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AC- Simon > Wk1 - Wk2 Lecture > Flashcards

Wk1 - Wk2 Lecture Flashcards

1
Q

Code of Health and Disability - services consumers’ RIGHT. What is it?

A

It sets out 10 rights as you have as a health consumer
Right 1 - should be treated with RESPECT (inc culture, values, belief and personal policy)
Right 4 - Every looking after you should work together to provide safe manner practice
Right 7 - You can decide whether you can go ahead with treatments or not

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2
Q

Mobilisation Procedure - subjective interview

Stiller and Phillips (2003)

A
  • Medical notes
  • Past medical history
  • Recent symptoms of cardiovacular/respiratory dysfunction
  • Contraindication to mobilisation - e.g. medication
  • previous mobility/functional independence or exercise tolerance.
  • contraindications to mobilisation
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3
Q

Mobilisation - objective interview

What is sufficient cardiovascular reserve for mobilization?

A

Resting HR <20% variability recently

No evidence of MI or arrhythmia

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4
Q

What is sufficient respiratory reserve for mob?

A

PaO2/FiO2 >300, SpO2 > 90% and < 4% recent decrease in SpO2.
respiratory pattern satisfactory
mechanical ventilation able to be maintained during treatment

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5
Q

other factors needed to be considered for mob?

A 
* Blood results
  WCC (4.500 ~ 11000 cells/mm) 
  RBC
 Temp <38
 No neuro contraindication
 No othopedic contradindications
 obesity
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6
Q

Strong Opioid

A 
Morphine
Pethidine
Oxycodone
Methadone
Fentanyl
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7
Q

Weak opioid

A

Codein

Tramadol

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8
Q

General anaesthetic

A

Ketamine

Propofol

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9
Q

NSAIDs

A

Ibuprofen

Diclofenac

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10
Q

non-narcotic analgegic

A

Paracetamol

Aspirin

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11
Q

Causes for Hypoxaemia

A

V/Q mismatch
Hypoventilation
Decrease in FiO2
Diffusion limitation

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12
Q

Categorisation of Hypoxamia - PaO2 and SaO2

A

Mild: 8-10.5 kPa 90-94% SaO2

Moderate: 5.3-7.9 kPa 75-89% SaO2

Severe: PaO2 <75% SaO2

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13
Q

Causes for Hypercapnia

A

Hypoventilation (e.g. due to pain or medication)
increased metabolism (e.g. burn)
increased dead space (e.g. pneumonia)

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14
Q

Causes for Hypocapnia

A

increased respiratory drive e.g. hyperventilation

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15
Q

What are the 3 key principles required for delivery of oxygen to tissue?

A
  1. Ventilation
  2. Gas Exchange (perfusion)
  3. Circulation
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16
Q

Difference between SpO2 and SaO2

A 
SpO2 = oxygen saturation of haemoglobin measured by pulse oximeter
SaO2 = oxygen saturation of arterial blood measured directly by ABG
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17
Q

Where do we measure ABG?

A

often measure from the radial artery at the wrist

18
Q

physiological adaptation to inadequate oxygenation

A

increase RR
increase HR
Cyanosis (central or peripheral)
confusion, agitation, reduced conscious level

19
Q

clinical features of abnormal CO2 - High and Low

A

High = headache, drowsy, difficult to rouse (keep awake)

Low = parasthesia fingertips / around lips
Lightheaded “spaced out”
far less common than increased CO2

20
Q

How to manage impaired gas exchange?

A 
determined depending on underlying cause
 - controlled oxygen therapy
 - secretion clearance techniques
 - positioning
 - Non-invasive ventilation (NIV) 
       (CPAP)
21
Q

What is CPAP?

A

Continuous Positive Airway Pressure (CPAP)
Similar to PEP device but instead of the positive pressure is applied on exhalation, constant positive pressure is applied for CPAP.

22
Q

True or False

Oxygen therapy is used for breathlessness

A

No, it is treatment for hypoxaemia. Oxygen has not been shown to have any effect on the sensation of breathlessness in non-hypoxaemic patients

23
Q

key concepts for oxygen therapy

A
  1. hypoxamia
  2. prescribed according to target range
  3. aim to achieve normal or near normal SpO2 APART from HyperCAPNIC failure
  4. Too much oxygen can cause problems
  5. Hazards of fire
  6. All patients on the therapy should be monitored and if possible, wean off O2.
24
Q

WHY should we not give oxygen therapy to those who are at risk of hypercapnic failure?

