Caring For Certain Emergencies Chapters 14-17 Flashcards
Characteristics of normal breathing
- normal limits, 10 to 30 breaths per minute for an adult
- Average range, 12 to 24 an adult. Respiratory raise can be as high as 60 for a newborn and steadily decrease with age
- Normal depth (tidal volume). Normal breaths are not too shallow and not too deep. Your best indicator is an obvious rise and fall of the chest and or abdomen with each breath.
- Work of breathing. Normal respirations are effortless and unlabored as the diaphragm muscle moves up and down with each breath.
Inadequate (abnormal) breathing
Common signs of inadequate, breathing include increased work of breathing, increased respiratory rate (early sign), decreased respiratory rate (late sign), respirations that are too deep or too shallow, irregular breathing rhythm, audible breath sounds, such as gurgling, snoring, or wheezing.
Patient may be in tripod position, which is a body position, characterized by the individual, sitting forward with hands on knees, shoulders arched upward, and head forward.
Accessory muscles
Muscles of the neck, chest, and abdomen that can assist during respiratory difficulty
Agonal respirations
An abnormal breathing pattern characterized by slow, shallow, gasping breaths that typically occur following cardiac arrest.
Chest trauma
Injuries to the chest to such as blunt trauma, or a penetrating injury can damage the muscles and bones of the chest wall, making it difficult and painful for the patient to breathe, thus leading to inadequate breathing. Damage can also occur to the structure, such as the lungs and trachea that made disrupt the normal exchange of gases, also leading to inadequate breathing. Bleeding can also occur inside the chest cavity, reducing the effectiveness of respirations.
Pulmonary edema
The accumulation of fluid inside the lungs is known as pulmonary edema, and is a common complication for many patients, with a history of cardiac compromise. The presence of fluid in the lungs can be heard with the stethoscope and, in extreme cases, can be heard without a stethoscope. It presents as a crackling sound each time the individual breathes in or out.
Pneumonia
Pneumonia is caused by an infection of one or both lungs and results in the accumulation of thick mucus called pus. The pus fills the alveoli and prevents the exchange of oxygen and carbon dioxide, resulting in respiratory compromise.
Respiratory anatomy
The upper airway includes the pathways, where air enters the body (nose and mouth) referred to as the nasal and the areas at the back of the throat, called the oropharynx, as well as the larynx. The oropharynx leads down the throat into the structure at the top of the trachea called the larynx. It is in the larynx where the vocal cords are positioned. All spaces and structures above the vocal cords, make up the upper airway, and all structures and spaces below the vocal cords make up the lower airway. Once air passes through the larynx it enters the trachea and travels down to the carina. The carina is the point at which the trachea splits into the right and left main stem bronchi. These large air passages get smaller as the air passes down into the lungs. The smaller airways are called bronchioles, and eventually terminate at the alveoli. Within the alveoli is where the exchange of oxygen and carbon dioxide takes place. The alveoli are surrounded by tiny blood vessels that drop off the carbon dioxide while picking up fresh oxygen.
Signs and symptoms of respiratory compromise
- labored or difficulty breathing; a feeling of suffocation
- Audible, breathing sounds
- Rapid or slow rate of breathing
- Abnormal pulse rate (too fast or too slow)
- Poor skin color, particularly of the lips and nail beds
- Tripod position
- Altered mental status
Chronic obstructive pulmonary disease
COPD is a general term used to describe a group of lung diseases that commonly cause respiratory distress and shortness of breath. The signs and symptoms may include:
- History of heavy cigarette smoking
- Persistent cough
- Chronic shortness of breath
- Pursed lip breathing
- maintaining a tripod position
- Fatigue
- Tightness in the chest
- Wheezing
- Barrel chest
In advance cases, there may be altered mental status, or a strong desire to remain sitting, even when, and pale or blue discoloration of the skin, lips, and nail beds
Bronchitis
A condition of the lungs characterized by inflammation of the bronchial, airways and mucus formation; a form of a chronic obstructive pulmonary disease, COPD. It is a disease process that causes, swelling and thickening of the walls of the bronchi and bronchioles. It can cause an overproduction of mucus in the air passages. Some people have a condition called chronic bronchitis. Chronic bronchitis is defined as a productive cough that continues for three consecutive months and occurs for at least two consecutive years.
Signs and symptoms of chronic bronchitis includes:
- Overweight
- Mild to moderate shortness of breath
- Pale complexion
- Productive cough
- Wheezes
Emphysema
A progressive condition of the lungs, characterized by destruction of the alveoli; a form of chronic obstructive pulmonary disease or COPD it is most often associated with cigarettes smoking. It is also common in individuals who have been exposed to environmental toxins over a long period of time, such as coal miners. Emphysema causes the destruction of the alveoli, making them useless for the exchange of oxygen and carbon dioxide. In addition, it causes the lungs to become less elastic, Ing carbon dioxide to become trapped. The loss of elasticity, and the resulting accumulation of air caused the chest wall to expand overtime. This is often described as the barrel chest appearance. The majority of emphysema patients are middle-aged and older and spend most of their energy just trying to breathe. Common signs and symptoms of emphysema include:
- Moderate to severe shortness of breath
- Very thin appearance
- Large barrel chest
- Nonproductive cough
-Extended exhalations
- Pursed lip breathing
- wheezes
Asthma
Asthma is a condition affecting the lungs, characterized by narrowing of the air, passages and wheezing. It is a reactive airway disease that affects millions of people in the United States. Asthma is a disease of the lower airway caused by an increased sensitivity or reaction to a variety of irritants, such as pollen, pollutants, and even exercise. When exposed to these irritants, the bronchioles spasm and constrict. Once irritated, they also swell and produce excess mucus. These factors all contribute to making the air passages smaller resulting in an acute onset of respiratory distress. The narrowing of the air passages will often cause the presence of a wheezing. Wheezing is a high-pitched, whistling sound that is created when air passes through the narrowed airways. In extreme cases, wheezing can be heard without a the stethoscope, most individuals with asthma have few or no symptoms between acute attacks. Asthma, patients often carry medication in the form of metered-dose inhaler that they breathe into their lungs when they feel an asthma attack coming on. These medication’s are called bronchodilators because they dilate the bronchial passages to help make breathing easier. However, if left untreated, an asthma attack can be severe enough to cause respiratory arrest, and even death.
Hyperventilation syndrome
Hyperventilation is a temporary condition characterized by uncontrolled, rapid, deep breathing, that is usually self correcting; often caused by anxiety, but may have more serious causes as well. Normal breathing can be affected by an emotional response, or a sudden onset of anxiety. Other medical conditions, such as a blockage of an artery in the long or pulmonary embolism And overdosing on certain drugs can also cause hyperventilation. In some instances, hyperventilation can be a sign of something more serious, such as an impending heart attack or other serious medical condition. Be alert for cyanosis, or other signs and symptoms of inadequate breathing. Regardless of the underlying cause, your priority in the care of these patients is to reduce anxiety by reassuring and comforting them. Signs and symptoms include moderate to severe shortness of breath, anxiety, numbness or tingling of the fingers, lips, and or toes, dizziness, spasms of the finger, and or toes, chest discomfort. it is not recommended that you have the patient and breathe into a paper bag or similar device because this could make the situation worse if there is an underlying medical problem. If your local protocols allow, you may use low flow oxygen, while helping to calm the patient down and slow his or her breathing.
Pulse oximetry
A simple tool that can be used to assess how much oxygen is getting to the patient’s blood. A normal range for oxygen saturation is between 94% and 99%.
