Pink puffers and Blue Bloaters -COPD

#KYJ #pinkpuffers and #bluebloaters
I was teaching on COPD in Christchurch last week, and mentioned Pink Puffers and Blue Bloaters. It occurred to me that these old fashioned expressions may be jargon that not all nurses have heard.
So here goes another episode of #KnowingYourJargon
COPD or Chronic Obstructive Pulmonary Disease  (or Airways disease = COAD) is a chronic lung disease causing restriction and obstruction to the Bronchi, bronchioles and alveoli.
It is a collection of two or three diseases in one.
Emphysema where the alveoli air sacs undergo membrane degradation and alveoli septal wall disintegration.
Chronic Bronchitis which is degenerative inflammation to the larger bronchi, and chronic Asthma where there is narrowing of the smaller bronchioles.

Most people with COPD have a dominant illness.
Those with dominant Emphysema are often barrel chested, emaciated pink in colour and have reasonable sats. Their chest is often silent.  These people may be referred to as Pink Puffers, as the gas trapping they experience causes rapid shallow breathing, puffing.

Blue bloaters are usually those with chronic Bronchitis.  They are usually larger framed, obese, cyanosed and will cough frequently to clear continuous secretions from over active sputum producing cells in their bronchi and bronchioles.  They wheeze and cough.  Rattles and Rhonchi (low pitched wheezing) is common on auscultation.
They are frequently Hypoxaemic with sats below our normal 94%,  frequently hovering in the high 80s.
So there we have it. Blue bloaters with their bronchitis, and pink puffers with their emphysaema.
It's not too late to come to my Respiratory Failure seminar. Just check out our what's on page www.ect4health.com.au

Ross River Virus infection

After recent big rain and a cyclone in the South East of Qld, we find our selves on the cusp of an epidemic of Ross River Virus

This painful condition is spread by Mosquitos breeding in water dishes, puddles, pot plant trays, and any still sources of water around the home.  Easily recognised as small black Mosquitos with white dots on their torso and "magpie footy socks" the Aedes genus are also responsible for other diseases. 

The virus is harboured in kangaroos, wallabies and Flying foxes. Once bitten by the mozzie the virus is transmitted to humans when we are bitten.

Symptoms are awful.  Aching joints (polyarthritis), headache, fever and victim feel lethargic.  The incubation is 3-14 days and symptoms last on average 4-6 weeks and are debilitating.

There is no cure, it is not fatal, and all victims recover.

Only symptomatic treatment is available (anti-inflammatory medications. Rest and gentle joint movement is recommended.

Brisbane, Gold and Sunshine Coast, and the Darling downs are about to see huge numbers of infection.

Prevention of mozzie breeding and protection from being bitten is paramount. 

KYJ - Understanding Heart Failure

#KYJ. Understanding heart failures.

In a nut shell, heart failure is the condition diagnosed when your heart “fails” to pump an adequate volume/minute.  It is measured using Cardiac output and its components- stroke volume (the amount of blood your heart pumps each beat) x the heart rate.

CO = SVxHR

Normally your CO is 4.2-7litres /min.

Now SV is measured as the volume your left ventricle squirts out each pump.  It is about 70 mls.
That 70 mls is approximately 70% of what was in your full ventricle (100ml).

So... if you fill with 100 and pump out 70ml.  Then the efficiency of your Squirt is called Ejection Fraction (and it’s approx 70%)

Fall short and you have Left heart failure....

Causes could be a weak pump or a stiff ventricle wall, or low volume or injury to the left ventricle (commonly seen after MI)

Let’s recap our plumbing...
Blood in veins (returning blood to the heart) traveling to  the Arterial side of circulation must travel through three way points;
Right heart , lungs and left heart

When arterial blood pressure is too high (Hypertension), also referred to as "Afterload",  the left heart has difficulty with its forward traffic flow.  Traffic backs up in the Left heart causing it to fail. - left heart failure.

Once this happens, blood attempting to drain into the left heart can't, and and pressure builds in the pulmonary vessels; it's called pulmonary hypertension.

