Chapter 16 Post Questions
If the cells of the body are not getting an adequate supply of oxygen, they begin to die. This state of inadequate oxygen supply is called:
Hypoxia Shortness of breath, abnormal upper airway sounds, faster- or slower-than-normal breathing rates, poor chest rise and fall, and other signs and symptoms of respiratory distress may be indications that the cells of the body are not getting an adequate supply of oxygen, a condition known as hypoxia. Respiratory emergencies may range from shortness of breath, or dyspnea, to complete respiratory arrest, or apnea. Both of these conditions lead to hypoxia. Shock has its root in hypoxia.
You are treating a 45-year-old woman who has been struggling in trying to breathe. She has a history of COPD from years of smoking more than two packs of cigarettes a day. Aside from administering the appropriate amount of oxygen, what else is an appropriate treatment? A. Assist the patient with her bronchodilator according to your protocols. B. Administer an epinephrine self-injector. C. Lay the patient down and raise her legs. D. Administer four baby aspirins.
A. Assist the patient with her bronchodilator according to your protocols. Administer a bronchodilator to the patient by metered-dose inhaler (MDI) or small-volume nebulizer (SVN). The patient must exhibit signs and symptoms of breathing difficulty (respiratory distress). The patient must have a physician-prescribed metered-dose inhaler containing a medication that was specifically prepared to be delivered by nebulization. The EMT must have received approval from medical direction, whether on-line or off-line, to administer the medication.
Where does the lower airway begin? A. At the level of the vocal cords B. At the bronchiole branches C. At the bronchial bifurcation D. At the uvula
A. At the level of the vocal cords The respiratory system can be divided into three portions. The first two are the upper and lower airways, the vocal cords (or glottic opening) being the transition between the two. The primary purpose of the upper and lower airways is to conduct air into and out of the lungs. The third portion of the respiratory system consists of the lungs and accessory structures, which work in concert with the upper and lower airways to allow the oxygenation of body cells and the elimination of carbon dioxide from the bloodstream.
Which of the following is consistent with normal breathing? A. Bilateral breath sounds B. Diaphoretic skin C. Decreased mental status D. Altered mental status
A. Bilateral breath sounds Bilateral breath sounds are consistent with normal breathing.
Which of the following medications is the EMT NOT allowed to use for the acute management of a patient with bronchoconstriction, wheezing, and a history of asthma? A. Salmeterol xinafoate B. Albuterol C. Isoetharine D. Levalbuterol
A. Salmeterol xinafoate A drug that is commonly prescribed for patients with uncontrolled asthma is the Advair Diskus. Unlike the short-acting beta 2 agonists (e.g., albuterol, Proventil, Xopenex, Bronkosol) that can be delivered with the assistance of the EMT via an MDI or SVN, Advair is a long-acting beta 2-specific drug (salmeterol xinafoate) that also contains a steroid (fluticasone propionate) that is used as a maintenance drug. Even though Advair is used to treat asthma, it is not to be used as a rescue inhaler for a patient who is experiencing an acute asthma attack.
Which of the following is NOT a contraindication to administering a bronchodilator by MDI to a patient with asthma? A. The patient is in severe respiratory distress. B. The patient is not responsive enough to use the MDI. C. The patient has already taken the maximum allowable dose. D. An MDI is not prescribed for the patient.
A. The patient is in severe respiratory distress. The fact that the patient is in respiratory distress and has a history of asthma is actually an indication for use of a metered-dose inhaler (MDI). However, if the patient is unresponsive, is not the patient to whom the MDI is prescribed, or has already reached the maximum number of doses, the patient should not receive the medication.
Pulmonary edema can be caused by all of the following EXCEPT: A. a stroke. B. high-altitude sickness. C. narcotic overdose. D. left heart failure.
A. a stroke. Pulmonary edema is most often seen in patients with cardiac dysfunction leading to congestive heart failure. Other disease processes, such as altitude sickness and narcotic overdose, could also lead to pulmonary edema as well. The most significant problem associated with pulmonary edema is hypoxia.
