Deep breath and blow the HCA role in respiratory care

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Deep breath and blow - the HCA role in
respiratory care

• Hilary Andrews
• Nurse Advisor
• Woodlands Health Centre
• Paddock Wood, Kent

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Respiratory Care

• Lung Function Tests
• Peak Flow (PEFR)
• Asthma
• Spirometry
• COPD Monitoring, QOF
• Reversibility testing to exclude asthma
• Opportunistic Over 35yrs, asthmatic coughing
  smokers
• Health Promotion

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The Respiratory System
Nasal Cavity
Pharynx
Larynx
Trachea
Right Bronchus
Left Bronchus
Left Lung
Right Lung
Heart Position
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Asthma

• Tightening of muscles surrounding bronchiole
  causes Bronchospasm
• Allergens cause inflammation which further
  narrows airway
• Secretions

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COPD

• Chronic Obstructive Airways Disease
• Umbrella term for Emphysema and Chronic
  Bronchitis
• Walls of alveoli break down with loss of surface
  area

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Other respiratory terms

• Pack Years
• An estimation of the amount someone has smoked
• Dyspnoea
• Difficulty Breathing
• Orthopnoea
• Breathlessness relieved by sitting upright
• LTOT
• Long Term Oxygen Therapy
• Expectorating
• Coughing up sputum
• Haemoptysis
• Coughing up blood
• Exacerbation
• Increase in severity of a disease
• Cyanosis
• Blueness of skin

• Transcutaneous Oxygen Saturation
• Concentration of oxygen in the blood measured
  through the skin
• FEV1
• Forced Expiratory Volume in 1 second (often
  expressed as predicted)
• FVC
• Forced Vital Capacity (often expressed as
  predicted)
• Preventers
• Medication given to prevent inflammation of
  airways eg steroids
• Relievers
• Medication given to relieve obstructed airways eg
  bronchodilators salbutamol
• CXR
• Chest X-ray

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PEFR

• Peak Flow demonstrates maximum flow rate of lungs
• What device is used?
• Peak Flow Meter
• Technique?
• Fast Blast not Slow Blow
• Limitations
• Insufficient effort
• Poor seal
• Not horizontal
• When can it be performed?
• Anytime, at home, in surgery, after exercise etc
• PEFR Diary

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Peak Flow Diary
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Spirometry

• Spirometry demonstrates airflow obstruction
• New Diagnosis COPD
• Monitoring COPD
• Devices
• Contraindications
• Technique Accuracy

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Spirometers
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Contraindications to Spirometry

• Pneumothorax or within 2 weeks of resolution
• Following recent MI
• Unstable angina
• Haemoptysis
• Following recent eye surgery
• Following recent abdominal or thoracic surgery
• Following recent CVA
• Previous vasovagal episodes
• Cervical Disc problems
• Ruptured tympanic membrane in last 6 months

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Other points to consider prior to Spirometry

• Chest infection in last four weeks
• Alcohol in last four hours
• Vigorous exercise in last 30 minutes
• Is clothing restrictive?
• Large meal eaten in previous 2 hours?

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Technique and Accuracy

• Calibration of spirometer
• New mouthpiece
• Checklist
• Prepare the patient
• Standing preferably
• Breathe in as deeply as possible
• Blow breath out forcibly, as hard and fast as
  possible
• Keep blowing!
• Repeat at least twice
• Check for consistency in trace
• Store or print results

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Normal Spirometry Trace
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Identifying abnormal spirometry traces
Slow start to forced expiration
Coughing during exhalation
Early stoppage of test
Extra breath taken during test
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Health Promotion

• 900,000 people diagnosed with COPD in UK
• 450,000 estimated as being undiagnosed
• Cost of COPD to NHS
• 982,000,000 estimated cost/year (2004)

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Health Promotion

• Therefore-
• Smoking
• Offer help to stop smoking at every opportunity
• Smoking cessation allows the rate of decline in
  lung function to return to that of non-smoker
• Recognition of other problems that may be
  affecting the patients quality of life

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For more information

• Spirometry in practice - A practical guide to
  using spirometry in primary care
• The BTS COPD Consortium www.brit-thoracic.org.uk
  
• www.patient.co.uk
• www.wipp.nhs.uk