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89 Cards in this Set
- Front
- Back
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Sputum: bacterial infection |
yellow, green, rust (blood mixed with yellow sputum), clear, or transparent; purulent; blood streaked; sticky
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Sputum: viral infection |
blood-streaked (not common) |
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Sputum: chronic infectious disease |
yellow, green, rust (blood mixed with yellow sputum), clear, or transparent; purulent; blood streaked; sticky; blood streaked particularly abundant in the early morning; slight intermittent blood streaking with occasionally large amounts of blood |
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sputum: cancer |
slight, persistent, intermittent blood streaked
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sputum: infarction |
blood clotted, large amounts of blood
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sputum: TB |
occasional large amounts of blood
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dyspnea
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difficult and labored breathing with shortness of breath
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orthopnea
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SOB that begins or increases when the patient lies down; ask whether the patient needs to sleep on more than one pillow and whether that helps.
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paroxysmal nocturnal dyspnea
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a sudden onset of SOB after a period of sleep; sitting upright is helpful
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platypnea
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dyspnea increases in the upright posture
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Rate and depth of breathing INCREASE with:
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acidosis (metabolic), CNS lesions (pons), anxiety, asa poisoning, oxygen need (hypoxemia), and pain
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Rate and depth of breathing DECREASE with:
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alkalosis (metabolic), CNS lesions (cerebrum), myasthenia gravis, narcotic OD, obesity (extreme)
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normal resp. pattern
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regular and comfortable at rate of 12-20 bpm
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bradypnea
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slower than 12 bpm
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tachypnea
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faster than 20 bpm
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hyperventilation (hyperpnea)
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faster than 20 bpm, deep breathing
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sighing
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frequently interspersed deeper breath
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air trapping
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increasing difficulty in getting breath out
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cheyne-stokes
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varying periods of increasing depth interspersed with apnea
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kussmaul
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rapid, deep, labored
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biot
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irregularly interspersed periods of apnea in a disorganized sequence of breath
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ataxic
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significant disorganization with irregular and varying depths of respiration
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primary apnea
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a self-limited condition, and not uncommon after a blow to the head. It is especially noted immediately after the birth of a newborn, who will breathe spontaneously when sufficient carbon dioxide accumulates in the circulation.
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secondary apnea
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breathing stops and will not begin spontaneously unless resuscitative measures are immediately insutituted. Any event that severely limits the absorption of oxygen into the bloodstream will lead to secondary apnea.
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reflex apnea
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when irritating and nausea-provoking vapors or gases are inhaled, there can be an involuntary, temporary halt to respiration.
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sleep apnea
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characterized by periods of an absence of breathing and oxygenation during sleep. With obstruction, airflow is not maintained through the nose and mouth.
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apneustic breathing
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characterized by a long inspiration and what amounts to expiration apnea. The neural center for control is in the pons. When it is affected, breathing can become gasping because inspirations are prolonged and expiration constrained.
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periodic apnea of the newborn
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a normal condition characterized by an irregular pattern of rapid breathing interspersed with brief periods of apnea that one usually associates with REM sleep.
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upper airway is obstructed when there is:
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* inspiratory stridor (with an I/E ratio of more than 2:1) * a hoarse cough or cry * flaring of the alae nasi * retraction at the suprasternal notch |
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Upper airway severely obstructed when:
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* stridor is inspiratory and expiratory * cough is barking * retractions also involve the subcostal and intercostal spaces * cyanosis is obvious even with supplemental oxygen |
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airway obstruction is above glottis when:
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* stridor tends to be quieter * the voice is muffled * swallowing is more difficult * cough is not a factor * the head and neck may be awkwardly positioned to preserve the airway (e.g. extended with retropharyngeal abscess; head to the affected side with peritonsillar abscess). |
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airway obstruction is below glottis when:
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* stridor tends to be louder, more rasping * the voice is hoarse * swallowing is not affected * cough is harsh, barking * positioning of the head is not a factor |
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pleural effusion
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dullness to percussion and tactile fremitus are most useful findings for pleural effusion. Dullness to chest percussion makes the probability of a pleural effusion more likely. Absence of reduced tactile vocal fremitus makes pleural effusion less likely.
