Alexander ch20 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 20
Respiratory Disorders

• Applies fundamental knowledge to provide basic
and selected advanced emergency care and
transportation based on assessment findings for
an acutely ill patient.
Advanced EMT
Education Standard

1. Define key terms introduced in this chapter.
2. Explain the importance of being able to quickly recognize
and treat patients with respiratory emergencies.
3. Obtain an appropriate history for a patient with a
respiratory problem.
4. Conduct an appropriate examination for a patient with a
respiratory problem.
Objectives (1 of 3)

5. Explain the relationship between dyspnea and hypoxia.
6. Describe the pathophysiology by which specific
conditions lead to inadequate oxygenation.
7. Use patient histories and clinical presentations to
differentiate among causes of respiratory emergencies.
8. Engage in effective clinical reasoning in order to develop
a safe and appropriate treatment plan for patients with
respiratory emergencies.
9. Given a list of patient medications, recognize medications
that are associated with respiratory disease.
Objectives (2 of 3)

10.Differentiate between short-acting beta2 agonists
appropriate for prehospital use and respiratory
medications that are not intended for emergency use.
11.Use reassessment to identify responses to treatment
and changes in the conditions of patients presenting
with respiratory complaints and emergencies.
Objectives (3 of 3)

• Respiratory distress
– Can rapidly deteriorate into respiratory failure
and arrest
– Death follows quickly unless measures are taken
to restore ventilation and oxygenation.
– Can interfere with delivery of oxygen to the tissues
– Exacerbated by stress response and increased use
of respiratory muscles
Introduction (1 of 3)

• Cellular metabolism with inadequate oxygen
leads to inefficient energy production and
respiratory acidosis.
• The combination of uncorrected underlying
problem, exhaustion, and acidosis can overwhelm
the body’s attempts to compensate and restore
homeostasis.

• Quickly recognize difficulty breathing and
intervene.
• Ensure open airway, adequate ventilation,
and circulation.
• Understanding anatomy, physiology, and
pathophysiology of the respiratory system helps
to provide the best care.

Think About It
• What are your hypotheses about Mr. Emerson’s
problem?
• What additional information should you obtain to
help you arrive at a clinical impression?
• What treatments should you begin prior to
transport?

• Cellular energy production depends on oxygen
reaching each cell.
– Adequate oxygen in atmosphere
– Airway open to allow air to reach alveoli
– Each alveolus in close contact with capillaries
– Adequate hemoglobin to carry oxygen
– Cardiovascular system working effectively
– Anything that interferes can lead to hypoxia, cell
dysfunction, and death.
Anatomy and Physiology Review

Anatomy and Physiology Review—
The Need for Oxygen
• Cells must produce energy to carry out their
functions.
• Aerobic metabolism
– Energy production in presence of oxygen is efficient;
results in byproducts easily eliminated by body.
• Anaerobic metabolism
– Energy production is limited and H+ accumulates as
lactic acid, decreasing pH and causing acidosis.

Figure 20-2
Relationship between pulmonary and systemic circulation.

Structure and Function of the Lungs (1 of 3)
• Passageway of air
– Mouth and nose
– Pharynx
– Larynx
– Trachea
– Right and left mainstem bronchi
– Right and left lung
– Bronchioles
– Alveolus

• Bronchioles have smooth muscle that allow the
diameter to change in response to alveolar
ventilation required.
– Smooth muscle has sympathetic beta2 receptors;
respond to epinephrine.
• Respiratory tract secretes mucus and
microscopic, hair-like cellular projections (cilia).

• Walls of distal (terminal) bronchioles and alveoli
are a single cell-layer thick.
• Alveoli and capillaries
– Respiratory membrane.
– Separated by extracellular fluid.
– Diffusion of gases depends on concentrations on each
side of cell membrane.

Figure 20-3
The diaphragm and intercostal muscles contract, increasing the volume of the thoracic
cavity, which lowers intrathoracic (and intrapulmonary) pressure and thus allows inspiration.

