Clinical Presentation Of Respiratory Diseases Flashcards
Three major categories of respiratory diseases
Obstructive
Restrictive
Vasculature abnormalities
Common concerning symptoms
Chest pain
Dyspnea
Wheezing
Cough
Hemoptysis
Daytime sleepiness and/or disordered sleep
Top 3 causes for chronic coughing
Asthma
- usually associated with wheezing
GERD
- symptoms worse at night
Allergies
- shows allergy symptoms in conjunction
- note chronic coughing is almost always non-infectious
3 types of restrictive pulmonary diseases and examples
Parenchyma disease
- idiopathic pulmonary fibrosis
- asbestosis
- sarcoidosis
Neuromuscular weakness
- ALS
- guillian-Barre syndrome
- myasthenia gravid
Pleural diseases
- scoliosis
- ankylosis spondylitis
- pleural effusions
4 main types of chests
1) normal
- ratio of AP diameter to lateral is 0.7-0.9
- increases with aging
- normal shaped
2) pectus excavatum (funnel chest)
- sternum is posteriorly displaced dramatically
- can appear with murmurs
3) barrel chest
- AP diameter is increased
- accompanies with obstructive disorders
4) pectus carinatum
- sternum is anteriorly displaced dramatically
Flail chest
Multiple rib fractures in multiple places
- produces an inward movement of ribs when inhaling and moves outward with expiration
- moves separately from the rest
Special landmarks for respiratory
2nd intercostal space near sternum
- area for needle insertion for tension pneumothorax
4th intercoastal space mid way better run sternum and anterior axillary line
- area for chest tube insertion
T7-8 intercostal space posteriorly
- area for thoracentesis just superior to the 8th rib
Normal respiratory rates in children and adults
Adults= 14-20
Children = 14-44
Bradypnea
Slow breathing with or without increased tidal volume to maintain alveolar ventilation
Without increased tidal volume = uremia, respiratory depression, increased intracranial pressures
Sighing respiration
Breathing rates that are normal except for frequent punctuated sighs
- suggests hyperventilation syndrome and is a common cause of dyspnea/dizziness
can be normal to prevent atelectasis as long as it is not frequent (<1 min)
Tachypnea
Rapid shallow breathing
Numerous causes but is commonly seen in restrictive lung diseases or fractured ribs/sternum
Cheye-stokes breathing
Periods of deep breathing alternating w/ periods of apnea (no breathing)
Normal in children and older adults
Not normal in young adults
- signals brain injury, heart failure, uremia and/or respiratory depression
Obstructive breathing
Always found in obstructive lung diseases
- asthma and COPD are most common
Inspiration is normal, but expiration is prolonged since the narrowed airways increase resistance to air flow
Hyperpnea
Rapid deep breathing that occurs in a metabolic demand increased
- examples are: sepsis, high altitude, anemia
Is often seen in diabetic ketoacidosis
Ataxic breathing
“Blot breathing”
Breathing is irregular w/ periods of apnea alternating w/ regular deep breaths
Causes include
- meningitis
- respiratory depression
- brain injury
Types of breathing sounds
Tracheal
- loud harsh sounds heard over the trachea in the neck
Bronchial
- loud harsh and high pitchers sounds in the lungs
- produce short silence between inspiration and expiration as well
Bronchovesicular
- sounds in inspiration and expiration are equal in length but sometimes present w/ silent intervals
Vesicular
- soft/low pitched breathing
- heard well in inspiration, but fade away in the middle of expiration
Key things to do with auscultation
Ask patient to cough once or twice to clear mild non-pathological sounds
Always place the stethoscope directly on skin and not clothing
Stridor
Musical high-pitched sound heard best over trachea or upper airways
Almost always indicates upper-airway obstruction W/ lesions
- needs ER to treat.
Rhonchus
Musical low-pitched sounds similar to snoring
- lower pitched than wheezing and can be heard on either inspiration ro expiration
Associated with rupture of fluid films, abnormal airway collapsibility
- bronchospasms, edema
Pleural friction rubs
Non musical explosive biphasic sounds usually heard in basal regions of lungs
- often indicates pleural effusions
What is the sound characterizes for abnormal percussion
1) Dullness sounds
- Usually indicates any of the following
- pneumonia
- pleural effusions of any kind
- fibrous tissue/tumors
2) generalized hyper resonance
- indicates COPD/asthma due to increased air present in lungs
3) unilateral hyper resonance
- indicates large pneumothorax
- 100% pneumothorax if tracheal shift is present on imaging
Abnormalities in palpation
1) unilateral decreases of delays in chest expansion
- chronic fibrosis
- pneumoniae
- pleural effusions
- diaphragm paralysis
2) frenitus (vibratory tremors, ask patient to say 99 or blue balloons)
- COPD
- Pleural effusion
- pneumonothorax
Crepitus (crackling/rales)
- respiratory distress
- emphysema
Accessory muscle use
SCM
Scalenes
Intercostals
Abdominal obliques
*monitor all of these muscles and if they are being used, can signify respiratory distress
What is the value for total lung capacity that indicates restrictive pulmonary diseases?
<80% (0.8)
What is the cardinal value for obstructive lung diseases?
FEV1% = <70% (0.7)
