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61 Cards in this Set

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What 2 conditions cause Hypoxia?
COPD and CHF ( CHF is Congestive Heart Failure)
"Whatever the cause, it is critical to id the presence of --------, including breathing problems, because ALL causes are serious and potentially devastating."
hypoxia
Why? because our cells need oxygen to survive . we can go longer without food and water but not very long without oxygen!
What are 4 subtle signs we can observe in a patient before they have a full blown case of hypoxia?
1.changes in skin color-skin is slightly blue
2.confusion
3. can't handle exercise
4.Fatigue
Review COPD is?
COPD-chronic obstructive pulmonary disease. The alveoli absorb. No more friendly exchange between Co2 and O2 the alveoli are destroyed!
Review CHF is?
CHF is Chronic Heart Failure. When a patient has CHF there ia backup of fluid in the aveoli of the lungs which blocks cellular respiration( that means that oxygen( o2) and carbon dioxide ( CO2) can not exchange . This happens even if the patient is trying to breath right and if the patient has plenty of fresh air.
what is COPD and what does it affect in the lungs?
COPD is chronic obstructive pulmonary disease. In COPD the alveoli can no longer absorb and do the exchange between carbon dioxide( CO2) and Oxygen ( O2):(
What does hypoxia mean?
Low level of oxygenation a the tissue level.
What 2 diseases are associated with Hypoxia?
CHF-Congestive Heart Failure and COPD-chronic obstructive pulmonary disease.
What disease of the blood do we see low oxygen levels ?
Anemic Hypoxia for example is caused by different problems ex: heart attack, co2 poisening, suffocation etc..,
Review: hypoxemia vs.hypoxia?
Hypoxemia is low oxygen in the blood ( ex: normocytic anemia )
hypoxia low oxygen in the tissue.( CHF and COPD)
what is a really common lifestyle behaviour that our patients do that causes hypoxia?
Smoking
In clinic often a patient reports SOB. What do we need to look at for early red flags for hypoxia?
1. confusion
2. SOB
3. Fatigue
4. decreased exercise tolerance
5.slight changes in skin color-bluish
6. nails are bluish
is this hypoxia or hypoxemia?" Failure to circulate enough normally oxygenated blood around to the tissues, because of pump failure of the heart( CHF)?"
hypoxia
key words" not enough normally oxygenated blood around to the tissues."
What are 5 reasons to cause hypoxia?
1. Blocked arteries can't get oxygen to the the tissues
2.COPD(alveoli of lungs don't exchange oxygen and CO2) and 3CHF( pump failure)
4..Decrease in RBC or decrease in Hemoglobin ( this is at the tissue level ) EX: Different types of Anemia
5..Combos of all of the above( very common)
What kind of patient is the most common to come in with just a little SOB, with sl cyanosis( slight blue color) of lips and nails?
The SMOKER
Re; previous patient question. If you see a patient who reports sl SOB , has sl cyanosis of lips and nails what do you do?
this is a red flag for advanced hypoxia!!!!
Refer to MD if they have not already been diagnosed with COPD.
What if your patient tells you that they awaken from sleep at night and have to stand up or to sit up? what could be the cause? what is this called? patient reports they feel better in 10-30 m.
Severe SOB that makes the patient wake up and they have to sit or stand.
"Paroxymal nocturnal dyspenea" (PND) This patient has Congestive Heart Failure( CHF) and this is the side effect of it.
What is the patient advice for the previous question?
For severe SOB that makes a patient wake up and have to stand or sit for 10 -30 m called "Paroxymal Nocturnal Dyspenea"
Advice: Avoid heavily salted food
Take your RXS if you have them for HTN and or Heart Dx ( don't miss any doses) Take diuretic if on them as well
Do not Exercise until you get evaluated from your MD.
In the previous question is this an ER situation ?
"Paroxysmal nocturnal dyspnea " this depends on how severe the ss are. if ER is needed. This is a semi -urgent situation. Every case is evaluated for PND on a case by case basis.
Patient comes in with chest pain, moderate to severe SOB, pallor, sweating, an anxious look on their face or bluish color around mouth or nail beds. What do you do?
Call 911!
what is a really common lifestyle behaviour that our patients do that causes hypoxia?
