arrhythmics do?

A

stabilises cardiac muscle to control abnormal rhythms

e.g. amiodarone, metoprolol

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25
Q

What do bronchodilators do?

A

relax the smooth muscles of the airways

e.g. ventolin, salbutamol, bricanyl

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26
Q

What do anti-emetics do?

A

reduce nausea and vomiting

e.g. ondansetron, maxalon

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27
Q

What do anti-hypertensives do?

A

reduce blood pressure through vasodilation

e.g. metoprolol, catopril

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28
Q

What do anti-coagulants do?

A

reduces the clotting levels of blood

e.g. heparin, warfarin, aspirin

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29
Q

What do analgesics do?

A

impacts the reception of pain signals

e.g. fentanyl, morphine, oxycodone, endone

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30
Q

What do sedatives do?

A

reduces the alertness of a patient

e.g. diazepan, midazolam

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31
Q

What do mucolytics do?

A

breaks down proteins in sputum, which reduces the viscosity of sputum and aids in its clearance

e.g. pulmozyme

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32
Q

What do diuretics do?

A

causes increases in urine production to reduce total body fluid load

e.g. lasix, frusemide

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33
Q

Main markers for blood count

A

haemoglobin - carries O2
WBC - infection marker
haematocrit
RBC
C reactive protein - infection marker
Neutrophils

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34
Q

markers of coagulation/clotting

A

platelets
partial thrombin time
internalised normalised ratio (INR)

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35
Q

Normal INR

A

0.8-1.2

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36
Q

What are the cardiac biomarkers

A

Troponin
Creatine kinase
Lactate

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37
Q

What are the electrolyte panel markers

A

potassium
sodium
calcium
chloride

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38
Q

Kidney markers

A

blood urea nitrogen
serum creatine
glucose testing

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39
Q

What is compliance

A

the ability of the lungs to stretch

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40
Q

What is V/Q ratio

A

ratio of ventilation to perfusion

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41
Q

What is ventilation

A

flow of air into and out of the alveoli

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42
Q

What is perfusion

A

flow of blood to alveolar capillaries

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43
Q

What is a shunt

A

blood but no air (reduced ventilation)

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44
Q

What is dead space

A

air but no blood (reduced perfusion)

dead = no blood

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45
Q

What is pleural effusion

A

accumulation of fluid in the pleural space

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46
Q

What is pneumothorax

A

accumulation of air in the pleural space

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47
Q

What nerve innervates the diaphragm

A

phrenic nerve

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48
Q

What is tidal volume and normal value

A

normal breathing - the amount of air that moves in or out of the lungs with each respiratory cycle
500ml

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49
Q

Normal values for vital capacity

A

4L

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50
Q

Normal values for Functional Residual Capacity

A

2.5L

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50
Q

What is residual volume and Normal values for Residual volume

A

Amount of air in lungs after maximal expiration
1L

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51
Q

Normal values for Total lung capacity

A

5L

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52
Q

What is Inspiratory Residual Volume and what are the Normal values

A

Maximum volume that can be inhaled after a normal inhalation
2L

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53
Q

What is Expiratory Residual Volume and what are the Normal values

A

Maximum volume that can be exhaled after a normal exhalation
1L

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54
Q

Restrictive respiratory disease

A

Can’t get Oxygen In

Can’t get it IN

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55
Q

Obstructive respiratory disease

A

Can’t get CO2 Out

Can’t get it OUT

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56
Q

Restrictive disorders impact … measures

A

inspiratory

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57
Q

Obstructive disorders impact … measures

A

expiratory

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58
Q

COPD
- Obstructive/restrictive
- Symptoms
- clinical features

A

obstructive

Symptoms
- Dysnpnoea
- Cough
- Sputum production

Clinical features
- barrel chest
- accessory muscle use
- decreased breath sounds on auscultation
- oxygen desaturation
- hyperinflation on chest radiograph
- reduced functional exercise capacity

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59
Q

Why does CO2 rise (not getting out)

A

Decreased neurological control of breathing
Increased airway resistance (narrowed airway)
Decreased lung compliance
Decreased chest wall compliance

