LO9 Respiratory Assessment Flashcards

1
Q

Proper ventilation is necessary because

A

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

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2
Q

negative pressure vacuum effect

A

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

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3
Q

negative pressure vacuum effect occurs because

A

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

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4
Q

sucking chest wound

A

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

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5
Q

When multiple ribs are broken in more than one place

A

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

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6
Q

Retraction

A

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

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7
Q

what happens When you ventilate someone with positive pressure

A

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

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8
Q

Exhalation is normally a what kind of process

A

Exhalation is normally a passive process

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9
Q

exhalation is no longer passive process when

A

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

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10
Q

Difficulty in inhalation may indicate

A

upper airway obstruction

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11
Q

Four parts of the brain responsible for

A

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

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12
Q

Apneustic breathing

A

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

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13
Q

Biot respirations

A

are seen when the center that controls breathing rhythm is damaged

Grossly irregular sometimes with lengthy apneic periods

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14
Q

Cheyne stroke respirations

A

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

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15
Q

Hering-breuer reflex

A

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

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16
Q

Agonal respirations

A

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

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17
Q

Ataxic respirations

A

completely irregular respirations that indicates severe brain injury or brainstem herniation

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18
Q

Bradypnea

A

unusually slow respirations

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19
Q

Central neurogenic hyperventilation

A

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

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20
Q

Hypernea

A

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

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21
Q

Hypopnea

A

unusually shallow respirations

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22
Q

Kussmaul respirations

A

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

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23
Q

Respiration

A

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

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24
Q

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

A

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

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25
Hyperventilation
the person breathe faster or deeper than normal and blows off more carbon dioxide than usual resulting in alkalosis
26
Anxiety
can be an early sign of hypoxia while confusion, lethargy and coma or typically later signs
27
Dizziness and tingling extremities
could signify hyperventilation
28
Injury high in the spinal cord
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
29
Bodies immediate response to hypoxaemia
is to increase the heart rate to deliver a higher volume of blood to tissues to compensate for lower blood oxygen levels
30
Severe hypoxia often causes
bradycardia
31
Orthopnea
shortness of breath
32
Renal status
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
33
The classic presentation of a patient with emphysema
(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
34
Patients who have chronic bronchitis tend to be
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
35
A spontaneous pneumothorax tends to occur in
tall, thin young adults and women who smoke and take birth control pills or predisposed to pulmonary embolus
36
Tripod position
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
37
Purposeful hyperextension
occurs when a patient maximize airflow through the upper airway
38
Head tilt chin lift or sniffing position
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
39
head bobbing
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
40
Chest wall retractions
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
41
Soft tissue retractions
in most patients the bones are rigid and do not move but the soft tissue is pulled in around the bones
42
Tracheal tugging
the thyroid cartilage is pulled upward and the area just above the sternal notch is sucked in word with inhalation
43
Pyridoxal respiratory movement
the epigastrium is pulled in with inhalation while the abdomen pushes out creating a seesaw appearance as the two move in opposing directions
44
Pulses paradoxus
profound intrathoracic pressure changes caused the peripheral pulses to weaken on inspiration these pulses are easier to palpate during exhalation
45
Minute volume
respiratory rate X tidal volume
46
decline in PAO2
hypoxaemia will manifest initially as restlessness, confusion and in worst case scenario is a combative behaviour
47
increase in PaCO2
usually has sedative effects making the patient sleepy
48
Healthy adults have a haemoglobin level of
120 to 140 g/L
49
healthy persons will begin to exhibit the blue discolouration of cyanosis one about
50 g/L is desaturated meaning their oxygen saturation would be roughly 65%
50
Chocolate brown skin:
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
51
Hepatojugular reflux
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
52
Tracheal deviation is a classic sign of
tension pneumothorax
53
Tracheal breath sounds
are not commonly auscultated but know how harsh and tubular they sound
54
bronchial breath sounds
are also quite loud but no the exhalation predominates
55
peripheral bronchialvascular sounds
are softer and have equal inspiratory and expiratory sides
56
Sound moves better through
fluid than air
57
The breath sounds of a patient who has one sided pathological condition will sound
louder over the side with abnormality then they will over the healthy side
58
Managing patients with dyspnea
Supportive prehospital care, ensure airy adequacy, administer high concentration supplemental oxygen therapy and provide monitoring and transport for patients Treatment of bronchoconstriction with bronchodilators
59
Rehydration
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
60
circulation potential common signs of anaphylaxis
Tachycardia, hypertension and shock
61
IV access anaphylaxis
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
62
Puritis
itching
63
what does epinephrine do for anaphylaxis
vasoconstriction, improvement of cardiac contractility, bronchodilation and suspension of the release of histamine
64
If the patient is on a beta blocker and needs epilepsy
they may not be a good response Epnephrine so give glucagon