This document discusses the management of breathlessness, which is a common and distressing symptom. It begins by defining breathlessness and describing how patients experience it. Various scales for measuring breathlessness are then outlined. The document notes that breathlessness is a major cause of emergency department visits and ambulance calls but is under-reported in primary care. Non-pharmacological interventions like breathing techniques and pulmonary rehabilitation are discussed as ways to reduce breathlessness. Pulmonary rehabilitation in particular is highlighted as an effective program. The role of pharmacological interventions is also summarized.
DEFINITION
Pulmonary rehabilitation is a restorative and preventive process for patients with chronic respiratory disease. It is defined as a “multi-disciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy.”
Consequences of Respiratory Disease
Peripheral Muscle dysfunction
Respiratory muscle dysfunction
Nutritional abnormalities
Cardiac impairment
Skeletal disease
Sensory defects
Psychosocial dysfunction
ASSESSMENT
At the start of the pulmonary rehabilitation program, your medical history will be obtained and your fitness level will be assessed, usually by doing a walking test. From this assessment, an exercise program will be set for you at your fitness level.
Another assessment will be completed at the end of the program.
Chart Review
Patient examination
medical history
Family history
Social history
Signs & symptoms
Patient Interview (1)Use of tobacco, alcohol, and nonprescription drugs
• Usual activity level, including employment, recreation, and home
• Regularity of exercise, including availability of equipment at home)
2)The nutritional evaluation should include the following:
• Weight• Height• Calculation of BMI• Documentation of recent weight change
chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.
The document provides guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (COPD) from the European Respiratory Society and American Thoracic Society. It aims to improve COPD patient care, promote a disease-oriented approach, and be updated based on new evidence. The guidelines cover defining COPD, epidemiology, pathogenesis, diagnosis, management of stable COPD including pharmacological therapies, pulmonary rehabilitation, and smoking cessation.
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation and tissue destruction due to chronic inflammation from smoke exposure. Symptoms include cough, dyspnea, and sputum production that worsen over time. The diagnosis is confirmed by spirometry showing airflow limitation that is not fully reversible with treatment. Management includes smoking cessation, pulmonary rehabilitation, inhaled bronchodilators and corticosteroids to control symptoms and reduce exacerbations.
Define and understand the types of advanced lung disease (ALD)
Discuss the impact of ALD on patients, family, and the health system
Describe the symptom burden of ALD
Appreciate factors associated with a poorer prognosis in ALD
Identify guidelines for referral to Hospice
Review the medical management of ALD
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
COPD Treatment in Ghatkopar,Mumbai. Dr Kumar DoshiDr Kumar Doshi
Are you or a loved one affected by Chronic Obstructive Pulmonary Disease (COPD)? Discover comprehensive and advanced treatment options with Dr. Kumar Doshi, a preeminent COPD specialist based in Ghatkopar, Mumbai.
Dr. Kumar Doshi is dedicated to delivering the highest standard of care for COPD patients. Whether you are seeking a diagnosis, a second opinion, or exploring new treatment avenues, this presentation will guide you through the exceptional services available at his practice in Ghatkopar, Mumbai.
The document provides guidelines for the diagnosis and management of COPD in India. It summarizes the burden of COPD globally and in India. It discusses the risk factors, symptoms, signs, and role of spirometry in diagnosis. It recommends using the post-bronchodilator FEV1/FVC ratio below the LLN as the diagnostic criterion. The document also provides classification of COPD severity based on FEV1, symptoms, and exacerbation frequency. It discusses the role of various inhalers and oral medications in the management of stable COPD. It emphasizes the need for a multi-dimensional approach and management of comorbidities in COPD patients in India.
DEFINITION
Pulmonary rehabilitation is a restorative and preventive process for patients with chronic respiratory disease. It is defined as a “multi-disciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy.”
Consequences of Respiratory Disease
Peripheral Muscle dysfunction
Respiratory muscle dysfunction
Nutritional abnormalities
Cardiac impairment
Skeletal disease
Sensory defects
Psychosocial dysfunction
ASSESSMENT
At the start of the pulmonary rehabilitation program, your medical history will be obtained and your fitness level will be assessed, usually by doing a walking test. From this assessment, an exercise program will be set for you at your fitness level.
Another assessment will be completed at the end of the program.
Chart Review
Patient examination
medical history
Family history
Social history
Signs & symptoms
Patient Interview (1)Use of tobacco, alcohol, and nonprescription drugs
• Usual activity level, including employment, recreation, and home
• Regularity of exercise, including availability of equipment at home)
2)The nutritional evaluation should include the following:
• Weight• Height• Calculation of BMI• Documentation of recent weight change
chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.
The document provides guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (COPD) from the European Respiratory Society and American Thoracic Society. It aims to improve COPD patient care, promote a disease-oriented approach, and be updated based on new evidence. The guidelines cover defining COPD, epidemiology, pathogenesis, diagnosis, management of stable COPD including pharmacological therapies, pulmonary rehabilitation, and smoking cessation.
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation and tissue destruction due to chronic inflammation from smoke exposure. Symptoms include cough, dyspnea, and sputum production that worsen over time. The diagnosis is confirmed by spirometry showing airflow limitation that is not fully reversible with treatment. Management includes smoking cessation, pulmonary rehabilitation, inhaled bronchodilators and corticosteroids to control symptoms and reduce exacerbations.
Define and understand the types of advanced lung disease (ALD)
Discuss the impact of ALD on patients, family, and the health system
Describe the symptom burden of ALD
Appreciate factors associated with a poorer prognosis in ALD
Identify guidelines for referral to Hospice
Review the medical management of ALD
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
COPD Treatment in Ghatkopar,Mumbai. Dr Kumar DoshiDr Kumar Doshi
Are you or a loved one affected by Chronic Obstructive Pulmonary Disease (COPD)? Discover comprehensive and advanced treatment options with Dr. Kumar Doshi, a preeminent COPD specialist based in Ghatkopar, Mumbai.
