logging in or signing up Respiratory aSGuest1243 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 803 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: October 18, 2008 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript 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 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Respiratory aSGuest1243 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 803 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: October 18, 2008 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript 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