Respiratory Tutorial Information

Question 1

In terms of the respiratory system and the rapid assessment. What would we assess under “a”

Answer 1

Airway Patency: Can this patient talk? Is their airway under threat?

Question 2

In terms of the respiratory system and the rapid assessment. What would we assess under “b”

Answer 2

Respiratory rate, Posterior chest assessment, Use of accessory muscles, Patient positioning, Peak flow, Are they requiring Oxygen supplement (method of delivery), are they speaking in full sentences?

Question 3

In terms of the respiratory system and the rapid assessment. What would we assess under “c”

Answer 3

SpO2, HR, BP, Capillary Refill, Colour of mucous membranes (in the mouth), Temp, Urine output (fluid balance chart + is it concentrated?), and diaphoresis?.

Question 4

In terms of the respiratory system and the rapid assessment. What would we assess under “d”

Answer 4

anxiety, fatigue, AVPU, COLDSPA (for pain or cough), orientation.

Question 5

In terms of the respiratory system and the rapid assessment. What would we assess under “e”

Answer 5

EWS, Braden, Fall risk, ADD, Smoking risk, adherence to medication, home/work environment, allergies?, cultural safety?, health history.

Question 6

What does SOAPIE stand for?

Answer 6

Subjective
Objective 
Analysis (diagnosis) 
Plan
Interventions
Evaluation

Question 7

What is dysponea?

Answer 7

Patient stating they are feeling short of breath

Question 8

What is orthopnea?

Answer 8

SOB when laying down

Question 9

What does SOB mean

Answer 9

Shortness of breath

Question 10

What does SOBOE mean?

Answer 10

Shortness of breath on exertion

Question 11

Whats the acronym we use to remember the posterior chest assessment?

Answer 11

I - General Inspection
P - Palpation
P - Percussion
A - Auscultation

Question 12

Whats involved in the general inspection (posterior chest assessment)?

Answer 12

General notes, positing, respiratory rate, shape of bony thorax, scars, masses, use of accessory muscles, AP - transverse diameter.

Question 13

Whats involved in the palpation (posterior chest assessment)?

Answer 13

Using hands on the back of the chest to assess chest (lung) expansion

Question 14

Whats involved in the percussion (posterior chest assessment)?

Answer 14

Using percussion (dull and resonant) to find the lung fields for ausculation

Question 15

Whats involved in auscultation (posterior chest assessment)?

Answer 15

Assessing the character and intensity of breath sounds, and adventitious sounds (crackes, wheeze, rubs).

Question 16

What are some examples of actual problems?

Answer 16

SOB, increased RR, increased WOB/accessory muscle use, inability to speak in full sentences, impending sense of doom, audible wheeze.

Question 17

What are some examples of potential problems?

Answer 17

decreased Sp02, increasing RR, increasing HR, increasing NZEWS, decreasing BP, central cyanosis, increasing confusion/agitation, increasing fatigue, loss of consciousness, and respiratory arrest.

Question 18

How do we treat asthma?

Answer 18

Bronchodilators (inhaler/nebuliser)
Corticosteroids (oral/IV/inhaled)
Metered Dose Inhaler (MDI/spacer/nebuliser use)
Oxygen therapy
Positioning (sit upright)
Reassurance to decrease anxiety with reduces SNS response.

Question 19

What are some quick facts about Short acting (SABAs) relievers?

Answer 19

Used for asthma
Provide relief for 4-6 hours
Can have an effect on the heart and cause tachycardia
Rapid onset (5-10mins)
Can be used in an acute asthma attack (blue inhalers)
Most common is Salbutamol

Question 20

What are some quick facts about long acting (LABAs) controlled?

Answer 20

Used for asthma
Has a long duration of action (12hrs) 
Slow onset of acton 
Doesnt work for acute situations
Most common is salmeterol.

Question 21

What are Inhaled corticosteroids - ICS used for?