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60
Q

Main causes of decreased PaO2

A

alveolar ventilation
ventilation/perfusion mismatch
diffusion impairment

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61
Q

What is the DRSABCE approach for Chest X Rays

A

D: Details
RIPE: Rotation, Inspiration, Projection, Exposure
S: Soft tissues and bones

A: Airway - trachea, carina, bronchi, hilar structures
B: Breathing - lungs and pleura
C: Cardiac - heart size and borders
D: Diaphragm - assessment and costophrenic angles
E: Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas

62
Q

D in DRS ABCDE

A

Details
Patient details
Date/time
Previous imaging

63
Q

R in DRS ABCDE

A

RIPE

Rotation: clavicles equidistant

Inspiration: is patient well inflated, look at number of ribs

Projection: AP or PA (usually PA)

Exposure: brightness/darkness of chest

64
Q

S in DRS ABCDE

A

Soft tissues and bones

look at bones, fat, lung marking

65
Q

A in DRS ABCDE

A

Airway
- inspect trachea: located centrally
- carina: point where is divides into bronchi
- hilar structures:

66
Q

B in DRS ABCDE

A

Breathing

Looking for lung markings
divide lungs into upper, middle, lower zone
Look for borders of each lung to observe pneumothorax
increased darkness = too much air == collapsed lung

67
Q

C in DRS ABCDE

A

Cardiac

heart should occupy no more than 50% of thoracic width
2/3 to left and 1/3 to right

68
Q

Second D in DRS ABCDE

A

Diaphragm

Costophrenic angles
Flat diaphragm

69
Q

What does a blunt costophrenic angle indicate

A

lung hyperinflation as a result of diaphragmatic flattening

70
Q

What does oxygen saturation indicate

A

The O2 carrying capacity of blood

71
Q

Normal range of PaO2 (ABGs)

A

80-100mmHg

72
Q

When PaO2 and Sp/SaO2 are low (Hypoxemia), what happens?

A

Insufficient oxygen is transported and delivered to the tissues (hypoxia)

73
Q

High PaO2 =

A

good delivery of O2 to the tissues
Hb takes up O2 well

74
Q

Value for hypoxemia

A

PaO2 < 80mmHg

75
Q

What is FiO2 and what are normal values with room air

A

the fraction of inspired O2 when we breathe in air (concentration of room air breathed in that is oxygen)
21% (0.21)

76
Q

What is PF ratio and what are normal values

A

PaO2 / FiO2
Normal: >500mmHg

Measures respiratory reserve

77
Q

If a patient has low O2 measures, what cardiorespiratory impairment would they have?

A

Oxygen movement impairment

78
Q

If pH falls out of normal range, what compensates to ensure it returns to normal

A

Respiratory or metabolic (kidney) system

79
Q

What is pH and Normal pH values

A

Acid base balance of the body
7.35-7.45

80
Q

pH too low =

A

acidosis

81
Q

pH too high =

A

alkalosis

82
Q

Normal CO2 levels

A

35-45mmHg

83
Q

High PaCO2 =

A

acidosis (>45)
Result of hypoventilation (slow breathing) - retaining too much CO2
Carbon dioxide movement impairment

84
Q

Low PaCO2 =

A

alkalosis (<35)
Result of hyperventilation (fast breathing) - getting rid of too much CO2

85
Q

Normal Bicarbonate levels

A

22-26 mEq/L

86
Q

BE normal range

A

-2 to +2 mEq

87
Q

BE < -2

A

Base deficit
Metabolic acidosis

88
Q

BE > +2

A

Base excess
Metabolic alkalosis

89
Q

Low Bicarbonate =

A

Acidic

90
Q

High Bicarbonate =

A

Alkalinic

91
Q

Acidic/Alkalinic pattern

A

Acidic (LHLL)
pH: Low
PaCO2: High
HCO3: Low
BE: Low

Alkalinic (HLHH)
pH: high
PaCO2: low
HCO3: high
BE: high

92
Q

Type 1 lung failure

A

PaO2 is low < 60
PaCO2 is normal

93
Q

Type 2 pump failure

A

PaO2 is low < 60
PaCO2 is high >45

94
Q

Forced Expiratory Ratio

A

FEV1/FVC

FVC: amount of air that can be forcibly expired during a maximal expiration

FEV1: amount of air expired during the first second of that maximal expiration

95
Q

FEV1/FVC ratio measured <70%

A

Obstruction
Taking long time to get air out

96
Q

FVC predicted of normal <80%

A

Restriction
Can’t take enough air in so less blown out

97
Q

FEV1/FVC <0.70
What does FEV1 give you

A

Classification of airflow limitation severity
GOLD

98
Q

What initiates contraction of the heart?

