LO9 Respiratory Assessment

Question 1

Proper ventilation is necessary because

Answer 1

provide adequate oxygen to the blood stream and to remove carbon dioxide increasing the amount of available oxygen ensures that even a patient who is not moving adequate volumes of gas (hypoventilation) can still maintain adequate oxygen saturation

Question 2

negative pressure vacuum effect

Answer 2

the expansion of the chest and downward movement of the diaphragm create negative pressure in the thorax areas pull through the mouth and the nose and is sucked into the trachea

Question 3

negative pressure vacuum effect occurs because

Answer 3

the thorax is essentially an airtight box with a flexible diaphragm at the bottom and an open tube at the top which air is sucked into and fills the increasing space inside the thorax

Question 4

sucking chest wound

Answer 4

holes in the thorax provides a place for air to be sucked in

Question 5

When multiple ribs are broken in more than one place

Answer 5

causing a flail chest free-floating sections of the thorax get pulled in when you breathe limiting the amount of air that can be sucked into the trachea

Question 6

Retraction

Answer 6

or in drawing of the intercostals in ribs when airflow is restricted by disease processes exhibited by infants and small children

Question 7

what happens When you ventilate someone with positive pressure

Answer 7

air is forced into the upper airway and flows into both the trachea and esophagus unless steps are taken to help direct it into the trachea

Question 8

Exhalation is normally a what kind of process

Answer 8

Exhalation is normally a passive process

Question 9

exhalation is no longer passive process when

Answer 9

When a patient has trouble exhaling they may need to use a domino muscles to push air out when this occurs exhalation is no longer passive process and indicates obstructive disease

Question 10

Difficulty in inhalation may indicate

Answer 10

upper airway obstruction

Question 11

Four parts of the brain responsible for

Answer 11

the smooth rhythmic respirations one area helps control rate, another depth, another inspiratory pause, another rhythmicity

Most of these respiratory centres are in and around the brain stem

Question 12

Apneustic breathing

Answer 12

results from damage to the apneustic center in the brain which regulates inspiratory pause

A patient exhibiting apneustic respirations will have a short, brisk inhalation with a long pause before exhalation which is indicative of severe pressure within the cranium or direct trauma to the brain

Question 13

Biot respirations

Answer 13

are seen when the center that controls breathing rhythm is damaged

Grossly irregular sometimes with lengthy apneic periods

Question 14

Cheyne stroke respirations

Answer 14

are a high brain function

Deep sleepers and intoxicated peoplewill exhibit this type of respiratory pattern

The depth of breathing gradually increases then decreases followed by an apneic period

Exaggerated Cheyne stroke respirations may be seen in patients who have a severe brain injury the apneic period may last 30 to 60 secs

Question 15

Hering-breuer reflex

Answer 15

limits inspiration and may cause coughing if you take too deep a breath

Question 16

Agonal respirations

Answer 16

irregular gasps that are a few and far between usually represent strain or logical impulses in the dying patient it’s not unusual for patients who are pulseless to have an occasional agonal gasp

Question 17

Ataxic respirations

Answer 17

completely irregular respirations that indicates severe brain injury or brainstem herniation

Question 18

Bradypnea

Answer 18

unusually slow respirations

Question 19

Central neurogenic hyperventilation

Answer 19

rapid and deep respirations caused by increased intercranial pressure or direct Brain Injury drives CO2 levels down and pH levels up resulting in respiratory alkalosis

Question 20

Hypernea

Answer 20

unusually deep breathing seen in various neurological or chemical disorders certain drugs may stimulate this type of breathing in patients who have overdosed it does not reflect respiratory rate only respiratory depth

Question 21

Hypopnea

Answer 21

unusually shallow respirations

Question 22

Kussmaul respirations

Answer 22

the same pattern as central neurogenic hyperventilation but caused by the body’s response to metabolic acidosis the body is trying to rid itself of blood at the tone via the lungs these are seen in patients who have diabetic keto acidosis and are accompanied by a fruity breath odour the mouth and lips are usually cracked and dry

Question 23

Respiration

Answer 23

is the process by which oxygen is taken into the body distributed to the cells and used by the cells to make energy it takes place in each cell

The primary by product of this process is carbon dioxide the respiratory system is involved in the delivery of the oxygen to the blood stream and the removal of waste carbon dioxide from the body

Question 24

When the lungs are not working adequately carbon dioxide is not efficiently disposed of and accumulates in the blood

Answer 24

this combines with water to form bicarbonate ions and hydrogen ions also known as acid resulting in acidosis

Question 25

Hyperventilation

Answer 25

the person breathe faster or deeper than normal and blows off more carbon dioxide than usual resulting in alkalosis

Question 26

Anxiety

Answer 26

can be an early sign of hypoxia while confusion, lethargy and coma or typically later signs

Question 27

Dizziness and tingling extremities

Answer 27

could signify hyperventilation

Question 28

Injury high in the spinal cord

Answer 28

may paralyze the intercostal muscles and even the diaphragm resulting in the inability of respiratory muscles to function normally in response to the respiratory drive

Question 29

Bodies immediate response to hypoxaemia

Answer 29

is to increase the heart rate to deliver a higher volume of blood to tissues to compensate for lower blood oxygen levels

Question 30

Severe hypoxia often causes

Answer 30

bradycardia

Question 31

Orthopnea

Answer 31

shortness of breath

Question 32

Renal status

Answer 32

Fluid balance, acid base balance and blood pressure are controlled by the kidneys