Dr. Kumar Doshi is dedicated to delivering the highest standard of care for COPD patients. Whether you are seeking a diagnosis, a second opinion, or exploring new treatment avenues, this presentation will guide you through the exceptional services available at his practice in Ghatkopar, Mumbai.
The document provides guidelines for the diagnosis and management of COPD in India. It summarizes the burden of COPD globally and in India. It discusses the risk factors, symptoms, signs, and role of spirometry in diagnosis. It recommends using the post-bronchodilator FEV1/FVC ratio below the LLN as the diagnostic criterion. The document also provides classification of COPD severity based on FEV1, symptoms, and exacerbation frequency. It discusses the role of various inhalers and oral medications in the management of stable COPD. It emphasizes the need for a multi-dimensional approach and management of comorbidities in COPD patients in India.
1. Restrictive lung diseases are pulmonary disorders defined by restrictive patterns on spirometry that limit lung expansion and reduce lung volumes. They can be caused by intrinsic lung parenchyma diseases or extrapulmonary factors that restrict chest wall or lung movement.
2. Common symptoms include shortness of breath, cough, and fatigue. Pulmonary function tests show reduced total lung capacity and forced vital capacity with preserved ratio of forced expiratory volume to forced vital capacity. Chest imaging and exercise testing are also used in evaluation.
3. Treatment is individualized and may include medications, oxygen therapy, pulmonary rehabilitation, and sometimes transplantation. The goals are to improve quality of life and respiratory function through exercise, education, and management of
Pulmonary rehabilitation is a comprehensive intervention for patients with chronic respiratory diseases like COPD. It involves exercise training, education, behavior changes, and promotes long-term healthy habits. Programs last 4-12 weeks with supervised sessions twice weekly. Benefits include increased quality of life, exercise tolerance, and decreased symptoms and healthcare utilization. Outcomes are assessed through measures of functional capacity, symptoms, and quality of life. Maintenance rehabilitation is important to sustain benefits long-term.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It includes chronic bronchitis and emphysema. The main risk factor is exposure to tobacco smoke, which accounts for 80-90% of COPD cases. Patients experience symptoms of cough, sputum production, and dyspnea on exertion. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy to relieve symptoms and reduce exacerbations. Nursing care includes education on disease management, breathing exercises, medication administration, and promoting lifestyle changes to improve quality of life.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It includes chronic bronchitis and emphysema. The main risk factor is exposure to tobacco smoke, which accounts for 80-90% of COPD cases. Patients experience symptoms of cough, sputum production, and dyspnea on exertion. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy to relieve symptoms and reduce exacerbations. Nursing care includes education on disease management, breathing exercises, medication administration, and promoting lifestyle changes to improve quality of life.
This document provides information on the care of patients with chronic obstructive pulmonary disease (COPD). It defines COPD and lists its components. It describes the causes and risk factors, clinical manifestations, pathophysiology, diagnostic evaluation, medical management including pharmacotherapy, surgical options, pulmonary rehabilitation, and nursing management of COPD patients. The medical management focuses on assessing and monitoring the disease, reducing risk factors, managing stable COPD, and managing exacerbations according to WHO guidelines.
This document discusses chronic obstructive pulmonary disease (COPD). It defines COPD as a progressive airway disease associated with abnormal lung inflammation in response to noxious particles. Key features include small airway disease, airway remodeling, and parenchymal destruction leading to airflow limitation. The document reviews the epidemiology and burden of COPD in India, mechanisms of inflammation and different COPD phenotypes. It emphasizes the importance of spirometry in diagnosis and differentiating COPD from asthma. Management strategies discussed include smoking cessation, bronchodilators, pulmonary rehabilitation and long-term oxygen therapy. The document also provides Indian guidelines for COPD diagnosis and management at primary, secondary and tertiary levels of care.
Pulmonary rehabilitation is a comprehensive intervention for patients with chronic respiratory diseases. It includes exercise training, education, breathing exercises, and nutritional counseling. The goals are to improve physical and psychological health and promote long-term management of the respiratory condition. Pulmonary rehabilitation programs typically last 6-12 weeks with two or three supervised sessions per week. A multidisciplinary team provides personalized treatment that matches the severity of lung involvement. Exercise is individually prescribed according to testing and progressively increased. Pulmonary rehabilitation provides benefits like reduced symptoms, improved quality of life and exercise capacity.
This document provides guidelines for the diagnosis and management of COPD in India. It discusses definitions of COPD, risk factors such as smoking and biomass fuel exposure, symptoms, signs, and the role of spirometry in diagnosis. It recommends classifying COPD severity based on FEV1 and exacerbation frequency. For management of stable COPD, it suggests using short-acting bronchodilators for mild COPD and long-acting bronchodilators +/- inhaled corticosteroids for moderate-severe COPD. It emphasizes treating comorbidities and the roles of inhalers, oral medications, and non-pharmacologic measures.
Pulmonary rehabilitation in interstitial lung diseaseShradha Khati
Pulmonary rehabilitation programs aim to improve quality of life for patients with interstitial lung disease through education, exercise conditioning, breathing techniques, and psychological support. The goals are to decrease symptoms, encourage self-management, improve physical fitness and emotional well-being, and reduce hospitalizations. Components include exercise to strengthen muscles, breathing exercises, diet counseling, oxygen therapy if needed, and psychological counseling to help with conditions like depression. Studies show pulmonary rehabilitation can effectively improve exercise tolerance and quality of life while reducing hospital admissions for patients with interstitial lung disease.
