Ch16: Respiratory Emergencies Flashcards
symptoms of asthma
bronchospasms
wheezing
symptoms of anaphylaxis
flushed skin, hives
hypotension
difficulty breathing, wheezing
generalized edema
laryngeal edema (neck closing up)
what is bronchitis
inflammation of bronchi that may damage lung tissue
symptoms of bronchitis
production of sputum
chronic cough
difficulty breathing, wheezing
tachypnea
chronic bronchitis - blue bloater!
what is bronchiolitis
inflammation of bronchioles; usually happens in children under 2yrs
symptoms of bronchiolitis
shortness of breath
wheezing
tachypnea
tachycardia
coughing
fever
dehydration
how to remember bronchitis vs bronchiolitis symptoms
bronchiolitis affects the bronchioles –> there are much more of bronchioles than bronchi hence there are more symptoms to bronchiolitis
what is congestive heart failure
heart fails to pump blood because heart is too weak or stiff to fill and pump blood properly (including coronary artery disease)
symptoms of congestive heart failure and why
crackles in lungs - CHF causes fluid buildup in lungs
paroxysmal nocturnal dyspnea and orthopnea - blood flow not strong enough to keep circulation going while lying down
edema in lower extremities - decreased efficiency of blood pumping and returning to heart
symptoms of common cold
cough
sore throat
runny or stuffy nose
symptoms of COVID
cough
fever
dyspnea
chest pain
anosmia (lack of smell)
what is croup
viral infection that leads to narrowing of upper respiratory system; more commonly in children
symptoms of croup
fever
barking cough (bc of swollen vocal cords)
stridor
mostly in pediatric patients
what is diphtheria?
severe infection of nose and throat; can be prevented with vaccine
symptoms of diphtheria
thick grey sheet at the back of mouth
difficulty breathing and swallowing
sore throat
fever
symptoms of emphysema
pink puffer
barrel chest
pursed lip breathing
dyspnea or exertion
cyanosis
wheezing
more in older patients
what is epiglottitis
inflammation of epiglottis caused by infection
symptoms of epiglottitis
drooling
high fever
difficulty swallowing
severe sore throat
stridor
particular sitting position eg tripod or sniffing
more seen in pediatric patients
symptoms of pertussis, whooping cough
coughing spells with a “whoop” sound
fever
what is pertussis (whooping cough)
highly contagious airborne infection
most commonly found in children < 6 yrs
pneumonia
green, red or rust-colored sputum
localized wheezing or crackles
chills
fever
dyspnea
symptoms of pneumothorax
chest pain with dyspnea
decreased breath sounds on the AFFECTED SIDE
subcutaneous emphysema (air gets into the skin, causing a person to look swelled up)
what is pulmonary embolus/embolism
blood clot that gets lodged in the pulmonary system and backs up the flow of blood
symptoms of pulmonary embolus
occasionally sharp chest pain
occurs suddenly
tachycardia
clear breath sounds initially
dyspnea
signs of tension pneumothorax
decreased or absent breath sounds on one side
hypotension
JVD
altered LOC
severe dyspnea
tracheal deviation (late sign)
what is respiratory syncytial virus
viral infection of lungs and breathing passages that can lead to other conditions like bronchitis and pneumonia
symptoms of respiratory syncytial virus
wheezing
cough
fever
dehydration
symptoms of tuberculosis
bloody sputum
fever
cough
fatigue
influenza type A (flu) symptoms
fever
cough
runny/stuffy nose
sore throat
fatigue
danger of providing assisted ventilations to a patient with end-stage COPD
in patients with end-stage COPD, ventilations are usually controlled by hypoxic drive. low O2 concentrations will stimulate more ventilations. hence assisted ventilations with high oxygen delivery can slow or completely stop ventilations in an end-stage COPD patient
how to manage croup?
administer humidified oxygen
can you use bronchodilators for croup?
not recommended. it can make it worse
what is wheezing associated with?
anaphylaxis
pneumonia
asthma
COPD
CHF
bronchitis
why is croup rarely seen in adults?
adults have a larger respiratory tract so it is less affected by inflammation and mucus production
what vaccine is used against epiglottitis
vaccine against Haemophilus influenzae
how to treat children with epiglottitis
allow them to sit in a comfortable position
do not put anything in their nasal passages as it might cause full obstruction
what causes decreased or absent breath sounds
hemothorax
pneumothorax
tension pneumothorax
atelectasis (collapsed lung)
asthma
COPD
what is rhonchi associated with?
COPD
pneumonia
bronchitis
*rmb rhonchi is because of mucus
what causes stridor
croup
epiglottitis
what are crackles associated with?
pneumonia
pulmonary edema/CHF
*crackles = fluid
PASTE mnemonic for finding out more about respiratory issues
Progression - did it occur gradually or suddenly
Accompanied by chest pain?
