Respiratory

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RESPIRATORY : 

RESPIRATORY Respiratory Assessment

Respiratory Assessment : 

Respiratory Assessment Airway Listen - To Pt. Breathe or Talk Noisy Breathing is Obstructed Breathing Not All Obstructed Breathing is Noisy Snoring - Tongue Blocking Airway Stridor - “Tight” Upper Airway from Partial Obstruction

Respiratory Assessment : 

Respiratory Assessment Anticipate Airway Problems in Patients With: Decreased LOC Head Trauma Maxillofacial Trauma Neck Trauma Chest Trauma OPEN - CLEAR - MAINTAIN

Respiratory Assessment : 

Respiratory Assessment Breathing Is the Pt. Moving Air? Is the Pt. Moving Air Adequately? Is the Pt’s Blood Being Oxygenated?

Respiratory Assessment : 

Respiratory Assessment LOOK - LISTEN - FEEL Look for Symmetry of Chest Expansion Look for Signs of Increased Respiratory Effort Look for Changes in Skin Color Listen for Air Movement at Mouth & Nose Listen for Air Movement in Peripheral Lung Fields Feel for Air Movement at Mouth & Nose Feel for Symmetry of Chest Expansion

Respiratory Assessment : 

Respiratory Assessment Tachypnea/Bradypnea? Orthopneic? Signs of Respiratory Distress Nasal Flaring Tracheal Tugging Retractions Accessory Muscle Use Use of Abdominal Muscles on Exhalation

Respiratory Assessment : 

Respiratory Assessment Cyanosis? (Late, unreliable sign of Hypoxia) Oxygenate Immediately! Especially If: Decreased LOC Possible Shock Possible Severe Hemorrhage Chest Pain Chest Trauma Respiratory distress or dyspnea HX of any Kind of Hypoxia

Respiratory Assessment : 

Respiratory Assessment Consider Assisting Ventilations <10 >24 Insufficient Inspiratory O2 (Tidal Volume Inadequate) If the Pt. Has compromised breathing, bare the chest and assess for: Open Pneumothorax Flail Chest Tension Pneumothorax

Respiratory Assessment : 

Respiratory Assessment Platitudes IF YOU CAN’T TELL WHETHER A PT. IS MOVING AIR ADEQUATELY, HE ISN’T! THE NEED TO INTUBATE IS NOT THE SAME AS THE NEED TO VENTILATE! IF YOU THINK ABOUT GIVING O2, GIVE IT!

Respiratory Assessment : 

Respiratory Assessment Circulation Is the heart beating? Is there major external hemorrhage? Is the Pt. Perfusing? Effects of hypoxia: Early in adults - Tachycardia Late in adults - Bradycardia Children - Bradycardia

Respiratory Assessment : 

Respiratory Assessment Don’t let respiratory failure distract you from assessing for circulatory failure. Vascular Access

Respiratory Assessment : 

Respiratory Assessment Disability Restlessness, anxiety, combativeness = HYPOXIA Until Proven Otherwise Drowsiness, lethargy = HYPERCARBIA When the Pt. Stops fighting, he is not necessarily getting better

Respiratory Assessment : 

Respiratory Assessment Chief Complaint Dyspnea Subjective sensation that breathing is excessive, difficult, or uncomfortable

Respiratory Assessment : 

Respiratory Assessment HX of Present Illness How long has dyspnea been present? Gradual or sudden onset? What aggravates or alleviates? Coughing? Productive cough? What does sputum look/smell like? Pain? What does the pain feel like?

Respiratory Assessment : 

Respiratory Assessment Secondary Assessment Respiratory Pattern Kussmaul Cheyne-Stokes Central Neurogenic Hyperventilation

Respiratory Assessment : 

Respiratory Assessment Secondary Assessment Neck Trachea Midline? Jugular Vein Distention? Sub-cutaneous Emphysema? Accessory Muscle Use/Hypertrophy?

Respiratory Assessment : 

Respiratory Assessment Secondary Assessment Chest Barrel Chest? Deformity/Discoloration/Symmetry? Flail Segment/Paradoxical Movement? Breath Sounds? Adventitious Sounds?

Respiratory Assessment : 

Respiratory Assessment Secondary Assessment Chest Third Heart Sounds? (S3) Tenderness/Instability? Sub-cutaneous Emphysema? Fremitus? Symmetrical Expansion? Dullness/Hyperresonance to Percussion?

Respiratory Assessment : 

Respiratory Assessment Secondary Assessment Extremities Pre-tibial/Pedal Edema Nailbed Color “Clubbing” of digits

Adventitious Sounds : 

Adventitious Sounds Snoring respiration Upper Airway Partial obstruction of the upper airway by the tongue Stridor High pitched crowing sound Usually heard on inspiration Indication of a tight upper airway

Adventitious Sounds : 

Adventitious Sounds Wheezing Whistling sound Usually heard on expiration Indication of narrowing of lower airways caused by: Bronchospasm Edema Foreign material

Adventitious Sounds : 

Adventitious Sounds Rhonchi Rattling sound Caused by mucus in larger airways Rales Fine crackling sound Indication of fluid in the alveoli

Adventitious Sounds : 

Adventitious Sounds Cough Forced exhalation against partially closed glottis Reflex response to mucosa irritation Determine circumstances At work Postural changes Lying down Productive vs non-productive

Adventitious Sounds : 

Adventitious Sounds Sneeze Forced exhalation via nasal route Clears nasal passages Reflex response to mucosa irritation Sighing Slow, deep inspiration - Prolonged, audible exhalation Reexpands areas of atelectasis

Adventitious Sounds : 

Adventitious Sounds Hiccough Hiccups, singultus Spasm of diaphragm followed by glottic closure No useful purpose Benign, transient

Adventitious Sounds : 

Adventitious Sounds Hiccough Usually corrected by: Breath-holding Rebreathing from paper bag Valsalva maneuver

Adventitious Sounds : 

Adventitious Sounds Hiccough Serious causes include: Brain stem lesions Increased intracranial pressure Renal failure Pancreatitis Hepatitis Liver cancer Pneumonia

Chief Complaint : 

Chief Complaint Dyspnea - Sensation that breathing is: Excessive Difficult Uncomfortable

History of Present Illness : 

History of Present Illness How long? Onset gradual or sudden? What makes it better of worse? Cough? Productive? Sputum color? Pain? What kind?

Past History : 

Past History Hypertension, AMI, diabetes ? CHF with pulmonary edema Chronic cough, smoking, recurrent flu ? COPD Allergies, acute/seasonal SOB episodes ? Asthma

Past History : 

Past History Lower extremity trauma, recent surgery, immobilization ? Pulmonary embolism

Medications : 

Medications Breathing Pills, Inhalers Bronkodyl Bronkolixer Brokotabs Elixophyllin Theo-Dur Theofort Asthma

Medications : 

Medications CHF Lasix Diuril Hydrodiuril Digitalis

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