The document discusses chronic obstructive pulmonary disease (COPD). It defines COPD as a progressive lung disease characterized by airflow obstruction caused by chronic bronchitis or emphysema. The document provides statistics on the prevalence and mortality of COPD worldwide and in India. It identifies the major risk factors, clinical manifestations, diagnostic evaluations, management including medications, oxygen therapy, surgery, and rehabilitation. It also discusses nursing care for patients with COPD.
This document provides an overview of respiratory emergencies for EMS providers. It reviews anatomy and physiology of the respiratory system, tools for assessment including pulse oximetry and capnography, and treatments for specific conditions like COPD, asthma, pneumonia, and pulmonary embolism. Assessment focuses on detection of life-threatening symptoms, while treatment aims to address hypoxia and respiratory distress through oxygen therapy, medications, ventilation support, and monitoring of vital signs.
1. Chronic Obstructive Pulmonary Disease (COPD) refers to a group of lung diseases including chronic bronchitis and emphysema that are characterized by persistent airflow obstruction and breathing-related problems.
2. The primary symptoms of COPD include cough, sputum production, and shortness of breath with exertion.
3. The main risk factor for COPD is tobacco smoke, accounting for 80-90% of COPD cases. Management of COPD focuses on relieving symptoms, preventing progression, reducing complications, and improving quality of life through smoking cessation, medications, pulmonary rehabilitation, oxygen therapy and surgery.
Mr. Rewat singh, a 63-year-old male stone mine laborer, presented with worsening shortness of breath over the past 7 days and a chronic cough for 3 years. He smokes 4 bundles of bidi per day and has a history of hypertension. On examination, his respiratory rate was increased and breath sounds were diminished. He was diagnosed with pneumonia based on his symptoms and physical exam findings.
Pharmacology Lecture Slides on COPD - Chronic obstructive pulmonary disease by Sanjaya Mani Dixit Assistant Professor of Pharmacology at Kathmandu Medical College
This document discusses Chronic Obstructive Pulmonary Disease (COPD). It outlines key factors to assess in a COPD patient's history including risk factors, symptoms, and comorbidities. Diagnostic tests for COPD include spirometry, chest X-rays, and blood gases. The goals of COPD management are to relieve symptoms, prevent progression, reduce mortality, and prevent/treat complications. Treatment involves smoking cessation, bronchodilators, pulmonary rehabilitation, oxygen therapy, and management of exacerbations. Nursing care focuses on assessing the patient's condition, educating on medications, breathing exercises, and self-care activities.
Pulmonary rehabilitation is a comprehensive, multidisciplinary intervention for patients with chronic respiratory diseases. It aims to reduce symptoms, optimize functional status, increase participation and quality of life. For patients with neuromuscular disorders, pulmonary rehabilitation includes education, exercise training, breathing retraining, chest physical therapy, nutritional interventions, psychological support and outcome assessments. It can improve symptoms, exercise tolerance and quality of life. Mechanical ventilation may be needed for some patients and decisions around long-term support require consideration of individual circumstances and goals of care.
Chronic obstructive pulmonary disease (COPD) refers to progressive lung diseases such as emphysema and chronic bronchitis. It is characterized by increasing breathlessness over many years that is caused by an abnormal inflammatory response of the lungs to noxious particles, primarily from cigarette smoking. While COPD affects the lungs, it also produces systemic effects. The main symptoms include worsening shortness of breath, chronic cough, and excess mucus production. Diagnosis involves assessing symptoms, medical history, and lung function tests. Treatment focuses on smoking cessation and medications to relieve symptoms.
DEPRESSION AND ANXIETY IN COPD : DIAGNOSIS AND MANAGEMENT ISSUES _ 15SoM
- Depression and anxiety are common in patients with COPD, affecting their quality of life and ability to manage their condition.
- Simple screening tools can help doctors detect depression and distinguish mild symptoms from major depressive disorder or panic disorder, which require specific treatment.
- While antidepressants may help treat depression and panic disorder in COPD patients, studies are limited and inconclusive on the best treatment approach. Current best practices include screening, treating if needed, and referring patients who do not respond to specialists.
The ECG is useful for diagnosing and managing patients with chest pain. It can help predict infarct size, prognosis, and localize the site of infarction based on specific ECG patterns. ST elevation myocardial infarction (STEMI) involves ST segment elevation, while non-ST elevation acute coronary syndrome (NSTEACS) includes non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA), which are usually differentiated retrospectively based on cardiac enzyme levels. Common ECG patterns of NSTEACS include ST depression and T wave changes. The morphology, distribution, and magnitude of ST depression provide information about ischemia. Wellens' syndrome and other ECG patterns also provide important clues.
This document discusses the evaluation and management of hyperthyroidism. It covers thyroid function tests, imaging, medications like carbimazole and propylthiouracil, radioactive iodine treatment, surgery, and special considerations for Graves' disease and pregnancy. Key points include using anti-TSH receptor antibodies to diagnose Graves' disease, treating it initially with anti-thyroid drugs, and considering radioactive iodine or surgery for relapses while avoiding risks to the eyes. Careful management of hyperthyroidism in pregnancy is also emphasized.
1. Restrictive lung diseases are pulmonary disorders defined by restrictive patterns on spirometry that limit lung expansion and reduce lung volumes. They can be caused by intrinsic lung parenchyma diseases or extrapulmonary factors that restrict chest wall or lung movement.
2. Common symptoms include shortness of breath, cough, and fatigue. Pulmonary function tests show reduced total lung capacity and forced vital capacity with preserved ratio of forced expiratory volume to forced vital capacity. Chest imaging and exercise testing are also used in evaluation.
