Exam 2 Flashcards
persistent dry cough
be on the look for
tumor
congestion
hypersensitive airways
productive cough with purulent sputum
be on the look for
infection
productive cough with non-purulent sputum
be on the look for
nonspecific, indicates airway irritation
rust colored sputum
be on the look for
pneumonia
hemoptysis
be on the look for
A pathologic condition—infection, inflammation, abscess, tumor, or infarction
dyspnea
Usually indicates hypoxemia
Orthopnea: dyspnea when the patient is lying down
cyanosis
Bluish color of the skin & mucous membranes (more evident in lips, tongue, gums)
Depends on the O2 saturation of arterial blood & circulating hemoglobin
clubbing
Thickening & widening of the terminal phalanges
Typically result of pulmonary disease & resultant hypoxia
altered breathing patterns
Changes in the rate, depth, regularity, and effort of breathing
Observe for accessory muscles (SCM, scalenes, etc.)
most common pulmonary pain patterns
increases with ___
anterior chest, ribs, upper trap, shoulder, thoracic spine
Also refers to neck, medial arm from shoulder
Usually increases with inspiratory movements
Tracheobronchial Pain
referred to
Referred to neck & anterior chest at the same levels as the points of irritation in air passages
Trachea & large bronchi innervated by vagus trunks
Finer bronchi & lung parenchyma have no pain innervation
tracheobronchial pain
caused by
inflammatory lesions, irritating foreign materials, tumors
pleural pain
Occurs when disease extends to parietal pleura
Sharp, localized pain
Present with pleurisy, pneumonia, pulmonary infarct, tumor, & pneumothorax
Diaphragmatic pleural pain
Pain innervation from phrenic nerve & intercostal nerves- ipsilateral pain pattern
Phrenic nerve damage causes ipsilateral diaphragm paresis
Peripheral area irritation referred to costal margins
Central area irritation refers to shoulder & upper trap
common innervation of C5-6
respiratory acidosis can results from
Damage to the medulla
Obstruction of airways
Loss of lung surface ventilation
Weakness of respiratory muscles
Overdose of respiratory depressant drugs
s/sx of respiratory acidosis
Decreased ventilation
Confusion
Sleepiness and unconsciousness
Diaphoresis
Shallow, rapid breathing
Restlessness
Cyanosis: observable in mucous membranes, fingertips, lips
respiratory alkalosis
Results from increased respiratory rate & depth that decreases the amount of available CO2 and hydrogen
Usually caused by hyperventilation
If more severe, can observe muscular tetany and convulsions
s/sx of respiratory alkalosis
Hyperventilation
Light-headedness
Dizziness
Numbness & tingling of the face, fingers, & toes
Syncope
COPD
Several disorders that have abnormal airway structures (narrowing airways) resulting in obstruction of air exiting & entering the lungs
A leading cause of morbidity & mortality for smokers
Symptom severity depends on how much lung parenchyma has been damaged or destroyed
predisposing factors of COPD
Smoking
Air pollution
Occupational exposure (e.g., aerosol pesticides, art materials)
Genetics
Infection
Allergies
Aging
Potentially harmful drugs and chemicals
acute bronchitis s/sx
Mild fever from 1-3 days
Malaise
Back and muscle pain
Sore throat
Cough with sputum production, f/b wheezing
Possible progression to laryngitis
acute bronchitis
An inflammation of the trachea and bronchi
Short duration
May result from chemical irritation or with viral infections (measles, whooping cough, influenza)
chronic bronchitis
“a person with chronic bronchitis is anyone who coughs for at least 3 months/year for 2 consecutive years without having had a precipitating disease”
Prolonged exposure to nonspecific bronchial irritants
Mucous hypersecretion & structural changes in bronchi
s/sx of chronic bronchitis
Persistent cough with production of sputum (worse in the morning & evening)
Reduced chest expansion
Wheezing
Fever
Dyspnea/SOB
Cyanosis
Decreased exercise tolerance
s/sx of bronchiectasis
Chronic “wet” cough & abundant foul-smelling secretions
Hemoptysis (spitting blood)
Occasional wheezing sounds
Dyspnea
Sinusitis– inflammation of paranasal cavities
Weight loss
Anemia
Malaise
Recurrent fever and chills
Fatigue
bronchiectasis
Chronic, progressive type of bronchitis
Occurs after infections such as childhood pneumonia
Permanent dilation of bronchi and destruction of bronchial walls
emphysema
