Pulmonary Screening Flashcards
What are the two most common symptoms associated with pulmonary disorders?
cough and dyspnea
others may include: chest pain, abnormal sputum, hemoptysis, cyanosis, digital clubbing, altered breathing patterns
Productive cough w/ purulent sputum indicates ______. Productive cough w/ nonpurulent sputum indicates _______.
Infection
Airway Irritation
Shortness of breath (SOB) or Dyspnea usually indicates _______.
Hypoxemia
-usually caused by diffuse or extensive pulmonary disease. If dyspnea occurs when lying down it is called orthopnea.
Gasping inspiration with short expiration is called ______. This is typically from midpons lesion or basilar artery infarct.
Apneustic breathing
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.
Ataxic or Biot’s breathing
-common from exercise, shock, cerebral hypoxia, heat stroke, spinal meningitis, head injury, brain abscess, or encephalitis.
The most common sites for referred pain from the pulmonary system are _______.
- chest, ribs, upper trapezius, shoulder, thoracic spine.
- pulmonary pain usually increases w/ inspiratory movements such as laughing, coughing, sneezing, etc.
_______ pain is referred to sites in the neck or anterior chest at the same levels as the points of irritation in the air passages.
Tracheobronchial
Sharp, localized pain that is aggravated by any respiratory movement is called _______
pleural irritation
Diaphragmatic pleura receive dual pain innervation from which 2 nerves?
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
Acid-Base balance in the body needs to remain between what levels to maintain proper hemostasis for breathing?
7.35 - 7.45
______ refers to a condition of decreased pulmonary ventilation which increases CO2 retention
Respiratory Acidosis
-as hypoxia becomes severe - will see diaphoresis, rapid breathing, restlessness, cyanosis, confusion, decreased ventilation
When there is an increased respiratory rate and depth there will be a decrease in CO2 and H+ creating _______.
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.
Obstructive bronchitis, emphysema, and asthma combine to form what condition?
COPD - all will narrow the airways
S/S of mild fever, malaise, back and muscle pain, sore throat, cough w/ sputum, wheezing, possible laryngitis may suggest _______
Acute Bronchitis
S/S of persisten cough w/ sputum production, reduced chest expansion, wheezing, fever, dyspnea, cyanosis, decreased exercise tolerance may suggest _______.
Chronic Bronchitis
-eventually the bronchial walls thicken and mucous glands increase
________ 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.
Bronchiectasis
-S/S include: chronic wet cough w/ foul secretions, hemoptysis, wheezing, dyspnea, sinusitis, anemia, malaise, fever chills.
_______ is a condition which develops over a long history of chronic bronchitis in which alveolar walls are destroyed leading to increased ventilatory dead space.
Emphysema
-S/S include: SOB, dyspnea, orthopnea, chronic cough, barrel chest, weight loss, malaise, accessory muscles for breathing, wheezing, pursed-lip breathing
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”
Asthma
-may also experience irregular breathing (prolonged expiration), cough w/ sputum, hunched posture, unusual pallor, fatigue with sports or activity
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.
Pneumonia
Very young/old, smoking, air pollution, recent chest surgery, chronic disease, prolonged immobility, aspiration, immunosuppressive medication are all risk factors for _______.
Pneumonia
Health care workers, older age, overcrowded housing, immigrants, alcohol dependency, under age 5, reduced immunity, RA, DM are all risk factors for ________.
Tuberculosis
S/S of fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats, frequent productive cough, dyspnea, dull chest pain/tightness suggest ________
Tuberculosis
________ is a restrictive lung disease o unknown origin is characterized by inflammation and fibrosis of many organs. Skin changes may precede visceral alterations.
Systemic Sclerosis (scleroderma)
-S/S include exertional dyspnea, nonproductive cough, peripheral edema, orthopnea, paroxysmal nocturnal dyspnea, hemophtysis
Age over 50, smoking/tobacco use, low fruit/veggie consumption, exposure to air pollution/chemicals, previous lung disease all predispose to ________
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.
_______ may present w/ vague achy chest pain, pleuritic pain w/ inspiration, unexplained weight loss, hemoptysis, wheezing, dyspnea and possible fever, chills, malaise
Lung Cancer
Centrally located lung tumors cause ________
increased cough, dyspnea, diffuse chest pain referred to shoulder/scapula/upper back
Peripheral located lung tumors cause _________
Often asymptomatic until the tumor extends to the pleura then causes localized sharp, pleuritic pain which is aggravated by inspiration
Apical (Pancoast’s) Tumors cause ________
They are usually asymptomatic
Lung pain can be confused with _________
Trigger points of the serratus anterior which also mimics C8 nerve root compression
_______ is an inherited disease of the exocrine glands affecting the digestive/respiratory systems which accumulates a thick and sticky mucus ultimately obstructing breathing
Cystic Fibrosis
With cystic fibrosis, you may see the S/S of _______
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
Asbestosis and Mesothelioma are common in which professions?
construction and industry. They will cause scaring of the lung tissue.
Pneumoconioses (the dust diseases) are common in which professions?
miners, construction workers, sandblasters, potters, foundry/quarry workers
_______ refers to a pulmonary vascular obstruction by a displaced thrombus, air bubble, clump of bacteria, or vegetations on heart valves.
Pulmonary Embolism
-DVT is the most common type of PE
The 3 main risk factors for a DVT are _____, ______, _______.
blood stasis, endothelial injury, hypercoaguable states
Tenderness, leg pain, unilateral swelling, warmth, discoleration all suggest what?
DVT
-can use Homan’s sign
Approximately ______ the cases of DVT are asymptomatic. Approximately ______ of clients with apparent DVT have no DVT upon testing.
- 1/2
- 1/3
Dyspnea, pleuritic chest pain (sharp, localized), persistent cough, hemoptysis, apprehension, increased HR, increased respiratory rate, fever all suggest ________
pulmonary embolism
Peripheral edema, chronic cough, exertional dyspnea, distention of neck veins, fatigue, wheezing, weakness suggest a medical emergency called ________
Cor Pulmonale. This is a sudden dilation of the right ventricle as a result of PE
________ is a condition of vasoconstriction of the pulmonary arterial vascular bed. It can be self-perpetuating inducing eventual right-sided heart failure.
Pulmonary Arterial Hypertension.
-it may present as progressive dyspnea, dull retrosternal chest pain, fatigue, dizziness on exertion.
________ is a condition of the pleura caused by infection, injury, or tumor.
Pleurisy
-chest pain is sudden and aggravated by breathing, coughing, laughing. May also see fever, chills, and tachypnea
________ describes a situation where free air in the pleural cavity between the visceral and parietal pleurae. This is common in _______, ________, _______
Pneumothorax.
-trauma, surgery, scuba diving
Pneumothorax will present as….
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.
Abrupt onset of dyspnea w/ weak and rapid pulse and fall in BP calls for _______
Immediate Medical Attention
Chest, rib, or should pain w/ neurological symptoms following recent scuba diving calls for ________
Immediate Medical Attention
Seeing symptoms of inadequate ventilation or CO2 retention calls for _________
Immediate Medical Attention
Shoulder pain aggravated by respiratory movements calls for ________
Physician Referral
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 ________
Physician Referral
-often is pleuritic in origin
Shoulder or chest pain that subsides while lying on painful side calls for ________
Physician Referral
Signs of asthma or bronchial activity during exercise calls for _______
Physician Referral
Weak and rapid pulse accompanied by fall in PB calls for ________
Physician Referral
-likely pneumothorax
Persistent cough, dyspnea, or constitutional symptoms calls for _______
Physician Referral
Clues to Screen for Pulmonary Disease
- 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)
