Respiratory Emergencies Textbook PDF

CHAPTER 16 Respiratory Emergencies Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies (1 of 5)...

CHAPTER 16 Respiratory Emergencies Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies (1 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Medicine Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. National EMS Education Standard Competencies (2 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Respiratory  Anatomy, signs, symptoms, and management of respiratory emergencies, including those that affect the  Upper airway  Lower airway National EMS Education Standard Competencies (3 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Respiratory (cont’d)  Anatomy, physiology, pathophysiology, assessment, and management of  Epiglottitis  Spontaneous pneumothorax  Pulmonary edema  Asthma  Chronic obstructive pulmonary disease National EMS Education Standard Competencies (4 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Respiratory (cont’d)  Anatomy, physiology, pathophysiology, assessment, and management of (cont’d)  Environmental/industrial exposure  Toxic gas  Pertussis  Cystic fibrosis  Pulmonary embolism National EMS Education Standard Competencies (5 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Respiratory (cont’d)  Anatomy, physiology, pathophysiology, assessment, and management of (cont’d)  Pneumonia  Viral respiratory infections Introduction Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patients often complain of dyspnea.  Can be caused by many different conditions  Cause can be difficult to determine. Anatomy of the Respiratory System (1 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Respiratory system includes all the structures that contribute to breathing  Diaphragm  Chest wall muscles  Accessory muscles of breathing  Nerves to the muscles Anatomy of the Respiratory System (2 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Upper airway consists of structures above the vocal cords.  Nose and mouth  Jaw  Oral cavity  Pharynx  Larynx Anatomy of the Respiratory System (3 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 16-1 The upper airway includes the nose, mouth, jaw, oral cavity, pharynx, and larynx. The lower airway includes the trachea, © Jones & Bartlettbronchi, Learning. Anatomy of the Respiratory System (4 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Principal function of lungs is respiration.  Exchange of oxygen and carbon dioxide  Air travels through trachea into lungs to:  Bronchi (larger airways)  Bronchioles (smaller airways)  Alveoli (where actual exchange takes place) Physiology of Respiration (1 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Respiration process  Inspiration  Expiration  Oxygen is provided to the blood.  Carbon dioxide is removed.  Takes place rapidly at level of alveoli Physiology of Respiration (2 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 16-3 The exchange of oxygen and carbon dioxide in the tissues. A. Oxygen FIGURE 16-2 An enlarged view of a passes from the blood through single alveolus (air sac) showing where capillaries to tissue cells. Carbon dioxide the exchange of oxygen and carbon passes from tissue cells through capillaries to dioxide between air in the sac and blood the blood. B. In the lungs, oxygen is picked up in the © Jones pulmonary & Bartlett Learning. capillaries takes place by the A, B, C: blood, © Jones and carbon dioxide is given off. & Bartlett Learning. Physiology of Respiration (3 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  In the alveoli:  Oxygen passes into capillaries.  Carbon dioxide returns to lungs.  Brainstem senses blood’s carbon dioxide levels.  Regulates breathing rate and depth Pathophysiology (1 of 2)  Oxygen exchange can be hindered by: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Conditions in the anatomy of the airway  Disease processes  Traumatic conditions  Abnormalities in pulmonary vessels Pathophysiology (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Recognize the signs and symptoms of inadequate breathing and know what to do about it.  Some patients have chronic carbon dioxide retention.  Low levels of oxygen control breathing.  Use caution when administering oxygen. Causes of Dyspnea (1 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patients often have dyspnea or hypoxia with:  Pulmonary edema  Hay fever  Pleural effusion  Obstruction of the airway  Hyperventilation syndrome  Environmental/industrial exposure  Drug overdose Causes of Dyspnea (2 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Dyspneic patients may have:  Gas exchange obstructed  Damaged alveoli  Obstructed air passages  Obstructed blood flow to the lungs  Excess fluid in pleural space  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Causes of Dyspnea (3 of 4) Causes of Dyspnea (4 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patients may also complain of chest tightness or air hunger.  Common with cardiopulmonary diseases  Pain can cause rapid, shallow breathing. Upper or Lower Airway Infection  Infectious diseases may affect all parts of the airway.  Some forms of obstruction cause dyspnea. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Mucus and secretions obstructing airflow in major passages  Swelling of soft tissues in upper airways  Impaired exchange of gases in the alveoli Croup  Inflammation and swelling of pharynx, larynx, and trachea Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Stridor and seal-bark cough  Responds well to humidified oxygen FIGURE 16-4 Croup results in swelling of the whole airway: pharynx, © Jones & Bartlett Learning. larynx, and trachea. Epiglottitis  Bacterial infection causing inflammation of epiglottis Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Children are often found in tripod position and drooling.  Position comfortably and provide oxygen. FIGURE 16-5 Acute epiglottitis is caused by a bacterial infection that results in severe swelling of the epiglottis, which could obstruct © Jones & Bartlett Learning. the airway. Respiratory Syncytial Virus (RSV)  Common cause of illness in young children Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Causes infection in the lungs and passages  Look for signs of dehydration.  Treat airway and breathing problems.  Humidified oxygen is helpful. Bronchiolitis Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Viral illness often caused by RSV  Usually affects newborns and toddlers  Bronchioles become inflamed, swell, and fill with mucus.  Provide oxygen therapy and frequently reassess Pneumonia Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Bacterial pneumonia will come on quickly and result in high fever.  Viral pneumonia presents more gradually and is less severe.  Especially affects people who are chronically ill  Assess temperature and provide airway support and supplemental oxygen. Pertussis Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Airborne bacterial infection that mostly affects children younger than 6 years  Patients will be feverish and exhibit a “whoop” sound on inspiration after a coughing attack.  Watch for dehydration and suction as needed. Influenza Type A  Became pandemic in 2009 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Symptoms include fever, cough, sore throat, muscle aches, headache, and fatigue.  May lead to pneumonia or dehydration COVID-19 (SARS-CoV-2)  Similar to the virus that causes the common cold Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Preferentially affects the elderly, those living in close quarters with one another, and those with weakened immune systems.  Transmitted by aerosol droplets and airborne particles  Respiratory deterioration may occur rapidly. Tuberculosis (TB) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Bacterial infection that most often affects the lungs  Can remain inactive for years  Patients often complain of fever, coughing, fatigue, night sweats, and weight loss.  Wear gloves, eye protection, and an N-95 respirator (at a minimum). Acute Pulmonary Edema (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Heart muscle cannot circulate blood properly.  Fluid builds up within alveoli and in lung tissue.  Usually result of congestive heart failure  Most patients have a long-standing history of chronic congestive heart failure.  In severe cases, a frothy pink sputum forms at the nose and mouth. Acute Pulmonary Edema (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 16-6 In pulmonary edema, fluid fills the alveoli and separates the capillaries from the alveolar wall, interfering with the exchange of oxygen and © Jones & Bartlett carbon dioxide. Learning Chronic Obstructive Pulmonary Disease (COPD) (1 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Slow process of dilation and disruption of airways and alveoli  Caused by chronic bronchial obstruction  Tobacco smoke can create chronic bronchitis. Chronic Obstructive Pulmonary Disease (COPD) (2 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Emphysema is most common type of COPD.  Loss of elastic material in the lungs  Causes include inflamed airways, smoking.  Most patients with COPD have elements of both chronic bronchitis and emphysema. Chronic Obstructive Pulmonary Disease (COPD) (3 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 16-7 Repeated episodes of irritation and inflammation in the alveoli result in the obstruction, scarring, and some dilation of the alveolar © Jones & Bartlettsac characteristic of COPD. Learning. Chronic Obstructive Pulmonary Disease (COPD) (4 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patients with pulmonary edema will have “wet” lung sounds.  Patients with COPD will have “dry” lung sounds.  Can be easily confused with congestive heart failure  Treat the patient, not the lung sounds. Asthma, Hay Fever, and Anaphylaxis (1 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Result of allergic reaction to inhaled, ingested, or injected substance  In some cases, allergen cannot be identified.  In some cases, there is no identifiable allergen. Asthma, Hay Fever, and Anaphylaxis (2 of 4)  Asthma is acute spasm of smaller air passages (bronchioles), Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com associated with excessive mucus production and swelling of the mucus membranes. FIGURE 16-8 Asthma is an inflammation of the lungs associated with excessive mucus production and swelling of the bronchioles. A. Cross section of A, B:a normal © Jones & Bartlett Learning bronchiole. B. The bronchiole in spasm; a mucus plug has formed and partially obstructed the Asthma, Hay Fever, and Anaphylaxis (3 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Asthma affects all ages.  