Permanent overdistention of air space and loss of normal elastic tension in the lung tissue
Results in air passage obstruction & difficult expiration
s/sx of emphysema
SOB
Dyspnea on exertion
Orthopnea immediately after assuming the supine position
Chronic cough
Barrel chest
Weight loss
Malaise
Use of accessory muscles of respiration (pec minor, SCM, scalenes)
Prolonged expiratory period (with grunting)
Wheezing
Pursed-lip breathing
Increased respiratory rate
Peripheral cyanosis
asthma
Reversible obstructive lung disease caused by an increased reaction of the airways to various stimuli
Chronic inflammatory condition with acute exacerbations
Inflammation obstructs airways
asthma triggers
Respiratory infections, colds
Cigarette smoke
Allergic reactions to pollen, mold, animal dander, feather, dust, food, insects
Indoor & outdoor air pollutants
Physical exertion or vigorous exercise
Exposure to cold air or sudden temperature change
Excitement, strong emotion, psychologic or emotional stress
pneumonia
what is it and what is it caused by
Inflammation of the lungs
Caused by:
Aspiration of food, fluids, or vomitus
Inhalation of toxic or caustic chemicals, smoke, dust, or gases
A bacterial, viral, or mycoplasmal infection
pneumonia risk factors (some)
Age (very young, very old)
No prior pneumococcal vaccination
Smoking
Air pollution
Upper respiratory infection (URI)
Altered consciousness: alcoholism, head injury, seizure disorder, drug overdose, general anesthesia
Endotracheal intubation, nasogastric tube
Recent chest surgery
Prolonged immobility
Immunosuppressive therapy: corticosteroids, cancer chemotherapy
Nonfunctional immune system
pneumonia s/sx
Sudden/sharp pleuritic chest pain aggravated by chest movement
Shoulder pain (referral area)
Hacking, productive cough (rust-colored or green, purulent sputum)
Dyspnea
Tachypnea with decreased chest excursion (affected side)
Cyanosis
Headache
Fever and chills
Generalized aches & myalgia
Painful & swollen knees possibly
Fatigue
Confusion in older adult
tuberculosis
Bacterial infectious disease transmitted by gram-positive, acid-fast bacillus Mycobacterium tuberculosis
Most commonly spread with repeated close contact with an infected person
Full course of treatment lasts 6-9 months
TB risk factors
Health care workers, especially those working in older hospitals (centralized ventilation), homeless shelters, or extended care facilities
Older adults
Overcrowded housing & homeless
Incarceration
US-born non-Hispanic African Americans
Immigrants from Southeast & Central Asia, Ethiopia, Mexico, Latin America, Eastern Europe
Alcohol or other chemical dependency with resultant malnutrition, debilitation, poor health
Infants/ children < 5 years age
Reduced immunity or malnutrition & HIV-positive lung cancer or head and neck cancer
RA
DM and/or end-stage renal disease
Hx of GI disease
s/sx of TB
Fatigue
Malaise
Anorexia
Weight loss
Low-grade fever
Night sweats
Frequent productive cough
Dull chest pain, tightness, or discomfort
Dyspnea
scleroderma
Restrictive lung disease of unknown etiologic origin
Inflammation and fibrosis of many organs
Affects skin and the visceral organs
s/sx of scleroderma
Dyspnea on exertion
Nonproductive cough
Peripheral edema (secondary to cor pulmonale)
Orthopnea
Paroxysmal nocturnal dyspnea
Hemoptysis
s/sx of lung cancer
Any change in respiratory patterns
Recurrent pneumonia or bronchitis
Hemoptysis– REFER
Persistent cough
Change in cough or development of hemoptysis (for a chronic smoker)
Hoarseness or dysphagia
Dyspnea
Wheezing
Sharp chest, upper back, shoulder, scapular, rib, or arm pain aggravated by inspiration or accompanied by respiratory SxS
Sudden, unexplained weight loss; anorexia; fatigue
Chest, shoulder, or arm pain; bone aching, joint pain
Atrophy and weakness of the arm and hand muscles
Fecal breath odor
s/sx of early stage CF
Persistent coughing and wheezing
Recurrent pneumonia
Excessive appetite, but poor weight gain
Salty skin/sweat
Bulky, foul-smelling stools
s/sx of CF in older children and young adults
Infertility
Nasal polyps
Periostitis
Glucose intolerance
possible complications due to CF
Pneumothorax
Hemoptysis
Right-sided heart failure secondary to pulmonary hypertension
pulmonary embolism
Pulmonary vascular obstruction from:
Displaced thrombus (DVT most common cause)
Air bubble
Fat globule
Clump of bacteria
Amniotic fluid
Vegetations on heart valves that develop with endocarditis
Other particulate matter
