Terms Flashcards
Hemoptysis
Coughing up blood or blood streaked sputum from the LUNGS
What are the common causes of massive hemoptysis?
Bronchiectasis, lung abscess, and acure or chronic tuberculosis
What is considered massive hemoptysis vs nonmassive?
Massive: > 300 ml of blood expectorated over 24 hours
What are the common causes for nonmassive hemoptysis?
Infection of airway, tuberculosis, trauma, and pulmonary embolism
What is hematemesis?
Blood vomited from the GASTROINTESTINAL TRACT.
Occurs in patients with GI disease
(Sometimes difficult to differentiate the origin of bleeding since committing can stimulate the cough reflex)
Chest pain
Pleuritic or NonPleuritic
Pedal Edema
Swelling of lower extremities most likely due to heart failure.
2 types
Pitting edema
Weeping edema
Weeping edema
Small Fluid leaks from skin with finger pressure often seen with Severe chronic heart failure.
Pitting Edema
Indentation mark left in skin after pressure is applied
Someone with chronic hypoxemic lung disease usually develop right heart failure due to pulmonary hypertension, would have this symptom in their lower extremities
Pedal Edema
What is the scale to measure severity of pitting edema?
“1 plus” -trace pitting with RAPID refill
“4 plus” - severe pitting with refill time more than 2 minutes
Pectus Carinatum
Abnormal Protrusion of sternum
Depression of part, or entire, sternum, which can produce a restrictive lung defect
Pectus excavatum
Spinal Deformity in which the spine has an abnormal ANTEROPOSTERIOR CURVATURE
Kyphosis
Spinal Deformity in which the spine has a LATERAL curvature
Scoliosis
Kyphoscoliosis
Combination of kyphosis and scoliosis which may produce a severe restrictive lung defect as a result of poor lung expansion
Hallmark Sign of increased breathing effort
Recruitment of accessory breathing muscles in the neck and thorax to maintain ventilation
WOB
Work of breathing
Common causes of an increase in WOB include :
Narrowed airways
“Stiff Lungs” (e.g: acute respiratory distress syndrome, cardiogenic pulmonary edema) both cause fluid to enter alveoli
A stiff chest wall (eg, ascites, anasarca, pleural effusions) these restrict expansion not due to pulmonary issues but surrounding areas
Distortions in the chest wall due to increased WOB
Retractions are inward. Sinking of the chest wall during inspiration. Occurred when inspiration muscle contractions generate large negative intrathoracic pressures
Apnea
An absence of breathing
Causes: cardiac arrest, narcotic OD, severe brain trauma
Intermittent prolonged gasps and then apnea
Agonal Breathing
Apneustic breathing
Deep, gasping inspiration with brief, partial expiration
Causes: damage to upper medulla or pins cause by stroke or trauma; sometimes observed with hypoglycemic coma or profound hypoxemia
Prolonged exhalation with recruitment of abdominal muscles
Asthmatic breathing. Caused by obstruction to airflow out of the lungs
Biots Respiration
Clustering of rapid, shallow breaths w the same volumes coupled with periods of apnea
Causes: Damage to medulla or pons caused by stroke or trauma ; severe intracranial hypertension
Deep and Fast Respiration
Kussmaul breathing. Caused by diabetic ketoacidosis and metabolic acidosis
Cheney-Stokes respiration
Irregular type of breathing: breaths increase and decrease in depth of volume and rate with periods of apnea
Causes : Most often caused by severe damage to bilateral cerebral hemispheres and basal ganglia (usually infarction)
Also see. In patients with CHF owing to increased circulation time and in various forms of encephalopathy
Paradoxical breathing
Abnormal movement of the abdomen and thorax
Abdominal paradox
Abdominal wall moves inward on inspiration and outward on expiration
Diaphragmatic fatigue or paralysis
Chest Paradox
Part or all of the chest wall moves inward with the inhalation and out with exhalation
Typically observed in chest trauma with multiple rib (flail chest) or sternal fractures ; also found in patients with high spinal cord injury with paralysis of intercostal muscles
Hoover sign
Contraction of a flat diaphragm tends to draw in the lateral costal margins instead of normal expansion outward
Signs of diaphragmatic fatigue
Tachypnea
Diaphragm and rib cage muscles take turn powering breathing (respiratory alternans)
Abdominal paradox occurs with complete diaphragmatic fatigue
Vocal Fremitus
Vibrations created by vocal cords during speech. Vibrations transmitted down the tracheobronchial tree and through the lung to the chest wall.