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resonant percussion tone
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Intensity: loud Pitch: low Duration: long Quality: hollow |
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flat percussion tone
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Intensity: soft Pitch: high Duration: short Quality: very dull |
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dull percussion tone
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Intensity: medium Pitch: medium to high Duration: medium Quality: dull thud |
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tympanic percussion tone
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Intensity: loud Pitch: high Duration: medium Quality: drumlike |
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hyperresonant percussion tone
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Intensity: very loud Pitch: very low Duration: longer Quality: booming abnormal sound - result of air trapping (e.g. in obstructive lung disease) |
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sweet, fruity breath
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diabetic ketoacidosis; starvation ketosis
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fishy, stale breath
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uremia (trimethylamines)
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ammonia-like breath
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uremia (ammonia)
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musty fish, clover breath
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fetor hepaticus; hepatic failure, portal vein thrombosis, portavacal shunts
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foul, feculent breath
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intestinal obstruction
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foul, putrid breath
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nasal/sinus pathology; infection, foreign body, cancer; respiratory infections; empyema, lung abscess, bronchiectasis
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halitosis
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tonsillitis, gingivitis, respiratory infections, Vincent angina, GERD
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cinnamon breath
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pulmonary tuberculosis
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vesicular breath sounds
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normal heard over most of lung fields; low pitch; soft and short expirations; more prominent in a thin person or a child, diminished in the overweight or very muscular patient |
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broncovesicular breath sounds
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normal heard over main bronchus area and over upper right posterior lung field; medium pitch; expiration equals inspiration |
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bronchial/tracheal (tubular)
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normal heard only over trachea; high pitch; loud and long expirations, sometimes a bit longer than inspiration |
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fine crackles
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adventitious breath sound high-pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; not cleared by a cough |
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medium crackles
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adventitious breath sound lower, more moist sound heard during the midstage of inspiration; not cleared by a cough |
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course crackles
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adventitious breath sound loud, bubbly noise heard during inspiration; not cleared by cough |
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rhonchi (sonorous wheeze)
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adventitious breath sound loud, low, coarse sounds like a snore most often heard continuously during inspiration or expiration; coughing may clear sound (usually means mucus accumulation in trachea or large bronchi) |
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wheeze (silibant wheeze)
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adventitious breath sound musical noise sounding like a squeak; most often heard continuously during inspiration or expiration; usually louder during expiration - whistling high-pitched bronchus |
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pleural friction rub
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adventitious breath sound dry, rubbing, or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface |
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asthma findings
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inspection: tachypnea, nasal flairing, intercostal retractions palpation: tachycardia, diminished fremitis percussion: occasional hyperresonance, occasional limited diaphragmatic descent; diaphragmatic level lower auscultation: prolonged expiration, wheezes, diminished lung sounds |
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atelectasis findings
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inspection: delayed and/or diminished chest wall movement (respiratory lag), narrowed intercostal spaces on affected side, tachypnea palpation: diminished fremitus, apical cardiac impulse deviated ipsilaterally, trachea deviated ipsilaterally percussion: dullness over affected lung auscultation: in upper ove, bronchial breathing, egophony, whispered pectoriloquy; in lover lobe, diminished or absent breath sounds; wheezes, rhonchi, and crackles in varying amounts depending on extent of collapse |
