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Acute Care and Rehab > respiratory care + assessments > Flashcards

respiratory care + assessments Flashcards

1
Q

What are clinical markers of failing respiration?

A

Important symptoms: rapid and significant muscle weaknening, facial muscle weakness, bulbar palsy and shallow/rapid breathing with reduced breath sound
Other symptoms: staccato speech, inability to count above 10, a low FVC of 1 litre, dysautonmia, tachycardia, brow sweating, paradoxical breathing, mental clouding or somnolence

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2
Q

What is non-invasive ventilation (NIV)

A

NIV improves lung volume during expiratory phase and PEP effect
helps patient with severe/end-stage diseases, muscle weakness, hypoxia and dyspnoea
helpful in combination with clearance technqieus for those who struggle with expectorating

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3
Q

what a laboratory markers of failing respiration?

A

Oxygen saturation less than 92%, pO2 <8kPa, CO2 >6kPa
FVC 30% of FVC from baseline within 24 hours
inconsistent or falling values of FVC at a single test session
A decline in vital capacity by more than 15-20%in the supine position

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4
Q

what is cough assist

A

provides effective cough flows
prevents pneuomonia and episodes of acute respiratory failure (ARF) and to train patients who have little to no vital capacity

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5
Q

what is secretion managemnt

A

open and closed circuit and uses aseptic technique with sterile gloves

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6
Q

Why perform ausculation?

A
  • Help better understand patients symptoms
  • Check condition of airways
  • Where tightness and secretions are
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7
Q

How does auscultation inform assessment?

A
  • Informs which techniques may be needed
  • Whether simple positioning
  • ACBT – which huff do more off
  • Acapella
    Whether secretions need moving or further medication to help open airways
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8
Q

What are the points that need auscultating?

A

Anterior:
Apices (next to collar bone)
Superior lobes
Middle lobe / lingula - no middle lobe L side due to heart
Inferior lobes
Posterior:
Apices
Superior lobes
Inferior lobes
Lung bases

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9
Q

How should auscultation be performed?

A
  • Patient in sitting is preferable
  • Instruct patient to breathe a little deeper than normal through mouth
  • Stethoscope on chest wall
  • Should be systematic
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10
Q

What are possible sounds that may be heard?

A

Wheezing
Crackling / rales / crepitations
Ronchi
Pleural friction rub
Stridor

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11
Q

What is wheezing?

A

A sound caused by vibrations of narrowed walls of small airways

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12
Q

What is crackling / rales / crepitations?

A

 Sounds like crackling or clicking when someone is breathing
 Crackling is due to air bubbles passing through fluid
 Mucus
 Normally heard in the bases
 Coughing occurs as a reaction to clear this fluid

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13
Q

What are the types of crackles and what do they indicate?

A

Coarse crackles are prolonged, low pitched sounds
- Indicators of build up of secretions
Fine crackles are higher pitched sounds
- Fine crackles are indicators of fibrosis and sound like velcro
Biphasic crackles are a combination of both types

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14
Q

What is ronchi?

A

 Low pitched continuous gurgling or bubbling when someone inhales or exhales
 Build up of secretions in airways
 Described like snoring sound
 Normally can clear with strong cough

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15
Q

What is pleural friction rub?

A

 Quick explosive sound when breathing in or out
 Sign of interruption of movement of pleural membranes

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16
Q

What is stridor?

A

 Similar to wheezing but louder
 Indicate upper airway blockage or narrowing
 Breathing in indicates blockage/narrowing above larynx
 When out means narrowing in trachea
 Inspiratory, expiratory or biphasic

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17
Q

What abnormal sounds may be heard in COPD?

A

Wheezing
Stridor
Crackling
 More commonly coarse crackles in COPD
Ronchi
Pleural friction rub
 Due to inflammation

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18
Q

What sounds may you hear in asthma?

A

Wheezing
Stridor
 If infection may have ronchi
May here crackles
 Pneumonia, pulmonary fibrosis, acute bronchitis, bronchiectasis
Diminished lung sounds
 May occur in asthma flare-up
Silent chest
 May occur in severe asthma attack

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19
Q

What lung sounds might you expect to hear in pneumonia?

A

Wheezing
Crackling
Pleural rub

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20
Q

What lung sounds might you expect to hear in CF?

A

Wheezing
General lung sounds of infection

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21
Q

What lung sounds might be sound in bronchiectasis?

A

Crepitations on inspiration and expiration due to sharp opening and closure of airways
Ronchi from secretion movement
High pitch inspiratory squeeks

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22
Q

What sounds might be heard post surgery?

A

Signs of infection such as crackles and wheezing.

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23
Q

What are precautions for auscultation?

A

Patient being able to maintain sitting or being comfortable sitting.
Perform in side lying if unable.
Be careful around any incisions.

24
Q

What is type 1 respiratory failure?

A

Reduced oxygen without normal CO2

25
Q

What is type 2 respiratory failure?

A

Reduced oxygen with increased CO2

26
Q

What is the normal range for pH?

A

7.35-7.45

27
Q

What is the normal range for CO2 (kPa and mmHg)?

