Term Definition
Signs Vs Symptoms Signs: Subjective, Patient description, Measured by the patient’s perception (anything the patient says they are experiencing) Symptoms: Objective, Measurable, Assessed Values (tachycardia, bradycardia)
Assessing Symptoms is important in order to determine the…. 1.) Seriousness of problem, 2.) potential underlying causes of problem 3.) effectiveness of the treatment
Primary symptoms of Cardiopulmonary disorders are: – Cough – Sputum production – Hemoptysis – shortness of breath – chest pain
Hemoptysis Coughing up blood
Dyspnea Difficulty breathing
A cough is a protective reflex by the stimulation of receptors in the: -pharynx -larynx -bronchi -lung and visceral pleura.
Coughing is caused by these types of stimulation: 1.) Mechanical (obstructive, airway tension) 2.) Inflammatory (chemical allergy) 3.) Thermal stimulation of receptors
Inflammatory Stimulation is due to: – Infection – lung abscess – drug reaction – allergy – edema – hyperemia – collagen vascular disease – radiotherapy – pneumoconiosis – tuberculosis
Mechanical Stimulation is due to: -inhaled dust -suction catheter -presence of food
Obstructive Stimulation of coughing is due to: -foreign bodies -aspirations of nasal secretions -tumors or granulomas within or around lung -aortic aneurysm
Airway Wall Tension Stimulation of coughing is due to: -pulmonary edema -atelectasis – fibrosis – chronic interstitial pneumonitis
Chemical Stimulation of coughing is due to: Inhaled irritants: gas, fumes, smoke, etc
Temperature Stimulation of coughing is due to: hot or cold air
Stimulation of coughing due to ear: tactile pressure in ear canal or otitis media (middle ear infection)
Pulmonary edema looks like…. and should be treated with…. pink frothy secretions… diuretics
Atalactisis collapsed alveoli You may hear popping or cracking when the alveoli begin to fill again.
Fibrosis overuse causing shearing damage Shearing damage caused by bending back and forth, eventually forming weak points that break and is replaced with scar tissue.
Afferent Pathway of a cough vagus -> phrenic -> glossopharyngeal -> trigeminal nerves
Efferent Pathway of a cough Phrenic and Spinal nerve
Phases of Coughing Inspiratory, Compression, Expiratory
Reduced effectiveness of coughing is due to: weak inspiration and expiration muscles, malfunction of glottis opening and closing, altered airways, decrease of lung recoil, abnormal quantity/quality of mucus production
Acute Vs Chronic Coughing Acute: has a sudden onset, severe, short course, self limiting like a viral infection. Chronic: is persistant, last longer than 3 weeks, may be caused by post nasal drip, COPD, Allergic rhinitis, GERD, Chronic Bronchitis and left heart failure.
Paroxysmal periodic prolonged forceful episodes of coughing.
Associated symptoms of coughing Wheezing, Stridor, Chest Pain and Dyspnea
Complications of coughing may cause torn chest muscles, rib fractures, a distruption of surgical wounds, pneumothorax, syncope, arrhythmia, esophageal rupture and urinary incontinence
Sputum production vs. Phlegm Sputum: Secretions from tracheobronchial tree, pharynx, mouth, sinuses and nose. Phlegm: Secretions from lungs and tracheobronchial tree.
Components of Sputum -Mucus -Cellular Debris -Microorganisms -Blood -Pus -Foreign Particles Normal production: 100mL/ day
Abnormal Sputum Production Excessive Production Should pay close attention to: color, quantity, consistency, odor, time of day, and presence of blood
Causes of Hemoptysis -Bronchopulmonary, Cardiovascular, Hematologic, or Systemic Disorders – Fungal infections – Tuberculosis
Look at Table 3.3 for Presumptive Sputum Analysis Appearances Possible causes clear normal Black smoke/ dust inhalation Brownish cig. smoker Frothy white or pink Aspiration
Hemoptysis Vs. Hematemesis Hemoptysis= cough up blood Hematemesis= vomit blood
view table 3-4 for distinguishing hemoptysis and hematemesis history associated symptoms blood pH mixed with froth color
SOB- Short or Breath distressing symptom of respiratory disease, limiting ability to function
Dyspnea subjective experience of breathing discomfort: perception of the sensation: breathless, short winded, or feeling like they are sufficating
Scoring system of Dyspnea Scale 0 (No SOB) – 10 (max SOB) modified by: Borg Scale
Causes, Types and clinical presentation of Dyspnea -WOB abnormally high for given level of exertion -Ventilatory capacity is reduced -Drive to breath is elevated
Look at Table 3-7 and 3-8 for types of dyspnea and causes
Clinical types of dyspnea Cardiac and Circulatory, Psychogenic, Hyperventilation, Acute/Recurrent, or Chronic
Cardiac/ circulatory Types of Dyspnea Inadequate supply of oxygen to tissues; Primarily during exercise
Psychogenic types of Dyspnea Panic Disorders, not related to exertion
Hyperventilation Exceeding body’s metablolic need; Results in hypocapnia and decreased cerebral blood flow.