Anatomy and Physiology
Review—Ventilation (1 of 3)
• Stimulates increased carbon dioxide in blood and
cerebrospinal fluid, or decreased level of oxygen
• Motivates inspiratory center of brain in medulla
oblongata
• Inspiratory center sends nervous impulses to the
diaphragm and intercostal muscles to contract.

• Muscular contraction increases volume of thoracic
cavity.
• Inverse relationship between volume of a gas and
its pressure
• Air moves from areas of higher pressure to areas
of lower pressure; air moves from environment
into lungs.

Figure 20-4
The diaphragm and intercostal muscles relax, which reduces the volume of the thoracic
cavity and increases intrathoracic (and intrapulmonary) pressure, allowing expiration.

• Tidal volume
– Amount of air that moves in and out of lungs
 5–7 mL/kg (500 mL) average-sized adult
– Anatomical dead space air
 150 mL remains in the airway and is unavailable for gas
exchange.
• Expiration
– Stretch receptors and nervous signal stimulate
– Diaphragm and intercostal muscles relax
– Higher intrapulmonary pressure in environment; air
flows out of lungs

• Respiratory problems can exist in varying
degrees.
– Mild dyspnea
 Short of breath
– Severe dyspnea
 Respiratory distress, barely able to speak, tripod, wheezing,
coughing, accessory muscle use
– Hypoxia and exhaustion
 Cyanosis, altered mental status, weak respiratory effort, leads
to respiratory failure.
– Respiratory arrest
 Ineffective respiratory effort, or apnea
General Assessment and Management
of Respiratory Emergencies (1 of 2)

Table 20-1
Signs of Respiratory Distress, Respiratory Failure, and
Respiratory Arrest
Normal Breathing Respiratory Distress Respiratory Failure Respiratory Arrest
Respiratory
rate
12–20 per minute May be normal, but likely
slightly outside normal
range
8 or less, or 30 or greater Agonal or absent
Tidal volume Free movement of air,
adequate depth
May be increased or
decreased
Inadequate Minimal to absent
Breath
sounds
No abnormal sounds;
breaths sounds
present and equal in
all lung fields
May have stridor,
wheezing, rhonchi,
crackles (rales); breath
sounds may be
diminished or unequal
May have stridor, wheezing,
rhonchi, crackles (rales);
breath sounds may be
diminished, reflecting
inadequate air movement
Absent
Work of
breathing
Normal Slightly to moderately
Increased
Increased, but patient may
be showing signs of fatigue
Minimal to absent
Patient
appearance
Good skin color Anxious Anxious, may have
cyanosis; level of
responsiveness may begin
to decrease; patient may be
confused
Decreased
responsiveness,
cyanotic
Necessary
interventions
As long as the
patient’s SpO2 is 95
percent or higher
on room air, no
intervention is required
Administer supplemental
oxygen as needed to
maintain a target SpO2 of
95%
Assist ventilations with
CPAP, bagvalve-mask
device, or FROPVD;
administer supplemental
oxygen
Provide ventilations
using bag-valve-mask
device, FROPVD,
or ATV; administer
supplemental oxygen

of Respiratory Emergencies (2 of 2)
• Maintain SpO2 of 95 percent.
• All patients with inadequate ventilations require
assistance by bag-valve-mask device with
supplemental oxygen.
• Maintaining patient’s airway, breathing,
oxygenation, and circulation are critical.
• Attempt to reverse underlying cause.

