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Clinical Reasoning > Dyspnea > Flashcards

Dyspnea Flashcards

1
Q

What is dyspnea?

A

SUBJECTIVE complaint, abnormally increased awareness of breathing OR sensation of difficulty of breathing

2nd most common reason for ER visits in US

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2
Q

When taking a history, what is the FIRST question you need to ask for a pt w/ a CC of dyspnea?

A

HOW LONG HAS THIS BEEN GOING ON FOR???????

acute vs. chronic dyspnea is VERY IMPORTANT!

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3
Q

How does a slow progression of dyspnea differ from a rapid progression?

A
  • Slow progression = likely to lead to a chronic etiology
  • Rapid = likely to lead to an acute etiology and/or likely to coincide w/ alarm symptoms that may need immediate intervention
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4
Q

What are 10 possible associated symptoms?

A
  1. Chest pain
  2. Hemoptysis
  3. Fever
  4. Cough (productive vs. nonproductive)
  5. Wheezing
  6. Constitutional : fever, night sweats, weight loss, fatigue
  7. Itching/hives
  8. Edema
  9. Weight Loss
  10. Feeling of impending doom
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5
Q

What could chest pain indicate?

A
  1. Myocardial infarction…..(ask about radiation, description of pain)
  2. Pneumothorax
  3. Pulmonary embolism (can be unilateral or bilateral pleuritic pain too)
  4. Cardiac tamponade (central chest heaviness)
  5. Pericarditis (pleuritic pain radiating to the back w/ positional improvement)
  6. Pleuritic vs. cardiac
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6
Q

What could a FEVER indicate?

A

80% of pts. w/ pneumonia have fever

20% of pts. w/ PE have fever

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7
Q

What could a NON PRODUCTIVE cough indicate?

A

Asthma
Pulmonary embolism
GERD

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8
Q

What could a PRODUCTIVE cough indicate?

A

Acute Pneumonia
Flash pulmonary edema
COPD (chronic bronchitis)

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9
Q

What could WHEEZING indicate?

A

Asthma
COPD
Anaphylaxis

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10
Q

What could ITCHING/HIVES indicate?

A

Anaphylaxis

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11
Q

What could UNILATERAL EDEMA OF EXTREMITIES indicate?

A

DVT w/ PE

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12
Q

What could BILATERAL EDEMA OF EXTREMITIES indicate?

A
  1. Cardiomyopathy - more likely to have bilateral edema (DVT…unilateral)
  2. Pericardial disease
  3. Pulmonary Hypertension
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13
Q

What could WEIGHT LOSS indicate?

A

Cancer

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14
Q

What could a FEELING OF IMPENDING DOOM indicate?

A

Anxiety

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15
Q

MODIFIERS……Worse when LYING FLAT???

A

YES – ORTHOPNEA –> CHF

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16
Q

MODIFIERS…. Pain better when lay on one side or the other?

A

Trepopnea … occurs w/ unilateral effusions

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17
Q

What are 11 risk factors/associated diseases for dyspnea?

A
  1. Hx CHF
  2. Hx MI
  3. Hx CAD
  4. Meds –> especially new meds that were started around the time of onset
  5. Smoking history … hx of COPD, CAD, Lung CA
  6. Occupation …. was there occupational exposure?
  7. Prolonged immobilization
  8. Hx of CA
  9. OCP/ Estrogen Use
  10. Surgery
  11. Recent Travel
18
Q

What are the 5 Risk Factors for DVT/PE?

A
  1. Prolonged Immobilization
  2. Hx of CA
  3. OCP/ Estrogen Use
  4. Surgery
  5. Recent travel
19
Q

What are the 6 Alarm Symptoms for Dyspnea?

A
  1. Chest pain (pleuritic vs. Cardiac)
  2. Lip swelling, hives AND wheezing
  3. Pink frothy sputum
  4. Fever w/ sputum production
  5. Fever w/ worsening sore throat and hoarse voice
  6. Awakens from a sleep
20
Q

What does ALARM SYMPTOM CHEST PAIN indicate?

A
  1. Pleuritic –> sharp, unilateral chest pain that increases with respiration….

serious causes = Pulmonary embolism, PTX, pneumonia

  1. Cardiac –> MI
21
Q

What does ALARM SYMPTOM “LIP SWELLING, HIVES AND WHEEZING” indicate?

A

Anaphylaxis, angioedema

22
Q

What does ALARM SYMPTOM “PINK FROTHY SPUTUM” indicate?

A

Flash Pulmonary Edema

23
Q

What does ALARM SYMPTOM FEVER W/ SPUTUM PRODUCTION indicate?