A

4.7-6.0 kPa / 35.2-45 mmHg

28
Q

What is the normal range of O2 (kPa/mmHg)?

A

11-13 kPA / 82.5-97.5 mmHg

29
Q

What is the normal range for bicarbonate?

A

22-26 mEq/L

30
Q

What is the range for base excess (BE)?

A

-2 to 2+ mmol/L

31
Q

What pH is acidotic and what is alkalosis in the body?

A

below 7.35 is acidotic, above 7.45 is alkalosis

32
Q

What occurs in respiratory acidosis?

A

Co2 increases to pH decreases
↑CO2 pH↓

33
Q

What occurs in respiratory alkalosis?

A

Decreased CO2 leading to increased pH as not enough hydrogen ions
↓CO2 pH↑

34
Q

What occurs in metabolic acidosis?

A

decreased bicarbonate so there is a drop in pH
↓HCO3- ↓pH

35
Q

What occurs in metabolic alkalosis?

A

Increased bicarbonate leads to increase in pH
↑ HCO3-↑pH

36
Q

What are causes of respiratory failure?

A

Increased work of breathing
Hypoxia
Increased secretion load
Ineffective airway clearance
Reduced lung volume

37
Q

What are treatments for hypoxia?

A

Increasing O2

38
Q

How can increased secretion load and ineffective airway clearance be treated?

A

 Manual percussions
 Vibrations
 ACBT
 Acapella
 Airobika
 Suction

39
Q

How can increased work of breathing be improved?

A

Increased oxygen
Nebuliser
Positioning
Diaphragmatic breathing

40
Q

Why analyse ABGs?

A

Gives picture of patient condition
What treatments are best for the patient e.g. if need oxygen therapy
- Idea of type of respiratory failure patient in if at all

41
Q

What are the components of an A-E assessment?

A

Airway
Breathing
Circulation
Disability
Exposure

42
Q

What is involved in airway of A-E?

A

Oral/nasal airways
Tracheostomy
Endotracheal intubation
Key elements to know:
- Patent/ obstructed airway?
- Self-ventilating
- Coughing
 Strength
- Position of patient
- How talking / able

43
Q

Why check airway?

A

a critically unwell patient may need support to maintain their airway

44
Q

Why check breathing?

A

may need support with their breathing and ventilation to maintain oxygenation and gas exchange

45
Q

What are components of breathing in an A-E assessment?

A

May be using
- invasive controlled modes
- invasive spontaneous modes
- non-invasive ventilation
Key areas to find out:
- type of breathing
- if increased WOB / chest expansion
- breathing stats
- auscultation
- chest x-ray
- Palpable fremitus
- Cough strength
- ABGs

46
Q

What might breathing look at in terms of WOB?

A

Use of accessory muscles
Splinting of abdomen
Rib recession
Tracheal tug in children

47
Q

What are areas for breathing stats?

A

Respiratory rate
SpO2
FiO2

48
Q

What is a normal respiratory rate?

A

12-15/12-18 breaths per min

49
Q

What is normal SpO2?

A

Normal 94-100
In COPD 88-92

50
Q

What is normal FiO2?

A

Normally 21% in normal atmospheric conditions

51
Q

What notation might be used for auscultation?

A

 BSTO = breath sounds throughout
 Reduced BS = reduced breath sounds
 E.g. crackles
 Right LL = right lower lobe
 Bilat UL = bilateral upper lobes

52
Q

Why is circulation assessed?

A

may need support to maintain adequate circulation and cardiac function to optimise perfusion if vital organs

53
Q

What elements may be added from monitoring circulation?

A

Continuous monitoring via ECG and arterial lines
Delivery of intravenous medication via central lines e.g. inotropes/vasopressors

54
Q

What are key components that should be included in circulation?

A

Heart rate
BP normal between 90/60 – 120/80
CRT >2s = capillary refill time
CRP and WCC
possibly ABGs

55
Q

What aspects may be included in disability?

A

Induced low arousal by sedative or anaesthetic medication
Consequence of critical illness e.g. respiratory, kidney or liver failure, metabolic derangement or brain injury
Critically ill patients are at high risk of delirium, which may present as fluctuating arousal an cognitive disturbance
AVPU = alert, voice, pain, unresponsive
GCA
Bloods
- CRP
- WCC
- HB and platelets
- Drugs that patient on
Pain
Blood glucose
Possibly position here
Bowel movement?

56
Q

What may be included in exposure?

A

All other bodily symptoms
e.g. May require kidney support with dialysis or nutritional/gastrointestinal support with feeding tubes or infusions
E.g.
Stiff rib cage
Barrel chest
Abdominal splinting
Accessory muscle use
Lower limb oedema
Frailty
Temperature
Attachments e.g. catheter, NG tube, arterial line, PCA
Details e.g. stoma

57
Q

Why should an A-E assessment be carried out?

A
  • Methodical way of assessing
  • Looks at wider picture of patient as well as specific measurable factors
  • Takes into account both labs and immediate checks done at bed side.

Acute Care and Rehab (8 decks)

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