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27 Cards in this Set

  • Front
  • Back

clinical manifestations and assessment of respiratory disease

A and P by Rogier


Wilkens assessment in respiratory care

Wilkins clinical assessment in RC

Chapter 2 and 3 plus questions

Egans chapter 15

REviewing the medical record

Admitting Dx

CC(chief complaints)

Med Hx


Tx Regimen

SOAP subjective, objective, assessment, plan


Subjective information

:what patient or family tells you


:What you see, hear, feel (tactile)

:observe, measure


:What you understand and think regarding input

:derived from the S + O


:What course of action based on input

:what is the treatment regimen


Eupnea, normal breathing

Dyspnea, shortness of breath

Orthopnea, difficulty breathing lying down

Platypnea, difficulty breathing sitting up

Tachypnea, increased rate of breath, over 20

Bradypnea, decrease rate of breath, less than 10


Pain, position, potty, personal belongings

Patient interview

Review H and P, history and physical before you interview

:if available

Don't Interrupt: Don't be interrupted


:door, curtain closed

Listen to what they say

Look professional


Don't appear rushed

Make eye contact

:use cultural awareness

Introduce yourself, purpose of visit

:use Mr. or Mrs. (Ms.)

::unless directed otherwise

Ensure Modesty

Patient Interview

Don't rearrange room without permission

Respect confidentiality

Be honest regarding Tx, etc

Do not volunteer info patient is not yet aware

Listen to pt questions, concerns

Educate but don't argue

Use different question types to have effective interview




Cardiopulmonary Symptoms

Dyspnea (subjective)

:sensation of breathing discomfort by ;patient (subjective feeling)

Most important symptom RT is called upon to assess and treat


:sensation of unpleasant urge to breathe

:Can be triggered by acute hypercapnia, acidosis and hypoxemia

Dyspnea scoring systems

Scale of 0 (no SOB) to 10 (max SOB)

Visual analog scale

Modified Borg scale

ATS (american thoracic society ) SOB scale

UCSD SOB questionnaire

Cardiopulmonary symptoms

10 is severe

8 is moderately severe

5 is moderate

2 is slight

0 is no shortness of breath, no dyspnea

Cardiopulmonary symptoms


:subjective experience

::should not be inferred from observing patients breathing pattern


:Sensory input to cerebral cortex

:Perception of the sensation

::"breathless, shortwinded, feeling of suffucation"

Cardiopulmonary symtoms


:dyspnea in reclining position, associated with CHF


:dyspnea in upright position associated with arteriovenous malformation

Degree of dyspnea is evaluated by asking about level of exertion at which it occurs

American thoracic society of shortness of breath scale

0 to 4

0 is none except with exercise

1 is slight trouble when hurring on the level

2 is moderate and walks more slowly than others

3 severe breathlessness after 100 years

4 too breathless to leave the house

Causes, types and clinical presentation of dyspnea

WOB abnormally high for the given level of exertion

:asthma and pneumonia

Ventilatory capacity is reduced

:neuromuscular disease

Drive to breath is elevated

:hypoxemia, acidosis, exercise

Wilkens chart 3-7

Clinical types of dyspnea, know them all

Clinical types of dyspnea

Cardiac and circulatory

:inadequate supply of oxygen to tissues

:primarily during exercise


:panic disorder

:not related to exertion


:rate, depth exceeds bodies metabolic need

:leads to hypocapnia and can lead to decreased cerebral blood flow


Patient will have increased AP diameter and will pursed lip breath because of dynamic airway collpase and air trapping. He uses accessory muscles of respiration and is tympanic or hyper tympanic to percussion. He also has profound hypoxemia

Typmanic means drum like sound, versus normal

Table 3-8

Causes of dyspnea by body system

Acute and Chronic Dyspnea

Acute or Recurrent


::Asthma, Bronchiolitis, Croup, epiglottis


::Pulmonary embolism




::Pulmonary edema



Acute and Chronic dyspnea


:most common causes



:Acute on Chronic dyspnea (Dx)

::This would be someone with COPD or CHF that gets pneumonia or pulmonary edema, or has a panic attack

Description of Dyspnea

Paroxysmal Nocturnal dyspnea

:Sudden dyspnea when sleeping in the recumbent position

:Associated with coughing

:Sign of left heart failure, or CHF, or pulmonary edema


:Dyspnea when lying down

:Associated with left heart failure or CHF

what causes cor pulmonale

O2 is a vaso dialator in the lung and a vaso constrictor in the systemic system

CO2 is opposite, its a vasoconstrictor in the lung and a vasodialator in the systemtic system

O2 and CO2

Description of dyspnea


:Dyspnea when lying on one side

:Unilateral lung disease, pleural effusion


:difficulty breathing when upright


:Hypoxemia in upright position, relieved by returning to a recumbent position, can be caused by postural hypotension

Platypnea and orthodeoxia

:Patients with right to left intracardiac shunts or venoarterial shunts

Table 3-9

Terms commonly used to describe breathing

Cardiopulmonary symptoms

Language of dyspnea

Ask patient about quality and characteristics of dyspnea

:Patients w/ asthma frequently complain of chest tightness

:Patients with Iinterstitial lung disese may complain of increased WOB, shallow breathing and gasping

:Patients with CHF may complain of feeling suffocated

Cardiopulmonary symptoms

Assessing dyspnea during and interview

:pay attention to whether patient can speak in full sentences

:Questions should be brief and limited to quality and intensity of dyspnea and circumstances of symptom onset

:Assessment should correspond with gross examination of patients breathing pattern

Cardiopulmonary symptoms

Psychogenic dyspnea: panic disorders and hyperventilation

:patients have normal cardiopulmonary function with intense dyspnea and suffocation

:May coincide with symptoms, such as chest pain, anxiety, palpitation and paresthesia (tingling)

:anxiety often accompanied by breathlessness and hyperventilation