Download module 4 ch 17 13e

CHAPTER
17
Respiratory Emergencies
Handout 17-1: Evaluating Content Mastery
Student’s Name
EVALUATION
CHAPTER 17 QUIZ
Write the letter of the best answer in the space provided.
______ 1. The respiratory structure that allows air to flow in and out of the lungs
through contraction and relaxation of its muscles is the:
A. larynx.
C. diaphragm.
B. epiglottis.
D. alveoli.
______ 2. An adequate rate of breathing, or breaths per minute, for most adults is:
A. 25–50.
C. 15–30.
B. 20–40.
D. 12–20.
______ 3. All of the following are signs of inadequate breathing EXCEPT:
A. present and equal breath sounds.
C. cyanotic skin color.
B. shallow respirations.
D. use of accessory muscles.
______ 4. The preferred method of providing artificial ventilation is:
A. pocket face mask with supplemental oxygen.
B. two-person bag-valve mask with supplemental oxygen.
C. flow-restricted, oxygen-powered ventilator.
D. one-person bag-valve mask with supplemental oxygen.
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______ 5. An adequate number of breaths per minute for artificial ventilation of
infants and children are:
A. 40.
C. 20.
B. 30.
D. 12.
______ 6. In an infant or a child, bradycardia is a sign of:
A. circulatory collapse.
C. respiratory failure.
B. cardiac arrest.
D. fatigue.
______ 7. If a patient is experiencing breathing difficulty but is breathing adequately, she should be placed in a:
A. sitting position.
C. prone position.
B. supine position.
D. position of comfort.
______ 8. All of the following are examples of chronic obstructive respiratory
disease (COPD) EXCEPT:
A. emphysema.
C. black lung.
B. chronic bronchitis.
D. asthma.
______ 9. The whistling sound from a narrowed bronchial airway is called:
A. snoring.
C. wheezing.
B. stridor.
D. rhonchi.
______10. A condition in infants and small children in which the movement of the
diaphragm causes the chest and abdomen to move in opposite directions is called:
A. nasal flaring.
C. retractions.
B. seesaw breathing.
D. grunting.
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______11. A harsh, high-pitched sound during breathing is called:
A. gurgling.
C. stridor.
B. crackles.
D. retractions.
______12. All of the following are examples of medications delivered via prescribed inhalers, EXCEPT:
A. albuterol.
C. Ventolin.
B. aspirin.
D. Atrovent.
______13. An active process in which the intercostal (rib) muscles and the diaphragm contract, causing air to flow into the lungs, is known as:
A. bronchoconstriction.
C. expiration.
B. exhalation.
D. inspiration.
______14. A possible side effect from a prescribed inhaler is:
A. increased pulse rate.
C. cyanosis.
B. hypotension.
D. altered mental status.
______15. Sporadic, irregular breaths that are usually seen just before respiratory
arrest are called:
A. seesaw breathing.
C. diaphragmatic breathing.
B. agonal respirations.
D. hypoxic drive.
______16. All of the following are contraindications for CPAP use EXCEPT:
A. tachycardia.
C. hypotension.
B. apnea.
D. poor mask seal.
______17. Wet, gurgling lung sounds are an indication of:
A. COPD.
C. asthma.
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B. anaphylaxis.
D. pulmonary edema.
______18. Respiratory distress caused by an infection is most likely from:
A. COPD.
C. anaphylaxis.
B. pneumonia.
D. CHF.
_______19. Patients with absent or diminished lung sounds on one side only are suffering from:
A. pulmonary edema.
C. pneumothorax.
B. pulmonary embolism.
D. COPD.
_______20. A person who collapses from a clot in the pulmonary artery is suffering from:
A. pulmonary edema.
C. pulmonary hypertension.
B. pulmonary embolism.
D. pulmonary effusion.
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HANDOUT 17-2: Reinforcing Content Mastery Student’s Name
REINFORCEMENT
IN THE FIELD
Read the following real-life situation. Then answer the questions that follow.
Your unit has just received a call from the emergency medical dispatcher. A 73-year-old woman
at 154 Adams Way reports difficulty breathing. You and your partner head to the scene, arriving
12 minutes after the call.
Upon entry into the house, you find the patient sitting in a chair, leaning forward with her hands
on her knees. She appears anxious and has difficulty speaking in full sentences without gasping
for air. She tells you, “I can’t seem to get enough air.” As she struggles to catch her breath, the
patient adds, “My chest is so tight.”
You position yourself at eye level with the patient and try to calm her fears. You introduce yourself and explain that you will need to ask several questions before beginning treatment. From
your questions, you learn that the patient has a history of emphysema and that she takes Lasix,
atenolol, and Ventolin. However, she has not taken these medications for several days in an effort to prolong the prescriptions. “Refills are so expensive,” she explains.
Upon physical examination, you find the patient alert but restless. Her pulse rate is 120 beats per
minute, her blood pressure is 110/68 mmHg, her respiratory rate is 20 per minute. Breaths are
labored and noisy. Her skin is warm and pale.
1. Is the patient’s breathing adequate or inadequate?
2. When you elicited a focused history of the condition, what questions
should you have asked the patient?
3. What steps would you take to treat this patient?
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4. How would you administer oxygen to the patient?
5. Should you assist this patient in taking her prescribed inhaler?
6. In what position should this patient be transported to the hospital?
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HANDOUT 17-3: Reinforcing Content Mastery Student’s Name
REINFORCEMENT
CHAPTER 17 REVIEW
Write the word or words that best complete each sentence in the space provided.
1. ______________________ complaints are among the most common reasons that people
call EMS.
