Pulmonary assessment and treatment Flashcards by Antonio Michell

What does the Short Physical Performance Battery (SPPB) measures?

Measures lower extremity function in the elderly population. It has been used as a predictive tool for possible disabilities.

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A patient is been discharged from the hospital. Which professional will be the most appropriate to assist with organizing placement (hostel or nursing home)?

Social worker

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What does The de Morton Mobility Index (DEMMI) measure?

Changes in the mobility of the elderly population across different settings.

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What is the DEMMI?

The de Morton Mobility Index

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Mention the 5 most common walking aids

Rollator (Forearm Support Frame FASF)
Hopper Frame (Pick Up Fram PUF)
Wheeled frame
Crutches
Walking sticks

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What do the ISWT measures?

Exercise capacity in patients with chronic obstructive pulmonary disease (COPD), is employed as an outcome measure for pulmonary rehabilitation.

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What is the name of the test?
“The patient is required to walk around two cones set 9 metres apart (so the final track is 10 metres) in time to a set of auditory beeps played on a CD.”

Incremental Shuttle Walking Test (ISWT)

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What does Barthel Scale/Index (BI) measures?

Measure performance in activities of daily living (ADL)

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What is 6MWT?

6 minutes walking test

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What does the ABCDE rule stand for?

A - Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure

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Safety
Prior to mobilization, what should you ask the patient?
Hint: lower limb

Ask about pins and needles, tingling, numbness or heaviness of their legs.

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What does the 6MWT measure?

Functional capacity based on aerobic capacity and endurance.

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Order these levels of independence from the less dependent to the more dependent

Requires minimal physical assistance x 1
Unable to perform even with maximal assistance
Requires verbal cueing
Requires physical assistance x 2
Requires supervision
Requires moderate physical assistance x 1
Independent

Independent
Requires supervision
Requires verbal cueing
Requires minimal physical assistance x 1
Requires moderate physical assistance x 1
Requires physical assistance x 2
Unable to perform even with maximal assistance

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What are the 5 minimum requirements for documentation to include in an assessment? (Focused on independency and physical capacity)

Type of activity that the patient is able to perform
Level of assistance
Type of assistance (physical, verbal)
Weight bearing status if relevant
Equipment required

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What measure would you take to prevent orthostatic complications before sitting/standing a patient?

Encourage the patient to move his ankles
Make some slow deep breath
Ask for any symptoms of orthostatic intolerance

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What are S.M.A.R.T goals?

Specific
Measurable
Achievable
Relevant
Time-Bound

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What is the ISWT?

Incremental shuttle walking test

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What is the SPPB?

Short Physical Performance Battery

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What does the Berg balance scale (BBS) measures?

The Berg Balance Scale (BBS) is used to objectively determine a patient’s ability (or inability) to safely balance during a series of predetermined tasks

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What do you have to ask on a hospitalized child during the respiratory assessment? (4)

Timing of last feed
How is the child being fed (Oral, NG or IV)
How well the infant tolerates handling
How long the child takes o recover from the handling episode

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Clinical signs of respiratory distress in children (7)

Recession (intercostal, subcostal, sternal)
Nasal flaring
Tachypnoea
Expiratory grunting
Stridor
Cyanosis
Abnormal breath sounds

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It occurs when high negative intrathoracic pressure during inspiration pulls the soft, compliant chest wall inward.

Recession

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Sign of increased respiratory effort that you can appreciate on the chest wall.

Recession

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Three types of muscle recession in infants

intercostal - subcostal - esternal

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Is a dilatation of the nostrils by the dilatores naris muscles and is a sign of respiratory distress in the infant.

Nasal Flaring

What is a RR >60 breaths/ min on infants

Tachypnea

Tachypnea in infants is a respiratory rate above

60 breaths per minute

Sounds that is heard in the presence of a narrowing of the upper trachea and/or larynx

Stridor

Definition | Bluish colour of the skin and mucous membranes caused by hypoxaemia

Cyanosis

Normal value of pH

7.35-7.45

Normal value of PaCO2 on an Arterial Blood Gas Analysis (ABG)

35-45 mmHg

Normal value of HCO3 on an Arterial Blood Gas Analysis (ABG)

22-26

Normal value of PaO2 on an Arterial Blood Gas Analysis (ABG)

90-100 mmHg

True or False | The higher the pH, the higher the [H+] and vice versa

False | The higher the pH, the lower the [H+] and vice versa

Is the inverse log of the concentration of hydrogen ions ([H+])

pH - ABG

Value of acidaemia?

pH < 7.35

Value of alkaemia

pH>7.45

True or False | If PaCO2 is normal then there is no respiratory component involvement / compensation

True

True or False | PaCO2<35 indicates alveolar hyperventilation (alkalosis)

True

True or False | PaCO2<35 indicates alveolar hypoventilation (alkalosis)

False | PaCO2<35 indicates alveolar hyperventilation (alkalosis)

True or False | PaCO2<35 indicates alveolar hyperventilation (acidosis)

False | PaCO2<35 indicates alveolar hyperventilation (alkalosis)

True or False | A PaCO2 > 45 indicates alveolar hypoventilation (acidosis)

True

True or False | A PaCO2 < 45 indicates alveolar hypoventilation (acidosis)

False | A PaCO2 > 45 indicates alveolar hypoventilation (acidosis)

Which organ regulates the HCO3 concentration?

