Respiratory DistressSigns & SymptomsABGs
Identification     LOOK at the patient
Identification   Early Assessment   Adequate Time of Implementation   Avoidance of Advanced or Invasive    Procedures
Cardiopulmonary Symptoms   Cough   Sputum Production   Hemoptysis   Dyspnea   Chest Pain   Dizziness/Fainting   Swe...
Coughing   Acute                 -   allergies, Bronchitis   Chronic               -   COPD, Asthma, TB   Recurrent    ...
Coughing Paroxysmal            -   Aspiration, Asthma Barking               -   Croup, Epiglottitis Brassy/Hoarse      ...
Coughing Afternoon or         -   Exposure to  Evening                  irritants Associated with  Position Change      ...
Sputum Production   Cause    ◦ Mucus Glands (Most often)   Characteristics    ◦ Color (clear, green, yellow, blood tinge...
Hemoptysis   Coughing up blood streaked or bloody    sputum   Hemoptysis is not Hematemesis
Dyspnea   Shortness of Breath (SOB)   Respiratory and cardinal symptom of    Cardiac   Hematologic, metabolic, chemical...
Dyspnea Work of Breathing (WOB) abnormally  high Ventilatory capacity is reduced Drive to breath is elevated
Signs of Difficulty Breathing   Tripod    ◦ Support arms on a      stationary object   Accessory Muscles    ◦ Intercosta...
Signs of Difficulty Breathing   Nasal Flaring
Signs of Difficulty Breathing   Cyanosis    ◦ Central    ◦ Acrocyanosis
Chest Pain (Angina) Cardinal Symptom of Heart Disease Variation    ◦ Classic symptoms: Left sided arm, jaw,      shoulde...
Chest Pain: Pulmonary Causes   Pleuritis    ◦ Tachypnea, splinting affected side    ◦ Sharp, stabbing   Pulmonary Embolu...
Chest Pain: Pulmonary Causes   Pneumothorax    ◦ Sharp, Tearing, Sudden, Localized    ◦ Dyspnea, Tachypnea    ◦ Tension P...
Syncope   Dizziness and Fainting   Reduced Blood Flow   Reduced Supply of Oxygen
Syncope   Causes    ◦ Obstruction of blood flow      Thrombosis      Embolism      Hypovolemia    ◦ Prolonged bouts of...
Swelling of the Ankles   Peripheral Edema    ◦ Capillaries of the lungs narrow    ◦ Pressures Build    ◦ Fluid moves to o...
Fevers, Chills, Night Sweats   Pulmonary Origins    ◦ Infection most likely      Abscess      TB      Pneumonia    ◦ C...
Headache and AlteredMental Status   Inadequate Oxygen    ◦ If hypercapnia continues        Alertness        Drowsiness ...
GERD   Gastroesophageal Reflux Disease   Abnormal Reflux of Gastric Contents    into the Esophagus.   Can cause or wors...
Causes   Asthma    ◦ Wheezing, Prolonged Expiration   Pneumothorax    ◦ Acute, Sharp Pleuritic pain, Decreased or      a...
Tension Pneumothorax
Tension Pneumothorax Diminished breath sounds Tachycardia, Hypertension Immediate Decompression of the Chest    ◦ 18 ga...
Causes   Foreign Body Aspiration     Stridor, Wheeze, Retractions   Pulmonary Emboli     Chest Pain, Arrhythmias, Tach...
Remember   One of the most important things…      LOOK at your patient
References   Wilkins, Robert L.; Stoller, James K.; Kacmarek, Robert M.    2009. Fundamental’s of Respiratory Care. Ninth...
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Respiratory distress

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  • 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
  • Respiratory distress

    1. 1. Respiratory DistressSigns & SymptomsABGs
    2. 2. Identification LOOK at the patient
    3. 3. Identification Early Assessment Adequate Time of Implementation Avoidance of Advanced or Invasive Procedures
    4. 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. 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. 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. 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. 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. 9. Hemoptysis Coughing up blood streaked or bloody sputum Hemoptysis is not Hematemesis
    10. 10. Dyspnea Shortness of Breath (SOB) Respiratory and cardinal symptom of Cardiac Hematologic, metabolic, chemical, neurologic, psycogenic, mechanical
    11. 11. Dyspnea Work of Breathing (WOB) abnormally high Ventilatory capacity is reduced Drive to breath is elevated
    12. 12. Signs of Difficulty Breathing Tripod ◦ Support arms on a stationary object Accessory Muscles ◦ Intercostal Muscles ◦ Supraclavicular ◦ Subscapular
    13. 13. Signs of Difficulty Breathing Nasal Flaring
    14. 14. Signs of Difficulty Breathing Cyanosis ◦ Central ◦ Acrocyanosis
    15. 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. 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. 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. 18. Syncope Dizziness and Fainting Reduced Blood Flow Reduced Supply of Oxygen
    19. 19. Syncope Causes ◦ Obstruction of blood flow  Thrombosis  Embolism  Hypovolemia ◦ Prolonged bouts of coughing ◦ Hypoxia ◦ Hypocapnia
    20. 20. Swelling of the Ankles Peripheral Edema ◦ Capillaries of the lungs narrow ◦ Pressures Build ◦ Fluid moves to other tissues
    21. 21. Fevers, Chills, Night Sweats Pulmonary Origins ◦ Infection most likely  Abscess  TB  Pneumonia ◦ Chills ◦ Night Sweats
    22. 22. Headache and AlteredMental Status Inadequate Oxygen ◦ If hypercapnia continues  Alertness  Drowsiness  Disorientation  Stupor  Coma
    23. 23. GERD Gastroesophageal Reflux Disease Abnormal Reflux of Gastric Contents into the Esophagus. Can cause or worsen symptoms of asthma
    24. 24. Causes Asthma ◦ Wheezing, Prolonged Expiration Pneumothorax ◦ Acute, Sharp Pleuritic pain, Decreased or absent breath sounds ◦ Tracheal shift ◦ Tension Pneumothorax  Life Threatening/Minutes
    25. 25. Tension Pneumothorax
    26. 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. 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. 28. Remember One of the most important things… LOOK at your patient
    29. 29. References Wilkins, Robert L.; Stoller, James K.; Kacmarek, Robert M. 2009. Fundamental’s of Respiratory Care. Ninth Ed. Mosby Elsevier

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