Term Definition
SYMPTOM Evidence of disease or physical disturbance that indicates the presence of bodily disorder.
SYMPTOMS DETERMINE -Seriousness of problem -Potential cause of problem -Effectiveness of treatment
CHARACTERISTICS OF SYMPTOMS -Objective -Measureable -Assessed values EX. HR, BP, and Respiratory Rate
SIGNS Subjective experiences reported to the physician from the patient. Ex. Fatigue
SIGNS DETERMINE -Outcome of current bodily state -Past existence of disease or condition -Recognition and Identification of Disease
CHARACTERISTICS OF SIGNS -Subjective -Patient Description -Measured by patient perception Ex. Pain, shortness of breath, cough
CARDIOPULMONARY DISEASE A medical condition in which the heart and lungs don’t function properly.
PRIMARY SYMPTOMS OF CARDIOPULMONARY DISORDERS -Cough -Sputum production -Hemoptysis -Shortness of breath (Dyspnea) -Chest pain
COUGH -Protective reflex -Stimulation of receptors, -Pharnyx, larynx, trachea, large bronchi, lung and visceral pleura
COUGH -Caused by inflammatory, mechanical, chemical, or thermal stimulation of cough receptors
COUGH Key to determine etiology is careful history, physical exam, and CXR
POSSIBLE CAUSES OF COUGH RECEPTOR STIMULATION INFLAMMATORY -infection -lung abscess -drug reaction -allergy -edema -hyperemia -collagen vascular disease -radiotherapy -pneumoconiosis -tuberculosis
POSSIBLE CAUSES OF COUGH RECEPTOR STIMULATION OBSTRUCTIVE -Foreign bodies -aspirations of nasal secretions -tumor or granulomas within or around the lung -aortic aneurysm
POSSIBLE CAUSES OF COUGH RECEPTOR STIMULATION AIRWAY WALL TENSION -pulmonary edema -atelectasis -fibrosis -chronic interstitial pneumonitis
POSSIBLE CAUSES OF COUGH RECEPTOR STIMULATION EAR -tactile pressure in the ear canal (Arnold Nerve Response) -Otitis media
COUGH AFFERENT PATHWAY -vagus, phrenic, glossopharyngeal, trigeminal nerves
COUGH EFFERENT PATHWAY -smooth muscles of larynx and tracheobronchial tree via phrenic, spinal nerves
COUGH PHASES -inspiratory -compression -expiratory
REDUCED EFFECTIVENESS OF COUGH -weakness of inspiratory or expiratory muscles -inability of the glottis to open or close correctly
REDUCED EFFECTIVENESS OF COUGH -obstruction, collapsibility, or alteration in shape or contours of the airways -decrease in lung recoil (ex. Emphysema)
REDUCED EFFECTIVENESS OF COUGH -abnormal quantity or quality of mucus production (Ex. thick sputum)
ACUTE -sudden onset -severe, short cause -self-limiting -viral infection
CHRONIC -persistent -last >3 weeks
CAUSES OF CHRONIC COUGH -postnasal drip -allergic rhinitis -asthma -GERD -COPD exacerbation -chronic bronchitis -bronchiectasis -left heart failure
PAROXYSMAL -periodic -prolonged, forceful episodes
ASSOCIATED SYMPTOMS OF COUGH -wheezing -stridor -chest pain -dyspnea
COMPLICATIONS OF COUGH -torn chest muscle -Rib fractures -Disruption of surgical wounds
COMPLICATIONS OF COUGH -pneumothorax of pneumomediastinum -syncope -arrhythmia
COMPLICATIONS OF COUGH -esophageal rupture -urinary incontinence
SPUTUM Secretions from tracheobronchial tree, pharynx, mouth, sinuses, nose
PHLEGM Secretions from lungs and tracheobronchial tree
SPUTUM PRODUCTION COMPONENTS -mucus, cellular debris, microorganisms, blood, pus, foreign particles
NORMAL SPUTUM -upward displacement via wavelike motion of cilia until swallowed
ABNORMAL SPUTUM PRODUCTION -excessive production by inflamed glands caused by; infection, cigarette smoking, allergies -Describe color, quantity, consistency, time of day, presence of blood
HEMOPTYSIS -Expectoration of sputum containing blood -from streaking to frank bleeding
HEMOPTYSIS CAUSES -Bronchopulmonary -Systemic disorders -Cardiovascular -Turberculosis -Hematologic -fungal infections
DESCRIPTION OF HEMOPTYSIS -Amount -massive hemoptysis: 400 ml/3h or 600 ml/24h
DESCRIPTION OF HEMOPTYSIS -odor -color -acuteness
HEMATEMESIS Vomitted blood
DETERMINE SOURCE -oropharynx -swallowed from respiratory tract -esophagus or stomach -alcoholism or cirrhosis of liver
SHORTNESS OF BREATH -Most distressing symptom of respiratory disease -single most important factor limiting ability to function -cardinal symptom of cardiac disease
