1 First Aid and Emergency Nursing (Theory)University of Tabuk Faculty of Applied Medical Sciences Department of Nursing First Aid and Emergency Nursing (Theory) (NUR 410)
2 Curriculum & Course Development CommitteeTopics Outline Respiratory Emergencies Assessment Signs and Symptoms Emergency Care/Inadequate Breathing Types of Chronic Obstructive Pulmonary Disease (COPD) Chronic Bronchitis Emphysema Asthma Pneumonia Cardiac Emergencies DEPARTMENT OF NURSING Curriculum & Course Development Committee Department of Nursing
3 Respiratory EmergenciesFailure of: Ventilation: air in/ air out Diffusion: movement of gases Perfusion: movement of blood
4 Assessment Initial Assessment Mental status Position - (Tripod)Facial expression Speech (1 or 2 word dyspnea) Skin color
5 Assessment Mucus membranes Suction if necessary Chest Respiratory rateLook, Auscultate, Feel Respiratory rate Adequate Inadequate Priority patient
6 Signs and Symptoms Restlessness and anxietyIncreased or irregular heart rate Tachypnea Bradyapnea Cyanosis Abnormal airway sounds Audible wheezing Diminished ability to speak Retractions
7 Signs and Symptoms Diaphragmatic breathing Shallow breathing CoughingTripod position Barrel chest (emphysema) Altered mental status Chest trauma Pursed-lip breathing
8 Emergency Care/Inadequate BreathingEstablish airway Begin positive pressure ventilation with supplemental oxygen Expeditiously transport Oxygen 15 lpm. Assess baseline vitals Administer patients Metered Dose Inhaler (MDI) with Med. Control order Complete focused history/physical exam Transport in Fowlers or semi-Fowlers position
9 Chronic Obstructive Pulmonary Disease (COPD)Obstruction to airflow in the lungs Common causes Chronic bronchitis Emphysema Most patients are aware of the problem and will report it during the SAMPLE history
10 Emphysema Destruction of alveolar walls along with distension of air sacs Elasticity is lost Reduction of surface in contact with capillaries Air becomes trapped causing build up of CO2. Breathing becomes difficult Barrel chested appearance due to trapped air
11 Sign & Symptoms of EmphysemaThin barrel chest appearance Coughing, but with little sputum Prolonged exhalation Diminished breath sounds Wheezing and rhonchi Pursed-lip breathing
12 Sign & Symptoms of Emphysemaextreme SOB on exertion Pink complexion Tachypnea Diaphoresis Home oxygen
13 Chronic Bronchitis Inflammation, swelling, excessive mucous in the bronchi & bronchioles Productive cough for last 3 months out of the year for at least 2 years Does not affect alveoli, however they can’t expand fully because air can’t get past the diseased bronchi or bronchioles Recurrent infections cause scar tissue
14 Signs & Symptoms of Chronic BronchitisTypically overweight Chronic cyanotic complexion Difficulty in breathing less prominent than emphysema Productive cough (sputum) Course rhonchi
15 Emergency Care Ensure airway Position of comfortAdminister supplemental Oxygen Hypoxic drive High CO2 levels in blood cause receptors to respond If receptors pick up high levels of O2 patient may stop breathing MDI if patient has one (Med control) Never withhold oxygen from any patient who needs it!
16 Asthma Increased sensitivity of lower airway to irritants. CausesBronchospasms Edema Increased production of mucous Attacks are usually acute or periodic Usually no or very few signs & symptoms between attacks
17 Extrinsic Asthma Status Asthmaticus True emergency Prolonged attacks that doesn’t respond to oxygen or medication Consider ALS back-up Infection, emotional stress, or strenuous exercise Exhalation becomes difficult Air becomes trapped in alveoli Exhalation becomes active process Respiratory arrest may soon follow
18 Sign And Symptoms of Extrinsic AsthmaDyspnea Productive cough Wheezing Tachypnea Tachycardia Anxiety and apprehension Possible fever Runny nose, blood shot eyes, or stuffy nose
19 Severe Signs and SymptomsExtreme fatigue or exhaustion Inability to speak Cyanosis to core of body Tachycardia greater than 130 bpm. Quiet or absent lung sounds
20 Emergency Care Ensure airwayoxygen mask or positive pressure ventilation Assess circulation Try to calm the patient to reduce breathing workload Patients MDI (Med control order) Transport
21 Note: All that wheezes is not asthma.Patient may be suffering from an obstructed airway Never assume anything
22 Pneumonia Acute infectious disease Bacteria or virusIrritants or aspiration Affects lower respiratory tract Lung inflammation and fluid or pus-filled alveoli Poor gas exchange or hypoxia
23 Signs and Symptoms Malaise and decreased appetite FeverCough productive or non-productive Dyspnea Tachypnea & tachycardia Chest pain made worse when breathing Shallow respirations Splinting of thorax with arms Rales and rhonchi
24 Emergency Care Ensure airway Ensure adequate oxygenationPosition of comfort Consult med-control or follow protocol concerning MDI