Most prevalent in children 5–17 years  Produces characteristic wheezing  Asthma attack may be caused by allergic reaction to foods or allergens or severe emotional distress, exercise, and respiratory infections. Asthma, Hay Fever, and Anaphylaxis (4 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Hay fever causes cold-like symptoms.  Allergens include pollen, dust mites, pet dander.  Anaphylactic reaction can produce severe airway swelling.  Total obstruction is possible.  Treat with epinephrine, oxygen, and antihistamines. Spontaneous Pneumothorax (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Pneumothorax is accumulation of air in pleural space.  Most often caused by trauma  May be caused by medical conditions  Spontaneous pneumothorax Spontaneous Pneumothorax (2 of 2)  Occurs with lung infections or in weak lungs Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patient becomes dyspneic.  Breath sounds may be absent on affected side. FIGURE 16-10 A pneumothorax occurs when air leaks into the pleural space from an opening in the chest wall or the surface of the lung. The lung collapses as air fills the pleural space and the two ©pleural surfaces Jones & Bartlett Learning are no longer in Pleural Effusion Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Collection of fluid outside the lung  Compresses lung and causes dyspnea  Can stem from irritation, infection, congestive heart failure, or cancer  Upright position eases pain. Obstruction of the Airway (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patient with dyspnea may have mechanical obstruction.  In unconscious patients, obstruction may be caused by aspiration of vomitus or tongue blocking the airway.  If patient was eating just before dyspnea, always consider foreign body obstruction. Obstruction of the Airway (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 16-12 A. Foreign body obstruction occurs when an object, such as food, is lodged in the airway. B. Mechanical obstruction also occurs when the head is © Jones & Bartlett Learning not properly positioned, causing the tongue to fall back into the Pulmonary Embolism (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A blood clot that circulates through the venous system  Circulation cut off partially or completely  Significantly decreases blood flow  If large enough, can cause sudden death Pulmonary Embolism (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Signs and symptoms include:  Dyspnea  Tachycardia  Tachypnea  Varying degrees of hypoxia  Cyanosis  Acute chest pain  Hemoptysis Hyperventilation (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Overbreathing to the point that arterial carbon dioxide falls below normal  May be indicator of life-threatening illness  Body may be trying to compensate for acidosis.  Buildup of excess acid in blood or body tissues Hyperventilation (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Can result in alkalosis  Buildup of excess base in body fluids  Can cause symptoms of panic attack:  Anxiety  Dizziness  Numbness  Tingling or painful spasms of the hands/feet Environmental/Industrial Exposure Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Pesticides, cleaning solutions, chemicals, chlorine, and other gases can be released.  Carbon monoxide  Odorless  Highly poisonous  Produced by fuel-burning appliances and smoke.  Do not put yourself at risk. Scene Size-up Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Scene safety  Use standard precautions and PPE.  Consider possibility of infectious disease or toxic substance.  Mechanism of injury/nature of illness  If in question, ask why 9-1-1 was activated.  Question the patient, family, and/or bystanders to determine NOI. Primary Assessment (1 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Identify immediate life threats.  Form a general impression.  Note age and position of patient.  Use AVPU scale.  Ask patient about chief complaint. Primary Assessment (2 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Airway and breathing  Make sure airway is patent and adequate.  Assess rate, rhythm, and quality.  Ask the following questions:  Is the air going in?  Does the chest rise and fall with each breath?  Is the rate adequate for the victim’s age? Primary Assessment (3 of 5)  Assess breath sounds  Check breath sounds on the right and left sides of the chest. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Abnormal sounds include wheezing, rales, rhonchi, and stridor. FIGURE 16-15 Locations of the stethoscope bell for auscultation of breath sounds. © Jones & Bartlett Learning. Primary Assessment (4 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Circulation  Assess pulse rate, rhythm, and quality.  Evaluate for shock and bleeding.  Assess perfusion by evaluating skin color, temperature, and condition. Primary Assessment (5 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Transport decision  If condition is unstable and there is possible life threat:  Address the life threat.  Proceed with rapid transport. History Taking (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Investigate chief complaint.  Find out what the patient has done for the breathing problem.  