Intro for resp failure

A condition characterized by a chronically high blood level of carbon dioxide in which the respiratory center no longer responds to high blood levels of carbon dioxide.

carbon dioxide retention

Patients signs and symptoms will improve when they're removed from the environment. High flow oxygen by nonrebreathing mask is the best treatment for conscious patients. Patients who are unconscious or have an altered level of consciousness may need full airway control with insertion of an airway adjunct and BVM ventilation. In the worst cases, patients may be treated with hyperbaric or pressurized oxygen therapy.

carbon monxide treatment

The process that occurs with normal breathing. Involves contraction of the diaphragm and intercostal muscles and decrease in intrathoracic pressure; as a result, air is pulled into the lungs.

negative pressure ventilation

a critical physiologic compensation mechanism that circulates oxygenated blood faster, thus helping to maitain adequate perfusion of the bodys vital organs. (however, if the underlying cause of the patients hypoxemia is not corrected the nervous system which also requires oxygen, will no longer be able to compensate and the patients heart rate will begin to fall.)

Tachycardia

Severe shortness of breath, decreased/ altered level of consciousness, neck vein distention, tracheal deviation (late sign), hypotensions; signs of shock (late sign)

Tension pneumothorax (signs and symptoms)

Voice box, a complex structure formed by many independent cartilaginous structures that all work together; where the upper airway ends and the lower airway begins.

Larynx

responsible for pumping oxygenated blood to the rest of the body. When it fails to do this blood back up in the lungs, resulting in pulmonary edema. Signs and symptom of pulmonary edema include dyspnea especially when lying flat, rapid and shallow respirations, and in severe cases coughing up pink frothy sputum.

Left side of the heart

Rescue inhaler Dilates bronchioles "beta-antagist" Trade name is Xopenex Used for acute disease : Asthma, Bronchitis, COPD

Levalbuterol

maybe obese, difficulty with expiration, frequent or chronic cough, excessive thick mucus sputum, fever, tachypnea

chronic bronchitis (signs and symptoms)

The problem causing dyspnea is always some form of obstruction: a. Mucus and secretions obstructing airflow in major passages

cold, diphtheria

a disease of the heart characterized by shortness of breath, edema, and weakness. Patient may or may not smoke.

congestive heart failure

Recuse inhaler medication. Trade names are proventil, Ventolin, Volmax Used for asthma, bronchitis, and COPD dilates the bronchiles "beta-antagonist" Used for acute disease

Albuterol

Obstuctive pulmonary disease and acute pulmonary edema are alert and can follow commands have tachypnea pulse oximetry reading of less than 90% contriduction is low bp not used in pts with pneumothorax or chest trama have active gastriostenial bleeding, a tacheostomy deceased LOC (who can't follow commands) If autorized by med control or local protocals do so, otherwise provide prompt transport to the ED. Continue to reassess pts using for signs of deterioration and or respiratory failure.

CPAP

a maintenace inhaler trade names are beclovent, Beconase, Qvar, Vanceril Is an anti-inflamatory which reduces swelling, Used for chronic disease just as asthma

Beclomethasone

resuce inhale dilates bronchioles "beta-2 antagonist trade name is terbutaline Used for acute diseases

Bretine

respiratory illness that often occurs due to respiratory syntactical virus and results in severe inflammation of the bronchioles which become inflamed, swell, and fill with mucus. Occurs most frequently in newborns and toddlers, especially boys, airways can easily become blocked. Infections are common during the winter and spring. Increased risk for developing childhood asthma. Provide oxygen therapy and frequently reassess for signs of respiratory distress.

Bronchiolitis

Mainly supportive. Provide appropriate oxygen therapy and allow the patient to remain in position of comfort. Reassess frequently for signs of worsing respiratory distress. Be prepared to provide airway management and positive-pressure ventilation should the patient develop respiratory failure.

Bronchiolitis treatment

clear or white sputum chronic cough wheezing (dry) or rhonchi (wet) breath sounds, tachypnea, cyanosis fever inflammation of the mucous membrane in the bronchial tubes of the lung

Bronchitis (signs and symptoms)

Slow process of dilation and disruption of airways and alveoli caused by chronic bronchial obstruction (Estimated 12 million diagnosed, an additional 12 million undiagnosed. 3rd leading cause of death) 2. an umbrella term used to describe a few lung diseases, including emphysema and chronic bronchitis (ongoing irritation of the trachea and bronchi) Wheezing or "dry" lung sounds because of bronchial construction. May also present crackles, rhonici 3. May be a result of direct lung and airway damage from repeated infections or inhalation of toxic gases or particles a. Most often results from cigarette smoking 4. Tobacco smoke is a bronchial irritant and can create chronic bronchitis, an ongoing irritation of the trachea and bronchi. a. With bronchitis, excessive mucus is constantly produced, obstructing small airways and alveoli. b. Airways are weakened as the lungs' protective devices are destroyed. c. Chronic oxygenation problems can also lead to right heart failure and fluid retention. i. Pneumonia develops easily. ii. Repeated episodes of irritation and pneumonia cause scarring in the lung and some dilation of the obstructed alveoli, leading to this

COPD (chronic obstructive pulmonary disease)

Home oxygen, broncialodilators, and corticorsteriods.