• Always ensure your own safety.
• Form general impression.
• Establish level of responsiveness.
• Check carotid pulse.
• Check patient position.
• Listen to ease of speaking.
General Assessment and Management of
Respiratory Emergencies—Scene Size-Up

Figure 20-8
Use a bag-valve-mask device to assist with or provide ventilations for any patient with
inadequate or absent breathing.

of Respiratory Emergencies—Primary
Assessment (1 of 2)
• Ensure patient has open airway.
– Use manual position, suction, and basic airway
adjuncts as needed.
• Assess adequacy of breathing.
– Assist ventilations by bag-valve-mask device with
supplemental oxygen.
• Adequate ventilations, begin treatment with
oxygen as needed.

of Respiratory Emergencies—Primary
Assessment (2 of 2)
• Assess pulse.
– Tachycardia indication of hypoxia
• Determine priority for transport.
– Respiratory distress can quickly progress to respiratory
failure and respiratory arrest.
– Effective prehospital treatment can improve condition.
– Request paramedic assistance as needed.

of Respiratory Emergencies—Secondary
Assessment
• Focus on details that are most relevant.
– Auscultation
– Vital signs
– Pulse oximetry
– Capnometry
– Cardiac monitoring
– Medical history

Table 20-2 (1 of 2)
Patient Medications That May Indicate a Respiratory Illness
Drug Category Examples Actions
Antibiotics Amoxicillin, azithromycin (Zithromax),
ciprofloxin (Cipro), erythromycin
Antibiotics work by various
mechanisms to treat bacterial
infections such as pneumonia and
bronchitis
Anti-inflammatory (steroids/
corticosteroids)
Prednisone, fluticasone (Flovent), triamcinolone
(Azmacort), beclomethasone (Beclovent)
Reduces the inflammatory component
of asthma and COPD
Anti-inflammatory (mast
cell stabilizers)
Cromolyn (Intal) Reduces inflammation by preventing
mast cells from releasing chemical
mediators of inflammation, such as
histamine
Anti-inflammatory
(leukotriene inhibitors)
Montelukast (Singulair) Inhibits the release of leukotrienes,
which are chemical mediators of
inflammation
Bronchodilators (short-
acting beta2 adrenergic
agonists)
Albuterol (Proventil), levalbuterol (Xopenex) Fast acting, but short duration; cause
smooth muscle relaxation in the
bronchioles
Bronchodilators (long-
acting beta2 adrenergic
agonists)
Terbutaline (Brethine), salmeterol (Serevent),
formoterol
Slower acting with a longer duration of
action, especially when taken in tablet
form; cause smooth muscle relaxation
in the bronchioles

Table 20-2 (2 of 2)
Patient Medications That May Indicate a Respiratory Illness
Drug Category Examples Actions
Bronchodilators
(anticholinergics)
Ipratropium (Atrovent), tiotropium (Spiriva) Inhibits bronchoconstriction through
inhibition of parasympathetic
(cholinergic) action on the bronchioles
Bronchodilators (xanthines) Theophylline (less frequently prescribed) Stimulates respiratory drive and
causes bronchodilation; associated
with cardiac dysrhythmia
Cough suppressants
(antitussives)
Codeine, hydrocodone, dextromethorphan Act on the central nervous system to
suppress dry coughs
Expectorants/mucolytics Guaifenesin (expectorant), acetylcysteine
(mucolytic)
Thin mucus to allow it to be more
easily expectorated
Pancreatic enzymes Pancrelipase (Pancrease) Used in cystic fibrosis, a disease
associated with thick mucus
production, to support pancreatic
digestive enzymes that are blocked by
mucus secretions
Oxygen Portable or fixed oxygen cylinder or oxygen
concentrator used with a nasal cannula
Provides supplemental oxygen to
patients with advanced chronic
respiratory diseases

of Respiratory Emergencies
• Clinical reasoning process
– Understand pathophysiology of difficult breathing.
– Helps to know what questions to ask
– Develop and test hypotheses about underlying cause
of respiratory emergency.

of Respiratory Emergencies—Treatment
• Maintain airway, ventilation, oxygenation, and
circulation.
• Combitube® or supraglottic airway device
• Continuous positive airway pressure (CPAP)
• IV fluids
• Nitroglycerin; epinephrine

of Respiratory Emergencies
• Reassessment
– Ongoing respiratory distress, acidosis, and hypoxia can
lead to exhaustion.
– Respiratory distress can progress quickly to respiratory
failure and arrest.
– Frequently reassess mental status.
– Be prepared to change treatment.