Smoking
In clinic often a patient reports SOB. What do we need to look at for early red flags for hypoxia?
1. confusion
2. SOB
3. Fatigue
4. decreased exercise tolerance
5.slight changes in skin color-bluish
6. nails are bluish
is this hypoxia or hypoxemia?" Failure to circulate enough normally oxygenated blood around to the tissues, because of pump failure of the heart( CHF)?"
hypoxia
key words" not enough normally oxygenated blood around to the tissues."
What are 5 reasons to cause hypoxia?
1. Blocked arteries can't get oxygen to the the tissues
2.COPD(alveoli of lungs don't exchange oxygen and CO2) and 3CHF( pump failure)
4..Decrease in RBC or decrease in Hemoglobin ( this is at the tissue level ) EX: Different types of Anemia
5..Combos of all of the above( very common)
What kind of patient is the most common to come in with just a little SOB, with sl cyanosis( slight blue color) of lips and nail beds?
The SMOKER w COPD!
When a patient has "paroxymal nocturnal dyspnea from CHF what advice should we give them regarding lifestyle?(2)
No salt cuz it causes excess fluid retention in the vascular system
DO NOT Exercise until evaluated by your doc!
What is the main difference between Heart failure and Congestive Heart failure?
Heart failure: inability to pump enough bld out of the heart into circulation to meet the needs of the body
Congestive Heart failure: all of the above plus has congestion of bld that is trying to get into the heart. Sounds like bld stasis to me.
What are the 4 big typical ss/sx and hx of PND( paroxymal nocturnal dyspnea ) are ?
1 ankle swelling
2.exercise intolerance
3.Fatigue
4.SOB
Patients in Heart Failure tend to look like?
pale and sometimes ashen
What are some additional ss that a patient may have when in Heart Failure?
1.Anxious facial expression
2.Blue around mouth or nail beds( extreme case)
3. Bilateral ankle swelling
4.Moderate to severe SOB
5.Sweating
What is the most common reason for a hospital visit for patients over 65?
CHF ( chronic heart failure)
What are 5 risk factors for CAD( coronary artery disease)?
1.Abnormal Lipids( cholesterol is high and so can triglycerides be high)
2.Diabetes Mellitus
3.Family hx
4..High C -reactive protein ( CRP)
5. Smoking
6.Sedentary lifestyle
7.Male gender
3
What are 5 risk factors for HTN( high blood pressure)?
1 Age
2.African American
3.Sitting around too much
4.Potassium def
5.Smoking( nicotine)
6.obesity
7.Family hx
8.Renal dx\
9.STRESS
10. Too much alcohol
11.idiopathic( unknown)
12.Maybe low vit d
What are the risk factors for Heart failure from valvular dx and dysfunction?(2)
1.Congenital valvular disorders
2.Hx of severe sore throat that caused rheumatic heart dx
What causes Heart failure from cardiomyopathy ( dx of heart muscle)
(3)
1.Alcoholism
2.Diabetes Mellitis
3.Viruses
Compare and contrast Heart failure from valvular dx vs. Heart failure from Cardiomyopathy.
Valvular Dx vs Cardiomyopathy
Congenital Alcoholism, Diabetes
Sore throat Viruses( Shoghi Effendi)
Rheumatic
Heart failure has another cause that has to do with?
Conduction and Rhythm problems
ex: Irregular heart beat
Mechanism of Heart Failure Review
(5)
1.CAD-coronary artery Dx-cholesterol
2.Cardiomyopathy-Damaged heart muscle
3.HTN-high bld pressure causes backup pressure against the bld that comes out of the L ventricle
4.Arrhythimias and conduction -Sick sinus syndrome, Pt gets dizzy( red flag) A-fib is ex. Irregular heart beat
What is the Main difference between Heart failure caused by HTN and Heart failure caused by CAD?
HTN Heart failure-High blood pressure causes backward pressure to L ventricle
CAD-coronary heart dx-plaque Atherosclerosis
What is the Main difference between Heart failure from Arrhythmias/conduction and Valvular Heart Dx?
Arrhythmias/conduction:many lead to acute heart failure , but some lead to slower onset CHF( coronary heart failure) "Sick sinus syndrome"
Valvular Heart DX:
Aortic and or /mitral valves are too loose or too tight-if too loose the valve regurgitates backwards into heart or if too tight won't let the blood flow outwards
What is the Main difference between Heart failure from cardiomyopathy and CAD?
