Module 4 - Complex Resp. Flashcards
(75 cards)
stimulated neural receptor along the respiratory tree → cough center in the medulla → complex reflex arc efferent pathway to the expiratory musculature
Acute (lasting <3 weeks), subacute (lasting 3 to 8 weeks), and chronic (persisting beyond 8 weeks).
Chronic Cough
Three most common causes of chronic cough with NORMAL chest radiography, no smoking, or an ACE include
corticosteroid-responsive eosinophilic airway diseases (asthma, cough variant asthma, and eosinophilic bronchitis)
upper airway cough syndrome (postnasal drip syndrome)
GERD
A cough associated with constant throat clearing and thick mucus production, especially on rising from bed
Upper airway cough and sinusitis
A cough that lasts for 3 consecutive months for more than 2 consecutive years
chronic bronchitis
A sudden onset of cough in the supine position with an associated sour taste in the mouth
GERD
A cough associated with rhinorrhea or sneezing
Viral or common cold-
Intermittent productive cough associated with wheezing
Asthma
loud hacking cough during the daytime that is nonproductive, leads to exhaustion, and is associated with emotional stress
Psychogenic cough-
Sputum Yellow-green, purulent:
bronchitis
Sputum Pink frothy
pulmonary edema
Sputum Fetid purulent
anaerobic infections
Sputum Rust colored
pneumococcal pneumonia
Chronic inflammation causes structural changes and a narrowing of the small airways and destruction of the lung parenchyma that leads to the loss of alveolar attachments to the small airways and decreases lung elastic recoil.
Cigarette smoke and an occupation that involves regular exposure to a dusty environment are the two major external factors.
COPD
The physical examination findings in early disease are often normal. (SOB, chronic cough, sputum)
Late- clubbing of fingernails, increase AP diameter (barrel chest), increase intercostal space, pursed lip breathing, tripod position, decrease expiratory, increased resonance on chest percussion
Diminished transmission of breath sounds on auscultation is the most reliable finding
COPD
Gold standard dx tool for COPD
Spirometry
A forced expiratory time of 6 seconds or more suggests obstructive pulmonary disease
Treatment for COPD
Smoking cessation***
_____ assessment: grades each question 0-5; all added up at the end for score
Cough; phlegm/mucus; chest tightness; out of breath when walking up a hill/stairs; limited in activities at home; confidence in leaving house despite lung condition; sleep; energy
CAT Assessment for COPD
None (0): No dyspnea except with strenuous activity
Slight (1): SOB when hurrying on the level or walking up a slight hill
Moderate (2): Breathlessness causes slower on-the-level walking than ppl of same age
Severe (3): stops fro breath after walking about 100m or after a few min on same level
Very Severe (4): too breathless to leave house; breathless when dressing/undressing
MRC dyspnea scale: grade 0-4
COPD
First line for intermittent symptoms of COPD
short acting B2 adrenergic agonist (bronchodilator)
first line of maintenance therapy for patients with daily COPD symptoms.
anticholinergics
Treating COPD pts with inhaled corticosteroids
FEV1 rechecked after 3 to 4 months of therapy
Use with LABA - reduces exacerbations for s/s COPD patients, FEV < 60, and repeated exacerbations
COmbination therapy for COPD
#1 anticholinergic and a short-acting β 2 agonist long-acting β 2 agonist and long-acting anticholinergic, and long-acting β 2 agonist and inhaled glucosteroid
When should COPD pt get oxygen therapy
SPO2 < 88%
Prescribe O2 to keep SaO2 at or above 90% → recheck in 60-90 days to see if pt still requiring supplemental O2
What could it be ? …
Chest tightness and constriction
asthma or COPD , foreign body, bronchitis
