13.1 Respiratory signs & symptoms Flashcards
What are common respiratory symptoms?
- Breathlessness
- Cough
- Sputum (production)
- Haemoptysis (coughing up of blood from the respiratory tract)
- Chest pain
What are some questions to ask when someone is experiencing breathlessness?
- Does it affect lungs, heart, brain, muscles
- Is it acute/chronic (onset & severity)
- Is it continuous/episodic
Is hard to find disease severity using breathlessness
What are good scoring tools to use when a patient is breathless?
-
MRC Dyspnoea scale
- INCREASE in score = WORSE
- This scale is used the most
-
ECOG/WHO score
- INCREASE in score = WORSE
- Links more to function
What are some questions to ask if someone has a cough?
- Is the cough acute/chronic
- Is it wet/dry
- What time of day/variability (e.g. different in asthma
- Is there a first cough (e.g. wake up & stand up)
- Is there a relation to speaking/eating/environment/occupation/travel
What are goodd scoring tools to use when someone has a cough?
- VAS scores
-
LCQ (Leicester cough questionnaire)
- Grades when cough occurs
What could be an exacerbating factor of a cough?
ACE inhibitors (end in -pril) = these cause cough
Explain how you’d check the following sputum samples
-
Blood in sputum (red)
- Check for cancer
- Check for any signs of PE (pulmonary embolism)
-
Green
- Could mean poor control of asthma
- Bacterial infection
-
Pseudonomas infection
- Doesn’t respond to antibiotics
What are some questions to ask when someone has haemoptysis?
- Is there blood
- Duration, frequency, amount
- Is massive if lose >250ml in 24 hours
- If blood streaked sputum
- Blood coughed/vomited
- Sputum PURULENCE (increase pus formation = green = infection)
What are the common causes of haemoptysis?
- Pulmonary hypertension
- Severe mitral stenosis
- Decompensated congestive left heart failure
- Pulmonary embolism
- Cancer
How to access someone with chest pain?
Site
Onset
Character (pleuratic = worse when breathing)
Radiation (in back = pancreatitis/aortic dissection)
Alleviating factors (GTN sprays, sitting forward = pericarditis)
Timing
Exacerbating factors (exercise/effort = cardiac), (arm movement/pressing on chest = musculoskeletal)
Severity (1-10)
What are the life threatening causes of chest pain & what are less threatening causes?
Preparation for respiratory exam steps
- Bed at 45 degree angle
- Expose patient’s chest
- DO NOT remove bra (offer blanket)
- Expose legs
What is some respiratory equipment that a patient may have or things that could make respiration worse?
-
Oxygen delivery mask
- Note what type of mask
-
Sputum pot
- Note volume & colour
- Mobility aids
-
Fluid balance
- Check overload/dehydrated
- ECG leads
- Inhalers
- Nebulisers
- Catheters
- Cannulas
- Medication
- Vital signs
- CIGARETTES/VAPING EQUIPMENT
What is clubbing and what test to do to confirm diagnosis?
Clubbing = soft tissue swelling at terminal phalynx of digit
TEST = diamond-shaped window NOT formed = CLUBBING
What are the causes of clubbing?
- Lung cancer
-
Interstitial lung disease
- Large group of diseases that cause scarring (fibrosis) of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream
- Cystic fibrosis
-
Bronchiectasis
- Long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection
What could be the cause of a fine tremor in a respiratory exam?
- Beta-2-agonist
- e.g. salbutamol
What is asterixis and what are the causes of it?
- Is the flapping tremor when arms are out and fingers facing up (30secs)
- CAUSES = CO2 retention due to COPD, uraemia, hepatic encephalopathy
What is a good and bad respiratory rate (& causes)?
-
GOOD
- 12-20bpm
-
BAD
- <12bpm (BRADYPNOEA)
- Causes = opiate overdose
- >20bpm (TACHYPNOEA)
- Causes = acute asthma
- <12bpm (BRADYPNOEA)
Explain some scars that you might see on a respiratory exam
-
Midline sternotomy
- Cardiac valve replacement
- Coronary artery bypass grafts (CABG)
-
Pacemaker
- Infraclavicular scar
- For pacemaker insertion
- Infraclavicular scar
- Anterolateral thoracotomy
-
Posterolateral thoracotomy
- Lobectomy (remove of lobe of organ)
- Pneumotomy (surgical procedure of making an incision into a lung)
- Oesophageal surgery
-
Axillary thorocotomy
- Through 4th/5th intercostal space
- For chest drains
- Through 4th/5th intercostal space
What are some radiotherapy-associated skin changes due to?
- Lung cancer
- Xerosis (dry skin)
- Hyperkeratosis (thickened skin)
- Depigmentation & telangiectasia (widened venules cause threadlike red lines or patterns on the skin)
What are these chest deformities known as?
LEFT = pectus carinatum
RIGHT = pectus excavatum
What is the chest’s appearance on hyperexpansion?
Chest wall appears WIDER and TALLER than normal
What is the cricosternal distance & why would it increase?
- It is the distance between the cricoid cartilage & the sternum
- Do this by palpation of the trachea (say to patient that will be uncomfortable)
- Cricosternal distance may INCREASE due to tension pneumothorax or large pleural effusion
- Causes trachea to DEVIATE towards LOBAR COLLAPSE
How much should the chest wall expand during inspiration and how can you access this?
The chest wall should expand roughly 2cm
What conditions could be indicated when measuring chest expansion in a respiratory examination?
-
SYMMETRICAL
- Parenchymal lung disease (restrictive disease)
-
ASYMMETRICAL
- Pneumothorax
- Pneumonia
- Plural effusion
Which areas would you percuss in a respiratory examination?
- Subclavian region
- Infraclavicular region
- Chest wall
- Axilla
What things do you look for during percussing a patient in a respiratory examination
-
DULLNESS (increase vibration in vocal resonance)
- Means INCREASE tissue density
- Meaning collapse or consolidation
- Means INCREASE tissue density
-
STONY DULLNESS (decrease vibration in vocal resonance - as fluid/air in lung)
- Could mean pleural effusion
- HYPER-RESONANCE
Vocal resonance = the intensity of tone when speak
What is tactile vocal fremitus?
- Is palpation of the chest wall to detect changes in intensity of vibrations
- Vocal resonance is prefered to tactile vocal fremitus
Give 7 breathe sounds and what they can indicate
-
VESICULAR
- NORMAL quality breath sounds
-
BRONCHIAL
- HARSH-sounding
- Equal INSPIRATION & EXPIRATION, with a pause between
-
QUIET BREATH SOUNDS
- DECREASED air entry
- Could mean pneumothorax
-
WHEEZE
- Whistling sound continuous by TURBULENT FLOW
- Could mean obstructive airway disease
-
STRIDOR
- INCREASE pitch inspiration
- LARGE airway obstruction
-
COARSE CRACKLES
- DIScontinuous popping lung sounds
- Pneumonis
- Pulmonary oedema
-
FINE-END INSPIRATORY CRACKLES
- Sounds like VELCRO
- Pulmonary fibrosis
What lymph nodes would you check in a respiratory examination?
- Submental/submandibular
- Pre-auricular/post-auricular
- Cervical chains
- Supraclavicular
- Axillary
What are the causes of peripheral oedema?
- Right sided heart failure
- Left sided heart failure
- Immobility
- Hyperalbuminaemia
What is the difference between chronic bronchitis and emphysema (symptoms and complications)?
