the resp system can be divided into three portions :
first two:
the upper/lower with the vocal cords being the transition between the two
third:
lungs/accessory muscles
findings consistent with a Pt who is breathing adequately:
open airway normal RR normal rise and fall of the chest normal resp rhythm breath sounds present bilaterally chest expansion and relaxation some to no accessory muscle use
norm skin cond.
norm mental status
norm Spo2
norm muscle tone
receptors near the alveoli that detect when the alveolar-capillary beds are becoming abnormally engorged with blood as a result of heart failure
juxtacapillary receptors
three basic types of abnormal breath sounds that you might hear upon auscultation of the thorax - may be early indicators of impending resp distress.
wheezing
rhonchi
crackles
high pitched, musical, whistling sound that is best heard initially on exhalation but may also be heard during inhalation in more severe cases. an indication of swelling and constriction of the inner lining of the bronchioles.
wheezing
sounds heard here represent airflow through the larger conducting airways. airway structure are still supported by cartilage. abnormal sounds heard best here include stridor and rhonchi
second intercostal space, midclavicular line
sounds hear here represent airflow through smaller conducting airways (bronchioles). you may also be able to hear some airflow into the air sacs (alveoli). the abnormal breath sound heard best in this location is wheezing
third intercostal space, anterior axillary line
OR
fourth intercostal space, midaxillary line
while the Pt is sitting upright, the sounds heard here represent airflow into the alveoli. this is the best location to hear alveolar airflow. the abnormal sound heard here is most commonly crackles (rales)
fifth or sixth intercostal space, posterior midscapular line
snoring or rattling noises heard upon auscultation. they indicate obstruction of the larger conducting airways of the respiratory tract by thick secretions or mucus.
rhonchi
bubbly or crackling sounds heard during inhalation. these sounds are associated with fluid that has surrounded or filled the alveoli or very small bronchioles.
crackles AKA rales
decreased O2 in the bloodstream typically defined as an SpO2 reading of
hypoxemia
difficulty breathing or shortness of breath
dyspnea
complete respiratory arrest/not breathing
apnea
hypercarbia
increased CO2 levels in the blood
a Pt who is having difficulty breathing but has an adequate tidal volume and RR is said to be in___________.
respiratory distress
if either tidal volume or the RR becomes or is inadequate, the Pts resp statue becomes inadequate.
the Pt is said to be in _________, since the resp tidal volume or rate is no longer able to provide an adequate ventilatory effort.
respiratory failure
______ is when the breathing effort ceases completely. can lead to cardiac arrest in minutes
respiratory arrest
a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. a permanent disease characterized by destruction of the alveolar walls and distension of the alveolar sacs
emphysema
COPD that involves inflammation, swelling, and thickening of the lining of the bronchi and bronchioles and excessive mucus production.
chronic bronchitis
a prolonged life-threatening attack that produces inadequate breathing and severe signs and symptoms is called_______. a severe asthmatic attack that does not respond to either oxygen or medication.
status asthmaticus
an abnormally large drop is systolic BP during inspiration
pulsus paradoxus
a primarily acute infectious disease caused by bacterium or a virus that affects the lower resp tract and causes lung inflamation and fluid- or pus-filled alveoli. can also be cause by inhalation of toxic irritants or aspiration of vomitus and other substances
pneumonia
a sudden blockage of blood flow through a pulmonary artery or one of its branches, 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.
pulmonary embolism
______occurs when an excessive amount of fluid collects in the spaces between the alveoli and the capillaries
acute pulmonary edema
typically related to an inadequate pumping function of the heart that drastically increases the pressure in the pulmonary capillaries, which in turn forces fluid to leak into the spaced between the alveoli and capillaries and, eventually, into the alveoli themselves.
cardiogenic pulmonary edema
AKA acute resp distress syndrome (ARDS), results from destruction of the capillary bed that allows fluid to leak out.
noncardiogenic pulmonary edema
a sudden rupture of a portion of the visceral lining of the lung, not cause by trauma, that causes the lung to partially collapse
spontaneous pneumothorax
areas of weakened lung tissue
blebs
the ________ syndrome Pt is often anxious and experiences the feeling of not being able to catch his breath. is commonly associated with situations in which the Pt is emotionally upset or very excited.
