Chapter 16 Flashcards
wheezing
high-pitched, musical, whistling sound that is best heard initially on exhalation but can also be heard during inhalation in more severe cases. It is an indication of swelling and constriction of the inner lining of the lower airways, primarily the bronchioles
Rhonchi
also be referred to as coarse crackles, are snoring or rattling noises heard on auscultation. They indicate obstruction of the larger conducting airways of the respiratory tract by thick secretions of mucus. Rhonchi are often heard in chronic bronchitis, emphysema, aspiration, and pneumonia.
crackles/rales
bubbly or crackling sounds heard during inhalation. These sounds are associated with fluid that has surrounded or filled the alveoli or small bronchioles.
can indicate pulmonary edema or pneumonia
hypoxemia
decreased oxygen in bloodstream
hypercarba
increased co2 in bloodstream
common s/s of respiratory distress
-Subjective complaint of shortness of breath
-Restlessness and anxiety
-Tachycardia (early finding)
-bradycardia (later finding)
-Tachypnea
-Pale, cool, clammy skin (early finding)
-cyanosis (later finding)
-Abnormal respiratory pattern
-Wheezing, rhonchi, or crackles
-Difficulty or inability to speak
-Muscle retractions
-Altered mental status
-Abdominal breathing
-Excessive coughing
-Tripod position
-Pulse oximeter reading < 94
breathing disturbance 3 categories
Respiratory distress
Respiratory failure
Respiratory arrest
respiratory distress
has a normal minute ventilation from compensation in the tidal volume (breathing deeper) and/or the respiratory rate (breathing faster). Because the tidal volume and respiratory rate are still adequate, the patient is compensating
respiratory failure
when the tidal volume or respiratory rate is inadequate and no longer can provide an adequate oxygenation of the cells. If the tidal volume decreases or the respiratory rate increases or decreases significantly, you must provide immediate positive pressure ventilation and oxygenation with a bag-valve-mask device or other ventilation device
respiratory arrest
complete cessation of breathing effort or the patient experiences agonal breathing
diseases that cause respiratory problems
Obstructive pulmonary diseases
-Emphysema
-Chronic bronchitis
-Asthma
Pneumonia
Pulmonary embolism
Pulmonary edema
Spontaneous pneumothorax
Hyperventilation syndrome
Epiglottitis
Pertussis
Cystic fibrosis
Poisonous exposures
Viral respiratory infections
emphysema
permanent disease process distal to the terminal bronchioles that is characterized by the destruction of the alveolar walls and the distention of the alveolar sacs and a gradual destruction of the pulmonary capillary beds with a severe reduction in the alveolar/capillary area in which gas exchange can occur.
more common in men
emphysema s/s
Anxious, alert, and oriented
Dyspneic
Uses accessory muscles
Thin, barrel-chest appearance
Coughing, but with little sputum
pink puffer
Prolonged exhalation
Diminished breath sounds
Wheezing and rhonchi on auscultation
Pursed-lip breathing (physiologic PEEP)
Extreme difficulty of breathing on minimal exertion
Tachypnea—breathing rate usually greater than 20 per minute at rest
Tachycardia
Diaphoresis (sweating; moist skin)
Tripod position
May be on home oxygen
chronic bronchitis
characterized by a productive cough that persists for at least three consecutive months a year for at least two consecutive years.
involves inflammation, swelling, and thickening of the lining of the bronchi and bronchioles and excessive mucus production
chronic bronchitis s/s
Cough (hallmark sign) is prominent; vigorous coughing produces sputum
blue bloater
Minimal difficulty in breathing and anxiety, unless in respiratory failure
Scattered rales (crackles) and coarse rhonchi
Wheezes and, possibly, crackles at the bases of the lungs
Asterixis (flapping of the extended wrists) may be seen in respiratory failure
asthma
increased sensitivity of the airways to irritants and allergens, causing bronchospasm, which is a diffuse, reversible narrowing of the bronchi and bronchioles, as well as inflammation to the lining of the lower airways.
extrinsic asthma
results from a reaction to dust, pollen, smoke, or other irritants in the air
intrinsic asthma
usually results from infection, emotional stress, or strenuous exercise.
