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Cardiopulmonary Exam 1 > POMA to Respiratory Disease > Flashcards

POMA to Respiratory Disease Flashcards

1
Q

Problem-oriented medical approach to respiratory disease

A
  1. data base (hx, PE, test results…)
  2. problem prioritization & definition
  3. plans (diagnostic, therapeutic, client ed)
  4. follow-up
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2
Q

initial data base information

A

history and PE

  • often enough to help confirm or localize: upper airway, lower airway, extrapulmonary
  • some clinical signs are not specific or overlap
  • characterization of respiration
  • observation of respiration
  • auscultation
  • signalment
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3
Q

characterization of respiration

A
  • look and listen
  • rate, effort, patient positioning & attitude
  • audible or auscultable sounds
  • inspiration vs. expiration
  • body wall movements
  • auscult full lung fields and large airway
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4
Q

observation of respiration

A
  • general respiratory patterns
    • eupnea, tachypnea, bradypnea, hyperpnea, hypopnea, apnea, dyspnea
  • specific respiratory patterns
    • orthopnea, apneustic, ataxic (agonal), paradoxic, flail chest
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5
Q

eupnea

A

normal breathing

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6
Q

tachypnea

A

increased rate/frequency

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7
Q

bradypnea

A
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8
Q

hyperpnea

A

increased depth/airflow

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9
Q

hypopnea

A

decreased depth/airflow (shallow breathing)

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10
Q

apnea

A

cessation of breathing (>10 sec?)

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11
Q

dyspnea

A

difficult, labored breathing

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12
Q

hyperventilation

A

tachypnea + hyperpnea

increased rate/freq + increased depth/airflow

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13
Q

hypoventilation

A

bradypnea + hypopnea

decreased rate/freq + deceased depth/airflow

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14
Q

orthopnea

A
  • dyspnea while lying down (positional)
  • corrected upon restoring upright position
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15
Q

apneustic

A
  • deep, long inspiration followed by breath-holding and then rapid exhalation (pause in the middle)
  • associated with some parenchymal disease and upper respiratory diseases
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16
Q

ataxic (agonal)

A
  • continuous irregular shifts of hyperventilation, hypoventilation & apnea
  • pre-death breathing!
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17
Q

kussmaul breathing

A
  • “air hunger”
  • big inspiratory pattern
  • can look like airway obstruction
  • can be confused with paradoxical breathing
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18
Q

paradoxic

A

abdomen and thorax moving in opposition to each other (normally the same)

19
Q

flail chest

A
  • segment of chest wall moves independently
  • fairly pathopneumonic for rib fractures
20
Q

auscultation of respiratory sounds

A
  • normal
    • bronchial, vesicular, bronchovesicular
  • abnormal
    • stertor, stridor, crackles, wheezes, end-expiratory grunts, pleural rubs, fluid line/dull regions
21
Q

bronchial sounds

A
  • turbulent airflow in trachea
  • timing duration: I≈E (pause between)
  • intensity: I>E
22
Q

vesicular sounds

A
  • turbulent airflow in large airways
  • timing/duration: I >> E
  • intensity: I >> E
  • lower in chest
23
Q

stertor

A

snoring sound produced by partial obstruction of upper airway

brachycephalics!

24
Q

stridor

A

high pitched, harsh, vibratory noise caused by partial upper airway obstruction

-laryngeal paralysis

25
Q

crackles

A

discontinuous bubbling/popping sounds as air passes through fluid or forces collapsed airway/alveolar walls open

26
Q

wheezes

A

continuous whistling sounds caused by air turbulence in narrowed lower airways

27
Q

end-expiratory grunts

A

may indicate bronchoconstriction, air trapping

28
Q

chief complaint(s) related to nose/nasopharynx

A
  • nasal discharge, epistaxis, sneezing
  • nasal passage occlusion, stertor, mouth breathing
  • facial asymmetry or deformity
  • ocular signs (exophthalmus, discharge)
  • anorexia or other non-specific symptoms
29
Q

chief complaint(s) related to upper airway disease

A
  • coughing
  • wheezing
  • altered breathing pattern
    • altered I:E (I<e></e>
    </e>
  • exercise intolerance
  • tachypnea, dyspnea, distress
30
Q