DYSPNEA -Subjective experience of breathing discomfort -components -sensory input to cerebral cortex -perception of the sensation; breathless, short-winded, feeling of suffocation
DYSPNEA SCORING SYSTEMS -Scale of 0(no SOB to 10(max SOB) -visual analog scales -modified Borg scales -ATS SOB scale -UCSD SOB Questionnaire
CLINICAL TYPES OF DYSPNEA: CARDIAC AND CIRCULATING -Inadequate supply of oxygen to tissues -Primarily during exercise
CLINICAL TYPES OF DYSPNEA: PSYCHOGENIC -panic disorder -not related to exertion
CLINICAL TYPES OF DYSPNEA: HYPERVENTILATION -Rate, depth exceeds body’s metabolic need -Results in hypocapnia and decreased cerebral blood flow
ACUTE AND RECURRENT: CHILDREN -Asthma -Bronchiolitis -Croup -Epiglottitis
ACUTE AND RECURRENT: ADULTS -pulmonary embolism -pulmonary edema -Asthma -hyperventilation -Pneumonia -panic disorder -Pneumothorax
CHRONIC DYSPNEA -Most common causes: -COPD -CHF
PAROXYSMAL NOCTURNAL DYSPNEA (PND) -Sudden dyspnea when sleeping in recumbent position -Associated with coughing -Sign of left heart failure
ORTHOPNEA -Dyspna 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 relieved by returning to a recumbent position
CHEST PAIN -Causes -cardiac ischemia -inflammatory disorders of thorax, abdomen -musculoskeletal disorders, trauma, anxiety -referred pain from indigestion, dissecting aortic aneurysm
CARDINAL SYMPTOMS OF HEART DISEASE -Angina -quickly assess if pain is an emergency condition
PULMONARY CAUSES OF CHEST PAIN -Involvement of chest wall or parietal pleura -Pleuritic pain -Inspiratory, sharp, and abrupt in onset
PULMONARY CAUSES OF CHEST PAIN -Worsens w/ inspiration, cough, sneeze, hiccup, or laughter -increase w/ pressure and movement
CHEST WALL PAIN -Intercostal and pectoral muscles -well localized
DIZZINESS AND FAINTING (SYNCOPE) -Temporary loss of consciousness -resulting from reduced cerebral blood flow and oxygen
DIZZINESS AND FAINTINR (SYNCOPE) CAUSES -Thrombosis, embolism, atherosclerotic obstruction -Pulmonary: embolism, bouts of coughing,hypoxia, hypocapnia
VASOVAGAL -Most common type of syncope -loss of peripheral venous tone
ORTHOSTATIC HYPOTENSION -Sudden drop in blood pressure when a person stands up. -Dizziness,blurred vision, weakness, syncope -Elderly, vasodilator use, dehydration
CAROTID SINUS SYNCOPE -Hypersensitive carotid sinus -slows pulse rate, decrease blood pressure, syncope
TUSSIVE SYNCOPE -Syncope caused by strong coughing -seen most often in men with COPD, obesity, a positive smoking history, and frequently use of alcohol
DEPENDENT EDEMA -Edema is soft tissue swelling from abnormal accumulation of fluid
BILATERAL PERIPHERAL EDEMA -Most often occurs in ankles and lower legs -Most often caused by right or left heart failure -right heart failure often caused by cor pulmonale
EUTHERMIA -97 TO 99.5 degrees Fahrenheit
FEVER (HYPERTHERMIA PYREXIA) -sustained -remittent -intermittent -relapsing
CAUSES OF FEVER -Hot Environment -Dehydration -Reaction to chemicals -Drugs -Hypothalamic damage -Infection -Malignancy
PULMONARY INFECTIONS Lung abscess, empyema, tuberculosis, pneumonia -Remittent fever in mycoplasma, pneumonia, Legionnaires disease, acute viral infections
INFECTIONS WITH NO FEVER -High-dose corticosteroids -Immunosuppressants -Immunocompromised (Leukemia, AIDS)
HEADACHE A Manifestation of cerebral hypoxia and hypercapnia -Lung disease altitude
ALTERED MENTAL STATUS IN HYPERCAPNIA -From affected alertness to coma
PERSONALITY CHANGES IN ADVANCED PULMONARY DISORDERS -Forgetfulness, inability to concentrate, anxiety irritability
SNORING -Serious concern when associated with apnea -evaluation for OSA
INCIDENCE AND CAUSES OF SNORING -10% to 12% of children -10% to 30% of adults -Peak at age 50 to 59 (male), 60 to 64 (female)
INCIDENCE AND CAUSES OF SNORING -Obesity is one the most common -Fatigue -Excessive daytime sleepiness (daytime somnolence)
GASTROESOPHAGEAL REFLUX (GERD) -Heart burn and regurgitation -Extraesophageal manifestations -Laryngitis, asthma, chronic and nocturnal dry cough, chest pain, dental erosion -GER more than twice a week = GERD
Risk Factors -Obesity -Cigarette smoking -Pregnancy