COPD medications

Excessive mucus production with airway obstruction pulmonay capillary bed undamaged compensation by decreasing ventilation and increasing cardiac output poorly ventilated lungs, leading to hypoxemia increased carbon dioxide retention often blue skin color

Chronic bronchitis pathophysiology

Difficulty breathing with exertion because the heart cannot keep up with the body's need for oxygen. Report a sudden attack of respiratory distress that wakes them at night when they are in a reclining position. This is caused by fluid accumulation in the lungs. Patients also report coughing, feeling suffocated, cold sweats, and tachycardia. In primary assessment you may find the patient has cool, diaphoretic, cyantoic skin and you will hear adventitious breath sounds like crackles or wheezing. Pulse will be tachycardiac. Early hypertension, followed by deterioration to hypotension as a late finding. (Elevated blood pressure) Pedal edema jugular vein distension

Congestive heart failure (signs and symptoms)

wheezing (dry) breath sounds Patient usually experiences dyspnea with rapid, shallow respirations. In severe cases, a frothy pink sputum forms at the nose and mouth.

Congestive heart failure/pulmonary edema (signs and symptoms)

shock, respiratory distress. decreased or absent breath sounds

hemothroax (signs and symptoms)

Severe shortness of breath, especially at night after several hours of reclining; the person is forced to sit up to breath. Found in cogestive heart failure patients

parasymal nocturnal breathing

skins color, temperature, condition. could be caused by chronic anemia, a wound, internal bleeding, or simply shock

perfussion (assessment)

Collection of fluid outside the lung on one or both side of the chest. It compresses the lung or lungs and causes dyspnea. This fluid may collect in large volumes in response to any irritation, infection, congestive heart failure, or cancer. signs and symtoms Sudden dyspnea. Contribute to shortness of breath in lung cancer patients. You will hear decreased breath sounds over the region of the chest where fluid has moved the lung away from the chest wall. Patients feel better if they are sitting upright. Removal of fluid must be done by physician so nothing will completely relive patient until removal.

pleural effusion

general term referring to an infection of the lungs. The infection collects in the surrounding normal lung tissues, impairing the lungs ability to exchange oxygen and carbon dioxide. Often a secondary infection. Meaning it begins after and upper respiratory tract infection such as cold or sore throat. Can be caused by a virus or bacterium, or by a chemical injury after an accidental ingestion or a direct lung injury from a submersion incident. Intervention like intubation and tracheotomy can increase the risk of development. Commonly affects people who are chronically ill. Lower parts of the lungs near the abdomen, there may be fever, abdominal pain, and vomiting rather than dyspnea.

pneumia

General term that refers to an infection of the lungs Often a secondary infection that begins after an upper respiratory tract infection Can be caused by a virus or bacterium, or by a chemical injury or direct lung injury i. Bacterial will come on quickly and result in high fevers. ii. Viral presents more gradually and is less severe. d. especially affects people who are chronically and terminally ill.

pneumia (signs and symptoms)

increase in the severity of a disease or its symptoms

Exacerbation

Sometimes the heart muscle cannot circulate blood properly. The LEFT SIDE of the heart cannot remove blood from the lung as fast as the right side delivers it. Fluid builds up within the alveoli and in lung tissue. This accumulation of fluid is referred to as this condition. Usually results from congestive heart failure, but also can occur because of direct lung damage. Patient usually experiences dyspnea with rapid, shallow respirations (especially when lying flat) In severe cases, a frothy pink sputum forms at the nose and mouth. Most patients have a long-standing history of chronic congestive heart failure that can be kept under control with medication. Not all patients with this have heart disease. Inhaling large amounts of smoke or toxic chemical fumes, traumatic injuries to the chest, and exposure to high altitudes can produce this Treatment Administer 100% oxygen best position is sitting up An unconscious pt may require full ventilatory support, including placement of an airway adjunct, CPAP and suctioning.

Acute pulmonary edema

Dyspnea may be associated with cardiac disease or direct lung damage. Administer 100% oxygen, and if necessary, carefully suction any secretions. The best position for a conscious patient who has a myocardial infarction or direct lung injury is easiest to breath usually sitting up. unconscious patient may require fully ventialotory support, placement of an airway adjunct, CPAP with oxygen and suctioning.

Acute pulmonary edema treatment

The buildup of excess acid in the blood or body tissues that results from the primary illness. Because carbond dioxide, mixed with water in the bloodsteam, can add to the blood aciditiy, lowering the level of carbon dioxide helps to compensate for the other acids.

Acidois

Causes a blockup of blood into the systemic circulatory system, and typically causes symtoms of peripeheral edema in the hands and feet.

Acute right heart failure

The buildup of excess base (lack of acids) in the body fluids. In a healthy person, blood acidity can be diminished by excessive breathing because it "blows off" too much carbon dioxide. The result is a realvie lack of acids.

