Ch 15 Respiratory Emergencies Flashcards
Acidosis
Buildup of excess acid in the blood or body tissue that results from a primary illness
Adventitious breath sounds
Abnormal breathing sounds such as wheezing, stridor, rhonchi and crackles
Alkalosis
Buildup of excess base (lack of acids) in the body fluids
Anaphylaxis (anaphylactic shock)
An extreme, life threatening, systemic allergic reaction that may induce shock and respiratory failure
Asthma
An acute spasm of the smaller air passages (bronchioles) associated with excessive mucus production and swelling of the mucous lining of the respiratory passages
Atelectasis
Collapse of the alveolar spaces of the lungs
Bronchial breath sounds
Normal breath sounds made by air moving through the bronchi
Bronchiolitis
Inflammation of the bronchioles that usually occurs in children younger than 2 and is often caused by the respiratory syncytial virus
Bronchitis
Acute or chronic inflammation of the lung that may damage lung tissue; usually associated with cough, production of sputum, and fever (depending on cause)
Carbon dioxide retention
Condition characterized by a chronically high blood level of carbon dioxide in which the respiratory center no longer responds to high levels of CO2 in the blood
Carbon monoxide
An odorless, colorless, tasteless and highly poisonous gas that results from incomplete oxidation of carbon in combustion
Chronic bronchitis
Irritation of the major lung passageways from infections disease or irritants such as smoke
COPD
Chronic obstructive pulmonary disease
A slow process of dilation and disruption of the airways and alveoli caused by chronic bronchial obstruction
CPAP
Continuous positive airway pressure
A method of ventilation used primarily in the treatment of critically ill patients with respiratory distress; can prevent endotracheal intubation
Crackles
Crackling, rattling breath sounds signaling fluid in the air spaces of the lungs, formerly called rales
Croup
An inflammatory disease of the upper respiratory system that may cause partial airway obstruction and is characterized by a barking cough; usually seen in children
Diphtheria
An infectious disease in which a membrane forms, lining the pharynx; this lining can severely obstruct the passage of air into the larynx
Dyspnea
Shortness of breath or difficulty breathing
Embolus
A blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage
Emphysema
A disease of the lungs in which there is extreme dilation and eventual destruction of the pulmonary alveoli with poor exchange of oxygen and carbon dioxide; loss of elasticity that leaves “holes” that resemble air pockets or cavities; one form COPD
Epiglottitis
A disease in which the epiglottis becomes inflamed and enlarged and causes partial or complete upper airway obstruction; symptoms are sudden onset
Hay Fever
Allergic response to outdoor airborne allergens such as pollen or sometimes indoor allergens such as dust mites or pet dander; Allergic Rhinitis
Hyperventilation
Rapid or deep breathing that lowers the blood carbon dioxide level below normal
Hyperventilation syndrome
Panic attack
Occurs in the absence of other physical problems; respirations may be as high as 40 shallow breaths per min or as low as only 20 very deep breaths per min
Hypoxia
When the body’s cells and tissues do not have enough oxygen
Hypoxic drive
When chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with chronic lung diseases
Influenza type A
A virus that has crossed the animal/human barrier and infected humans, recently reaching the pandemic level with H1N1
Metered-dose inhaler
MDI
Miniature spray canister used to direct medications through the mouth and into the lungs
Orthopnea
Severe dyspnea experienced when lying down and relieved by sitting up
Pandemic
An outbreak that occurs on a global scale
Paroxysmal Nocturnal Dyspnea
Severe shortness of breath, especially at night after several hours of reclining; the person is forced to sit up and breathe
Pertussis
Whooping cough
Airborne bacterial infection that affects mostly children under 6; patients will be feverish and exhibit a “Whoop” sound on inspiration after a coughing attack; highly contagious through droplet infection
Can lead to pneumonia in infants, cracked ribs in geriatric patients; Patients may find it hard to eat, sleep or breathe
Pleural effusion
Collection of fluid between the lungs and the chest wall that may compress the lung
Pleuritic chest pain
Sharp, stabbing pain in the chest that is worsened by a deep breath or other chest wall movement; often caused by inflammation or irritation of the pleura
Pneumonia
Infection of the lungs that damages the lunch tissue
Risk factors include:
Institutional residence (Nursing home, etc)
Recent hospitalization
Chronic diseases (renal failure, etc)
Immune system compromise (chemotherapy, HIV, etc)
History of COPD
Pneumothorax
Partial or complete accumulation of air in the pleural space; “collapsed lung”
Pulmonary edema
Buildup of fluid in the lungs, usually as the result of CHF
Pulmonary embolism
A blood clot that breaks off from a large vein and travels to the blood vessels of the lungs, causing obstruction of blood flow
Respiration
The exchange of oxygen and carbon dioxide
Respiratory Syncytial Virus
RSV
Virus that causes a infection of the lungs and breathing passages; can lead to other illnesses such as bronchiolitis and pneumonia; Highly contagious through droplets
Rhonchi
Coarse breath sounds heard in patients with chronic mucus in the airways
Small-volume nebulizer
Device that holds liquid medicine that is turned into a fine mist; patients inhale the medication into the airways and lungs as treatment for conditions such as asthma
stridor
A harsh, high pitched, barking inspiratory sound often heard in acute laryngeal (upper airway) obstruction
TB
Tuberculosis
A disease that can lay dormant in a person’s lungs for decades, then reactivate; Many strains are resistant to antibiotics; Spread through cough
Ventilation
the exchange of air between the lungs and the environment, spontaneously by the patient or with assistance; “breathing”
Vesicular breath sounds
Normal breath sounds made by air moving in and out of the alveoli
Wheezing
A high-pitched, whistling breath sound, characteristically hear on expiration in patients with asthma or chronic obstructive pulmonary disease
Your patient has a chronic respiratory condition. His stimulus to breathe is triggered by low oxygen levels in the blood. This is known as the _____
hypoxic drive
What must be assessed in every respiratory patient?
