Screening for Pulmonary Disease (Exam 2) Flashcards
List the signs and symptoms of pulmonary disease.
what are the 2 most common?
- *1.Cough (most common)
2. Dyspnea (most common)**
3. Cyanosis
4. Clubbing
5. Altered Breathing Patterns
6. May also demonstrate chest pain, abnormal sputum, hemoptysis
describe cough
Persistent dry cough or
Productive cough
• Purulent sputum=may indicate infection
• Non-purulent sputum=airway irritation
• Rust colored sputum=may be a sign of pneumonia
• Hemoptysis=indicates pathologic condition
describe what dyspnea usually indicates
usual indicates hypoxia (can indicate fear/anxiety as well)
describe cyanosis
bluish color of skin and mucous membranes
describe clubbing
when would it require a med referral?
Thickening/widening of terminal phalanges of fingers and toes
• Usually results from chronic O2 deprivation in tissue beds
• Often observed in pts with COPD, congenital heart defects and cor pulmonale
• Can occur w/in 10 days in pt with acute systemic condition (ie pulmonary abscess, malignancy or polycythemia)
• Rapid development of digital clubbing over the course of a 10-day to 2-week period requires immediate medical evaluation.
• Schamroth’s window disappears with clubbed fingernails (the window of space visible between two fingers when placed facing each other)
what is an altered breathing pattern?
Changes in rate, depth, regularity and effort
We should screen individuals presenting with complaints of what body regions for pulmonary disease in the presence of pulmonary signs and symptoms? (5 main sites)
• Most common referral sites are chest, ribs, upper trap, shoulder, and thoracic spine
- What are the most common pulmonary conditions that may mimic a MSK disorder?
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Summarize key findings for pulmonary pain patterns
Pulmonary Pain patterns: Pain from pulmonary source
- Increases with inspiratory movements
- Pt notes dyspnea, persistent cough, fever and chills
- Palpation and resisted movements will not reproduce
- Symptoms may worsen with recumbency
How would you differentiate intercostal strain/broken rib from a pulmonary condition?
- Autosplinting will NOT be present.
Pleural Pain: Pleural irritation is sharp, localized pain
- Autosplinting: Pain is relieved by lying ON the affected side.
- Present pleurisy, pneumonia, pulmonary infarct, tumor, pneumothorax
Diaphragmatic Pleural Pain:
- Peripheral portions: Sharp pain along costal margins (can refer to lumbar region)
- Central portions: sharp pain referred to upper trap and shoulder on ipsilateral side of stimulation
- How would you differentiate intercostal strain/broken rib from a pulmonary condition?
Autosplinting for pulmonary NOT intercostal strain/broken rib, not reproducible with palapation etc.
What is auto splinting
Pain is relieved by lying ON the affected side.
- What region(s) of the body is referred pain likely to be in a patient with pneumonia?
- Sudden/sharp pleuritic chest pain
- Shoulder pain
- What areas of the body is lung cancer most likely to metastasize to? Which are is most common?
- Metastasizes usually to long bones, vertebral column, liver, adrenal glands and brain
- Brain is most common, with 50% of cases metastasize to the brain
9What primary cancers are most likely to metastasize to the lung?
- Kidney
- breast
- pancreas
- colon
- uterus
What clinical features would increase concern for a Pancoast’s tumor?
what nerves are most frequently involved?
Where is the pain for most people (most common initial symptom)
Apical (Pancoast’s) Tumor
- Tumor of the lung apex
- Frequently involve 8th cervical and 1st thoracic nerve
- Presents in distribution of C8, T1 and T2 dermatomes
- Loss of hand function
- Horner’s syndrome
- Enophthalmos (sunken in eyes)
- Ptosis
- Anhidrosis (inability to sweat)
- Miosis
- Sharp (posterior) shoulder pain most common initial symptom
- Can mimic thoracic outlet syndrome
Note the clinical signs & symptoms that would accompany a spontaneous pneumothorax. (9)
- Dyspnea
- Change in respiratory movements
- Sudden, sharp chest pain
- Increased neck vein distention
- Weak and rapid pulse
- Fall in BP
- Dry, hacking cough
- Shoulder pain
- Sitting upright is most comfortable position
What is asthma?
Reversible obstructive lung disease
Increased reaction of the airways to various stimuli
Can be life-threatening if not managed
Categorized as conventional asthma, occupational asthma or exercise-induced asthma
What clinical signs and symptoms should you listen for in a patient with asthma?