A

SA (sinoatrial) Node
Purkinje fibres

99
Q

Electrical conductivity of the heart ensure that ___ contract first, allowing blood to flow into the ___, via the opening and closing of ___

A

atria
ventricles
valves

100
Q

What do working heart valves prevent

A

leaking and backflow of blood

101
Q

What is myocardium

A

muscular layer of the heart wall
Composed of cardiac muscle

102
Q

Whereis the myocardium thicker

A

Ventricles

103
Q

What is the fluid filled sac which covers the heart

A

pericardial sac

104
Q

What is found between the two thin layers of pericardium

A

pericardial fluid

105
Q

What is the visceral pericardium

A

inner layer that covers the heart

106
Q

What is the parietal pericardium

A

attaches heart to the chest wall

107
Q

Describe flow of blood in the heart

A

Right atrium receives deoxygenated blood from body (Vena Cava)
Right ventricle receives deoxygenated blood from right atrium and sends it to lungs via pulmonary artery
Left atrium receives oxygenated blood from lungs via pulmonary veins
Left ventricle receives oxygenated blood via left atrium and sends it to body via atrium

108
Q

Cardiac function measures

A

Heart rate
Stroke volume
Cardiac output
Mean arterial pressure
Systemic vascular resistance

109
Q

Stroke volume and normal value

A

volume of blood pumped out of the left ventricle during each systolic cardiac contraction
Normal: 50-100mls

110
Q

What is cardiac output and normal volume

A

amount of blood pumped by the heart each minute and is the mechanism whereby blood flows around the body, blood flow to the brain and other vital organs
Is the product of HR x SV

Normal: 5-6L/min

111
Q

What is mean arterial pressure and normal value

A

average arterial pressure throughout one cardiac cycle
Normal: 80-100mmHg

112
Q

What is systemic vascular resistance

A

diameter of blood vessels and viscosity of blood

113
Q

Increased viscosity of blood =

A

increased resistance

114
Q

Smaller diameter of blood vessels =

A

increased resistance

115
Q

What is myocarditis and how is it commonly caused

A

inflamed myocardium (heart muscle) caused by vital infection or autoimmune responses

116
Q

What is pericarditis and how does it present

A

inflamed pericardium (lining of the heart)
can have heart attack presentation - chest pain due to rubbing of inflamed lining

117
Q

What marker would be elevated in coronary artery disease

A

Troponin

118
Q

How is coronary artery disease caused

A

inadequate blood supply to the heart due to blockage in the blood vessels which supply it
- caused from clot/embolism or atherosclerosis

119
Q

what is atherosclerosis

A

build up of plaque inside blood vessels which reduces blood flow to heart

120
Q

What is angina pectoris

A

discomfort above waist (chest, jaw, shoulder, back and arms) experienced when the heart muscle is deprived of adequate oxygen

Aggravated by exertion or emotional stress

121
Q

Difference between stable and unstable angina

A

Stable angina relieved with rest and unstable angina not relieved with rest

122
Q

What is acute myocardial infarction

A

Heart attack
caused by decreased or complete cessation of blood flow to a portion of the myocardium

Present with chest pain behind sternum (retrosternal) and may describe pressure of heaviness

123
Q

What symptom would present in heart attacks for women but not men

A

males dont report nausea or headache as much as women

124
Q

Types of infarcts

A

anatomical location of ventricle involved

degree of thickness
- transmural (full thickness)
- subendendocardial (part of myocardial wall)

125
Q

How can you diagnose heart disease

A

Cardiac stress testing
- progressively harder on treadmill and monitoring BP, ECG, etc

Coronary angiography
- insert catheter up to heart and find main blockages in blood vessels

126
Q

What is a percutaneous coronary intervention

A

procedure to unclog blocked coronary arteries and restore blood flow to ischemic areas

127
Q

types of percutaneous coronary intervention and risk of re-stenosis

A

balloon angioplasty
- reinflate balloon which compresses plaque to outer perimeter of artery so blood can flow
- 30% re-stenosis

