Care of the Patient with Dyspnoea

Question 1

What is Asthma?

Answer 1

• it is a chronic inflammatory disease of the respiratory passages.

Question 2

Asthma symptoms:

Answer 2

• cough
• chest tightness
• wheezing
• dyspnoea

Question 3

Other Symptoms of Asthma:

Answer 3

• expiration requires effort and becomes prolonged
• central cyanosis (lips and mouth)
• diaphoresis (swelling)
• tachycardia
• use of accessory muscles

Question 4

Chronic Obstructive Pulmonary Disease (COPD)

Answer 4

• COPD is characterized by airflow limitation that is not fully reversible.
• the airflow limitation is usually progressive.
• it is associated with an inflammatory response of the lungs to noxious particles or gases, resulting in narrowing of airways, hypersecretion of mucus and changes in the pulmonary vasculature.

Question 5

COPD Symptoms

Answer 5

• chronic cough
• sputum production
• dyspnoea on exertion
• weight loss
• use of accessory muscles

Question 6

Pneumonia

Answer 6

• it is an infection of the lungs parenchyma caused by various microorganisms, including bacteria, fungi and viruses.
• an inflammatory reaction occurs in the alveoli, producing an exudate that interferes with the diffusion of oxygen and carbon dioxide.

Question 7

Pneumonia Symptoms:

Answer 7

• clinical features vary depending on the causative microorganism.
• sudden chills and rapidly rising fever.
• pleuritic chest pain which is aggravated by inspiration and coughing.

Question 8

Other Symptoms of Pneumonia:

Answer 8

• headache
• tachypnoea (high breathing rate)
• tachycardia
• dyspnoea
• sputum production which may be viscous, green and blood-tinged.

Question 9

Pulmonary Embolism

Answer 9

• PE refers to the obstruction in the lungs, by an embolus (travelling blood clot from a different site, that originates somewhere in the venous system or in the right side of the heart).
• gas exchange is impaired in the part of the lung supplied by the obstructed artery.
• life-threatening emergency.

Question 10

PE symptoms:

Answer 10

• dyspnoea
• tachypnoea (high breathing rate)
• tachycardia
• cough
  -diaphoresis (sweating to a high degree not because of physical exertion or warmness)

Question 11

Pneumothorax:

Answer 11

• a pneumothorax is a collection of air outside the lung but within the pleural cavity.
• air accumulates between the parietal and visceral pleurae, creating a pressure and collapses the lung.

Question 12

Pneumothorax Symptoms:

Answer 12

• pleuritic pain of sudden onset.
• minimal respiratory distress with small pneumothorax; acute respiratory distress if large.
• dyspnoea
• use of accessory muscles
• breath sounds are diminished or absent
• percussion on the affected side is normal or hyperresonant depending on the size of the pneumothorax.
• decreased chest expansion
• tracheal shifts from the midline, depending on the size of the pneumothorax.

Question 13

Pulmonary Oedema:

Answer 13

• an abnormal build-up of fluids in the lungs which interferes with gaseous exchange.
• a main cause of pulmonary odema is congestive heart-failure.

Question 14

The Respiratory Process:

Answer 14

Ventilation (entry of air in the lungs) –> Diffusion (of oxygen and CO2) –> perfusion (transport)

Question 15

Respiratory Problem is a result of failure of:

Answer 15

• ventilation
• diffusion
• perfusion
  This will decrease gaseous exchange and hence, oxygenation of tissues leading to hypoxemia and hypoxia.

Question 16

ABCDEF

Answer 16

Airway -> breathing -> circulation -> disability -> exposure -> full history/full vitals

Question 17

What do we assess when a patient complains of dyspnoea?

Answer 17

• posture (usually upright, standing and holding on to a table, so that the lungs are easier to expand).
• respiratory distress (dyspnoea, orthopnoea)
• noisy breathing
• respiration rate (tachypnoea, bradypnoea)
• ability to speak (conversational dyspnoea)
• use of accessory muscles

Question 18

Assesment;

Answer 18

• mental status
• pulse oximetry
• peripheral/central cyanosis
• diaphoresis
• lower PEFR when compared to usual.

Question 19

Target SpO2

Answer 19

94%-98%
- lower target SpO2; 88-92% for patient with COPD/ long-term smokers

Question 20

Vital Signs

Answer 20

• tachycardia
• fever
  -hypertension

Question 21

PEFR - Peak Expiratory Flow Rate

Answer 21

• it is a measure of how fast a person can exhale air from their particularly during a forceful breath.
• PEFR is often used to assess the function of the respiratory system, especially in conditions such as asthma.

Question 22

Nursing Diagnoses:

Answer 22

• impaired breathing pattern
• impaired airway clearance
• increased anxiety
• increased fatigue and activity intolerance
• impaired nutritional status
• difficulty coping with condition
• lack of knowledge on condition

Question 23

Impaired Breathing Pattern:

Answer 23

• administer bronchodilators as prescribed
• administer oxygen as prescribed
• encourage the use of an inspiratory muscle trainer if prescribed.
• encourage alternating activity with rest periods.
• maintain head of bed elevated to promote lung expansion.

Question 24

Bronchodilators;

Answer 24

Quick-relief bronchodilators; for immediate treatment of symptoms.
Long-acting bronchodilators; to achieve and maintain control of respiratory condition.

Question 25

Quick Relief Bronchodilators;

Answer 25

• short-acting beta2-adrenergic agonists (inhaled or nebulised)
• ventolin or atrovent metered aerosol

Question 26

Long-acting Bronchodilators;

Answer 26

• inhaled corticosterioids (e.g Beclomethasone, budesonide).
• long-acting beta2-adrenergic agonists (e.g Formoterol)

Question 27

Medication Regime:

Answer 27

• controllers/preventers; inhaled corticosteroids
• relievers; short-acting beta2-adrenergic agonists & anticholinergic drugs