Pulmonary Screening

Question 1

What are the two most common symptoms associated with pulmonary disorders?

Answer 1

cough and dyspnea

others may include: chest pain, abnormal sputum, hemoptysis, cyanosis, digital clubbing, altered breathing patterns

Question 2

Productive cough w/ purulent sputum indicates ______. Productive cough w/ nonpurulent sputum indicates _______.

Answer 2

Infection

Airway Irritation

Question 3

Shortness of breath (SOB) or Dyspnea usually indicates _______.

Answer 3

Hypoxemia

-usually caused by diffuse or extensive pulmonary disease. If dyspnea occurs when lying down it is called orthopnea.

Question 4

Gasping inspiration with short expiration is called ______. This is typically from midpons lesion or basilar artery infarct.

Answer 4

Apneustic breathing

Question 5

Irregular pattern of deep and shallow breaths w/ abrupt pauses is called _____. This is caused by disruption of the respiratory rhythm generator in the medulla.

Answer 5

Ataxic or Biot’s breathing
-common from exercise, shock, cerebral hypoxia, heat stroke, spinal meningitis, head injury, brain abscess, or encephalitis.

Question 6

The most common sites for referred pain from the pulmonary system are _______.

Answer 6

• chest, ribs, upper trapezius, shoulder, thoracic spine.

- pulmonary pain usually increases w/ inspiratory movements such as laughing, coughing, sneezing, etc.

Question 7

_______ pain is referred to sites in the neck or anterior chest at the same levels as the points of irritation in the air passages.

Answer 7

Tracheobronchial

Question 8

Sharp, localized pain that is aggravated by any respiratory movement is called _______

Answer 8

pleural irritation

Question 9

Diaphragmatic pleura receive dual pain innervation from which 2 nerves?

Answer 9

Phrenic and Intercostal

• peripheral portions results in sharp pain along the costal margins.
• central portions results in sharp pain referred to the upper trapezius and ipsilateral shoulder

Question 10

Acid-Base balance in the body needs to remain between what levels to maintain proper hemostasis for breathing?

Answer 10

7.35 - 7.45

Question 11

______ refers to a condition of decreased pulmonary ventilation which increases CO2 retention

Answer 11

Respiratory Acidosis

-as hypoxia becomes severe - will see diaphoresis, rapid breathing, restlessness, cyanosis, confusion, decreased ventilation

Question 12

When there is an increased respiratory rate and depth there will be a decrease in CO2 and H+ creating _______.

Answer 12

Respiratory Alkalosis

• symptoms include hyperventilation, lightheadedness, dizziness, syncope, and numbness in face/fingers/toes
• if this continues, kidneys will excrete H+ or bicarbonate thus adjusting pH called renal compensation.

Question 13

Obstructive bronchitis, emphysema, and asthma combine to form what condition?

Answer 13

COPD - all will narrow the airways

Question 14

S/S of mild fever, malaise, back and muscle pain, sore throat, cough w/ sputum, wheezing, possible laryngitis may suggest _______

Answer 14

Acute Bronchitis

Question 15

S/S of persisten cough w/ sputum production, reduced chest expansion, wheezing, fever, dyspnea, cyanosis, decreased exercise tolerance may suggest _______.

Answer 15

Chronic Bronchitis

-eventually the bronchial walls thicken and mucous glands increase

Question 16

________ is a progressive and chronic pulmonary condition which occurs after infections. There is a vicious cycle of infection and inflammation of the bronchial wall causing lung damage.

Answer 16

Bronchiectasis

-S/S include: chronic wet cough w/ foul secretions, hemoptysis, wheezing, dyspnea, sinusitis, anemia, malaise, fever chills.

Question 17

_______ is a condition which develops over a long history of chronic bronchitis in which alveolar walls are destroyed leading to increased ventilatory dead space.

Answer 17

Emphysema

-S/S include: SOB, dyspnea, orthopnea, chronic cough, barrel chest, weight loss, malaise, accessory muscles for breathing, wheezing, pursed-lip breathing

Question 18

Patient’s with this inflammatory respiratory disorder experience episodes of SOB, wheezing, cough, and may say “I’m more out of shape than I thought”

Answer 18

Asthma

-may also experience irregular breathing (prolonged expiration), cough w/ sputum, hunched posture, unusual pallor, fatigue with sports or activity

Question 19

This condition may result from aspiration, inhalation of harmful chemicals/smoke/dust, or some type of infection. The patient may experience fever, chills, sweats, pleuritic pain, cough w/ sputum, dyspnea, fatigue, tachypnea, general aches, myalgia, and possible shoulder pain.

Answer 19

Pneumonia

Question 20

Very young/old, smoking, air pollution, recent chest surgery, chronic disease, prolonged immobility, aspiration, immunosuppressive medication are all risk factors for _______.

Answer 20

Pneumonia

Question 21

Health care workers, older age, overcrowded housing, immigrants, alcohol dependency, under age 5, reduced immunity, RA, DM are all risk factors for ________.

Answer 21

Tuberculosis

Question 22

S/S of fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats, frequent productive cough, dyspnea, dull chest pain/tightness suggest ________

Answer 22

Tuberculosis

Question 23

________ is a restrictive lung disease o unknown origin is characterized by inflammation and fibrosis of many organs. Skin changes may precede visceral alterations.

Answer 23

Systemic Sclerosis (scleroderma)

-S/S include exertional dyspnea, nonproductive cough, peripheral edema, orthopnea, paroxysmal nocturnal dyspnea, hemophtysis

Question 24

Age over 50, smoking/tobacco use, low fruit/veggie consumption, exposure to air pollution/chemicals, previous lung disease all predispose to ________

Answer 24

Lung Cancer

-lungs contain enormous capillary beds which flow the entire venous circulation making it easy to metastasize. Clinical signs wont’ be seen until it is at advanced stage.