This leakage causes the spaces between capillaries and alveoli to fill with plasma leaking from the pulmonary capillaries-  it's called pulmonary Oedema and when severe the patient is breathless, wheezing, and may cough pink frothy sputum. Being caused by Left heart failure, this type of oedema is defined as Cardiogenic pulmonary oedema. Wet crackling lungs and desaturation leads to a respiratory failure on top of cardiac failure.

Right heart failure (Cor Pulmonale)
The venous network drains into the right heart.  The right heart then pumps relatively deoxygenated blood through the Lungs to become oxygenated.  When the Right heart fails to efficiently pump, blood backs up into the venous system causing venous congestion, engorgement, ankle and peripheral oedema, Jugular venous pressure elevation, and Ascites.

The Right heart will fail if you snore chronically.  When sleeping (obstructive sleep apnoea) is a major contributor of Right heart failure. It's the sequelae of untreated snoring (you don't have to just live with it!)
In fact any restrictive airway disease that is unmanaged, causes more pressure in the lungs (pulmonary hypertension), making the right heart have to work harder to pump blood through the lungs.  If you force an engine to work too hard for too long, it inevitably fails. Get that snoring looked at- especially if you see stricture marks on your legs after wearing socks.  If you have ankle swelling.  You are probably already experiencing the beginning of Right Heart Failure.

There is so much more to this.   Consider coming to one of our Cardiac days.
Book me to present to your crew.
Or check out our CPD seminars near you - here
Www.Ect4Health.Com.Au/whats  

Check out the latest Videos

KYJ- Recording CPD

Question I was asked.

What constitutes CPD for AHPRA if I was Audited.

Answer: any diarised active learning done that relates to 

1.  Your role

2.  Offers education towards your diarised learning plan that you have linked to one of the 10 nursing competency standards of NMBA.

When the day comes, and your number is randomly selected for audit, AHPRA are not interested in the certificates of attendance you collected, or the list of courses, workshops,conferences and seminars you went to;  they want your diary. This diary is called the professional portfolio.  It contains your personal CPD learning plan. Where you noted that one day you went to work, and identified that you needed to develop a new skill; or seek learning about a patient's presentation for which you were not previously familiar.  Perhaps you needed to brush up on a rusty procedure, or refresh your understanding of a professional aspect of practice.

What ever it is, you noted it in your portfolio, and documented that you needed to seek some education on your identified learning need.  You must review the NMBA standards and link that  learning to one of those standards.

Eg Sally was challenged by Joan about why she administered Ventolin via a puffer to her Asthma patient; and not a nebuliser.  Sally told Joan that as an RN she is allowed to give a Metered Aerosol of Salbutamol with out an order, but not a neb. Having recently moved from interstate, Joan did not realise this and noted that she will seek education on current drug legislation.  Joan reviewed the NMBA standards and found that standard 1 states that a nurse "complies with legislation relating to practice"

So, homework time.  

Do you have a Professional portfolio?

In it, do you have a "learning plan" that meets the Registration standard?

Do you know the NMBA competency standards? 

Here --> http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F1342&dbid=AP&chksum=N5ws04xdBlZijTTSdKnSTQ%3D%3D

Nurses, this CPD can be gained anywhere. Of course I want you to read my blogs and attend my cruises and seminars, and claim the CPD to be had, but if you think AHPRA cares one bit about the wad is certificates you want to send them at audit time, you are sadly mistaken.  They don't even look at them. They are interested only in your Learning plan, and how you recorded your CPD. 

Final question :  Yes mandatory training is 100% acceptable as CPD.  Ref= section 8 of the NMBA registration standard.

This excerpt from the NMBA standards for registration
Documentation of CPD

7. Documentation of self-directed CPD must include dates, a brief description of the outcomes, and the number of hours spent in each activity. All evidence should be verified. It must demonstrate that the nurse or midwife has:
a) identified and prioritised their learning needs, based on an evaluation of their practice against the relevant competency or professional practice standards
b) developed a learning plan based on identified learning needs
c) participated in effective learning activities relevant to their learning needs
d) reflected on the value of the learning activities or the effect that participation will have on their practice. 
8. Participation in mandatory skills acquisition may be counted as CPD.