Respiratory Flashcards
Tachypnea Causes
Fever
Respiratory distress
Toxins
Hypoperfusion
Brain lesion
Metabolic acidosis
Anxiety
Bradypnea Causes
Narcotics/sedative
Drugs/ETOH
Metabolic disorders
Hypoperfusion
Fatigue
Brain injury
Cheyne-Stokes respirations
Alternating periods of increased & decreased rate & depth w/ brief periods of apnea
Causes:
-Increased ICP
-CHF
-Renal failure
-Toxins
-Acidosis
*Repeating pattern
*May indicate spinal injury
Biot’s respirations
Similar to Cheyne-Stokes but irregularly irregular
Cause:
-Meningitis
-Increased ICP
-Neurological emergency
Kussmaul’s respirations
Deep & fast breaths lacking any apneic periods (Deep labored breathing that indicates severe acidosis)
Cause:
-Metabolic
-Renal failure
-Diabetic ketoacidosis
Apneustic respirations
A long, gasping inspiration followed by a very short expiration in which the breath is not completely expelled. Result is chest hyperinflation (causes severe hypoxemia)
Causes:
-Brain lesion
Central neurogenic hyperventilation
Very deep & rapid respiratory rate (>25)
Central nervous system acidosis triggers rapid, deep breathing = systemic alkalosis
Stridor
inspiration
-Croup
-Epiglottitis
-FBA
Rhonchi
Primarily expiration
-Frank aspiration
-Bronchitis
-Cystic fibrosis
-Pneumonia
Wheeze
Primarly expiration
-Reactive airway disease
-Asthma
-CHF
-Chronic bronchitis
-Emphysema
-Endobronchial obstruction
Wheeze
End-inspiration
-Pneumonia
-CHF exacerbation
-Pulmonary edema
Diminished breath sounds
Either or both
-Emphysema
-Atelectasis
-Pneumothorax (simple or tension)
-Flail chest
-Neuromuscular disease
-Pleural effusion
Pleural rub
Either
-Pleuritis
-Pleurisy
-Pleural effusion
Respiratory Distress TX
-Dual Neb
-IV & EtCO2
-Solumedrol (125mg)
-Mag (2g/15min)
-CPAP
-Epi (0.3mg of 1:1)
-Ventilatory Support
-Position of comfort
- Typically overweight
- Fatigue
- Chest discomfort
- Course Rhonchi or Wheezing
- Productive cough w/ sputum
Chronic Bronchitis
Increase in the number and size of mucus-producing glands, which results from prolonged exposure to irritants (most often cigarette smoke)
- Resistance on inspiration & expiration
- Chronic cyanosis
- Thin, barrel chested
- Swollen lower extremities
- Pink complexion
- Non productive cough
- Wheezing & Rhonchi
- Prolonged inspiration (pursed-lip breathing)
- Extreme dyspnea on exertion
Emphysema
Permanent abnormal enlargement of the air spaces beyond the terminal bronchioles and by destruction and collapse of the alveoli
- Productive cough w/ sputum production
- Pleuritic chest pain
- Tachypnea & Tachycardia
- Wheezing, crackles, or Rhonchi
- Flank or Back pain
- Fever “shaking chills”
- Anorexia
- Nausea/Vomiting
HX:
-Flu or Cold
-Over 65 or under 2 yrs
-Cystic Fibrosis, Asthma, COPD, Sarcoidosis
-Hospital, Long term Care Facility
-Weak immunity
Pneumonia
Specific infections that cause an acute inflammatory process of the respiratory bronchioles and the alveoli
Resp Distrss TX
-IV fluids to support blood pressure and to thin and loosen mucus
-Cardiac monitoring
-CPAP
- Dyspnea & Hypoxia
- Tachypnea & Tachycardia
- Increasing demand for supplemental O2 to maintain adequate saturation
- Fever & hypotension
- Rales/crackles (may or may not be heard on auscultation)
HX:
-Drug users/Workers = Inhaling chemicals
-Pneumonia
-Trauma
-Dialysis = Blood transfusions
-Alcoholic = Pancreatitis
-OD/Vomiting = Aspiration
-Swimming = Near drowning
Acute Respiratory Distress Syndrome
TX:
- Fluids (hypotension)
- Nitro
- Acute sharp chest pain (worse when breathing)
- Acute Dyspnea/Tachypnea
- Persistent Cough &/or Hemoptysis
- Acute wheezing/Rales
- ALOC/Anxiety/Syncope
- Acute tachycardia/cardiac arrhythmia
- DVT signs/Leg pain
- Fever
- Shock
HX:
- Recent surgery/Trauma
- DVT
- Pregnant
- Long Travel
- Bed rest/Inactivity
- Blood clotting Disorder
- HF/Afib/HTN/Diabetes/Smoker
Pulmonary Embolism
TX:
-High flow 02 (Vent if indicated)
-IV & EtCO2
-Nitro (Reduce right-sided workload & pain)
-Morphine (if pain persists)
-Fluids or Epi if Hypotensive (Caution to not over work heart)
-Tx for shock
- Dyspnea (on exertion)
- Orthopnea
- Chest pain
- Diminished breath sounds
- Better upright
HX:
- Infections/Pneumonia
- CHF
- PE
- Trauma
- Cancer/Tumors
- Autoimmune (Lupus, Rheumatoid Arthritis)
Pleural effusion
A buildup of fluid between the tissues that line the lungs and the chest;
Fluid can accumulate around the lungs due to poor pumping by the heart or by inflammation
- Dyspnea (cardinal symptom)
- Weakness
- Fatigue
- Syncope
- Increased S2 sound
- Tricuspid murmur