Emergency medical care for a child who is experiencing significant difficulty breathing may include: A. beginning positive pressure ventilations if breathing becomes inadequate. B. reassessing the patient every 15 minutes while en route to the hospital. C. applying a nasal cannula if the patient will not tolerate a nonrebreather mask and is in respiratory arrest. D. removing the child from the parent and securing the child to the ambulance stretcher.
A. beginning positive pressure ventilations if breathing becomes inadequate. If at any time the infant or child's breathing becomes inadequate (respiratory failure), remove him from the parent, establish an open airway, and begin positive pressure ventilation with supplemental oxygen.
A condition that can cause obstruction of an infant's upper airway is swelling of the epiglottis from an infection. This condition is known as: A. epiglottitis. B. asthma. C. croup. D. chronic obstructive pulmonary disease (COPD).
A. epiglottitis. Epiglottitis, an inflammation that affects the upper airway, can be an acute, severe, life-threatening condition if left untreated. In epiglottitis, the epiglottis, the area around the epiglottis, and the base of the tongue become infected. As the condition progresses, these structures become inflamed and swollen, leading to a compromised airway and resultant respiratory compromise. If untreated, this partial-to-complete airway obstruction leads to ineffective gas exchange in the lungs, hypoxia, acidosis, and eventually death. Croup, also commonly seen in children, involves swelling of the larynx, trachea, and bronchi, causing breathing difficulty. Asthma is characterized by increased sensitivity of the lower airways to irritants and allergens, causing bronchospasm. COPD is not considered an infant illness.
While you are obtaining your patient's blood pressure, you notice that the needle drops more than 10 mm/Hg each time the patient inhales. This is called: A. pulsus paradoxus. B. pulsus alternans. C. pressus invertus. D. hypoxia-induced tachycardia.
A. pulsus paradoxus. If the EMT notes a drop in the systolic pressure during inhalation, it may be from a drastic increase in pressure inside the chest due to a pulmonary dysfunction. If the needle drops more than 10 mmHg when the patient inhales, it is a significant finding of a severe respiratory condition such as obstructive lung disease. This finding is referred to as pulsus paradoxus. You may also note this as a sudden decrease in the amplitude (strength) of the pulse when the patient inhales. As the patient exhales, the pulse strength returns. Pulsus alternans is a finding on a 12-lead ECG that can also be found with this condition. Tachycardia is a sign of hypoxia.
A condition in which a lung collapses without any chest trauma is called: A. spontaneous pneumothorax. B. hemopneumothorax. C. random pneumothorax. D. vacuous pneumothorax.
A. spontaneous pneumothorax. A sudden rupture of a portion of the visceral lining of the lung, not caused by trauma, causes the lung to partially collapse. Many patients with a spontaneous pneumothorax have a history of cigarette smoking or a connective tissue disorder such as Marfan syndrome or Ehlers-Danlos syndrome. Patients with a history of COPD are more prone to spontaneous pneumothorax as a result of areas of weakened lung tissue called blebs.
A 22-year-old woman tells you she is having a panic attack. Her vital signs are P110, R 36, BP 132/76, and her SPO2 is 99%. Which of the following is the appropriate treatment for this patient? A. Administer supplemental oxygen at 10 lpm via a nonrebreather (NRB) mask. B. Coach her to slow her breathing. C. Have her breathe into a paper bag. D. Assist her with a bronchodilator.
B. Coach her to slow her breathing. One technique is to have the patient close her mouth and breathe through her nose. You might need to coach the patient to help her slow her rate of breathing. Do not have the patient breathe into a paper bag or oxygen mask not connected to oxygen to allow her to rebreathe carbon dioxide.
