Respiratory Flashcards
Danger Signals
(5)
COVID-19
Lung Cancer
Acute Carbon Monoxide Poisoning
Pulmonary Emboli
Impending Respiratory Failure (Asthmatic Exacerbation)
COVID-19
Infection is caused by the SARS-CoV-2 virus
- Symptoms appear __ to __ days after exposure and may include?
- For some, the presenting symptom is the sudden loss of t____ and/or s____. Some have cold-like symptoms such as sore ___, nasal _____, and rh_____.
- Persons with ______ medical conditions such as heart or lung disease or diabetes are at higher risk of developing more serious ______.
- Most people have mild illness and are able to recover at ____. Advise patient to call their primary care provider for testing instructions and treatment.
- Close contacts need to self-quarantine for a __-day duration. Patients with serious disease (e.g., trouble breathing, confusion) will need ______.
- Symptoms appear 2 to 14 days after exposure and may include?
- For some, the presenting symptom is the sudden loss of taste and/or smell. Some have cold-like symptoms such as sore throat, nasal congestion, and rhinitis.
- Persons with underlying medical conditions such as heart or lung disease or diabetes are at higher risk of developing more serious complications.
- Most people have mild illness and are able to recover at home. Advise patient to call their primary care provider for testing instructions and treatment.
- Close contacts need to self-quarantine for a 14-day duration. Patients with serious disease (e.g., trouble breathing, confusion) will need hospitalization.
Lung Cancer
Symptoms depend on location(s) and tumor metastases.
- Majority of patients already have ad_____ disease on presentation.
- _____ (50%–75%) in a smoker or former smoker that persists should raise suspicion.
- _____tysis and dys____ may accompany cough.
- Some have ____ pain, which is described as a d___, a___, persistent pain; some have shoulder and/or b____ pain.
- Recurrent _____ on the same lobe might be a sign of local tumor obstruction.
- Can present with ____ loss, an_____, fa___, and f____.
- ______ syndrome (pupil constriction with ptosis) is present in some patients.
Symptoms depend on location(s) and tumor metastases.
- Majority of patients already have advanced disease on presentation.
- Cough (50%–75%) in a smoker or former smoker that persists should raise suspicion.
- Hemoptysis and dyspnea may accompany cough.
- Some have chest pain, which is described as a dull, achy, persistent pain; some have shoulder and/or bone pain.
- Recurrent pneumonia on the same lobe might be a sign of local tumor obstruction.
- Can present with weight loss, anorexia, fatigue, and fever.
- Horner syndrome (pupil constriction with ptosis) is present in some patients.
Lung Cancer
- (1)* most common type of lung cancer (85%).
- Screening test for lung cancer is (1)*?
- The test is recommended for adults age __ to __ years who are chronic ____ (or quit smoking ).
- Non–small-cell lung cancer is the most common type (85%).
- Screening test for lung cancer is an annual low-dose computed tomography (LDCT) of the lung.
- The test is recommended for adults age 55 to 80 years who are chronic smokers (or quit smoking <15 years previously).
ACUTE CARBON MONOXIDE POISONING
- Mild-to-moderate cases of carbon monoxide poisoning can present with (1), the most common symptom.
- It can be accompanied by nausea, malaise, and dizziness. In some cases, it may resemble a viral (1) infection (URI).
- Symptoms are variable and can range from mild con____ to co__. There may be a cherry-___appearance of the skin and lips, but it is considered an “insensitive sign.”
- Severe toxicity can present with se____, syncope, or coma.
- Diagnosis is based on history and physical examination in conjunction with elevated carboxyhemoglobin level measured by __oximetry of an ____ blood gas sample. A venous sample can be used, but it is less accurate.
- Mild-to-moderate cases of carbon monoxide poisoning can present with headache, the most common symptom.
- It can be accompanied by nausea, malaise, and dizziness. In some cases, it may resemble a viral upper respiratory infection (URI).
- Symptoms are variable and can range from mild confusion to coma. There may be a cherry-red appearance of the skin and lips, but it is considered an “insensitive sign.”
- Severe toxicity can present with seizures, syncope, or coma.
- Diagnosis is based on history and physical examination in conjunction with elevated carboxyhemoglobin level measured by cooximetry of an arterial blood gas sample. A venous sample can be used, but it is less accurate.