Answer 21

As preventers for asthma

Question 22

How do inhaled corticosteroids work?

Answer 22

They reduce the hyperesponsiveness of the bronchial smooth muscle to irritants

Question 23

When you use a spacer to take inhaled corticosteroids what is important that you do?

Answer 23

Rinse mouth after administration to avoid infections (caused by the steroids)

Question 24

Inhaled corticosteroids make “what” more manageable?

Answer 24

Asthma

Question 25

What does an inhaler do?

Answer 25

Pushes out a pre-measured spray of asthma medicine

Question 26

What does a spacer do?

Answer 26

A spacer is a specially designed plastic tube for use with an inhaler. A spacer used with a puffer delivers more medication into the lungs than using puffer on its own. (This requires the patient to be calm and in control of the spacer)

Question 27

What does a nebuliser do?

Answer 27

A machine that converts liquid medication into a fine mist, which is inhaled through a mask or mouthpiece.

Question 28

Which is more effective? A spacer or a nebuliser?

Answer 28

A spacer is just as effective as a nebuliser for getting medicine into the lungs in an acute asthma attack. Its also faster to access and less expensive to use.

Question 29

What are the effects of hypercapnia?

Answer 29

Tachypnoea (inc RR) to “blow off” excess CO2

Use of accessory muscles to increase chest expansion and help with forces exhalation to expel CO2 and recruit O2

Question 30

What are the effects of Hypoxaemia?

Answer 30

Tachypnoea once PO2 is less than 60mmHg to recruit more OR into the blood stream
Activation of SNS response (inc HR + BP) to inc O2 circulation to tissues 
Peripheral vasoconstriction (poor peripheral perfusion) to preserve O2 for vital organs.

Question 31

A patient with COPD will have chronic hyper what?

Answer 31

Hypercapnia

Question 32

Chronic hypercapnia leads to what?

Answer 32

Low grade acidosis all the time

Question 33

What is low grade acidosis?

Answer 33

When the blood becomes too acidic, respiratory acidosis occurs.

Question 34

What is respiratory alkalosis?

Answer 34

Respiratory alkalosis occurs when you breathe too fast or too deep and carbon dioxide levels drop too low. This causes the pH of the blood to rise and become too alkaline.

Question 35

Alveolar hyperventilation leads to what ? causing what?

Answer 35

Leads to hypocapnia causing respiratory alkalosis

Question 36

Alveolar hypoventilation induces what, causing what?

Answer 36

Alveolar hypoventilation induces hypercapnia cause respiratory acidosis

Question 37

What does the term CO2 retainer mean and why should we be careful giving them O2?

Answer 37

When a patients is termed a CO2 retainer, they are quite literally their bodies retain more CO2 than normal. These patients therefore have a lower, more acidic, baseline pH.

Question 38

Is O2 a medication?

Answer 38

Yes and it must be prescribed

Question 39

What hazards do you need to consider when administering O2?

Answer 39

All electrical appliances should be working properly: smoking is prohibited as a spark may cause a fire.

Question 40

When do we use nasal prongs?

Answer 40

When low-medium concentration of O2 is required. For example, less than 4L/min. Its useful when a patient is eating and cannot use a face mask.

Question 41

When do you use a simple face mask? (may also be called a hudson mask)

Answer 41

When oxygen concentration given needs to be greater than 4L/min

Question 42

How can we evaluate whether oxygen therapy has been effective?

Answer 42

Resp rate lowers
Depth of respirations increases
Tissue oxygenation increases (mucous membranes)
WOB/accessory muscle use decreases
Work of myocardium in pts with cardiac disease decreases
SpO2 increases

Question 43

What triggers asthma?

Answer 43

Infections, allergies, exercise, irritants, different medications, changes in temperature, and emotional tension.

Question 44

What type of disorder is asthma?

Answer 44

Chronic inflammatory disorder

Question 45

What is asthma characterised by?

Answer 45

Exaggerations and remissions.