Alkalosis

Life threatening emergency First step : Remove the offending agent maintain the airway Have sit in an easy breathing position of comfort Use appropriate oxygen device Rapid transport Early admin of epinephrine, if allowed by protocal

Anaphylaxis treatment

Acute Lower airway disease that causes the bronchioles in the lungs to constrict (bronchospasm) assoicated with excessive mucus production and with swelling of the mucous lining in the respiratory passages. 25 million have acute infection Highest prevalence in 5 - 17 y.o. Produces a characteristic wheezing as the patient tries to exhale through partially obstructed air passages. Acute : caused by allergic response, emotional stress, exercise, and respiratory infections. Most severe : allergic reaction can cause anaphylaxis that could lead to coma or death.

Asthma

Approximately 25 million Americans have this bronchospasm c. Affects all ages but is most prevalent in children 5-17 years of age d. Produces a characteristic wheezing caused by partially obstructed airways i. Wheezing is indicative of a partial lower airway obstruction. ii. Wheezing may be so loud that you can hear it without a stethoscope. e. In other cases, the airways are so blocked that no air movement is heard. f. An acute attack may be caused by allergic reaction to specific foods or some other allergen. i. Attacks may also be caused by severe emotional distress, exercise, and respiratory infections. ii. In its most severe form, an allergic reaction can produce anaphylaxis. iii. May result in respiratory distress severe enough to lead to coma or death g. Most patients with asthma are familiar with their symptoms and know when an attack is imminent. i. Listen to the needs of the patient; they often know exactly what they need.

Asthma (signs and symptoms)

COPD patients may have an altered LOC or may be unresponsive from hypoxia. Assist with the patients prescribed inhaler, if there is one. Look for side effects from too much MDI. Transport to ed in the sitting up position if they are most comfortable.

COPD treatment

Often a reoccuring pathologic condition So ask if pt can breath normallly at other times Vital signs Pulse rate will be normal or elevated the blood pressure may be slightly elevated respirations increased Be prepared to suction (large amounts of mucus) If you do suctin, do not withold oxygen for more than 15 seconds for adults, 10 for child, 5 for infant In sever csease use a BVM (problem is getting air out of the lungs so) 10-12 shallow breaths/min

Asthma treatment

When assisting a pediatric patient look for retractions of the skin above the sternum and betwen the ribs. Coughing is not always a symptom of a cold it could asl signal pneumoia or X The emergency care of a child with shortness of breath is ahte same for an adult, including the use of supplemtnal oxygen. Rather than fight with a child about wearing a supplemental oxygen mask, provide blow-by oxygen by holding the oxygen mask in front of the childs face or ask the parent or caregiver to hold the mask. In adults causes bronchospams, swelling of the lining of the airways and an accumulation of secretions. Attacks are easily triggered by air pollutants, viral infections, allergens, and sometimes something as simple as exposure to cold air.

Asthma treatment

a noninvasive means of providing ventilatory support for patients experience respiratory distress associated with obstructing pulmonary disease and acute pulmonary edema. Increases pressure in the lungs, opens collapsed alveoli, pushes more oxygen across the alveolar membrane, and forces interstitial fluid back into the pulmonary circulation. Use oxygen to deliver the positive ventilatory pressure to the patient. Can be used for patients who have moderate to severe respiratory distress form an underlying disease such as pulmonary edema or obstructive pulmonary disease, are alert and able to follow commands, have tachypnea, or have a pulse oximetry reading of less than 90%. Contraction : Low blood pressure. pneumothroax, or chest trauma. a tracheotomy, decreased LOC, active gastrointestinal bleeding.

CPAP (continuous positive airway pressure)

"silent killer" A colorless, odorless, tasteless, and highly poisonous gas. Leading cause of accidental poisoning deaths. Can cause permanent brain damage. Produced by fuel-burning household appliances such as gas water hearts, space heaters, grills, and generators, also present in fir or cigarettes. Initially report headache, dizziness, fatigue, and nausea and vomiting may report dyspnea on exertion and chest pain and display nervous system symptom like impaired judgment, confusion, or even hallucination. Worst exposure may result in syncope or seizure. Has a much stronger bond with hemoglobin than does oxygen. 250 times more. Which can lead to cellular death and organ failure. When you access the scene do not put yourself at risk and look for consider if the environment presents more than one patient experience same signs and symptoms.

Carbon monoxide

Not a form of astma but rather a type of coughing coughing or wheezing that occursrs with left sided heart failure.

Cardiac asthma

Sounds of air trying to pass through fluid in the alveoli. typically head on inspiration. crackling, bubbling breath sounds signaling fluid in the air spaces of the lungs; formerly called rales. High pitches "fine" Low pitches "coarse" Often a result of congestive heart failure or pulmonary edema

Crackles breath sounds (wet)

maintenance inhaler Trade name is Intal Decreases release of histamines Used in chronic conditions such as asthma

Cromolyn

Is the bodys attempt to divert blood to the core to help keep the vital organs functioning. Can be seen fist in the lips and mucous production.

Cyaonsis

Anything in the circulatory system that moves from its point of origin to a distant site and lodges there, obstructing subsequent blood flow in that area. Can be anything from foreign bodies that enter the circulation such as an air bubble to fragments of blood clots in the artery or vein that break off and travel through the bloodstream. Beyond the point of obstruction, circulation can be significantly decreased or completely blocked.

