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Unit 13 (Tommy) > 13.1 Respiratory signs & symptoms > Flashcards

13.1 Respiratory signs & symptoms Flashcards

1
Q

What are common respiratory symptoms?

A
  1. Breathlessness
  2. Cough
  3. Sputum (production)
  4. Haemoptysis (coughing up of blood from the respiratory tract)
  5. Chest pain
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2
Q

What are some questions to ask when someone is experiencing breathlessness?

A
  • 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

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3
Q

What are good scoring tools to use when a patient is breathless?

A
  1. MRC Dyspnoea scale
    • INCREASE in score = WORSE
    • This scale is used the most
  2. ECOG/WHO score
    • INCREASE in score = WORSE
    • Links more to function
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4
Q

What are some questions to ask if someone has a cough?

A
  1. Is the cough acute/chronic
  2. Is it wet/dry
  3. What time of day/variability (e.g. different in asthma
    • Is there a first cough (e.g. wake up & stand up)
  4. Is there a relation to speaking/eating/environment/occupation/travel
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5
Q

What are goodd scoring tools to use when someone has a cough?

A
  1. VAS scores
  2. LCQ (Leicester cough questionnaire)
    • Grades when cough occurs
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6
Q

What could be an exacerbating factor of a cough?

A

ACE inhibitors (end in -pril) = these cause cough

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7
Q

Explain how you’d check the following sputum samples

A
  • 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
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8
Q

What are some questions to ask when someone has haemoptysis?

A
  1. Is there blood
    • Duration, frequency, amount
    • Is massive if lose >250ml in 24 hours
  2. If blood streaked sputum
  3. Blood coughed/vomited
  4. Sputum PURULENCE (increase pus formation = green = infection)
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9
Q

What are the common causes of haemoptysis?

A
  • Pulmonary hypertension
  • Severe mitral stenosis
  • Decompensated congestive left heart failure
  • Pulmonary embolism
  • Cancer
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10
Q

How to access someone with chest pain?

A

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)

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11
Q

What are the life threatening causes of chest pain & what are less threatening causes?

A
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12
Q

Preparation for respiratory exam steps

A
  1. Bed at 45 degree angle
  2. Expose patient’s chest
    • DO NOT remove bra (offer blanket)
  3. Expose legs
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13
Q

What is some respiratory equipment that a patient may have or things that could make respiration worse?

A
  • 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
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14
Q

What is clubbing and what test to do to confirm diagnosis?

A

Clubbing = soft tissue swelling at terminal phalynx of digit

TEST = diamond-shaped window NOT formed = CLUBBING

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15
Q

What are the causes of clubbing?

A
  • 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
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16
Q

What could be the cause of a fine tremor in a respiratory exam?

A
  • Beta-2-agonist
    • e.g. salbutamol
17
Q

What is asterixis and what are the causes of it?

A
  • Is the flapping tremor when arms are out and fingers facing up (30secs)
  • CAUSES = CO2 retention due to COPD, uraemia, hepatic encephalopathy
18
Q

What is a good and bad respiratory rate (& causes)?

A
  • GOOD
    • 12-20bpm
  • BAD
    • <12bpm (BRADYPNOEA)
      • Causes = opiate overdose
    • >20bpm (TACHYPNOEA)
      • Causes = acute asthma
19
Q

Explain some scars that you might see on a respiratory exam

A
  • Midline sternotomy
    • Cardiac valve replacement
    • Coronary artery bypass grafts (CABG)
  • Pacemaker
    • Infraclavicular scar
      • For pacemaker insertion
  • 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
20
Q

What are some radiotherapy-associated skin changes due to?

A
  • Lung cancer
  • Xerosis (dry skin)
  • Hyperkeratosis (thickened skin)
  • Depigmentation & telangiectasia (widened venules cause threadlike red lines or patterns on the skin)
21
Q

What are these chest deformities known as?

A

LEFT = pectus carinatum

RIGHT = pectus excavatum

22
Q

What is the chest’s appearance on hyperexpansion?

A

Chest wall appears WIDER and TALLER than normal

23
Q

What is the cricosternal distance & why would it increase?

A
  • 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
24
Q

How much should the chest wall expand during inspiration and how can you access this?

A

The chest wall should expand roughly 2cm

25
Q

What conditions could be indicated when measuring chest expansion in a respiratory examination?

A
  • SYMMETRICAL
    • Parenchymal lung disease (restrictive disease)
  • ASYMMETRICAL
    • ​Pneumothorax
    • Pneumonia
    • Plural effusion
26
Q

Which areas would you percuss in a respiratory examination?

A
  1. Subclavian region
  2. Infraclavicular region
  3. Chest wall
  4. Axilla
27
Q

What things do you look for during percussing a patient in a respiratory examination

A
  • DULLNESS (increase vibration in vocal resonance)
    • Means INCREASE tissue density
      • Meaning collapse or consolidation
  • 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

28
Q

What is tactile vocal fremitus?

A
  • Is palpation of the chest wall to detect changes in intensity of vibrations
  • Vocal resonance is prefered to tactile vocal fremitus
29
Q

Give 7 breathe sounds and what they can indicate

A
  1. VESICULAR
    • NORMAL quality breath sounds
  2. BRONCHIAL
    • HARSH-sounding
    • Equal INSPIRATION & EXPIRATION, with a pause between
  3. QUIET BREATH SOUNDS
    • ​​DECREASED air entry
    • Could mean pneumothorax
  4. WHEEZE
    • ​​Whistling sound continuous by TURBULENT FLOW
    • Could mean obstructive airway disease
  5. STRIDOR
    • ​​INCREASE pitch inspiration
    • LARGE airway obstruction
  6. COARSE CRACKLES
    • ​​DIScontinuous popping lung sounds
    • Pneumonis
    • Pulmonary oedema
  7. FINE-END INSPIRATORY CRACKLES
    • ​​Sounds like VELCRO
    • Pulmonary fibrosis
30
Q

What lymph nodes would you check in a respiratory examination?

A
  1. Submental/submandibular
  2. Pre-auricular/post-auricular
  3. Cervical chains
  4. Supraclavicular
  5. Axillary
31
Q

What are the causes of peripheral oedema?

A
  • Right sided heart failure
  • Left sided heart failure
  • Immobility
  • Hyperalbuminaemia
32
Q

What is the difference between chronic bronchitis and emphysema (symptoms and complications)?

A

Unit 13 (Tommy) (15 decks)

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