Republic Of Yemen Faculty of nursing 4th

.J. U. For Medical & Health sci level

Data 25/10/2022

Respiratory emergencies

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 Chronic obstructive pulmonary disease
2

 COPD is a term that is used to describe

various diseases (e.g. chronic bronchitis,
emphysema, chronic asthma). It is a slowly
progressive and irreversible disease.
 -It usually occurs in old age people over50y
of age, and smoker

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Assessment of the breathless patient with COPD
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 information about the severity of the disease can be gained from the
Patient's history.

 In mild disease, a ‘smoker’s cough’ is the only abnormal sign.

 In moderate disease, there is breathlessness and/ or wheeze on

moderate exertion, cough, and generalized reduction in breath sounds.

 In severe disease, there is breathlessness at rest, cyanosis, prominent

wheeze and/ or cough, and lung overinflation.

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 Chronic obstructive pulmonary disease
4

Record the following:

 -current treatment— inhalers, nebulizers, antibiotics, steroids, O2, and

theophyllines; in refractory COPD more side effect ci in cardiac pt

 exercise tolerance; • previous admissions,;

 the reason for ED attendance—exacerbation has been accompanied by

an increase in the amount or colour of sputum produced.

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 :assess for the following
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 cough
 cyanosis
 sputum— colour and amount;
 wheeze and tachypnoea
 accessory muscle usage
 lip pursing on expiration
 poor chest expansion;
 fever and dehydration;
 confusion or reduction in conscious level;
 pain.
 -treat any signs of sepsis, severe sepsis, or septic shock immediately.
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.…assess for the following: Count

 The mainstays of drug therapy of stable COPD are bronchodilators as

beta agonists and anticholinergics, inhaled glucocorticoids, …….given
alone or in combination depending upon the severity of disease and
response to therapy

 Long-term oxygen therapy, should be prescribed for all patients with

COPD who have chronic hypoxemia-- Secretion clearance ,
Smoking cessation -antibiotic,,antiviral

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 Investigations
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 Continuous monitoring— HR, RR, and SpO2.

 CXR.

 ECG.

 ABG analysis as soon as possible.

 CBC, U&E, • Sputum for C&S if purulent.

 Blood cultures if the patient is pyrexial

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 8 Nursing interventions
 Reassurance and upright position.

 O2 therapy to keep saturations in the range of 88– 92%

 Nebulizers (may need to be continuous).

 Steroids.

 IV theophylline

 Mouth care.

 IV fluids if the patient is dehydrated.

 Analgesia.


.Non- invasive ventilation
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 NIV >patients who meet the following criteria:

 respiratory acidosis (pH <7.35, PaCO2 >6kPa) that persists despite
maximal medical therapy
 GCS score >8
 able to protect the airway
 cooperative and conscious
 haemodynamically stable
 no excess respiratory secretions

Intensive care
 Patients with exacerbations of COPD should not be automatically
excluded From> invasive ventilation if all other treatments are failing.
 Pulmonary embolism
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 is a blockage of an artery in the lungs by a substance that has moved

from elsewhere in the body through the bloodstream (embolism).

 -Symptoms of a PE may include shortness of breath, chest pain upon

breathing in, and coughing up blood. Symptoms of a blood clot in the leg
may also be present, such as a red, warm, swollen, and painful leg.

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 Pulmonary embolism
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 -Signs of a PE include low blood oxygen levels, rapid breathing, rapid

heart rate, and sometimes a mild fever.]

 - Severe cases can lead to passing out, abnormally low blood pressure,
obstructive shock, and sudden death

 PE occurs when a thrombus, from a distant site (the deep veins), lodges
in the pulmonary vasculature. Less commonly, fat (from long bone
fracture), air, or amniotic fluid can cause an embolism.
 -Around 50% of these cases are in hospitalized patients or those in some
form of long- term care.
-commonest cause of maternal death
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 Signs and symptoms
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 • Tachypnoea (>20 breaths/ min)—

 • Tachycardia

 .• Pleuritic chest pain

 .• Haemoptysis.

 • hypotension.

The signs and symptoms of PE are non- specific and are

often found in patients without PE.

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 13 Classification

 Massive PE

 medium PE

 Small

 Multiple recurrent PE >This presents as increase breathlessness

over a period of weeks or months, with associated lethargy,
exertional syncope, and occasional angina.

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Nursing assessment for patients with possible PE
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 A careful history significant risk factor such as abdominal or orthopaedic

surgery, late pregnancy, Caesarean section, pre- eclampsia, malignancy,
lower leg fracture, or varicose veins. Sedentary travel, • pyrexia— low-
grade fever may be a response to the inflammatory

 changes in infarcted lung tissue;• hypotension— can be suggestive of

massive PE;

 • haemoptysis; • AVPU and GCS score

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 15
Investigations
 • E CG • CXR to rule out other causes.• SpO2.• ABG analysis • FBC and
U&E.

 • D- dimer • Computed tomographic pulmonary angiography (CTPA).

 D- dimer testing

 -D- dimer is a protein found in the blood after the breakdown of a blood
clot. It can be detectable in the blood for many reasons. -D- dimer is
useful only for excluding PE

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 Nursing interventions for the stable patient
16 with a high probability of PE

 • Continuous monitoring. • O2. • Analgesia.• LMWH. • Imaging.

 Interventions for patients with massive PE

 collapse and/ or hypotension that is unexplained, together with hypoxia

and engorged neck veins. • Thrombolysis— IV alteplase • In cardiac

arrest, a bolus dose of 50mg of alteplase can be considered, and CPR
should be continued for at least 30min.

 • If the patient is stable (alert, RR 10– 30 breaths/ min, systolic BP

>100mmHg, and O2 saturation <92% on air), treat with LMWH.

 • Urgent echocardiography
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 Heart failure
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 Heart failure (HF), also known as congestive heart failure (CHF), is a

syndrome, a group of signs and symptoms, caused by impairment of
the heart's function to pump blood.

 Symptoms commonly include shortness of breath, excessive tiredness,

and leg swelling.

 It may cause shortness of breath when exercising or while lying down,

and may wake a person up at night,

 chest pain including angina is not typically caused by heart failure,

but can occur if the heart failure is caused by a heart attack.

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 Heart failure

 18- The severity of the heart failure is measured by the severity of symptoms with exercise. ---

 -Other diseases that may have symptoms similar to heart failure include obesity, kidney failure,
liver problems, anemia, and thyroid disease.

 -Patients with mild, moderate, or severe heart failure may present to the ED with
breathlessness.

 - Acute heart failure can result from MI, arrhythmia, anaemia, infection ,medication
changes, or patients reducing their diuretic therapy.

 -Features within the history that may point to heart failure as the cause of dyspnoea
include:
C breathlessness on exertion; A. fatigue
B. orthopnoea (breathlessness when lying flat).
D. nocturnal breathlessness

 -Patients with acute heart failure often present to the ED in early morning and are
 Nursing intervention
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 12- lead ECG.

 • IV access, and collect blood for FBC, U&E, clotting,appropriately

timed TnI or TnT (early may be negative).

 Ensure pain relief. • For acute coronary syndrome (ACS), consider

aspirin and clopidogrel (unless contraindicated).

 • CXR.

 • Reassure, and offer support and comfort to the patient and

family,minimizing anxiety as much as possible

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Thank you