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20 Cards in this Set
- Front
- Back
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Autonomy
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patient right to refuse
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Beneficence
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do the right thing (promote well being of others, not self)
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Non malfiecence
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do no harm
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Justice
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fairness (same level of care for everyone)
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HIPAA Requirements
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-protect the privacy of patient's medical information
-offers patients certain rights with respect to their information -administrative protections must be in place (privacy officer, staff training, policies adn procedures) |
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PFT's done for pulmonary rehab
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FVC
FEV1 DLCO |
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Primary goal of PR
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inprove quality of live of ADL
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Objectives of PR
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-to control, reduce, and alleviate the symptoms and pathophysiologic complications of chronic pulmonary diseases.
-to train patients how to reach the highest possible level of independent functions for ADL's within the limitations of their pulmonary disease -to train patients to self manage their daily living consistent with their pulmonary disease process -reduce doctor visits and hospitalization |
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Why people are discharged?
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-PR treatment goals are achieved or the patient has reached maximum medical benefit
-there is minimal or no potential to make significant progress -the patient is non-compliant with the established plan of care -the patient no longer requires skilled PR services |
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List the potential respiratory complications associated with neuromuscular disease
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– Hyperventilation or hypoventilation
– Sleep apnea – Aspiration – Atelectasis causing hypoxemia – Pulmonary (HTN) – Cor pulmonale |
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Identify the clinical signs and symptoms associated with respiratory muscle weakness.
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•Initially: exertional dyspnea, fatigue, orthopnea, or symptoms of cor pulmonale
–Occur secondary to muscles inability to maintain adequate ventilation •Sometimes power and volume of voice decline. •Deterioration may lead to rapid shallow breathing and hypoventilation (⇑PaCO2). |
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List the changes in measures of pulmonary function seen in patients with neuromuscular disease.
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•Pathophysiology and PFTs
•NMD normal lung parenchyma reveals restrictive defect. •Decreased VC, FEV1, TLC •Normal RV and diffusing capacity corrected for VA •Positional changes suggest diaphragmatic weakness •Seated to supine: >20% decline in FEV1 and VC •Decreased PImax and Pemax •ABG: ⇓PaO2, ⇓PaCO2, but deterioration leads to ⇑PaCO2 |
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Describe techniques for monitoring the patient with respiratory muscle weakness.
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•Progressive NMD leads to fatigue and respiratory failure.
–May necessitate MV, so monitor carefully to determine when to initiate •Monitoring involves serial measurements of PImax, VC, and ABG values. •May monitor maximal nasal sniff inspiratory force and nocturnal oximetry •Close monitoring of all respiratory function is important. |
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Describe the general respiratory care management of patients with respiratory muscle weakness
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Weakness leads to respiratory insufficiency and retained secretions.
•Consider NIV or MV via tracheostomy. •Augmentation of secretion clearance and cough •NIV increasingly used to treat acute deterioration. –i.e., Pneumonia or surgical event •Diaphragmatic pacing for spinal injuries FDA |
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Duchennes muscular dystrophy
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-x linked recessive muscle wasting disorder
-waddling gait, lordosis, freq falls -death occurs by age 20, secondary resp. infection -OSA = PPV -FVC < 30% |
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Myotonic dystrophy
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-1 in 8,000 persons
Hallmark = delayed muscle relaxation (myotonia) Respiratory dysfunction is common - respiratory muscle weakness -OSA and CSA very common even at early age -aspiration -chromosome = 19 |
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Polymyositis
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inflammatory myopathy of unknown cause
ventilatory insufficiency and failure are usual - progression of limb weakness -10-30% develop interstitial lung disease, with diffuse infiltrates predominantly in the bases. 50%pt antibodies Jo-1 antigen (histidyl transfer RNA synthetase)protein. O2 exchange abnor/pul HTN |
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Myasthenia gravis
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intermittent muscle weakness
- 20%pt protein attack muscle specific kinase -younger female predominant 3:1 to 4.5:1 -10% thyoma Signs: - eyelid drooping -double vision -difficulty swallowing -decreased TLC, VC, PImax, PEmax |
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Myasthenic crisis
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acute respiratory insufficiency caused by infection, surgery, excessive anticholinesterases
-ET intubation and MV req. immediately = prolonged |
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Lambert eaton syndrome
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2/3 assoc. w/cancer, most of those with small cell lung CA.
-autoantiboidies interfere with release of ACh. 66% cancer 50% carcinoma (sm cell lung CA) -60 yrs old tx: 3,4 diaminopyridine, IV immunoglobulin -tiredness or weakness of proximal muscle groups -increasing strenght with repetition differentiates LES from MG |