25 Pulmonary Embolism Blockage of pulmonary artery or branchesby Blood clot, fat particle, air bubble, foreign body Decreased blood flow Interrupts breathing and heart rhythm
26 Factors Surgery Prolonged immobilization ThrombophlebitisBirth control pills Chronic atrial fibrillation Multiple fractures
27 Signs & Symptoms Sudden onset of unexplained dyspneaRespiratory distress, rapid breathing Sudden onset of sharp, stabbing chest pain Cough (may cough up blood) Tachypnea & tachycardia Syncope Cool moist skin Restlessness and anxiety Decreased BP (Late sign) Cyanosis (Late sign) Distended neck veins (Late sign)
28 Emergency Care Ensure airway Ensure proper oxygenationMonitor the patient Rapid transport
29 Acute Pulmonary Edema Fluid collects in space between alveoli and capillaries Two Kinds Cardiogenic Non-cardiogenic
30 1. Cardiogenic Inadequate pumping action of the heartIncreased pressure in the pulmonary capillaries Fluid is forced to leak into the space between alveoli and capillaries Eventually fluid will enter the alveoli
31 2.Non-Cardiogenic Destruction of the capillary bed allows fluid to leak out Pneumonia, aspiration, near-drowning, narcotic overdose, inhalation of smoke or other toxic gases, high altitudes, trauma
32 Signs & Symptoms Dyspnea (especially on exertion)Difficulty breathing while laying flat Frothy pink or white sputum (late sign) Tachycardia Anxiety, Confusion, combativeness Tripod position
33 Signs & Symptoms Fatigue Rales, possible wheezing CyanosisPale moist skin Distended neck veins Swollen lower extremities
34 Emergency Care Ensure airway Ensure proper oxygenation, big O’s.Position patient in Fowlers position Transport without delay
35 Cardiac Emergency Cardiac CompromiseMay include one or all of the following: Squeezing, dull pressure, chest pain commonly radiating down the arms or to the jaw Sudden onset of sweating Difficulty breathing Anxiety, irritability
36 Cardiac Emergency Cardiac Compromise Feeling of impending doomAbnormal pulse rate (may be irregular) Abnormal blood pressure Epigastric pain Nausea/vomiting
37 Causes of cardiac compromiseCoronary Artery Disease-narrowing or blocked coronary arteries Aneurysm-weakened sections in the arterial walls Electrical malfunctions-an irregular, or absent, heart rhythm Mechanical malfunctions-mechanical pump failure Angina Pectoris- a pain in the chest Acute myocardial infarction- heart muscle that dies due to oxygen starvation Congestive heart failure-excessive fluid build-up Hypertensive Crisis- High blood pressure
38 Emergency Care Equipment should include Oxygen Oxygen adjunctsSuction equipment Equipment to assess vital signs Defibrillator
39 Treatment Priorities ABC’s Oxygen Vital signs NitroglycerinRapid Transport
40 Assessment Onset Provocation Quality Radiation Severity Time
41 SAMPLE Signs and SymptomsAllergies Medications Past medical history Last meal Events leading up to the illiness
42 Medication Nitroglycerin-Nitrostat relaxes smooth muscle, which causes venous dilation and results in decreased stress on the heart. It also dilates the arteries leading to the heart which help to improve oxygen supply to the heart.
43 Acute Coronary Syndromes (Chest Pain)Primary ABCD Survey Body Substance Isolation procedure Assess responsiveness Open airway Assesses pulse Attaches monitor
44 Secondary Survey Obtains vital signsPlaces Patient on 02 at appropriate rate Initiates IV line Performs targeted history, OPQRST, SAMPLE
45 Treatment Administers 325mg AspirinAdministers Nitro 0.4mg SL then Q 5 minutes X2, (if B/P > 100 Systolic & pain not relieved)
46 Contraindications HypotensionSuspected increased intracranial pressure Viagra or Levitra within past 24 hours & Cialis within past 96 hours
47 Question no. 1 During an assessment of a patient, which of the following findings would indicate to the nurse that the patient might have bacterial pneumonia? Ronchi and crackles on auscultation of breath sounds absence of fever and coughing that is always productive Hypotension and chest pain Frothy pink or white sputum (late sign) Answer A Department of Nursing Department of Nursing
48 Question no. 2 True regarding Chronic BronchitisIncreased sensitivity of lower airway to irritants. Blockage of pulmonary artery or branches by Blood clot, fat particle, air bubble, foreign body c. Destruction of alveolar walls along with distension of air sacs d. Does not affect alveoli, however they can’t expand fully because air can’t get past the diseased bronchi or bronchioles Ans d Department of Nursing Department of Nursing
49 References Daniel Limmer ,Michael F. O’keefe. Emergency Care .12 th ed, Pearson Education, Inc., ISBN-10: X • ISBN-13: •Kathleen Sanders Jordan, Emergency Nursing Core Curriculum,5 th ed, Philadelphia, W.B. Saunders company :A division of Harcourt Brace & company,2000. Department of Nursing