3. Treatment is individualized and may include medications, oxygen therapy, pulmonary rehabilitation, and sometimes transplantation. The goals are to improve quality of life and respiratory function through exercise, education, and management of
Pulmonary rehabilitation is a comprehensive intervention for patients with chronic respiratory diseases like COPD. It involves exercise training, education, behavior changes, and promotes long-term healthy habits. Programs last 4-12 weeks with supervised sessions twice weekly. Benefits include increased quality of life, exercise tolerance, and decreased symptoms and healthcare utilization. Outcomes are assessed through measures of functional capacity, symptoms, and quality of life. Maintenance rehabilitation is important to sustain benefits long-term.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It includes chronic bronchitis and emphysema. The main risk factor is exposure to tobacco smoke, which accounts for 80-90% of COPD cases. Patients experience symptoms of cough, sputum production, and dyspnea on exertion. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy to relieve symptoms and reduce exacerbations. Nursing care includes education on disease management, breathing exercises, medication administration, and promoting lifestyle changes to improve quality of life.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It includes chronic bronchitis and emphysema. The main risk factor is exposure to tobacco smoke, which accounts for 80-90% of COPD cases. Patients experience symptoms of cough, sputum production, and dyspnea on exertion. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy to relieve symptoms and reduce exacerbations. Nursing care includes education on disease management, breathing exercises, medication administration, and promoting lifestyle changes to improve quality of life.
This document provides information on the care of patients with chronic obstructive pulmonary disease (COPD). It defines COPD and lists its components. It describes the causes and risk factors, clinical manifestations, pathophysiology, diagnostic evaluation, medical management including pharmacotherapy, surgical options, pulmonary rehabilitation, and nursing management of COPD patients. The medical management focuses on assessing and monitoring the disease, reducing risk factors, managing stable COPD, and managing exacerbations according to WHO guidelines.
This document discusses chronic obstructive pulmonary disease (COPD). It defines COPD as a progressive airway disease associated with abnormal lung inflammation in response to noxious particles. Key features include small airway disease, airway remodeling, and parenchymal destruction leading to airflow limitation. The document reviews the epidemiology and burden of COPD in India, mechanisms of inflammation and different COPD phenotypes. It emphasizes the importance of spirometry in diagnosis and differentiating COPD from asthma. Management strategies discussed include smoking cessation, bronchodilators, pulmonary rehabilitation and long-term oxygen therapy. The document also provides Indian guidelines for COPD diagnosis and management at primary, secondary and tertiary levels of care.
Pulmonary rehabilitation is a comprehensive intervention for patients with chronic respiratory diseases. It includes exercise training, education, breathing exercises, and nutritional counseling. The goals are to improve physical and psychological health and promote long-term management of the respiratory condition. Pulmonary rehabilitation programs typically last 6-12 weeks with two or three supervised sessions per week. A multidisciplinary team provides personalized treatment that matches the severity of lung involvement. Exercise is individually prescribed according to testing and progressively increased. Pulmonary rehabilitation provides benefits like reduced symptoms, improved quality of life and exercise capacity.
This document provides guidelines for the diagnosis and management of COPD in India. It discusses definitions of COPD, risk factors such as smoking and biomass fuel exposure, symptoms, signs, and the role of spirometry in diagnosis. It recommends classifying COPD severity based on FEV1 and exacerbation frequency. For management of stable COPD, it suggests using short-acting bronchodilators for mild COPD and long-acting bronchodilators +/- inhaled corticosteroids for moderate-severe COPD. It emphasizes treating comorbidities and the roles of inhalers, oral medications, and non-pharmacologic measures.
Pulmonary rehabilitation in interstitial lung diseaseShradha Khati
Pulmonary rehabilitation programs aim to improve quality of life for patients with interstitial lung disease through education, exercise conditioning, breathing techniques, and psychological support. The goals are to decrease symptoms, encourage self-management, improve physical fitness and emotional well-being, and reduce hospitalizations. Components include exercise to strengthen muscles, breathing exercises, diet counseling, oxygen therapy if needed, and psychological counseling to help with conditions like depression. Studies show pulmonary rehabilitation can effectively improve exercise tolerance and quality of life while reducing hospital admissions for patients with interstitial lung disease.
The document discusses chronic obstructive pulmonary disease (COPD). It defines COPD as a progressive lung disease characterized by airflow obstruction caused by chronic bronchitis or emphysema. The document provides statistics on the prevalence and mortality of COPD worldwide and in India. It identifies the major risk factors, clinical manifestations, diagnostic evaluations, management including medications, oxygen therapy, surgery, and rehabilitation. It also discusses nursing care for patients with COPD.
This document provides an overview of respiratory emergencies for EMS providers. It reviews anatomy and physiology of the respiratory system, tools for assessment including pulse oximetry and capnography, and treatments for specific conditions like COPD, asthma, pneumonia, and pulmonary embolism. Assessment focuses on detection of life-threatening symptoms, while treatment aims to address hypoxia and respiratory distress through oxygen therapy, medications, ventilation support, and monitoring of vital signs.
1. Chronic Obstructive Pulmonary Disease (COPD) refers to a group of lung diseases including chronic bronchitis and emphysema that are characterized by persistent airflow obstruction and breathing-related problems.
2. The primary symptoms of COPD include cough, sputum production, and shortness of breath with exertion.
3. The main risk factor for COPD is tobacco smoke, accounting for 80-90% of COPD cases. Management of COPD focuses on relieving symptoms, preventing progression, reducing complications, and improving quality of life through smoking cessation, medications, pulmonary rehabilitation, oxygen therapy and surgery.
Mr. Rewat singh, a 63-year-old male stone mine laborer, presented with worsening shortness of breath over the past 7 days and a chronic cough for 3 years. He smokes 4 bundles of bidi per day and has a history of hypertension. On examination, his respiratory rate was increased and breath sounds were diminished. He was diagnosed with pneumonia based on his symptoms and physical exam findings.