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bronchiectasis findings
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inspection: tachypnea, respiratory distress, hyperinflation, clubbing (esp. cystic fibrosis) palpation: few, if any, consistent findings percussion: no unusual findings if there are no accompanying pulmonary disorders auscultation: a variety of crackles, usually coarse, and rhonchi, sometimes disappearing after cough |
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bronchitis findings
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inspection: occasional tachypnea, occasional shallow breathing, often no deviation from expected findings palpation: tactile fremitus undiminished percussion: resonance auscultation: breath sounds may be prolonged. occasional crackles, expiratory wheezes and rhonchi |
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COPD findings
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inspection: respiratory distress, audible wheezing, cyanosis, distention of neck veins, peripheral edema (in presence of right-sided heart failure), clubbing (rarely) palpation: somewhat limited mobility of diaphragm, somewhat diminished vocal fremitus percussion: occasional hyperresonance auscultation: postpertussive rhonchi (sonorous wheezes) and silibant wheezing; inspirational crackles (best heard with stethoscope held over open mouth); breath sounds somewhat diminished |
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emphysema findings
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inspection: tachypnea, deep breathing, pursed lips, barrel chest, thin - underweight palpation: apical impulse may not be felt, liver edge displaced downward, diminished fremitus percussion: hyperresonance; limited descent of diaphragm on inspiration; upper boarder of liver dullness pushed downward auscultation: diminished breath and voice sounds with occasional prolonged expiration; diminished audibility of heart sounds; only occasional adventitious sounds |
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pleural effusion and/or thickening findings
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inspection: diminished and delayed respiratory movement (lag) on affected side palpation: cardiac apical impulse shifted contralaterally; trachea shifted contralaterally; diminished fremitus; tachycardia percussion: dullness to flatness; hyperresonant note in area superior to effusion auscultation: diminished to absent breath sounds; bronchophony, whispered pectoriloquy; egophony and/or crackles in area superior to effusion; occasional friction rub |
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pneumonia consolidation findings
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inspection: tachypnea; shallow breathing; flaring of alae nasi; occasional cyanosis; limited movement at times on involved side; splinting palpation: increased fremitus in presence of consolidation; decreased fremitus in presence of a concomitant empyema or pleural effusion; tachypnea percussion: dullness if consolidation is great auscultation: a variety of crackles with lobar and occasional rhonchi; bronchial breath sounds; egophony, bronchophony, whispered pectoriloquy |
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pneumothorax findings
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inspection: tachycardia, cyanosis, respiratory distress, bulging intercostal spaces, respiratory lag on affected side, tracheal deviation with tension pneumothorax palpation: diminished to absent fremitus; cardiac apical impulse, trachea, and mediastinum shifted contralaterally; diminished to absent tactile fremitus; tachycardia; subcutaneous crepitance from air leaking percussion: hyperresonance auscultation: diminished to absent breath sounds, succussion splash audible if air and fluid mix, sternal and precordial clicks and crackling (Hamman sign) if air underlies that area; diminished to absent whispered voice sounds |
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Asthma (reactive airway disease)
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small airway obstruction due to inflammation and hyperreactive airways pathophysiology: acute episodes triggered by allergens, anxiety, cold air, exercise, upper respiratory infections, cigarette smoke, or other environmental agents; results in mucosal edema, increased secretions, and bronchoconstriction with increased airway resistance and impeded respiratory flow. subjective data: episodes of paroxysmal dyspnea; chest pain is common and, with it, a feeling of tightness; episodes may last for minutes, hours, or days; may be asymptomatic between episodes. objective data: tachypnea and paroxysmal coughing with wheezing on expiration and inspiration; expiration becomes more prolonged with labored breathing, fatigue, and anxious expression as airway resistance increases; hypoxemia by pulse oximetry; decreased peak expiratory flow rate |
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Atelectasis
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incomplete expansion of the lung at birth or collapse of the lung at any age. patho: collapse caused by compression from outside (e.g. exudates or tumors) or resorption of gas from the alveoli in the presence of airway obstruction; loss of elastic recoil of the lung may be due to thoracic or abdominal surgery, plugging, exudates, or foreign body. subj: frequently seen in the postoperative setting; symptoms of postobstructive pneumonia may develop in the setting of airway obstruction from a foreign body or tumor. obj: auscultation dampened or muted in the involved area because the affected area of the lung is airless; radiograph may show consolidation associated with postobstructive pneumonia |
