High Yield Handout Dyspnea Flashcards
ATS definition of dyspnea
subjective experience of breathing discomfort that consists of quantitatively distinct sensations that vary in intensity.
Dyspnea is
a self reported symptom
Tachypnea is
a sign that is characterized by accessory uscle use and intercostal retractions due to the increased work of breathing
85% of SoB is caused by
cardiac and pulmonary
COPD
strongly associated with smoking, occupational lung disease, or medication.
Progressive symptoms over a long period of time leading to the feeling that one is unable to take a breath
stable angina
typically described as heavy, squeezing, pressure, tightness or choking but rarely as pain
angina equivalents include dyspnea, nausea, and fatigue
typically relieved with rest in 1-5 minutes
compare side to side in lung exam in a what pattern?
ladder
when listening to the lungs patient should breathe
with mouth open
common findings with COPD
barrel chest
limited rib motion
percussion yielding generalized hyperresonance
decreased breath sounds
rib motion is what for pulmonary complaints
a ‘special test’
1st step of dyspnea diagnostics
walking oximetry
peak flow assessment
2nd step of dyspnea diagnostics ‘phase 1’
chest x-ray
spirometry
EKG
CBC/BMP
3rd step of dyspnea diagnostics ‘phase 2’
Chest CT
Lung volumes/DLCO/tests
Echocardiogram
Cardiac stress Test
4th step of dyspnea diagnostic ‘phase 3’
consider cardiopulmonary exercise testing (and referral)
COPD diagnostic requirement
FEV/eFEV <70%
Typical X-ray findings of COPD
flattening of the diaphragm
increased AP diameter
sympathetic to heart
T1-6
sympathetic to lungs
T1-7
parasympathetic to heart and lungs
vagus
lungs chapmans’ points
anterior 2, 3, 4 ICS along sternum
posterior lateral T2 spinous process
intertransverse space between T2-3, T3-4, and T4-5
Beta Agonist side effects
tremor
tachycardia
anticholinergic muscarinic antagonist side effcts
dry mouth
biomechanical OMT COPD goals
improve thoracic cage compliance and skeletal motion
neurological OMT COPD goals
normalize autonomic tone
resp-circ OMT COPD goals
maximize efficiency of the diaphragm and enhance lymphatic tone
metabolic-energetic-immune OMT COPD goals
enhance self-regulatory and self-healing mechanisms
behavioural OMT COPD goals
improve psychosocial components of health
Complications of COPD
progressive hypoxia
Eaxerbations
Respiratory Failure
progressive hypoxia complication of COPD
requires oxygen supplementation
exacerbations of COPD
increased in frequency as FEV1<50% of predicted
driven by airway inflammation and >50% are related to bacterial infection
1/3 to viral
repiratory failure of COPD
during exacerbation, patients may need support with oxygen
BIPAP or intubation with mechanical ventilation may be required
Primary prevention of COPD
annual flu vaccine
pneumococcal vaccine followed by pneumovax 1 year later
TDAP to protect against bordetella pertussis
Seconday prevention of COPD
avoidance of other dust and fumes
tertiary prevention of COPD
Smoking Cessation/abstinence.
Pulmonary Rehab is a comprehensive treatment program
that incorporates exercise, education, psychosocial and
nutritional counseling. Proven to improve health-related
quality of life, dyspnea and exercise capacity as well as
reduce rates of hospitalization.
Will a patient express the sensation of pain with stable angina
no, discomfort including tight, squeezing, heavy, pressure, etc but NO pain
anginal equivalents
dyspnea
nausea
fatigue
CAD in men
> 50
CAD in women
> 60
physical examination for stable angina
Pulomary evaluation
ascultation over all 4 cardiac listening posts.
palpate for PMI
auscultate for carotid bruits
peripheral pulses
assess for edema
stable angina in stress echo
wall motion abnormalities
cardiac stress test in stable angina
ST depressions identified during increased cardiac workload
may cause dyspnea
with stable angina who is at high risk for coronary events
inability to exercise <6min
secondary prevention for stable angina
asses pt for other CV symptoms (claudication for example)
screening for thyroid dysfunction, anemia, that can increase cardiac workload and cause symptoms to reoccur
tertiary prevention for stable angina
cardiac rehab
smoking cessation/abstinence
treatment of lipid disorders and other comorbidities that increase risk of atherosclerosis or increase cardiac workload, such as anemia and thyroid dysfunction