Pharmacology Lecture Slides on COPD - Chronic obstructive pulmonary disease by Sanjaya Mani Dixit Assistant Professor of Pharmacology at Kathmandu Medical College
This document discusses Chronic Obstructive Pulmonary Disease (COPD). It outlines key factors to assess in a COPD patient's history including risk factors, symptoms, and comorbidities. Diagnostic tests for COPD include spirometry, chest X-rays, and blood gases. The goals of COPD management are to relieve symptoms, prevent progression, reduce mortality, and prevent/treat complications. Treatment involves smoking cessation, bronchodilators, pulmonary rehabilitation, oxygen therapy, and management of exacerbations. Nursing care focuses on assessing the patient's condition, educating on medications, breathing exercises, and self-care activities.
Pulmonary rehabilitation is a comprehensive, multidisciplinary intervention for patients with chronic respiratory diseases. It aims to reduce symptoms, optimize functional status, increase participation and quality of life. For patients with neuromuscular disorders, pulmonary rehabilitation includes education, exercise training, breathing retraining, chest physical therapy, nutritional interventions, psychological support and outcome assessments. It can improve symptoms, exercise tolerance and quality of life. Mechanical ventilation may be needed for some patients and decisions around long-term support require consideration of individual circumstances and goals of care.
Chronic obstructive pulmonary disease (COPD) refers to progressive lung diseases such as emphysema and chronic bronchitis. It is characterized by increasing breathlessness over many years that is caused by an abnormal inflammatory response of the lungs to noxious particles, primarily from cigarette smoking. While COPD affects the lungs, it also produces systemic effects. The main symptoms include worsening shortness of breath, chronic cough, and excess mucus production. Diagnosis involves assessing symptoms, medical history, and lung function tests. Treatment focuses on smoking cessation and medications to relieve symptoms.
DEPRESSION AND ANXIETY IN COPD : DIAGNOSIS AND MANAGEMENT ISSUES _ 15SoM
- Depression and anxiety are common in patients with COPD, affecting their quality of life and ability to manage their condition.
- Simple screening tools can help doctors detect depression and distinguish mild symptoms from major depressive disorder or panic disorder, which require specific treatment.
- While antidepressants may help treat depression and panic disorder in COPD patients, studies are limited and inconclusive on the best treatment approach. Current best practices include screening, treating if needed, and referring patients who do not respond to specialists.
The ECG is useful for diagnosing and managing patients with chest pain. It can help predict infarct size, prognosis, and localize the site of infarction based on specific ECG patterns. ST elevation myocardial infarction (STEMI) involves ST segment elevation, while non-ST elevation acute coronary syndrome (NSTEACS) includes non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA), which are usually differentiated retrospectively based on cardiac enzyme levels. Common ECG patterns of NSTEACS include ST depression and T wave changes. The morphology, distribution, and magnitude of ST depression provide information about ischemia. Wellens' syndrome and other ECG patterns also provide important clues.
This document discusses the evaluation and management of hyperthyroidism. It covers thyroid function tests, imaging, medications like carbimazole and propylthiouracil, radioactive iodine treatment, surgery, and special considerations for Graves' disease and pregnancy. Key points include using anti-TSH receptor antibodies to diagnose Graves' disease, treating it initially with anti-thyroid drugs, and considering radioactive iodine or surgery for relapses while avoiding risks to the eyes. Careful management of hyperthyroidism in pregnancy is also emphasized.
This document summarizes acute complications of diabetes, including diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and hypoglycemia. It notes that DKA and HHS are caused by absolute or relative insulin deficiency with excess counterregulatory hormones, and presents symptoms like polyuria, nausea, and altered mental status. The document contrasts DKA and HHS, noting DKA primarily affects type 1 diabetics and is characterized by ketosis, while HHS usually affects elderly type 2 diabetics and presents without ketosis. Management of both involves fluid replacement and treatment of the underlying causes.
A 3-year-old male child presented with 8 days of fever and 4 days of respiratory distress. On examination, the child had pallor, pedal edema, tachycardia, dyspnea, and bilateral inspiratory creps. On the 3rd day of hospitalization, an eschar was noticed on the child's left knee. Serology testing was positive for scrub typhus. The child was treated with doxycycline and supportive care and showed improvement.
This document outlines the key components and steps in analyzing arterial blood gases (ABGs). It discusses:
1) The main components measured in an ABG - pH, pCO2, pO2, HCO3.
2) A 7-step process for ABG analysis including determining if there is acidemia/alkalemia, the primary acid-base disorder, appropriate compensation, and calculating anion/delta gaps.
3) Causes and expected changes in metabolic and respiratory acidosis/alkalosis.
4) Examples of ABG cases and working through the full analysis, including identifying acute respiratory acidosis in one case and acute respiratory alkalosis in another.
The document discusses the change from traditional CPR to Cardiocerebral Resuscitation (CCR). CCR emphasizes continuous chest compressions without interruptions and deemphasizes ventilation. Studies have found CCR increases survival rates compared to CPR by up to 3 times by minimizing interruptions in blood flow through continuous, high-quality chest compressions without stopping for ventilation. CCR focuses on circulating oxygenated blood to the heart and brain as the priority for cardiac arrest patients rather than additional oxygenation through ventilation.
Approach To Meningitis and Encephalitis.pptxDeepaNesam1
This document discusses the approach to meningitis and encephalitis. It provides information on the common bacteria that cause bacterial meningitis at different ages. The clinical signs, symptoms and investigations for both conditions are outlined. Empirical antimicrobial therapy for bacterial meningitis is recommended as soon as possible based on patient age and likely pathogens. For encephalitis, the approach involves establishing an etiologic diagnosis through history, examinations, body fluid analysis, biopsy and serologic testing to help determine prognosis, potential prophylaxis and public health interventions. Targeted antiviral and other treatments are discussed based on the identified infectious cause.