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Bronchitis
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inflammation of the large airways patho: inflammation of the bronchial tubes leads to increased mucus secretions; acute bronchitis is usually due to an infection, whereas chronic bronchitis is usually due to irritant exposure subj: acute bronchitis may be accompanied by fever and chest pain; in chronic bronchitis, the cough may be productive obj: may have hacking nonproductive cough with minimal auscultation findings with no respiratory distress; greater involvement may lead to wheezing or dampened auscultation in involved areas. |
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Pleurisy
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inflammation process involving the visceral and parietal pleura patho: often the result of pulmonary infection (bacterial or viral) or connective tissue disease (e.g. lupus); sometimes associated with neoplasm or asbestosis subj: usually sudden onset with chest pain when taking a breath (pleuritic); rubbing of the pleural surfaces can be felt by the patient; pain can be referred to the ipsilateral shoulder if the pleural inflammation is close to the diaphragm obj: respirations are rapid and shallow with diminished breath sounds; a pleural friction rub can be auscultated; fever may be present |
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Pleural Effusion
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excessive non-purulent fluid in the pleural space patho: sources of fluid vary and include infection, heart failure, renal insufficiency, connective tissue disease, neoplasm, and trauma. subj: cough with progressive dyspnea is the typical presenting concern; pleuritic chest pain will occur with an inflammatory effusion obj: the findings on auscultation and percussion vary with the amount of fluid present and also with the position of the patient; dullness to percussion and tactile fremitus are the most useful findings for pleural effusion; when the fluid is mobile, it will gravitate to the most dependent position; in the affected areas, the breath sounds are muted and the percussion note is often hyperresonant in the area above perfusion |
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Empyema
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purulent exudative fluid collected in the pleural space patho: non-free-flowing purulent fluid collenction develops most commonly from adjacent infected or traumatized tissues; may be complicated by pneumonia simultaneous pneumothorax, or a bronchopleural fistula subj: often febrile and tachypneic, with cough and chest pain, and patient appears ill; progressive dyspnea develops; cough may produce blood or sputum obj: breath sounds are distant or absent in the affected area; percussion note is dull and vocal fremitus is absent; chest radiograph with pleural opaity that does not flow freely on lateral decubitus views |
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Lung Abscess
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well-defined, circumscribed, inflammatory, and purulent mass that can develop central necrosis patho: aspiration of food or infected material from upper respiratory or dental sources of infection are most common causes; it may elude diagnosis for some time subj: malaise, fever, and sob obj: percussion note is dull and the breath sounds are distant or absent over the affected area; pleural friction rub may be auscultated; cough may produce purulent, foul-smelling sputum. |
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Pneumonia
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inflammatory response of the bronchioles and alveoli to an infective agent (bacterial, fungal, or viral) patho: acute infection of the pulmonary parenchyma may be due to different organisms that may be acquired in the community or hospital setting; concomitant inflammatory exudates lead to lung consolidation subj: rapid onset (hours to days) of cough, pleuritic chest pain, and dyspnea; sputum production is common with bacterial infection; chills, fever, rigors, and nonspecific abdominal symptoms of nausea and vomiting may be present; involvement of the right lower lobe can stimulate the tenth and eleventh thoracic nerves to cause right lower quadrant pain and simulate an abdominal process. obj: febrile, tachypneic, and tachycardic; crackles and rhonchi are common with diminished breath sounds; egophony, bronchophony, and whisper pectoriloquy; dullness to percussion occurs over the area of consolidation; in children particularly, but also in adults, audible crackles are not always seen |
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influenza
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viral infection of the lung. although this is normally an upper respiratory infection, due to alterations in the epithelial barrier, the infected host is more susceptible to secondary bacterial infection patho: entire respiratory tract may be overwhelmed by intestinal inflammation and necrosis extending throughout the bronchiolar and alveolar tissue; when mild, it may seem to be just a cold, however, older adults, the very young, and the chronically ill are particularly susceptible subj: characterized by cough, fever, malaise, headache, coryza, and mild sore throat, typical of the common cold; significant respiratory distress can develop, leading to high morbidity and mortality, especially in the very young, very old, and immunocompromised patients obj: crackles, rhonchi, and tachypnea are common |