asthma s/s
dyspnea
coughing
wheezing
tachypnea
tachycardia
use of accessory muscles
diaphoresis
anxiety
chest tightness
difficulty sleeping
pulsus paradoxus
critically ill asthma s/s
upright position
tachypnea
tachycardia
pulsus paradoxia
pale cool diupheretic skin
single word speech
accessory muscle use
wheezing
decreasing conciousness
extreme fatigue
spo2 < 90 w/o2
pneumonia
acute infectious disease caused by bacterium or a virus that affects the lower respiratory tract and causes lung inflammation and fluid- or pus-filled alveoli
pneumonia s/s
decreased appetite
fever
cough
dyspnea or tachypnea
tachycardia
sharp localized chest pain worse with deep breath/cough
shallow respirations
self splinting thorax
Crackles, localized wheezing, and rhonchi
Altered mental status, especially in the elderly
Diaphoresis
Cyanosis
pulmonary embolism
sudden blockage of blood flow through a pulmonary artery or one of its branches. The embolism is usually caused by a blood clot, but it can also be caused by an air bubble, a fat particle, a foreign body, or amniotic fluid
pulmonary embolism s/s
Sudden onset of unexplained dyspnea
Signs of difficulty in breathing or respiratory distress; rapid breathing
Sudden onset of sharp, stabbing chest pain predominantly during inhalation
Cough (might cough up blood)
Tachypnea
Tachycardia
Syncope (fainting)
Cool, moist skin
Restlessness, anxiety, or sense of doom
Decrease in blood pressure or hypotension (late sign)
Cyanosis (might be severe) (late sign)
Distended neck veins (late sign)
Crackles
Fever
signs of complete circulatory collapse
two types of pulmonary edema
cardiogenic and noncardiogenic
cardiogenic pulmonary edema
related to an inadequate pumping function of the left ventricle that drastically increases the pressure in the pulmonary capillaries, which forces fluid to leak into the space between the alveoli and capillaries and, eventually, into the alveoli.
noncardiogenic pulmonary edema
known as acute respiratory distress syndrome (ARDS), results from destruction of the capillary bed that allows fluid to leak out. Common causes of noncardiogenic pulmonary edema are severe pneumonia, aspiration of vomitus, submersion, narcotic overdose, inhalation of smoke or other toxic gases, ascent to a high altitude, sepsis, and trauma
pulmonary edema
excessive amount of fluid collects in the spaces between the alveoli and the capillaries
which makes less oxygen available to the blood flowing through the capillaries (perfusion)
pulmonary edema s/s
Dyspnea, especially on exertion
Difficulty in breathing when lying flat (orthopnea)
Pink and/or frothy sputum (cardiogenic cause only)
Tachycardia
Anxiety, apprehension, combativeness, and confusion
Tripod position with legs dangling
Fatigue
Crackles and possibly wheezing on auscultation
Cyanosis or dusky-color skin
Pale, moist skin
Distended neck veins (cardiogenic cause only)
Swollen lower extremities (cardiogenic cause only)
Cough
Fever
Symptoms of cardiac compromise (cardiogenic cause only)
spontaneous pneumothorax
sudden rupture of a portion of the visceral lining of the lung, not caused by trauma, that causes the lung to partially collapse.