Lung sounds
Crackles (rales) are caused by _____
Air passing through fluid
“PASTE” is an alternate assessment tool for _____
respiratory patients
What is the genetic disorder that predisposes the patient to repeated lung infections?
Cystic fibrosis
In what area of the lungs does respiration occur?
Alveoli
In order for efficient pulmonary gas exchange to occur:
oxygen and carbon dioxide must be able to freely diffuse across the alveolar–capillary membrane
Which of the following is MOST characteristic of adequate breathing?
A) 22 breaths/min with an irregular pattern of breathing and cyanosis
B) 30 breaths/min with supraclavicular retractions and clammy skin
C) 20 breaths/min with shallow movement of the chest wall and pallor
Correct!
D) 24 breaths/min with bilaterally equal breath sounds and pink skin
D) 24 breaths/min with bilaterally equal breath sounds and pink skin
Which of the following conditions would be LEAST likely to result in hypoxia? A) Pleural effusion B) Severe anxiety C) Pulmonary edema D) Narcotic overdose
B) Severe anxiety
A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the most likely cause of this patient’s condition?
Spontaneous pneumothorax
Treatment with continuous positive airway pressure (CPAP) would MOST likely be contraindicated in which of the following situations?
A) Pulmonary edema, history of hypertension, and anxiety
B) Difficulty breathing, two-word dyspnea, and tachycardia
C) Conscious and alert patient with an oxygen saturation of 85%
D) Shortness of breath and a blood pressure of 76/56 mm Hg
D) Shortness of breath and a blood pressure of 76/56 mm Hg
Asthma is caused by a response of the:
Immune System
A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications. During your assessment, you hear wheezing over all the lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him high-flow oxygen, the most important treatment for this patient is:
epinephrine
When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has:
Abnormal breath sounds
While auscultating an elderly woman’s breath sounds, you hear low-pitched “rattling” sounds at the bases of both of her lungs. This finding is most consistent with what condition?
Aspiration pneumonia
You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient takes a deep breath and depresses the inhaler, you should:
instruct him to hold his breath for as long as he comfortably can.