Each of these factors also affects of pulmonary mechanics and hence the delivery of oxygen to tissues patients with severe renal disease often present with a respiratory signs and symptoms so you should always note signs of severe renal disease when evaluating the condition of the patient

Question 33

The classic presentation of a patient with emphysema

Answer 33

(pink puffer) includes a barrel chest, muscle wasting and pursed lip breathing search patients are often tachypneic and do not typically present with profound hypoxia and cyanosis

Question 34

Patients who have chronic bronchitis tend to be

Answer 34

more stationary and may be obese these patients are often encountered in a chair or recliner they may be surrounded by cups full of mucus, inhalers, several medication’s

Question 35

A spontaneous pneumothorax tends to occur in

Answer 35

tall, thin young adults and women who smoke and take birth control pills or predisposed to pulmonary embolus

Question 36

Tripod position

Answer 36

involves leaning forward and rotating the scapula outward by placing the arms on a table or by placing the hands on my knees the stabilizes the shoulder girdle improves efficiency of accessory breathing muscles and decreases the total with a breathing

Question 37

Purposeful hyperextension

Answer 37

occurs when a patient maximize airflow through the upper airway

Question 38

Head tilt chin lift or sniffing position

Answer 38

This position may indicate upper airway swelling but is also commonly seen in patients who are trying to maximize airflow maintaining this position uses a valuable energy

Question 39

head bobbing

Answer 39

A patient who is severely ill with respiratory disease begins to feel fatigue here she may hold her head up in the sniffing position during inhalation letting it fall during exhalation this head bobbing is very ominous sign signalling potential eminent decompensation

Question 40

Chest wall retractions

Answer 40

these are most common in infants and small children with a rigid structure of the thorax is still flexible on an elation the child may pull the sternum and ribs into the chest causing a visible deformity with each breath

Question 41

Soft tissue retractions

Answer 41

in most patients the bones are rigid and do not move but the soft tissue is pulled in around the bones

Question 42

Tracheal tugging

Answer 42

the thyroid cartilage is pulled upward and the area just above the sternal notch is sucked in word with inhalation

Question 43

Pyridoxal respiratory movement

Answer 43

the epigastrium is pulled in with inhalation while the abdomen pushes out creating a seesaw appearance as the two move in opposing directions

Question 44

Pulses paradoxus

Answer 44

profound intrathoracic pressure changes caused the peripheral pulses to weaken on inspiration these pulses are easier to palpate during exhalation

Question 45

Minute volume

Answer 45

respiratory rate X tidal volume

Question 46

decline in PAO2

Answer 46

hypoxaemia will manifest initially as restlessness, confusion and in worst case scenario is a combative behaviour

Question 47

increase in PaCO2

Answer 47

usually has sedative effects making the patient sleepy

Question 48

Healthy adults have a haemoglobin level of

Answer 48

120 to 140 g/L

Question 49

healthy persons will begin to exhibit the blue discolouration of cyanosis one about

Answer 49

50 g/L is desaturated meaning their oxygen saturation would be roughly 65%

Question 50

Chocolate brown skin:

Answer 50

high levels of methemoglobin derive from nitrates in some toxic exposures may turn the mucous membranes brown

This transformation is typically more evident in the patient’s venous blood then in the skin and mucous membranes

Question 51

Hepatojugular reflux

Answer 51

occurs when mild pressure in the patient’s liver causes the jugular vein’s to engorge further this is a specific sign of right heart failure

When a patient is in respiratory distress and they’re sitting up in a semi Fowler 45° position it is easy to check for hepatojugular reflux

Question 52

Tracheal deviation is a classic sign of

Answer 52

tension pneumothorax

Question 53

Tracheal breath sounds

Answer 53

are not commonly auscultated but know how harsh and tubular they sound

Question 54

bronchial breath sounds

Answer 54

are also quite loud but no the exhalation predominates

Question 55

peripheral bronchialvascular sounds

Answer 55

are softer and have equal inspiratory and expiratory sides

Question 56

Sound moves better through

Answer 56

fluid than air

Question 57

The breath sounds of a patient who has one sided pathological condition will sound

Answer 57

louder over the side with abnormality then they will over the healthy side

Question 58

Managing patients with dyspnea

Answer 58

Supportive prehospital care, ensure airy adequacy, administer high concentration supplemental oxygen therapy and provide monitoring and transport for patients
Treatment of bronchoconstriction with bronchodilators

Question 59

Rehydration

Answer 59

is supplemental therapy for patients with respiratory problems who are dehydrated

Always assess breath sounds before an after giving a fluid bolus to make certain you do not have volume overload

Question 60

circulation potential common signs of anaphylaxis

Answer 60

Tachycardia, hypertension and shock

Question 61

IV access anaphylaxis

Answer 61

IV access is important because the anaphylactic patient will need fluid replacement anaphylaxis causes leakage of fluid into tissues necessitating administration of large amounts of IV fluid

Question 62

Puritis

Answer 62

itching

Question 63

what does epinephrine do for anaphylaxis

Answer 63

vasoconstriction, improvement of cardiac contractility, bronchodilation and suspension of the release of histamine

Question 64

If the patient is on a beta blocker and needs epilepsy

Answer 64

they may not be a good response Epnephrine so give glucagon