Figure 20-11
Patients with COPD can exhibit “clubbing” of the fingers.

Figure 20-12
Pathophysiology of chronic bronchitis and emphysema.

Chronic Obstructive Pulmonary Disease
(1 of 6)
• Both emphysema and chronic bronchitis
• Third leading cause of death in United States
• Typically occur in middle age and caused by
cigarette smoking
• Difficulty breathing caused by progressive
destructive of lung tissue with
– Decreased diameter, loss of elasticity, obstruction from
inflammation and mucus production, and decreased
alveolar surface area for gas exchange

Chronic Obstructive Pulmonary
Disease (2 of 6)
• Right ventricle must work harder to circulate blood
through the lungs.
– Due to increased resistance to blood flow
– Results in enlargement of right ventricle, right-sided
heart failure, and pulmonary hypertension
– Digital clubbing
– Hypoxic drive

Disease (3 of 6)
• Chronic bronchitis
– Mucus-producing cells in bronchi increased in size;
produce more mucus than normal, resulting in
persistent “smoker’s cough”
– Destruction of cilia allow bacteria to become trapped.
– Decompensation (acute exacerbation) caused by
infection

Disease (4 of 6)
• Chronic bronchitis (continued)
– Cough produces sputum
– Wheezing due to bronchoconstriction
– “Blue Bloater”
– Cyanosis
– Prone to hypercapnia; can lead to confusion,
drowsiness, and headache

Disease (5 of 6)
• Emphysema
– Extensive destruction of walls of alveoli, resulting in
reduced surface area for gas exchange
– Compensates by increasing red blood cells to carry
oxygen
– “Pink Puffer”
– Respiratory distress, wheezing, thin with
well-developed accessory muscles
– Air trapped in alveoli
– Barrel-chested

Disease (6 of 6)
• COPD management
– Improve ventilation and oxygenation
– CPAP or BVM is indicated
– Supplemental oxygen to maintain SpO2 88–93%
– Humidified oxygen
– Sympathetic beta2 agonist (albuterol) per protocol
– Sympatholytic (ipratropium) per protocol
– IV fluids if indicated

Figure 20-14
Asthma has inflammatory and bronchoconstrictive components.

Asthma (1 of 4)
• Affects people of all ages; untreated can lead
to death
– Chronic inflammation of bronchioles and
bronchoconstriction during an “asthma attack”
– Triggers
 Cigarette smoke
 Pet dander
 Pollutants
 Exercise
 Respiratory infections
 Other irritants

Table 20-3
Signs and Symptoms of an Asthma Attack
Signs and Symptoms of a Milder Asthma Attack
• Nonproductive cough (may be worse at night, causing inability to sleep, or may be worse in early morning)
• Wheezing (may be induced by exercise, infection, or exposure to triggers; usually expiratory)
• Chest tightness
• Shortness of breath
• Tachypnea
• Tachycardia (below 150 beats/min.)
• Anxiety
• SpO2 > 95 percent before oxygen
Signs and Symptoms of a Severe Asthma Attack
• Fatigue, exhaustion
• Inability to speak
• Confusion or drowsiness
• Cyanosis
• Diminished or absent breath sounds
• Tachycardia or bradycardia
• Tachypnea (> 30 beats/min.)
• Diaphoresis
• SpO2 < 90 percent with oxygen

Asthma (2 of 4)
• Asthma management
– Status asthmaticus
 A severe, prolonged, life-threatening asthma attack that does
not respond to treatment with bronchodilators
 Approaching respiratory failure

Asthma (3 of 4)
• Asthma management (continued)
– Prehospital treatment
 Assess level of responsiveness, airway, breathing,
oxygenation, and circulation.
 If altered LOC, signs of exhaustion, cyanosis, and diminished
air movement; immediate life threat
– Establish airway, assist ventilation, and adminsiter supplemental
oxygen.
– Transport without delay. IV en route.
– Consult medical direction about subcutaneous or intramuscular
epinephrine for status asthmaticus.

