RCVII Essay Flashcards
purpose of prone positioning
The patient is kept in prone positioning to help increase lung volume, improve mucus clearance, improve ventilation perfusion mismatch and thereby manage any atelectasis and improve gas exchange.
precautions for prone positioning
attachments - oxygen, catheters
contraindications for prone position
only absolute contraindication is unstable spinal fracture. Relative contraindication haemodynamically unstable, unstable pelvic or long bone fracture, open abdominal wounds, raised intracranial pressure if head or neck obstructs cerebral venous drainage.
purpose and risk of IRV
reduce shunting, improve V/Q mismatch, reduce dead space ventilation, increase mean airway pressure. Risk of barotrauma, worsening of pulmonary oedema, patient must be sedated and paralysed.
contraindications of IRV
preexisting hemodynamic compromise or obstructive lung disease requiring a prolonged expiratory phase. (E Sembroski et al. 2018)
purpose of and definition of early Mobilisation
purpose - Early mobilisation which involves any physical activity that results in a physiological change with the first 2-5 days of illness, active mobilisation is preferred to prevent muscle atrophy and muscle weakness and to preserve physical function. (Kozu et al 2022).
precautions of early mobilisation
attachments, medications, NEWS score, nursing staff liaison, clinical notes to see if the patient is awaiting any further investigations or treatment e.g CT, dialysis
contraindications of early mobilisation
haemodynamically unstable, insufficient oxygen support, SpO2 of less than 80%, hypotensive, unstable angina, weakness in lower limbs
definition of pulmonary rehab
Pulmonary rehabilitation is a comprehensive intervention, based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviors
indications of pulmonary rehabiltation
Bronchiectasis – improve exercise capacity and HRQoL but difficult to maintain (Lee et al. 2017)
ILD – Improve functional exercise capacity, dyspnoea and QoL (Dowman et al. 2014)
Asthma – improve exercise capacity, asthma control, QoL, reduce wheeze and bronchial inflammation (Zampogna et al. 2020)
Reduced hospitalisation, reduced symptoms of dyspnea, enhanced self efficacy and knowledge, improved limb muscle strength and endurance
screening for pulmonary rehab
COPD – MRC 3-5 or mMRC 2-4
Where capacity and skill-set allows, PR programmes should accept other chronic respiratory disease patients with a functional limitation due to breathlessness e.g. MRC 2 (mMRC 1) if referred.
Must be motivated to participate
Must be able to exercise independently and safely
Able to travel to venue and access to appropriate equipment for PRP
Exclusion criteria – uncontrollable cardiovascular conditions limiting participation, limited mobility due to orthopaedic, psychological, neurological conditions, suspected underlying malignancy.
outcome measures for pulmonary rehab
HR, SpO2, BP, BMI
Measures of Dyspnoea. (Modified BORG Score, mMRC)
Functional capacity - 6-minute walk test,
Quality of life: for COPD – COPD Assessment Tool, for asthma Asthma Quality of Life Questionnaire (AQLQ for Asthma), for bronchiectasis The Quality of Life-Bronchiectasis (QOL-B)
Agreed goals (SMART goals)
Where possible a measure of quadriceps muscle strength is highly recommended.
components of pulmonary rehab
Pt assessment
An initial center-based assessment by a health care professional
An exercise test at the time of assessment
A field exercise test
Quality of life measure
Dyspnea assessment
Nutritional status evaluation
Occupational status evaluation
Program components
Endurance training
Resistance training
Method of delivery
An exercise program that is individually prescribed
An exercise program that is individually progressed
Team includes a health care professional with experience in exercise prescription and progression
Quality Assurance
Health care professionals are trained to deliver the components of the model that is deployed
exercise prescription of endurance exercise in pulmonary rehab
Duration – at least twice weekly supervised session with minimum 12 wks
Frequency – ACSM minimum 3-5 times a week, ATS/ERS 3-5 times a week, AACVPR 3-5 times weekly
Intensity – ACSM light intensity; 30-40% peak work rate, vigorous intensity; 60-80% peak work rate, or dysnpea rate 4-6 Borg, ATS/ESR > 60% maximal work rate, AACVPR high intensity; 60-80% peak work rate
Time ACSM – non specific, ATS/ERS 20-60min per session, AACVPR – 20-60 min per session for 4-12 wks
exercise prescription for resistance exercise in pulmonary rehab
Frequency – ACSM > 2times/wk, ATS/ERS 2-3times/wk, AACVPR no standard
Intensity – ACSM light intensity; 40-50%, moderate intensity; 60-70%, ATS/ERS 60-70% 1RM or 100% 8-12 RM, AACVPR start with lower weights/resistance and higher reps for endurance, higher weights and fewer reps for strength
Time – ACSM 1-4 sets, 8-10 exercises, 10-15 reps, ATS/ERS not stated, AACVPR not stated.
haemodynamic monitoring definition
The ability of the body to maintain homeostasis and deliver oxygen to tissues via circulation is essential for healthy organs. Therefore it is essential to be able to assess this status and the effects of our treatments
how is BP measured invasive and non invasively
Invasive via arterial line sited in artery
Continuous Monitoring of Systolic, Diastolic and Mean Arterial Pressure
abnormal blood pressure in haemodynamic monitoring
normal range 120/80
hypotensive SBP <90, DBP <60
hypertensive SBP >180, DBP >100
Orthostatic hypotension 5 mins lying, 1 min standing, 3 min standing, > 20 SBP drop or > 10 DBP drop.
why is the transdeucer placement important for BP monitoring
Transducer position is important pressure displayed is pressure relative to position of transducer.In order to reflect blood pressure accurately transducer should be at level of heart. Over-reading will occur if transducer too low and under-reading if transducer too high
how is CVP measured
central venous pressure
Pressure in superior vena cava measured via central line
importance of Central Venous Pressure
CVP gives a crude estimate of left atrial pressure (LAP), measures venous return
LAP approximates to left ventricular end-diastolic pressure (LVEDP) which is related to preload