Embolus

A form of copd, a disease of the respiratory system in which airways develop chronic inflammation, excessive mucus is produced and narrows the airways, and destruction of alveoli and small airways lead to a loss of lung elasticity. As a result, the expiatory phase of respiration becomes difficult and gas exchange in the lungs becomes impaired. Is an irreversible condition. Number one cause is cigarette smoke. (long term exposure to toxic agents and frequent pulmonary infections also causes)

Emphysema

destruction of the airways distal to the bronchiole destruction of the pulmonay capillary bed decreased ability to oxygenate the blood lower cardiac output and hyperventilation development of muscle wasting and weight loss

Emphysema Pathophysiology

Emphysema is the most common type of COPD. a. is the loss of elastic material in the lungs as a result of chronic stretching of the alveoli. b. Smoking can directly destroy the elasticity of the lung tissue. c. As a result of diminished elasticity, air is no longer expelled rapidly from the alveoli, and the walls of the alveoli and surrounding small airways bloat to trap air and collapse easily after exhalation. d. Most patients with COPD have elements of both chronic bronchitis and this condition e. Most patients will chronically produce sputum, have a chronic cough, and have difficulty expelling air from their lungs, with long expiration phases and wheezing. f. "holes" in the lung

Emphysema.

Ensure that all patients are decontaminated prior to treatment. Treat with oxygen, adjuncts, and suction on the basis of presentation. LOC, and level of distress that is observed in your patients.

Environmental/Industrial Exposure treatments

Inflammation of the epiglottis (soft tissue in the upper airway) usually as the result of a bacterial infection More predominant in children but can also occur in adults Usually develops suddenly Children look ill, report a very sore throat, and have a high fever. Often found in the tripod position and drooling Treat children gently and try not to make them cry. Position comfortably, usually sitting up and learning forward in the sniffling position provide high-flow oxygen, and do not put anything in their mouths. Keep adequate airway and transport to ed. Do not attempt to suction the airway or place an oropharyngeal airway. Also do not force a pt to lie down supine, may cause upper airway obsuction that could result in death.

Epiglottitis

Maintance inhaler Trade name is Flovent Diskus Anti-inflamatory helps reduce swelling Used for chronic disease such as asthma

Fluticase

Advair Diskus Maintanice inhaler Decsease secretions Used in chronic conditions such as asthma

Fluticasone, Salmeterol

Common in young child most under 5 leading cause of death (upper airway) abnormality in the voice poss sign The aspirated object will most likely go down the right mainstream bronchus. If the bronchus is fully obstructed, the lung could collapse. Aspiration pneumonia may also develop. Perform the appropriate airway cleaning technique for age appropriate. Provide oxygen, and transport to ED for x-ray x-ray (confirm the aspiration, its location, treatment) In older pts decreased cough and gag reflexes which can caused aspirated food or oral secretions that can develop into a potentially life-threatening pneumonia.

Foreign body Aspiration treatment

Allergic rhinitis, causes cold-like symptoms, including a runny nose, sneezing congestion, and sinus pressure. The symptoms are caused by an allergic response, usually to outdoor airborne allergens such as pollen or sometimes indoor allergens such as dust mites and pet dander. Worse in spring and summer

Hay fever

Emphysema : Small airway disease in the inner walls of alveolar progressively destroyed resulting in a loss of lung elasticity. Patients have a lot of air trapped in the alevoli. Chronic bronchitis : Inflammation in larger airways. Excess mucus constantly produced, which obstructs the bronchioles and alveoli. As a result, pulmonary gas exchange is less efficient. Chronic productive cough, this causes sputum to settle in the lungs and become infected, resulting in pneumonia.

How does empysema differ from bronchitis

Complete a primary assessment and gather a history of the event. Dont have pt breathe into paper-bag. (A pt w/underlying pulmonary disease who breathes into a bag may become severyl hypoxic) Reassure the patient in a calm, professional manner, supply supplemental oxygen provide prompt transport to ED.

Hyperventialion treatment

1. Hyperventilation is defined as overbreathing to the point that the level of arterial carbon dioxide falls below normal. a. This may be an indicator of a life-threatening illness. 2. The body may be trying to compensate for acidosis (the buildup of excess acid in blood or body tissues) A patient with diabetes who has a high blood glucose level, a patient who has taken an overdose of aspirin, or a patient with severe infection. Alkalosis is the cause of many of the symptoms. (the buildup of excess base or lack of acids in body fluids) The decision whether hyperventilation is being caused by a life-threatening illness or a panic attack should not be made outside the hospital. a. Verbally instruct patient to slow his or her breathing. b. If that does not work, give supplemental oxygen via nonrebreather and transport to the hospital.

Hyperventilation

Can can cause aspiration pneumonia that can result in eventual pulmonary edema. Inhaled toxin can cause lung damage, blood coming for the airway is an ominous signs.