Asthma (4 of 4)
• Asthma management (continued)
– Awake and breathing
 Base oxygen administration on level of distress, vitals,
and SpO2.
 Follow protocol in administering a beta2 agonist or combined
beta2 agonist/ anticholinergic by small-volume nebulizer.
 Hydration with IV fluids per protocol
 Reassess

Pulmonary Embolism (1 of 4)
• Obstruction to blood flow in pulmonary arterial
system by blood clot (embolus)
– Part of lung not able to exchange gas
• Causes imbalance in ventilation and perfusion;
ventilation-perfusion (VQ) mismatch
• Hypoxia results—Degree of distress depends on
degree of lung perfusion affected.

Table 20-4
Signs and Symptoms of Pulmonary Embolism
• Unexplained shortness of breath
• Tachypnea
• Tachycardia
• Hypotension
• Feeling of dread, anxiety
• Syncope
• Diaphoresis
• Chest pain (pleuritic)
• Coughing, hemoptysis
• New cardiac dysrhythmia
• Swollen, tender lower extremity (calf)

• Substantial obstruction; experience sudden
onset of severe dyspnea, hypotension, and
severe respiratory distress, and hypoxia
• Can deteriorate quickly, getting worse despite
attempts to oxygenate, ventilate, and increase
blood pressure
– Patient needs in-hospital treatment.

• Common risk factors
– Deep vein thrombosis (DVT) of pelvis or lower
extremities
– Recent surgery, cancer, immobilization, estrogen use,
pregnancy, older age
• Suspect pulmonary embolism with unexplained
dyspnea and hypoxia
– Chest pain, syncope, hypotension, tachycardia,
hemoptysis, swelling of one leg, cyanosis, cool and
diaphoretic skin, altered mental status, respiratory
failure

• Prehospital treatment
– Oxygen titrated to SpO2
– IV with fluids according to protocol
– Be prepared for respiratory and cardiac arrest.
– Notify receiving facility and consult medical direction
as needed.

Pulmonary Edema (1 of 3)
• Occurs when increase in interstitial fluid increases
distance of gas diffusion between alveoli and
pulmonary capillaries.
• Cardiogenic pulmonary edema
– Left-sided heart failure
– Nitroglycerin administered sublingually

• Noncardiogenic pulmonary edema
– Acute respiratory distress syndrome (ARDS);
delayed toxin-induced lung injury
– Complication of severe illnesses; rarely seen in
prehospital setting
– ARDS carries high mortality rate
– Prehospital treatment
 Ventilation and oxygenation

• Toxic substances that reach the lungs can lead
to noncardiogenic pulmonary edema and other
damage to the lungs.
– May not be evident immediately after exposure
– Referred to as delayed toxin-induced lung injury
– Obtain history and manage ventilation and
oxygenation.

Figure 20-16
Spontaneous pneumothorax.

Spontaneous Pneumothorax (1 of 5)
• Air accumulates within pleural cavity, outside lung,
interfering with ability of lung to expand during
inspiration.
• Spontaneous pneumothorax
– Occurs without trauma
• Simple pneumothorax
– Area of lung ruptures, air leaks out, and accumulates in
pleural space

• Guide oxygen therapy on level of distress and
SpO2. Position of comfort.
– Bag-valve mask is necessary.
• Reassess patient frequently, monitoring mental
status, breathing, lung sounds, oxygenation, and
vital signs.