PULMONARY EMBOLI
- An older adult complains of _____ onset of dyspnea and coughing. Cough may be productive of ___-tinged f____ sputum.
- Other symptoms are ____cardia, pallor, and feelings of impending ____.
- Any condition that increases risk of blood ____ will increase risk of pulmonary embolism (PE).
- These patients have a history of atrial _____, es_____ therapy, sm____, surgery, cancer, pr_____, long bone ______, and prolonged in_____.
- An older adult complains of sudden onset of dyspnea and coughing. Cough may be productive of pink-tinged frothy sputum.
- Other symptoms are tachycardia, pallor, and feelings of impending doom.
- Any condition that increases risk of blood clots will increase risk of pulmonary embolism (PE).
- These patients have a history of atrial fibrillation, estrogen therapy, smoking, surgery, cancer, pregnancy, long bone fractures, and prolonged inactivity.
IMPENDING RESPIRATORY FAILURE (ASTHMATIC EXACERBATION)
- An asthmatic patient presents with tachypnea (>20 breaths/min), tachycardia or bradycardia, c_____, and anxiety.
- The patient appears exhausted, fatigued, and diaphoretic and uses ______muscles to help with breathing.
- Physical exam reveals cyanosis and “_____” lungs with no wheezing or breath sounds audible.
- When speaking, the patient may speak only ___ or two words (cannot form complete sentence because needs to breathe).
- An asthmatic patient presents with tachypnea (>20 breaths/min), tachycardia or bradycardia, cyanosis, and anxiety.
- The patient appears exhausted, fatigued, and diaphoretic and uses accessory muscles to help with breathing.
- Physical exam reveals cyanosis and “quiet” lungs with no wheezing or breath sounds audible.
- When speaking, the patient may speak only one or two words (cannot form complete sentence because needs to breathe).
IMPENDING RESPIRATORY FAILURE (ASTHMATIC EXACERBATION)
Treatment Plan
(1) injection stat.
Call (1).
Oxygen at __ to __ L/min;
(1) nebulizer treatments
parenteral (1)
antihistamines (1)
H2 antagonist (1).
After treatment, what is a good sign?
What is the patient then discharged with?
Adrenaline injection stat.
Call 911.
Oxygen at 4 to 5 L/min;
albuterol nebulizer treatments
parenteral steroids
antihistamines (diphenhydramine)
H2 antagonist (cimetidine).
After treatment, a good sign is if breath sounds and wheezing are present (a sign that bronchi are opening).
Usually discharged with oral steroids for several days (e.g., Medrol Dose Pack).
Normal Breath Sounds
- Lower lobes:* ______ breath sounds (soft and low)
- Upper lobes:* ______ breath sounds (louder)
- Lower lobes:* Vesicular breath sounds (soft and low)
- Upper lobes:* Bronchial breath sounds (louder)
Normal Respiratory Rate
=
- Women tend to have slightly ____ rates than men.
- A very small increase in partial pressure of carbon dioxide (PaCO2) will affect the respiratory rate. But high levels of carbon dioxide (>70–80 mmHg) can _____ respiration and cause head_____, restlessness, un______, and d_____.
In adults is 14 to 18 breaths/min.
- Women tend to have slightly higher rates than men.
- A very small increase in partial pressure of carbon dioxide (PaCO2) will affect the respiratory rate. But high levels of carbon dioxide (>70–80 mmHg) can depress respiration and cause headaches, restlessness, unconsciousness, and death.
Normal Findings: Tachypnea
Increased respiratory rate has many causes, including increased oxygen _____, hyp____, and increased Pa_____.
Many conditions can cause tachypnea, such as p___, fe__, fev___, physical ex____, as____, pn______, P_, and h____thyroidism.
Increased respiratory rate has many causes, including increased oxygen demand, hypoxia, and increased PaCO2.
Many conditions can cause tachypnea, such as pain, fear, fever, physical exertion, asthma, pneumonia, PE, and hyperthyroidism.
Egophony
- Normal =*
- Abnormal =*
- Normal =* Will hear “eee” clearly instead of “bah.” The “eee” sound is louder over the large bronchi because larger airways are better at transmitting sounds; lower lobes have a softer-sounding “eee.”
- Abnormal =* Will hear “bah” sound.
Tactile Fremitus
How to test for tactile fremitus?