After administration of a bronchodilator, what would the EMT expect to hear during auscultation if the medication had its desired effect on the body? A. Slight increase in heart tones B. Diminishment in wheezing C. Diminishment in crackles D. Slight increase in tracheal sounds
B. Diminishment in wheezing A bronchodilator is designed to relax the bronchioles and allow for better airflow through them. Improved air movement in the lungs will produce clearer and louder breath sounds on both sides of the chest. Conversely, if the patient's condition deteriorates, the breath sounds become diminished to absent. Note that decreased wheezing may not indicate improvement; it may actually indicate severe bronchoconstriction with less air movement.
You are caring for a patient with a history of emphysema who has a primary complaint of shortness of breath and the following findings: pulse oximeter reading of 93 percent, heart rate 110, blood pressure 180/86, and respiratory rate 26/minute. You find the patient's skin to be diaphoretic with ashen fingers and toes. There are bilaterally diminished breath sounds with a slight expiratory wheeze, but alveolar sounds are still present. Given these findings, how would you characterize this patient's current ventilation adequacy? A. He is breathing inadequately, and significant findings of inadequacy are present. B. He displays respiratory distress, and he is at risk for deterioration. C. He is breathing inadequately but shows signs of improving. D. He is breathing adequately, and no indications of respiratory failure are present.
B. He displays respiratory distress, and he is at risk for deterioration A patient who is having difficulty breathing but has an adequate tidal volume and respiratory rate is said to be in respiratory distress. Because the tidal volume and respiratory rate are still adequate, the patient is compensating. However, because there are signs of respiratory distress, supplemental oxygen should be administered. Oxygen via a nasal cannula at 2 to 4 lpm can be used to increase or maintain the SPO2 reading at 94 percent or higher. Oxygen administration should be based on the patient's oxygenation status as measured and primarily guided by the pulse oximetry instead of using predetermined devices and flow rates for all patients. The patient who presents with moderate to severe respiratory distress and who is awake and alert may benefit from continuous positive pressure ventilation (CPAP). A patient who is presenting with a severely decreased SPO2 reading and obvious signs of severe hypoxia may benefit from higher concentrations of oxygen delivered by a nonrebreather mask at 15 lpm.
Which of the following conditions can initially present with lethargy and confusion? A. Dyspnea B. Hypercarbia C. Hypoxia D. Anoxia
B. Hypercarbia Initially, hypercarbia (too much carbon dioxide in the bloodstream) causes confusion, disorientation, and lethargy. The patient who is hypoxic (insufficient oxygen in the bloodstream) typically presents with confusion and anxiety from heightened sympathetic tone. Decreasing consciousness and bradypnea indicate severe hypercarbia and the progression from respiratory distress to impending respiratory failure. Anoxia is a severe form of hypoxia, indicating a total depletion of oxygen. Dyspnea is shortness of breath.
Which area of the brain is responsible for the gross rate and rhythm of the breathing pattern? A. Cerebellum B. Medulla oblongata C. Midbrain D. Stretch receptors
B. Medulla oblongata Accessory structures that are part of the respiratory system include the inspiratory and expiratory centers in the medulla and pons, located in the brainstem, which exert nervous control of breathing. The medulla houses the neural respiratory centers that are responsible for the gross rate and rhythm of the breathing pattern.
Your patient woke up in the middle of the night with extreme shortness of breath. He says that he has a "cardiac history" and always sleeps with three pillows. He denies any chest pain. What is his MOST likely condition? A. Pneumonia B. Pulmonary edema C. Spontaneous embolism D. Pulmonary embolism
B. Pulmonary edema Pulmonary edema is most frequently seen in patients with cardiac dysfunction leading to congestive heart failure. Acute pulmonary edema occurs when an excessive amount of fluid collects in the spaces between the alveoli and the capillaries. Patients with a cardiac history often have left heart failure that builds up in the middle of the night, causing severe breathing difficulty due to pulmonary edema.