Solution manual for managerial accounting 18th edition by ray garrison eric n...rightmanforbloodline
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa AjmanMalayali Kerala Spa Ajman
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Test bank clinical nursing skills a concept based approach 4e pearson educati...rightmanforbloodline
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
Basics of Electrocardiogram
CONTENTS
●Conduction System of the Heart
●What is ECG or EKG?
●ECG Leads
●Normal waves of ECG.
●Dimensions of ECG.
● Abnormalities of ECG
CONDUCTION SYSTEM OF THE HEART
ECG:
●ECG is a graphic record of the electrical activity of the heart.
●Electrical activity precedes the mechanical activity of the heart.
●Electrical activity has two phases:
Depolarization- contraction of muscle
Repolarization- relaxation of muscle
ECG Leads:
●6 Chest leads
●6 Limb leads
1. Bipolar Limb Leads:
Lead 1- Between right arm(-ve) and left arm(+ve)
Lead 2- Between right arm(-ve) and left leg(+ve)
Lead 3- Between left arm(-ve)
and left leg(+ve)
2. Augmented unipolar Limb Leads:
AvR- Right arm
AvL- Left arm
AvF- Left leg
3.Chest Leads:
V1 : Over 4th intercostal
space near right sternal margin
V2: Over 4th intercostal space near left sternal margin
V3:In between V2 and V4
V4:Over left 5th intercostal space on the mid
clavicular line
V5:Over left 5th intercostal space on the anterior
axillary line
V6:Over left 5th intercostal space on the mid
axillary line.
Normal ECG:
Waves of ECG:
P Wave
•P Wave is a positive wave and the first wave in ECG.
•It is also called as atrial complex.
Cause: Atrial depolarisation
Duration: 0.1 sec
QRS Complex:
•QRS’ complex is also called the initial ventricular complex.
•‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave.
‘R’ wave is followed by a small negative wave, the ‘S’ wave.
Cause:Ventricular depolarization and atrial repolarization
Duration: 0.08- 0.10 sec
T Wave:
•‘T’ wave is the final ventricular complex and is a positive wave.
Cause:Ventricular repolarization Duration: 0.2 sec
Intervals and Segments of ECG:
P-R Interval:
•‘P-R’ interval is the interval
between the onset of ‘P’wave and onset of ‘Q’ wave.
•‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node.
Duration:0.18 (0.12 to 0.2) sec
Q-T Interval:
•‘Q-T’ interval is the interval between the onset of ‘Q’
wave and the end of ‘T’ wave.
•‘Q-T’ interval indicates the ventricular depolarization
and ventricular repolarization,
i.e. it signifies the
electrical activity in ventricles.
Duration:0.4-0.42sec
S-T Segment:
•‘S-T’ segment is the time interval between the end of ‘S’ wave and the onset of ‘T’ wave.
Duration: 0.08 sec
R-R Interval:
•‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
•It signifies the duration of one cardiac cycle.
Duration: 0.8 sec
Dimension of ECG:
How to find heart rhytm of the heart?
Regular rhytm:
Irregular rhytm:
More than or less than 4
How to find heart rate using ECG?
If heart Rhytm is Regular :
Heart rate =
300/No.of large b/w 2 QRS complex
= 300/4
=75 beats/mins
How to find heart rate using ECG?
If heart Rhytm is irregular:
Heart rate = 10×No.of QRS complex in 6 sec 5large box = 1sec
5×6=30
10×7 = 70 Beats/min
Abnormalities of ECG:
Cardiac Arrythmias:
1.Tachycardia
Heart Rate more than 100 beats/min
Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
nursing management of patient with Empyema pptblessyjannu21
prepared by Prof. BLESSY THOMAS, SPN
Empyema is a disease of respiratory system It is defines as the accumulation of thick, purulent fluid within the pleural space, often with fibrin development.
Empyema is also called pyothorax or purulent pleuritis.
It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space.
Pus is a fluid that’s filled with immune cells, dead cells, and bacteria.
Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
Empyema usually develops after pneumonia, which is an infection of the lung tissue. it is mainly caused due in infectious micro-organisms. It can be treated with medications and other measures.
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2. Outline
• What is breathlessness?
• How do we measure it?
• Why is it important to treat
• What is the cause of breathlessness in
COPD
• Non pharmacological interventions
• Pharmacological interventions
3. Definition
• A subjective experience of breathing
discomfort that consists of qualitatively
distinct sensations that vary in intensity.
• The experience derives from interaction
among multiple physiologic,
psychological, social, and environmental
factors and may induce secondary
physiological and behavioral
responses”.
American Thoracic
society
4. Patients descriptions
“Its the worst feeling in the
world, the worst way to die, its
like smothering to death……to
lose control of your breathing”
“a frightening feeling
where you don’t think
you’ll get
another breath and
because it is
accompanied by fear and
panic, you can actually feel
tightening feeling of fear in
your chest and mind”
“We feel very
isolated
especially at night”
5. Breathlessness is a common and
distressing symptom that could be
better managed for the same
resource:
5
Over 54,000 emergency calls to the
London Ambulance Service a year are
due to acute breathlessness
‘Existing community services
could be better used with some
restructuring of appointments is
needed to enable an initial
assessment of 20-30 minutes
and there is also a case to be
made to restructure outpatient
services for people with severe
disease’
PCRS
6. Breathlessness – burden
•Breathlessness affects up to 10% of adult
population
•30% of older people
•Major cause of attendance at emergency
department BUT
•Only 1% of recorded GP consultations
•2/3 is cardio-pulmonary
•Assume all patients anxious to some extent –
how much and why?
11. NYHA Heart Failure Breathlessness scale
Table 2 - NYHAClassification - Thesymptoms of Heart Failure35
Class Patient Symptoms
ClassI (Mild) Nolimitation of physical activity. Ordinary physical activity does not
causeunduefatigue, palpitation, or dyspnea (shortness of breath).
