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Flashcards in Week 2 Deck (29):
1

What makes us breathless?

Pain
Exercise
Obesity
Genetics
Smoking
Allergy: Dust, Pollen, Fur and Grass

2

Common respiratory conditions:

Chest Infection
Pneumonia
Emphysema
Dyspnoea
Respiratory failure
Asthma
COPD
PE
TB
Bhronchiectasis
Bronchitis
Cystic fibrosis

3

Respiratory symptoms:

Look, Listen and Feel
Pain:
- Chest
- Shoulders
- Abdomen
- Accessory Muscles

Skin:
- Pale
- Sweaty
- Clammy
- Cyanosed
- Pink

Respiratory:
- Tachypnoea
- Dyspneic
- Cough
- Noisy airway
- Pulmonary oedema

Psychological:
- Anxiety
- Confusion

4

Breathing assessment

Respiration Rate
Depth
Rhythm
Assessment of the Lungs

5

A significant predictor of critical illness is...

Respiratory rate

6

Breathing patterns

Depth of Breathing:
- Deep, sighing (Kussmaul Breathing)
- Normal
- Shallow (Pain)

Difficulty in Breathing (Dyspnoea):
- Orthopnoea – DIB Lying down
- Use of accessory muscles
- Nasal Flaring
- Head bobbing (Children)

Chest Wall Movement:
- Symmetry
- Pneumothorax
- Rib fractures (Paradoxical Movement)
- Chest Recession (Sucking in )

Regularity of Breathing:
- Apnoea ( Absence 20sec>)
- Cheyne-Stokes

7

Stridor

High pitched noise on inspiration or expiration, indicates a disturbance to the airflow in the upper respiratory tract

8

Stertor

Snoring during sleep or altered consciousness

9

Wheeze

Whistling heard on expiration, indicates resistance to airflow in lower respiratory tract

10

Rattle

Heard on inspiration and expiration, associated with secretions in the lower respiratory tract (death rattle!)

11

Respiratory investigations

Blood tests:
- FBC
- U&E
- Blood Gases
- Clotting

Chest X-Ray
CT/MRI
ECG

Respiratory Function Tests:
- Forced Vital Capacity (FVC)
- Forced expiratory volume in 1 sec (FEV1)
- Peak expiratory flow rate (PEFR)

Sputum Specimen
Bronchoscopy

12

Care of the breathless patient

Nurse in Upright position in chair or bed
- Increases lung expansion
- Assists gaseous exchange in alveoli
- May help relieve anxiety
- Avoid laying flat
- Allow patient to lean e.g. over bedside table

13

Asthma

A chronic inflammatory disease of the airways
Causes hyper-responsiveness, mucosal oedema and mucous production
Allergy is the strongest predisposing factor
Inflammation leads to cough, chest tightness, wheezing and dyspnoea
Fully reversible (unlike COPD)

14

Why asthma makes it hard to breathe

Parasympathetic stimulation: leads to bronchoconstriction
Sympathetic stimulation: leads to bronchodilation
Inflammation causes swelling of the bronchial mucosa
Inflammation causes increased mucous production

15

Clinical manifestations of asthma

Wheeze & chest tightness
Dyspnoea &/or cough
Airflow limitation/prolonged expiration
Often recurrent & seasonal/worse nocte

16

Triggers of asthma

Exercise
Allergies
Emotions
Irritants
Infections
Cold air

17

Asthma diagnostic testing

Serial peak expiratory flow
Reversibility (often with short-acting broncho-dilator)
Various spirometry/lung function testing/exercise testing

18

Asthma medication treatment

Aim is for symptom control
Optimised lung function
Lowest effective dose of medication
Fewest possible side effects

19

Metered dose inhalers and Spacers

More medication gets into your lungs than if you use a puffer on its own.
They reduce the local side effects of inhaled steroids in preventer medications, because less of the medication sticks in your mouth and throat
You don’t need to coordinate pressing your puffer and breathing in at the same time

20

Asthma complications

Status asthmaticus – medical emergency where symptoms do not respond to bronchodilators
(aggressive treatment/ventilation/ICU)

Pneumonia
Atelectasis

COPD – not strictly a complication, pts may develop COPD alongside their asthma

21

Asthma patient teaching

The nature of asthma as a chronic inflammatory disease
Identification of triggers and how to avoid them
Purpose and action for each medication
Proper inhalation techniques
How to perform peak flow monitoring
How to implement an action plan
When and how to seek assistance

22

Oxygen cascade

The purpose of the cardio-respiratory system is to extract oxygen from the atmosphere and deliver it to the mitochondria of cells.
At sea level, the atmospheric pressure is 760mmHg, and oxygen makes up 21% (20.094% to be exact) of inspired air: so oxygen exerts a partial pressure of 760 x 0.21 = 159mmHg
Process of the decreasing oxygen pressures from the atmosphere to inside the cell

PaO2 of oxygen at sea level is 159mmHg
PaO2 of oxygen in arterial blood 80-100mmHg
PaO2 of oxygen in capillaries 40mmHg or less
Diffuses down to 3 or 4mmHg at cellular level

23

Hypoxia

Is a deficiency in the amount of oxygen reaching the tissues

24

Hypoxaemia

An abnormally low concentration of oxygen in the blood.

25

High flow oxygen system

Venturi mask
Guarantees FiO2 irrespective of breathing pattern
High & low concentrations possible

26

Low flow oxygen system

all other masks/devices
Mixes with room air
Influenced by breathing pattern

27

Causes of hypoxia

Hypoxaemic – decreased oxygen level in arterial blood
(ventilation-perfusion mismatch)
(?PE/atelectasis/pulm.oedema)
- provide supplemental oxygen/treat underlying cause

Circulatory - inadequate capillary blood flow
(decreased cardiac output/vascular obstruction/ cardiac arrest/shock)
- provide supplemental oxygen/treat underlying cause

Anaemic – reduced level of haemoglobin
(various anaemias/CO poisoning)
- provide supplemental oxygen/treat underlying cause

Histotoxic – inability of tissues to use the oxygen
(cyanide and various chemical poisoning)
- provide supplemental oxygen/treat underlying cause

28

Signs and symptoms of hypoxaemia

Neurological - headache, double vision, weakness, restlessness, confusion, agitation, altered LOC

Respiratory distress – nasal flaring, unequal chest expansion or inspiration, use of accessory muscles

29

Measuring effectiveness of oxygen therapy

Respiratory rate within patient’s normal limits.
Improved breath sounds/mental status/skin colour
Decreased dyspnoea both at rest/with exertion
Decreased anxiety/agitation/restlessness
Pulse/blood pressure at patient’s baseline