Respiratory Lecture part 2

Question 1

Do you get a fever with a heart failure exacerbation or a COPD exacerbation?NO! so that helps your differential diagnosis

Question 2

Is it worse or better any time of day? Is it new? Is it dry? Is it productive? If it is productive then we get into the next of what does it look like

Question 3

SOB=______________

Answer 3

Shortness of breath

Question 4

DOE=_____________ (ex:walking to the mailbox and back, maybe you put on a shirt and you got to take a break because your out of breath before you can continue getting dressed

Answer 4

Dyspnea on Exertion

Question 5

Dyspnea on exertion trouble breathing while doing something

Question 6

____________= shortness of breath while lying down that’s relieved by sitting or standing up

Answer 6

Orthopnea

Question 7

You will have heart failure patients tell you that they wake up in the middle of the night…gasping for air…very different than sleep apnea…very sequential short losses of air delivery as opposed to cardiac…

Question 8

sleep apnea is more a respiratory

Heart failure is more cardiac

Question 9

You can classify orthopnea in someone who has sleep apnea but usually we describe it in heart failure patients

Question 10

Paroxysmal nocturnal dyspnea happens at nighttime…paroxysmal means _______________so you get these bouts of trouble breathing at night

Answer 10

occassional

Question 11

_____________ its more commonly described when you have patients who tell you that they don’t sleep in bed anymore…they sleep on a recliner because they can’t sleep laying down because they have trouble breathing

Answer 11

Orthopnea

Question 12

From folks who are now moved to the living room or recliner in their sleep…sleeping in that recliner that’s usually because of the inability to get full inflation and air to breathe

Question 13

Chest pain is it respiratory or cardiac in nature, where is that pain, whats it like,is it radiating, it could be anxiety as well, is there a chest tightness to it

Question 14

Cyanosis is bluish, and gray…can be found in lips, and fingertips, clubbing, maybe the tip of nose or ears

Question 15

Looking at rhythm are we hyperventilating or hypoventilating…is there an increased respiratory rate or a depressed respiratory rate

Question 16

The depth and ease of breathing, using neck or accessory muscles…if someone is sitting and there bending over trying to breathe and their lips are pursed they are really just trying to get air in and that characterizes there respiratory issues

Question 17

_______________ (Take thumbs and make them parallel I’m going to line them up with the spine…I’m going to put the rest of my fingers over the lungs and as you breathe in…the lungs expands and so are your hands)

The goal is for the expansion to be symmetrical

Answer 17

Thoracic Expansion

Question 18

_____________= palm of your hands on the persons lung and says the word 99…when you put your hands on those lung feels and someone says 99 you feel the vibration of that…it’s the vibration and what your trying to feel they should be equal vibrations on both of those lung fields that’s tactile fremitus

If you have a shirt on then the shirt is going to absorb the vibrations…if you wear something thin you can hear vibrations from tactile fremitus

Answer 18

Tactile fremitus

Question 19

When we do percussion your trying to assess is there a mass in any part of those lung fields and so we break the lungs into 3 categories…

upper,middle,and lower

Question 20

Use middle finger and your putting that finger on the lung the back covering the lung and your tapping for percussion….if you have really long nails its not going to work…your tapping…upper left…upper right…middle left…middle right…lower left…lower left…trying to compare them is one side dull while the other is not….if its dull there is some kind of infection or mass or something in there