PE rule out criteria
Age < 50 years
Heart rate < 100 bpm
Oxyhemoglobin saturation >/= 95%
No hemoptysis
No estrogen use
No prior DVT or PE
No unilateral leg swelling
No surgery or trauma requiring hospitalization within the past 4 weeks
s/sx of PE
Dyspnea
Pleuritic (sharp, localized) chest pain
Diffuse chest discomfort
Persistent cough
Hemoptysis– REFER
Apprehension, anxiety, restlessness
Tachypnea– increases RR
Tachycardia
Fever
s/sx of cor pulmonale
Peripheral edema (bilateral LEs)
Chronic cough
Central chest pain
Exertional dyspnea or dyspnea at rest
Distention of neck veins
Fatigue
Wheezing
Weakness
cor pulmonale
Emergency cardiac condition from sudden dilation of the right ventricle due to PE
pulmonary arterial hypertension
Vasoconstriction of pulmonary arterial vascular bed
Can lead to eventual right-sided heart failure
risk factors of pleurisy
Pneumonia
TB
Lung abscess
Influenza
Systemic lupus erythematosus
RA
Pulmonary infarction
types of pleurisy
Dry: fluid between pleural layers not changed
Wet: abnormal increase of fluid between pleural layers
Purulent pleurisy: if fluid becomes infected & pus forms
s/sx of pleurisy
Pain distributions
Ipsilateral shoulder, upper trap, neck, lower chest wall, abdomen
Cough
Dyspnea
Fever, chills
Tachypnea
causes of pneumothorax
Pulmonary disease
Trauma (with perforation of chest wall; ex: stab wound)
Scuba diving (arterial gas embolism)
Overexertion
Sx/ medical procedures involving chest wall or thorax
s/sx of pneumothorax
Dyspnea
Change in respiratory movements (affected side)
Sudden, sharp chest pain (upper & lateral thoracic wall with referral to ipsilateral shoulder, across chest, abdomen)
Increased neck vein distention
Weak and rapid pulse (>100 bpm)
Fall in blood pressure
Dry, hacking cough
Shoulder pain
Sitting upright is most comfortable
cardiac valvular disease s/sx
Easy fatigue
Dyspnea
Palpitation
Chest pain
Pitting edema
Orthopnea or paroxysmal dyspnea
Dizziness and syncope
**all increase with workload
rheumatic fever
what is it and what are common symptoms
Infection caused by streptococcal bacteria
Rheumatic heart disease: chronic condition due to scarring & deformity of heart valves
Most common symptoms: fever & joint pain
endocarditis
caused by what
Heart infection
Causes inflammation of cardiac endothelium and damages the tricuspid, aortic or mitral valve
Caused by bacteria entering bloodstream remotely (e.g. skin infection, oral infection)
endocarditis risk factors
High risk:
Previous valvular damage
Injection drug users
Postcardiac surgical presentations
Congenital & degenerative heart disease
Invasive diagnostic procedures
s/sx with endocarditis
Arthralgia
Arthritis
MSK symptoms
Low back/sacroiliac pain
Myalgia
Petechiae/splinter hemorrhage
Constitutional symptoms
Dyspnea, chest pain
Cold and pain in the extremities
s/sx of fibrillation (damage to heart muscle cells)
Subjective report of palpitations
Sensations of fluttering, skipping, irregular beating or pounding, heaving action
Dyspnea
Chest pain
Anxiety
Pallor, fatigue
Dizziness, light-headedness, fainting
Nervousness
Cyanosis
sinus tachycardia
Abnormally rapid heart rate (>100 bpm)
Physiologic response to stressors (e.g., hypotension)
s/sx of sinus tachycardia
Palpitation
Restlessness
Chest discomfort or pain
Agitation
Anxiety and apprehension
sinus bradycardia
Sinus node discharges at a rate < 60 bpm
May be normal in athletes or young adults
s/sx sinus bradycardia
Sudden onset of weakness, sweating, nausea, pallor, vomiting, and distortion or dimming of vision
Reduced pulse rate
Syncope
raynaud’s phenomenon
what is it and what are triggers
Intermittent episodes during which small arteries or arterioles in extremities constrict, causing temporary pallor and cyanosis of the digits and change in skin temperature
Triggers:
Cold temperature
Strong emotion
s/sx of raynauds phenomenon
Pallor in the digits
Cyanotic, blue digits
Cold, numbness, pain of digits
Intense redness of digits
s/sx of superficial venous thrombosis
Subcutaneous venous distention
Palpable cord
Warmth, redness
Indurated (hard)
s/sx deep venous thrombosis
what do you use to dx this
Unilateral tenderness or leg pain
Unilateral swelling (>3 cm difference in leg circumference)
Warmth
Discoloration
wells criteria
chronic venous disorders are identified by
Chronic swollen limbs
Thick, coarse, brownish skin around the ankles
Venous stasis ulceration