SAMPLE history History Taking (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  OPQRST assessment  Onset, provocation/palliation, quality, radiation/region, severity  PASTE assessment  Specific for patients with dyspnea  Progression, associated chest pain, sputum, talking tiredness, exercise tolerance Secondary Assessment (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  More in-depth assessment of body systems  Proceed only after addressing life-threats.  Use monitoring devices if you have them. Secondary Assessment (2 of 2)  Look for signs of COPD Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patient older than 50 years of age  History of lung problems  Active or former cigarette smoker  Tightness in chest  Constant fatigue  Barrel-like appearance to chest  Use of accessory muscles  Abnormal breath sounds Reassessment Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Repeat the primary assessment.  Assess for changes in condition.  Interventions may include:  Oxygen via nonrebreathing mask at 15 L/min  Positive pressure ventilations  Airway management techniques  Positioning in high Fowler position or position of choice  Assisting with respiratory medications Emergency Medical Care (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Administer supplemental oxygen.  Some patients may need CPAP or bag-mask device.  Patient may have metered-dose inhaler (MDI) or small-volume nebulizer.  Consult medical control and make sure medication is indicated. Emergency Medical Care (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Ensure there are no contraindications  Most medications are used relax the muscles that surround the air passages in the lungs.  Common side effects of inhalers:  Increased pulse rate  Nervousness  Muscle tremors Treatment of Specific Conditions (1 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Upper or lower airway infection  Administer humidified oxygen (if available).  Do not attempt to suction the airway or place an oropharyngeal airway.  Position comfortably.  Transport promptly. Treatment of Specific Conditions (2 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Acute pulmonary edema  Provide 100% oxygen.  Suction if necessary.  Position comfortably.  Provide CPAP if indicated and allowed by protocol.  Transport promptly. Treatment of Specific Conditions (3 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Chronic obstructive pulmonary disease  Assist with prescribed inhaler.  Watch for side effects from overuse.  Position comfortably.  Transport promptly. Treatment of Specific Conditions (4 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Asthma  Be prepared to suction.  Assist asthma patient with prescribed inhaler.  Provide aggressive airway management, oxygen, and prompt transport. Treatment of Specific Conditions (5 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Hay fever  Unlikely to need emergency treatment  Anaphylaxis  Remove the offending agent.  Maintain the airway.  Transport rapidly.  Administer epinephrine. Treatment of Specific Conditions (6 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Spontaneous pneumothorax  Provide supplemental oxygen.  Transport promptly.  Monitor carefully.  Pleural effusion  Fluid removal must be done in hospital.  Provide oxygen.  Transport promptly. Treatment of Specific Conditions (7 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Obstruction of airway  Partial obstruction  Provide supplemental oxygen and transport.  Complete obstruction  Clear obstruction and administer oxygen.  Transport rapidly to emergency department. Treatment of Specific Conditions (8 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Pulmonary embolism  Supplemental oxygen is mandatory.  Position comfortably.  If hemoptysis is present, clear airway immediately.  Transport promptly. Treatment of Specific Conditions (9 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Hyperventilation  Complete primary assessment and gather history.  Do not have patient breathe into paper bag.  Reassure the patient and provide supplemental oxygen.  Transport promptly. Treatment of Specific Conditions (10 of 12) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Environmental/industrial exposure  Ensure patients are decontaminated.  Treat with oxygen, adjuncts, and suction based on presentation. Treatment of Specific Conditions (11 of 12)  Foreign body aspiration Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Clear the airway.  Provide oxygen and transport.  Tracheostomy dysfunction  Position comfortably.  Suction to clear the obstruction.  Provide oxygen. Treatment of Specific Conditions (12 of 12)  Asthma Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Provide blow-by oxygen.  Use MDIs.  Cystic fibrosis  Genetic disorder that affects the lungs and digestive system  Suction and oxygenate as needed. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. The process in which oxygen and carbon dioxide are exchanged in the lungs is called: A. respiration. B. ventilation. C. metabolism. D. inhalation. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: A Rationale: Respiration is defined as the exchange of gases between the body and its environment. The exchange of oxygen and carbon dioxide in the lungs is called pulmonary (external) respiration. The exchange of oxygen and carbon dioxide at the cellular level is called cellular (internal) respiration. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. The process in which oxygen and carbon dioxide are exchanged in the lungs is called: A. respiration. Rationale: Correct answer B. ventilation. Rationale: Ventilation is the exchange of air between the lungs and the environment. C. metabolism. Rationale: Metabolism is the series of processes by which food is converted into the energy and products needed to sustain life. D. inhalation. Rationale: Inhalation is the active, muscular part of breathing. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 2. Which of the following respiratory diseases causes obstruction of the lower airway? A. Croup B. Asthma C. Epiglottitis D. Laryngitis Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: B Rationale: Asthma is a lower airway disease that causes the bronchioles in the lungs to constrict (bronchospasm), resulting in various degrees of obstruction. Croup, epiglottitis, and laryngitis cause swelling, inflammation, and varying degrees of obstruction of the upper airway. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 2. Which of the following respiratory diseases causes obstruction of the lower airway? A. Croup Rationale: This causes an upper airway obstruction. B. Asthma Rationale: Correct answer C. Epiglottitis Rationale: This causes an upper airway obstruction. D. Laryngitis Rationale: This causes an upper airway obstruction. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 3. Which of the following diseases is potentially drug resistant and is thought to be transmitted by coughing? A. Tuberculosis B. Croup C. Diphtheria D. Epiglottitis Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: A Rationale: Tuberculosis is a bacterial infection spread by cough. It is dangerous because many strains are resistant to antibiotics. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 3. Which of the following diseases is potentially drug resistant and is thought to be transmitted by coughing? A. Tuberculosis Rationale: Correct answer B. Croup Rationale: Croup is an inflammatory condition of the larynx and trachea, marked by a cough, hoarseness, and difficulty in breathing. C. Diphtheria Rationale: Diphtheria is caused by a bacterium that attacks the membranes of the throat. D. Epiglottitis Rationale: Epiglottitis is an acute bacterial infection of the epiglottis. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 4. All of the following are causes of acute dyspnea, EXCEPT: A. asthma. B. emphysema. C. pneumothorax. D. pulmonary embolism. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: B Rationale: Emphysema—a form of COPD—is a chronic respiratory disease; therefore, it presents with progressively worsening dyspnea. Asthma, pulmonary embolism, and pneumothorax are all acute conditions; therefore, they typically present with an acute onset of dyspnea. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 4. All of the following are causes of acute dyspnea, EXCEPT: A. asthma. Rationale: Asthma is an acute condition with a sudden onset of dyspnea. B. emphysema. Rationale: Correct answer C. pneumothorax. Rationale: Pneumothorax is an acute condition with a sudden onset of dyspnea. D. pulmonary embolism. Rationale: Pulmonary embolism is an acute condition with a sudden onset of dyspnea. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 5. Bronchospasm is MOST often associated with: 5. asthma. 6. bronchitis. 7. pneumonia. 8. pneumothorax. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: A Rationale: Asthma—a reactive airway disease—is caused by bronchospasm (sustained constriction of the bronchioles). Common triggers to an acute asthma attack include environmental allergens, stress, and temperature changes. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 5. Bronchospasm is MOST often associated with: A. asthma. Rationale: Correct answer B. bronchitis. Rationale: Bronchitis is the inflammation of the mucous membrane in the bronchial tubes of the lungs. C. pneumonia. Rationale: Pneumonia is an inflammation of one or both lungs. D. pneumothorax. Rationale: Pneumothorax is the presence of air or gas in the pleural cavity surrounding the lungs, causing pain and difficulty in breathing. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 6. A sudden onset of difficulty breathing, sharp chest pain, and cyanosis that persists despite supplemental oxygen is MOST consistent with: A. severe pneumonia. B. myocardial infarction. C. a pulmonary embolism. D. a spontaneous pneumothorax. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: C Rationale: Signs of an acute pulmonary embolism include a sudden onset of difficulty breathing, sharp (pleuritic) chest pain, and cyanosis that persists despite the administration of high-flow oxygen. Patients who are immobile for prolonged periods of time (eg, confined to a hospital bed) are prone to a pulmonary embolism. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 6. A sudden onset of difficulty breathing, sharp chest pain, and cyanosis that persists despite supplemental oxygen is MOST consistent with: A. severe pneumonia. Rationale: This is an acute bacterial or viral infection associated with a fever, cough, and productive sputum. B. myocardial infarction. Rationale: A heart attack is associated with chest pain, sudden onset of weakness, nausea, sweating, and discomfort. C. a pulmonary embolism. Rationale: Correct answer D. a spontaneous pneumothorax. Rationale: This is when air escapes into the pleural cavity. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 7. Albuterol, a beta-2 agonist, is the generic name for: A. Alupent. B. Metaprel. C. Brethine. D. Ventolin. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: D Rationale: Albuterol is the generic name for Ventolin (Proventil). Albuterol is a beta-agonist, which dilates the bronchioles, and is commonly used to treat patients with asthma and other reactive airway diseases. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 7. Albuterol, a beta-2 agonist, is the generic name for: A. Alupent. Rationale: This is the trade name for metaproterenol, also a beta-2 agonist. B. Metaprel. Rationale: This is the trade name for metaproterenol, also a beta-2 agonist. C. Brethine. Rationale: This is the trade name for terbutaline, also a beta-2 agonist. D. Ventolin. Rationale: Correct answer Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 8. An acute bacterial infection that results in swelling of the flap that covers the larynx during swallowing is called: A. croup. B. laryngitis. C. epiglottitis. D. diphtheria. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: C Rationale: Epiglottitis—a potentially life-threatening illness—is an acute bacterial infection that causes swelling of the epiglottis (the flap the covers the larynx during swallowing). It is characterized by a sudden onset of high fever, difficulty breathing, stridor, drooling, and varying degrees of hypoxemia. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 8. An acute bacterial infection that results in swelling of the flap that covers the larynx during swallowing is called: A. croup. Rationale: This is an inflammatory condition of the larynx and trachea, marked by a cough, hoarseness, and difficulty in breathing. B. laryngitis. Rationale: This is an inflammation of the larynx, usually accompanied by hoarseness and coughing. C. epiglottitis. Rationale: Correct answer D. diphtheria. Rationale: This is caused by a bacterium that attacks the membranes of the throat. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 9. A 70-year-old man recently had a heart attack and now complains of severe difficulty breathing, especially when lying flat. He is coughing up pink, frothy secretions. This patient is MOST likely experiencing: A. acute right heart failure. B. severe left heart failure. C. an acute onset of bronchitis. D. an acute pulmonary embolism. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: B Rationale: As a result of his recent heart attack, the left side of this patient’s heart has been severely damaged. The left side of the heart is responsible for pumping oxygenated blood to the rest of the body. When it fails to do this, blood backs up into the lungs, resulting in pulmonary edema. Signs of pulmonary edema include dyspnea (especially when lying flat); rapid and shallow respirations; and, in severe cases, coughing up of pink, frothy sputum. Review 9. A 70-year-old man recently had a heart attack and now complains of severe difficulty breathing, especially when lying flat. He is coughing up pink, frothy Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com secretions. This patient is MOST likely experiencing: A. acute right heart failure. Rationale: Acute heart failure causes a backup of blood into the systemic circulatory system and typically causes symptoms of peripheral edema in the hands and feet. B. severe left heart failure. Rationale: Correct answer C. an acute onset of bronchitis. Rationale: This is an acute inflammation of the lungs associated with a cough, increased sputum, fever, and tachypnea. D. an acute pulmonary embolism. Rationale: This is a blood clot in the lungs and is seen as dyspnea, acute chest pain, cyanosis, tachypnea, and coughing up of blood. Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 10. Which of the following patients is breathing adequately? A. 36-year-old man with cyanosis around the lips and irregular respirations B. 29-year old woman with respirations of 20 breaths/min, who is conscious and alert C. 22-year-old man with labored respirations at a rate of 28 breaths/min and pale skin D. 59-year-old woman with difficulty breathing, whose respirations are rapid and shallow Review Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Answer: B Rationale: Adequate breathing in the adult is characterized by a respiratory rate between 12 and 20 breaths/min, good chest rise (indicates adequate tidal volume), unlabored breathing effort, nonaltered mental status, and good perfusion to the skin (ie, pink, warm, dry). Review 10. Which of the following patients is breathing adequately? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. 36-year-old man with cyanosis around the lips and irregular respirations Rationale: A patient with irregular respirations is not breathing adequately. Cyanosis is a sign of hypoxia. B. 29-year old woman with respirations of 20 breaths/min, who is conscious and alert Rationale: Correct answer C. 22-year-old man with labored respirations at a rate of 28 breaths/min and pale skin Rationale: The normal adult rate of respirations is 12–20 breaths/min. D. 59-year-old woman with difficulty breathing, whose respirations are rapid and shallow Rationale: A patient with adequate breathing has a normal rate and an unlabored breathing effort.