◦ Wheezing
◦ Irregular breathing with prolonged expiration
◦ Noisy, difficult breathing
◦ Episodes of dyspnea
◦ Clearing the throat
◦ Cough with or without sputum
What clinical signs and symptoms should you look for in a patient with asthma?
◦ Skin retraction (between the ribs)
◦ Hunched-over body position
◦ Pursed-lip breathing
◦ Nostrils flaring
◦ Unusual pallor or unexplained sweating
What are factors that may trigger asthma?
◦ Respiratory infections, colds
◦ Cigarette smoke
◦ Allergic reactions to pollen, mold, animal dander, feather, dust, food, insects
◦ Indoor and outdoor air pollutants, including ozone
◦ Physical exertion or vigorous exercise
◦ Exposure to cold air or sudden temperature change
◦ Excitement or strong emotion, psychologic or emotional stress
Name key characteristics of TB
Bacterial infectious disease
Usually spread by airborne droplets from an actively infected person
Most commonly spread via repeated close contact with an infected person
Most often involves the lungs; however, extrapulmonary TB may affect the kidneys, bone growth plates, lymph nodes and meninges
Rare but TB may affect hip joints and vertebrae (Potts disease) greater risk for spinal fractures
What are risk factors for TB? (7)
What 4 conditions put you at a greater risk for TB?
- Health care workers
- Older adults
- Overcrowded housing
- Alcohol or chemical dependency
- Infants and children <5
- Reduced immunity/malnutrition
- RA, DM, end stage renal disease, GI disease
What are clinical signs and symptoms of TB? (9)
- Night Sweats
- Fatigue
- Malaise
- Anorexia
- Weight loss
- Low-grade fever
- Frequent productive cough
- Dull chest pain/tightness
- Dyspnea
What is cystic fibrosis?
- Inherited disease of the exocrine glands
- Defective copy of CF transmembrane conductance regulator (CFTR)
- Causes salt to accumulate in cell lining in lungs and digestive tissues
- Making surrounding mucus abnormally thick and sticky
- Usually manifests in early childhood
What are clinical signs and symptoms of cystic fibrosis?
- Tachypnea
- Sustained chronic cough with mucus production and vomiting
- Barrel chest
- Use of accessory muscles for respiration
- Cyanosis and digital clubbing
- Exertional dyspnea with decreased exercise tolerance
Further complications
- Pneumothorax
- Hemoptysis
- Right-sided heart failure secondary to pulmonary hypertension
What are the 3 most common signs of a PE?
Dyspnea
Tachypnea
Pleuritic Chest Pain
How are the Well’s criteria for a PE interpreted?
a. 0-2 points = low risk
b. 3-6 points = moderate risk
c. >6 points = high risk
- What are the current established signs and symptoms of COVID-19? What constitutes a fever? (11)
- Fever or chills (100.4+)
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
What are the emergency warning signs of Covid-19? What should you do if anyone is showing these signs?
◦ Hypoxemia [may be asymptomatic for hypoxemia]
◦ Trouble breathing
◦ Persistent pain or pressure in the chest
◦ New confusion
◦ Inability to wake or stay awake
◦ Bluish lips or face
seek immediate emergency care if displaying these signs
- List as many clues that would prompt you to screen for a pulmonary condition as you can.
•Hx of smoking for many years
•Hx of breast, prostate, kidney, pancreas, colon or uterine CA
•Recent upper respiratory infection
•MSK pain increased by respiratory movements
•Respiratory movements are diminished or absent on one side
Dyspnea
•Unable to localize pain with palpation
•Pain unchanged by spinal motions
•Pain unchanged with alterations of position
•Increased symptoms with recumbency
•Presence of pulmonary signs/symptoms
•Autosplinting decreases pain
•Older person with shoulder pain and confusion
Guidelines for immediate medical attention
- Abrupt onset of dyspnea with weak and rapid pulse and fall in BP
- Symptoms of inadequate ventilation
Guidelines for MD referral (6)
- Shoulder pain aggravated by respiratory movements
- Shoulder pain aggravated by supine positioning (worse when lying down and improves with sitting up/leaning forward)
- Shoulder/chest pain that subsides with auto-splinting
- Signs of asthma during exercise
- Presence of persistent cough, dyspnea or constitutional symptoms
- Any red flag signs and symptoms in a client with a previous history of CA, especially lung CA