- Normal =*
- Abnormal =*
Instruct patient to say “99” or “one, two, three”; use finger pads to palpate lungs and feel for vibrations.
- Normal =* Stronger vibrations are palpable on the upper lobes and softer vibrations on lower lobes.
- Abnormal =* The findings are reversed; may palpate stronger vibrations on one lower lobe (i.e., consolidation); asymmetric findings are always abnormal.
Whispered Pectoriloquy
How to test for this?
- Normal =*
- Abnormal =*
Instruct patient to whisper “99” or “one, two, three.” Compare both lungs. If there is lung consolidation, the whispered words are easily heard on the lower lobes of the lungs.
- Normal:* Voice louder and easy to understand in the upper lobes. Voice sounds are muffled on the lower lobes.
- Abnormal:* Clear voice sounds in the lower lobes or muffled sounds on the upper lobes.
Percussion
How to percuss?
What sound is heard over normal lung tissue?
What sound is heard with chronic obstructive pulmonary disease (COPD), emphysema (overinflating). If empty, the stomach area may be?
What sound is heard with Bacterial pneumonia with lobar consolidation, pleural effusion (fluid or tumor). A solid organ, such as the liver?
Use middle or index finger as the pleximeter finger on one hand. The finger on the other hand is the hammer.
- Resonance* = Normal
- Tympany or Hyperresonance*
- Dull Tone*
Pulmonary Function Test
Gold Standard test for (2) (pre- and post-bronchodilator)
Measures ob_____ vs. r_____ dysfunction
Gold Standard test for Asthma and COPD (pre- and post-bronchodilator)
Measures obstructive vs. restrictive dysfunction
Pulmonary Function Testing Terms
- (1) =* Amount of air that a person can forcefully exhale in 1 second.
(1) = Total amount of air that can be exhaled during the FEV1 test.
(1) = Proportion of a person’s vital capacity that the person is able to expire in 1 second.
Forced expiratory volume in 1 second (FEV1): Amount of air that a person can forcefully exhale in 1 second.
Forced vital capacity (FVC): Total amount of air that can be exhaled during the FEV1 test.
FEV1/FVC ratio: Proportion of a person’s vital capacity that the person is able to expire in 1 second.
FEV1/FVC Ratio
Normal > ___%
COPD < ___%
Normal > 75%
COPD < 70% (0.7)
Obstructive vs. Restrictive Dysfunction
Classify these conditions as obstructive or restrictive dysfunction
Obstructive definition =
Restrictive definition =
- Asthma
- COPD (chronic bronchitis and emphysema)
- Pulmonary Fibrosis
- Diaphragm obstruction
- Bronchiectasis
- Pleural disease
Obstructive = reduction in airflow rates
Restrictive = reduction of lung volume due to decreased lung compliance
- Obstructive
- Obstructive
- Restrictive
- Restrictive
- Obstructive
- Restrictive
Chronic Obstructive Pulmonary Disease
Definition + Permanent loss of (1)
Most characteristic symptom of COPD (1)
FEV1/FVC < ____
Most common cause? Highest incidence in what gender, what age?
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease characterized by the permanent loss of elastic recoil of the lungs, alveolar damage, airflow limitation, chronic inflammation, and changes in the pulmonary vasculature.
Chronic and progressive dyspnea
FEV1/FVC < 0.7 (<70% lung function)
Chronic cigarette smoking, men >40 yo
COPD
Most patients have a mixture of (2)
May have (1) component that overlaps with COPD known as (ACOS)
Pulmonary hypertension aka (1) may develop in later stages
COPD now ___ leading cause of death in US
Most patients have a mixture of emphysema and chronic bronchitis
May have asthma component that overlaps with COPD known as (ACOS-asthma COPD overlap syndrome)
Pulmonary hypertension aka cor pulmonale may develop in later stages
COPD now 4th leading cause of death in US
Chronic Bronchitis
=
This is defined as coughing with excessive mucus production for at least 3 or more months for a minimum of 2 or more consecutive years. There is airway hypersecretion and inflammation.
Emphysema
=
Irreversible enlargement and alveolar damage with loss of elastic recoil result in chronic hyperinflation of the lungs. Expiratory respiratory phase is markedly prolonged.
Asthma
=
Airway inflammation resulting in hyperreactivity. The contribution of each disease (chronic bronchitis, emphysema, asthma) varies in each individual.