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2 Minute EBP Challenge

Monday, July 26, 2010
Ms. Shepard and DIC
This morning rapid response is called for Ms. Shepard who was admitted with a urinary tract infection and sepsis. Her blood pressure dropped during the evening hours and she is now hypotensive and is having difficulty breathing. Her IV sites are oozing and there is blood in the urinary catheter. Her physician suspects disseminated intravascular coagulation (DIC). The primary mechanism in the development of DIC is:

Monday, July 19, 2010
Thyrotoxicosis

Which of the following laboratory findings is indicative of thyrotoxicosis?

Monday, July 12, 2010
Urban CPR Patterns
In a recent study of inner-city neighborhoods, the authors found that out of hospital cardiac arrest was 2-3 times higher in some neighborhoods compared to others. In these high incidence neighborhoods what was the rate of bystander CPR?

 

Breath Sounds Tutor

Normal Breath Sounds

To be able to distinguish between types of abnormal breath sounds and their location, it is important to understand normal respiration and its effect on airway noises that make up breath sounds. Normal breath sounds are bronchovesicular in nature. They are loud pipe-like sounds in the large airways, and softer blowing-like sounds in the small airways. Normal breath sounds are loudest during inspiration and softest during expiration. The inspiratory phase is shorter with faster airflow. Although abnormal sounds may be louder during inspiration, they may be difficult to distinguish due to their short duration.

Normal Air Flow through the Lungs

Flow is greatest in the trachea and diminishes in the distal lung fields, until it reaches the alveoli, where there is no flow. Breath sounds are loudest over areas with greater flow, and distal pathology may be communicated to these areas. Therefore, auscultation over the trachea may reveal pathology there or communicated from distal regions of the lung.

**If breath sounds are really diminished, listen over the trachea**


Adventitious sounds
Wheezing: musical, whistling sound
  1. Usually more pronounced during expiration
  2. From narrowed airways
    • Bronchoconstriction
    • Secretions
  3. Interventions:
    • Bronchodilation
    • Hydration
    • Coughing


Rales: crackling sound
  1. Heard at the end of inspiration
  2. From collapsed or waterlogged alveoli
  3. Fine: beginning of fluid buildup / or atelectasis
  4. Coarse: greater volume of fluid buildup

  1. Interventions:
    Manage fluids
    • Budget volume resuscitation
    • Diuretics

Expectorate

    • Turn & position
    • Deep breathing
    • Forced expiration
    • Vibration & percussion

 
Rhonchi: bubbling
  1. The sound will be heard throughout inspiration and expiration.
  2. Louder than rales due to larger secretions
  3. Results from air bubbling past secretions in the airways

  1. Interventions:
    • Deep breathing
    • Coughing
    • Hydration (encourage fluids, if no restriction)
    • Humidify air
    • Mobilize

Friction rub: creaking, leathery sound
  1. End of inspiration and beginning of expiration
  2. Caused by rubbing of inflamed pleural surfaces against lung tissue.

  1. Interventions:
    • Chest x-ray
    • Anti-inflammatory medications

To listen to examples of these breath sounds check out the link below:

The RALE repository

For more information about breath sounds and respiratory treatments, see Mechanical Ventilation for Nurses, Pulmonary Interventions, or Pulmonary Emergencies.

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