Assessing and Managing Acute Respiratory Patient Flashcards
Which part of the ABCDE assessment come under respiratory assessment?
A and B - Airway and Breathing
A structured assessment of a respiratory patient includes what aspects? (7)
HIPPALO
- History taking
- Inspection
- Auscultation
- Percussion
- Palpation
- Look, Listen and Feel approach
- Other Clinical observations
When inspecting a patient’s chest, what features should you look out for?
• General appearance - colour
cyanosis?
- Symmetry?
- Obvious dyspnoea
- Ability to speak
• Use of accessory muscles,
shoulder hauling
• Air hunger
• Evidence of noisy
breathing/cough
- Position of trachea
- Movement of chest wall
• Chest wall/spinal deformities,
scars
• Finger clubbing/Nicotin
What is cyanosis and what is it an indication of?
It is a bluish/purpleish tinge to the skin which indicates hypoxemia
What is hypoxemia?
an abnomally low level of O2 in arterial blood.
What does it mean to “inspect” the the chest?
To look at the chest
What does it mean to “aucultate” the the chest?
To listen
Where are breath sound produced during chest auculation?
The large airways
What alters the sound of the chest when breathing?
obstructions to the flow
Obstructions to the flow can do what to chest aucultation?
alter the sound
The large airways are responsible for what during chest auculattion?
Breath sounds
Which parts of the lung should be auscultated?
Side to side
top to bottom
over anterior & posterior lung fields
bilaterally (both lungs)
Which part of the stethoscope is used for chest auscultation?
The diaphragm
What are the 3 normal lung sound?
Bronchial
Brochovesicular
vesicular
Where can bronchial sounds be heard?
on the anterior chest over trachea area
What do bronchial sounds sound like?
High pitched and loud
Inspiration slightly shorter than expiration
If patient has normal breath sounds which are:
High pitched and loud
Inspiration slightly shorter than expiration
what type do they have?
Bronchial chest sounds
What type of breath sounds can be heard on the anterior chest over trachea area?
Bronchial chest sounds
Where can broncho-vesicular sounds be heard?
anteriorly and posteriorly over the bronchi
anteriorly: 1st & 2nd Intercostal space
Posteriorly: between the scapulae
What do bronchial sounds sound like?
medium pitch
inspiration &expiration is equal
List examples of abnomal breath sound/
wheeze
Crackles
ronchi
Stridor
What does it mean to palpate the chest?
to physically feel the chest
What do clinicians look for when palpating the chest?
- Chest wall tenderness
- Chest wall movement
- Evidence of surgical emphysema
- Coarse/popping/grating-pleural friction rub
What can clinicians tell from percussing the chest
underlying lung structure
presence of
air, liquid or solid material
Prior to doing a respiratory assessment, what is the most important factor of the airway should be considered?
is it patent?
What indicates that a patient’s airway is patent?
If the patients is talking to you
When taking a history during a respiratory assessment, what question’s might you ask the patient?
Allergies?
Smoking?
Medication: Inhalers, Nebulisers, Home oxygen?
Travel history? (?TB)
Breathing symptoms? cough?
How long? sputum? colour of sputum?
Long-term condition? I.e Asthma, COPD?
What muscles a normally utilised during respiration?
diaphram
Intercostal muscles
Muscles other than the diaphram and intercostal muscles which are used during respiration are known as what?
Accessory muscles (i.e pectoral muscle)
What do quiet percussion sunds on a patient’s lung tell you about the structure?
medium is more dense
How do percussion sounds change thoughout the lung
sounds of air - loud
sounds over fluid - less loud
sounds over solid areas soft.
What can hyper-resonance indicate?
pneomothorax or over inflated lung (COPD)
How might pneumothorax or over-inflated lung be identified from percussion?
Hyper-resonant areas.
Why is it important to calculate RR consitently and accurately?
RR is the most sensitive clinical sign of changing condition
What is the normal range for RR in a healthy adult?
12-18bpm
How should normal l breathing be?
quiet, unlaboured and even
What is pulse oximetry and what is it used for?
