Respiratory emergency lecture

Question 1

What are upper airway breathing noises?

Answer 1

crowing
gurgling
snoring
stridor

Question 2

What is crowing?

Answer 2

a sound like a crow cawing that occurs when the muscles around the larynx spasm and narrow the opening into the trachea. Air rushing through the restricted passage causes the sound.

Question 3

what is gurgling?

Answer 3

sound like gargling, usually indicates the presence of blood, vomitus, secretions, or other liquid in the airway. Immediately suction the substance from the airway.

Question 4

What is snoring?

Answer 4

occurs when the upper airway is partially obstructed by the tongue or by relaxed tissues in the pharynx

Question 5

What is stridor?

Answer 5

harsh, high-pitched sound heard during inspiration. It is characteristic of a significant upper airway obstruction from swelling in the larynx. Stridor may also be heard if a mechanical obstruction by food or other objects is present.

Question 6

What is a COPD

Answer 6

Chronic obstructive pulmonary disease
causes an obstruction of airflow through the respiratory tract, leading to a reduction in gas exchange
examples: emphysema and chronic bronchitis

Question 7

What is Emphysema?

Answer 7

a permanent disease process distal to the terminal bronchioles that is characterized by the destruction of the alveolar walls and the distention of the alveolar sacs and a gradual destruction of the pulmonary capillary beds with a severe reduction in the alveolar/capillary area in which gas exchange can occur

Question 8

What are key points of Emphysema?

Answer 8

more common in men than in women and the primary causation factor is cigarette smoking

lung tissue loses its elasticity, the alveoli become distended with trapped air, and the walls of the alveoli are destroyed.
pt retains more co2

Exhaling becomes an active rather than a passive process, requiring muscular contraction, and the patient uses most of his energy to breathe.

Question 9

What are the emphysema s/s?

Answer 9

-Pursed-lip breathing dead give away that they are having -trouble emptying air out of their lungs
-Extreme difficulty of breathing on minimal exertion
-Pink complexion (These patients are often called “pink puffers.”)
-Tachypnea (breathing rate usually greater than 20 per minute at rest)
-Tachycardia
-Diaphoresis
-Tripod position
-May be on home oxygen to treat episodic cases of asthma.

Question 10

What is chronic bronchitis?

Answer 10

DEFINED AS Productive cough for two of more months for two or years in a row.

Question 11

What are the key points of chronic bronchitis?

Answer 11

the alveoli remain unaffected by the disease, but inflamed and swollen bronchioles and thick mucus restrict airflow to the alveoli so that they do not expand fully, causing respiratory distress and possible hypoxia.

Recurrent infections leave scar tissue that further narrows the airway.

A major problem with chronic bronchitis is the swelling and thickening of the lining of the lower airways and an increase in mucus production.

The airways become very narrow, causing a high resistance to air movement and chronic difficulty in breathing.

Question 12

what are the s/s of chronic bronchitis?

Answer 12

Chronic cyanotic complexion (They are often called “blue bloaters”.)

Difficulty in breathing, but less prominent than with emphysema

Vigorous productive chronic cough with sputum

Coarse rhonchi usually heard upon auscultation of the lungs

Wheezes and possibly crackles at the bases of the lungs
Respiratory infections that lead to more acute episodes

Question 13

What is pneumonia

Answer 13

acute infectious disease, caused by bacterium or a virus that affects the lower respiratory tract and causes lung inflammation and fluid- or pus-filled alveoli. This leads to poor gas exchange and eventual hypoxia.

Question 14

What is pulmonary edema?

Answer 14

the presence of fluid in the space between the alveoli and the capillaries that surround them, interfering with gas exchange.
most significant problem associated with pulmonary edema is hypoxia

often associated with left side heart failure

Question 15

What is a pulmonary embolism?

Answer 15

a sudden blockage of blood flow through a pulmonary artery or one of its branches. The embolism is usually caused by a blood clot, but it may also be caused by an air bubble, a fat particle, a foreign body, or amniotic fluid.

Question 16

what is a thrombosis?

Answer 16

it is a clot

Question 17

What are key points of risk factor for pulmonary embolism?

Answer 17

Patients at risk for suffering a pulmonary embolism are those who experience long periods of immobility, with heart disease, recent surgery, long-bone fractures, venous pooling associated with pregnancy, cancer, deep vein thrombosis (development of clots in the veins, most commonly in the legs); those taking estrogen therapy; and those who smoke.

Question 18

What is cardiogenic pulmonary edema?

Answer 18

typically related to an inadequate pumping function of the heart that drastically increases the pressure in the pulmonary capillaries. This forces fluid to leak into the space

Question 19

what is noncardiogenic pulmonary edema?

Answer 19

known as acute respiratory distress syndrome (ARDS), results from destruction of the capillary bed that allows fluid to leak out. Common causes of noncardiogenic pulmonary edema are severe pneumonia, aspiration of vomit, submersion, narcotic overdose, inhalation of smoke or other toxic gases, ascent to a high altitude, and trauma.

Question 20

What are the s/s of pulmonary embolism?

Answer 20

Unexplained dyspnea
Sudden onset of sharp, stabbing chest pain predominantly during inhalation
Cough (might cough up blood)
Tachypnea
Tachycardia
Syncope (fainting)
Cool, moist skin
Restlessness, anxiety, or sense of doom
Decrease in blood pressure or hypotension (late sign)
Cyanosis (might be severe) (late sign)
Distended neck veins (late sign)
Crackles
Fever

Question 21

What are the s/s of pulmonary edema?