Inhalation injuries

Atrovent Resuce inhaler Dilates bronchioles "beta-antongist" Used for acute diseases: Asthma, Bronchitis, COPD

Ipratropium bromide

Corticosteriods Anti-inflamatory (reduces swelling Beclomethasone (Beclovent, Beconase, Qvar, Vanceril) Cromolyn (Intal) Fluticasone (Flovent diskus) Fluticasone, salmeterol (Advantar Diskus) Montelukast (Singular) Salmeterol (Serevent Diskus)

Maintenece inhalers

Rescue inhaler Trade names are alupent, metaprel dilates bronchioles "beta-antagoist" Used in acute disease : Asthma, bronchitis, COPD

Metaproterenol sulfate

A miniature spray canister used to direct medications through droplets or particles may be inhaled by the mouth and into the lungs. Such as rescue inhalers such as albuterol. (Troventil, Ventolin, Volmax) Albuterol/ipratropium (combivent) Metaproterenol (Alupent, Metaprel) terbutaline (Brethine) Typically in asthma patients

Meter dose inhaler (MDI)

Trade name Singulair maintenance inhaler anti-inflammatory, reduces swelling Used in chronic disease : asthma and COPD

Montelukast

Associated with chest pain, sudden onset of weakness, nausea, sweating, and discomfort.

myocardial infraction (heart attack)

O(nset) When did the breathing problem begin? P(rovaction or palliation)? What makes the breathing difficulty worse? Q(Quality) How does the breathing feel? R(radiation/region) Does the discomfort move? S(everity) How much of a problems is the patient having? T(iming) Is the problem continuous or intermittent?

OPQRST

If the pt is a small child or someone who was eating just before dyspnea develed you may assume it is an inhaled or aspirated foreign body. Either partial or complete (If can talk and breath) partial : provide supplement oxygen position comfortablely to ED. Complete : No condition more immediately life threatening Try to open the airway with head-tilt-chin lift only after the you have ruled out a head or neck injury. If this doesn't solve the problem then assess the upper airway for obstruction if successful clearing airway treat like a partial

Obstruction of the airway

severe dyspnea in which breathing is very difficult when lying down and relieved by sitting up or standing. Found in cogestive heart failure patients.

Orthopnea (signs and symptoms)

P(rogession) Problem happen suddenly or over time? A(ssociated chest pain) Dyspnea can be a signficant symtom of a cardiac problem S(putum) Mucus like - respiratory infection pink froty - fluid in the lungs no sputum - pulmonary embolus T(alking tiredness) Have the patient repeat a sentence Report as "speaks in full sentences" or "speaks in two-to-three word sentences" E(xercise tolerance) Ask patient what he/she was able to do before problem started (Exercise tolerance will decrease as the breathing problem and hypoxia increase)

PASTE

Partial or complete accumulation of air in the pleural space. Most often caused by trauma, but it can also be caused by some medical conditions. In these cases, the condition is "spontaneous" Normally the "vacuum" pressure in the pleural space keeps the lung inflated. When the surface of the lung is disrupted, however, air escapes into the pleural cavity and results in a loss of negative vacuum pressure. The natural elasticity of the lung tissue causes the lung to collapse. The accumulation of air in the pleural space may be mild or severe.

Pneumothorax

a. An airborne bacterial infection that mostly affects children younger than 6 years b. Highly contagious and is passed through droplet infection c. Patients will be feverish and exhibit a "whoop" sound after a coughing attack. d. Coughing spells can last for more than a minute, during which the child may turn red or purple. coughing spells can last for weeks. e. Watch for signs of dehydration. May vomit and not want liquids f. Suction may be necessary. g. in adults can cause a severe upper respiratory infection that can lead to pneumonia. h. Has been a serious issue so can get vaccinated according to CDC.

Pertussis

Coughing spells, "whooping" sound, fever aka whooping cough

Pertussis (signs and symptoms)

Consists of removal of fluid collected outside the lung, which must be done by a physician. However, Provide oxygen and other routine support measures

Pleural effusion treatment

a sharp, stabbing pain on one side that is worse during inspiration and expiration or with certain movement of the chest wall. Breath sounds are absent or decreased on affected side.

Pleurtic chest pain

Deliver each breath over a period of 1 second, just enough to produce visible chest rise, at a rate that is appropriate for the patient (10-12bpm for adults, 12-20bpm for infants and children)

Positive-pressure techinique

1. An embolus is anything in the circulatory system that moves from its point of origin to a distant site and lodges there, obstructing subsequent blood flow in that area. a. Circulation can be cut off completely or partially. b. Emboli can result in a serious, life-threatening condition. c. Emboli can be fragments of blood clots in an artery or vein that break off and travel through the bloodstream. d. They can also be foreign bodies that enter the circulation, such as a bubble of air. 2 This condition is a blood clot that circulates through the venous system. a. May be the result of: i. Damage to the lining of the vessels ii. A tendency for blood to clot unusually fast iii. Slow blood flow in a lower extremity (often the result of long-term bed rest) Signs and symptoms: i. Dyspnea ii. Tachycardia iii. Tachypnea iv. Varying degrees of hypoxia v. CYANOSIS PERSITS ALTHOUGH HIGH LEVEL OXYGEN ADMINISTERED!!!! vi. Acute chest pain vii. Hemoptysis c. With a large enough embolism, complete obstruction of the output of blood from the right side of the heart can result in sudden death.

