Respiratory Conditions Flashcards
How can respiratory conditions cause hypoxia?
Airway obstruction
Impaired perfusion of the alveoli
What are obstructive airway conditions?
It is where pulmonary tissues causes obstruction to the free flow of air in the lungs
What are two examples of obstructive airway conditions?
COPD
Asthma
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
What are the two main COPD conditions?
Emphysema and chronic bronchitis
What percentage of people over 40 have COPD?
4.5%
How many people are living with COPD in the U.K.?
1.2 million
How much does COPD cost the NHS?
£9.9 billion annually
How many beds are taken up by COPD patients every year?
1 million
What is acute bronchitis?
It is short lived and is due to infection not COPD
What is chronic bronchitis?
Where the bronchus becomes inflamed and bronchial goblet cells secrete excess mucus which can block the airway
What is considered chronic bronchitis?
Persistent symptoms for at least 3 months of the year for 2 consecutive years to be considered chronic.
What are some risk factors of bronchitis?
Aged over 35
Are or have been a smoker
Had chest problems as a child
Been exposed to dust, fumes and chemicals as part of their job
What are some signs and symptoms of bronchitis?
Productive cough
Tachypnoea - rapid breathing
Dyspnoea - difficulty breathing
Use of accessory muscles
Decreased SPO2 - sats
Tachycardia - over 100 bpm
If hypoxia is severe, level of consciousness may be reduced
Slow capillary refill
Cyanosis (late sign)
Auscultations (stethoscope) may reveal rhonchi (low pitched rattling) and wheezes
Use of domiciliary O2
Heart failure
How would you manage bronchitis? (6)
Ensure an open airway - suction if required
Maintain patient in most comfortable position (as close to upright as possible)
Administer O2 according to JRCALC guidelines
Consider administration of salbutamol and ipratropium
Be prepared to ventilate
Collect sputum
What is emphysema? (3)
It is a distension (swelling) of the alveoli and destructive changes in the membranes
Lung tissue loses its elasticity and muscular integrity and collapses
Hypoxia is the main respiratory stimulus but patients are not usually cyanotic
What are some risk factors associated with emphysema? (5)
Aged over 35
Are or have been a smoker
Had chest problems as a child
Be exposed to dust, fumes and chemicals as part of their job
May have genetic condition called alpha-1-anti trypsin deficiency. This is rare but may cause COPD at a young age.
What are some signs and symptoms of emphysema?
Thin
Barrel chest
Tachypnoea - rapid breathing
Dyspnoea - difficult breathing
Use of accessory muscles
Pursed lips on expiration
Tachycardia
Confusion and anxiety may be present due to hypoxia
May be decreased lungs sounds
Wheezing and crackles on inspiration during auscultation (stethoscope)
Cardiac dysrhythmia (heart rhythm problems)
May be evidence of oedema (swelling caused by build up on fluid in body tissues, particularly in the ankles, wrists and legs)
How would you manage emphysema?
Ensure an open airway
Maintain patient in the most comfortable position (as close to upright as possible)
Administer O2 as per JRCALC guidelines
Consider administration of salbutamol and ipratropium
Be prepared to ventilate
What is asthma?
The narrowing of medium to small airways (particularly bronchi and bronchioles) due to muscle spasm, oedema and blockage by inflammatory cells
Can be caused by infections, cold air or inhaled irritants
What are the severities of asthma? (4)
Near fatal asthma
Life threatening asthma
Acute severe asthma
Mild/moderate exacerbated asthma
How do you treat mild/moderate asthma? (3)
Take patient to calm, quiet environment
Encourage use of own inhaler
If unresponsive to own inhalers, administer high doses of O2 and administer nebuliser salbutamol
How do you treat acute severe asthma? (5)
Administer high levels of supplement O2
Administer nebuliser salbutamol
If no improvement, administer ipratropium (must only be administered once after 1 dose of salbutamol and salbutamol must then continue unless no longer needed)
Administer steroids
Further salbutamol nebulisation may be necessary
How do you treat life threatening asthma? (6)
Administer high levels of supplement O2
Administer nebuliser salbutamol
If no improvement, administer ipratropium bromide
Administer steroids
Administer adrenaline 1:1000
Further salbutamol nebulisation may be necessary
How do you take a Peak Exploratory Flow? (9)
Ensure scale and meter are consistent with patients usual measurement
Measure peak flow before and after use of bronchodilators
Assemble device and ensure it is set to zero (or lowest point)
Place the patient in position of comfort, preferrebly standing
Ask patient to take deep breath, place device in their mouth and exhale as forcibly as possible, ensuring that the patient does not breath through their nose
Ensure that the patient does not obstruct the mechanism
Perform the test three times and take the best of three readings
Allow rest periods between measurements
Document results
What are some conditions caused by impaired perfusion of the alveoli?
Pneumonia Pleurisy Pulmonary embolism TB Industrial lung disease
What is pneumonia?
An acute inflammation of the lungs caused by bacteria and less commonly a virus
If often follows a cold, particularly in the elderly or those suffering from chronic bronchitis
What are some risk factors for pneumonia?
