Chapter 16

Question 1

wheezing

Answer 1

high-pitched, musical, whistling sound that is best heard initially on exhalation but can also be heard during inhalation in more severe cases. It is an indication of swelling and constriction of the inner lining of the lower airways, primarily the bronchioles

Question 2

Rhonchi

Answer 2

also be referred to as coarse crackles, are snoring or rattling noises heard on auscultation. They indicate obstruction of the larger conducting airways of the respiratory tract by thick secretions of mucus. Rhonchi are often heard in chronic bronchitis, emphysema, aspiration, and pneumonia.

Question 3

crackles/rales

Answer 3

bubbly or crackling sounds heard during inhalation. These sounds are associated with fluid that has surrounded or filled the alveoli or small bronchioles.
can indicate pulmonary edema or pneumonia

Question 4

hypoxemia

Answer 4

decreased oxygen in bloodstream

Question 5

hypercarba

Answer 5

increased co2 in bloodstream

Question 6

common s/s of respiratory distress

Answer 6

-Subjective complaint of shortness of breath
-Restlessness and anxiety
-Tachycardia (early finding)
-bradycardia (later finding)
-Tachypnea
-Pale, cool, clammy skin (early finding)
-cyanosis (later finding)
-Abnormal respiratory pattern
-Wheezing, rhonchi, or crackles
-Difficulty or inability to speak
-Muscle retractions
-Altered mental status
-Abdominal breathing
-Excessive coughing
-Tripod position
-Pulse oximeter reading < 94

Question 7

breathing disturbance 3 categories

Answer 7

Respiratory distress
Respiratory failure
Respiratory arrest

Question 8

respiratory distress

Answer 8

has a normal minute ventilation from compensation in the tidal volume (breathing deeper) and/or the respiratory rate (breathing faster). Because the tidal volume and respiratory rate are still adequate, the patient is compensating

Question 9

respiratory failure

Answer 9

when the tidal volume or respiratory rate is inadequate and no longer can provide an adequate oxygenation of the cells. If the tidal volume decreases or the respiratory rate increases or decreases significantly, you must provide immediate positive pressure ventilation and oxygenation with a bag-valve-mask device or other ventilation device

Question 10

respiratory arrest

Answer 10

complete cessation of breathing effort or the patient experiences agonal breathing

Question 11

diseases that cause respiratory problems

Answer 11

Obstructive pulmonary diseases
-Emphysema
-Chronic bronchitis
-Asthma
Pneumonia
Pulmonary embolism
Pulmonary edema
Spontaneous pneumothorax
Hyperventilation syndrome
Epiglottitis
Pertussis
Cystic fibrosis
Poisonous exposures
Viral respiratory infections

Question 12

emphysema

Answer 12

permanent disease process distal to the terminal bronchioles that is characterized by the destruction of the alveolar walls and the distention of the alveolar sacs and a gradual destruction of the pulmonary capillary beds with a severe reduction in the alveolar/capillary area in which gas exchange can occur.

more common in men

Question 13

emphysema s/s

Answer 13

Anxious, alert, and oriented
Dyspneic
Uses accessory muscles
Thin, barrel-chest appearance
Coughing, but with little sputum
pink puffer
Prolonged exhalation
Diminished breath sounds
Wheezing and rhonchi on auscultation
Pursed-lip breathing (physiologic PEEP)
Extreme difficulty of breathing on minimal exertion
Tachypnea—breathing rate usually greater than 20 per minute at rest
Tachycardia
Diaphoresis (sweating; moist skin)
Tripod position
May be on home oxygen

Question 14

chronic bronchitis

Answer 14

characterized by a productive cough that persists for at least three consecutive months a year for at least two consecutive years.

involves inflammation, swelling, and thickening of the lining of the bronchi and bronchioles and excessive mucus production

Question 15

chronic bronchitis s/s

Answer 15

Cough (hallmark sign) is prominent; vigorous coughing produces sputum

blue bloater

Minimal difficulty in breathing and anxiety, unless in respiratory failure

Scattered rales (crackles) and coarse rhonchi

Wheezes and, possibly, crackles at the bases of the lungs

Asterixis (flapping of the extended wrists) may be seen in respiratory failure

Question 16

asthma

Answer 16

increased sensitivity of the airways to irritants and allergens, causing bronchospasm, which is a diffuse, reversible narrowing of the bronchi and bronchioles, as well as inflammation to the lining of the lower airways.

