Week 2 Flashcards
What makes us breathless?
Pain Exercise Obesity Genetics Smoking Allergy: Dust, Pollen, Fur and Grass
Common respiratory conditions:
Chest Infection Pneumonia Emphysema Dyspnoea Respiratory failure Asthma COPD PE TB Bhronchiectasis Bronchitis Cystic fibrosis
Respiratory symptoms:
Look, Listen and Feel Pain: - Chest - Shoulders - Abdomen - Accessory Muscles
Skin:
- Pale
- Sweaty
- Clammy
- Cyanosed
- Pink
Respiratory:
- Tachypnoea
- Dyspneic
- Cough
- Noisy airway
- Pulmonary oedema
Psychological:
- Anxiety
- Confusion
Breathing assessment
Respiration Rate
Depth
Rhythm
Assessment of the Lungs
A significant predictor of critical illness is…
Respiratory rate
Breathing patterns
Depth of Breathing:
- Deep, sighing (Kussmaul Breathing)
- Normal
- Shallow (Pain)
Difficulty in Breathing (Dyspnoea):
- Orthopnoea – DIB Lying down
- Use of accessory muscles
- Nasal Flaring
- Head bobbing (Children)
Chest Wall Movement:
- Symmetry
- Pneumothorax
- Rib fractures (Paradoxical Movement)
- Chest Recession (Sucking in )
Regularity of Breathing:
- Apnoea ( Absence 20sec>)
- Cheyne-Stokes
Stridor
High pitched noise on inspiration or expiration, indicates a disturbance to the airflow in the upper respiratory tract
Stertor
Snoring during sleep or altered consciousness
Wheeze
Whistling heard on expiration, indicates resistance to airflow in lower respiratory tract
Rattle
Heard on inspiration and expiration, associated with secretions in the lower respiratory tract (death rattle!)
Respiratory investigations
Blood tests:
- FBC
- U&E
- Blood Gases
- Clotting
Chest X-Ray
CT/MRI
ECG
Respiratory Function Tests:
- Forced Vital Capacity (FVC)
- Forced expiratory volume in 1 sec (FEV1)
- Peak expiratory flow rate (PEFR)
Sputum Specimen
Bronchoscopy
Care of the breathless patient
Nurse in Upright position in chair or bed
- Increases lung expansion
- Assists gaseous exchange in alveoli
- May help relieve anxiety
- Avoid laying flat
- Allow patient to lean e.g. over bedside table
Asthma
A chronic inflammatory disease of the airways
Causes hyper-responsiveness, mucosal oedema and mucous production
Allergy is the strongest predisposing factor
Inflammation leads to cough, chest tightness, wheezing and dyspnoea
Fully reversible (unlike COPD)
Why asthma makes it hard to breathe
Parasympathetic stimulation: leads to bronchoconstriction
Sympathetic stimulation: leads to bronchodilation
Inflammation causes swelling of the bronchial mucosa
Inflammation causes increased mucous production
Clinical manifestations of asthma
Wheeze & chest tightness
Dyspnoea &/or cough
Airflow limitation/prolonged expiration
Often recurrent & seasonal/worse nocte
Triggers of asthma
Exercise Allergies Emotions Irritants Infections Cold air
Asthma diagnostic testing
Serial peak expiratory flow
Reversibility (often with short-acting broncho-dilator)
Various spirometry/lung function testing/exercise testing
Asthma medication treatment
Aim is for symptom control
Optimised lung function
Lowest effective dose of medication
Fewest possible side effects
Metered dose inhalers and Spacers
More medication gets into your lungs than if you use a puffer on its own.
They reduce the local side effects of inhaled steroids in preventer medications, because less of the medication sticks in your mouth and throat
You don’t need to coordinate pressing your puffer and breathing in at the same time
Asthma complications
Status asthmaticus – medical emergency where symptoms do not respond to bronchodilators
(aggressive treatment/ventilation/ICU)
Pneumonia
Atelectasis
COPD – not strictly a complication, pts may develop COPD alongside their asthma
Asthma patient teaching
The nature of asthma as a chronic inflammatory disease
Identification of triggers and how to avoid them
Purpose and action for each medication
Proper inhalation techniques
How to perform peak flow monitoring
How to implement an action plan
When and how to seek assistance
Oxygen cascade
The purpose of the cardio-respiratory system is to extract oxygen from the atmosphere and deliver it to the mitochondria of cells.
At sea level, the atmospheric pressure is 760mmHg, and oxygen makes up 21% (20.094% to be exact) of inspired air: so oxygen exerts a partial pressure of 760 x 0.21 = 159mmHg
Process of the decreasing oxygen pressures from the atmosphere to inside the cell
PaO2 of oxygen at sea level is 159mmHg
PaO2 of oxygen in arterial blood 80-100mmHg
PaO2 of oxygen in capillaries 40mmHg or less
Diffuses down to 3 or 4mmHg at cellular level
Hypoxia
Is a deficiency in the amount of oxygen reaching the tissues
Hypoxaemia
An abnormally low concentration of oxygen in the blood.
High flow oxygen system
Venturi mask
Guarantees FiO2 irrespective of breathing pattern
High & low concentrations possible
Low flow oxygen system
all other masks/devices
Mixes with room air
Influenced by breathing pattern
Causes of hypoxia
Hypoxaemic – decreased oxygen level in arterial blood
(ventilation-perfusion mismatch)
(?PE/atelectasis/pulm.oedema)
- provide supplemental oxygen/treat underlying cause
Circulatory - inadequate capillary blood flow
(decreased cardiac output/vascular obstruction/ cardiac arrest/shock)
- provide supplemental oxygen/treat underlying cause
Anaemic – reduced level of haemoglobin
(various anaemias/CO poisoning)
- provide supplemental oxygen/treat underlying cause
Histotoxic – inability of tissues to use the oxygen
(cyanide and various chemical poisoning)
- provide supplemental oxygen/treat underlying cause
Signs and symptoms of hypoxaemia
Neurological - headache, double vision, weakness, restlessness, confusion, agitation, altered LOC
Respiratory distress – nasal flaring, unequal chest expansion or inspiration, use of accessory muscles
Measuring effectiveness of oxygen therapy
Respiratory rate within patient’s normal limits.
Improved breath sounds/mental status/skin colour
Decreased dyspnoea both at rest/with exertion
Decreased anxiety/agitation/restlessness
Pulse/blood pressure at patient’s baseline
