Respiratory Tutorial Information Flashcards
In terms of the respiratory system and the rapid assessment. What would we assess under “a”
Airway Patency: Can this patient talk? Is their airway under threat?
In terms of the respiratory system and the rapid assessment. What would we assess under “b”
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?
In terms of the respiratory system and the rapid assessment. What would we assess under “c”
SpO2, HR, BP, Capillary Refill, Colour of mucous membranes (in the mouth), Temp, Urine output (fluid balance chart + is it concentrated?), and diaphoresis?.
In terms of the respiratory system and the rapid assessment. What would we assess under “d”
anxiety, fatigue, AVPU, COLDSPA (for pain or cough), orientation.
In terms of the respiratory system and the rapid assessment. What would we assess under “e”
EWS, Braden, Fall risk, ADD, Smoking risk, adherence to medication, home/work environment, allergies?, cultural safety?, health history.
What does SOAPIE stand for?
Subjective Objective Analysis (diagnosis) Plan Interventions Evaluation
What is dysponea?
Patient stating they are feeling short of breath
What is orthopnea?
SOB when laying down
What does SOB mean
Shortness of breath
What does SOBOE mean?
Shortness of breath on exertion
Whats the acronym we use to remember the posterior chest assessment?
I - General Inspection
P - Palpation
P - Percussion
A - Auscultation
Whats involved in the general inspection (posterior chest assessment)?
General notes, positing, respiratory rate, shape of bony thorax, scars, masses, use of accessory muscles, AP - transverse diameter.
Whats involved in the palpation (posterior chest assessment)?
Using hands on the back of the chest to assess chest (lung) expansion
Whats involved in the percussion (posterior chest assessment)?
Using percussion (dull and resonant) to find the lung fields for ausculation
Whats involved in auscultation (posterior chest assessment)?
Assessing the character and intensity of breath sounds, and adventitious sounds (crackes, wheeze, rubs).
What are some examples of actual problems?
SOB, increased RR, increased WOB/accessory muscle use, inability to speak in full sentences, impending sense of doom, audible wheeze.
What are some examples of potential problems?
decreased Sp02, increasing RR, increasing HR, increasing NZEWS, decreasing BP, central cyanosis, increasing confusion/agitation, increasing fatigue, loss of consciousness, and respiratory arrest.
How do we treat asthma?
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.
What are some quick facts about Short acting (SABAs) relievers?
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
What are some quick facts about long acting (LABAs) controlled?
Used for asthma Has a long duration of action (12hrs) Slow onset of acton Doesnt work for acute situations Most common is salmeterol.
What are Inhaled corticosteroids - ICS used for?
As preventers for asthma
How do inhaled corticosteroids work?
They reduce the hyperesponsiveness of the bronchial smooth muscle to irritants
When you use a spacer to take inhaled corticosteroids what is important that you do?
Rinse mouth after administration to avoid infections (caused by the steroids)
Inhaled corticosteroids make “what” more manageable?
Asthma
What does an inhaler do?
Pushes out a pre-measured spray of asthma medicine
What does a spacer do?
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)
What does a nebuliser do?
A machine that converts liquid medication into a fine mist, which is inhaled through a mask or mouthpiece.
Which is more effective? A spacer or a nebuliser?
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.
What are the effects of hypercapnia?
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
What are the effects of Hypoxaemia?
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.
A patient with COPD will have chronic hyper what?
Hypercapnia
Chronic hypercapnia leads to what?
Low grade acidosis all the time
What is low grade acidosis?
When the blood becomes too acidic, respiratory acidosis occurs.
What is respiratory alkalosis?
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.
Alveolar hyperventilation leads to what ? causing what?
Leads to hypocapnia causing respiratory alkalosis
Alveolar hypoventilation induces what, causing what?
Alveolar hypoventilation induces hypercapnia cause respiratory acidosis
What does the term CO2 retainer mean and why should we be careful giving them O2?
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.
Is O2 a medication?
Yes and it must be prescribed
What hazards do you need to consider when administering O2?
All electrical appliances should be working properly: smoking is prohibited as a spark may cause a fire.
When do we use nasal prongs?
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.
When do you use a simple face mask? (may also be called a hudson mask)
When oxygen concentration given needs to be greater than 4L/min
How can we evaluate whether oxygen therapy has been effective?
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
What triggers asthma?
Infections, allergies, exercise, irritants, different medications, changes in temperature, and emotional tension.
What type of disorder is asthma?
Chronic inflammatory disorder
What is asthma characterised by?
Exaggerations and remissions.
