Dyspnea Overview

Question 1

The sensation of dyspnea is provoked by the stimulation of receptors responsive to what?

Answer 1

Metabolic changes - decreased O2, pH, and/or increased CO2

Question 2

What can cause metabolic changes like decreased O2, pH, and/or increased CO2 leading to dyspnea?

Answer 2

• Decreased ventilation: narrowed airways in asthma (increased CO2)
• Decreased respiration: decreased ability to exchange gases between alveoli and blood as in pneumonia (decreased O2)
• Decreased circulation: decreased ability to exchange gases between alveoli and blood or between the blood and tissues because of poor blood flow as in anemia or hypotension (decreases O2 and pH)

Question 3

What are other triggers of shortness of breath, other than metabolic changes?

Answer 3

• Pulmonary interstitial stretch: fluid accumulation as in heart failure
• Respiratory muscle tension: over inflation from inadequate expiration as in asthma
• Central respiratory command: psychiatric malfunction as in anxiety

Question 4

What ROS questions should you ask a patient with dyspnea?

Answer 4

• Do you have any concerns about your mental health such as excessive sadness, etc?
• Do you have any problems with dizziness?
• Do you have any problems with headaches?
• Any problems with movement?
• Any problems with abnormal sensations?
• Any shortness of breath?
• Any cough?
• Any chest discomfort?
• Any chest fluttering?
• Any swelling in your arms or legs?

Question 5

What should you examine during a physical exam for a patient with dyspnea?

Answer 5

1. Wash hands
2. Drape patient to maintain modesty as needed
3. Eyes (conjunctiva)
4. Neck (JVP)
5. Auscultate anterior chest
6. Auscultate posterior chest
7. Percuss anterior chest
8. Percuss posterior chest
9. Auscultate in S1 and S2 in various listening posts
10. Lower extremities (edema)
11. OMM exam

Question 6

What tests should be ordered for an adult with dyspnea?

Answer 6

CXR, EKG, CBC, O2 sat