Week 9- Respiratory Management

Question 1

Assessment of the Pt with dyspnea

Answer 1

Initial assessment
- Body type association with a particular pathological condition

• Emphysema- barrel chest, muscle wasting, and pursed-lip breathing
• Chronic bronchitis: obese, seated
• End-stage disease: sickly appearance, rigors, and chills

Question 2

Position

Answer 2

• Seek the sitting position
• Tripod position
• Purposeful hyperextension

Question 3

Degree of Distress

Answer 3

Work of Breathing
- Muscles used in danger of tiring
- Chest-wall retractions
- Soft-tissue retractions
- Nasal flaring
- Tracheal tugging
- Paradoxical respiratory movement
- Pulsus paradoxus

Question 4

How to assess breathing

Answer 4

• Rate
• Depth
  (Respiratory noises audible without a stethoscope are abnormal)
  (Quiet may indicate hyperventilation syndrome, acidosis, or shock)

Question 5

Neurological Assessment

Answer 5

• LOC
• Restlessness
• Confusion
• Combative behaviour
• Sedated

Question 6

Skin Colour

Answer 6

Early impression of condition
- Cyanosis
- Chocolate brown skin
- Pale skin

Question 7

The Focused History

Answer 7

• Reason for calling for help (chronic resp pt’s are knowledgable about their condition and past treatments)
• Onset and duration (Rapid onset dyspnea, Paroxysmal noctural dyspnea
• Position of comfort
• Difficulty breathing

Question 8

History of the Problem

Answer 8

• Repeating conditions
• Attempts at treatment
• Associated symptoms

Question 9

The Focused Physical Examination

Answer 9

• Neck examination
• Chest and abdominal examination
• Examination of the extremities

Question 10

Sputum

Answer 10

• smoker or pt’s with chronic resp diseases
• Note change in colour and amount
• blood-tinged sputm

Question 11

Monitoring Devices

Answer 11

• Pulse oximetry (92-96%) (COPD- 88-92%)
• ETCO2 (35-45 mmHg) (COPD- 50-60 mmHg)

Question 12

Managing Dyspnea

Answer 12

• Supportive prehospital care
• Ensuring airway adequacy
• O2 Therapy
• Monitoring and transporting pt’s
• Treatment for bronchoconstriction

Question 13

Ensuring an Adequate Airway

Answer 13

• Get rid of any food, gum, chewing tobacco, or like items
• Suction of necessary

Question 14

Provide Supplemental Oxygen

Answer 14

• Administer 100% oxygen- BLS
• NRB, Nasal cannula, BVM