Acute or Recurrent Dyspnea In Children: asthma, bronchiolitis, Croup, epiglottitis In Adults: asthma, pulmonary embolism, pneumonia, pulmonary edema,hyperventilation and panic disorders
Chronic Dyspnea Most common in COPD or CHF
Paroxysmal Nocturnal Dyspnea (PND) sudden dyspnea when sleeping in recumbent position, associated with coughing, sign of left heart failure
Orthopnea dyspnea when lying down associated with left heart failure
Trepopnea dyspnea when lying on one side, unilateral lung disease, pleural effusion
Platypnea dyspnea in upright position
Orthodeoxia hypoxemia in upright position, releived by returning to a recumbent position
Platypnea and orthodeoxia are seen in patients with right to left intracardia shunts or venoarterial shunts just so you know!
Causes of chest pain cardia ischemia, inflammatory disorders, musculoskeletal disorders, trauma, anxiety, referred pain from indegestion, dissecting aortic aneurysm
Cardinal Symptoms of heart disease angina (pain)
Pleuritic pain -inspiratory, sharp and abrupt in onset -worsens with inspiration, cough, sneeze, hiccup, or laughter – increases with pressure and movement
Chest wall pain -intercostal and pectoral muscles -well localized
Dizziness and Fainting (syncope) -temporary loss of consciousness (from reduced cerebral blood flow and oxygen)
Causes of Syncope (dizziness and fainting) 1) Thrombosis- embolism, atherosclerotic obstruction 2.) Pulmonary- embolism, bouts of coughing, hypoxia, hypocapnia
Vasovagal -loss of peripheral venous tone -most common cause of syncope
Orthostatic Hypotension -sudden drop in BP when standing -dizziness, blurred vision and weakness -elderly, vasodilator use, dehydration
Carotid Sinus Syncope hypersenstive carotid sinuses, slow pulse rate, and decreased BP
Tussive Syncope caused by strong coughing, mainly in men with COPD obesity, smokers, and frequent users of alcohol
Edema soft tissue swelling from abnormal accumulation of fluid
Bilateral peripheral edema most often occurs in ankles and lower legs, due to left or right heart failure
Cor Pulmonale Right heart failure
Euthermia 97-99.5*F temp/ 36-37.5*C
FEVER: Hyperthermia/ Pyrexia sustained, remittent, intermittent, relapsing
Causes of Fever -hot environment -dehydration -reaction to chemicals -drugs -hypothalamic damage -infection -malignancy
personality changes in advance pulmonary disorders forgetfulness, inability to concentrate, anxiety and irritability
cerebral hypoxia and hypercapnia due to lung disease or high altitude causes a headache
SNORING is a serious concern when associated with apnea
When snoring goes bad… causes daytime fatigue, may cause occupational accidents, loss of employment, social dysfunction, and motor vehicle accidents
GERD- Gastroesophageal Reflux -Heartburn and regurgitation -Extraesophageal manifestations such as: laryngitis, asthma, chronic and nocturnal dry cough, chest pain, and dental erosion -Occurs more than twice a week
Risk factors of GERD obesity, smokers, and pregnancy
Question Answer
what is indicated by central and peripheral cyanosis ALWAYS ABNORMAL.
define the thoracic deformities that are characterized by abnormal anterior protrusion of the sternun barrel chest and is associated with emphysema.