Sputum
Talking tiredness
Exercise tolerance
trade name of albuterol
proventil, ventolin, volmax
albuterol: action and conditions it treats?
dilates bronchioles
for asthma, bronchitis and COPD
not for chronic conditions
trade names for beclomethasone
beclovent, beconase, qvar, vanceril
beclomethasone: action and conditions it treats?
anti-inflammatory
asthma
for chronic, not acute conditions
trade name of cromolyn
intal
cromolyn: action and conditions it treats?
decreases release of histamines
asthma
for chronic not acute conditions
fluticasone: action and conditions it treats?
anti-inflammatory
asthma
chronic not acute conditions
trade name for fluticasone
flovent diskus
tradename for fluticasone + salmeterol
advair diskus
trade name for ipratroprium bromide
atrovent
ipratropium bromide, albuterol, levalbuterol and metaprotorenal sulfate have what shared actions and addressed conditions
dilate bronchioles
for asthma, bronchitis, COPD
for acute not chronic conditions
how to assist a patient administer an MDI (like an inhaler)?
1) check medication, dose and expiration date
2) instruct patient about inhaling deeply while pressing MDI and holding breath
3) reapply supplemental oxygen if it was first used
advair diskus: action and conditions it treats?
decreases secretions
asthma
chronic, not acute conditions
ipratropium bromide: action and conditions it treats?
dilates bronchioles
asthma
bronchitis
COPD
acute, not chronic
when to use CPAP
for patients with moderate to severe respiratory distress as a result of underlying disease, who are alert and conscious
how to assist a patient in administering a nebulizer?
1) check medication, dose, route and expiration date
2) pour medication into nebulizer container (usually the whole thing). sometimes saline can be added to get it to optimal volume
3) attach medication tube to nebulizer, mouthpiece and tubing. attach it to oxygen tubing connected to oxygen cylinder (flow rate: 6L/min)
4) instruct patient to inhale and hold for 3-5 seconds before exhaling
5) do this until medication runs out or the patient no longer has shortness of breath
what do you NOT attempt on a patient with epiglottitis?
inserting airway adjunct or suctioning because it can trigger a spasm and cause full airway obstruction
what is CPAP?
continuous positive airway pressure: for chronic patients who need assisted ventilation.
harsh, high-pitched inspiratory sounds are characteristic of:
stridor
at the onset of an acute asthma attack, patients commonly experience difficulty breathing and:
a) rales and rhonchi
b) audible stridor
c) expiratory wheezing
d) profound cyanosis
b) audible stridor
two processes that occur during respiration are:
a) diffusion and oxygenation
b) inhalation and exhalation
c) oxygenation and ventilation
d) ventilation and diffusion
b) inhalation and exhalation
When assessing for fluid collection in the lungs during auscultation of lung sounds, you should:
A. note the presence of a high-pitched whistling sound, which is an indicator of fluid in the lungs.
B. pay special attention to the exhalation phase because this is when you will likely hear rales or rhonchi.
C. start at the lower lung fields and determine at which level you start hearing clear breath sounds.
D. auscultate the posterior chest first and compare the apex of one lung to the base of the opposite lung.
C. start at the lower lung fields and determine at which level you start hearing clear breath sounds.
Where are fine crackles usually located in the respiratory system? Select-all-that-apply:
A. Bronchi
B. Trachea
C. Alveoli
D. Bronchioles
C. Alveoli
D. Bronchioles
When would the nurse expect to auscultate coarse crackles during the respiratory cycle?
A. end of inspiration
B. beginning of inspiration
C. end of expiration
D. throughout inspiration and expiration
B. beginning of inspiration
Which statement below best summarizes why fine crackles are occurring in a patient?
A. “The pleural layers in the lungs are inflamed and rub against each other creating a harsh-grating sound.”
B. “When inhaled air enters into small airways that are collapsed, they suddenly explode open leading to a crackling sound.”
C. “As air leaves the trachea and bronchus it hits secretions like mucus and fluid, which creates a snoring like sound.”
D. “The narrowing of the larynx and trachea from either an object or swelling leads a popping sound on inhalation.”
B. “When inhaled air enters into small airways that are collapsed, they suddenly explode open leading to a crackling sound.”
