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74 Cards in this Set
- Front
- Back
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Symptoms
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Clinical findings associated with breathing difficulty that the patient "feels"
-subjective -based on patients perception -Ex. SOB, chest pain |
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Sign
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Clinical findings discovered by the examiner
-objective -can be measured by the examiner -Ex. Vital signs, Pulse Ox |
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6 Primary Symptoms of Resp. Disease
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1. Excessive Nasal Secretions
2. Cough 3. Sputum Production 4. Hemoptysis 5. Dyspnea 6. Chest Pain |
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Rhinorrhea
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Runny Rose
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Post Nasal Drip
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Cilia in nasopharynx sweeps mucus back toward oropharynx (mouth)
When too high: -Swallowed -Expectorated -Aspirated into the lungs |
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Causes of Increased Nasal secretions/mucosal swelling (inflammation)
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Irritants:
Smoke Chemicals Allergens: Pollen Animal Dander Infection: Upper Resp. Infection Sinusitis |
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Clinical Manifestations of post nasal drip
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Runny Nose
Post Nasal Drip: Frequent throat clearing Coughing Lower Resp. Tract Infection -Brochitis -Pnemonia Asthma Trigger |
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Mucosa
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continuous as it goes down the airway. if part of it gets infected, the infection can effect other areas
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Cough
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Most common symptom of Pulm. Disease
However, a cough is associated with so much it cannot be used to diagnose the patient Defense Mechanism of Resp. System Maintain airway by eliminating materials deposited on mucosa of resp. tract -accumulated secretions -foreign body |
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Cough Nerves
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-Vagus
-Phrenic -Glossopharyngeal -Trigeminal Sent by afferent impulses to distinct cough center area of medulla |
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Medulla impulses
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send efferent impluses to
-Larynx -Tracheobroncial Tree -Diaphragm -Abdominal Muscles |
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Ab Muscles
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Used for coughing and forced exhalation
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3 Phases of Cough
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1. Insp. Phase - Rapid, deep insp.
2. Compression Phase - Glottis closes while ab muscles contract to increase intrathoracic pressure 3. Exp. Phase - sudden glottic opening with explosive outflow of air and secretions |
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5 Steps of a Cough
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1. Deep Insp. of atleast 15mL/kg predicted body weight
2. Closure of Glottis - allows air to distribute distal to secretions 3. Contraction of exp. muscles (abs and internal intercostal mucles) -increases in intrapleural pressure -increases in intra-alv. pressure 4. Sudden opening of the glottis 5. Explosive outflow of air at high velocity expelling secretions and/or foreign material -shakes loose vibrations of --vocal cords --mucosal lining of airway |
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5 Patient Requirements for Effective Cough
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1. Ability to inhale deeply evidenced by a VC of atleast 15 mL/kg predicted BW
2. Ability to close the glottis 3. Ability to strongly contract the Exp. Muscles 4. Ability to generate and maintain high velocity exp. flow 5. Secretions that have normal volume and consistency |
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Things that inhibit ability to inhale deeply
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Paralysis/neuromuscular weakness
-cervical neck fx, GBS, MG Restrictive Lung Disease -Kyphoscolosis Pain -Abd/thoracic surgery or trauma |
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Things that inhibit ability to close the glottis
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Vocal cord paralysis
Artificial airway in place -Trach tube (btw 2nd and 3rd trach rings) -ET tube |
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Things that inhibit ability to contract exp. muscles
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Paralysis
Neuromuscular Disease Pain ex. Women who have had C-sections |
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Things that inhibit the ability to generate and maintain high velocity exp. flow
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Patients with conditions of increased airway resistance
-asthma -moderate to severe COPD |
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Things that make secretions abnormal
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Patient breathing gas for long periods of time
Cystic Fibrosis Chronic Brochitis Brochiectasis |
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Beneficial Cough
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Protects Airway
Clears Secretions Clears Foreign bodies |
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Harmful Cough
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Spread infection
Rib Fx (osteoporosis can be caused by systemic steroids) Cough Syncope (faint) (Increase in Intrapleural pressure due to coughing) Pneumothorax (severe COPD) Protracted Cough (cont. cough when you try to stop) |
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Effective Cough
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Strong enough to clear airway
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Inadequate Cough
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Too weak to mobilize secretions
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Productive Cough
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Mucus/material is expelled
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Non-productive
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No secretions are produced
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Sputum
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The substance expelled from the airway by a cough or clearing the throat
Contains materials from: Trach. Tree Pharynx Mouth Sinuses Nose |
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Normal Trach. Tree Sputum secretions
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100mL
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Expectoration
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The act of coughing of and spitting out sputum
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Sputum Production
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Color
Consistency Quantity Time of day Odor |
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Color
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Normal: Clear to White
Changes in color of sputum reveal: Infection Trauma Disease Response to treatment (lighter color tha what it was) |
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Yellow Color
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Infected sputum
-Contains large amts of WBC -Acute Pnemonia, Chronis Bronchitis, Broncheitasis |
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Green Color
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Stagnant/Pooled secretions from infection
-WBC make green color -Pnemonia, Brochietasis, Lung Abscess, Sinus infection |
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Rusty Color
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Presence of old blood
Pneumococcal pnemonia (very dangerous cld kill any one of any age) |
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Pink Color
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Presence of RBC's in frothy secretions
Pulmonary Edema from Congestive Hear Failure (left vent fails and blood is backing up into lungs) |
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Abscess
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pocket of infection
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Mucoid
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Thin, clear and somewhat viscid
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Purulent
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Thick, viscid, colored with a pus-like appearance from the presence of large amounts of WBC's in infected sputum
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Mucopurulent
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A heterogeneous mix of elements of both mucoid and purulent (bronchietasis)
