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