Respiratory Emergencies - Causes of Dyspnea part 2 & Assessment Flashcards
A lung disease that is characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible
Chronic obstructive pulmonary disease
COPD
Chronic obstructive pulmonary disease
An umbrella term that is used to describe several lung diseases, including emphysema and chronic bronchitis
COPD
An ongoing irritation of the trachea and bronchi
Chronic bronchitis
Cause of COPD
Direct lung and airway damage from repeated infections or inhalation of toxic gases and particles. But most commonly from cigarette smoking
With ___, excess musus is constantly produced, obstructing small airways and alveoli
Bronchitis
Chronic oxygenation problems can lead to ___
High-side heart failure and fluid retention, such as edema in the legs
Most common form of COPD
Emphysema
Loss of elastic material in the lungs that occurs when the alveolar air spaces are chronically stretched due to inflamed airways and obstruction of airflow out of the lungs
Emphysema
Most patients with COPD will ___
Chronically produce sputum, have a chronic cough, and have difficulty expelling air from their lungs, with long expiration phases and wheezing
Patients with pulmonary edema caused by congestive heart failure will often have ___ lung sounds. Those who it is caused by COPD will often have ___ lung sounds
- Wet
- Dry
Asthma, hay fever, and anaphylaxis are the result of ___
An allergic reaction
An acute spasm of the bronchioles associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages
Asthma
Asthma produces ___
A characteristic wheezing on exhalation, the same air passages open easily on inhalation
In severe cases of asthma, ___ may develop
Cyanosis and/or respiratory arrest
Allergic rhinitis
Hay fever
Hay fever causes ___
Coldlike symptoms, including runny nose, sneezing, congestion, and sinus pressure
Severe allergic reaction characterized by airway swelling and dilation of blood vessels all over the body, which may lower BP
Anaphylaxis
Most anaphylactic reactions occur within ___ of exposure to the allergen
30 minutes
Partial or complete accumulation of air in the pleural space
Pneumothorax
Pneumothorax caused by trauma or medical conditions is called ___
Spontaneous pneumothorax
The natural elasticity of the lung tissue causes the lung to ___ during pneumothorax
Collapse
Who is most susceptible to spontaneous pneumothorax
- Patients with emphysema and asthma when a weakened portion of the lung ruptures, often during severe coughing
- Tall, thin young men, particularly while performing strenuous activites
A patient with spontaneous pneumothorax has ___ and might report ___
- Dyspnea
- Pleuritic chest pain
A sharp, stabbing pain on one side that is worse during inspiration and expiration or with certain movement of the chest wall
Pleuritic chest pain
Collection of fluid outside the lung on one or both sides of the chest
Pleural effusion
What does pleural effusion do?
Compresses the lung or lungs and causes dyspnea
The fluid in pleural effusion may collect in large volumes in response to ___
Any form of irritation such as infection, congestive heart failure, or cancer
When you listen with a stethoscope to a patient with dyspnea resulting from pleural effusion, you will hear ___
Decreased breath sounds over the region of the chest where the fluid has moved the lung away from the chest wall
Patients with pleural effusion will frequently feel better if they are ___
Sitting upright
Always consider ___ first in patients who were eating just before becoming short of breath
Upper airway obstruction
Anything in the circulatory system that moves from its point of origin to a distant site and lodges there, obstructing subsequent blood flow in that area
Embolus
Emboli can be ___
Fragments of blood clots that break off and travel through the bloodstream, or foreign bodies that enter the circulation such as a bubble of air
A blood clot fired in a vein, usually in the legs or pelvis, that breaks off and circulates through the venous system
Pulmonary embolism
The embolus can also come from the ___ in a patient with atrial fibrillation
Right atrium
Pulmonary emboli may occur as as result of ___
Damage to the lining of vessels, a tendency for blood to clot unusually fast, or most often, slow blood flow in a lower extremity
Slow blood flow in the legs is usually caused by ___
Long-term bed rest
Risk factors for pulmonary emboli
Pregnancy, active cancer, and bed rest, as well as recent surgery in the legs or pelvis
Signs and symptoms of pulmonary emboli
- Dyspnea (often sudden onset)
- Tachycardia
- Tachypnea
- Varying degrees of hypoxia
- Cyanosis
- Acute chest pain
- Hemoptysis
Hemoptysis
Coughing up blood
Buildup of excess base in the body fluids
Alkalosis
Possible causes of hyperventilation
Patient with diabetes with high blood glucose level, overdose of aspirin, or a severe infection
Hyperventilation is the body trying to compensate for ___
Acidosis
Alkalosis is the cause of many of the symptoms associated with ___
Hyperventilation syndrome
Hyperventilation syndrome symptoms
- Anxiety
- Dizziness
- Numbness
- Tingling of the hands and feet
- Carpopedal spasms
Painful spasms of the hands and/or feet