Table 20-5
Signs and Symptoms of Simple and Tension Pneumothorax
Feature Simple Pneumothorax Tension Pneumothorax
Dyspnea Mild to severe Increasingly severe, progressing to respiratory
failure
Hypoxia Mild to severe Increasingly severe
Lung sounds (sounds from the
unaffected lung may be transmitted
to the affected side)
Decreased on affected side Decreased first on affected side, later on both
sides
Chest pain May be present Present in 90 percent of cases
Circulation May have tachycardia related to
anxiety and dyspnea
Hypotension, tachycardia, impaired return of
blood to heart results in jugular venous
distension; if untreated, cardiac arrest with
pulseless electrical activity or asystole
Other possible physical findings
(these signs are rarely seen and
may be subtle; be aware of their
meaning but do not rely on their
presence to identify tension
pneumothorax)
Generally none Pulsus paradoxus, tracheal deviation away
from affected side, hyperexpansion of the
chest, hyperresonance of the chest to
percussion. (These signs are rarely seen and
may be subtle. Be aware of their meaning, but
do not rely on their presence to identify tension
pneumothorax.)

• Tension pneumothorax
– Defect in lung large; cannot seal itself
– Air continues to accumulate; cannot escape
– Begins to compress the mediastinum and collapses
the opposite lung
– Critical, life-threatening emergency

• Tension pneumothorax (continued)
– Severe dyspnea, respiratory failure, cyanosis,
distended neck veins, and hypotension; tracheal
deviation late sign
– Needle thoracostomy decompresses chest.
– Request ALS; transport quickly.

• Lung sounds will often will be absent or
diminished in the affected area.
• Use least amount of pressure needed to ventilate.
• Start IV and infuse fluid for hypotension.
• Notify receiving facility as soon as possible.

Hyperventilation Syndrome (1 of 3)
• Minute ventilation exceeds metabolic demands
• Dyspnea, anxiety, chest pain, dizziness, near-
syncope, weakness, paresthesia, carpopedal
spasm
• Emotionally distressing event preceding onset of
symptoms
• Overlap between HVS and panic disorder

• Do not assume patient with increased ventilation
has HVS.
– Consider spontaneous pneumothorax and pulmonary
embolism as differential diagnoses.
• HVS cannot be diagnosed in field.
• Supplemental oxygen; focus on using abdominal
muscles to breathe; reassure patient

• Critical thinking discussion
– Why is breathing into a paper bag not an appropriate
treatment for a patient with hyperventilation syndrome?

Infectious Respiratory Diseases (1 of 6)
• Viruses, fungi, bacteria can all cause infection
of upper or lower respiratory system.
• Upper respiratory diseases are rarely life-
threatening.
• Lower respiratory infections
– Impairments of oxygenation; can become life-
threatening

• Pneumonia
– Infectious disease; inflammation of lungs
– Community-acquired or hospital-acquired (nosocomial)
– Can be fatal with weakened immune system
– Signs and symptoms
 Cough, difficulty breathing, shaking chills, fever, malaise,
productive cough (yellow or rust color)

• Pneumonia (continued)
– Treatment
 Oxygen if dyspnea and hypoxia
 Nebulized bronchodilators if patient is wheezing
 IV fluids if dehydrated

Table 20-6 (1 of 2)
Comparing and Contrasting Cardiogenic Pulmonary Edema
and Pneumonia
Feature Pulmonary Edema Pneumonia
Cause Left-sided heart failure Bacterial, viral, or fungal infection
Risk factors Known heart failure or heart disease, acute myocardial
infarction (AMI), history of hypertension
Smoking, COPD, asthma, influenza,
Immunocompromise
Pathophysiology Increased hydrostatic pressure in pulmonary capillaries
results in increased interstitial fluid between capillaries and
alveoli; fluid may enter Alveoli
Affects both lungs
Alveoli filled with fluid and pus; often
localized to a single lobe of one lung,
but may be bilateral
Onset Often occurs at night when the patient lies down, but can
occur at any time
Onset is often sudden
May be a history of recent respiratory
infection (influenza, bronchitis)
Chills and fever may occur suddenly
Dyspnea tends to be progressive