hyperventilation
signs and symptoms: anxious, alert, and oriented dyspneic uses accessory muscles thin, barrel-chest coughing with little sputum prolonged exhaustion diminished breath sounds wheezing and rhochi pursed-lip breathing dyspnea on minimal exhertion tachyapnea tachycardia diaphoresis
emphysema
signs and symptoms: cough, vigorous coughing produces sputum typically overweight prominent peripheral edema chronic jugular vein distention chronic cyanosis scattered rales and coarse rhonchi wheezes and possible, crackles at the base of the lungs
chronic bronchitis
signs and symptoms: dyspnea cough, worsens at night wheezing tachypnea tachycardia accessory muscle use anxiety possible fever runny nose chest tightness pulsus paradoxus
asthma
signs and symptoms: decreased appetite fever cough dyspnea tachypnea tachycardia chest pain decreased chest wall movement splinting of thorax by Pt with arm crackles, localized wheezing, and rhonchi altered mental status diaphoresis cyanosis
pneumonia
signs and symptoms: sudden onset of unexplained SOB sudden onset of sharp, stabbing chest pain cough ( may cough blood) tachypnea tachycardia syncope cool, moist skin restlessness, anxiety, or sense of impending doom cyanosis crackles fever
pulmonary embolism
signs and symptoms: dyspnea difficulty breathing when lying flat frothy sputum tachycardia anxiety, apprehension, combativeness, confusion tripod position fatigue crackles and possible wheezing cyanosis or dusky color skin pale, moist skin cough
pulmonary edema
signs and symptoms: sudden onset of SOB sudden onset of sharp chest pain or shoulder pain decreased breath sounds to one side of the chest subcutaneous emphysema tachypnea diaphoresis pallor cyanosis
spontaneous pneumothorax
signs and symptoms: fatigue nervousness and anxiety dizziness SOB chest tightness numbness and tingling around the mouth, hands, and feet tachypnea tachycardia spasms of the fingers and feet causing cramps
hyperventilation syndrome
an inflammation affecting the upper airway, can be acute, severe, life-threatening condition if left untreated.
epiglottitis
signs and symptoms: upper resp tract infection, usually 1-2 days prior dyspnea (usually rapid onset) high/mild fever sore throat and pharyngeal pain inability to swallow with drooling anxiety tripod fatigue stridor cyanosis trouble or pain during speaking
epiglottitis
resp disease characterized by uncontrolled coughing. it is highly contagious and effects the resp system and is caused by bacteria that reside in the upper airway of an infected person.
pertussis AKA whooping cough
signs and symptoms: Hx of upper resp infection sneezing, runny nose, low-grade fever increasing cough coughing fits inspiratory whoop heard at end of cough burst possible cyanosis diminishing SpO2 exhaustion trouble speaking and breathing during burst
pertussis (whooping cough)
mucous glands in the lining of the resp system that produce an overabundance in mucus, which is very thick and sticky. as the thick layer develops, there is blockage of the airways as well as an increase in the incidence of lung infections, since bacteria can readily grow in the thick mucus.
cystic fibrosis
signs and symptoms: commonly a known Hx of disease recurrent coughing expectoration of thick mucus during coughing Hx of pneumonia, bronchitis, and sinusitis gastrointestinal complaints abd pain from gas malnutrition despite healthy app dehydration clubbing of the digits trouble breathing signs of pneumonia
cystic fibrosis
signs and symptoms: Hx consistent w/an inhalation injury presence of chemicals finding of resp distress cough, stridor, wheezing, or crackles oral or pharyngeal burns dizziness H/A, confusion, altered mental status seizures cyanosis N/V abd distress/pain copious secretions vital sign changes
poisonous exposures
condition of the resp system caused by a virus. common VRI’s include bronchiolitis, colds, and the flu.
viral respiratory infections
signs and symptoms: nasal congestion sore or scratchy throat mild resp distress, coughing fever (usually around 101-102) malaise H/A and body aches irritability in infancts tachypnea exacerbation of asthma if Pt is asthmatic
viral respiratory infections
a drug that is commonly prescribed for Pts with uncontrolled asthma - NOT FOR EMERGENCY USE
advair
a condition with no respirations or respiratory effort; however, a pulse is still present.
respiratory arrest
commonly seen in children, involves the swelling of the larynx, trachea, and bronchi, causing breathing difficulty. the child typically does not feel well, has a sore or horse throat, and has a fever.
croup
pallor
pale skin
air trapped under the skin. felt as crackling sensations, often described as rice krispies under the fingertips
subcutaneous emphysema
deminished or absent breath sounds on one side of the chest mean that the lung is not being adequately ventilated because of _______, ______, or _______________.
obstruction, collapse, or surrounding air or fluid.
signs of inadequate breathing are present – poor chest rise and fall, poor volume heard and felt, diminished or absent breath sounds, inadequate rate, or severely altered mental status.
respiratory failure
breathing is adequate (adequate chest rise and fall, good volume of air being breathed in and out, good breath sounds bilaterally, and adequate rate) but the Pt complains of difficulty in breathing.
respiratory distress