2. The ______________________ is a muscular structure that divides the chest cavity from
the abdominal cavity.
3. ______________________ is an active process that uses the contraction of several muscles
to increase the size of the chest cavity.
4. Normal breathing may be determined by observing for ______________________,
______________________, and ______________________.
5. ______________________ ______________________ are sporadic, irregular breaths that
are usually seen just before respiratory arrest.
6. Infants and small children in respiratory distress exhibit ______________________
______________________, in which the movement of the diaphragm causes the chest and
abdomen to move in opposite directions.
7. A low, or ______________________, pulse in infants and small children in the setting of a
respiratory emergency usually means trouble!
8. A high-pitched sound during breathing is called ______________________.
9. Use the letters ______________________ to remember which questions to ask when eliciting a history of a respiratory disorder.
10. Never withhold ______________________ from a patient in respiratory distress.
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11. Emphysema—as well as chronic bronchitis and black lung—are examples of
______________________ ______________________ ______________________
______________________.
12. A patient who uses several pillows to prop himself up when sleeping may be suffering from
____________________ ______________________ ______________________.
13. A(n) ______________________ attack may be triggered by an allergic reaction to something inhaled, swallowed, or injected into the body.
14. Blockage, due to narrowing of the bronchi that lead from the trachea to the lungs, is known
as ______________________.
15. Contact ______________________ ______________________ for specific authorization to
help a patient self-administer a prescribed inhaler.
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HANDOUT 17-4: Reinforcing Content Mastery Student’s Name
ADEQUATE AND INADEQUATE BREATHING
Complete the following table to review the characteristics of adequate and inadequate
breathing.
Adequate Breathing
Rate
Inadequate Breathing
Adult:
Adult:
Child:
Child:
Infant:
Infant:
Rhythm
Quality
Breath sounds
Chest expansion
Effort of breathing
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HANDOUT 17-5: Reinforcing Content Mastery
Student’s Name
PRESCRIBED INHALER COMPLETION
Write in the missing information on the following medication flash card, and save the completed card for future reference.
Prescribed Inhaler
Medication Names
1. Generic:
______________________________________________________________________________
2. Trade:
______________________________________________________________________________
Indications
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
Contraindications
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
Medication Form:
______________________________________________________________________________
Dosage:
10
______________________________________________________________________________
Action:
______________________________________________________________________________
Side Effects
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
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Chapter 17 Answer Key
HANDOUT 17-1: Chapter 17 Quiz
1. C
4. A
7. D
10. B
13. D
2. D
5. C
8. D
11. C
14. A
3. A
6. C
9. C
12. B
15. B
16. A
17. D
18. B
19. C
20. B
HANDOUT 17-2: In the Field
1. Adequate, but with the potential to progress to inadequate.
2. OPQRST. When did the condition begin? What were you doing when it came on? Can you
describe the feeling you have? Does the feeling seem to spread to any other part of your
body? On a scale of 1 to 10, how bad is your breathing problem? How long have you had this
feeling? Have you taken any prescribed medications or done anything else to help relieve the
condition?
3. Perform an initial assessment, administer high-flow oxygen, phone medical direction for
permission to help the patient with her prescribed inhaler, and transport her rapidly to the
hospital.
4. Use a nonrebreather mask to administer 12 to 15 lpm of high-flow oxygen.
5. Assisting the patient with her prescribed inhaler should only be done after consulting medical
control online and receiving a direct order from medical control to assist the patient with her
inhaler. Depending on whether the breathing difficulty originates in the heart or the lungs, her
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inhaler may be either beneficial or potentially harmful.
6. In a position of comfort, most likely a seated position.
HANDOUT 17-3: Chapter 17 Review
1. Respiratory
2. diaphragm
3. Inspiration
4. rate, rhythm, quality
5. Agonal respirations
6. seesaw breathing
7. bradycardic
8. stridor
9. OPQRST
10. oxygen
11. chronic obstructive pulmonary diseases
12. pulmonary edema
13. asthma
14. bronchoconstriction
15. medical direction
HANDOUT 17-4: Adequate and Inadequate Breathing
Rate
Adequate Breathing
Inadequate Breathing
Adult: 12–20/min
Above or below normal rates for the pa-
Child: 15–30/min
tient’s age group
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Infant: 25–50/min
Regular
May be irregular
Breath sounds
Present and equal
Diminished, unequal, or absent
Chest expansion
Adequate and equal
Inadequate or unequal
Effort of breathing
Unlabored, normal res-
Labored—increased respiratory effort; use
piratory effort
of accessory muscles (may be pronounced in
Rhythm
Quality
infants and children with nasal flaring, seesaw breathing, grunting, and retractions between the ribs and above the clavicles and
sternum)
HANDOUT 17-5: Prescribed Inhaler Completion
Medication Names
1. Generic: albuterol, isoetharine, metaproterenol
2. Trade: Proventil, Ventolin, Bronkosol, Bronkometer, Alupent, Metaprel
Indications
1. Patient exhibits signs and symptoms of respiratory emergency.
2. Patient has physician-prescribed, handheld inhaler.
3. Medical direction gives specific authorization to use.
Contraindications
1. Patient is unable to use the device (e.g., not alert).
2. Inhaler is not prescribed for the patient.
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3. Medical direction has not authorized its use.
4. Patient has already taken the maximum dosage prior to EMT’s arrival.
Medication Form: Handheld, metered-dose inhaler
Dosage: Based on medical direction’s order or physician’s order
Action: Beta-agonist bronchodilator that dilates bronchioles, reducing airway resistance
Side Effects
1. Increased pulse rate
2. Tremors
3. Nervousness
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