Question 17

extrinsic asthma

Answer 17

results from a reaction to dust, pollen, smoke, or other irritants in the air

Question 18

intrinsic asthma

Answer 18

usually results from infection, emotional stress, or strenuous exercise.

Question 19

asthma s/s

Answer 19

dyspnea
coughing
wheezing
tachypnea
tachycardia
use of accessory muscles
diaphoresis
anxiety
chest tightness
difficulty sleeping
pulsus paradoxus

Question 20

critically ill asthma s/s

Answer 20

upright position
tachypnea
tachycardia
pulsus paradoxia
pale cool diupheretic skin
single word speech
accessory muscle use
wheezing
decreasing conciousness
extreme fatigue
spo2 < 90 w/o2

Question 21

pneumonia

Answer 21

acute infectious disease caused by bacterium or a virus that affects the lower respiratory tract and causes lung inflammation and fluid- or pus-filled alveoli

Question 22

pneumonia s/s

Answer 22

decreased appetite
fever
cough
dyspnea or tachypnea
tachycardia
sharp localized chest pain worse with deep breath/cough
shallow respirations
self splinting thorax
Crackles, localized wheezing, and rhonchi
Altered mental status, especially in the elderly
Diaphoresis
Cyanosis

Question 23

pulmonary embolism

Answer 23

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 can also be caused by an air bubble, a fat particle, a foreign body, or amniotic fluid

Question 24

pulmonary embolism s/s

Answer 24

Sudden onset of unexplained dyspnea
Signs of difficulty in breathing or respiratory distress; rapid breathing
Sudden onset of sharp, stabbing chest pain predominantly during inhalation
Cough (might cough up blood)
Tachypnea
Tachycardia
Syncope (fainting)
Cool, moist skin
Restlessness, anxiety, or sense of doom
Decrease in blood pressure or hypotension (late sign)
Cyanosis (might be severe) (late sign)
Distended neck veins (late sign)
Crackles
Fever
signs of complete circulatory collapse

Question 25

two types of pulmonary edema

Answer 25

cardiogenic and noncardiogenic

Question 26

cardiogenic pulmonary edema

Answer 26

related to an inadequate pumping function of the left ventricle that drastically increases the pressure in the pulmonary capillaries, which forces fluid to leak into the space between the alveoli and capillaries and, eventually, into the alveoli.

Question 27

noncardiogenic pulmonary edema

Answer 27

known as acute respiratory distress syndrome (ARDS), results from destruction of the capillary bed that allows fluid to leak out. Common causes of noncardiogenic pulmonary edema are severe pneumonia, aspiration of vomitus, submersion, narcotic overdose, inhalation of smoke or other toxic gases, ascent to a high altitude, sepsis, and trauma

Question 28

pulmonary edema

Answer 28

excessive amount of fluid collects in the spaces between the alveoli and the capillaries which makes less oxygen available to the blood flowing through the capillaries (perfusion)

Question 29

pulmonary edema s/s

Answer 29

Dyspnea, especially on exertion Difficulty in breathing when lying flat (orthopnea) Pink and/or frothy sputum (cardiogenic cause only) Tachycardia Anxiety, apprehension, combativeness, and confusion Tripod position with legs dangling Fatigue Crackles and possibly wheezing on auscultation Cyanosis or dusky-color skin Pale, moist skin Distended neck veins (cardiogenic cause only) Swollen lower extremities (cardiogenic cause only) Cough Fever Symptoms of cardiac compromise (cardiogenic cause only)

Question 30

spontaneous pneumothorax

Answer 30

sudden rupture of a portion of the visceral lining of the lung, not caused by trauma, that causes the lung to partially collapse.

Question 31

primary spontaneous pneumothorax

Answer 31

Occurs in patients who have no underlying lung disease. Primary spontaneous pneumothorax occurs in patients in their teenage years to early 20s who are tall and thin. It

Question 32

secondary spontaneous pneumothorax

Answer 32

Occurs in patients in which there is underlying lung disease. Many also have a history of cigarette smoking or a connective tissue disorder such as Marfan syndrome or Ehlers-Danlos syndrome. It also occurs in patients who have a history of lung disease such as COPD

Question 33

spontaneous pneumothorax s/s

Answer 33

Sudden onset of shortness of breath Sudden onset of sharp chest pain or shoulder pain Decreased breath sounds to one side of the chest (most often heard first at the apex, or top, of lung) Subcutaneous emphysema (can be found) Tachypnea Diaphoresis Pallor Cyanosis (can be seen late and in a large or tension pneumothorax)

