Respiratory Flashcards
hypoxia
Less than normal levels of 02 in the cells
Hypoxaemia
less than normal levels of 02 in the blood
Pa02 <80mmHg (<60mmHg significant hypoxaemia)
Hypercapnia
greater than normal levels of C02
PaC02 >45mmHg
Hypocapnia
less than normal levels of C02 (can occur when someone hyperventilates)
PaC02 <35mmHg
mechanical insufficiency: structural damage
- nervous system (could be brain stem injury, nerve impulses that are interrupted, high spinal injury, altered respiration and depth, ventilation is affected)
- intercostal muscles (trauma to the chest of diaphragm, can’t take a deep breath or expire air properly, pain, bruising, break in chest, affects ventilation)
- diaphragm
- abdominal muscles (if you have normal breathing you shouldn’t need muscles, forced breathing uses abdominal muscle, or if nerves are affected in the abdominal muscles you loose the ability to ventilate in that way)
mechanical insufficiency: air way obstruction
physiological and foreign objects (asthma, allergen, ventilation is affected)
mechanical insufficiency: medication
CNS depressants (anastasia, or opioids, ventilation affects rate and depth of breathing, benzos, alcohol sedatives anything that affects RR)
Functional insufficiency
- cardiac compromise (anything that changes conductivity of contractility of the heart= less cardiac output = less perfusion less blood going back to the heart efficiently from the lungs oxygenated)
- pulmonary embolism (obstruction, blocks off blood vessels in the heart, perfusion problem, anything under the embolism doesn’t get blood flow)
- HB (haemoglobin, if you don’t have enough Hb you can’t carry enough oxygen)
- Tumor (blockage that will affect perfusion)
- infection
- COPD
- compliance (ability for the lungs to expand and recoil)
- resistance (losing fluid in the alveoli increases resistance)
- surface area
perfusion problem (air in/air out) (any problem in the airways causes problems with gas exchange and getting C02 out)
inflammation of bronchial walls: causing epithelial oedema = decreased air entry, decrease gas exchange (creates swelling, constricts the area to expand and recoil)
exudate in lower airways: causing obstruction to airflow= decrease air entry , decrease gas exchange
exudate in alveoli: causing increased diffusion distance= decreased gas exchange
inflammation in alveolar walls: causing increased diffusion distance = decreased gas exchange
perfusion problem (blood to lungs and body) heart problem, blood not getting into the lung, if your not getting oxygen blood into alveoli the blood gets shunted to somewhere else
- partial or complete obstruction to pulmonary artery: causing blood flow= decreased gas exchange (vale problem, clot, partially or fully closing off of the blood flow)
- ineffective functioning alveoli (from exudate or oedema): causing vasoconstriction of surrounding pulmonary capillaries = further decrease in gas exchange
clinical presentation: respiratory rate (RR)
always start with RR as that is usually the first to decline
- tachypnoea (abnormally rapid breathing/ bradypnoea (abnormally slow breathing rate)
- orthopnoea (difficulty breathing, feels like they are drowning)when lying down , is relieved when sitting up
- dyspnoea (person reports difficulty of laboured breathing)
- rhythm and depth (is the patient breathing normally in a normal rhythm, gasping can’t take a deep breath ect)
clinical presentation: breath sounds
- wheeze
- crackles
- stridor (upper airway sound, barking or seal sound on inspiration, always bas, airway is obstructed)
- reduced air entry
- cough
clinical presentation: accessory muscle use
increase work of breathing
- sternocleidomastoid
- scalenes
- trapezius
- pectoral minor/major
- abdominals
clinical presentation: positioning
(always in rapid assessment, if they are slumped over the airways is getting obstructed, thinking about sitting them upright, expand the thoracic cavity, open airways)
- upright
- tripod
- chest symmetry
clinical presentation: neurological changes (SNS response or gas exchange, hypoxaemia, hypoxia, maybe not enough oxygen going up to the brain cells, are they ventilating properly, sit upright, medication support)
- anxiety
- agitation
- confusion
- drowsiness
- pain
clinical presentation: skin
always look at the skin, mucous membranes, like the lips
- diaphoresis (excessive sweating) different normal sweat, clammy all over, dripping feel cold. increase metabolic effort, hypocapnia also causes this)
- pallor (pale)
- cyanosis (bluish colour of the skin due to poor circulation or oxygenation in the blood, peripheral shut down in the peripheries, shinting the blood to the core, causing problems, in the peripheries, looking at core cap refill, then looking at the mouth or face)
- flushing (face becomes red)
- digital clubbing
- mucous membranes 9( if its nice and pink and well perfused, pale or cyanosis is bad)
clinical presentation: sputum
- colour
- odour
- haemoptysis (coughing up blood)
WOB: 5 signs of respiratory distress
DiapHRaGM
- Diaphoresis (excessive sweating) different to normal sweating, clammy al over dripping in sweat and they feel cold. increased metabolic effort. hypocapnia
- Hypoxia (less than normal level of 02 in the cells
- Respiratory rate
- Gasping associated with running out of breath, RR starts to drop and they start gasping, rhythm changes too)
- Accessory muscle
Need to intervene quickly or they can go into respiratory arrest
what we can measure: RR, depth and pattern
can be measured but a degree of subjectivity depending on how it is calculated
what we can measure: Work of breathing
- accessory muscle use
nasal flaring/ pursed lip breathing - speaking long/short sentences, single words only, not speaking
- intercostal indrawing
what we can measure: peak flow measurement
- measurement of maximal forced exhaled air flow (L/min)
- baseline and to measure effectiveness of interventions
- useful for people with asthma
- used to keep an eye on maximal force
what we can measure: specialist tests
- CXR (chest X-ray)
- spirometry
- CT/MRI
- ABG (arterial blood gas)