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tuberculosis
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chronic infectious disease that most often begins in the lung but may then have widespread manifestations patho: the tubercule bacillus is inhaled from airborne moisture of the coughs and sneezes of infected persons, infecting the recipient's lungs; potential for a postprimary spread locally or throughout the body subj: latent period: asymptomatic, some regional lymph nodes may be involved active infection: fever, cough, weight loss, night sweats; history of travel to region with endemic tb or close contact with infected persons obj: latent disease: no pulmonary findings active disease: consolidation and/or pleural effusion may develop with corresponding findings and cough with blood-streaked sputum; positive tb skin test and interferon-gamma release assays |
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pneumothorax
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presence of air or gas in the pleural cavity patho: may result from trauma or may occur spontaneously, perhaps because of rupture of a congenital or acquired bleb; in tension pneumothorax, air leaks continually into the pleural space, resulting in a potentially life-threatening emergency from increasing pressure in the pleural space subj: minimal collections of air may easily be without symptoms at first, particularly because spontaneous pneumothorax paradoxically has its onset most often when the patient is at rest; larger collections provoke dyspnea and chest pain obj: the breath sounds over the pneumothorax are distant; a mediastinal shift with tracheal deviation away from the involved side can be seen with tension pneumothorax; an unexplained but persistent tachycardia may be a clue to a minimal pneumothorax |
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hemothorax
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presence of blood in the pleural cavity patho: may be the result of trauma or invasive medical procedures (e.g. thoracentesis, central line placement or attempt, pleural biopsy); when air is present with the blood, this is called a hemopneumothorax subj: dyspnea and lightheadedness may develop depending on the degree and acuity of blood loss and decreased pulmonary function obj: breath sounds will be distant or absent if blood predominates; percussion note will be dull; tachycardia and hypoension with excessive blood loss |
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lung cancer
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generally refers to bronchogenic carcinoma, a malignant tumor that evolves from bronchial epithelial structures patho: etiologic agents include tobacco smoke, asbestos, ionizing radiation, and other inhaled carcinogenic agents subj: may cause cough, wheezing, a variety of patterns of emphysema and atelectasis, pneumonitis, and hemoptysis; peripheral tumors without airway obstruction may be asymptomatic obj: faindings are based on the extent of the tumor and the patterns of its invasion and metastasis; with airway obstruction, a postobstructive pneumonia can develop with consolidation; a malignant pleural effusion may develop |
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pulmonary emoblism
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the embolic occlusion of pulmonary arteries is a relatively common condition that is very difficult to diagnose patho: risk factors include, among others, age older than 40 years, a hx of venous thromboembolism, surgery with anesthesia longer than 30 minutes, heart disease, cancer, fracture of the pelvis and leg bones, obesity, and acquired or genetic thrombophilia subj: pleuritic chest pain with or without dyspnea is a major clue to embolism obj: there may be a low-grade fever or an isolated tachycardia; hypoxia by pulse oximetry may be evident |
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diaphragmatic hernia (infants, children, adolescence) |
result of an imperfectly structured diaphragm, occurs in slightly more than 2000 live births patho: on the left side, at least 90%of the time, the liver is not there to get in the way subj: the degree of respiratory distress can be slight or very severe depending on the extent to which the bowel has invaded the chest through the defect obj: bowel sounds are heard in the chest with a flat or scaphoid abdomen; the heart usually displaced to the right; tachypnea, retraction, and grunting |
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cystic fibrosis (infants, children, adolescence) |
autosomal recessive disorder of exocrine glands involving the lungs, pancreas, and sweat glands patho: thick mucus causes progressive clogging of the bronchi and bronchioles; bronchiectasis results with cyst formation and subsequent pulmonary infection; many states now screen for this autosomal recessive caused by mutations of CFTR subj: cough with sputum is a hallmark in children younger than 5 years old; salt loss in sweat is distinctive such that a parent may notice that the child's skin tastes unusually salty; there may be a history of malabsorption, large, bulky stools, constipation, poor weight gain, frequent infection, meconium ileus, or intestinal obstruction obj: bronchiectasis with the associated findings; barrel chest; nasal polyps; low body mass due to malabsorption; pulmonary dysfunction leads to clubbing, pulmonary hypertension, and cor pulmonale |
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epiglottitis (infants, children, adolescence) |