abnormalties practitioner should be on the lookout for during inspection of the extremities
define stridor loud, high-pitched sound, sometimes can be heard without a stethescope
what the presence of a stridor indicates the upper airway is compromised. in children, laryngomalacia is the most common cause of chronic stridor
central cyanosis indicates decreased oxygen in the entire pool of blood. always a sign of hypoxemia; central respiratory failure
peripheral cyanosis cyanosis in the digits. poor blood flow. when capillary blood flow is poor, tissues extract more O2 lowering the venous O2 content and raising the amount of reduced Hb. usually cool to touch
cyanosis becomes visible when the amount of unsaturated Hb in the capillary blood exceeds 5-6 g/dl. reduction in either arterial or venous oxygen content or both
cyanosis respiratory disease reduces arterial oxygen content. a bluish dicoloration of the tissues.
central cyanosis bluish discoloration around the lips and in the oral mucosa of the mouth
lymphadenopathy enlarged lymph nodes. infections, malignancy, sarcoidosis.
pectus carinatum abnormal protrussion of the sternum
pectus excavatum depression of part or the entire sternum, which can produce a restrictive lung defect.
kyphosis spinal deforminty in which the spine has an abnormal AP curvature
scoliosis spinal deformity in which the spine has a lateral curvature
kyphoscoliosis combination of kyphosis and scoliosis, which may produce a severe restrictive lung defect as a result of poor lung expansion
barrel chest when the anteroposterior(AP) diameter increase, the normal 45-degree angle of the articulation between the ribs and spone is increased, becoming more horizontal. very classic obstructive lung disease.
stridor is associated with external/inspiratory pressure in airway decreases/ obstruction to the neck
wheezing is associated with expiratory obstruction to the airway
define the characteristics of plueritic chest pain usually located laterally or posteriorly. worsens with deep breath. sharp, stabbing type pain. membranes around the lung. lines inner chest wall
examples of plueritic chest pain inflamed lung, pneumonia, pulmonary embolism
define the characteristics of nonpleuritic chest pain located in the center of the anterior chest and may radiate to the shoulder or back.it is NOT affected by breathing. dull ache or pressure type pain.
common causes of nonpleuritic chest pain angina, coronoary artery occlusion, gastroesophageal reflux, esophageal spasm, chest wall pain, gallbladder diseas
list which elements during medical history-taking, would be considered pertinent when reviewing the resp system family history, cough, history of present illness, frequency are duration on symptom, sputum, hemoptysis, chest pain, shortness of breath, hoarseness, dizziness, fever, peripheral edema,
identify the proper position related to the structure that should be observed on examination of a normal patient’s neck, and the cause of deviation sseen during inspection and palpation nof the neck. trach & JVP; trach is middle of the neck.
describe what is indicated by activity of the accessory muscles of ventilation at rest
give the term used for AP and lateral curvature of the spine barrel chest & scoliosis
You notice during inspiration your patient’s chest wall moves “out” while the abdomen tends to be drawn “in”. Which term would you use in charting this observation and give a cause
What is the term used to describe difficult breathing in the reclining position? orthopnea
In patients with chronic resp disease, what does pedal edema indicate?
While observing a patient’s breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which term would you use in charting this observations? Cheyne-Stokes respiration
What are the common abnormalties indentified during inspection of the fave in patients with resp disease? nose flaring (acidosis & hypoxemia) cyanosis, pursed lip breathing
What is the name of the upper portion of the sternum that articulated with the first and second ribs and the clavicle? manibruim
What is the name of the external landmark that identifies the point where the trachea branches into two main-stem bronchi? at the angle of Louis or Stemalangle
The use of pursed lip breathing during exhalation would be most common among patients with what conditions? COPD, emphysema
What term is used to describe coughing up bloody sputum? hemoptysis
High-pitched, loud, tubular breath sounds with an expiratory component equal to the inspiratory component best describes which breath sounds? bronchial breath sounds
Soft, muffled sound heard mainly during inspiration over the peripheral lung parenchyma best describes what breath sounds? vesicular breath sounds
What term best describes a loud, high-pitched continous sound heard(often with the unaided ear) primarily over the larynx or trachea during inhalation in patients with upper airway obstruction? stridor
