Prac exam

Question 1

Contraindications/precautions for PEP

Answer 1

CI: undrained pneumothorax
PC: increased WOB, increased ICP, haemodynamic instability, recent facial surgery, active sinusitis, active haemoptysis, drained pneumothorax

Question 2

Theory behind PEP

Answer 2

Collateral ventilation - recruits obstructed or collapsed airways, increased volume of air behind obstruction will force secretions centrally (stents open airways)

Question 3

Contraindications and precautions for oscillatory PEP

Answer 3

CI: frank haemoptysis and undrained pneumothorax

PC: increased WOB, increased intracranial pressure, active haemoptysis, drained pneumothorax, recent facial surgery, active sinusitis, haemodynamic instability

Question 4

What changes should be made to physio treatment if the patient experiences MODERATE haemoptysis

Answer 4

Cease percussion, vibrations, oscillatory PEP, hypertonic saline, head down tilt
Cease vigorous exercises

Continue with controlled ACT

Question 5

What changes should be made to physio treatment if the patient experiences SEVERE haemoptysis

Answer 5

Active bleeding: high side lying with bleeding side down

Cease ACT and exercise until active bleeding resolves

Question 6

What changes should be made to physio treatment if the patient experiences pneumothorax?

Answer 6

Gentle coughing, adequate humidification, cease PEP, avoid UL resistance exercises

Question 7

Why might patients in ICU have respiratory problems?

Answer 7

• Due to reason for admission or PMHx
  eg chest trauma, rib #, lung contusion
• Thoracic or abdominal surgery, pain, altered resp mechanics, effects of anaesthetic
• Medical, community acquired pneumonia, asthma, COPD, covid etc
• Result of mechanical ventilation + other factors associated with ICU care

Question 8

What factors can cause respiratory complications in the ICU?

Answer 8

• Mechanical ventilation
• Medication
• Position (decreased FRC, VQ mismatch)
• Immobility (muscle mass loss incl resp muscles, limited position changes altering airway clearance and vent)
• Sedation (lack of spont. cough, decreased cilial movement, less frequent position change)
• NGT

Question 9

What are some cardiovascular complications in ICU?

Answer 9

• Cardiac deconditioning
• Multisystem pathologies (eg sepsis, ARDS)
• Arrhythmia
• Hypo/hypertension
• Thromboembolism

Question 10

What are some complications of muscle atrophy and weakness?

Answer 10

• Immobility
• Inflammation
• Dysfunctional micro-circulation
• Electrolyte disturbances

Question 11

What are some neurological complications in ICU?

Answer 11

• Decreased level of consciousness

- Delirium

Question 12

How does CF affect the respiratory system?

Answer 12

• Abnormal, sticky secretions
• Recurrent infection and inflammation
• Wheezing
• Chronic cough

Question 13

Suction via ETT - what is the equation to work out the diameter of suction catheter needed?

Answer 13

(ETT diameter x 2) - 2
eg (8 x 2) - 2
= 14

Question 14

Types of suctioning

Answer 14

• Endotracheal (ETT)
• Tracheostomy
• Oropharyngeal
• Nasopharyngeal
• Oral

Question 15

Limitations to suctioning

Answer 15

• Cardiac arrhythmias
• Changeable BP
• Patient’s pain and anxiety
• Raised ICP
• Suctioning-induced hypoxaemia
• Tracheal trauma
• Severe bronchospasm

Question 16

Suction pressure

Answer 16

Up to 200mmHg of occluded pressure