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Respiratory

Bryony Williams Medical Complexities (28/05/19) Inglés 46 fichas

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  1. 1Why does respiratory efficiency increase in pregnancy?To meet increased metabolic demands of woman, fetus + placenta
  2. 2How does oxygen consumption change?Increases by 20%
  3. 3How does the diaphragm change?Position rises by ~4cm due to enlarging uterus
  4. 4How does chest diameter change?Increased transverse diameter of chest (rib flare)
  5. 5How does the respiratory tract change?Capillary engorgement with increased friability of mucous membranes
  6. 6How does resting minute ventilation change?Increases by 40-50% (mainly from rise in tidal volume due to rib flare)
  7. 7How does functional residual capacity change?Decreases by ~500ml (feelings of breathlessness)
  8. 8How do blood gases change?pH normally 7.38-7.45
    Mild respiratory alkalosis due to enhanced ventilation + reduced CO2
  9. 9How does labour affect respiration?- Strong contractions increase metabolism + increase O2 demands
    - Pain + anxiety can = hyperventilation (change in acid-base balance potentially hazardous to fetus)
    - Contractions decrease blood supply in intervillous space
  10. 10How does respiration change in PN period?- Rapid reversal of changes
    - Reduction in progestrone + decreased intra-abdominal pressure
    - Blood gases return to normal within 24 hrs
    - Anatomical + ventilatory changes return to normal within 1-3 wks
  11. 11What factors should be assessed in respiratory function?- RR
    - Depth
    - Pattern
    - Presence of cough
    - Wheezing
    - Sputum
    - Accessory muscle use
  12. 12What is PEFR?Peak Expiratory Flow Rate
    - Max ability of exhalation during forced expiration
    - Unaffected in pregnancy - balance between bronchodilating + bronchoconstricting factors
  13. 13What is FEV1?Forced Expiratory Volume in 1 sec
    - Amount of air forcibly expired after maximal expiration in 1 sec
    - Accurate measure of lung volume
    - Normally unaffected by pregnancy
  14. 14What other methods can be used to assess respiration?- O2 saturations
    - Chest X-ray (?fluid)
  15. 15When should humidification of O2 be considered?- If >4L/min delivered
    - Helps prevent drying of mucous membranes
    - Helps prevent tenacious sputum
  16. 16What O2 delivery systems should be used for which concentrations?- Non-rebreathe mask: high conc. (e.g. 85% at 15L/min)
    - Simple face mask: up to 40%
    - Venturi mask: low conc. (24-60%)
    - Nasal cannulae: 24-40% at 1-6L/min
  17. 17What is asthma?- Intermittent disorder characterised by temporary bouts of inflammation of airways which leads to wheezing, coughing + breathlessness
    - Occurs in 12% of pregnancies
    - Commonest chronic medical complication of pregnancy
  18. 18What is the pathophysiology of asthma?- Exposure to triggers = exaggerated inflammatory response
    - Relase of mast cells, eiosinophils, macrophages, T-lymphocytes + neutrophils (WBCs) + histamine + leukotriene
    - Airways narrow due to smooth muscle contraction + bronchial oedema
    - = mucus production + resp. difficulties
  19. 19What are common triggers of asthma?- Upper resp. tract infections
    - Dust mites, pollen, animal dander
    - Exercise
    - Omission/reduction of meds
    - Cold air
    - Hyperventilation
    - Drugs (e.g. aspirin + NSAIDs)
    - Food + drinks
    - GERD
    - Environmental factors
    - Stress
  20. 20What are the symptoms of an asthma attack?- Cough
    - Raised RR
    - Breathlessness
    - Tachycardia
    - Wheezing
    - Use of accessory breathing
    - Chest tightness
    - Inability to complete sentence
    - (Worse at night + early morning)
  21. 21What is Step 1 of asthma treatment?- For infrequent, mild asthma
    - Inhaler w/short-acting beta2-agonist
    - Relieves asthma for 3-6 hrs (works in 5 mins)
    - Relaxes airway muscles + stops mucus
    - Reliever inhalers (Salbutamol, Atrovent)
  22. 22What is Step 2?- More frequent asthma - woken with symptoms 1x wk, attack in last 2 yrs
    - Corticosteroids BD + reliever
    - Reduce inflammation + prevent attacks
    - Becotide, Budesonide
  23. 23What is Step 3?- Symptoms not under control (add-on)
    - Take along-side reliever - same action but lasts up to 12 hrs
    - If still unresponsive increase doses
    - Serevent, Foradil
  24. 24What is Step 4?- Persistent poor control
    - Increase corticosteroids to max
    - Consider oral leukotriene receptor antagonists (blocks inflammation), oral theophyllines (relaxes airway muscles) or slow-release beta2-agonist tablets (good for night symptoms)
  25. 25What is Step 5?- Long-term oral steroid use
    - Serious side effects if taken >3 months or 3-4 courses per year
    - Can cause osteoporosis, hypertension, DM, cataracts, glaucoma, muscle weakness
    - Commonly use prednisolone
  26. 26How does pregnancy impact course of asthma?- 1/3 of women improve
    - 1/3 of women remain same
    - 1/3 of women worsen