Table 20-6 (2 of 2)
Comparing and Contrasting Cardiogenic Pulmonary Edema
and Pneumonia
Feature Pulmonary Edema Pneumonia
Signs and
symptoms
Orthopnea (needs to sit up to breathe)
History of dyspnea on exertion
Paroxysmal nocturnal dyspnea (PND)
Altered mental status
Jugular venous distention (JVD)
Pink, frothy sputum
Peripheral edema
Decreased SpO2
Hypertension or hypotension
Crackles (rales) may be heard without a
stethoscope, or may require auscultation of the
lungs; may be present in both lungs, beginning at
the bases
Some wheezing may be heard
Malaise
Loss of appetite
Fever (may not always occur)
Chills
Dyspnea
Cough (productive or nonproductive)
Green, yellow, or rust-colored sputum
Altered mental status (especially in the elderly)
Tachypnea
Decreased SpO2
Localized crackles (rales)
Wheezing and rhonchi in affected lung
Decreased lung sounds over affected area
May complain of pleuritic chest pain
Diaphoresis and cyanosis may occur
Management Oxygen if needed
Assist ventilations if needed; CPAP may be useful
Start IV at a keep-open rate
Nitroglycerin may be ordered by medical direction
Medical direction may order a nebulized
bronchodilator if wheezing is significant
Oxygen if needed
Assist ventilations if needed
IV fluids for dehydration
Medical direction may order a nebulized
bronchodilator for significant wheezing

• Acute Bronchitis
– Inflammation of bronchi with increased mucus
production
– Mucus causes rhonchi; heard upon auscultation
– Caused by viruses, bacteria, and irritants

• Acute Bronchitis (continued)
– Signs and symptoms
 Wheezing, coughing (productive yellow or green sputum),
shortness of breath, fever, chills, and malaise
– Treatment
 Provide oxygen to treat dyspnea and hypoxia.
 Nebulized bronchodilator for wheezing
 IV fluids if dehydrated

• Viral respiratory diseases
– Influenza, SARS, HPS can lead to death from hypoxia
– Influenza vaccination is important.
– Signs and symptoms of influenza
 Malaise, fever, muscle and joint pain, and cough

Lung Cancer (1 of 3)
• Primary causes
– Smoking; exposure to asbestos; genetic predisposition
• Two types
– Small cell and non-small-cell
• Stage of cancer based on degree it has
metastasized
– 0 is localized to one area; 5 is extensive metastasis

• When responding to lung cancer patients, you will
often deal with issues of death and dying.
• Stages of grief
• Patients may be on hospice care and have
POLST of DNR.
• Patients may have respiratory depression and
hypotension caused by high doses of potent
narcotic medications.

• Cancer patients may suffer a variety of other
problems related to progression of the disease.
Behavioral changes may be due to brain
metastasis, hypoxia, or side effects of
medications.
• Pathological fractures may occur as a result of
bone metastasis.

Cystic Fibrosis
• Rare genetic disease of secretory glands causing
extremely viscous mucus
– Many organs affected (lungs; digestive tract)
• Thick secretions obstruct airways; lead to life-
threatening infection.
• Treat signs and symptoms
– Administer humidified oxygen. Consult medical
control for IV fluids, CPAP, nebulized bronchodilator
for wheezing.

Chapter Summary (1 of 3)
• Acute and chronic respiratory problems can be life
threatening due to impaired ventilation and
oxygenation.
• Respiratory distress can quickly progress to
respiratory failure and respiratory arrest.

• Problems:
• COPD, lung cancer, asthma, pulmonary edema, hyperventilation
syndrome, infectious diseases, and cystic fibrosis
• Recognize signs and symptoms; obtain relevant
history; develop clinical impression.
• Quick recognition of distress and intervention to
restore and maintain ventilation and oxygenation
can be lifesaving.

• In some cases, you will administer specific
treatments aimed at treating underlying cause
of distress.
• Ability to empathize and calmly interact with
patient is critical.

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