Respiratory Flashcards
What are the normative values for an ABG?
pH= 7.35 - 7.45
PaCO2= 4.7 - 6.0 kPa
PaO2= 11 - 13 kPa
HCO3= 22 - 26
BE= -2 - +2
What are the 4 Type of Respiratory problems we can influence?
- Sputum Retention
- Loss of Lung Volume
- Increased Work if Breathing
- Respiratory Failure
What are the key categories in a systematic Respiratory Assessment?
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure
In A-E Respiratory Assessment what things is A assessing?
- Is the airway patent? Is it their own? Are they able to talk? Are they self ventilating?
- Occluded/ Obstructed? (Added breath sounds: stridor, hoarse voice, orthopnoea, drooling, dysphasia)
- End of bed: paradoxical breathing, cynosis, added sounds, can feel the sounds
In A-E Respiratory assessment what is included in B section?
- Respiratory Rate (regular? over 25bpm=concern)
- Work if breathing? Using accessory muscles?
- Chest expansion? Even? Deviation of trachea?
- Saturation levels (95-98%, at least above 88%)? Are they on O2? How is it delivered?
- Have they had ABGs? Results?
- Chest X-ray findings?
- Auscultation- breath sounds throughout? Added sounds?
- Palpation- Secretions? Tactile fremitus? Hot/cold? Centrally/peripherally? Oedema?
- Cough- Strong/Weak, Dry/Wet, Productive/ Unproductive?
- Able to clear secretions?
In A-E Respiratory assessment what is included in C section?
- Heart Rate (60-100bpm)
- Blood Pressure (90-60mmHg to 120/80mmHg
-Capillary refill - Skin Colour
- Sweating
- Urine output (800 to 2000ml per day or 1.5 to 2 ml/kg per hour)
- Blood sugar levels(4-7mmol/l before eating and 8.5-9mmol/l 2 hours after eating)
In A-E respiratory assessment what is included in section D?
- Level of consciousness (Alert, Voice, Pain, Unresponsive)
-Glasgow Coma Scale - Are they sedated?
In A-E respiratory assessment what does section E include?
- Injuries/pressure wounds
-Are there any serious surgical wounds? Are these contraindications for any interventions?
-Do they have any drains? Are they swinging and bubbling? - Attachments: Catheter, Arterial line, NG tubes
What does SBAR stand for?
Useful format to deliver handovers/gather on call info:
Situation
-pts name?where they are? whos calling? help/advice needed?
Background
-pts arrival? current status/whats happened?PMH? normal status? previous physio? current obs (A-E)?
Assessment
-vital signs? clinical impressions? concerns? clinical reasoning?
Recommendation
-explain what you need? give advice/suggestions?
Normal urinary output?
0.5-1.0ml per kg of body weight per hour
Is a sensitive marker with poor output related to shock and risk of cardiovascular insufficiency
What are you assessing when using palpation for respiratory assessment?
Temperature- hot/cold, central compared to peripheral
Oedema- central/peripheral? impact on treatment?
Trachea- central? deviated due to collapse/mass?
Expansion- equal and consistent? insp and exp?
Tactile fremitus- crackles under hands? ausc and precussion
Chest X-Ray interpretation. What are we looking for
Patients name/date/orientation
A- Alignment (Film rotated? AP/PA? Airways- trachea)
B- Bones (all there and intact? #’s?)
C- Cardiac (correct position/size/clear borders?)
D- Diaphragm (correct position/clear contours/ angles)
E- Expansion (well expanded-5-7 ribs to pierce diaphragm in anterior midclavicular line? extra structures)
F- Lung Fields (fields clear? extend to edge of thorax?)
G- Gadgets (any lines, drains, tubes, sutures, clips?)
What can percussion indicate for chest physiotherapy?
Hyper-resonant (pneumothorax-air between pleura, or empysema-over expanded lung)
Dull (pleural effusion or consolidation)
What are normal breath sounds?
-Soft, muffled
-Louder on INSPIRATION and fade on expiration
-1:2 ratio for inspiration:expiration
What does bronchial breathing over the lung fields indicate?
Bronchial breathing= EXPIRATION louder and longer with pause between inspiration and expiration
-Consolidation
-Collapse without sputum plug
-Beginning of pleural effusion
What may be causing quiet or absent breath sounds?
-Poor expansion, low lung volumes, atelectasis
Also caused by:
-Shallow breathing
-Poor positioning
-Collapse with complete obstruction of airway
-Sounds reduced by hyperinflation
-Sounds reduced by pleura, chest wall (obese/muscular pts, pleural effusion/pneumothorax/haemothorax)
-Pneumothorax
What is a wheeze? and What does it indicate?
Wheeze= musical sound from narrowed airway, usually heard on EXPIRATION. Usually due to bronchcospasm or secretions in small airways.
- High pitched- bronchospasm-potential increased WOB
-Low pitched- Sputum- disrupted turbulant flow, change with coughing
-Localised- tumour/foreign body- one area on ausc
What does fine crackles indicate? and When does it occur?
Usually late INSPIRATON
Short, sharp at lung peripheries, lessens with deep breath
- Atelectasis
-Intraalveolar/pulmonary oedema
-Secretions small airways
What does coarse crackles indicate? and When does it occur?
May be during inspiration and expiration
Early EXPIRATORY- central airways
Late EXPIRATORY- peripheral airways
changes/clears with coughing
-Obstruction more proximal and larger airways with sputum.
What is a pleural rub? and its causes?
Creaking/rubbing (boots in snow) can be localised/genralised, soft/loud, EQUAL INSPIRATION AND EXPIRATION
- Inflammation of pleura
-Infection
-Tumour
What is stridor? and its causes?
Sound of constant pitch during BOTH INSPIRATION AND EXPIRATION in upper airways.
- Croup
- Laryngeal tumour
- Upper airway obstruction
*Alert medical staff!
What categories does NEWS measure?
What is a significant change?
A significant change in score of 3 in one or more categories, or 5+ in total can trigger critical care support
Measures:
-Resp rate
-SPO2
-Air/oxygen
-Systolic BP
-Pulse per min
-Consciousness
-Temperature
What is atelectasis and where can it occur?
Appearance on CXR?
-Atelectasis is a collapse! And is area of airless lung
- May involve small areas, an entire lobe or an entire lung (RUL-horizontal fissure/above whitness, RML (middle lobe)-indistinct heart boarder, RLL- whitness compared to L with visible heart boarder, LUL-all hazy, LLL-heart border)
-CXR= loss of lung volume, whiteness over area, shift of trachea/heart TOWARDS to fill space, elevation of hemidiaphragm compared to opposite site, less clear borders
What is consolidation?
Where can it occur/
Causes?
CXR appearance?
Consolidation is when air is replaced by fluid in the lung. May present patchy, or entire lobe/segment
CXR= whitness, poor/fluffy boarders, no loss of lung volume
- Pneumonia- infected fluid (most common)
- Aspiration- gastric contents/saliva (particularly RLL)
- Traumatic lung contusion- blood
-Alveolar pulmonary oedema- serus transudate (usually mid zones by hila)