Pulmonary Embolism Flashcards
What are the clinical signs of a PE?
Chest pain Dyspnea Cough Apprehension Disorientation 2/3 of patients who suffer a fatal PE do so within 30 minutes of becoming symptomatic
Common Signs and Symptoms of Pulmonary Disease
Cough Dyspnea Abnormal Sputum Chest pain Hemoptysis Cyanosis Digital Clubbing Altered Breathing Patterns
What is a persistent dry cough commonly caused by?
tumor, congestion, or hypersensitive airways (allergies)
What does purulent sputum indicate?
infection
A productive cough with nonpurulent sputum indicates:
nonspecific and just indicates irritation
What does dyspnea usually indicate?
inadequate ventilation or insufficient amounts of oxygen in the circulating blood
What causes dyspnea?
Usually caused by diffuse and extensive rather than focal pulmonary disease
Orthopnea
Dyspnea when the person is lying down
Fluid shift leads to increased fluid in the lung.
The abdominal contents also exert pressure on the diaphragm, decreasing the efficiency of the respiratory muscles
Factors contributing to the sensation of dyspnea
Increased work of breathing
Respiratory muscle fatigue
Decreased breathing reserve
Strong emotions, particularly anxiety and anger
Pulmonary pain patterns
Usually localized in the substernal or chest region over the involved lung fields
May include anterior chest, side, or back
Where can pulmonary pain radiate?
the neck, upper trapezius, costal margins, thoracic back, scapulae, or shoulder
What does pleural irritation result in?
sharp, localized pain that is aggravated with any respiratory movement
What relieves chest pain?
autosplinting (or lying on the affected side), which diminishes the movement of that side of the chest
Hemoptysis
Coughing and spitting up blood
What does hemoptysis indicate?
Infection Inflammation Abscess Tumor Infarction
Cyanosis
A bluish discoloration of the skin and mucous
What can cyanosis be?
central
peripheral
Central cyanosis:
caused by decreased oxygen saturation of hemoglobin in arterial blood
Best observed in buccal (cheek) mucous membranes and lips
Peripheral cyanosis:
slow blood circulation in fingers and toes
Best observed in nail beds
Conditions that may cause clubbing:
Cystic fibrosis Lung cancer Bronchiectasis Pulmonary fibrosis Congenital heart disease Lung abscess Can be present with disorders of the liver and GI tract
Altered Breathing Patterns
Occur in response to any condition affecting the pulmonary system
Apneustic breathing
Gasping inspiration followed by short expiration
Localizes damage to the midpons and is most commonly due to a basilar artery infarct
Ataxic or Biot’s breathing
A haphazard random distribution of deep and shallow breaths
Caused by disruption of the respiratory rhythm generator in the medulla.
Cheyne-Stokes respiration
repeated cycle of deep breathing followed by shallow breaths or cessation of breathing
What is the most common cause of Cheyne-Stokes respiration?
CHF
Can occur with renal failure, meningitis, drug overdose, and increased intracranial pressure
Kussmaul’s respiration
a distressing dyspnea characterized by increased respiratory rate (>20/min), increased depth of respiration, panting, and labored respiration typical of air hunger
What condition is associated with Kussmaul’s respiration ?
strenuous exercise, metabolic acidosis
What causes hyperventilation?
anxiety, acute head injury, blood oxygenation, fever
What causes hypoventilation?
fibromyalgia syndrome, chornic fatigue syndrome, sleep apnea, muscle fatigue, muscle weakness, malnutrition, fever
What causes apneustic breathing?
midpons lesion, basilar artery infarct
What causes Biot’s breathing?
exercise, shock, cerebral hypoxia, heat stroke, spinal meningitis, head injury, brain abscess, encephalitis
Hypoxemia
Deficient oxygenation of arterial blood, which may lead to hypoxia
Caused by respiratory alterations
Hypoxia
A broad term meaning diminished availability of oxygen to the body tissues
May occur anywhere in the body
Causes of hypoxia
Caused by alterations of other systems that have no relation to changes in the pulmonary system
Pulmonary edema
Accumulation of fluid in the tissues and air spaces of the lung
Causes of pulmonary edema?
heart disease, esp. left ventricular failure, acute HTN, or mitral valve prolapse
pulmonary disease complications
liver kidney disorder
Later signs of pulmonary edema?
persistent cough, slight dyspnea, diaphoresis, and intolerance to exercise
What is seen in pulmonary edema patients?
May see engorged neck and hand veins, pitting edema of the extremities, and the paroxysmal noctural dyspnea
What may be one of the first signs of dyspnea?
difficulty breathing when lying down, relieved with sitting up (orthopnea)
Preferred position of pulmonary edema patients?
sitting position with legs dangling over the edge of the plinth is preferred position
Pulmonary Tuberculosis
An infectious, inflammatory systemic disease that affects the lungs that may disseminate to involve lymph nodes and other organs
Cause of Pulmonary Tuberculosis
mycobacterium tuberculosis
Symptoms suggestive of TB include
Productive cough of more than 3 weeks duration especially when accompanied by other symptoms Weight loss Fever Night sweats Fatigue Malaise Anorexia
TB patients may have:
Chest expansion may be decreased
Tracheal deviation may be present
Postural adaptations may have developed in late stages because of poor breathing patterns
Should also assess overall posture, gait, muscle strength, balance, and functional mobility
Chronic Obstructive Pulmonary Disease (COPD)
number of disorders that affect movement of air in and out of the lungs, particularly within the small airways. The most important of these disorders are obstructive bronchitis, emphysema, and asthma
Chronic bronchitis
excessive secretion of bronchial mucus and is manifested by daily productive cough for 3 months or more in at least 2 consecutive years
Emphysema
pathologic diagnosis that denotes abnormal permanent enlargement of air spaces distal to the terminal bronchiole, with destruction of their walls and without obvious fibrosis
What does exercise do for COPD patients?
enhance CV fitness and train skeletal muscles to function more effectively
Asthma
inflammatory condition with secondary bronchospasm marked by recurrent attacks of dyspnea, with wheezing due to the spasmodic constriction of the bronchi
Need to monitor vital signs if suspected (asthma):
Increasing tachypnea
Hypertensive BP readings due to hypoxemia
Auscultate the lungs for wheezing and quality of air movement
Pleurisy
pleura (parietal) caused by infections, injury (rib fracture), or tumor
Symptoms of pleurisy:
Sudden onset of symptoms – usually a sharp, sticking chest pain worse with inspiration, coughing, sneezing, or movement associated with deep inspiration
May have cough, fever, chills, and rapid shallow breathing (tachypnea)
Pleural Effusion
Collection of fluid in the pleural space (between the membrane encasing the lung and the membrane lining the thoracic cavity)
Infected pleural effusion
an accumulation of pus that occurs occasionally as a complication of pleurisy or some other respiratory disease, usually pneumonia
Lab findings for pulmonary embolism:
ECG
Arterial blood gas
D-dimer
Wells for PE
S&S of DVT Alternative diagnosis less likely HR greater than 100 Immobilization for more than 3 days in previous 4 weeks Previous DVT or PE Hemoptysis Cancer
Wells high:
greater than 6
Wells moderate:
2-6
Wells low:
less than 2