Pulmonary emboli (signs and symptoms)

Supplemental oxygen necessary Place pt in a sitting up position assist breathing as necessary If hemoptysis present clear from airway pt may have an unusually rapid and possible irregular heartbeat transport the pt to the ed promptly pt may go into cardiac arrest

Pulmonary embolism treatment

strong, bounding, or weak (primary assesment)

Pulse (characteristics)

Albuterol : (Proventil, Ventolin, Volmax) Ipratropium, bromide : (Atrovent) Levaluterol : (Xopenex) Metaporterenol sulfate (Alupent, Metaprel) Dilates Brochioles

Rescue inhalers

humidifed oxygen is helpful. infants often refuse liquids. Treat airways and breathing problems as appropriate.

Respiratory Syncytial Virus (RSV) medication

is a common cause of illness in young children. Causes an infection in the lungs and breathing passages such as bronchiolottis Highly contagious Look for signs of dehydration. eTreat airway and breathing problems as appropriate. i. Humidified oxygen is helpful if available. Look for Cough, wheezing, fever, dehydration

Respiratory syncytial virus : RSV (signs and symptoms)

Low-pitched rattling sounds caused by secretion or muscus in the larger upper airways "junky" pneumia bronchitis cases of aspiration COPD bronchitis

Rhonchi breath sounds (wet lung)

maintanience inhaler trade name serevent diskus dilates bronchioles Used in acute diseases : Asthma, Bronchitis, COPD

Salmeterol

An acute bacterial or viral infection associated with fever, cough, and productive sputum.

Sever pneumonia

Albuterol (Proventil, Ventolin) Metaproterenol (Alupent, Metaprel) and epinephrine Works by providing a means for a fine mist of aerosolized medicine to get deep into the patient lungs and start to work quickyl. The patient inhales the mist through a mouthpiece which sends medication directly to the lungs. Typically in asthma, bronchiolitis, COPD, and anaphylaxis. Rate of 6L/min Can cause increased pulse, nervousness, and muscle tremors

Small volume nebulizer

May have severe or no distress at all report pleuritic chest pain Provide supplemental oxygen Transport to ED More comfortable sitting up (dyspnea) Watch for any sudden deterioration Be ready to support the airway assist respirations provide CPR if necessary

Spontaneous pnemothorax treatment

High-pitched sound heard on inspiration as air tries to pass through an obstruction in the upper airway. Indicates a partial obstruction of the trachea and occurs in patients with anatomic or foreign body airway obstruction. croup or epiglottitis

Stridor

Can become obstructioned by secretions, mucus, or foreign bodies including bleeding, leaking, dislodgement and infection. Immediate goal is to establish airway patency. Place the patient in a position of comfort and provide suctioning to clear the obstruction. If you're unable to clear the airway, consider ALS intervention. Once the obstruction is clear, oxygenate the patient and treat the patient and treat based on the patients presentation. (Position comfortable,y suction, and provide oxygen.)

Tracheostomy dysfuction

Treat the child with suction and oxygen using age appropriate adjuncts.

Treatment of cystic fibrosis

Continually reassess for anxiety, increased dyspnea, hypotension, absent or severely decreased breath sounds on one side, the presence of jugular vein distension, and cyanosis.

Treatment of pneumothorax

TB is a bacterial infection that most commonly affects the lungs. (myobacterium) It also can be found in almost any other organ. Can remain inactive for years before producing any symptoms Patients often complain of fever, coughing, fatigue, night sweats, and weight loss. With severe infection, patient will experience shortness of breath, coughing, productive sputum, bloody sputum, and chest pain. Prevalence is higher in homeless people, prison inmates, and nursing home residents. TB is also found in persons who abuse intravenous drugs or alcohol, or those with HIV If you suspect your patient may have active TB, you need to wear, at a minimum, gloves, eye protection, and an N-95 respirator.

Tuberculosis (TB)

Cough, fever, fatigue, productive/bloody sputum

Tuberculosis (TB) (signs and symptoms)

Severe allergic reaction characterized by severe airway swelling and dilation of the of blood vessels all over the body, which may significantly lower blood pressure. b. Signs and symptoms may be similar to asthma, associated with hive (uticaria), itching, signs of shock c. The airway can swell so much that total obstruction is possible in a matter of mins. Usually 30 mins. d. Patients may or may not be aware of their sensitivity to certain substances. can occur with any allergen e. In most cases, epinephrine is the treatment of choice. Patients often have their own EPIpen i. Oxygen and antihistamines are also helpful.

anaphlaxis

Common in patients with ASTHMA COPD (emphysema & bronchitis) pneumonia congestive heart failure/pulmonary edema, foreign body aspiration toxic fumes inhalation allergic reactions : anaphlaxis (Indicates constriction and/or inflammation in the bronchus.) Generally heard on exhalation as a high pitches (almost musical or whistling.) indicated of partial lower airway obstruction

Wheezing breath sounds

collapse of alveolar air spaces of the lungs

atelectasis

fever, decreased oxygen sensation, decreased or absent breath sounds

atelectasis (signs and symptoms)

Prevent the heart from speeding up to compensation for when the blood pressure drops. keep this in mind when you evaluate vs in geriatric patients.

beta-blockers

Shortness of breath Wheezing Coughing Fever Dehydration Tachypnea Tachycardia

bronchiolitis (signs and symptoms)

a condition resulting in ongoing irritation of the trachea and bronchi. Excess mucus production causes obstruction of the smaller airways. Further weakening of the airways results from a loss of protective cells and mechanisms needed to remove foreign particles from the airways. While there are numerous causes of chronic bronchitis, cigarette smoking is the most notorious.