Coronary angioplasty with bare metal stent
- keeps diameter of artery open
- 15% re-stenosis

Coronary angioplasty with drug eluting stent
- keeps diameter of artery open and releases drug which stops clotting
- 10% re-stenosis

128
Q

What is coronary artery bypass graft (CABG) and which grafts are commonly used

A

section of a peripheral blood vessel is grafted and relocated to the heart to bypass a blocked section of the coronary artery

Grafts
- Saphenous vein graft (SVG)
- Left internal mammary artery (LIMA)

129
Q

Typical Sternal precautions

A

no lifting >4kg
No weighted activities at >90 degree shoulder flexion/abduction
No scapular retraction past neutral
avoid trunk flexion and rotation with supine to sit

130
Q

What is heart failure with preserved ejection fraction (diastolic failure)

A

left ventricle loses its ability to relax normally (muscle has become stiff)
Heart can’t fill with blood during the resting period between each beat

131
Q

What is heart failure and what are the two types

A

The decline in the hearts ability to pump as much blood as the body needs

types
- Heart failure with reduced ejection fraction (systolic failure)
- Heart failure with preserved ejection fraction (diastolic failure)

131
Q

What is heart failure with reduced ejection fraction (systolic failure)

A

left ventricle loses its ability to contract normally.
Heart can’t pump with enough force to push enough blood into circulation

132
Q

Right sided heart failure

Left sided heart failure

Congestive heart failure

A

RSHF: back ups in the area that collects ‘used blood’

LSHF: failure to properly pump blood out to the body

CHF: fluid backs up into the lungs and tissues

133
Q

Signs and symptoms of chronic heart failure

A

shortness of breath

fatigue/lethargy/reduced exercise tolerance

cough/wheeze

shortness of breath worsened when lying flat

paroxysmal nocturnal dyspnoea - shortness of breath at night which wakes them up

Fluid retention

Enlarged liver

134
Q

O2 and CO2 movement impairment reasoning

A

Diaphragm impaired by anaesthetic

Not taking deep enough breaths to ventilate the whole lung

valves issues or heart failure: reduced efficiency to transport oxygen around the body

blockages: not able to transport oxygen around the body

135
Q

Secretion clearance impairment reasoning

A

not taking deep enough breaths
reduced strength of cough and not taking deep breaths

136
Q

mobility impairment reasoning

A

pain
bed rest
impacted by sternal precautions

137
Q

FEV1/FVC <70% =

A

Obstructive

138
Q

FVC predicted <80%

A

Restrictive

139
Q

how do you measure P/F ratio

A

Pa/O2 / FiO2

140
Q

ARDS (Acute Respiratory Stress Disorder) Severity

A

Mild: 200-300 PF ratio
Moderate: 100-200 PF ratio
Severe: <100 PF ratio

141
Q

What does a high pitched wheeze indicate?

A

near total obstruction

142
Q

What does a fixed monophonic wheeze indicate?

A

single obstructed airway

143
Q

What does a polyphonic wheeze (multiple) indicate?

A

widespread narrowing

144
Q

What does a localised wheeze indicate?

A

sputum retention

145
Q

How much sputum do healthy adults produce?

A

100ml

146
Q

What does mucoid sputum indicate

A

opalescent or white sputum
chronic bronchitis without infection, asthma

147
Q

What does mucopurulent sputum indicate

A

slightly discoloured but no frank pus
bronchiectasis, cystic fibrosis, pneumonia

148
Q

What does purulent sputum indicate?

A

thick viscous: can be yellow, dark green/brown, rusty, redcurrant jelly

haemophilius, pseudomonas, pneumococcus, mycoplasma, klebsiella

149
Q

What does frothy sputum indicate

A

pink or white

pulmonary oedema

150
Q

What does haemoptysis sputum indicate

A

ranging from blood specks to frank blood, old blood (dark brown)

infection (TB, bronchiectasis), infarction, carcinoma, vasculitis, trauma, coagulation disorders, cardiac disease

151
Q

what does black sputum indicate

A

black specks in mucoid secretions

smoke inhalation (fires, tobacco, heroin), coal dust

Seanos epic Acute (1 decks)

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