SET QUESTIONS Flashcards
Define the elements of the objective assessment of the respiratory patient
Airway
Circulation
Breathing
Disability
What is your understanding of the role of medication; antibiotics, CFTR modulators and antifibrotic medication in the role of symptom and respiratory disease management, give examples of these medications.
Antibiotics
Function: Used to treat acute and chronic infection. Long term antibacterial modalities reduce frequency of exacerbation
Examples: azithromycin, clarithromycin, erythromycin, tobramycin and roxithromycin
CFTR modulators
Function: improve function of intracellular processing and defective CFTR protein
Examples: Kalydeco, orkambi, symdeko, trikafta
Antifibrotics
Function: slow decline of lung function and reduce risk of respiratory deterioration.
Examples: nintedanib, pirfenidone
Identify the causes and treatment of hypoxemia and clinical features of hypoxia.
Hypoxemia
Causes:
alveolar hypoventilation - obstructive airway disease, resp muscle weakness
diffusion - pulmonary eodema, acute respiratory distress syndrome
V/Q mismatch - pneumothorax, obstructive airway disease, alveolar collapse
Treatment: oral corticosteroids, BiPAP, NIPPV, CPAP
Hypoxia
Clinical features: dyspnoea, arrythmia, coma, systemic hypotension, peripheral vasodilation
What is the role of oxygen therapy and humidification and when they should be used?
- Give an example of an ABG as uncompensated metabolic alkalosis/acidosis and state a potential cause
pH: 7.5
paCO2: 5.2
paO2: 12.4
HCO3-: 30
Cause of metabolic alkalosis:
GAIN OF BASE:
Alkali administration e.g., Sodium bicarbonate
LOSS OF ACID:
Loss of H+ ions e.g., through vomiting, NG suctioning
Shift of H+ ions into intracellular space – Mainly occurs in hypokalemia
- Define the different lung volumes and capacities, how do we calculate Forced Vital Capacity? Inspiratory Capacity? Vital Lung Capacity? Total Lung Capacity? Functional Residual Capacity?
Forced Vital Capacity =
Vital Lung Capacity = TV + IRV + ERV
Total Lung Capacity = TV + IRV + ERV + RV
Functional Residual Capacity = RV + ERV
- Describe modifiable and non-modifiable risk factors for cardiovascular disease?
Modifiable: smoking, cholesterol, diet, physical inactivity, obesity, diabetes mellitus
Non modifiable: family history, age, sex, ethnicity
Demonstrate and describe the purpose of the Active Cycle Breathing Technique. State the contraindications.
Supplement the body’s clearance system. Transport secretion. Allow air to move behind obstruction. Ventilate all regions distally. Propel secretions up the airways.
Contraindications: Acute pulmonary oedema. Recent lung surgery. Undrained pneumothorax. CVS instability. Frank haemoptysis
Define the elements of a subjective assessment of the respiratory patient.
Breathlessness. Cough. Sputum. Wheeze. Chest pain
What is your understanding of the role of medication: bronchodilators and corticosteroids in the role of symptom and respiratory disease management, give examples of these medications.
Bronchodilators
Role: management of obstructive pulmonary conditions eg. CF, COPD, non CF bronchiectasis, asthma
Examples: short acting beta 2 adrenergic agonist, short acting anticholinergic, long acting beta 2 adrenergic agonist, long acting muscarinic anticholinergic antagonist
Corticosteroid
Role: anti-inflammatory medication. Management for COPD, non CF bronchiectasis, idiopathic pulmonary fibrosis, asthma,
Examples: inhaled corticosteroids e.g. Flixotide, Seretide, Breo
- Describe how oxygen and carbon dioxide are transported in the blood
CO2 + H2O => CH2O3=> HCO3- + H+
On auscultation describe, the normal breath sounds.
Vesicular, inspo:expo 3:1
How do we use FEV1 to classify COPD in to GOLD stages?
FEV1 > 80 Mild
FEV1> 50-80 moderate
FEV1 50-30 severe
FEV1 <30 very severe
On auscultation describe the abnormal breath sound – wheeze/stridor. High pitch vs low pitch / monophonic vs polyphonic and give examples of when these abnormal BS may occur
Wheeze – high pitch, polyphonic means small airway obstruction, monophonic means large airway obstruction. Examples of when wheeze occurs - any narrowing of the airway, bronchospasm, mucosal oedema, sputum, pulmonary oedema.
Stridor – high pitched, monophonic. Examples - croup, foreign body obstruction, large airway tumour, post extubation.
Define the role of three different receptors involved in the control of ventilation
Irritant receptors
respond to irritant e.g. cigarette smoke, dust etc
change respiratory depth or frequency,
cause cough, sneeze, bronchospasm
mechanoreceptors
respond to stretch in inflation are in bronchial smooth muscle, trachea and visceral pleura
large stretch in inflation - stretch lung parenchyma - hering breuer reflex - stops inspiration
chemoreceptors
maintain resp gases and pH in arterial blood within normal blood range
controlled centrally in medulla and peripherally in artic arch and carotid