Non-invassive assessment of oxygen satuartion
gives indication of oxygen delivery to tissues.
When might pulse oximetry be unreliable?
if a person has poor peripheral perfusion, dark skin, extreme light.
What is the difference between oxygenation and ventilation?
oxygenation is addition of oxygen to the body
ventilation is the inhilation of room air into the lungs.
What are the 2 static lung volumes you need to know for the exam?
Functional residual capacity
residual volume
What is functional residual capacity?
volume of air which remains in the lungs after normal expiration.
What is residual volume?
Volume which remains in lungs after maximum expiration
What happens to FRC and RV in people who have COPD an Emphysema?
increases
What term is given to the volume of air which remains in the lungs after normal expiration?
functional residual capacity
What term is given to the Volume which remains in lungs after maximum expiration?
Residual volume
What do Peak flow meters measure?
How fast a patient can breathe out
Which vessels are ABGs usually taken from?
radial, brachial or femoral arteries
What can Abg values tell you?
Respiratory disturbance
metabolic disturbance
or combination of the two
compensation
What are the 2 types of respiratory disturbance?
respiratory acidosis
respiratory alkalosis.
A patient with resp acidosis may present with what type of valus on ABG reading?
low pH
High PaCO2
A patient with resp alkalosis may present with what type of valus on ABG reading?
high pH
Low PaCO2
If a patient has ABG readings which are of:
low pH
High PaCO2
what may be wrong with the patient?
Patient is in respiratory acidosis.
?retaining CO2
If a patient has ABG readings which are of:
Hight pH
Low PaCO2
what may be wrong with the patient?
respiratory akalosis
?patient hyperventilating
What does can PaO2 on an ABG strip say about a patient’s condition?
do they have normal arterial oxygen concentration?
are thy hypoxaemic?
What does low PaO2 indicate?
Hypoxaemia
How is Hypoxaemia indicated on an ABG strip?
Low PaO2 and/or low SO2
Which type of respiratory failure is hypoxaemia likely to occur in?
Type 1. Can happen in Type 2 however this does not necessarily happen
is hypoxaemia likely to be present in respiratory acidosis or alkalosis?
acidosis
Which values from an ABG strip are used to determine metablic disturbances?
pH
HCO3 and Base Excess levels
If a patient has ABG readings which are of:
low pH
Low HCO3
Low BE (-tive)
what may be wrong with the patient?
metabolic acidosis
If a patient has ABG readings which are of:
high pH
high HCO3
high BE (+tive)
what may be wrong with the patient?
metabolic alkalosis
How does the body compensate acidosis in the bood?
breath out more CO2, if this is not enough, more buffer is used to soak up the excess.
How is compensation demonstrated in an ABG strip?
pH restoring to normal value.
list some normal changes to the respiratory system as a result of age.
Chest wall compliance
elasticity of lung tissue
number of alveoli
strength of expiratory muscles
What are the types of respiratory failiure?
Type 1 and type 2
How is Type 1 respiratory failure classified?
hypoxaemia but no hypercania
low SpO2 or PaO2
PaCo2 normal or low
How is Type 2 respiratory failure classified?
Hypercapnia is always evident (but pH may be compensated)
High PaCO2
Hypoxaemia is also possible
List some of the causes for type 1 respiratory failiure
Chest infection
pneumonia
asthma
pulmonary embolism
List some of the causes for type2 respiratory failure
COPD
extreme obesity
List examples of acute respiratory disorders you might come across in the hospital?
Chest infection • Pneumonia • Asthma, COPD, Emphysema • Atelectasis • Pneumothorax
Whereabouts is in the respiratory tract does a chest infection occur?
in the upper respiratory tract
What are the main symptoms of a chest infection?
Productive cough
fever
What is atelectasis?
it is when aleveli structures in the lung collapse and close shut.
What can cause atelectasis?
General Anaesthesia, secretions blocking an airway, plural effusion
What does ARDS stand for?
Acute respiratory Distress Syndrome
