CH.3 Cardiopulmonary Symptoms Flashcards
Symptoms
–subjective
–patient description
–Measured by patient perception
–example: paint, shortness of breath, cough
Signs
–objective
–measurable
–assessed values
–example: heart rate, blood pressure, respiratory rate
Assess symptoms to determine
–seriousness of problem
–potential underlying cause of problem
–effectiveness of treatment
Primary symptoms of cardiopulmonary disorders
–cough
–sputum production
–hemoptysis
–shortness of breath (dyspnea)
–chest pain
Cough
–one of the most common symptoms seen in patients with pulmonary disease
–Protective reflex
–Stimulation of receptors: pharynx, larynx, trachea, large bronchi, lung, and visceral pleura
–Cause by: inflammatory, mechanical, chemical, or thermal stimulation of cough receptor
–Key to determine etiology is careful history, physical examination and CXR
Possible cause of Cough: Inflammatory
–infection, lung abscess, drug reaction, allergy, edema, hyperemia, collagen, vascular disease
Possible causes of Cough: Mechanical
–Inhaled dusts, suction, catheter, food
Possible causes of Cough: Obstructive
–foreign bodies, aspirations of nasal secretions, tumor or granulomas within or around the lungs, aortic aneurysm
Possible cause of Cough: Airway wall tension
–pulmonary edema, atelectasis, fibrosis, chronic interstitial pneumonitis
Possible causes of Cough: Chemical
–inhaled irritant gases
–fumes
–smoke
Possible cause of Cough: Temperature
–inhales hot or cold air
Possible causes of Cough: Ear
–tactile pressure in the ear canal
Cough: Afferent pathway
–vagus, phrenic, glossopharyngeal, and trigeminal
Cough: Efferent Pathway
–smooth muscles of larynx and tracheobronchial tree via phrenic, spinal nerves
Cough: Phases
–Inspiratory
–Compression
–Expiratory
Reduced effectiveness of cough
–weakness of inspiratory or expiratory muscles
–inability of the glottis to open or close correctly
–obstruction, collapsibility, or alteration in shape or contours of the airway
–decrease in lung recoil (emphysema)
–abnormal quantity or quality of mucus production (thick sputum)
Acute disease
–sudden onset
–severe, short course
–self-limiting: viral infection
Chronic disease
–persistent
–last more than 3 weeks
-Causes
–Postnasal drip: most common
–Asthma
–COPD exacerbation
–Allergic Rhinitis
–GERD
–Chronic bronchitis
–Bronchiectasis
–Left Heart Failure: CHF, pulmonary edema
Paroxysmal disease
–periodic
–prolonged, forceful episodes
Associated symptoms of cough
–wheezing
–stridor
–chest pain
–dyspnea
Complications of Cough
–torn chest muscle
–rib fracture
–disruption of surgical wounds
–Pneumothorax or Pneumomediastinum
–syncope
–arrhythmia
–esophageal rupture
–urinary incontinence
Sputum Production
–secretions from tracheobronchial tree, pharynx, mouth, sinuses, nose
–upper airways
Phlegm
–secretions from lungs and tracheibronchial tree
Components
–mucus, cellular debris, microorganisms, blood, pus, foreign particles
Normal sputum 100 mL/day
–upward displacement via wavelike motion of cilia until swallowed
Abnormal Sputum Production: Bronchorrhea
–more that 100 mL per day
-Excessive production by inflamed glands
–caused by: infection, cigarette smoking, allergies
–Describe: color, quantity, consistency, odor, time of day, presence of blood
Hemoptysis
–Expectoration of sputum containing blood: from streaking to frank bleeding
-Causes:
–Bronchopulmonary
–Cardiovascular
–Hematologic
–Systemic Disorders
–Tuberculosis or fungal infections
Appearance of Sputum: clear, colorless
–normal
Appearance of Sputum: Black
–smoke
–coal dust inhalation
Appearance of Sputum: Brownish
–cigarette smoker
Appearance of Sputum: Frothy white or pink
–pulmonary edema
–CHF
Appearance of Sputum: Blood-streaked or hemoptysis
–tuberculosis
–chronic bronchitis
–abscess
Hemoptysis
-Amount:
–Massive hemoptysis: 400 mL/3 h or 600 mL/ 24 h
–emergency condition
–cancer, tuberculosis, bronchiectasis, trauma
–Streak: pulmonary infection, lung cancer, and thromboemboli
-Odor
–Color
–Acuteness
Hematemesis
–vomited blood
-determine source
–Oropharynx: swallowed from respiratory tract
–Esophagus or Stomach: alcoholism or cirrhosis of liver
Shortness of Breath (SOB)
–Most distressing symptom of respiratory disease
–single most important factor limiting ability to function
–cardinal symptoms
Dyspnea
–subjective experience of breathing discomfort
-Components:
–sensory input to cerebral cortex
–Perceptions of the sensation: breathless, short-winded, and feeling of suffaction
Dyspnea Scoring Systems
–Scale of 0 (no SOB) to 10 (max SOB)
–Visual analog scales (kids)
–Modified Borg scale
–ATS SOB scale
–UCSD SOB questionnaire
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
cardiac and circulatory
–inadequate supply of oxygen to tissues
–primarily during exercise
Psychogenic
–panic disorder
–not related to exertion
Hyperventilation
–rate, depth exceeds body’s metabolic need
–results in hypocapnia and decreases cerebral blood flow
Acute Dyspnea: children
–asthma
–bronchiolitis
–croup
–epiglottitis
Acute Dyspnea: Adult
–pulmonary embolism
–asthma
–pneumonia
–pneumothorax
–pulmonary edema
–hyperventilation
–panic disorder
Chronic Dyspnea
–COPD
–CHF