Babies and young children
People over 65
People with long term heart, lung and kidney disease, or diabetes
People with cancer, especially those having chemo
People on drugs that suppress the immune system, and those with HIV
People who smoke or drink alcohol to excess
What are some signs and symptoms of pneumonia?
Tachypnoea
Coughs up sputum which may be blood stained
Deep breaths and coughing may cause distressing chest pain
Tachycardia
Pyrexia
How would you manage pneumonia?
Ensure open airway
Administer O2 as per JRCALC
Monitor vital signs
What is pleurisy?
Inflammation of the pleura, often occurs with pneumonia
Has a characteristic rubbing sound when listening to chest using stethoscope (auscultation)
Treated in same way pneumonia
What is pulmonary embolism (PE)?
A blood clot blocking part of a pulmonary artery, which deprives part of a lung of its blood supply
May cause pulmonary infarction (lung death)
What are some causes of pulmonary embolism?
Deep vein thrombosis (DVT)
Elderly
Bed ridden
Recent operation
Long distance travel
Childbirth
Contraceptive pill
What are some signs and symptoms of pulmonary embolism?
Tachypnoea
Dyspnoea
Pleuritic pain
Cough
Haemoptysis (coughing blood)
Tachycardia
Apprehension (anxiety)
May have experienced leg pain (clinical DVT)
How would you manage pulmonary embolism?
Ensure open airway
Administer O2 as per JRCALC
Consider Entonox
Be prepared to perform CPR
What is tuberculosis (TB)?
Chronic lung infection that may persist for several years
Patient may not have any particular symptoms
What are some signs and symptoms TB?
Fever
Weight loss
Cough - often with haemoptysis
Often related to travel to TB infected countries
Is prevalent amongst patients with HIV or those who are homeless
What is hyperventilation syndrome?
A rate of breathing that exceeds metabolic demand
It’s is higher than what is required to maintain normal CO2 levels
What are some causes of hyperventilation syndrome?
Pulmonary embolism
Diabetic Ketoacidosis
Asthma
Hypovolemia
Emotional stress and anxiety
What does hyperventilation syndrome do that is problematic to the body in relation to gases?
CO2 levels decrease which in turn reduces the uptake of oxygen
Patients can begin to become hypoxic
What are some symptoms of hyperventilation?
Acute anxiety
Tetany (muscle spasms)
Carpopedal spasm (flexion of wrists/fingers, dorsiflexion of ankles and plantarflexion of toes.
Numbness and tingling of mouth and lips
Aching of chest
Feeling lightheaded
What is tetany?
Muscle spasm
What causes tetany?
Caused by malfunction of the parathyroid glands and a consequent deficiency of calcium
How do you manage hyperventilation?
Ensure open airway
If cyanosed or decreased SPO2 then administer O2
Maintain calm approach
Coach respiration’s and encourage talking
DO NOT USE PAPER BAG technique
What is industrial lung disease? (5)
Pneumoconiosis (inhalation and retention of dust)
Coal-workers pneumoconiosis (inhalation and retention of coal dust)
Silicosis (inhalation and retention of respirable crystalline silica)
Asbestosis (inhalation and retention of asbestos fibres)
Byssinosis (inhalation and retention of textile fibre dust - less common in the U.K.)
Was is spontaneous pneumothorax?
More common in young men
Caused by a leakage of air from a small spontaneous rupture in the lung surface creating a build up of air in the pleural cavity
What is open pneumothorax AKA sucking wound?
Air is sucked into a lung and pleural cavity through an open chest wound during inspiration
Some of the air may bubble out of the wound when the patient exhales
What are the general signs and symptoms of pneumothorax?
Dyspnoea
Panic
Cyanosis
Haemoptysis
Pain at site
Tachycardia
Tachypnoea
Possible asymmetry of chest wall
What is tension pneumothorax?
Air enters the pleural cavity through an open chest wound but cannot escape due to a flap of tissue acting as a one way valve
Every time the patient exhales, the intrathoracic pressure increases
This is very serious and can be fatal
What are some signs and symptoms of tension pneumothorax?
Extreme respiratory distress
Severe pain
Increasing cyanosis
Asymmetry of the chest wall
Diminished breath sounds (on affected side)
Hyperresonance (on affected side)
Possible evidence of subcutaneous emphysema (gas or air under layer of skin)
Tracheal deviation (late sign) - unequal intrathoracic pressure within chest cavity
What is surgical emphysema?
Air is subcutaneous tissues
Swelling of affected area
Crepitus over site (grating sound)
Most commonly affects neck and thorax
What is haemothorax?
Damage to the lungs and surrounding tissues causes bleeding into pleural cavity
What is haemothorax?
Accumulation of blood within the pleural cavity
How do you manage chest injuries?
Ensure open airway
100% O2
Consider assisting ventilations
Seal any wounds with a occlusive, three sided dressing (open at the lowest edge to allow for drainage)
What are some signs and symptoms of haemothorax?
Chest pain
Difficulty breathing
Reduced breath sounds on affected side
Rapid heart rate
