Respiratory Flashcards
What is COPD
1)Pathophysiology
2)Common symptoms
3) treatment
1) umbrella term 4 two conditions - bronchitis + emphysema
Bronchitis - inflammation of bronchi
Emphasema - reduced elasticity of alveoli
2) chest tight, unable to speak in full sentence, low sats sob
3) salbutmol nebuliser - 6 minutes, IP seem to work better
* If discharging check mobility*. Sats change or not
What is asthma
1)Pathophysiology
2)Common symptoms (mild)
3) treatment (mild)
1) inflammation of the airway, localised in bronchioles. Causes histamine release - bronchoconstriction and mucus prevent exhalation
2) wheeze, sob, cough, tightness , able to speak in full sentence.
3) tell them to use own inhaler 2 puff every 2 minutes = max 10 + carm + 02 if needed
What is life threatening asthma π¨π¨
1) sign and symptoms (GHOST π»)
2) treatment
1) severe asthma symptoms +
G- reduced GCS
H - Hypotension
O- oxygen less than 92%
S - silent chest
T- tiredness ( exhaustion/ poor respiratory effort
C- cyanosis / arrhythmia
Treatment : adrenaline 1:1000, hydrocortisone 100mg, nebuliser. Blue light
What are the signs of severe asthma and treatment plan
1) unable to speak in full sentences
Hr : 110+
Rr : 25 +
Treatment: nebuliser (salbutamol )
- salbutamol
- ibpratropiym bromide
- canulate
- hydrocortisone
- salbutamol
Consider 3+ nebs to no effect = pre-Alert
Spontaneous pneumothorax π¨π¨π¨
1)Pathophysiology
2)Common symptoms
3) treatment
1) air in pleura canβt escape - lung collapses
2) unequal chest rise and fall, sob chest pain
Can cause tension pneumothorax - 12 flaps
3) maintain sats, prepare for needle needle Thoracentesis, BLUE LIGHT π΅
What is a pulmonary embolism
1)Pathophysiology
2)Common symptoms
3) treatment
1) a clot that gets stuck in lungs, normally from a DVT
2) pin point chest pain,reduced air entry + normal signs of respiratory distress + ECG changes - S1Q3T3
Causes important DVT, recent surgery, travel or immobile, baby stoppers,
3) any abc concerns = pre alert
What is cystic fibrosis
- pathophysiology
- what system does it effect and (how)
- symptoms
A gene abnormalities which affects coding of a protein thus effects **CL- reputake.( Needs 2 ressesive genes to have it)
Less calcium = less water uptake = sludge
Causes problem within the pancreas with blockage in cystine ducts = pancreatitis ( white poo, damage, poor nutrition)
Problem with lungs mucus is thick therefore cilla canβt move it = bacteria accumulation.
During sweating calcium not reabsorbed so skin tastes** salty**
Effects beta cells @ pancrease = insulin dependent pts
What is the detailed pathophysiology of COPD
Inflammation due to smoking asbestos ect - cause white blood cells and shit causes the Protease and anti protease imbalance - breakdown of healthy lung tissue causes
Oxidative stress - causes further antiprotease Imbalance + mucus production
What is chronic bronchitis
What is bronchiectasis
What are is pneumonia
What is anemia
What is anaphylaxis ( basic )
systemic inflammatatory reaction to an allergens. Whereby multiple reaction occur leading to significant histamine release causing
Bronchospasm + leaky capillarys+ vasodilation leading to spontaneous/Progressively worsening
ABC ISSUES + SKIN issues
What is a tracheostomy
An opening at the 2/3rd tracheal ring
A stoma is created and a tube is inserted to aid breathing
What are the main emergency with patient with Tracheostomy or largealostomy
Decannulation - removal of full Trachy
Displacement - accidental removal
Blockage ( blood or mucus )
What is a laryngectomy
What does this mean interm of airway
Total removal of larynx means a total removal of nose and mouth from the airway circuit they breath directly through neck
What are the different parts of a tracheostomy
Stoma which is the hole, the outer cannula sits through it securing it to the hole keeping it open, the inner cannula is a secondary safety - not always there( come out via pushin then out or twist.
How do you suction an tracheostomy
Take out the inner cannula measure it with your suction ( flexy one)
Pre oxygenate = hypoxic procedure
Put in a non fenistrated tube
Place in the suction *βupto** 2cm past the inner cannula,
Turn on suction and suction outwards @ 150/200 power
Re-oxgenate
How do you deal with patient struggling to breath due to a trachy/ larygenotectomy emergency
Remove moist exchanger
Assess patient for signs of respiratory distress ( look- rr, HRΨ spo2, accessory, cyanosis)
Feel for breath via neck and mouth holes depending
Oxygenate both trachy and mouth nose ( 15L)
Take out inner cannula ( check for blockage and suction)
Deflate cuff is appropriate
Close Tracy with hand ( BVM MOUTH AND NOSE - not in larygeno ) or BVM with Peds BVM/ IGEL the neck hole
What are the signs of choking
Mild
Severe/
Mild - coughing but able to speak
Severe - canβt speak, ineffective cough
How do you assist in clearing obstruction in those with choking
Conscious
Unconscious
When should you convey
Conscious - back blows then abdomen thrust ( check after each one )
Unconscious ( lygenoscope and magils )
In both patient if they feel something stuck in throat after patency - convay
What is plural effusion
1) pathophysiology
2) command symptoms
3) treatment
1) fluid enters the plural space = compression and pluritis or secondary to pluritis, infection, HF,
2) sharp stabbing pain on deep breathing, but sob, dullness of percussion, reduced breath sounds
3) any ABC probs = prealert otherwise convey
What is the management for Life -Threatning Asthma
Quick assessment of ABC + SKIN + BASIC HISTORY
- salbutamol nebuliser (if appropriate)
- oxygenation is key
- adrenaline 1:1000
- canulate bilateral
- hydrocortisone
- ibratropium neb (if appropriate)
PRE -ALERT
What are the risk factor for life-threatening asthma or asthmatic death
- brittle asthma
- ICU admission
- previous life threatening asthma
- anaphylaxis
What is a condition that can mimic anaphylaxis
- how did you manage it
Acute angioedema
- treat as anaphylaxis
Why is it dangerous to give prolonged high flow oxygen to ( COPD patient)
- what is the pathophysiology behind this phenomenon
What is hypercapnia drive
- pathophysiology of hypercapnic drive
- why may giving high flow 02 causes death/ acidosis/ coma in COPD patients
- whereby PT no longer rely on high carbon as a need to breath rather low O2
2) physiological changes in lungs = detected by baroreceptor, increases RR ( overtime receptor silenced)
Peripheral receptors ( PH+ CARBON/02) - react to decreasing PH = produces bicarb = homeostasis = long term changes = body is acclimated to high carbon in the body = every time O2 level low body breaths rather than co2 levels high.
- high flow 02 = drop in pheripral receptor drive = lower RR, increases carbon = sudden increase in acid
High flow 02 = redistribution of blood to anatomical dead spaces = poor poor ventilation to blood ratio
High flow 02 = haldaine effect = body had lower affinely to co3 than 02 = drop the co2 for 02 = increased carbon in body
What questions should you ask PT with asthma
Amount of inhaler - over 2= should go for review
- exercise tolerance
- how are they before bed/morning / wake up during night = sob
- spacer ( important meds actually to lung not coating mouth and throat