Kidneys

True or False | On a ABG analysis if HCO3- is normal then there is no metabolic component involvement/ compensation

True

True or False | A HCO3- < 22 mEq/L indicates acidosis

True

True or False | A HCO3- < 22 mEq/L indicates alkalosis

False True or False A HCO3- < 22 mEq/L indicates acidosis

True or False | A HCO3- > 22 mEq/L indicates acidosis

False | A HCO3- < 22 mEq/L indicates acidosis

True or False | HCO3- > 26 mEq/L indicates alkalosis

True

True or False | HCO3- > 26 mEq/L indicates acidosis

HCO3- > 26 mEq/L indicates alkalosis

ABG analysis Is a condition that occurs when the lungs cannot remove all of the carbon dioxides the body produces. This causes body fluids, especially the blood, to become too acidic.

Respiratory acidosis

Is a condition marked by low levels of carbon dioxide in the blood due to breathing excessively

Respiratory alkalosis

True or False | Metabolic acidosis is a condition in which there is too much acid in the body fluids.

True

What is diabetic ketoacidosis?

Develops when substances known as ketone bodies, which are acidic, build up during uncontrolled type 1 diabetes. Characteristic of fruity/nail polish remover smell.

Which types of alkalosis/acidosis are amendable to physiotherapy?

Only respiratory alkalosis and acidosis via administration of oxygen.

ABG analysis - True or False No compensation means that pH remains abnormal, and the ‘other’ value (where the problem isn’t occurring, i.e. CO2 or HCO3- ) will remain normal or has made no attempt to help normalise the pH.

True

Is this full compensation? pH is still abnormal, and the ‘other’ value is abnormal in an attempt to help normalise the pH.

No, this is Partial Compensation

ABG When The pH is normal, as the ‘other’ value is abnormal and has been successful in normalising the pH, we say that there is....

Full Compensation

What is the definition of Radiolucent?

X-rays that pass through low-density tissue (lung) strike the film more directly and causes the shadow to turn darker.

What is the definition of Radiopaque?

X-rays that pass through high-density tissue (e.g. bone) are more absorbed and leave the exposed film lighter

What are air bronchograms?

filled airways surrounded by infiltrates from filling of surrounding alveoli.

Is air radiolucent or radiopaque?

Air is radiolucent.

Is bone radiolucent or radiopaque?

Bone is radiopaque

What is a costophrenic angle?

It is the arch of when the diaphragm and chest wall meet, and it forms a point. For the purpose of the exam, if you see a question about a “blunted costophrenic angle”, know that the answer is Pleural Effusion.

On an X-ray - How do you determine if the patient is properly positioned?

The spinous process is midway between medial ends of clavicles and in middle of tracheal air column.

X-ray | If more than 7 anterior ribs are visible above the diaphragm, what is present?

Hyperinflation

When may a radiograph appear normal in respiratory failure?

Obstructive lung disease.

What are the four tissue types that are visible on X-Rays?

Air (radiolucent or black), Fat (dark grey), Soft tissue (grey), and Bone (radiopaque or white).

During full inspiration, the hemidiaphragms on an adult chest film should be:

At the level of the 10th rib.

When evaluating a PA film of the chest, you note that the right costophrenic angles are blunted. What does this suggest?

Presence of a pleural effusion on the right.

Lines and tubings | What to do if arterial line is displaced?

Apply immediate pressure, call for assistance

Can a patient do exercise with a Central Venous Pressure Catheter? (Central Venous Line)

Exercise is possible, but mobility may need to be restricted near the catheter insertion

In congestive heart failure, the heart is not able to what?

To move as much blood as it should with each beat.

What is the difference between: | HYPOXIA and HYPOXEMIA

PaO2, the partial pressure of oxygen in the arterial blood, is determined solely by the pressure of inhaled oxygen (the PIO2) Hypoxia = low level of O2 in the tissue despite adequate perfusion of the tissue Hypoxemia = low level (PaO2 < 80 mmHg) in the arterial blood

What is the difference between ALKALEMIA and ACIDEMIA

``` Alkalemia = >7.45 pH of blood Acidemia = < 7.35 pH of blood ```

List the uses of respiratory drugs

* Relievers * Symptom controller * Preventers * Combined

Bronchodilators are commonly used when there is an obstruction of the airways. List the four mechanisms which can lead to Airway obstruction.

* Spasm of the airway * Swelling of airway * Build-up of sputum in the airway * Airways become “floppy”

Why are premature infants at risk of RDS (Respiratory Distress Syndrome) and what is commonly done to prevent this?

Premature infants are at risk of RDS because surfactant is not present in the lungs until quite late in gestation. Survanta and Curosurf are artificial surfactants administered into the lungs of the preterm infant via an endotracheal tube.

Name 4 modes of delivery for Respiratory Drugs

Per Oral, Metered Dose Inhaler (MDI), Nebulisation, Intra-venous (IV)

List three adverse affects of the us of B2 agonists

Fine tremor, palpitations, vasodilation which may lead to hypotension, overuse or overdosing may result in hypokalemia and raise blood sugar levels