Question 34

hyperventilation syndrome

Answer 34

pt is often anxious patient begins to “blow off” excessive amounts of carbon dioxide

Question 35

hyperventilation syndrome s/s

Answer 35

Fatigue Nervousness and anxiety Dizziness Shortness of breath Chest tightness Numbness and tingling around the mouth, hands, and feet Tachypnea Tachycardia Spasms of the fingers and feet causing them to cramp (carpopedal spasm) Seizures that may be precipitated in a patient with a seizure disorder

Question 36

epiglotitis

Answer 36

epiglottis, area around the epiglottis, and base of the tongue become infected. As the condition progresses, the epiglottis and the structures connected to or immediately surrounding it and the base of the tongue become inflamed and swollen

Question 37

epiglotitis s/s

Answer 37

Upper respiratory tract infection, usually for 1 to 2 days prior to onset Dyspnea, usually with a more rapid onset High fever (although it can occur with only mild fevers) Sore throat and pharyngeal pain Inability to swallow with drooling (late sign of impending failure) Anxiety and apprehension Tripod position, usually with jaw jutted forward (late sign of impending failure) Fatigue High-pitched inspiratory stridor Cyanosis Trouble speaking or pain during speaking

Question 38

pertussis "whooping cough"

Answer 38

respiratory disease that is characterized by uncontrolled coughing. It is a highly contagious disease that affects the respiratory system and is caused by bacteria that reside in the upper airway of an infected person

Question 39

pertussis s/s

Answer 39

History of upper respiratory infection Sneezing, runny nose, low-grade fever General malaise (weakness, fatigue, not feeling well) Increase in frequency and severity of coughing Coughing fits, usually more common at night Vomiting Inspiratory “whoop” heard at the end of coughing burst Possible development of cyanosis during coughing burst Diminishing pulse oximetry finding Exhaustion from expending energy during coughing burst Trouble speaking and breathing (dyspnea) during coughing burs

Question 40

cystic fibrosis

Answer 40

abnormal gene alters the functioning of the mucous glands lining the respiratory system, and there is an overabundant production of mucus, which is 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 because bacteria can readily grow in the thick mucus

Question 41

cystic fibrosis

Answer 41

Commonly a known history of the disease Recurrent coughing General malaise (weakness, fatigue, and not feeling well) Expectoration of thick mucus during coughing Recurrent episodes or history of pneumonia, bronchitis, and sinusitis Gastrointestinal complaints that can include diarrhea and greasy and foul-smelling bowel movements Abdominal pain from intestinal gas Malnutrition or low weight despite a healthy appetite Dehydration Clubbing of the digits Trouble speaking and breathing (dyspnea) with mucus buildup Signs of pneumonia

Question 42

most common poison exposures

Answer 42

Carbon monoxide Cyanide Natural gas Chlorine gas Liquid chemicals or sprays Ammonia Sulfur dioxide Anesthetic gases Solvents Industrial gases Hydrogen sulfide Fumes/smoke from fires Paints or Freon Glue (Toluene) Nitrogen dioxide (silo gas) Amyl or butyl nitrate

Question 43

Viral Respiratory infections

Answer 43

a condition of the respiratory system caused by a virus. Common VRIs include bronchiolitis, colds, and the flu.

Question 44

VRI s/s

Answer 44

Nasal congestion Sore or scratchy throat Mild respiratory distress, coughing Fever (usually approximately 101°F–102°F) Malaise Headaches and body aches Irritability in infants and poor feeding habits Tachypnea Exacerbation of asthma if patient is asthmatic

Question 45

metered-dose inhaler (MDI) or small-volume nebulizer (SVN) indicators

Answer 45

signs and symptoms of respiratory distress from bronchoconstriction. patient has a physician-prescribed metered-dose inhaler or small-volume nebulizer, EMT has received approval from medical direction, whether on-line or off-line, to administer the medication

Question 46

metered-dose inhaler (MDI) or small-volume nebulizer (SVN) contraindications

Answer 46

The patient is not responsive enough to use the MDI or SVN. The MDI or SVN is not prescribed for the patient or is not in the EMTs protocol. Medical direction has not granted permission. The patient has already taken the maximum allowed dose(s) prior to your arrival.

Question 47

chronic obstructive pulmonary disease COPD s/s

Answer 47

Cough TachypneaChange or increase in sputum production Dyspnea with prolonged expiratory phase Tripod posture Diffuse wheezing Decreased breath sounds bilaterally (severe) Barrel chest Purse lip breathing