Chapter 16 - Treatment of Respiratory Conditions

Vesicular/Bronchial Breath Sounds

normal breath sounds

Adventitious Breath Sounds

abnormal breath sounds

Wheezing

• Constriction/inflammation of the bronchus

• high pitched whistling sound

Crackles (Rales)

• air trying to pass through fluid in alveoli

• normally heard on inspiration

• fine or corse crackles

• related to pulmonary edema or congestive heart failure

Rhonchi

• Low pitched rattling sounds

• Caused by mucus secretions in larger airway

• Associated with lung infections

Stridor

• High pitched

• heard breathing in

• Associated with obstruction of upper airway

Additional Assessment for Shortness of Breath

• Progression

• Associated chest Pain

• Sputum

• Talking Tiredness

• Exercise Tolerance

Congestive Heart Failure

• constantly elevated bp

• swollen legs and feet

COPD

• older than 50

• recurring lung problems

• Smokers

• tightness of chest and constant fatigue

• Accessory muscles used to breathe

Interventions for Respiratory Problems

• Providing oxygen via a nonrebreathing mask at 15 L/min

• Providing positive-pressure ventilations using a bag-mask device

• Using airway management techniques such as an oropharyngeal (oral) airway, a nasopharyngeal (nasal) airway, suctioning, or airway positioning

• Providing noninvasive ventilatory support with continuous positive airway pressure (CPAP)

• Positioning the patient in a high Fowler position or a position of choice to facilitate breathing

• Assisting with respiratory medications found in a patient-prescribed metered-dose inhaler or a small-volume nebulizer

Primary Treatments

• Managing ABC

• O2

• Suction

Supplemental O2

• If pt has breaths less than 12 or greater than 20

• Give 15 L/min

• May need bag-mask device

• check respirations every 5 minutes

Supplemental O2 & COPD

start with low flow O2 (2 L/min) and work slowly upward until symptoms have improved

Contraindications for MDI and Small volumes nebulizer

• The patient is unable to help coordinate inhalation with depression of the trigger on an MDI or is too confused to effectively administer medication through a small-volume nebulizer. These devices will be only minimally effective when patients are in respiratory failure and have only minimal air movement.

• The MDI or small-volume nebulizer is not prescribed for this patient.

• You did not obtain permission from medical control and/or it is not permissible by local protocol.

• The patient has already taken the maximum prescribed dose before your arrival.

• the medication is expired.

• There are other contraindications specific to the medication.

Assisting with an MDI

1. Follow standard precautions.

2. Obtain an order from medical control or local protocol.

3. Check that you have the right medication, right patient, right dose,

and right route and that the medication is not expired.

4. Make sure that the patient is alert enough to use the inhaler.

5. Check whether the patient has already taken any doses.

6. Make sure the inhaler is at room temperature or warmer

7. Shake the inhaler vigorously several times.

8. Stop administering supplemental oxygen, and remove any mask from the patient’s face.

9. Ask the patient to exhale deeply and, before inhaling, to put his or her lips around the opening of the inhaler

10. Have the patient depress the hand-held inhaler as he or she begins to inhale deeply.

11. Instruct the patient to hold his or her breath for as long as is comfortable to help the body absorb the medication

12. If a spacer is used, the patient may need to take several breaths from the mouthpiece, without depressing the inhaler again, to get the full initial dose of the medication.

13. Continue to administer supplemental oxygen (replace the oxygen mask).

14. Allow the patient to breathe a few times, then repeat a second dose per direction from medical control or local protocol

Assisting with a Nebulizer

1. Rights of medication administration & make sure meds aren’t expired

2. Make sure pt is alert enough to use the device

3. Open the medication container on the nebulizer and pour the medication (generally the whole volume of the medication) into the container

4. Attach the medication container to the nebulizer mouthpiece and to the oxygen tubing. Attach the oxygen tubing to the oxygen tank.

5. Adjust oxygen flow to 6 L/min to establish a misting effect

6. Stop administering supplemental oxygen, and remove the nonrebreathing mask from the patient’s face

7. Ask the patient to put his or her lips around the mouthpiece of the device, inhale the mist, and hold it for 3 to 5 seconds before exhaling

8. Place non rebreathing mask back on the patient

9. Reassess vitals

Treating an Upper Airway Infection

• Administer humidified O2

• Transport to hospital keep pt in most comfortable position

Treating Acute Pulmonary Edema

• Administer 100% oxygen

• Suction if needed

• Place pt in most comfortable position

• Unconscious = full ventilary support

• CPAP

Treating COPD

• Place pt in sitting position

• Assist with inhaler & monitor for side effects

• Transport to ED

Treating Asthma

• Assess vital signs

• Suction & administer O2 if needed

• Help with medication administration

• Bag mask device in severe cases

• Prolonged asthma attack = oxygen and ED

Treating Spontaneous Pneumothorax

• Supplemental O2

• Transport to hospital ASAP

• Place in comfortable position

• Monitor pt carefully

Treating Pleural Effusion

• Supplemental O2

• Transport to ED ASAP

Treating Pulmonary Embolism

• supplemental o2

• Place pt in comfortable position

• Clear coughed up blood

• Transport to ED

Treating Hyperventilation

• Primary Assessment

• Gather Event history

• Stay calm

• give supplemental o2

• transport to ED

Treating Foreign Body Aspiration

• Use appropriate technique to remove from airway

• provide o2 if needed

• transport if serious

Treating Tracheostomy Dysfunction

• Establish an airway

• Have caregiver replace the airway

• Request ALS if you can’t clear airway

• Oxygenate once airway is clear