You are reassessing a patient to whom you have administered oxygen and an MDI for respiratory distress. During your reassessment, you find that there is only slight expiratory wheezing, the pulse oximeter reading is 97 percent, the patient is speaking in full sentences, and the patient's color is good. Given this, which of the following characterizes the patient? A. She is displaying mild respiratory arrest. B. She is displaying mild respiratory distress. C. She is displaying mild respiratory failure. D. She is in respiratory arrest.
B. She is displaying mild respiratory distress. Respiratory emergencies may range from shortness of breath, or dyspnea, to complete respiratory arrest, or apnea, in which the patient is no longer breathing. A patient who is having some difficulty breathing but has an adequate tidal volume and respiratory rate is said to be in respiratory distress. Because the tidal volume and respiratory rate are adequate, the patient is compensating well now. Because there are still signs of respiratory distress, however, supplemental oxygen should be continued. A nasal cannula at 2 to 4 lpm can be used to maintain the SpO2 reading at 94 percent or higher. Oxygen administration should be based on the patient's oxygenation status as measured and primarily guided by the pulse oximetry instead of by using predetermined devices and flow rates for all patients. Ongoing monitoring of the patient would be warranted at this time.
Besides the symptom of respiratory distress, how would an EMT know that a patient may have a viral infection affecting the respiratory system? A. The presence of a rash across the chest B. The presence of a fever C. The presence of leaking blisters on the lips D. The presence of a purple-colored bruise on the arm
B. The presence of a fever Viral respiratory infections affect the pulmonary system. These include bronchiolitis, colds, and the flu. In most situations for adults, viral respiratory infections are fairly mild, self-limiting, and confined to the upper respiratory system. In children, however, the infection has a greater propensity to spread into the lower airways, where more significant infections can occur that will result in patient deterioration. Some of the symptoms of a viral respiratory infection are nasal congestion, sore or scratchy throat, mild respiratory distress and coughing, fever (usually around 101degreesF to 102degreesF), malaise, headaches, and body aches. There are no specific treatments for viral infections that the EMT can administer. The mainstay of emergency treatment for respiratory distress secondary to a viral respiratory infection is supportive.
In the asthma patient, all of the following contribute to the increasing resistance to airflow and difficulty breathing, EXCEPT: A. edema of the inner lining in the airways. B. malaise and decreasing appetite. C. bronchoconstriction. D. mucus that causes plugging of the smaller airways.
B. malaise and decreasing appetite. The most common complaint of the asthma patient is severe shortness of breath. Many asthma patients are aware of their condition and have medication to manage the disease and its signs and symptoms. You may be called to the scene for a patient who is suffering an early-onset asthma attack or one in which the patient's medication is not reversing the attack. Asthma involves bronchoconstriction, edema of the inner lining in the airways, and increased secretion of mucus that causes plugging of the smaller airways.
All of the following are considered chronic obstructive pulmonary diseases, EXCEPT: A. emphysema. B. pulmonary embolism. C. chronic bronchitis. D. black lung disease.
B. pulmonary embolism. An obstructive lung disease causes an obstruction of airflow through the respiratory tract, leading to a reduction in gas exchange. The most severe consequence of reduced airflow is hypoxia. COPD includes emphysema, chronic bronchitis, asthma, asbestosis, and black lung disease. In pulmonary embolism, an obstruction of blood flow in the pulmonary arteries leads to hypoxia. Pulmonary embolism is a sudden blockage of blood flow through a pulmonary artery or one of its branches. The embolism is usually caused by a blood clot, but it may also be caused by an air bubble, a fat particle, a foreign body, or amniotic fluid. The embolism prevents blood from flowing to the lung. As a result, some areas of the lung have oxygen in the alveoli (adequate ventilation) but are not receiving any blood flow (reduced perfusion).
The patient who has pneumonia usually has all of the following, EXCEPT: A. decreased appetite. B. vomiting blood. C. malaise. D. fever.
