POMA to Respiratory Disease Flashcards
1
Q
Problem-oriented medical approach to respiratory disease
A
- data base (hx, PE, test results…)
- problem prioritization & definition
- plans (diagnostic, therapeutic, client ed)
- follow-up
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
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
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
5
Q
eupnea
A
normal breathing
6
Q
tachypnea
A
increased rate/frequency
7
Q
bradypnea
A
8
Q
hyperpnea
A
increased depth/airflow
9
Q
hypopnea
A
decreased depth/airflow (shallow breathing)
10
Q
apnea
A
cessation of breathing (>10 sec?)
11
Q
dyspnea
A
difficult, labored breathing
12
Q
hyperventilation
A
tachypnea + hyperpnea
increased rate/freq + increased depth/airflow
13
Q
hypoventilation
A
bradypnea + hypopnea
decreased rate/freq + deceased depth/airflow
14
Q
orthopnea
A
- dyspnea while lying down (positional)
- corrected upon restoring upright position
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
16
Q
ataxic (agonal)
A
- continuous irregular shifts of hyperventilation, hypoventilation & apnea
- pre-death breathing!
17
Q
kussmaul breathing
A
- “air hunger”
- big inspiratory pattern
- can look like airway obstruction
- can be confused with paradoxical breathing
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
crackles
discontinuous bubbling/popping sounds as air passes through fluid or forces collapsed airway/alveolar walls open
26
wheezes
continuous whistling sounds caused by air turbulence in narrowed lower airways
27
end-expiratory grunts
may indicate bronchoconstriction, air trapping
28
chief complaint(s) related to **nose/nasopharynx**
* 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
chief complaint(s) related to **upper airway disease**
* coughing
* wheezing
* altered breathing pattern
* altered I:E (I
* exercise intolerance
* tachypnea, dyspnea, distress
30
species differences in respiratory disease
* 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
breed differences in respiratory disease
* big categories
* tracheal collapse in small breed dogs
* environmental factors (blasto in hunting dogs)
* brachycephalics
* specific rare conditions
* pneumocystis in Dachshunds
32
history questions for nasal/nasopharyngeal disease
* 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
history questions for airway or pulmonary dz
* 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
PE of nasal/nasopharyngeal dz
* **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
characterization of nasal discharge
* symmetry
* unilateral vs. bilateral
* character
* serous, mucoid, mucopurulent, purulent, hemorrhagic
36
PE of airway or pulmonary dz
* 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
cough
* 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
ausculation for cough
* heart
* murmur?
* rate/rhythm?
* lungs
* harsh bronchovesicular sounds
* wheezes/rhochi
* crackles/rales
* grunts
* pleural rubs
* areas of dull or absent sound
39
comparison of inspiration vs expiration
* timing and effort
* helps with localization
* helps with differential diagnosis
* pay attention to normal breathing
40
respiratory distress
* "difficult breathing"
* abnormal breathing rate and/or effort
* sign of ineffective oxygen delivery to tissues
* very important to recognize and identify this
41
pathophysiology of respiratory distress
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
respiratory distress: patient evaluation
* 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
localization and respiratory distress
* 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)