You are attending to a 3-year-old male patient who is presenting with severe shortness of breath. His parents report that he has had a cough and cold with a low grade fever for the past two days. They became worried today, as his level of distress has increased dramatically. On assessment, the patient is sitting upright and making high-pitched noises with each breath. Based on this information, the patient is most likely suffering from:
viral infection of the upper respiratory tract
His parents tell you that their son has had a chest infection for the past two days and when they took him to their family doctor, they were told it was likely due to the respiratory syncytial virus (RSV). They have kept him well hydrated, but the infection seems to have gotten worse. On auscultation, you hear decreased air entry bilaterally with fine expiratory wheezes and the occasional coarse wet crackle. Based on this information, your patient is most likely suffering from:
bronchiolitis
You are attending to a 54-year-old female patient in a homeless shelter. The patient tells you that she had the flu a couple of weeks ago, and she has not gotten over it. She has been tired and keeps waking up at night, sweating. She has been coughing up green sputum occasionally and has been experiencing episodes of chest pain that get worse when she breathes. Based on this information, your patient is most likely suffering from:
Tuberculosis
Deoxygenated blood is carried from the heart to the lungs through the
Pulmonary arteries and arterioles
Oxygenated blood is carried from the lungs to the heart through the
Pulmonary veins and venules
S/S of Asthma
Wheezing on inspiration/expiration
Bronchospasm
S/S of Anaphylaxix
Flushed skin or hives Generalized edema Decreased BP Laryngeal edema with dyspnea Wheezing or stridor
S/S of Bronchiolitis
Shortness of breath Wheezing coughing fever dehydration tachypnea tacycardia
S/S of Bronchitis
Chronic cough (with sputum production)
Wheezing
Cyanosis
tachypnea
S/S of CHF
Dependent edema
crackles (pulmonary edema)
Orthopnea
Paroxysmal nocturnal dysnpnea
S/S of the Common Cold
cough
runny nose
sore throat
S/S of Croup
Fever
barking cough
stridor
mostly seen in pediatric patients
S/S of Diphtheria
Difficulty breathing and swallowing
Sore throat
thick, gray buildup in throat or nose
fever
S/S of Emphysema
Barrel chest pursed lip breathing dyspnea on exertion Cyanosis Wheezing/decreased breath sounds
S/S of Epiglottitis
Dyspnea high fever stridor drooling difficulty swallowing severe sore throat tripod or sniffing position
S/S of Influenza type A
Cough
Fever
Sore throat
fatigue
S/S of Pertussis
Coughing spells
“Whooping” sounds
fever
S/S of Pneumonia
Dyspnea chills, fever cough green, red or rust colored sputum localized wheezing or crackles Presentation in children is often: Rapid, labored breathing, lips/fingernails present bluish gray, may be fever, abdominal pain, vomiting
S/S of Pneumothorax
sudden chest pain with dyspnea
decreased breath sounds unilaterally
subcutaneous emphysema
S/S of Pulmonary embolus
Sharp chest pain Sudden onset dyspnea tachycardia clear breath sounds initially
S/S of Tension pneumothorax
Severe shortness of breath decreased/altered LOC neck vein distension tracheal deviation (late sign) hypotension; signs of shock (late sign)
S/S of Respiratory syncytial virus
Cough
wheezing
fever
dehydration
S/S of Tuberculosis
cough
fever
fatigue
productive/bloody sputum
Cardiac asthma
Wheezing experienced due to left-sided heart failure because the alveoli are so full of fluid that bubbles (the condition that gives the sound of crackles) cannot form
PASTE
Progression - O of OPQRST, when it began, how has it worsened over time
Associated chest pain - Can be a symptom of cardiac problems
Sputum - Have they been coughing up sputum?
Talking tiredness - Indicator of distress, full sentences or only a few words?
Exercise tolerance - decreases with dyspnea and hypoxia, what were they doing before?
Administer _____ (if available) for patients with upper airway infections and dyspnea
humidified oxygen
Do not attempt suctioning or an oropharyngeal airway for patients with suspected ____
Epiglottitis
Low blood pressure contradicts the use of ____
CPAP
Because of increased pressure inside the chest, blood flow returning to the heart is diminished
CPAP is not used in patients with the following conditions
Respiratory arrest S/S of pneumothorax tracheotomy decreased LOC inability to follow commands active gastrointestinal bleeding
Treatment for spontaneous pneumothorax
Administer O2
Prompt transport
Closely monitor
Be ready to assist with ventilations, support the airway and provide CPR if needed
Treatment for COPD
Assist with patient’s prescribed inhaler, but be alert for side effects as COPD pts often overuse
Prompt transport
Place in most comfortable position (likely upright)
Treatment for anaphylaxis
Remove the offending agent Administer epinephrine Maintain the airway Administer oxygen and be ready to assist breathing as needed Prompt transport
Treatment for asthma
Administer oxygen Assist with inhaler as needed Prompt transport Effort breathing = exhausting, a patient who stops struggling to breath is NOT recovering and is likely at a critical stage Aggresive airway management Oxygen Transport and consider ALS
Treatment for PE
Administer Oxygen
Place in position of comfort
Prompt transport
Treatment for airway obstruction
Clear the airway if possible
Airway management - chin-tilt, jaw-thrust
Administer oxygen
Prompt transport
Tracheostomy disfunction
At home ventilation connected by a tracheostomy tube typically in children or geriatric patients; may become obstructed – clear the obstruction of possible, place in a position of comfort, provide suctioning
If unable to airway the obstruction, consider ALS
Cystic Fibrosis
Genetic disorder affecting lungs and digestive systems. Disrupts the normal function of cells that make up the sweat glands in the skin and that line the lungs and digestive systems. Disrupts the natural balance of salt and water, and results in thick, sticky mucus in the lungs or other organs
