What can make us breathless?
- pain
- exercise
- obesity
- genetics
- smoking
- allergies=dust, pollen, fur…
What are some common respiratory conditions?
- chest infections
- pneumonia
- emphysema = chronic obstructive pulmonary disease
- dyspnoea
- asthma
- pulmonary embolism
- tuberculosis
- COPD
- Broncholiectasis
With doing a breathing assessment what are you observing?
- respiration rate
- depth
- rhythm
- assessment of the lungs
List 4 types of abnormal breath sounds?
- stridor=high pitched screeching sound
- stertor= snoring during sleep or altered consciousness
- wheezing = whistling heard on expiration
- rattle=heard on inspiration and expiration
What is asthma?
Asthma is a chronic inflammatory disease of the airways.
-one of the most common respiratory diseases.
What is status asthmaticus?
This a medical emergency where symptoms do not respond to bronchodilators. ( either will need aggressive treatment/ ventilation/ICU)
Why do we not intubate a pt who is suffering from an asthma attack?
Intubation is a last ditch effort as the lungs become dependant.
What would you be teaching your pt who has asthma?
You would be teaching about:
- identifying triggers and how to avoid them
- purpose of each medication and its action potential
- how to perform peak flow monitoring
- how to implement an action plan
What is hypoxia?
Ventilation and perfusion imbalance causing shunting of the lungs. Hypoxia is defined as the reduction of oxygen supply at the tissue level, which is not measured directly by a laboratory value.
What is hypoxaemia?
Hypoxemia can be defined as a condition where arterial oxygen tension or partial pressure of oxygen (PaO2) is below normal (normal value is between 80 and 100 mmHg).
What are some causes of Hypoxia?
- circulatory- inadequate capillary blood flow
- histotoxic -inability of tissues to use the oxygen
- anaemic- reduced level of haemoglobin
- hypoxaemia- decreased oxygen level in arterial blood
What is the treatment for a pt stuffing with asthma?
- ensure communication is maintained = they will be scared and we should be using close ended questions.
- aim is for symptom control/ optimised lung function
- using the lowest effective dose of medication that has the fewest side effects.
What would you be teaching a pt about asthma?
- the nature of asthma as a chronic inflammatory disease
- identification of triggers and how to avoid them
- purpose and action for each medication including proper inhalation techniques
- how to perform peak flow monitoring
- how to implement an action plan including when and how to seek assistance.
What is compliance?
A measure of the elasticity, expandability and distensibility of the lungs and thoracic structures.
What is shunting?
It is a state of low ventilation and perfusion.
It is an important consideration in the transport of O2 in cardiac output
Airway management is required to provide an open airway when the pt?
- is unconscious
- has an obstructed airway
- needs rescue breathing
How would you be measuring the effectiveness of the oxygen therapy?
- the resp rate is within the pt’s normal limits
- improved breath sounds/ mental status/ skin colour
- decreased dyspnoea both at rest/ with exertion
- decreased anxiety/agitation/ restlessness
- pulse/BP at pt’s baseline
- maintenance of the condition (basically not worsening or maybe improving)
What symptoms might a pt who is breathless present with?
- Pain = chest, shoulders, abdomen, accessory muscles
- skin =pale, sweaty, clammy, cyanosed, pink(COPD)
- respiratory = tachypnoea, dyspnoeic, cough, noisy airway, pulmonary oedema
- psychological = anxiety, confusion
What investigations might be performed on a breathless pt?
- blood tests -FBC , U&E, Blood gases, Clotting
- chest x-ray
- CT/MRI
- Respiratory Function tests
- Sputum specimen
- Bronchoscopy
How would you provide care for a breathless pt?
- Communication = reassure, maintain eye contact,
- observe non-verbal cues
- use closed questions as much as possible
- nurse in upright position= increased lung expansion, assists in gas exchange in alveoli
- allow pt to lean
what clinical manifestations might a person suffering from asthma present with?
- wheeze and chest tightness
- dyspnoea and/or cough
- airflow limitations/ prolonged expiration
what are some triggers for asthma?
- exercise
- allergies
- emotions
- irritants
- infections
- cold air
Health hx focuses on physical and functional problems of the pt, including the ability to carry out ADL’s. What other questions would we be asking?
- reason pt is seeking healthcare
- when did the symptoms start?
- how long has it last?
- any relieving factors?
- duration, location, associated symptoms
- any psychosocial factors present? anxiety, role change
- how much triggers SOB?
- is there a cough associated with it?
- onset? gradual or sudden
- is it worse lying down?
- rate the intensity of SOB?
Although the majority of signs and symptoms of respiratory disease are related to the duration and severity of the disease, list the some of the common symptoms that are usually present.
- Dyspnoea (SOB) = common to many pulmonary disorders
- cough= can indicate serious pulmonary disease; an evaluation of characteristic should be done.
- sputum production = reaction of the lungs to any constantly recurring irritant
- chest pain = assess the quality, intensity and ration of pain; assess inspiration and expiration.
- wheeze= associated with a pt with bronchoconstriction or airway narrowing.