What is the deformity characterized by an abnormal depression of part of all of the sternum? pectus excavatum
A diabetic patient admitted to the emergency room is breathing quickly and deeply. Which term would you use in charting this observation?? Kussmaul breathing
Inspiratory crackles in patients without excess secretions are most commonly associated with? when collapsed airways pop open during inspiration

 

Question Answer
Where does the trachea shift when there is an affected lung (collapsed lung, like atelectasis) Towards
Where does the trachea shift when there is increased air (pleural effusion) Away
What is subcutaneous Emphysema AKA crepitus. Air leaks from lung into subcutaneous layer of tissue. (feels like rice krispies) eventually have facial or upper extremity swelling
What is brown sputum old blood
What is yellow sputum infection
What is green sputum old, retained secretions
What is green/foul smelling pseudonomas/other anaerobic organism
Capillary refill If sluggish or abnormal, indicates that vasoconstriction is marked enough to reduce circulation (perfusion) to vital organs
What does the patient assesment include Observation,palpation, percussion -ausculation – temp – RR – Pulse -BP
Tempature is controlled by what hypothalamus (in brain)
Hypothermia decreased oxygen consumption decreased CO2 production
Bradycardia maybe caused by lack of oxygen (hypothermia)
sighing respiration normal RR and depth with periodic deep, audible breaths
intermittent breathing irregular breathing wtih periods of apnea
What is the normal for pulse pressure 30-40
What is the rationale or reason to do auscultation -to assess patient for adequate ventilation -determine which areas of lung are abnormal -identify abnormal sounds -assess effectiveness of therapy -assess adverse reactions to therapy and changes in patient condition.
Which ones transmits sound better? Air or fluid? Fluid except in pleural space Ex. emphysema has lots of air so breath sounds are reduced
Pectus carinatum sternal protusion (pigeon breast) sticks out
Pectus excavatum depression of part or all of sternum (sucks in)
kyphosis abnomal A-P spinal curvature (hunch back)
scoliosis abnormal lateral curvature (S)
Tactile Fremitus (cat purring) (99) What are factors that increase this Solid tissue (pneumonia or tumor)
Tactile Fremitus What are factors that decrease this obesity, pneumothorax, fluid muscular, and emphysema
Thoracic Expansion How far? and what inceases it 3-5 cm normal bilaterally in COPD decreases with nueromuscular diseases
Question Answer
Damage to the lungs results in difficulty blowing air out, causing SOB? COPD
A form of COPD, usually caused by smoking. The fragile walls between the lung air sacs (alveoli) are damaged, trapping air in the lungs; making breathing difficult? Emphysema
Repeated, frequent episodes of productive cough, usually caused by smoking. Breathing also becomes difficult in this form of COPD? Chronic Bronchitis
Infection in one or both lungs. Bacteria, especially streptococcus pneumoniae, are the most common cause? Pneumonia
The lungs airways (bronchi), become inflamed and can spasm, causing SOB and wheezing. Allergies, viral infections, or air pollution cause _ symptoms? Asthma
An infection of the lungs large airways (bronchi), usually caused by a virus. Cough is the main symptom? Acute Bronchitis
A form of interstitial lung disease. The interstitium (walls between air sacs), making lungs stiff and causing SOB? Pulmonary Fibrosis
Tiny areas of inflammation can affect all organs in the body, with the lungs involved most of the time? The symptoms are usually mild, and usually found in xrays? Sarcoidosis
Extra weight makes it difficult to expand the chest when breathing. Obesity Hypoventilation Syndrome
Fluid builds up in the normally tiny space between the lung and inside of chest wall (pleural space). If large can cause breathing problems? Pleural Effusion
Inflammation of the lining of the lung pleura, which often causes pain when breathing in. Autoimmune conditions, infections, or pulmonary embolism may cause? Pleurisy
The airways (bronchi) become inflamed, and expand abnormally, usually after repeated infections. Coughing, with large amounts of mucus? Bronchiectasis
A rare condition, which cysts form throughout the lungs, causing breathing problems, similar to emphysema. Occurs in women of childbearing age. LAM
A genetic condition, in which mucus does not clear easily from the airways. The excess mucus causes repeated episodes of bronchitis & pneumonia throughout life? Cystic Fibrosis
A slowly progressive pneumonia caused by the bacteria mycobacterium tuberculosis. Chronic cough, fever, weight loss, and night sweats are common symptoms? TB
Severe sudden injury to the lungs caused by serious illness. Life support with mechanical ventilation is usually needed to survive until the lungs recover? ARDS