pulmonary HPI AND PE Flashcards
dyspnea
difficult and labored breathing with SOB
important to establish with dyspnea
- present at rest
- walking on level or climbing stairs
- necessary to stop and rest
- what ADL’s bring on dyspnea
orthopnea
SOB begins or increases when laying down
paroxysmal nocturnal dyspnea
sudden SOB after a period of sleep
platypnea
dyspnea increases in the upright posture
Kussmaul breathing
deep labored breathing
-a form of hyperventilation
kussmaul breathing is associated with
metabolic acidosis
-breathing is rapid and shallow but as acidosis worsens breathing gradually becomes labored and gasping
cheyne-stokes respirations
abnormal breathing with progressively deeper and sometimes faster breathing followed by gradual decrease that results in temporary apnea
-this is a repetitive pattern
cheyne-stokes is a oscillation of …
ventilation between apnea and hypernea with a crescendo-decresendo pattern and is associated with changing serum partial pressures of oxygen and carbon dioxide
rhonchi
course crackles
-coarse rattling caused by secretions (rolling thunderstorm)
dx for rhonchi
pneumonia or chronic bronchitis
rales
fine crackles
soft high-pitched and very brief sound (velcro opening)
rales is associated with
usually indicates an interstitial process such as pulmonary fibrosis or CHF
fremitus
vibration transmitted though the body when patient speaks 99
two types of fremitus
tactile: vibration intensity felt on the chest wall
vocal: heard with a stethoscope on the chest wall
fremitus intensity increases and decreases
increases: consolidation or fibrosis
decreases: fluid or air (effusion, pneumothorax)
bronchial space
is upper center chest
bronchovesicular space
is the branches of the trachea like a vest for your lung tree - middle chest
vesicular space
outer portion of the lung fields
adventitious breath sounds
abnormal breath sounds heard during auscultation
- pleural rub
- rales
- rhonchi
- stridor-foreign body
- wheezes
anoxia
total absence of oxygen in body tissues
pneumothorax
collection of air in the pleural cavity
hemothorax
collection of blood in the pleural cavity
pleural effusion
abnormal presence of fluid in the pleural cavity
either trauma of spontaneous
spontaneous pneumothorax patient description
25 yo white tall skinny male usually smoker walking in with acute onset of SOB
underlying pathology for pink puffer
emphysema
pathophysiology for pink puffer
destruction of the airway distal to the terminal bronchiole, this includes the gradual destruction of the pulmonary capillary bed and thus decreased inability to oxygenate the blood
-less surface area for gas exchange there is also less vascular bed for gas exchange
blue bloater underlying pathology
chronic bronchitis
blue bloater pathophysiology
caused by excessive mucus production with airway obstruction resulting from hyperplasia of mucus-producing glands, goblet cell metaplasia and chronic inflammation around bronchi
-unlike emphysema the pulmonary capillary bed is undamaged
patient description of blue bloater
age: 40-45
dyspnea: mild
cough: early with copious sputum
overweight & cyanotic
peripheral edema
rhonchi and wheezing
cardiac enlargement
patient description for pink puffer
older thin cachectic
severe dyspnea
pursed lip breathing and accessory muscle use
decreased breath sounds
ineffective cough
x-ray: hyperinflation with flattened diaphragm
where does the pink come from in pink puffer
increased CO2 retention
pectus excavatum
aka sunken or funnel chest
pectus carinatum
pigeon chest -prominent bony protrusion of chest
barrel chest
determine by looking at the anteriorposterior and transverse chest ratio.
- normal adult is a 1:2
- barrel chested patients is 1:1
post-tussive crackles
listen-cough-listen
whispered pectoriloguy
bilaterally
increased volume of whisper throughout chest wall
egophony
E to A change bilaterally