B. vomiting blood. Pneumonia is primarily an acute infectious disease caused by a bacterium or virus that affects the lower respiratory tract and causes lung inflammation and fluid- or pus-filled alveoli. This leads to a ventilation disturbance in the alveoli with poor gas exchange, hypoxemia, and eventual cellular hypoxia. Pneumonia can also be caused by inhalation of toxic irritants or aspiration of vomitus and other substances. It can present with malaise, decreased appetite, and fever but does not typically involve vomiting of blood.
When a blood clot ends up in the lungs, the patient may have sudden development of: A. GI symptoms. B. a fever. C. dyspnea. D. "crushing" chest pain.
C. dyspnea. Pulmonary embolism is a sudden blockage of blood flow through a pulmonary artery or one of its branches. The embolism is usually caused by a blood clot, but it may also be caused by an air bubble, a fat particle, a foreign body, or amniotic fluid. The embolism prevents blood from flowing to the lung. As a result, some areas of the lung have oxygen in the alveoli (adequate ventilation) but are not receiving any blood flow (reduced perfusion). Pulmonary embolism can cause sudden onset of dyspnea.
A patient with which of the following signs indicates respiratory failure? A. Absent alveolar breath sounds to left apical zone, pulse oximeter reading of 89%, mild confusion B. Respiratory rate of 32/minute, intercostal retractions noted, and tachycardia C. Central cyanosis, one- to two-word dyspnea, pulse oximeter reading of 84% D. Pale skin, expiratory wheezing, respiratory rate of 26/minute
C. Central cyanosis, one- to two-word dyspnea, pulse oximeter reading of 84% All of these are indications of difficulty in breathing. However, a patient with cyanosis, one- to two-word dyspnea, and a pulse oximeter reading in the mid-80s is most in need of positive pressure ventilation, as he displays classic findings of respiratory failure. The patient is said to be in respiratory failure because the respiratory tidal volume or rate is no longer able to provide an adequate ventilator effort. This requires you to immediately begin ventilation with a bag-valve-mask device or other ventilation device. Supplemental oxygen must be delivered through the ventilation device. Inadequate breathing that is not treated promptly is likely to deteriorate to respiratory arrest.
After administering the 45-year-old female patient's bronchodilator, you notice that she continues to have considerable distress and her mental status is becoming altered. Aside from administering oxygen, what else should you be considering? A. Administering an epinephrine self-injector B. Administering another bronchodilator treatment C. Getting out the bag-valve mask and preparing to assist ventilations D. Using CPAP
C. Getting out the bag-valve mask and preparing to assist ventilations Respiratory emergencies may range from shortness of breath, or dyspnea, to complete respiratory arrest, or apnea, in which the patient is no longer breathing. If either the tidal volume or the respiratory rate is inadequate or becomes inadequate, the patient's respiratory status becomes inadequate. The patient is said to be in respiratory failure, since the respiratory tidal volume or rate is no longer able to provide an adequate ventilatory effort. This is evident when the bronchodilator does not work and the patient's mental status becomes more altered. In this case, the patient may go into respiratory arrest, so get your bag-valve mask out and be ready to assist ventilations. Supplemental oxygen must be delivered through the ventilation device.
What is the pathophysiology of cystic fibrosis? A. Bronchodilation of the lower airways B. Ankle edema C. Overabundant production of mucus in the lower airways D. Swelling of the tongue
C. Overabundant production of mucus in the lower airways Cystic fibrosis is a hereditary disease. Although it commonly causes pulmonary dysfunction as a result of changes in the mucus-secreting glands of the lungs, it also affects the sweat glands, the pancreas, the liver, and the intestines. In cystic fibrosis, an abnormal gene alters the functioning of the mucous glands lining the respiratory system, and there is an overabundant production of mucus, which is very thick and sticky. As this thick mucus layer develops, there is blockage of the airways as well as an increase in the incidence of lung infections, as bacteria can readily grow in the thick mucus.