Question 25

_______ may present w/ vague achy chest pain, pleuritic pain w/ inspiration, unexplained weight loss, hemoptysis, wheezing, dyspnea and possible fever, chills, malaise

Answer 25

Lung Cancer

Question 26

Centrally located lung tumors cause ________

Answer 26

increased cough, dyspnea, diffuse chest pain referred to shoulder/scapula/upper back

Question 27

Peripheral located lung tumors cause _________

Answer 27

Often asymptomatic until the tumor extends to the pleura then causes localized sharp, pleuritic pain which is aggravated by inspiration

Question 28

Apical (Pancoast’s) Tumors cause ________

Answer 28

They are usually asymptomatic

Question 29

Lung pain can be confused with _________

Answer 29

Trigger points of the serratus anterior which also mimics C8 nerve root compression

Question 30

_______ is an inherited disease of the exocrine glands affecting the digestive/respiratory systems which accumulates a thick and sticky mucus ultimately obstructing breathing

Answer 30

Cystic Fibrosis

Question 31

With cystic fibrosis, you may see the S/S of _______

Answer 31

persistent cough/wheezing, recurrent pneumonia, excessive appetite, salty skin, foul smelling stools, rapid breathing, barrel chest, accessory muscles used, exertional dyspnea
-other possible symptoms include infertility, nasal polyps, periostitis, glucose intolerance

Question 32

Asbestosis and Mesothelioma are common in which professions?

Answer 32

construction and industry. They will cause scaring of the lung tissue.

Question 33

Pneumoconioses (the dust diseases) are common in which professions?

Answer 33

miners, construction workers, sandblasters, potters, foundry/quarry workers

Question 34

_______ refers to a pulmonary vascular obstruction by a displaced thrombus, air bubble, clump of bacteria, or vegetations on heart valves.

Answer 34

Pulmonary Embolism

-DVT is the most common type of PE

Question 35

The 3 main risk factors for a DVT are _____, ______, _______.

Answer 35

blood stasis, endothelial injury, hypercoaguable states

Question 36

Tenderness, leg pain, unilateral swelling, warmth, discoleration all suggest what?

Answer 36

DVT

-can use Homan’s sign

Question 37

Approximately ______ the cases of DVT are asymptomatic. Approximately ______ of clients with apparent DVT have no DVT upon testing.

Answer 37

• 1/2

- 1/3

Question 38

Dyspnea, pleuritic chest pain (sharp, localized), persistent cough, hemoptysis, apprehension, increased HR, increased respiratory rate, fever all suggest ________

Answer 38

pulmonary embolism

Question 39

Peripheral edema, chronic cough, exertional dyspnea, distention of neck veins, fatigue, wheezing, weakness suggest a medical emergency called ________

Answer 39

Cor Pulmonale. This is a sudden dilation of the right ventricle as a result of PE

Question 40

________ is a condition of vasoconstriction of the pulmonary arterial vascular bed. It can be self-perpetuating inducing eventual right-sided heart failure.

Answer 40

Pulmonary Arterial Hypertension.

-it may present as progressive dyspnea, dull retrosternal chest pain, fatigue, dizziness on exertion.

Question 41

________ is a condition of the pleura caused by infection, injury, or tumor.

Answer 41

Pleurisy

-chest pain is sudden and aggravated by breathing, coughing, laughing. May also see fever, chills, and tachypnea

Question 42

________ describes a situation where free air in the pleural cavity between the visceral and parietal pleurae. This is common in _______, ________, _______

Answer 42

Pneumothorax.

-trauma, surgery, scuba diving

Question 43

Pneumothorax will present as….

Answer 43

dyspnea, change in respiratory movements, increased neck vein distention, weak/rapid pulse, fall in BP, dry/hacking cough, shoulder pain, sitting upright is most comfortable.

Question 44

Abrupt onset of dyspnea w/ weak and rapid pulse and fall in BP calls for _______

Answer 44

Immediate Medical Attention

Question 45

Chest, rib, or should pain w/ neurological symptoms following recent scuba diving calls for ________

Answer 45

Immediate Medical Attention

Question 46

Seeing symptoms of inadequate ventilation or CO2 retention calls for _________

Answer 46

Immediate Medical Attention

Question 47

Shoulder pain aggravated by respiratory movements calls for ________

Answer 47

Physician Referral

Question 48

Shoulder pain that is aggravated by supine positioning or pain that improves when lying down and improves when sitting up or leaning forward calls for ________

Answer 48

Physician Referral

-often is pleuritic in origin

Question 49

Shoulder or chest pain that subsides while lying on painful side calls for ________

Answer 49

Physician Referral

Question 50

Signs of asthma or bronchial activity during exercise calls for _______

Answer 50

Physician Referral

Question 51

Weak and rapid pulse accompanied by fall in PB calls for ________

Answer 51

Physician Referral

-likely pneumothorax

Question 52

Persistent cough, dyspnea, or constitutional symptoms calls for _______

Answer 52

Physician Referral

Question 53

Clues to Screen for Pulmonary Disease

Answer 53

• over 40, smoker, PMH of cancer
• upper respiratory infection
• MS pain exacerbated by respiratory movements
• respiratory movements diminished or absent on one side (pneumothorax)
• dyspnea accompanied by unexplained weight loss (lung cancer)
• unable to localize pain by palpation
• pain does not change w/ spinal motions or changes in position
• symptoms increased w/ recumbency (puts more pressure on the diaphragm)
• if eliminate trigger points resolves symptoms = MS condition
• if an older person has shoulder pain and confusion (diaphragmatic impingement)