Revision Flashcards

1
Q

interconnections of alveoli

A

martin = bronchial + bronchial (interbronchial)
lambert = bronchial + alveoli (broncho-alveolar)
Kohn = alveoli (interalveolar)

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2
Q

how does obstruction of alveoli without collateral ventilation affect the alveoli

A

gas tension in obstructed area is equilibrated with mixed venous blood (diffusion - from high conc to low conc, both conc are same, no direction for flow to go)
no further gas exchange
cannot maintain pressure
atelectasis occurs

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3
Q

alveolar interdependence

A

deep inspiration causes alveoli to expand and less expanded alveoli to re expanded due to the traction force of neighbouring alveoli and elasticity of interstitium

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4
Q

purpose of forced expiratory technique

A

increased expiratory flow to shear mucus from airway walls

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5
Q

describe equal pressure theory

A

point in which pressure in bronchial is equal to pressure outside bronchial
intrapleural pressure is high due expiration
pressure moves to alveoli - increas

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6
Q

Consequences of immobilisation

A

Loss of muscle
Loss of aerobic capacity
General functional decline
Increased risk of clots
Reduced range of motion

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7
Q

Tidal Volume

A

the amount of air that can be inhaled or exhaled during one respiratory cycle

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8
Q

Inspiratory Reserve Volume

A

the amount of air that can be forcibly inhaled after a normal tidal volume.

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9
Q

Expiratory Reserve Volume

A

the volume of air that can be exhaled forcibly after exhalation of normal tidal volume.

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10
Q

Residual Volume

A

the volume of air remaining in the lungs after maximal exhalation

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11
Q

Inspiratory capacity

A

IRV+TV

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12
Q

Total Lung Capacity

A

four primary lung volumes (TV, IRV, ERV, RV).

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13
Q

Vital Capacity

A

TV+IRV+ERV.

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14
Q

Function Residual Capacity

A

the amount of air remaining in the lungs at the end of a normal exhalation.

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15
Q

contraindications of mobilisation

A

Safety considerations (balance, power)
Portsmouth sign (HR > SBP)
Tachycardia (>100) or bradycardia (<40)
Blood pressure (140/90 = clinical hypertension, 200/110= severe hypertension)
SpO2 (maintain >90%) or fall of >4%

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16
Q

Management of Breathlessness

A

Pursed lip breathing
Medications
Pacing

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17
Q

mechanism of action of pursed lip breathing

A

Creates a back pressure which produces a small PEEP (positive end expiratory pressure)
PLB helps support breathing by opening the airways during exhalation and increasing the removal of CO2

18
Q

PEP

A

Positive Expiratory Pressure

19
Q

Mechanism of action of PEP

A

a handheld mouthpiece increases resistance to expiratory airflow to promote mucus clearance by preventing airway closure, reduce gas trapping and increasing collateral ventilation

20
Q

benefits of PEP

A

Air get behind the mucus
Move mucus from lung and airway walls
To hold the airways open for longer[3]

21
Q

Indications for PEP

A

Reduce hyperinflation/ Air trapping e.g. bronchitis, emphysema
improve airway clearance for CF, chronic bronchitis, bronchiectasis

22
Q

types of PEP

A

oscillating e.g aerobika, Flutter

23
Q

mechanism of action for oscillating PEP

A

Oscillations during expiration decreases the viscoelasticity properties of mucus, effecting its movement which depends on the oscillating frequency.

24
Q

What is the BiPAP

A

Helps lungs expand when inhaling by supplying pressurised air into airways positive pressure ventilation

25
difference between BiPAP and CPAP
BiPAP gives higher pressure of air when breathing in CPAP gives same pressure of air breathing in and out
26
physiological benefits of BiPAP
↑ Collateral ventilation ↑ Tidal Volume ↑ FRC ↑ Alveolar ventilation
27
Indications for BiPAP
Sputum retention Atelectasis Blood gas abnormality Respiratory muscle weakness Inability to actively engage with ACBT
28
Contraindications for BiPAP
CVS instability Head injury / ↑ ICP Lung Transplant / surgery Severe Haemoptysis /Epistaxis Undrained Pneumothorax
29
contraindications for manually assisted cough
Undrained pneumothorax Frank haemoptysis Vomiting Facial fractures CVS instability
30
describe mechanism for cough assist device
Applies a positive pressure to fill the lungs, quickly switching to a negative pressure to produce a high expiratory flow rate and simulate a cough.
31
how is assistive cough device usually applied
a mask, mouthpiece, endotracheal or tracheostomy tube
32
indications for assistive cough device
Peak cough flows of <180 L/min are unlikely to be effective at clearing secretions​ Audible secretions at the mouth​ Crackles heard on auscultation​ Tactile fremitus​
33
what is breath stacking
person is encouraged to breathe in slowly at intervals, stacking one breath on top of the other. This technique allows the lungs take in more oxygen than normal inspiration by encouraging the patient to breathe in slowly breathing and stacking one breath on top of other as tolerance allows
34
ACBT cycle
breath control 3-4 thoracic expansion (insp hold, perc, vibs) breath control 3-4 thoracic expansion (insp hold, perc, vibs) breath control forced expiratory technique (huff) breath control
35
indications for manual clearance techniques
have secretion cannot clear secretions from ACBT and positioning alone Patient has acute lobar atelectasis done with postural drainage
36
precautions for manual clearance techniques
elderly patient on steroids bronchospasm attachments thin malnourished
37
contraindications for manual clearance technique
rib fractures recent haemoptysis osteoporosis subcutaneous emphysema burns/skin grafts/open wounds
38
positions of ease purpose
ease of breathlessness
39
examples of positions of ease
forward leaning sitting high side lying released standing
40
contraindications for POE
Head and neck pathology (surgery, immediate post op, nosebleeds, ICP > 20mmHg, C spine # Cardiovascular pathology (HTN, cardiac failure, pulmonary oedema) oesophageal surgery abdominal surgery (pregnancy, obesity)