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Frothy
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A bubbly or foamy appearance (air mixed in)
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Tenacious
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Extremely sticky, strongly adheres to walls of the airway (cystic fibrosis)
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Quantify Subjectively
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Small
Moderate Large Copious (more than one paper towel) |
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Quantify Objectively
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5mL = size of teaspoons
15mL = size od tablespoons Graduated markings on a sputum container |
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Time of Day
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Maybe consistent thru out the day or night
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Odor
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Ranges From:
No Odor Foul smelling odor Sweet smelling odor May be characteristics of: Site of origin in lung (abscess -foul smelling) Type of organism (Pseudomonas - sweet) |
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Hemoptysis
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Expectoration of sputum containing blood (streak to "frank" bleeding) that originated in the resp. tract below the level of the pharynx
Frank = bright (means the blood is recent) Can be life threatening Can indicate a more-serious underlying lung disease (lung cancer) Can cause and obstruction of the airway (blood clot) |
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Massive Hemoptysis
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Expectoration of > 600mL blood within 24 hrs
Expectoration of > 400mL blood in 3 hrs |
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Three common causes of Hemoptysis
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Lung Infection-destroy lung tissue
-Tuberculosis -Lung Abcess -Bronchiectasis -Fungal Infection Bronchogenic carcinoma (cancer that originates in the airway walls) -50% display hemoptysis -Second most-frequent cause Cardiovascular Disease -10% patients diagnosed with Pulm. Embolism producing ischemia & necrosis |
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Bloody Cough
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Hemoptysis
Bloody sputum that originated in the resp. tract below the pharynx Requires careful questioning -coughing -pain or dyspnea -bright red? -Mixed with sputum? |
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Bloody vomit
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Hematemesis
Blood vomited from the GI tract Requires careful questioning: -Vomiting -Nausea +/- stomach pain -Blood that looks like coffee grounds -Mixed with food |
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Hemoptysis - Pt. Management
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Focus should be on preventing airway obstruction from blood or blood clot
Identify source of bleeding -GI vs Resp. -Patient History -Bronchoscopy Maintain pt airway -Emergency intubation equipment -Suction equipment -Manual Resuscitator Bed rest, close observation, mild sedation If unilateral pulm. source - position with that side down to isolate the bad side. |
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Dyspnea
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A subjective experience of breathing discomfort
Patient might not be experiencing SOB even tho it looks like they are SOB May often be the first symptom of disease |
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Cheif Complaint
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initial symptom
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Dyspnea Clinical
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Associate with a level of activity that causes discomfort
-running -walking -daily actvities (bathing) -Rest (significant) Dyspnea scoring systems |
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Visual Analog Scale
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Not Breathless---------Extremely Breathless
Patient marks line Line is measured, reported as ie. 6/10 |
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Modified Borg Scale
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0 to 10 grading system
Descriptive terms for perceived intensity Nothing..........................................Maximal Sensation |
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UCSD SOB Questionaire
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Patients rate their SOB over a wide variety of activities of daily living from 0-5
24 items Score is summed Range is 0 to 120 Lower score-less dyspnea |
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Paroxysmal Nocturnal Dyspnea
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PND
sudden SOB experienced while patient is asleep and in a recumbent position pt is awakened by coughing and SOB 1-2 hrs after lying down typical in CHF pt caused by acute pulm. edema as fluid from lower extremities gradually moves into lungs Relieived by patient sitting in upright position Dyspnea associated with time of day |
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Orthopnea
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Dyspnea experienced when lying down flat
pt will elevate their upper body with pillows in order to get relief to sleep two or three pillow orthopnea associated with left sided CHF dyspnea associated body position |
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Platypnea
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Dyspnea caused by an upright position
relieved by assuming a recumbent position associated with right to left intracardiac shunt Dyspnea associated with body position |
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Psychogenic Dyspnea
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Pt that complain of SOB despite no organic reason. abnormal awareness of normal breathing
-panic disorders |
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How does Dyspnea increase WOB
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Increased demand for Vent
Altered Pulm. Mechanics Abnormal funtion of Resp. Muscles |
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Increased demand for an increased MV
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PCR stimulation
CCR stimulation phsiological |
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Altered Pulm Mechanics
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Increased Airway Resistance
Decreased Lung Compliance |
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Abnormal Function of Resp. Muscles
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Muscle weakness
Muscle Paralysis Muscle wasting Reduced mechanical advantage -ab. high (pregnancy) -ab. low (Severe COPD) |
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Chest Pain
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All Chest pain mus be taken seriously
May range from insignificant to serious condition The thorax of the organ within it may be the site of the orgin of pain Well localized Soreness increases with direct pressure or arm movement |
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Where should you start when you are questioning about chest pain
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start on the outside and work in
1. skin 2. muscles 3. nerves 4. ribs and cartilage etc |
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Where is the most common site for chest wall pain?
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Chest wall pain
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Pleuritic Pain
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Parietal Pleura is well supplied with pain fibers
Lung parenchyma and viceral pleura contain no pain fibers |
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Most common type of pleuritic pain?
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Pleurisy
inflammation of the parietal pleura |
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Chracteristics of Pleuritic pain
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Sharp stabbing, or catching pain during breathing, usually inspiration
Pain increases with Inspiration Cough Sneeze Hiccup Laugh Usually localized to one side of the chest only partially relieved by splinting and pain meds |
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Pleural Effusion
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extra fluid between viceral and parietal pleural
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Cardiac Chest Pain Characteristics
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Dull, crushing, substernal pain
Aching, squeezing, vise-like pressure Pain may radiate to neck jaw arm Worsen with activity Pain may diminish with rest Pt. must be seen by a physician |
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Most common causes of Cardiac chest pain
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Ischemia which cause angina (pain symptom)
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