species differences in respiratory disease

A
  • cats ≠ dogs
  • nasal/nasopharyngeal (polyps in cats, aspergillus in dogs)
  • upper airway disease (lar par and tracheal collapse in dogs)
  • lower airway (cats rarely cough)
  • pleural space dz (CHF in cats vs. dogs)
31
Q

breed differences in respiratory disease

A
  • big categories
    • tracheal collapse in small breed dogs
    • environmental factors (blasto in hunting dogs)
  • brachycephalics
  • specific rare conditions
    • pneumocystis in Dachshunds
32
Q

history questions for nasal/nasopharyngeal disease

A
  • what do clients see/hear?
  • onset and duration of clinical signs?
  • changes/progression of clinical signs?
  • obvious triggers?
  • other concurrent clinical signs?
  • prior tx? response to tx?
33
Q

history questions for airway or pulmonary dz

A
  • confirm principal clinical signs
  • if cough:
    • regurgitation or vomiting?
    • reverse sneezing?
    • characterize cough
  • HW preventative
  • contact with other animals
  • medication
  • provocative environmental stimuli
  • other underlying dz
  • exercise intolerance
  • trauma
34
Q

PE of nasal/nasopharyngeal dz

A
  • stertor?
  • open mouth breathing?
  • obstruction?
  • visible discharge?
  • asymmetry, deformation, masses, ulceration, pain?
  • asymmetry, deformation, masses, ulceration, pain?
  • dental dz, oral masses?
  • ocular retropulsion?
  • regional lymph nodes?
  • pulmonary involvement?
35
Q

characterization of nasal discharge

A
  • symmetry
    • unilateral vs. bilateral
  • character
    • serous, mucoid, mucopurulent, purulent, hemorrhagic
36
Q

PE of airway or pulmonary dz

A
  • can you observe/characterize a cough?
  • respiratory rate, effort, pattern, noises
  • response to throat/neck palpation
  • regional lymph nodes
  • mucous membrane color
  • nasal discharge
  • heart rate/sounds, pulse rhythm/strength/character
37
Q

cough

A
  • sudden expiratory effort producing noisy expulsion of air from lungs
  • glottis is closed at beginning
  • intended to remove real or perceived foreign material or secretions
  • can be voluntary or involuntary
  • symptom not disease!
  • cough receptors located primarily in URT and large airways
  • try to differentiate between cardiac and respiratory causes
38
Q

ausculation for cough

A
  • heart
    • murmur?
    • rate/rhythm?
  • lungs
    • harsh bronchovesicular sounds
    • wheezes/rhochi
    • crackles/rales
    • grunts
    • pleural rubs
    • areas of dull or absent sound
39
Q

comparison of inspiration vs expiration

A
  • timing and effort
  • helps with localization
  • helps with differential diagnosis
  • pay attention to normal breathing
40
Q

respiratory distress

A
  • “difficult breathing”
  • abnormal breathing rate and/or effort
  • sign of ineffective oxygen delivery to tissues
  • very important to recognize and identify this
41
Q

pathophysiology of respiratory distress

A

components of adequate O2 delivery:

  • oxygen in air
  • enough air gets to lung
  • air moves from inside lungs to blood
  • blood able to hold enough oxygen
  • blood able to get to tissues

this process involves environment, nervous system, respiratory system, CV system and hematologic system

42
Q

respiratory distress: patient evaluation

A
  • be very careful with these patients
  • stress can significantly worsen respiratory distress
  • make diagnostic and therapeutic plans accordingly
  • keep ABCs in mind
  • observation of respiration
  • auscultation

true respiratory distress automatically localizes problem to level of larynx or lower

43
Q

localization and respiratory distress

A
  • stertor = nasal involvement
  • true respiratory distress = larynx or below
  • respiratory distress can occur without primary pulmonary disease
  • muffled lung sounds support pleural space dz
  • expiratory effort supports intrathoracic airway lesion(s)
  • inspiratory effort supports extrathoracic airway lesion(s)

Cardiopulmonary Exam 1 (10 decks)

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