Answer 21

Dyspnea, especially on exertion
Difficulty in breathing when lying flat
Pink and/or frothy sputum (cardiogenic cause only)
Tachycardia
Anxiety, apprehension, combativeness, and confusion
Tripod position with legs dangling
Fatigue
Crackles and possibly wheezing on auscultation
Cyanosis or dusky-color skin
Pale, moist skin
Distended neck veins (cardiogenic cause only)
Swollen lower extremities (cardiogenic cause only)
Cough
Fever
Symptoms of cardiac compromise (cardiogenic cause only)

Question 22

What is spontaneous pneumothorax?

Answer 22

portion of the visceral pleura ruptures without any trauma having been applied to the chest. This allows air to enter the pleural cavity, disrupting its normally negative pressure and causing the lung to collapse.

Question 23

What are the two types of spontaneous pneumothorax?

Answer 23

primary and secondary

Question 24

What is primary spontaneous pneumothorax?

Answer 24

patients who have no underlying lung disease. Primary spontaneous pneumothorax occurs in patients in their teenage years to early 20s who are tall and thin.

Question 25

What is Secondary spontaneous pneumothorax?

Answer 25

Occurs in patients in which there is underlying lung disease. Many also have a history of cigarette smoking or a connective tissue disorder such as Marfan syndrome or Ehlers-Danlos syndrome.

Question 26

What are the s/s of spontaneous pneumothorax?

Answer 26

Sudden onset of shortness of breath
Sudden onset of sharp chest pain or shoulder pain
Decreased breath sounds to one side of the chest (most often heard first at the apex, or top, of lung)
Subcutaneous emphysema (can be found)
Tachypnea
Diaphoresis
Pallor
Cyanosis

Question 27

What is hyperventilation syndrome?

Answer 27

The hyperventilation syndrome patient is often anxious and feels unable to catch his breath.
The patient then begins to breathe faster and deeper, causing many of the signs and symptoms of hyperventilation to occur.
The true hyperventilation syndrome patient will “blow off” excessive amounts of carbon dioxide, which further worsens the signs and symptoms.
The patient becomes more anxious because of the symptoms and breathes even faster.
One result is that the amount of calcium in the body decreases, causing the muscles of the feet and hands to cramp

Question 28

what are the s/s of hyperventilation syndrome?

Answer 28

Fatigue
Nervousness and anxiety
Dizziness
Shortness of breath
Chest tightness
Numbness and tingling around the mouth, hands, and feet
Tachypnea
Tachycardia
Spasms of the fingers and feet causing them to cramp (carpopedal spasm)
Seizures that may be precipitated in a patient with a seizure disorder

Question 29

What is epiglottitis?

Answer 29

inflammation affecting the upper airway, can be an acute, severe, life-threatening condition if left untreated

Do not inspect or place anything in the mouth of a patient with suspected epiglottitis.

Question 30

What are the s/s of epiglottitis?

Answer 30

Upper respiratory tract infection, usually for 1 to 2 days prior to onset
Dyspnea, usually with a more rapid onset
High fever (although it can occur with only mild fevers)
Sore throat and pharyngeal pain
Inability to swallow with drooling (late sign of impending failure)
Anxiety and apprehension
Tripod position, usually with jaw jutted forward (late sign of impending failure)
Fatigue
High-pitched inspiratory stridor
Cyanosis
Trouble speaking or pain during speaking

Question 31

What is Pertussis?

Answer 31

“whooping cough” a respiratory disease that is characterized by uncontrolled coughing. It is a highly contagious disease that affects the respiratory system and is caused by bacteria that reside in the upper airway of an infected person.

Question 32

What are some key points on Pertussis?

Answer 32

patient develops episodes of rapid coughing (15 to 24 episodes in close sequence) as the body attempts to expel thick mucus from the airway, followed by a “crowing” or “whooping” sound made during inhalation as the patient breathes in deeply.

has been found to occur in all age brackets, but it is mostly reported in children

Complications of pertussis include pneumonia, dehydration, seizures, brain injuries, ear infections, and even death

Question 33

What is s/s of Pertussis?

Answer 33

History of upper respiratory infection
Sneezing, runny nose, low-grade fever
General malaise (weakness, fatigue, not feeling well)
Increase in frequency and severity of coughing
Coughing fits, usually more common at night
Vomiting
Inspiratory “whoop” heard at the end of coughing burst
Possible development of cyanosis during coughing burst
Diminishing pulse oximetry finding
Exhaustion from expending energy during coughing burst
Trouble speaking and breathing (dyspnea) during coughing burs

Question 34

What is cystic Fibrosis?

Answer 34

a hereditary disease. Although it commonly causes pulmonary dysfunction because of changes in the mucus-secreting glands of the lungs, it also affects the sweat glands, the pancreas, the liver, and the intestines

Question 35

What are viral respiratory infections?

Answer 35

condition of the respiratory system caused by a virus. Common VRIs include bronchiolitis, colds, and the flu.

Question 36

What are the s/s of VRI

Answer 36

Nasal congestion
Sore or scratchy throat
Mild respiratory distress, coughing
Fever (usually approximately 101°F–102°F)
Malaise
Headaches and body aches
Irritability in infants and poor feeding habits
Tachypnea
Exacerbation of asthma if patient is asthmatic

Question 37

What is Asthma?

Answer 37

characterized by an increased sensitivity of the airways to irritants and allergens, causing bronchospasm, which is a diffuse, reversible narrowing of the bronchi and bronchioles, as well as inflammation to the lining of the lower airways.

Question 38

what are the s/s of asthma?

Answer 38

dyspnea
tachycardia
tachypnea
cough
wheezing
use of accessory muscles
Anxiety and apprehension.
Speaks in sentences (mild), phrases (moderate), or only words or syllables (severe).

Question 39

what is pulsus paradoxus

Answer 39

drop in systolic blood pressure of > 10 during inhalation)