bronchitis

Abdominal distention depended edema (sacral or pedal) tachycardia increase respiratory rate anxiety inability to lie flat ashen or cyanotic confusion distended neck veins wet lung condition (crackles/rhonchi) crackles and wheezing breath sounds dependent edema coughing may be present, increases when supine pink frothy sputum shortness of breath all the time sudden onset of shortness of breath

congestive heart failure (signs and symptoms)

diuretics and antihypertensitve help promote cardiac function and reduce fluid loads on the heart

congestive heart failure medication

damaged ventricles and failure of heart as a pump attempt by heart to compensate with increased rate enlarged left ventricle backup of fluid into the body as the heart fails to pump adequately

congestive heart failure pathophysiology

home oxygen, broncholdilators, and steroid help open the airways. Start administer of oxygen at 2L/m and increase the rate by one after checking oximeter in a nonrebreather, unless they need a BVM.

copd medication

caused by inflammation and swelling of the pharynx, larynx, and trachea. Starts with a low grade fever that develops over 2 days. Hallmark of stridor and seal bark cough. marked by a cough, hoarsness, dypnea cause swelling, inflammation, and varying degrees of obstruction in the upper airway

croup

Inflammation and swelling of the soft tissues pharynx, larynx, and trachea in the upper airway Typically seen in children between 6 months and 3 years of age Easily passed between children (infectious) Hallmark signs of croup are stridor and a seal-bark cough. often responds well to the administration of humidified oxygen.

croup (signs and symptoms)

responds well to administration of humidified oxygen. Bronchodilatorsr are not indicated and can worsen a patient condition.

croup medication

cause swelling, inflammation, and varying degrees of obstruction in the upper airway

croup, epiglottitis, laryngitis

Genetic disorder that affects the lungs and digestive system. Disrupts the normal function of cells that make up the sweat glands in the skin and that also line the lungs and the digestive and reproductive systems. predisposes the child to repeated lung infection. Disrupts the essential balance of salt and water needed to maintain a normal coating of fluid and mucus inside the lungs and other organs. The end result is that the mucus becomes thick, sticky, and hard to move. The mucus hold germs, caused the lungs to become infected. Symptoms range from sinus congestion to wheezing and asthma;like complaints. A chronic cough that produces thick, heavy, discolored mucus may develop in the child. Often causes death in childhood because of chronic pneumonia secondary to the very thick, pathological mucus in the airway. Also causes malabsorption of nutrients in the intestines. Adults are predisposed to other medical conditions, including arthritis, osteoporosis, diabetes , and liver problems.

cystic fibrosis

An infectious disease in which a membrane forms, lining the pharynx, this lining can severely obstruct the passage of air into the larynx. Caused by a bacterium that attacks the membranes of the thorat

diphtheria

Difficulty breathing and swallowing, sore throat, thick, gray buildup in throat or nose, fever

diptheria (signs and symptoms)

thin apperance with barrel chest "puffing" (pursed lip) style of breathing dyspnea on exertion, wheezing tripoid position, pink skin color, dry lung, little or no cough, no mucus

emphysema (signs and symptoms)

The problem causing dyspnea is always some form of obstruction: Swelling of soft tissues in upper airways

epiglottitis, croup

may be caused by pneumia or pulmonary embolism or resp distress caused by other problems, because they are trying to "blow off" more carbon dioxide to compensate for acidosis caused by a poision, a severe infection, or a high level of blood glucose, or having a stress reaction.

hyperventilation

Alkalosis is the cause of many of the symptoms. which include anxiety, dizziness, numbness, tingling of the hands and feet, and painful spasm of the hands and/or feet (carpopedal spams) Often feel they can't catch their breath. Occurs in the absence of other physical problems. Commonly occurs when a patient is experiencing physiological stress. Respirations as high as 40 or low as 20 breaths per min.

hyperventilation syndrome

The decision weather to treat as a life-threatening condition or as a psychological one should be made at the hospital. Verbally instruct patient to slow his or hear breathing, however, if that does not work, give supplemental oxygen and provide transport to the ed.

hyperventilation treatment

Whenever the bodys demand for oxygen increases and its supply decreases, the nervous system increased the production of epinephrine from the adrenal glands. Epinephrine is a hormone that causes tacycardia.

hypoxemia

a condition in which the body's cells and tissues do not have enough oxygen. Examples of diseases are pulmonary edema, hay fever, pleural effusion, obstruction of the airway, hyperventilation syndrome, environmental/industrial exposure, carbon monoxide poisoning, drug overdose.

hypoxia

A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with chronic lung diseases.

hypoxic drive

epiglottitis, bronchitis, tuberculousis, pnemonia, and pertussis.

infectious disease (assoicated with dyspnea)

An animal respiratory disease that has mutated to infect humans In 2009, the H1N1 strain of influenza type a became pandemic (an outbreak that occurred on a global scale). Symptoms include fever, cough, sore throat, muscle aches, headache, and fatigue. May lead to pneumonia or dehydration

influenza type a

Cough, fever, sore throat, fatigue

influenza type a (signs and symptoms)

