Respiratory Flashcards
What does the supine position suggest?
That they are too exhausted to stay upright.
What should a respiratory assessment include?
Listen for audible noises Skin colour Breathing rate Regularity See if chest movements are deep or shallow. Limited rise and fall may suggest inadequate tidal volume. Asymmetrical breathing Use of accessory muscles and indrawing Pursing of lips, head bobbing or nasal flaring Coughing Saturations
What are some physical indicators of respiratory distress?
Skin discolouration Retractions in the muscles of the neck Jugular venous distension (sometimes the jugular veins will stand our and pulse) Indrawing Altered level of consciousness Abnormal lung soundsq
What is the normal respiration rate in an infant?
25-50 breaths per minute
Whats the normal respiration rate for a child?
18-30 breaths
Whats the normal respiration rate for an adult?
12-20 breaths
What are normal lungs sounds called?
Vesicular
What are crackles?
Bubbling or crackling noises heard on inspiration. Characterised by discrete discontinuous sounds each lasting just a few milliseconds. Which may be fine, high pitched or coarse. These are associated with fluid in the airways. Usually hear these sounds at the base of the lobes in patients sitting upright.
What does the tripod position indicate?
It indicates that they are trying to open their chest by leaning forward. it shows that they are mildly distressed.
What is a wheeze?
A high pitched musical or whistling sound. Heard mainly on expiration. Associated with the narrowing of bronchioles (bronchospasm). Commonly heard in the asthma patient.
What is stridor?
High pitched sound heard during inspiration and expiration (but more prevalent during inspiration). It is associated with obstruction of the upper airway.
What are the three characteristics of asthma?
Bronchospasm
Oedema
Increased mucous production
How does increased mucous production affect asthma?
Leads to blockages of the smaller airways
How does oedema affect asthma?
Leads to swelling of the linings of the bronchioles and therefore narrowing
How does bronchospasm affect asthma?
Causes increased resistance due to decreased bronchiole diameter.
Is exhalation an active or passive process in asthmatics?
Active, as they have to overcome greater resistance in order to breath out. This involves using accessory muscles. The air that is forced through these constricted airways creates the wheezing noise.
What does the absence of a wheeze in an asthmatic patient suggest?
It does not always mean they are getting better. If it is still coupled with poor perfusion, altered level of consciousness etc it may mean they are no longer moving a sufficient amount of air to make a noise. This indicates their condition is deteriorating as they are exhausted.
What other factors do we take into consideration when determining the seriousness of an asthmatic patient?
The length of time from onset of the episode
Recent admissions to hospital, particularly ICU
Ongoing medications such as steroids
Recent affliction with chest infections or colds
What is status asthmaticus?
A prolonged asthma attack that does not respond to medication
What are the symptoms of mild-moderate asthma?
SOB Air movement Ability to speak sentences No significant chest/neck indrawing Wheeze
What are the symptoms of severe-life threatening asthma?
Extreme SOB Not much air movement Few words per breath Marked indrawing unless exhausted Probably not moving enough air to create a wheeze
What are the three diseases classified as CORD?
Chronic bronchitis
Emphysema
Chronic asthma
What is chronic bronchitis?
Inflammation of the bronchial tubes
Considered chronic when a patient has a productive cough for three months of the year for two years.
Smoking is a major causative factor
What are the characteristics of chronic bronchitis?
Oedema and thickening of the lining of the bronchioles - results in air trapping of the alveoli.
Excessive mucus production in bronchioles or bronchi - results in air trapping of the alveoli.
Restricted air movement
Compromised gas exchange
Wheezing produced by air being forced through constricted airways.
Why is chronic bronchitis often called the blue bloater?
Because a chronic bronchitis patient will often have:
Cyanosis of the face/lips
Excess weight
Vigorous productive cough
Crackles and wheeze on auscultation
A History of frequent persistent pulmonary infections.
What is the pathophysiology of emphysema?
Usually caused by smoking or toxic environments which lead to destructive lung changes.
There is a narrowing of the lower airways and a loss of elasticity in the alveolar walls.
This leads to air trapping and distended alveolar walls which then break down.
This means that less surface area is in contact with the capillaries so there is less gas exchange. The result is lower oxygen and higher carbon dioxide levels.
What are the symptoms of emphysema?
Restricted air movement. Thin barrel shaped chest. Pink colouration Pursed lip breathing Prolonged expiration Dyspnoeic on exertion Wheezing Diminished breath sounds
What is the main difference in asthma and CORD?
Asthmatics are usually under 50 and symptom free between attackes.
CORD patients are usually over 50 and are not symptom free between attacks
How do we manage CORD?
Oxygen to keep saturations between 88-92%
Nebulised bronchodilators. Alternating between 5 min on and 5 min off if their sats are greater than 92% during the neb.
ICP back up if their condition is moderate-severe.