acute, life-threatening infection involving the epiglottis and surrounding tissues patho: acute inflammation of the epiglottis due to bacterial invasion, leading to life-threatening airway obstruction, may cause death; immunization against haemophilus influenza type B has greatly reduced the incidence in the United States; most common in children between 3 and 7 years old subj: begins suddenly and progresses rapidly without cough; painful sore throat with difficulty swallowing; muffled voice obj: child sits straight up with neck extended and head held forward, appearing very anxious and ill, unable to swallow and drools from an open mouth; high fever, beefy red epiglottis |
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croup / laryngotracheal bronchitis (infants, children, adolescence) |
syndrome that generally results from infection with a variety of viral agents, particularly the parainfluenza viruses, occurring most often in children from about 1.5 to 3 years of age patho: the inflammation is subglottic and may involve areas beyond the larynx; an aspirated foreign body may mimic croup on occasion subj: an episode begins with upper respiratory symptoms, mild fever; the child often awakens suddenly after going to bed, often very frightened, with a harsh, barking cough obj: labored breathing, retraction, hoarseness, barking cough, and inspiratory stridor are characteristic; restless, irritable; fever does not always accompany croup - the child does not have the toxic, drooling facies of persons with epiglottitis |
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tracheomalacia (infants, children, adolescence) |
lack of rigidity or a floppiness of the trachea or airway patho: trachea narrows in responses to the varying pressures of inspiration and expiration; tends to be benign and self-limited with increasing age; need to eliminate the possibilities of fixed lesions (e.g. a vascular lesion), tracheal stenosis, or even a foreign body subj: "noisy breathing" or wheezing in infancy is often inspiratory stridor obj: stridor, wheezing, and findings of respiratory distress develop with airway collapse or severe compromise |
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bronchiolitis (infants, children, adolescence) |
bronchiolar (small airway) inflammation leading to hyperinflation of the lungs, occurring most often in infants younger than 6 months patho: usual cause is respiratory syncytial virus (RSV), other viral organisms include adenovirus, parainfluenza virus, and human metapneumovirus; the virus acts as a parasite invading small bronchioles. the virus bursts and invades other cells that die and obstruct and irritate the airway subj: begins with upper respiratory symptoms; poor feeding, vomiting and diarrhea; lethargy; expiration becomes diffacult, and the infant appears anxious obj: breaths are rapid and short with generalized retractions and perioral cyanosis developing; wheezing, grunting, diminished breath sounds; altered mental status; lung hyperinflation leads to an increased AP diameter of the thoracic cage and abdomen; hyperresonant percussion |
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COPD
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nonspecific designation that includes a group of respiratory problems in which coughs, chronic and often excessive sputum production, and dyspnea are prominent features. Ultimately an irreversible expiratory airflow obstruction occurs. Chronic bronchitis, bronchiectasis, and emphysema are the main conditions that are included in this group.
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Emphysema
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condition in which the lungs lose elasticity and alveoli enlarge in a way that disrupts function patho: most patients have an extensive smoking history; chronic bronchitis is a common precursor leading to dilation of the air spaces beyond the terminal bronchioles and rupture of alveolar walls, permanently hyperinflating the lung; alveolar gas is trapped, in expiration, and gas exchange is seriously compromised. subj: dyspnea is common even at rest, requiring supplemental oxygen when severe; cough is infrequent without much production of sputum obj: chest may be barrel-shaped, and scattered crackles or wheezes may be heard; overinflated lungs are hyperresonant on percussion; inspiration is limited with a prolonged expiratory effort (i.e. longer than 4-5 seconds) to expel air |
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bronchiectasis
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chronic dilation of the bronchi or bronchioles caused by repeated pulmonary infections and bronchial obstruction patho: frequently seen in cystic fibrosis; malfunction of bronchial muscle tone and loss of elasticity subj: the cough with expectoration of large amounts of sputum is most often the major clue; severe hemoptysis may occur obj: tachypnea and clubbing; crachles and rhonchi, sometimes disappearing after cough |
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chronic bronchitis
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large airway inflammation, usually a result of chronic irritant exposure; more commonly a problem for patients older than 40 patho: large airways are chronically inflamed, leading to mucus production; smoking is prominent in the history with many of these patients being emphysematous; recurrent bacterial infections are common. subj: dyspnea may be present although not severe; cough and sputum production are impressive obj: wheezing and crackles; hyperinflation with decreased breath sounds and a flattened diaphragm; severe chronic bronchitis may result in right ventricular failure with dependent edema. |
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