ClassII (Mild) Slight limitation of physical activity. Comfortable at rest, but ordinary
physical activity results in fatigue, palpitation, or dyspnea.
ClassIII (Moderate) Marked limitation of physical activity. Comfortable at rest, but less than
ordinary activity causesfatigue, palpitation, or dyspnea.
ClassIV (Severe) Unable to carry out any physical activity without discomfort. Symptoms
of cardiac insufficiency at rest. If anyphysical activity is undertaken,
discomfortis increased.
12.
13. MRC and mMRC Breathlessness Scale
Table 1 - Medical Research Council dyspnoea scale34
Grade Degree of breathlessness related to activities
1 Not troubled by breathlessness except on strenuous exercise
2 Short of breath when hurrying or walking up a slight hill
3 Walks slower than contemporaries on level ground because of breathlessness, or has to
stop for breath when walking at own pace
4 Stops for breath after walking about 100m or after a few minutes on level ground
5 Too breathless to leave the house, or breathless when dressing or undressing
MMRC Dyspnea
Scale
Grade Description of Breathlessness
0 I only get breathless with strenuous exercise.
1 I get short of breath when hurrying on level ground or walking up a slight hill.
2 On level ground, I walk slower than people of the same age because of
breathlessness,
or
have to stop for breath when walking at my own
pace.
3
4
I stop for breath after walking about 100 yards or after a few minutes on level
ground. I am too breathless to leave the house or I am breathless when
dressing.
16. Diagnosis requires skilled
assessment by a doctor
combining high quality
history- taking and
examination with a limited
number of evidence-
based objective tests
21. Providing better care for
people who are breathless
would improve care for
people with COPD, asthma,
heart failure, anxiety and
obesity and break down
silos and improve
coordination
22. What are the health needs in
breathless patients?
• Knowledge of diagnosis & prognosis
• Information regarding illness,
disease management
– HCP speaking with same voice
• Psychology input
• Supervised exercise
– Often purchase equipment and too scared to
use
• Someone to listen to their concerns
• Awareness of local services
Habraken 2007, Booth 2003
23. Cardiolog
y
cause
Patient presents
with shortness
of breath
Joint diagnostic clinic – ECG, spirometry (or review of
tests performed in primary care), ECHO, BNP
Respiratory
cause
Cardiology
service
management
MDT for patients with
co-morbidities or
complexity
Respiratory service
management
Joint rehabilitation services covering a range of
abilities lifestyle change/psychological
therapies
24. Breathlessness – treatment challenges
•Strong evidence base for treatments for single conditions, but much
weaker for multiple
•But need more flu vaccination, stop smoking as treatment, support
to increase physical activity, referral to programmes of
rehabilitation, weight management, as well as NICE-
pharmacotherapy
•Needs to be locally sensitive: demography, relationships, knowledge,
services
27. Hyperinflation is a key component of
COPD
References:
1. GOLD 2015
2. Nici et al. Am J Respir Crit Care Med 2006
3. O’Donnell and Laveneziana. Eur Respir
Rev 2006
• Expiratory airflow limitation and airway
obstruction trap air progressively during
expiration, leading to hyperinflation1
• Hyperinflation is thought to develop early in
the disease, and is the main mechanism for
exertional dyspnea1
• Hyperinflation reduces inspiratory capacity,
such that functional residual capacity
increases, particularly during exercise
(dynamic hyperinflation)1
– Results in worsening of dyspnea and
limitation of exercise capacity1
• Hyperinflation manifests as:
– an increase in total lung capacity3
– an increase in residual volume (i.e.
‘gas trapping’)3
COPD
Norma
l
Reduced
IC
31. In COPD Shortness of breath is the most
bothersome symptom
• Shortness of breath is gradual in onset, so patients often relate it to the
ageing process or lack of fitness
– As lung function deteriorates, shortness of breath becomes more intrusive1,2
• Patients report that shortness of breath is the most bothersome symptom and
is the reason most seek medical attention1,2
• Patients restrict activities to avoid shortness of breath1,2
– Patients with COPD spend only a third of the day walking or standing3
– Healthy age-matched healthy individuals spend over half of their time in these
activities3
• This leads to gradual deterioration of HRQoL,4 increased dependency and
social
isolation1
HRQoL, health-related quality of
life
Reference:
1. Barnett M. J Clin Nurs. 2005;14:805–12; 2. GOLD. COPD guidelines 2014.
Available at http://www.goldcopd.org [Accessed Dec. 2015]; 3. Cooper CB. Respir
Med. 2009;103:325–34;
4. O'Donnell DE. Eur Respir Rev. 2006;15:37–41
31
32. Low BMI
Decreased exercise
capacity Mmrc score
High CRP
Ct showing
emphysema FEV1
Exacerbations
Comorbid disease
including anxiety and
depression Chronic
hypercapnia
IN COPD Prognosis is
linked to degree of
breathlessness
34. Breathing Techniques
• STOP, DROP and FLOP:
– STOP what you are doing
– Sit down or lean forward with hand on
knees and DROP shoulders
– Then FLOP by relaxing muscles around
shoulders and chest
– Focus on breathing OUT – not in
35. ‘Breathe Better, Feel Good, Do
More’ ’
Pulmonary Rehabilitation
High Value Care in COPD
36. Pulmonary
Rehabilitation
• 6-8 week exercise based
class with complimentary
education classes
• Run with the intention to
cover all aspects of self
management
• Always an MDT approach
• Aims for
lifestyle/behavioural
changes
• Goal orientated
• Common criteria – Chronic
lung diagnosis and able to
walk >10m, MRC 2-4
38. Appropriate pharmacologic therapy can reduce COPD
symptoms, reduce the frequency and severity of
exacerbations, and improve health status and
exercise tolerance.
