Wk1 - Wk2 Lecture Flashcards
Code of Health and Disability - services consumers’ RIGHT. What is it?
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
Mobilisation Procedure - subjective interview
Stiller and Phillips (2003)
- 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
Mobilisation - objective interview
What is sufficient cardiovascular reserve for mobilization?
Resting HR <20% variability recently
No evidence of MI or arrhythmia
What is sufficient respiratory reserve for mob?
PaO2/FiO2 >300, SpO2 > 90% and < 4% recent decrease in SpO2.
respiratory pattern satisfactory
mechanical ventilation able to be maintained during treatment
other factors needed to be considered for mob?
* Blood results WCC (4.500 ~ 11000 cells/mm) RBC Temp <38 No neuro contraindication No othopedic contradindications obesity
Strong Opioid
Morphine Pethidine Oxycodone Methadone Fentanyl
Weak opioid
Codein
Tramadol
General anaesthetic
Ketamine
Propofol
NSAIDs
Ibuprofen
Diclofenac
non-narcotic analgegic
Paracetamol
Aspirin
Causes for Hypoxaemia
V/Q mismatch
Hypoventilation
Decrease in FiO2
Diffusion limitation
Categorisation of Hypoxamia - PaO2 and SaO2
Mild: 8-10.5 kPa 90-94% SaO2
Moderate: 5.3-7.9 kPa 75-89% SaO2
Severe: PaO2 <75% SaO2
Causes for Hypercapnia
Hypoventilation (e.g. due to pain or medication)
increased metabolism (e.g. burn)
increased dead space (e.g. pneumonia)
Causes for Hypocapnia
increased respiratory drive e.g. hyperventilation
What are the 3 key principles required for delivery of oxygen to tissue?
- Ventilation
- Gas Exchange (perfusion)
- Circulation
Difference between SpO2 and SaO2
SpO2 = oxygen saturation of haemoglobin measured by pulse oximeter SaO2 = oxygen saturation of arterial blood measured directly by ABG
Where do we measure ABG?
often measure from the radial artery at the wrist
physiological adaptation to inadequate oxygenation
increase RR
increase HR
Cyanosis (central or peripheral)
confusion, agitation, reduced conscious level
clinical features of abnormal CO2 - High and Low
High = headache, drowsy, difficult to rouse (keep awake)
Low = parasthesia fingertips / around lips
Lightheaded “spaced out”
far less common than increased CO2
How to manage impaired gas exchange?
determined depending on underlying cause
- controlled oxygen therapy
- secretion clearance techniques
- positioning
- Non-invasive ventilation (NIV)
(CPAP)What is CPAP?
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.
True or False
Oxygen therapy is used for breathlessness
No, it is treatment for hypoxaemia. Oxygen has not been shown to have any effect on the sensation of breathlessness in non-hypoxaemic patients
key concepts for oxygen therapy
- hypoxamia
- prescribed according to target range
- aim to achieve normal or near normal SpO2 APART from HyperCAPNIC failure
- Too much oxygen can cause problems
- Hazards of fire
- All patients on the therapy should be monitored and if possible, wean off O2.
WHY should we not give oxygen therapy to those who are at risk of hypercapnic failure?
Because CO2 will further increase by 3 mechanisms.
- V/Q mismatch due to reversed hypoxic-vasoconstriction
- Haldane effect (CO2 dissociate from haemoglobin due to increased FiO2)
- Decrease hypoxic drive (RR decreases due to decreasing hypoxic drive in response to normal/ close to normal oxygen level acquired from oxygen therapy).
3 types of devices for Low Flow oxygen therapy
- Nasal cannula/prongs
- Simple face masks
- non re-breather face mask
Characteristics for Nasal Cannula/prongs
- low flow and low FiO2
- open circuit
- dry
- low flow (1-4 l/m)
- FiO2 concentration between 24% - 36%
Advantage and Disadvantage of Nasal Cannula
Advantage
- no rebreathing - good for type 1 & 2 respiratory failure
- comfortable
- Low cost, safe and simple
- good for confused patients - less easily pulled off
- able to eat and drink and talk
Disadvantage
- Unpredictable FiO2
- Not suitable for patients with nasal obstructions
- less effective for mouth breather
Characteristics of simple face mask
- 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.
Characteristics of Non re-breather mask
- 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
3 types of High Flow oxygen therapy
- Venturi Mask
- Ambu bag
- HFNP (High Flow Nasal Prongs)
Characteristics of Venturi Mask
- 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
Characteristics of Ambu Bag
- Closed circuit
- Dry
- reservior bag
- 100% FiO2
Characteristics of HFNP
- open circuit
- humidified
- High flow
- accurate FiO2 21-60%
- PEEP
- FiO2 and Flow rate can be altered independently
Indications for Humidification
- prolonged oxygen therapy
- high flow oxygen (> 4 l/m) for more than 4 hours
- viscous/ thick secretions
- hyper-reactive airways e.g. athma
Type of humidification
Systemic - IV or Oral
Inhaled - sterile water (warm or cold)
Dangers of inhaled humidification
Cold = risk of bronchoconstriction Medium = bacterial growth
Characteristics of Warm Humidification
- 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
Indication for Long Term Oxygen Therapy (LTOT) use
PaO2 < 7.3 kPa at rest
OR
SaO2 <90% for over 30% of the night
Benefit of LTOT
- reversal of arterial hypoxaemia
- decrease right ventricle work load and incr in CO
- improve cognitive function
- increase sleep and incr exercise capacity
- decrease exacerbations & hospital admissions
- increase survival rate
Dysponea Management
Treat underlying cause - identify cause of altered ABGs
Positioning
Breathing Control
Education - reassurance
Key components of oxygen therapy
Device
FiO2 and Flow rate
Monitoring
