Cough Flashcards
Cough
. Body response when something irritates throat
. Irritant simulates nerve that relays message to brain to have muscles in chest and abdomen push air out of lungs to force out irritant
Prolonged vigorous coughing can cause ___
Headaches, urinary incontinence and broken ribs
Acute cough
. <3 weeks
. Viral URI (most common)
. Acute bronchitis, pneumonia, left-sided HF, Asthma, Foreign body, smoking, ACE-inhibitor therapy
Sub-acute cough
. 3-8 weeks
. Post-infectious cough, pertussis, acid reflux (GER), Bacterial sinusitis, asthma
Chronic cough
. Over 8 weeks
. Post nasal drip (PND), asthma, gastroesophageal reflux (GER), chronic bronchitis, bronchiectasis
Bronchiectasis
. Bronchial wall inflammation causing inability to clear mucous
. Usually from infection
ROS important when evaluating cough
. General . Skin . Musculo/osteopathic . HEENT . Neck . Chest, heart, lungs . Abdomen/GI . Extremities . Neurologic
Chest pain, shortness of breath, and cough
. Can be from heart, lungs, and other structures
Important information in relation to cough
. Fever . Weight loss/gain . Type of cough (dry, purulent, blood, whitish-clear sputum) . Post nasal drip . wheeze . Orthopnea
What spinal level is tracheal bifurcation
T4
What rib level is inf. Tip of scapula
Level at 7th rib
Thoracentesis landmark
Interspace T7-8
Right lung lobes
. Upper
. Middle
. Right
. Separated by horizontal and right oblique fissures
Left lobes
. Upper
. Lower
. Separated by left oblique fissure
Trachea
. Bifurcated at sternal angle ant. And T4 spinous process post.
. Bifurcated into 2 main bronchi at carina
. Right and left mainstem bronchus
Pleura
Membrane that covers lung
Parietal pleura
. Lines inner rib cage and upper surface of diaphragm
. Richly innervated by intercostal and phrenic nerves
Visceral pleura
. Covers outer surface of lung
. Lacks sensory nerves
Pleural space
. Space between parietal and visceral pleura
. Some fluid to lubricate surfaces (pleural fluid)
. May inc. size or fill w/ fluid (pleural effusion)
T/F auscultate directly on skin not through clothing
T
Rales
. Fine Crackles (soft, high pitched) . Coarse crackles (louder, low pitched) . Intermittent non-musical . Smaller airways . Fluid in lungs (alveoli) . Seen in CHF, pneumonia . Doesn’t clear w/ coughing
Rhonchi
. Larger airways . Obstruction/fluid accumulation in larger airways . Low pitched . May change w/ or w/o coughing . Seen in COPD, pneumonia
Wheezing
. Effects bronchi
. Constriction
. Air trying to pass through bronchioles
. Seen in asthma and bronchitis
. Occurs during expiration
. Musical sounds, prolonged through narrow airways
. High pitched
Stridor
. Upper airway
. Over trachea
. Foreign airway obstruction
Adventitious lung sounds
. Abnormal sounds heard when auscultations a patient’s lungs and/or airways
Pleural friction rub
. Squeaking/grating sounds of pleural linings rubbing together
. Directly assoc. w/ inspiration and expiration (can’t be auscultated if patient holds breath
. Result of inflamed pleural layers which are inflamed and lost lubrication
GREAT BAD TOM CAT
. GERD . Rhinitis . Embolism . Asthma/COPD . TB . Bronchitis . Aspiration . Drugs . Thoughts . Other (hiatal hernia) . Malignancy . CF/cardiogenic . Achalasia: failure esophageal smooth muscle to relax . Thyroid enlargement
Vesicular sounds
. Inpiratory sounds . Last longer than exploratory sounds . Soft . Low pitch . Found over most of both lungs
Bronchovesicular sounds
. Inspiratory and expiratory sounds equal
. Intermediate sound intensity
. Intermediate pitch
. Found in 1st and 2nd interspaces ant. And btw scapulae
Bronchial sounds
. Expiratory sounds last longer than inspiratory ones
. Loud sound
. High pitch
. Found overmanubrium (larger prox. Airways)
Tracheal sounds
Inspiratory and expiratory sounds equal
. Very loud high pitch
. Found over trachea in neck
Chronic obstructive pulmonary disease (COPD)
. Chronic disease of lungs where alveoli become damaged
. Inc. mucous production and overly distended alveoli/general hyperaeration
Hyperaeration
. Limitation of expiratory air flow
COPD signs and symptoms
. Progressive dyspnea . +/- wheezing . Dec. exercise tolerance . Cough/sputum production . Inc. chest in AP diameter . Nicotine stained fingers . Central cyanosis . Nail clubbing . Pursed lip breathing
COPD etiology
. Smoking/secondhand smoke
. Occupational dust/chemicals
. Indoor air pollution from cooking stoves
Emphysema
. Pathological diagnosis
. Permanent enlargement/destruction of airspaces distal to terminal bronchiole
Emphysema signs/symptoms
. Older and thin
. Severe dyspnea
. Quiet chest
. Hyperinflation w/ flatter diaphragms on x-ray
GERD
Condition where gastric fluid flows backward into esophagus
GERD signs and symptoms
. Cough . Bloating . Burping . Nausea . Weight loss . Wheezing . Heartburn/chest pain . Red vocal cords . Hoarseness . Dysphagia . Melena . Hematochezia
GERD etiology
. Overeating . Weak/dysfunctional lower esophageal sphincter . Prolonged transit time . Inc. stomach acidity . Foreign body . Anatomic abnormality
Conditions that inc. risk of GERD
. Obesity . Smoking . Meds . Pregnancy . CT disorders . Fatty food diet
Bronchitis
. Inflammation of mucous membrane in bronchial tubes
. Infectious etiology
. Causes bronchospasm and coughing, nausea, fever, weakness, dyspnea, chest pain, weight loss, inspiratory stridor
Pneumonia
. Inflammation of lungs
. Etiology (bacterial, viral, fungal, atypical) that causes air sacs to full w/ pus and become solid
. Inflammation may affect both lungs, one, or only certain lobes
Asthma
. Reversible respiratory condition
. Bronchial hyperresponsiveness involving release of inflammatory mediators, inc. airway secretions, and bronchoconstrition
Asthma signs and symptoms
. Cough . Wheezing . Chest tightness . Dyspnea . Dec. breath sounds
Asthma etiology
. Exposure to various irritants and substances that trigger allergies
. Can trigger signs and symptoms of asthma
Fine crackle
. Predominantly inspiration
. Dry, high pitched crackling, popping
. Short duration
. Seen in COPD, CHF, pneumonia, pulmonary fibrosis, atelectasis
Coarse crackle
. Inspiration
. Moist, low pitched crackling, long duration, gurgling
. pneumonia, Pulmonary edema, bronchitis, atelectasis
Sonorous wheeze
. Low pitched snoring
. Expiration
. Asthma, bronchitis, airway edema, tumor, bronchiolar spasm, obstruction
Sibilant wheeze
. Expiration
. High pitched, musical
. Asthma, chronic bronchitis, emphysema, tumor, obstruction
Chronic bronchitis
. Daily productive cough for 3+ months in at least 2 consecutive years . Overweight . Cyanotic . Elevated Hb . Peripheral edema . Rhonchi and wheezing
Melena
Dark black poop assoc. w/ upper GI bleeding
Hematochezia
Fresh blood through anus in or w/ poop
. Bright red