None of the existing medications for COPD has been
shown conclusively to modify the long-term decline
in lung function.
Responsible Prescribing: Key Points
40. Long-acting inhaled bronchodilators are
convenient and more effective for symptom relief
than short- acting bronchodilators.
Long-acting inhaled bronchodilators reduce
exacerbations and related hospitalizations and
improve symptoms and health status.
Combining bronchodilators of different
pharmacological classes may improve efficacy
Responsible Prescribing:
Bronchodil
ators
41.
42.
43.
44.
45. Arm selection and patient position
• BP should initially be measured in both arms, after
which the arm with the higher reading(s) should be
used for subsequent measurements .
• Although a difference in BP measurements between
the arms can be expected in 20% of patients, if this
difference is >20mmHg for systolic or >10mmHg for
diastolic measurement, BP should be measured on
both arms for the next reading.
• If these differences are seen in three consecutive
readings (with a one-minute gap between each),
further investigation may be indicated .
47. Manual auscultatory measurement
• Manual BP measurement devices require the user to inflate the
upper-arm cuff to occlude the brachial artery, then listen to the
Korotkoff sounds through a stethoscope while the cuff is slowly
deflated. When the cuff is slowly deflated, five different sound
phases can be heard:
• Phase I – a thud;
• Phase II – a blowing or swishing noise;
• Auscultatory gap – in some patients, the sounds disappear for a
short period;
• Phase III – a softer thud than in phase I;
• Phase IV – a disappearing blowing noise;
• Phase V – silence: all sounds disappear .
• The patient’s systolic (phase I) and diastolic (phase V) BP are
recorded from the readings on the sphygmomanometer.
48. Errors in measurement
• There are numerous causes of errors in BP measurements,
including:
• Patient not being rested and relaxed when BP is measured;
• Defective equipment – for example, leaky tubing or a faulty valve;
• Too-rapid deflation of the cuff;
• Use of incorrectly sized cuff;
• Cuff not being on a level with the heart;
• Poor technique;
• ‘Digit preference’ – rounding a reading up to the nearest 5mmHg or
10mmHg;
• Observer bias – for example, expecting a young patient’s BP to be
normal;
49. Pulse
• Arterial pulses can be examined at various sites around
the body. Systematic examination normally involves
palpating in turn radial, brachial, carotid, femoral and
other distal pulses. Palpation of the abdominal aorta
would also form part of this systematic examination (to
identify abdominal aortic aneurysms for example).
• Other sites may be examined for pulses, in special
circumstances - for example, the temporal artery (for
tenderness in temporal arteritis) and the ulnar artery
(if the radial cannot be felt or before arterial access at
the radial site).
50.
51. • Rhythm, which means if the pulse is equal, with regular intervals, just like
the music and the beats.
• Strength: intensity of impact that receive the fingers that palpate the
artery. It depends on the strength of myocardial contraction.
• Amplitude: degree of excursion of the artery. 1. high, aortic insufficiency
2. small, aortic stenosis, mitral stenosis
• Tension or validity: the amount of compression that must be exercised
because the pulsation disappears downstream. The pulse will be tense
when the arterial pressure is high and hypotensive or soft in the opposite
case. Palpando the radial is exercised with the ring finger that is found
upstream, a pressure on the artery, while the other fingers can grasp the
moment in which the pulsation disappears.
• Consistency or hardness: chicken trachea.
• Duration:
1. rapid or shocking: aortic insufficiency, fever, hyperthyroidism
2. late: aortic stenosis
• Equality: normally the beats of the pulse are all the same between
them, when they are not, it is called irregular pulse.
52.
53.
54.
55. What is the pulse rate?
• A normal pulse rate after a period of rest is
between 60 and 80 beats per minute (bpm). It
is faster in children. However, if tachycardia is
defined as a pulse rate in excess of 100 bpm
and bradycardia is less than 60 bpm then
between 60 and 100 bpm must be seen as
normal.
56. What is the pulse rhythm?
• Sinus arrhythmia occurs when there is variation of rate with
breathing. It accelerates a little on inspiration and slows a little on
expiration. This can be quite marked in children and adolescents
but is uncommon over the age of 30. It can persist a little longer in
the physically fit.
• Pulsus paradoxus:
– The pulse slows on inspiration in pulsus paradoxus and it can occur
with pericardial effusion, constrictive pericarditis and severe
pneumothorax, especially tension pneumothorax, severe asthma and
severe chronic obstructive pulmonary disease (COPD)[1].
– In normal circumstances, the systolic blood pressure often falls slightly,
by less than 10 mm Hg on inspiration; however, in pulsus paradoxus it
falls by more than this[2]. This fall can be used to assess the severity of
cardiac tamponade.
57. • Irregularity is more difficult to discern if the rate is fast.
• Note if it is regularly irregular of irregularly irregular:
– Variable heart block or premature ventricular excitation will cause either an
extra beat or a missed one. Premature ventricular contraction may cause a
missed beat because the ventricle has not had time to fill adequately and so
the stroke volume is low. The beat following a missed beat, whether due to
premature excitation or failure of the ventricle to beat, may be rather stronger
than the others, as the ventricle has filled more in the longer diastole. This
irregularity will follow a regular pattern.
– A much more random irregularity is a feature of AF. If the rate is fast in AF, it
may be difficult to note if the irregularity is random or even if there is
irregularity at all. It may be helpful to measure the rate at both the cardiac
apex and the wrist and in AF there is usually a deficit at the radial pulse. This is
usually done with two people timing simultaneously but it can be done alone,
not timing but merely noting if the rates differ. The rate in AF and the rarer
atrial flutter depends upon the degree of A-V block but it can be very fast.