Table 8-2 Dyspnea

Question 1

Problems (9)

Answer 1

1. Left sided heart Faiure (left ventricular failture/mitral stenosis)
2. Chronic Bronchitis*
3. COPD - chronic obstructive pulmonary disease
4. Asthma
5. Diffuse Interstitial Lung Disease
   - sarcoidosis,
   - widespread neoplasms
   - asbetsosis
   - idiopathic pulmonary fibrosis
6. Pneumonia
7. Spontaneous Pneumothorax
8. Acute Pulmonary Embolism
9. Anxity with Hypertension

Question 2

Process of Left-sided heart failure

Answer 2

Elevated pressure in pulmonary capillary bed with trasudation of fluid into interstitial spaces and avleoli

Decreased compliance (increased stffness) of lungs

Increased work of breathing

Question 3

is compliance increased or decreased in Left sded heart failture (left ventricular failture/mitral stenosis)

Answer 3

decreased

Question 4

Timing of Left sided heart failture

Answer 4

Dyspnea may progress SLOWLY

OR suddenly as in ACUTE pulonary edema

Question 5

Factors that aggravate left sided heart failure

Answer 5

Exertion

Lying down

Question 6

Factors taht relieve Left sided heart falture

Answer 6

Rest

Sitting up

Though dyspnea may become persistent

Question 7

Ass symptoms of Left heart failure

Answer 7

Cough
Orthopnea
Paroxysal nocturnal dyspnea
sometimes wheezing

Question 8

setting of left sided heart failure

Answer 8

Hx of heart disease or its predisposing factors

Question 9

Process of crhonic bronchitis

Answer 9

Excessive mucus production in bronchi

Followed by chronic obstruction of airway

Question 10

Timing of bronchitis

Answer 10

Chronic productive cough followed by

SLOWLY progressive dyspnea

Question 11

Aggravating factors Bronchitis

Answer 11

Exertion
Inhaled irritinats
Respiratory infections

Question 12

Factors that relieve Bronchitis

Answer 12

Exectroation
Rest
Though dyspnea may become persistent

Question 13

Ass syptoms of Bronchitis

Answer 13

Chronic Productive Cough
Recurrent respiratory infections
Wheezing may develop

Question 14

Setting of Bronchitis

Answer 14

Hx of smoking
air pollutants
recurrent respiratory infections

Question 15

Process of COPD

Answer 15

1. Overdistension of air spaces distal to terminal bronchioles
2. With destruction of alveolar septa and 3. chronic obstructino of airways

Question 16

What is the timing of COPD

Answer 16

Slowly progressive DYSPNEA

Relatively mild cough later

Question 17

Factors that aggravate COPD

Answer 17

Exertion

Question 18

Factors that relieve COPD

Answer 18

Rest

Though dyspnea may become persistent

Question 19

Associated symptoms of COPD

Answer 19

Cough with Scant Mucoid Sputum

Question 20

COPD setting

Answer 20

Hx of smoking
air pollutants
sometimes a familial deficiency in alpha1-antitrypsin

Question 21

Process of Asthma

Answer 21

Bronchial hyperresponsiveness involving release of inflammatory mediators

Increased airway secretion

Bronchoconstriction

Question 22

Timing of Asthma

Answer 22

Acute episodes
separated by symptom-free periods

Nocturnal episodes common

Question 23

Factors That Aggravate Asthma

Answer 23

Variable, including alelrgens, irritants, respiratory infections, eercise, emtion

Question 24

Factors that Relieve Asthma

Answer 24

Separation fro Aggravating factos

Question 25

Ass symptoms with Asthma

Answer 25

Wheezing Coughing Tightness in chest

Question 26

Setting of Asthma

Answer 26

Environmental and Emotional Conditions

Question 27

Types of Diffuse Interstitial Lung Diseases

Answer 27

Environmental and EmSarcoidosis Widespread neoplasms Asbestosis Idiopathic Pulmonary Fibrosis

Question 28

Process of Diffuse Interstitial Lung Disease

Answer 28

Abnormal and widespread infiltration of cells, fluid, and collagen into interstitial spaces between alveoli Many cuases

Question 29

Timing of DILD

Answer 29

Progressive Dyspnea Which varies in its rate of development with the cause

Question 30

Factors that aggravate DILD

Answer 30

Exertion

Question 31

Factors that relive DILD

Answer 31

Rest, though dyspnea may beocome persistant

Question 32

Ass. symptoms with DILD

Answer 32

Often weakness, fatigue. Cough less common than in other lung diseases

Question 33

Setting of DILD

Answer 33

Varied Exposure to one of many substances may be causative

Question 34

Process of Pneumonia

Answer 34

Inflammation of lung parenchyma from the respiratory bronchioles to the alveoli

Question 35

Timing of Pneumonia

Answer 35

An acute ilness, timing varies with causative agent

Question 36

Ass. symptoms of Pneumonia

Answer 36

Pleuritic pain Cough Sputum fever, though not necessarily present

Question 37

Process of spontaneous Pneumothorax

Answer 37

Leakage of air into pleural space through blebs on visceral pleura, with resulting partial or complete collaspe of lung

Question 38

Timing Spontaneous Pneumothorax

Answer 38

Suddne onset of dyspnea

Question 39

Ass. symptoms of Spontaneous Pneumothorax

Answer 39

Pleuritic pain, cough

Question 40

Setting of pneumothroax

Answer 40

Often a previously helathy young adult

Question 41

Process of acute Pulmonary Embolism (PE)

Answer 41

Sudden occlusion of all or part of pulmonary arterial tree by a blood clot htat usually originates in deep veins of legs or pelvis

Question 42

where does PE occur

Answer 42

Blood clot that orgiiantes in DEEP VEINS of legs or pelvis

Question 43

Timing of PE

Answer 43

Sudden onset of dyspnea

Question 44

What are associated symtpoms

Answer 44

Often none. Retrosternal oppressive pain if the occlusion is massive Pleuritic pain, cough, and hemoptysismay follow an embolism if pulmonary infarction ensues. Symptoms of anxiety

Question 45

Setting of PE

Answer 45

Postpartum or postoperative periods; Prolonged bed rest CHF, chronic lung disease fractures of hip or leg DVT (often not clincially apparent)

Question 46

Process of Anxiety with Hyerpventilation

Answer 46

Overbreathing, with resultant respiratory alkalosis and fall in partial pressure of CO2 in the blood

Question 47

Timing of Anxiety/hypervent

Answer 47

Episodic, often recurretn

Question 48

Factors that aggravate anxiety/hypervent

Answer 48

More often occurs at REST than after exerceise An upsetting event may not be evident

Question 49

Facotors that relieve anxiety/hypervent

Answer 49

Breathign in and out of a paper or plastic bag sometimes helps the associated symptoms

Question 50

Ass. symptoms of anxiety/hypervent

Answer 50

Sighing Lightheadedness numbess or tingling of the hadns/feet, palpiations, chest pain

Question 51

Setting of axiety/hypervent

Answer 51

Other manifestions of anxiety may be present