While you are listening to breath sounds, the patient should be in what anatomic position whenever possible? A. Lying down on their side B. Positioned supine in a bed C. Sitting upright D. Standing erect
C. Sitting upright To achieve the most accurate interpretation of breath sounds, it is important to auscultate in the appropriate fashion. Whenever feasible, have the patient sit upright, and while using the diaphragm end of your stethoscope over bare skin (never auscultate over clothing), instruct the patient to cough one or two times and then take deep rhythmic breaths (inhalation and exhalation) with his mouth open and not to talk.
You are standing by at a local 5K race when you are asked to take a look at a runner who did not complete the race. He is a 29-year-old skinny man who describes a sudden onset of sharp chest pain on the right side with shortness of breath. What is the MOST likely problem? A. STEMI B. Pulmonary embolism C. Spontaneous pneumothorax D. Embolic stroke
C. Spontaneous pneumothorax A spontaneous pneumothorax is a sudden rupture of a portion of the visceral lining of the lung, not caused by trauma, which causes the lung to partially collapse. In spontaneous pneumothorax, a portion of the visceral pleura ruptures without any trauma having been applied to the chest. This allows air to enter the pleural cavity, disrupting its normally negative pressure and causing the lung to collapse. The lung collapse causes a disturbance in gas exchange and can lead to hypoxia.
You are managing a patient who you believe is severely hypoxic, and the pulse oximeter is not functioning properly. Given this information, what is the BEST thing you could do for the patient? A. Start low-flow oxygen at 4 lpm via face mask. B. Place the patient in a tripod position. C. Start high-flow oxygen. D. Initiate artificial ventilation.
C. Start high-flow oxygen. Regardless of the cause, a complaint of breathing difficulty requires your immediate intervention. If severe hypoxia is present, time is critical because of the detrimental effects of severely or prolonged low oxygen levels on all cells and organs. Typically, the EMT will use the pulse oximeter reading to help identify oxygenation needs, but if the pulse oximeter is unavailable or not working properly, the EMT will still have to make a decision about oxygen use. If the patient is breathing adequately but has other objective findings of hypoxia, place the patient in a sitting position and start oxygen via NRB. If the patient is not breathing adequately, initiate PPV with high-flow supplemental oxygen.
Which of the following includes the proper way to assess for breath sounds? A. Tell the patient to sit upright, use the bell end of the stethoscope, and listen to the posterior side only. B. Instruct the patient to breathe through the nose as you listen, and listen for three complete breaths. C. Use the diaphragm end of the stethoscope, listen over bare skin, and instruct the patient to cough first. D. Expose the patient's skin and use the bell end of the stethoscope on bare skin as you instruct the patient to breathe with the mouth open.
C. Use the diaphragm end of the stethoscope, listen over bare skin, and instruct the patient to cough first. Whenever feasible, have the patient sit upright, and while using the diaphragm end of your stethoscope over bare skin (never auscultate over clothing), instruct the patient to cough one or two times and then take deep rhythmic breaths (inhalation and exhalation) with her mouth open and not to talk.
You respond to a call from the regional airport to remove an elderly patient experiencing respiratory distress from a plane that just landed after a long flight. A respiratory condition that may be caused by a deep vein thrombosis that develops when a person has been sitting for a long time is: A. spontaneous pneumothorax. B. croup. C. pulmonary embolism. D. asthma attack.
C. pulmonary embolism. In pulmonary embolism, an obstruction of blood flow in the pulmonary arteries leads to hypoxia. Patients who are at risk for suffering a pulmonary embolism are those who experience long periods of immobility (e.g., bedridden individuals, those who travel for a long period confined in one position, those with splints to extremities) as well as those with heart disease, recent surgery, long-bone fractures, venous pooling associated with pregnancy, cancer, deep vein thrombosis (development of clots in the veins, most commonly in the legs), estrogen therapy, clotting disorders, or history of previous pulmonary embolism and those who smoke.