- Jugular venous pulsations
- Pittting edema
HX:
- Uppers
- Severe Chronic lung Disease
- Congenital Heart Disease
- Childbearing Aged Women
- 50-60 yr old Women
- Sickle Cell Disease
Pulmonary Artery Hypertension
TX:
-Nitro
-Versed (if indicated)
-EKG 12 lead
-Dental Pain
-Fever/Chills
-Drooling
-Sore Throat
-Chocking/Dysphagia or Suffocation
-Sublingual & Tongue Edema (Elevated Tongue)
-Firm, Red, & Edema in the anterior throat
HX:
-Dental Decay
-Severe Gingivitis & Cellulitis
Ludwig’s Angina
Deep-space infection below the mandible
-Persistent painful cough that lasts more than three weeks and usually brings up phlegm, which may be bloody
-Chest Pain
-Weight loss
-Night sweats
-Fever/Chills
-Fatigue
-Loss of appetite
-Acute & persistent Edema
HX:
-Close contact with a person with infectious TB
-Immigration from an area with a high prevalence of TB
-Age younger than 5 years
-Correctional facilities
-Homeless shelters
-Hospitals
-Nursing homes
-Living with IV drug users
TB
Acquired through inhalation of a dried-droplet nucleus containing tubercle bacilli (M tuberculosis, Mycobacterium bovis, or a variety of atypical mycobacteria)
-Pharyngitis
-Dysphagia
-Dyspnea
-Fever/Chills
-Neck Pain, Stiffness, or Redness
-Drooling
-Trismus (difficulty opening mouth)
-Vocal Changes
-Inspiratory Stridor
HX:
-ENT Infection
Retropharyngeal & Prevertebral Abscess
Infections that develop behind the esophagus & in front of the cervical vertebrae
- Acute Sharp/Stabbing Chest/Back pain
- Decreased breath sounds on affected side
- SOB & Tachypnea
- Tachycardia
- Diaphoresis
- Fatigue
- Altered mental status
- Pallor/Cyanosis
HX:
- Tall & Thin
- Smoker
- Asthma
- COPD
- Cystic fibrosis
- Tuberculosis
- Whooping cough
Spontaneous Pneumothorax
TX:
-Needle Decompress
-High flow 02/Ventilatory support)
-IV & EtCO2
-TX for shock
-Increasing dyspnea or difficulty ventilating with a bag-mask device
-Unilateral decreased or absent breath sounds
-Anxiety & Tachycardia
-Cyanosis
-Hypotension or unexplained signs of shock
-JVD
-Unequal expansion of the chest (tension does not fall with respiration)
-Subcutaneous emphysema
-Tracheal deviation (a late sign)
HX:
-Trauma
Tension pneumothorax
-Chest Pain
-SOB & Diminished breath sounds on affected side
-Tachypnea & Tachycardia
-Confusion, Restlessness/Anxiety
-Pallor
-Hypotension
HX:
-Trauma
-Surgery
-Blood Clotting Disorder
-Pulmonary Infacrtion
-Lung Cancer or TB
Hemothorax
Accumulation of blood in the pleural space caused by bleeding from the lung parenchyma or damaged vessels
-Flat neck veins
-Tachypnea & Dyspnea
-Cyanosis (often not evident in hemorrhagic shock)
-Diminished or decreased breath sounds
-Hypovolemic shock
-Narrow pulse pressure
HX:
-Trauma
Hemopneumothorax
-Tachypnea
-Tachycardia
-Cough
-Hemoptysis
-Apprehension
-Respiratory distress
-Dyspnea
-Crackles
-Evidence of blunt chest trauma
-Cyanosis
HX:
-Trauma
Pulmonary Contusion
-Stridor
-Dysphonia or Dysphagia
-Hemoptysis
-High riding hyoid bone
-Massive subcutaneous emphysema
-Dyspnea & Severe Hypoxia
-Tachypnea & Tachycardia
-Persistent Pneumothorax
-Respiratory Distress
HX:
-Trauma
Tracheobronchial injury
-Respiratory Distress (Anxious, Tachypneic, & Pale)
-Abdominal Pain & Tenderness
-Grey Turner Sign
-Decreased breath sounds
-Bowel sounds auscultated over the chest
Ruptured diaphragm
-Purple-red discoloration of the face and neck (the skin below the area remains pink)
-JVD
-Swelling or hemorrhage of the conjunctiva (subconjunctival petechiae may appear)
Traumatic asphyxia
Severe crushing injury to the chest and abdomen that results in an increase in intrathoracic pressure
-Whooping cough
-Runny nose
-Tearing eyes
-Fatigue
-Fever
-Difficulty breathing
-Vomiting
-Apnea, cyanosis
HX:
-Infant/PED
Pertussis
-Fever
-Severe cough
-Wheezing
-Tachypnea/Dyspnea
-Cyanosis
Infants are affected worse
RSV
Very common respiratory illness that infects the lower respiratory tract;
It usually occurs during the winter months
-High fever
-Muscle aches
-Cough
-Pneumonia
SARS
A form of Coronavirus
-Fever/Chills
-Muscle Aches
-Malaise
-Dry cough/SOB
-Headache/Dizziness
-Nausea/Vomiting
-Severe respiratory distress and shock
HX:
-Roden Infestation
Hantavirus
The virus is carried by rodents and is transmitted by inhalation of aerosol material contaminated with rodent urine and feces
Anaphylaxis TX
- IM Epi 0.3 (may repeat q 5-15 min)
- Duoneb (wheezing)
- Large Bore IV Access
- 20ml/kg fluid (hypotensive)
- Vitals & HX
- Diphenhydramine 1mg/kg (50mg max)
- Solumedrol 2mg/kg (125mg max)