primary spontaneous pneumothorax
Occurs in patients who have no underlying lung disease. Primary spontaneous pneumothorax occurs in patients in their teenage years to early 20s who are tall and thin. It
secondary spontaneous pneumothorax
Occurs in patients in which there is underlying lung disease. Many also have a history of cigarette smoking or a connective tissue disorder such as Marfan syndrome or Ehlers-Danlos syndrome. It also occurs in patients who have a history of lung disease such as COPD
spontaneous pneumothorax s/s
Sudden onset of shortness of breath
Sudden onset of sharp chest pain or shoulder pain
Decreased breath sounds to one side of the chest (most often heard first at the apex, or top, of lung)
Subcutaneous emphysema (can be found)
Tachypnea
Diaphoresis
Pallor
Cyanosis (can be seen late and in a large or tension pneumothorax)
hyperventilation syndrome
pt is often anxious
patient begins to “blow off” excessive amounts of carbon dioxide
hyperventilation syndrome s/s
Fatigue
Nervousness and anxiety
Dizziness
Shortness of breath
Chest tightness
Numbness and tingling around the mouth, hands, and feet
Tachypnea
Tachycardia
Spasms of the fingers and feet causing them to cramp (carpopedal spasm)
Seizures that may be precipitated in a patient with a seizure disorder
epiglotitis
epiglottis, area around the epiglottis, and base of the tongue become infected. As the condition progresses, the epiglottis and the structures connected to or immediately surrounding it and the base of the tongue become inflamed and swollen
epiglotitis s/s
Upper respiratory tract infection, usually for 1 to 2 days prior to onset
Dyspnea, usually with a more rapid onset
High fever (although it can occur with only mild fevers)
Sore throat and pharyngeal pain
Inability to swallow with drooling (late sign of impending failure)
Anxiety and apprehension
Tripod position, usually with jaw jutted forward (late sign of impending failure)
Fatigue
High-pitched inspiratory stridor
Cyanosis
Trouble speaking or pain during speaking
pertussis “whooping cough”
respiratory disease that is characterized by uncontrolled coughing. It is a highly contagious disease that affects the respiratory system and is caused by bacteria that reside in the upper airway of an infected person
pertussis s/s
History of upper respiratory infection
Sneezing, runny nose, low-grade fever
General malaise (weakness, fatigue, not feeling well)
Increase in frequency and severity of coughing
Coughing fits, usually more common at night
Vomiting
Inspiratory “whoop” heard at the end of coughing burst
Possible development of cyanosis during coughing burst
Diminishing pulse oximetry finding
Exhaustion from expending energy during coughing burst
Trouble speaking and breathing (dyspnea) during coughing burs
cystic fibrosis
abnormal gene alters the functioning of the mucous glands lining the respiratory system, and there is an overabundant production of mucus, which is thick and sticky. As this thick mucus layer develops, there is blockage of the airways as well as an increase in the incidence of lung infections because bacteria can readily grow in the thick mucus
cystic fibrosis
Commonly a known history of the disease
Recurrent coughing
General malaise (weakness, fatigue, and not feeling well)
Expectoration of thick mucus during coughing
Recurrent episodes or history of pneumonia, bronchitis, and sinusitis
Gastrointestinal complaints that can include diarrhea and greasy and foul-smelling bowel movements
Abdominal pain from intestinal gas
Malnutrition or low weight despite a healthy appetite
Dehydration
Clubbing of the digits
Trouble speaking and breathing (dyspnea) with mucus buildup
Signs of pneumonia
most common poison exposures
Carbon monoxide
Cyanide
Natural gas
Chlorine gas
Liquid chemicals or sprays
Ammonia
Sulfur dioxide
Anesthetic gases
Solvents
Industrial gases
Hydrogen sulfide
Fumes/smoke from fires
Paints or Freon
Glue (Toluene)
Nitrogen dioxide (silo gas)
Amyl or butyl nitrate
Viral Respiratory infections
a condition of the respiratory system caused by a virus. Common VRIs include bronchiolitis, colds, and the flu.
VRI s/s
Nasal congestion
Sore or scratchy throat
Mild respiratory distress, coughing
Fever (usually approximately 101°F–102°F)
Malaise
Headaches and body aches
Irritability in infants and poor feeding habits
Tachypnea
Exacerbation of asthma if patient is asthmatic
metered-dose inhaler (MDI) or small-volume nebulizer (SVN) indicators
signs and symptoms of respiratory distress from bronchoconstriction.
patient has a physician-prescribed metered-dose inhaler or small-volume nebulizer,
EMT has received approval from medical direction, whether on-line or off-line, to administer the medication
metered-dose inhaler (MDI) or small-volume nebulizer (SVN) contraindications
The patient is not responsive enough to use the MDI or SVN.
The MDI or SVN is not prescribed for the patient or is not in the EMTs protocol.
Medical direction has not granted permission.
The patient has already taken the maximum allowed dose(s) prior to your arrival.
chronic obstructive pulmonary disease COPD s/s
Cough
TachypneaChange or increase in sputum production
Dyspnea with prolonged expiratory phase
Tripod posture
Diffuse wheezing
Decreased breath sounds
bilaterally (severe)
Barrel chest
Purse lip breathing