  27. 27What impact does pregnancy have on asthma?- Severity peaks ~29-36 wks w/peak progesterone levels (affects responsiveness to drugs)
    - Rise in free cortisol at 1-10/40 + 37-40/40 dampens down symptoms
    - GERD can cause attacks later one
  28. 28How does asthma affect pregnancy?- Most women fine
    - Poor control can cause mat. + fetal hypoxia
    - If uncontrolled, risk of IUGR, preterm birth, LBW, C/S
  29. 29How do asthma attacks affect pregnancy?- Mild asthma unlikely to worse
    - Severe asthma more likely to worsen
    - Acute attacks unlikely in labour due to increased endogenous steroids (bronchodilation)
    - Frequent attacks due to non-compliance w/drug regimen (?fear, ?misinformation)
  30. 30How should acute severe asthma be managed?- May require short dose steroids
    - Status asthmaticus emergency
    - Rapid deterioration of mat. condition if no immediate intervention
  31. 31Symptoms of acute severe asthma?- PEFR <50% of normal
    - O2 sats <90% or less
    - Blood gases abnormal
    - Tachypnoea (>25/min)
    - Tachycardia (>110bpm)
    - Acute distress, unable to speak, cyanosis, collapse
  32. 32What is the first-line treatment of acute severe asthma?- Urgent transfer to hospital
    - O2 therapy (sats >95%)
    - Bronchodilators via nebuliser
    - Systemic corticosteroids
    - Resp. stimulants
    - ?Chest X-ray
    - DO NOT AVOID STEROIDS
  33. 33What are the principles of AN care with asthma?- Advice + monitoring of resp. funciton
    - Involve obstetrician + GP
    - Assess + document triggers
    - Educate inc. smoking cessation
    - Encourage compliance w/drugs
    - For in-pts, esnure access to meds + equipment
  34. 34What are the principles of intrapartum care with asthma?- Acute asthma rare
    - Closely monitor mum (resp. physician)
    - Fetal wellbeing - CEFM if severe
    - Maintain hydration + pain relief
    - Regional blockade if analgesia required
    - Continue normal meds (if taking >7.5mg steroids, will require IV steroids in labour)
  35. 35What impact do normal drugs in labour have on asthma?Prostaglandins (IOL, PPH):
    - Dinoprostone can = brochodilation
    - Hemabate can = bronchospasm
    Analgesia:
    - Entonox can dry airways = wheezing
    - Opiates can = resp. depression
    Uterotonics:
    - Ergot. can = bronchospasm (esp. if GA)
    - Syntometrine okay
  36. 36What are the principles of PN care with asthma?- Monitor for PPH
    - Encourage BF (esp. if family Hx)
    - Women return to normal asthma status by 3 months PN
    - Avoid use of NSAIDs (e.g. diclofenac)
  37. 37What is cystic fibrosis?- Most common autosomal recessive condition in Caucasians
    - Affects 1 in 2000
    - ~1-20 are carriers
    - Mean age of survival 31 yrs
  38. 38What is the pathophysiology of CF?- Faulty gene on chromosome 7
    - Gene contains info cells need to produce protein regulating transfer of Na across cell membranes in certain glandular cells
    - = transport altered + secretions (e.g. sweat, pancreatic juice) unusually salty + thick
  39. 39How does CF affect fertility?Fertility:
    - 98% males infertile
    - Menstrual irregularities (underweight, thick mucus blocks sperm passage)
    Pregnancy:
    - ?Pregnancy w/assisted conception
  40. 40How does CF affect respiratory system?Respiratory:
    - Thick secretions clog airway
    - Increased risk of infection
    - ?High dose Abx
    - Physiotherapy
    Pregnancy:
    - High demands can affect lungs
    - Risk of death from pulmonary hypertension
    - Increased risk of preterm birth
  41. 41How does CF affect cardiac system?Cardiac:
    - Pulmonary hypertension + ventricular hypertrophy
    Pregnancy:
    - Increased cardiac demands (risk of collapse)
    - Reduced O2 to fetus
  42. 42How does CF affect GI system?GI:
    - Malabsorption of fat + protein
    - Nutrient depletion - weight loss
    - Vitamin deficiencies (esp. K)
    Pregnancy:
    - Pregnancy-related GI issues
    - Anameia + disordered clotting
    - Malnutrition can = IUGR
  43. 43How does CF affect hormonal system?Hormones:
    - Impaired insulin production (pancreatic disease
    Pregnancy:
    - DM-related issues (risk of GDM)
    - Pregnancy can show impaired glucose tol
    - Tight blood sugar control required
  44. 44How does CF affect fetus?- Teratogenicity of medical treatments (risk:benefit)
    - IUGR
    - Prematurity
    - Impact of malnutrition
  45. 45How does CF affect skeletal system?Skeletal:
    -Osteoporosis due to nutritional deficit + steroids
    Pregnancy:
    - May affect mobility
  46. 46How does CF affect psychosocial wellbeing?- Maintain normal life w/demands of treatment
    - Life expectancy
    - Genetic fault carrier
    = Concerns in long-term parenting, ?genetic counselling

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(Respiratory) Medical Complexities (28/05/19) Fichas sobre Respiratory, creado por Bryony Williams el 17/05/2019.
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Bryony Williams
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