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354 > Resp > Flashcards

Resp Flashcards

1
Q

Roles of respiratory system

A

warm, humidify air
Oxygenation
removal of CO2
pH regulation

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2
Q

dysfunctional breathing def

A

breathing disorder where breathign pattern is changes, causing dyspnoea and other symptoms AND that cant be explained by resp and cardiac disease.

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3
Q

hyperventilation syndrome

A

breathing in excess of metabolic demands, leads to hypocapnia = respiratory alkalosis

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4
Q

Normal breathing

A

nose, slow, low
1:2 insp:exp
passive exp
diaphragm

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5
Q

BPD fight or flight cycle

A

Perceived threat triggers SNS.
SNS prepares for action so increases depth/rate of breathing (hyperventilation).
hyperventilation = hypocapnia symptoms
hypocapnia symptoms = anxiety
anxiety stimulates SNS = more symptoms
symptoms = more hyperventilation = more anxiety

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6
Q

Hypocapnia 4 physiological effects

A
  1. decreased CO2= increased pH = alkalosis
  2. Haldane effect: alkalosis increases O2 afiinity of Hb = decreased O2 provision to cells
  3. electrolyte shift = smooth muscle constriction (lungs)
  4. vasoconstriction = decreased BF
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7
Q

Hypocapnia signs and symptoms - neuro

A

confusion, headaches, tinnitus, fait, decreased balance, dizziness, blurry vision, brain fog, epilespy..

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8
Q

Hypocapnia signs and symptoms - resp

A

SOB, sighing/yawning, tight chest, cough

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9
Q

Hypocapnia signs and symptoms - CV

A

HR increase, palpitation, arrhythmias, cold extremities, angina symptoms, ECG changes

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10
Q

Hypocapnia signs and symptoms - MSK

A

twitch, shiver, weakness, tetany, pain, hyperreflexio, increased muscle tension

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11
Q

Hypocapnia signs and symptoms - psych

A

anxiety, anger

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12
Q

Hypocapnia signs and symptoms - gut

A

cramps, bloating nausea

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13
Q

Hypocapnia signs and symptoms - other

A

poor sleep, decreased exercise tolerance, dry mouth, bladder hyperactivity

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14
Q

Subj assessment of BPD

A

medical Hx: asthma, allergies, anxiety/panic attack, sinusitis, cough, resp infection. MSK problems, anaemia, CV problems, meds.
social: support, family, home envrmt, lifestyle (diet, exercise), occupation (demands, type support, finance)
tests/investigations: blood test, lung function/spirometry, previous Rx

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15
Q

Obj assessment of BPD

A

posture
chest shape
breathing patten
accessory muscle palpation
nose/mouth breathing
nasal patency
hands - cold/clammy
speech
yawning/sighing/
cough
PEFR/max inspP/tidal spirometry

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16
Q

Nijmegen questionnaire (nymiguen)

A

score 0-4 for each symptom (never - very often).
>23 = +ve.
symptoms:
chest pain, tense, feeling, SOB, confusion …..

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17
Q

BPD Treatment (3)

A
  1. education: normal pattern, abnormal pattern, how it causes symptoms, potential triggers.
  2. awareness of own pattern
  3. retraining:
    - start in comfy position, progress to sitting, w motion
    - relaxation technique
    - nose low slow, aim to activate diaphragm, 1:2 ratio, aim to hold post exp
    - use biofeedback (own/pt hands, sandbag)
    - can train diaphragm if weak
    - refer if see other components(psychological)
18
Q

Asthma - definition and main symptoms

A

chronic inflammatory disease of airways from hyper-reactivity to allergen.
wheezing, SOB, tight chest, coughing

19
Q

Asthma - diagnosis

A

based on Rx response, signs&symptoms response, absence of alternate explanation

need to take careful clinical Hx and assess spirometry response after bronchodilator/ICS use
no reliable gold standard diagnosis.

20
Q

Asthma risk factors

A

enrvrmt
occupation
family hx
other medical conditions
ethnicity - pacific ppl
sex

21
Q

Asthma triggers

A

house dust mites
cigarette/wood smoke
animals
weather change
pollen
chemicals - perfume
animals

22
Q

Aims of asthma Rx

A

control signs and symptoms, how they affect daily life.
prevent attacks/flare ups.
keep lungs healthy as long as possible.