A

Pneumonia vs. bronchitis…

Pneumonia = bacterial

Most of Bronchitis = VIRAL…AKA NO ANTIBIOTICS!!

24
Q

What does ALARM SYMPTOM “FEVER W/ WORSENING SORE THROAT AND HOARSE VOICE” indicate?

A

Epiglottis

25
Q

Why does dyspnea occur?

A

The purpose of breathing is to meet the metabolic demands of the body…

26
Q

What are the FOUR major physiologic reasons dyspnea results from?

A
  1. Any condition that increases the work of breathing … CANT GET THE AIR IN!
  2. POOR oxygen uptake
  3. Any condition that increases respiratory drive
  4. Exacerbation of primary psychological conditions
27
Q
  1. Any condition that increases the work of breathing… CAN GET THE AIR IN!
A
  1. Airway obstruction
    Changing in lung compliance
    Respiratory muscle weakness

THINK OF ANATOMY…

a) Upper airway –> epiglottis, foreign body
b) Bronchi –> asthma, acute bronchitis
c) Alveoli –> Emphysema, Interstitial lung disease
d) External compression –> PTX
e) Thoracic wall –> scoliosis

28
Q
  1. Poor oxygen uptake
A

LUNG CIRCULATION PROBLEM

a) Pulmonary Embolism
b) Left sided Heart Failure
c) Pulmonary Hypertension

HEMOGLOBIN DISORDER

a) Anemia
b) Carbon monoxide poisoning

29
Q
  1. Any condition that increases respiratory drive
A

Hypoxia, metabolic acidosis

REMEMBER…. metabolic acidosis is a surplus of positive cations (hydrogen)… the way the body compensates for a metabolic acidosis is to increase the respiration rate… WHY? in the respiratory system, CO2 is an ACID… to decrease CO2, you need to increase the respiratory rate… which results in DYSPNEA

30
Q
  1. Exacerbation of primary psychological conditions
A

Anxiety

BE CAREFUL!!!!!!!! MANY PATIENTS who have organic causes for their dyspnea will appear to be anxious.

31
Q

What can manifest as ANXIETY?

A

HYPOXIA!!!!

32
Q

Whats the FIRST THING TO DO when categorizing dyspnea?

A

Determine if its ACUTE OR CHRONIC!

Will help us determine what type of questions will be most important.

33
Q

What is the duration of acute dyspnea?

A
34
Q

What are the FOUR physical signs of ACUTE dyspnea?

A
  1. Can only say 2-3 words w/o stopping to take a breath
  2. Nasal flaring
  3. Cyanosis
  4. ACCESSORY MUSCLE USE: chest wall retractions, abdominal muscle use, neck muscle use (particularly the sternocleidomastoid and scalene muscles)
35
Q

What are the CAUSES of ACUTE dyspnea? (8)

A

PPOPPA-MM

  1. Pulmonary Embolism
  2. Pulmonary Edema
    a) Pulmonary (less common than cardiogenic): high altitude, gas inhalation
    b) Cardiogenic : CHF
  3. Obstructed Airway
    a) Foreign body
    b) Epiglottis
  4. Pneumothorax (spontaneous)
  5. Pneumonia/Bronchitis
  6. Asthma or COPD
  7. MI/tamponade
  8. Medications
36
Q

What is the duration of chronic dyspnea?

A

> 1 Month

37
Q

What will the majority of people w/ chronic dyspnea of unclear etiology end up having? (5)

A 
COPD
Asthma
Interstitial Lung Disease
Myocardial Dysfunction
Obesity/Deconditioning
38
Q

What are the CARDIOVASCULAR causes of CHRONIC DYSPNEA? (4)

A

Muscle : cardiomyopathies

Vessels : Ischemia

Valves : Regurgitation, stenosis, or infection

Pericardium : Effusion, inflammation

39
Q

What are the PULMONARY causes of CHRONIC DYSPNEA? (6)

A

Bronchi : Mass, Foreign Body

Bronchioles : Asthma, chronic bronchitis

Interstitial Lung Disease

Alveoli : Emphysema, Chronic Pneumonia

Pleura : Effusions

Lung Cancer

40
Q

What are the “OTHER” causes of CHRONIC DYSPNEA? (5)

A

Anemia

Chest wall abnormalities : Scoliosis, Pectus Excavatum (sternum and chest wall appear to be sunken in)

Deconditioning

Acidosis

Neurmomuscular Disease
(either an issue w/ ACTUAL MUSCLES DOING THE WORK of breathing… OR issue w/ the CONTROL of respirations in the CNS)

Clinical Reasoning (3 decks)

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