Cardiomyopathy Heart Dx: Damage heart muscle
CAD: Coronary artery dx- plaque blocks the artery or arteries.
What kind of a cough is a RED FLAG?
A cough w episodic Severe SOB and Expiratory Breathing
What is the difference between Extrinsic or intrinsic asthma?
Extrinsic asthma means allergic asthma . Way to remember is an ex husband is someone you could be allergic to!
intrinsic asthma is divided further into exercise induced asthma and the chemical induced asthma.
What suggestion would you offer to the patient who has Extrinsic asthma?
advise to avoid things that cause the allergies for them.
What kind of follow-up with Moderately severe asthma even if they are not reactive that often?
All asthmatics of this kind can get very ill and or die from this dx. They are at risk for pneumonia and bronchitis and a severe allergic response. Have this patient follow-up regularly with PCP.
How this pt is taken to the PCP or Er depends upon the severity of the response. There are 4 grades to this . See next set of questions.
Review Grade System for Asthma:
Grade 1: No hx of SOB that is significant, no hx of ED visits or being in the hospital for same-tell patient to see Dr in 1-2 days unless ss get worse.
Grade 2: Moderate wheezing and mild SOB w hx of hospital and ED visits -same day referral . Pt should not drive
Grade 3: moderate wheezing and Moderate SOB and hx of ED or hospital Send to PCP if they have a NEBULIZER if not then to URGI CARE if none of these then to ED. PT should not drive!l
Grade 4:Severe SOB and Wheezing ED, 911
Grade 2: Moderate wheezing and mild SOB w hx of hospital and ED visits -same day referral . Pt should not drive
Grade 3: Mod SOB and Wheezing- Choices:Nebulizer PCP, URGI Care or hospital depends on what is available to pt. PRIVATE transport ok , PT Can not drive!
4. SEVERE SOB AND WHEEZING ED And 911
If a pt presents with mild wheezing and sob with no hx of ED visits or hospital visits what kind of referral if any? what kind of referral is this?
Refer to PCP for 1-2 day follow-up. This is a semi-urgent referral
Describe grade 3 referral for asthma.
Pt has MOD sob and wheezing w hx of hospital visit send to PCP if office has NEBULIZER. If none send to URGI CARE or hospital . Pt can not drive they need someone to drive for them.
When do we refer on the same day to the PCP with hx of hospital visits in re: to asthma?
Grade 2:Mild -Mod Wheezing w Mild SOB
What are the most obvious ss with active asthma?
SOB and DRY cough!
SOB and DRY Cough for asthma are the
most obvious ss
How important is past history related to referrals for asthma pt?
Very important! past history of hospital visits and ED visits. Asthma can be life threatening!
What question should you ask a patient with asthma to determine how sick they are?
ask if there is an infection at same time ex: flu, sore throat, a cold things like this
What two dx are often seen together w an asthmatic pt?
"asthmatic bronchitis" asthma with bronchitis
if a pt is wheezing and there is a quiet spot in the wheezing is this serious or not? what does it mean?
means that the patient may have to go to the hospital . This can be serious.
If a pt has asthma, high fever and purulent spit what can they also have ? (2)
bronchospasm or pneumonia
What is the END point of severe asthma?
pt who is really SOB, loud wheezing, can't get enough air in, turns blue and is unconscious eventually.
What are 5 risk factors for asthma pt?
1. personal or fam hx
2. hx of atopy( being predisposed to getting allergies) or nasal allergies
3.Cigarettes not good for asthmatics! DUH
4. Being Obese
5. Hx of a lot of bronchial infections
True or false?
Bronchospasm isn't the only thing that can decrease the airway caliber?
True- when the pt has bronchitis the mucus can also block the airway .
To distinguish extrinsic asthma includes these (2)things.
.also called atopic asthma
1.begins in childhood
2. pt has other types of atophy Immunogloblin E mediated allergy like eczema,allergic rhinitis
intrinsic asthma?(4)
1.some drugs like aspirin
2.Endocrine status
3. NSAIDS
4.Exercise and Anxiety
5. yellow food dye
6.temp and humidity
7.Respiratory infections
8.Noxious fumes