Carpopedal spasms
Hyperventilation syndrome breath range
- As high as 40 shallow breaths/min
- As low as 20 deep breaths/min
How to treat hyperventilation
Initially verbally instruct to slow breathing, if that doesn’t work, give oxygen and transport to the hospital
In cases of patient exposure to industrial chemicals at an industrial site, the patient needs to be ___
Decontaminated by trained responders before you take responsibility
After a patient has been decontaminated from exposure to industrial chemicals, you should ___
Gather info from the first responders about the substance and the cause of dyspnea
Inhalation injuries can cause ___
Aspiration pneumonia that can result in pulmonary edema. Can also cause lung damage
People exposed to CO may think they have the ___
Flu
Patients exposed to CO initially report ___
Headache, dizziness, fatigue, nausea, and vomiting. May report dyspnea on exertion and chest pain and display nervous system symptoms such as impaired judgement, confusion, or even hallucinations
The worst CO exposures may result in
Syncope or seizure
Treatment for conscious CO poisoning patients
Removal from space and high-flow oxygen by nonrebreathing mask
Treatment of unconscious or those with an altered LOC CO poisoning patient
May need all airway control with an airway adjunct and ventilation using a bask-mask device
The worst case patients of CO poisoning may be treated with ___
Hyperbaric or pressurized oxygen therapy
If there are multiple people with dyspnea, consider the possibility of ___
An airborne hazardous material release
A patient in significant respiratory distress will want to ___
Sit up
If the patient is in respiratory distress ___
Place them in the Fowler or semi-Fowler position and administer oxygen at 15 L/min via non-rebreathing mask
If the patient’s breathing has inadequate depth or the rate is too slow, ___
Ventilations may need to be assisted with a bag-mask device
Questions to ask yourself when evaluating a patient’s ventilations
- Is air going in and out
- Does the chest rise and fall with each breath
- Is the rate appropriate for the age of the patient
Life threats to the patient found in the primary assessment
- Problems with the ABCs
- Poor initial general impression
- Unresponsiveness
- Potential hypoperfusion or shock
- Chest pain associated with a low BP
- Severe pain anywhere
- Excessive bleeding
Placement of the stethoscope when listening to breath sounds from the back
Place the head between and below the scapulae
Normal breath sounds made by air moving in and out of the alveoli
Vesicular breath sounds
Abnormal breath sounds, such as wheezing, stridor, rhonchi, and crackles
Adventitious breath sounds
Normal breath sounds made by air moving through the bronchi
Bronchial breath sounds
Make sure to listen for a ___ at each location on the chest
Full respiratory cycle
When assessing for fluid collection in the lungs, ____
Pay special attention to the lower lung fields. Start from the bottom up and determine at which level you start to hear clear breath sounds
Snoring sounds are indicative of a ___
Partial upper airway obstruction, usually in the oropharynx
Wheezing indicates ___
Constriction and/or inflammation in the bronchus
Wheezing is generally heard ___
On exhalation as a high-pitched, almost musical or whistling sound
Crackles used to be called ___
Rales
The sounds of air trying to pass though fluid in the alveoli
Crackles
A crackling or bubbling sound typically heard on inspiration
Crackles
High-pitched crackles are called ___
Fine crackles
Low-pitched crackles are called ___
Coarse crackles
Low-pitched rattling sounds caused by secretions or mucus in the larger airway
Rhonchi
Rhonchi are sometimes referred to as ___
Junky lung sounds
The high-pitched sound heard on inspiration as air tries to pass through an obstruction in the upper airway
Stridor
This sound indicates a partial obstruction of the trachea
Stridor
Any sign or symptom that commonly accompanies a particular condition, but is absent
Pertinent negative
Diseases associated with wheezes
- Asthma
- COPD
- Congestive heart failure
- Pneumonia
- Bronchitis
- Anaphylaxis
Diseases associated with rhonchi
- COPD
- Pneumonia
- Bronchitis
Diseases associated with crackles
- Congestive heart failure
- Pneumonia
Diseases associated with stridor
- Croup
- Epiglottitis
Diseases associated with decreased or absent breath sounds
- Asthma
- COPD
- Pneumonia
- Hemothorax
- Pneumothorax
- Atelectasis
Questions to ask about a patient in respiratory distress
- What is the patient’s general state of health
- Has the patient had any childhood or adult diseases
- Have there been any recent surgical procedures or hospitalizations
- Have there been any traumatic injuries
An additional assessment for a compliant of shortness of breath or difficulty breathing uses the mnemonic ___
PASTE
PASTE
P: Progression
A: Associated chest pain
S: Sputum
T: Talking tiredness
E: Exercise tolerance
A secondary assessment of the cardiovascular system, especially when there is associated chest pain, should include ___
Checking and comparing distal pulses, reassessing the skin condition, and being alert for bradycardia and tachycardia
