Chapter 3: Cardiopulmonary Flashcards
Symptoms
- Subjective
- Patient description
- Measured by patient perception
- Ex. pain, shortness of breath, cough
Signs
- objective
- measurable
- assessed values
- ex. heart rate, blood pressure, respiratory rate
Primary symptoms of cardiopulmonary disorders
- cough
- sputum production
- hemoptysis
- shortness of breath (SOB) (dyspnea)
- chest pain
Cough
- protective reflex
- stimulation of receptors (pharynx, larynx, trachea,a bronchi, lung and visceral pleura)
Acute cough
- sudden onset
- severe, short course
- self limiting (viral infection)
Chronic cough
- persistent
- last > 3 weeks
- causes:
- postnasal drip
- asthma
- COPD exacerbation
- allergic rhinitis
- GERD
- chronic bronchitis
- bronchiectasis
- left heart failure
Paroxysmal
- periodic
- prolonged, forceful episodes (comes and goes)
Associated symptoms of cough
- wheezing
- stridor
- chest pain
- dyspnea
clear, colorless, like egg white
normal sputum
black
smoke or coal dust inhalation
brownish
cigarette smoker
frothy white or pink
pulmonary edema
sand or small stone
aspiration of foreign material, broncholithiasis
purulent
purulent - contains pus
- infection of pneumonia
apple-green, thick
haemophilus influenzae
pink, thin, blood-streaked
streptococci or staphylococci
red current jelly
klebsiella species
rusty
pneumococci
yellow or green copious
pseudomonas species pneumonia, advanced chronic bronchitis, bronchiectases (separates into layers)
foul odor (fetid)
lung abscess, aspiration, anaerobic infections, bronchiectasis
mucoid (white-gray and thick)
emphysema, pulomonary tuberculosis, early chornic bronchitis, neoplasma, asthma
grayish
legionnaires disease
mucopurulent
infection, pneumonia, cystic fibrosis
blood-streaked or hemoptysis (frankly bloody)
bronchogenic carcinoma, tuberculosis, chronic bronchitis, coagulopathy, pulmonary contusion or abscess
silicone-like casts
bronchial asthma
hemoptysis
- coughing up blood
- expectoration of sputum containing blood (streaking to frank bleeding)
causes of hemoptysis
- bronchopulmonary
- cardiovascular
- hematologic
- systemic disorders
- tuberculosis or fungal infections
what to look for in hemoptyis
amount, odor, color, acuteness
hematemesis
- vomited blood
- determine source:
1. oropharynx (swallowed from respiratory tract)
2. esophagus or stomach (alcoholism or cirrhosis of liver)
differences between hemoptysis and hematemesis
hemoptysis: - cardiopulmonary disease - coughed up from lungs/chest dyspnea, pain or tickling sensation in chest - alkaline - sputum - may be present (froth) - bright red color
Hematemesis: - gastrointestinal disease vomited from stomach - nausea, pain referred to stomach - acidic - food - froth absent - dark, clotted, coffee grounds
SOB
shortness of breath
- most distressing symptom of respiratory disease
- single most important factor limiting ability to function
- cardinal symptom of cardiac disease
dyspnea
- subjective experience of breathing discomfort
- components:
- sensory input to cerebral cortex
- perception of the sensation (breathless, short-winded, feeling of suffocation)
causes 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 (hypoxia, acidosis, exercise)
clinical types of dyspnea
- cardiac and circulatory
(inadequate supply of oxygen to tissues, primary during exercise) - psychogenic
(panic disorder, not related to exertion) - hyperventilation
(rate, depth exceeds bodys metabolic need, results in hypocapnia and decreased cerebral blood flow)
dependant edema
- soft tissue swelling from abnormal accumulation of fluid
- bilateral peripheral edema
- most often occurs in ankles and lower legs
- most often caused by right and left heart failure
- right heart failure often caused by cor pulmonale
fever with pulmonary disease
- pulmonary infections
- lung abscess, empyema, tuberculosis, pneumonia
- remittent fever in mycoplasma pneumonia, legionaaires disease, acute viral infections - infections with no fever
- high dose corticosteroids
- immunosuppressants
- immunocomprimised (leukemia, AIDS)
headache is a manifestation of…
cerebral hypoxia and hypercapnia
–> lung disease and high altitute
personality changes in advanced pulmonary disorders
- forgetfulness, inability to concentrate, anxiety, irritability
altered mental status in hypercapania
from affected alertness to coma
sleep deprivation…
COPD, CHF, neuromusular disorders, etc.
snoring and apnea incidence and causes
- 10-12% children
- 10-30% adults
- peak at age 50 to 59 (male), 60-64 (female)
- obesity is one of the most common causes of snoring and sleep apnea
- OSA is a common cause of obesity
complex presentation of CHF
- dilated pupils
- skin pale, gray, cyanotic
- orthopnea
- crackles, wheeze
- decreased BP
- nausea and vomiting
- ascites
- dependant pitting edema
- anxiety
- falling O2 sat
- confusion
- jugular vein distension
- infarct
- fatigue
- s3 gallop, tachycardia
- enlarged spleen and liver
17 decreased urine output - weak pulse, cool, moist skin
