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Respiratory distress
- 1. Respiratory Distress Signs & Symptoms ABGs
- 2. Identification LOOK at the patient
- 3. Identification Early Assessment Adequate Time of Implementation Avoidance of Advanced or Invasive Procedures
- 4. Cardiopulmonary Symptoms Cough Sputum Production Hemoptysis Dyspnea Chest Pain Dizziness/Fainting Swelling of the Ankles Fever, Chills, Nights Sweats Headache, AMS, Personality changes GERD
- 5. Coughing Acute - allergies, Bronchitis Chronic - COPD, Asthma, TB Recurrent - Asthma, Allergies Dry - PE, Inhale irritants Dry then Productive - Pneumonia, asthma, smoking Chronic Productive - Chronic Bronchitis, Pneumonia Inadequate - Muscle weakness, Sedation, Emphysema
- 6. Coughing Paroxysmal - Aspiration, Asthma Barking - Croup, Epiglottitis Brassy/Hoarse - Laryngitis, Inspiratory Stridor Bronchitis - Obstruction, Croup, Wheezy Epiglottitis - Asthma, Bronchitis, Bronchospasm Morning - Smoking, Chronic Bronchitis
- 7. Coughing Afternoon or - Exposure to Evening irritants Associated with Position Change - Bronchiectasis, Left Associated with Heart Failure, Eating or Drinking GERD - Aspiration, Neromuscular Diseases
- 8. Sputum Production Cause ◦ Mucus Glands (Most often) Characteristics ◦ Color (clear, green, yellow, blood tinged) ◦ Consistency (thin, thick, viscous, tenacious, frothy) ◦ Odor ◦ Quantity ◦ Time of day
- 9. Hemoptysis Coughing up blood streaked or bloody sputum Hemoptysis is not Hematemesis
- 10. Dyspnea Shortness of Breath (SOB) Respiratory and cardinal symptom of Cardiac Hematologic, metabolic, chemical, neurologic, psycogenic, mechanical
- 11. Dyspnea Work of Breathing (WOB) abnormally high Ventilatory capacity is reduced Drive to breath is elevated
- 12. Signs of Difficulty Breathing Tripod ◦ Support arms on a stationary object Accessory Muscles ◦ Intercostal Muscles ◦ Supraclavicular ◦ Subscapular
- 13. Signs of Difficulty Breathing Nasal Flaring
- 14. Signs of Difficulty Breathing Cyanosis ◦ Central ◦ Acrocyanosis
- 15. Chest Pain (Angina) Cardinal Symptom of Heart Disease Variation ◦ Classic symptoms: Left sided arm, jaw, shoulder, back pain or pressure ◦ Center of the chest ◦ Radiating to Back and Legs ◦ Nausea ◦ Vomiting ◦ Dizziness
- 16. Chest Pain: Pulmonary Causes Pleuritis ◦ Tachypnea, splinting affected side ◦ Sharp, stabbing Pulmonary Embolus/Infarction ◦ Stabbing, Sudden, Increased by Inspiration ◦ Dyspnea, Tachypnea, Blood-tinged Sputum
- 17. Chest Pain: Pulmonary Causes Pneumothorax ◦ Sharp, Tearing, Sudden, Localized ◦ Dyspnea, Tachypnea ◦ Tension Pneumothorax Mediastinal shift, Jugular Distention Pulmonary Hypertension ◦ Similar to Angina, also caused by stress ◦ Dyspnea, Tachypnea, anxiety, jugular distention
- 18. Syncope Dizziness and Fainting Reduced Blood Flow Reduced Supply of Oxygen
- 19. Syncope Causes ◦ Obstruction of blood flow Thrombosis Embolism Hypovolemia ◦ Prolonged bouts of coughing ◦ Hypoxia ◦ Hypocapnia
- 20. Swelling of the Ankles Peripheral Edema ◦ Capillaries of the lungs narrow ◦ Pressures Build ◦ Fluid moves to other tissues
- 21. Fevers, Chills, Night Sweats Pulmonary Origins ◦ Infection most likely Abscess TB Pneumonia ◦ Chills ◦ Night Sweats
- 22. Headache and Altered Mental Status Inadequate Oxygen ◦ If hypercapnia continues Alertness Drowsiness Disorientation Stupor Coma
- 23. GERD Gastroesophageal Reflux Disease Abnormal Reflux of Gastric Contents into the Esophagus. Can cause or worsen symptoms of asthma
- 24. Causes Asthma ◦ Wheezing, Prolonged Expiration Pneumothorax ◦ Acute, Sharp Pleuritic pain, Decreased or absent breath sounds ◦ Tracheal shift ◦ Tension Pneumothorax Life Threatening/Minutes
- 26. Tension Pneumothorax Diminished breath sounds Tachycardia, Hypertension Immediate Decompression of the Chest ◦ 18 gauge needle ◦ Over second rib on the anterior aspect of chest ◦ Rush of air through the needle ◦ Remain in place until more conventional chest tube is inserted ◦ Patient should become more stable quickly
- 27. Causes Foreign Body Aspiration Stridor, Wheeze, Retractions Pulmonary Emboli Chest Pain, Arrhythmias, Tachypnea, Wheezing Pulmonary Edema Dyspnea on exertion, Crackles at bases of lungs
- 28. Remember One of the most important things… LOOK at your patient
- 29. References Wilkins, Robert L.; Stoller, James K.; Kacmarek, Robert M. 2009. Fundamental’s of Respiratory Care. Ninth Ed. Mosby Elsevier
Notas del editor
- A patient with a nosebleed at night could wake up with hemoptysis in the morningSometimes difficult to determine origin. Those with a history of slcoholism or cirrhosis may cause nausea and vomiting. This could be introduced into the lungs(aspiration) and cause the symptom of hemoptysis. Conversely, when there is bronchopulmonary bleeding at night, the patient could swallow the blood and vomit in the morning.
- For that level of exertion neuromuscular disease Hypoxemia, exercise
- If you have ever seen Mom flare her nostrils when she gets mad… this is for a different kind of distress.
- The Parietal Pleura is the serous membrane that lines the inner chest wall. This and the chest wall are filled with pain fibers unlike the inner tissue of the lungs. Those existing conditions may not hurt, such as tumors, however the inflammation may cause a tearing or sharp pain.
- Obstruction of blood flow to the heart, reducing oxygen transport to the rest of the body Hypovolemia, or low volume, causes a decrease in available blood or Hemoglobin . Hypocapnia, few and shallow breaths, can be caused by sedation or OD
- When those fluids start to back up, it can cause right heart failure, fluid can overload the lungs causing respiratory distress.
- The contents of the stomach can be an irritant on the lungs and cause exacerbation of asthma or other lung conditions
- Most common in children, cough may indicate asthmatic bronchitis Pneumothorax is the presence of air within the pleural space. This space is the ling of the lung and the lining of the chest wall. This normally has no air. This can happen during mechanical ventilation and trauma such as in the following video