Respiratory distress | Respiratory system diseases | NCLEX-RN | Khan Academy


Voiceover:Respiratory distress is one of those things where if you had it, nobody has to tell you that
you’re short of breath. But I think it’s important
to recognize when somebody else is in respiratory distress. First, let’s just draw
our generic patient. Let’s call him Bob and
let’s give him some hair. I feel like giving hair
to my stick figures masks the fact that I can’t draw (laughs). Okay, so Bob here has
respiratory distress. Let’s draw the rest of his body. Here we’re gonna talk about
acute respiratory distress. In other words, it happened
pretty recently in terms of days not like Bob has had lung
disease for years and years. That will look like a different picture. If somebody has respiratory distress, we’re going to talk about
the things you can see to tell you and things you can hear. Those are the only two senses
that are really important. I don’t think you can touch
or taste respiratory distress. In terms of things you can see. First of all, you never
really see a person lying down saying, “I’m short of breath.” The first thing that somebody would do if they’re short of breath is to sit up. That’s why in the hospital
if somebody has lung disease you rarely see them lying
down all the way in bed. Now, of course, there
are many different kinds of lung disease, but the fact that they like to sit up has a few common reasons. First there’s our muscle
called the diaphragm. In normal breathing this
curved muscle moves down, which expands the chest
cavity and that’s how air goes in through your mouth and your nose. Just by simple rule of
gravity we have to move something down and it’s easier
to do that when sitting up. Just so you don’t have to
fight the push of gravity down on your chest where you’re trying to move your diaphragm toward your feet. Another reason, the reason
you are short of breath is because a fluid, if we
think about how fluid behaves then when it’s flat, again,
gravity makes it distribute all over the place and your whole
lungs are bathed in the fluid. If you sit up the fluid
kind of pulls to the bottom. This frees up the top of the lungs here to breathe a little better, so usually people like to sit up
when they can’t breathe. Next, you might notice that the rate of breathing might go up. In an adult, our normal
rate of breathing is eight to 16 per minute
and this is gonna go up just because when you
can’t move breath as well people tend to compensate
by breathing more. Along with that, the
panic of breathing faster and everything, happens
to trigger the sympathetic nervous system, which is our
fight or flight response. This is what happens to
your body when it’s in an emergency and it’s trying
to either run away or fight. One thing that happens here,
which is kind of not related to our topic is that
sympathetic nervous system allows your pupils to get bigger. This allows more light in and
additionally your blood flows to your arms and your
legs and away from your intestines so you don’t
have to digest for the few minutes that you’re gonna be fighting. In our lungs, though,
sympathetic nervous system can cause bronchial dilation, which
literally just means these airways in our lungs as they
branch off, they get bigger. And just the bigger diameter
allows air to flow better. I didn’t mean to draw his trachea, his windpipe, so deviated here. Imagine that this is straight down and in the middle of the neck. But in fact, actually if you
have respiratory distress because of something
like a pneumal thorax, when one lung has
collapsed, then this trachea would deviate to one side or the other. But we can’t see that by
just looking at the person without an x-ray or some
other form of imaging. Today we’re just talking about
naked eye seeing someone. So rate goes up and then
the next thing there’s a group of signs we call it
increased work of breathing. Which is at the same time really specific, work of breathing, and also
really vague, what is that? Work of breathing usually is pretty quiet. The diaphragm moves down,
the chest expands as you’re doing right now it doesn’t
take too much conscious effort. If someone is short of breath,
other muscles get recruited. Like muscles in the neck,
muscles in the shoulders. You might see them kind
of tensing up their neck and shoulders trying to force
that chest cavity bigger. Additionally, we have these
what’s called retractions, which just means there’s
muscles between our ribs. Our ribs going all the
way up and the muscles between them can work
so hard to compensate for respiratory distress that
you can see the markings. If you take off our patient’s
shirt, you might be able to see the traces of their ribs
both because the muscles are working hard and the decreased
pressure in the lungs because you can’t breathe
well sucks that tissue in. These tracks are called retractions and that’s part of work of breathing. In an infant, you might
see something called nasal flaring, where
their nostrils get bigger. If you try it right now you can sort of consciously increase the
size of your nostrils and that just, again, let’s more air in. That’s more seen in little babies. Another thing you might
see is called cyanosis. Which it just means that it’s
blue, purplish discoloration. Now, we think of blue blood
as being lacking oxygen and it’s not really blue, but
it’s just a little darker. This in our body can
show up kind of bluish. This actually tends to
happen in mucous membranes because there’s less
skin to cover that color. So in the lips and in the eyes and sometimes in the
extremities just because they’re the furthest away from our heart. So the hands and the feet
sometimes might get blue. Now we’re talking about
acute distress here, but if Bob goes on to have this for years and years, a sign you can see in chronic respiratory distress is called clubbing. Usually we have our hand,
1,2,3 that’s 4 fingers. So you have your hand
and the fingers kind of taper off at the fingertips,
that’s the normal shape. But in clubbing, the tips
of the fingers get big and kind of sausage like
instead of tapering. It’s called clubbing and this is chronic. The theory is that because these tips lack oxygen year in,
year out, they kind of go through this hypertrophuge,
which means more tissues grow to try to gather more oxygen. That’s why clubbing happens. This again, is chronic. So now you can see it today in Bob since he just developed this. Alright, now moving on
to things you can hear. There are a lot of lung
sounds that are associated with having lung disease,
but in terms of respiratory distress one thing that
comes to mind is stridor. Stridor is usually above
the chest cavity so the restriction is not so much down there but up here in the
shoulder and neck level. I don’t know if I can
make a convincing noise for stridor, but it just
sounds like (labored inhale). When this person is taking a breath in there’s that extra noise. It’s like if you put a
straw in your mouth and you try to inhale, this
is an inhalation noise. Next, you might hear some grunting. This is just because there
are so many muscles between the abs, the shoulders, the
neck trying to force air in and out and some of it goes
across our vocal cords. And it just makes a grunt. This is like in the
movies in the martial arts when they’re punching
someone and just using so much muscle force
that this grunt escapes. In general I think of grunting
as kind of an exhaling noise. For example, in emphysema
when air doesn’t get out some patients use their
abs to try to force it out. And the grunting happens when they exhale. Usually an adult should be
able to say, “I can’t breathe.” They might not say
respiratory distress, but they will definitely say, “I
can’t catch my breath.” But in the event that
they can’t tell you that or if it’s a baby or a
child, it’s important to keep these signs in mind. The things you can see and you can hear when somebody’s in respiratory distress.

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