There are many problems that can cause chest pain. A symptom that usually signals pneumonia rather than another cause of chest pain is: A. tachypnea. B. weakness. C. the presence of a fever. D. dyspnea.
C. the presence of a fever. Pneumonia is primarily an acute infectious disease caused by a bacterium or virus that affects the lower respiratory tract and causes lung inflammation and fluid- or pus-filled alveoli. This leads to a ventilation disturbance in the alveoli with poor gas exchange, hypoxemia, and eventual cellular hypoxia. The signs and symptoms of pneumonia vary with the cause and the patient's age. The patient generally appears ill and may complain of fever and severe chills.
A 25-year-old woman appears to be suffering from hyperventilation syndrome. You should A. apply a nonrebreather without oxygen attached. B. provide positive pressure ventilations. C. try to calm the patient. D. have her breathe into a paper bag.
C. try to calm the patient. The primary management of hyperventilation syndrome is to get the patient to calm down and slow his breathing.
As the lead EMT on a call for a dyspneic patient, you are reviewing the medications the patient takes. If the clinical criteria are met for assisting the patient with the administration of a bronchodilator, which of the following would the EMT be unable to use? A. Xopenex B. Proventil C. Bronkosol D. Advair
D. Advair A drug that is commonly prescribed for patients with uncontrolled asthma is the Advair Diskus. Unlike the short-acting beta 2 agonists (e.g., albuterol, Proventil, Xopenex, Bronkosol) that can be delivered with the assistance of the EMT via an MDI or SVN, Advair is a long-acting beta 2-specific drug (salmeterol xinafoate) that also contains a steroid (fluticasone propionate) that is used as a maintenance drug. Even though Advair is used to treat asthma, it is not to be used as a rescue inhaler for a patient who is experiencing an acute asthma attack.
Which assessment finding in a patient who is dyspneic is a clear indication of hypoxia? A. Rambling speech B. Nasal flaring C. Diaphoresis D. Cyanosis
D. Cyanosis Cyanosis (bluish gray skin color) is a clear indication of hypoxia but also a sign that may occur late. Look at the area around the nose and mouth when getting the general impression. You will examine many other areas for cyanosis in the physical examination. A patient with respiratory distress commonly is diaphoretic and may present with flaring nostrils.
The EMT will encounter many patients with respiratory distress. Which of the following will be the most common cause? A. Hemorrhagic lung disease B. Infectious lung disease C. Cancerous lung disease D. Obstructive lung disease
D. Obstructive lung disease Responding to a call for a patient complaining of shortness of breath who has an obstructive pulmonary (lung) disease is common in the prehospital environment. An obstructive lung disease causes an obstruction of airflow through the respiratory tract, leading to a reduction in gas exchange. The most severe consequence of reduced airflow is hypoxia. The three most commonly encountered obstructive pulmonary diseases are emphysema, chronic bronchitis, and asthma.
Your patient is exhibiting minimal use of accessory muscles while breathing. This is a sign of A. respiratory collapse. B. respiratory distress. C. respiratory failure. D. normal breathing.
D. normal breathing. When a patient exhibits minimal use of accessory muscles while breathing, it is a sign of normal breathing.
If your patient is breathing adequately but with difficulty and the pulse oximeter reads 84 percent, you should: A. contact medical control for permission to administer nitroglycerin. B. apply supplemental oxygen by cannula at 1 to 6 lpm. C. administer a bronchodilator. D. provide oxygen by a nonrebreather mask at 15 lpm.
D. provide oxygen by a nonrebreather mask at 15 lpm. Do not take the time to try to determine the exact cause of the breathing difficulty unless your patient is a trauma patient with a possible chest injury that must be managed in addition to the breathing difficulty itself. If the breathing is adequate (adequate chest rise and fall, good volume of air being breathed in and out, good breath sounds bilaterally, and an adequate rate) but the patient complains of difficulty in breathing (respiratory distress) with a poor pulse oximeter, administer supplemental oxygen and assess the baseline vital signs.