Problems with ABCs Poor initial general impression unresponsiveness (unstable) potential hypoperfusion or shock chest pain associated with low blood pressure severe pain anywhere excessive bleeding

life threats (examples)

ratio of 1;4 or 1;5 (normal 1;2) Twice as long to exhale as to inhale Patients brionchioles significantly narrow when he or she has difficulty exhaling, as a result causes chronic air trapping in the lungs.

obstructive lung disease

The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs.

oxygentation

Signs and symptoms include: i. Rapid or labored breathing (in children) ii. Blue or gray lips or fingernails iii. Fever iv. Dry skin v. Decreased skin turgor vi. Exertional dyspnea vii. Productive cough : green, red, or rust colored sputum viii. Chest discomfort and pain ix. Headache x. Nausea and vomiting xi. Musculoskeletal pain xii. Weight loss xiii. Confusion xiv. Diminished breath sounds : localized wheezing (dry), crackles, or rhonchi xv. pleuritic chest pain xvi : inflammation of one or both lungs f. If possible, assess temperature to determine presence of fever. g. Provide airway support and supplemental oxygen.

pneumia (signs and symptoms)

The problem causing dyspnea is always some form of obstruction: Impaired exchange of gases in the alveoli

pneumonia

sudden chest pain with dypnea, decreased breath sounds on affected side, subcutaneous emphasemia, plueristic chest pain decreased or absent breath sounds The prescence of air or gas in the pleural cavity surrounding the lungs causing pain and dyspnea

pneumothorax (signs and symptoms)

Excessive red blood cell production. Which is why the patients tend to maintain a pink skin color, even the the presence of hypoxemia. The absence of cyanosis does not rule out hypoxemia in any patient especially a patient with emphysema for this reason. (emphysema patients maintain chronically low blood oxygen levels and chronically elevated carbon dioxide levels)

polycythemia

Involves pushing air into the lungs, as with artificial ventilation. It is critical to perform correctly. If delivered too fast or with too much force (hyperventilation) the resultant increase in thoracic pressure may compress the venae cavae and thereby impair blood return to the right atrium. If blood return is impaired, less blood is pumped from the left ventricle per contraction. (stroke volume). As a result. The patients blood pressure (and perfusion status) will go down. (Deliver each breath over a period of 1 second, just enough to produce visible chest rise, at a rate that is appropirate for the paitnet (10-12bpm for adults, 12-20bpm for infants and children)

positive-pressure ventilation

A blood clot formed in a vein, usually in the legs or pelvis, that breaks off and circulates through the venous system. The embolus can also come from the right atrium in a patient with atrial fibrillation. The clot moves through he right side of the heart and into the pulmonary artery where it comes lodged, significantly dreaseing or blocking blood flow (circulation.) (Even though the lung itself can continue the process of inhalation and exhaltaino, no exchange of oxygen or carbon dioxide takes place in the areas of blocked blood flow because there is no effective circulation. In this circumstance, oxygen levels in the bloodsteam may drop enough to cause cyanosis.) The severity of cyanosis and dyspnea is directly related to the size of the embolism and the amount of tissue affected. May occur as a result of damage to the lining of vessels, most often slowing blood flow in a lower extremity. Can be caused by bed rest anyone who is not active is at risk. With a large enough embolus, sudden obstruction of the output of blood flow from the right side of the heart can result in sudden death.

pulmonary embolism

Acute sharp chest pain "pluertic chest pain" , sudden onset, dyspnea, tachycardia, tachypnea cyanosis that persists despite oxygen, clear breath sounds initially, hematoposis (coughing up blood) (Patients who are immobile for long periods of time are prone.)

pulmonary embolus (signs and symptoms)

associated with emphysema because patients learn that if they push air out slowly at a higher residual rate they can exhale more air than if they try to push it out faster. Explains barrel chest appearance.

pursed lip breathing

The exchange of gasses between the body and its environment. The exchange of oxygen and carbon dioxide in the lungs is called pulmonary "external" the exchange of oxygen and carbon dioxide at the cellular level is called cellular "internal" Rate of 12-20 bpm

respiration

Regular or irregular (primary assessment)

rhythm

Chronic oxygenation problems can also lead to this and fluid retention. i. Pneumonia develops easily. ii. Repeated episodes of irritation and pneumonia cause scarring in the lung and some dilation of the obstructed alveoli, leading to COPD

right heart failure

indicative of a partial upper airway obstruction usually in the oropharynx.

snoring breath sounds

when air escapes into the pleural cavity

sponatenous pneumothorax

Occurs in patients with certain lung infections or in young people born with weak areas of the lung. People with emphysema or asthma are at higher risk. often during coughing spells Tall, thin males are also at higher risk. especially while doing strenuous activities A patient with this condition becomes dyspneic and might complain of pleuritic chest pain (a sharp, stabbing pain on one side that is worse during breathing or with certain movements of the chest wall). You can sometimes tell that breath sounds are absent or decreased on the affected side.

spontaneous pneumothorax

Excahnge of air between the lungs and the environment

ventialtion

Normal breath sounds made by air moving in and out of the alveoli

vesicular breath sounds