23
Q

Asthma management strategies (5) and barriers

A
  1. management plan -review yearly
  2. smoking cessation - whole household
  3. education - incl ppl surroundings
  4. review inhaler/spacer
  5. regular PEFR readings

barriers: cultural beliefs, family dynamic, cost, age

24
Q

Asthma meds

A

reliever therapy (adults)
- long term Inhaled corticosteroid (ICS)/fast B agonist reliever (NOT SABA ALONE).
preventive therapy (adults)
- ICS

AIR therapy - anti-inflam reliever

25
Q

Inhaler devices for Asthma - considerations, instructions

A

hand weakness, coordination issues, breath holding ability, adherence.

  • hold inhaler up right and shake
  • place inhaler in to spacer opening
  • seal mouth tightly around mouth piece
  • press inhaler once
  • 6 slow breaths, maintaining spacer
  • remove space and repeat for more doses
26
Q

Asthma - Physio management (3)

A
  1. breathing retraining for dyspnoea/hyperventilation
  2. education on mamagement plan, inhaler/space use and benefit.
    3 improvement of CV fitness
    - increases lung function
    - decreases airway inflam.
    - increases QoL
    - via walking, swimming, biking, gymnastic..
27
Q

Managing an asthma attack

A
  1. sit person upright
  2. give them 4 doses with spacer(4 slow breaths)
  3. wait 4 mins
  4. no improvements = repeat 4 doses
  5. no improvements = AMBO
28
Q

Asthma warning signs

A

usual symptoms worsen
decreased PEFR, increased dyspnoea, tight chest, wheeze
can develop fast and be life threatning

29
Q

Obstructive Sleep Apnoea (OSA) - definition + pathophysiology

A

recurrent partial.complete obstruction of upper airways. it is the most common sleep disorder.

upper airway collapse, decreased muscle tone, increased intra-thoracic P, changes in neural reflexes.

30
Q

OSA diagnosis (AHI)

A

any of:
- complete airflow obstruction> 10 secs
- airflow reduction for 50% for 10 secs
- airflow reduction 30% for 10 secs + O2 desaturation 3%

AHI: Apnea-hypopnea index = number of events/total sleep time.

31
Q

OSA risk factors

A

large neck circumference - obesity
genetics - narrow airway, neuromsk disease, cranio-facial morphology
low PA
posture - protraction
old
men

32
Q

OSA untreated effects

A
  • hypertension risk
  • increased mortality - stroke, CVD in sever OSA
  • uncertain increased CV risk in moderate OSA
33
Q

OSA associated conditions

A

atrial fibrillation
HTN
stroke
CVD
obesity
T2DM

34
Q

OSA symptoms - daytime

A
  • increased somnolence
  • morning headache
  • wakign unrefreshed
  • poor concentration
  • irritability
  • impaire memory
35
Q

OSA symptoms - nighttime

A
  • rapid sleep onset
  • snoring
  • witnessed apnoea
  • choking
  • nocturia
36
Q

OSA sleep questionaires (4)

A
  1. Epsworth sleep scale (ESS) - symptom frequency
  2. STOP -BANG - risk factor scale
  3. Functional outcome of sleep (FOSQ) - functional implications of OSA
  4. Pittsburg sleep quality index (PSQI) - functional
37
Q

OSA management

A
  • CPAP
  • sleep posture
  • surgery (UPPP)
  • dentaal appliances
38
Q

CPAP

A

for OSA
keeps Positive pressure in ins + exp
splints airways open
poor adherence, weight gain, no increased PA

39
Q

benefits PA in OSA

A
  • helps weight loss
  • decreased apnea severity
  • strengthens oropharyngeal muscles
  • mitigates risk factors
  • decreased fatigue
  • increased QoL

upper airway strengthening
- oropharyngeal exercises
- wind instruments
- singing

40
Q

Phsyio role in management of OSA

A
  • education and awareness
  • exercise prescription
  • motivational interviewing
  • behavioural change techniques

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