Which patient below would be at risk for experiencing high-pitched wheezes? Select all that apply:
A. A patient with COPD.
B. A patient with epiglottitis.
C. A patient with heart failure.
D. A patient with asthma.
A. A patient with COPD.
D. A patient with asthma.
fine crackles
timing:
pitch:
continuous/discontinuous:
location:
characteristic:
timing: end of inspiration (bc of sudden opening of small airways)
pitch: high
discontinuous
location: small airways - bronchioles and alveoli
characteristic: like popping bubble wrap rapidly, cannot be cleared with a cough
coarse crackles
timing:
pitch:
continuous/discontinuous:
location:
characteristic:
timing: towards the start of inspiration (bc it it located in bronchi) and can extend to expiration
pitch: low
continuous/discontinuous: discontinuous
location: bronchi
characteristic: gurgling, bubbling sound; cannot be cleared with a cough
wheezes
timing:
pitch:
continuous/discontinuous:
location:
characteristic:
timing: mainly during inspiration, but can be during both (bc inspiration is an active process)
pitch: high
continuous/discontinuous: continuous
location: throughout resp. tract
characteristic: musical, squeaky tone
rhonchi
timing:
pitch:
continuous/discontinuous:
location:
characteristic:
timing: mainly expiration (bc of air passing out of mucous in trachea & bronchi)
pitch: low
continuous/discontinuous: continuous
location: large airways (trachea and bronchi)
characteristic: snoring sound
stridor
timing:
pitch:
continuous/discontinuous:
location:
characteristic:
timing: inspiration or expiration
pitch: high
continuous/discontinuous: continuous
location: upper resp system
characteristic: screeching, squawking (because of inflammation in trachea and voice box!!)
You assess a patient with difficulty breathing who has a history of COPD and is breathing through pursed lips. What is the patient trying to do while breathing through pursed lips?
a. Providing back pressure to the alveoli
b. Providing oxygen a way to move out of the lungs
c. Providing oxygen into the lungs and moving carbon dioxide out of the lungs
d. Providing a way to get air to the blood stream
c. Providing oxygen into the lungs and moving carbon dioxide out of the lungs
You have been dispatched to a private residence for a 24-year-old male having a seizure. Upon arrival at the scene, you find the patient lying on the living room floor in a postictal state. As you approach the patient, you note that he is breathing at 14 breaths per minute. The victim’s sister stated that she called 911 after she walked into the house and found her brother lying on the ground seizing.
Your initial approach to this patient should include:
a. Placing a nasopharyngeal airway and perform bag-valve assisted ventilations at a rate of 10-12 per minute.
b. Placing an oropharyngeal airway and perform bag-valve assisted ventilations at a rate of 10 to 12 per minute.
c. Opening the airway using the modified jaw-thrust maneuver followed by bag-valve assisted ventilations.
d. Opening the airway using the modified jaw-thrust maneuver followed by the administration of high-flow oxygen through a nonrebreather mask.
d. Opening the airway using the modified jaw-thrust maneuver followed by the administration of high-flow oxygen through a nonrebreather mask.
You respond to an unresponsive patient at a local festival. Upon your arrival, bystanders say the patient has been drinking heavily. As you assess the patient, you note a heavy odor of alcohol. The patient is responsive to painful stimuli, has gurgling respirations and vomitus on his face, and breathing deeply at 14 times per minute.
What are the initial airway management priorities for this patient?
a. Open the airway, suction, apply a nonrebreather mask at 15 L/min, and monitor the patient’s airway
b. Open the airway, insert an oral airway, and place the patient on a non-rebreather mask at 10 L/min
c. Open the airway, suction the airway, and ventilate the patient with a bag-valve-mask device
d. Open the airway, insert an oral airway, and ventilate the patient with a bag-valve-mask device
a. Open the airway, suction, apply a nonrebreather mask at 15 L/min, and monitor the patient’s airway
The anatomy of the airway consists of the upper and the lower airway. The upper airway starts at the mouth and Nares and ends at the _________?
A. Thyroid cartilage
B. Epiglottis
C. Cricoid cartilage
D. Vocal cords
C. Cricoid cartillage
You are an EMT, eating lunch with your partner at a local park when a panicked lady runs towards you, holding a baby in obvious respiratory distress. She tells you that she’s babysitting the 10-month-old female and saw the baby’s three-year-old brother shove a whole grape into her mouth, and she started choking on it. The babysitter tells you she doesn’t know what to do. What treatment would you immediately provide?
A) Perform ten back slaps followed by five chest thrusts, repeating until the grape is dislodged or the patient becomes unresponsive.
B) Perform five abdominal thrusts followed by five chest thrusts, repeating until the grape is dislodged or the patient becomes unresponsive.
C) Perform five back slaps followed by five chest thrusts, repeating until the grape is dislodged or the patient becomes unresponsive.
D) Perform five back slaps followed by five abdominal thrusts, repeating until the grape is dislodged or the patient becomes unresponsive.
C) Perform five back slaps followed by five chest thrusts, repeating until the grape is dislodged or the patient becomes unresponsive.