A

Because CO2 will further increase by 3 mechanisms.

  1. V/Q mismatch due to reversed hypoxic-vasoconstriction
  2. Haldane effect (CO2 dissociate from haemoglobin due to increased FiO2)
  3. Decrease hypoxic drive (RR decreases due to decreasing hypoxic drive in response to normal/ close to normal oxygen level acquired from oxygen therapy).
25
Q

3 types of devices for Low Flow oxygen therapy

A
  1. Nasal cannula/prongs
  2. Simple face masks
  3. non re-breather face mask
26
Q

Characteristics for Nasal Cannula/prongs

A
  • low flow and low FiO2
  • open circuit
  • dry
  • low flow (1-4 l/m)
  • FiO2 concentration between 24% - 36%
27
Q

Advantage and Disadvantage of Nasal Cannula

A

Advantage

  1. no rebreathing - good for type 1 & 2 respiratory failure
  2. comfortable
  3. Low cost, safe and simple
  4. good for confused patients - less easily pulled off
  5. able to eat and drink and talk

Disadvantage

  1. Unpredictable FiO2
  2. Not suitable for patients with nasal obstructions
  3. less effective for mouth breather
28
Q

Characteristics of simple face mask

A
  • open
  • low flow and medium FiO2
  • open circuit
  • Dry
  • FIo2 btw 35 - 60%
  • Flow rate must be >5 m/m to avoid rebreathing Co2
  • suitable for when accurate O2 concentration is not required.
29
Q

Characteristics of Non re-breather mask

A
  • low flow and High FiO2
  • open circuit
  • dry
  • flow rate 10-15 l/m
  • reservior bag
  • variable FiO2 btw 60-80%
  • Short term, trauma, A&E, paramedics
30
Q

3 types of High Flow oxygen therapy

A
  • Venturi Mask
  • Ambu bag
  • HFNP (High Flow Nasal Prongs)
31
Q

Characteristics of Venturi Mask

A
  • open circuit
  • dry
  • fixed FiO2
  • venturi valves for changing FiO2 (24-28-31-35-40-60%)
  • often used for px with COPD who has chronically compensated elevated CO2 level
32
Q

Characteristics of Ambu Bag

A
  • Closed circuit
  • Dry
  • reservior bag
  • 100% FiO2
33
Q

Characteristics of HFNP

A
  • open circuit
  • humidified
  • High flow
  • accurate FiO2 21-60%
  • PEEP
  • FiO2 and Flow rate can be altered independently
34
Q

Indications for Humidification

A
  • prolonged oxygen therapy
  • high flow oxygen (> 4 l/m) for more than 4 hours
  • viscous/ thick secretions
  • hyper-reactive airways e.g. athma
35
Q

Type of humidification

A

Systemic - IV or Oral

Inhaled - sterile water (warm or cold)

36
Q

Dangers of inhaled humidification

A 
Cold = risk of bronchoconstriction 
Medium = bacterial growth
37
Q

Characteristics of Warm Humidification

A
  • mimics natural process
  • avoid stimulating bronchospasm
  • heated air prevents bacterial colonisation
  • Tubing and chamber should be cleaned daily
  • Chamber kept below patient to avoid tipping water
38
Q

Indication for Long Term Oxygen Therapy (LTOT) use

A

PaO2 < 7.3 kPa at rest
OR
SaO2 <90% for over 30% of the night

39
Q

Benefit of LTOT

A
  1. reversal of arterial hypoxaemia
  2. decrease right ventricle work load and incr in CO
  3. improve cognitive function
  4. increase sleep and incr exercise capacity
  5. decrease exacerbations & hospital admissions
  6. increase survival rate
40
Q

Dysponea Management

A

Treat underlying cause - identify cause of altered ABGs
Positioning
Breathing Control
Education - reassurance

41
Q

Key components of oxygen therapy

A

Device
FiO2 and Flow rate
Monitoring

AC- Simon (12 decks)

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