Vibrations felt on the chest wall
Tactile fremitus
Asking patient to repeat the word “ninety nine” while RT palpates the anterior lateral and posterior portions
Increased with pneumonia and atelectasis (consolidation)
Vocal and tactile fremitus
Reduced with emphysema, pneumothorax, and pleural effusion
Vocal and Tactile Fremitus
Percussion of the chest
Tapping on a surface to evaluate the underlying structure, provides a sound and palpable vibration useful in evaluating underlying lung tissue
Evaluated with percussion
Resonance of chest. Normal . Increased or decreased resonance
Decreased Resonance during percussion of the chest
Pneumonia or pleural effusion (consolidation)
Increased Resonance
Emphysema or pneumothorax (air)
Normal breath sounds
Lung sounds are audible vibrations primarily generated by turbulent airflow in the larger airways
Sounds are altered as they travel through the lung periphery and chest wall
Passes low frequency sounds
Heard directly over trachea. Created by turbulent flow. Loud with expiratory component equal to or slightly longer than inspiratory content
Tracheal breath sounds
Bronchovesicular breath sounds
Heard around sternum, softly and slightly lower in pitch
Heard of lung parenchyma (tissue) ; very soft and low pitched
Vesicular breath sounds
Adventitious lung sounds (not normal) types
Discontinuous and Continuous
Discontinuous adventitious lung sounds
Intermittent crackling
Bubbling sounds of short duration
Referred to as “crackles”
Continuous Adventitious lung sounds
Heard over bronchi , bronchioles is called “wheezes”
Heard over the upper airway (larynx) is called “stridor”
Bronchial breath sounds
Abnormal if heard over peripheral lung regions
Replacing normal vesicular sound when lung tissues density increases
Diminished breath sounds
Occur when sound intensity at site of generation (larger airways) is reduced due to shallow or slow breathing
When sound transmission through lung or chest wall is decreased. (COPD or asthma)
A high or low pitched quasi-musical sound (lower airway- bronchioles)
Wheezes
Monophonic wheezes indicate one airway is affected.
Polyphonic wheezing indicates many airways are involved
High pitched airflow sound. Audible. Upper airway-Larynx
Stridor.
Chronic stridor (laryngomalacia)
Acute Stridor (croup)
Inpiratory stridor - narrowing above glottis-epiglottis
Expiratory stridor- narrowing of lower trachea
Coarse crackles (upper airway)
Airflow moves secretions or fluid in AIRWAYS
Fine crackles (lower airway)
Sudden opening of small airways in lung deep breathing
Heard w pulmonary fibrosis and atelectasis
Fluid overload conditions such as CHF
Fined end inspiratory crackes: Atelectasis or fluid
Pleural friction rub
Lung sounds
Wheezes
Stridor
Coarse crackles
Fine crackles
Lung sound that is Caused by asthma or CHF
Wheezes. Rapid airflow through obstructed airways. High pitched , usually expiratory
Stridor lung sounds
Rapid airflow through UPPER AIRWAY, high pitched, monophonic,
Croup, epiglottis, Post extubation laryngeal edema
Coarse Crackles
Excess airway secretions moving through airways.
Coarse , inspiratory and expiratory
Causes: severe pneumonia, bronchitis
Fine crackles
Sudden opening of peripheral airways
Fine , late inspiratory
Causes: atelectasis, fibrosis , pulmonary edema
Examination of extremities
Checking for clubbing and cyanosis
Clubbing (not common)
Is seen in large variety of chronic conditions: congenital heart disease, bronchiectasis, various cancers, and interstitial lung diseases.
Depth of finger at the base of the nail is greater than the depth of the interphalangeal joint with clubbing
Bluish or purplish discoloration of the skin
Cyanosis
Types of Cyanosis
Peripheral or central.
Peripheral cyanosis
Signifies poor perfusion of the extremities (digits) so that the tissues extract more o2
Central cyanosis
When the mucosa or the torso are invoked and may signal severe lung diseases, profound hypertension, or presence of certain congenial heart diseases
Digital cyanosis (acrocyanosis)
Sign of poor perfusion, hands and feet typically cool to touch in such cases
Capillary refill
Assess peripheral perfusion by pressing firmly on fingernails until nail bed is blanched . Then released to refill. Normal refill time is 3 seconds or less
Diagnosis:
The process of identifying the nature and cause of illness
Differential diagnosis
The term used when signs and symptoms are shared by many diseases and the exact cause is UNCLEAR
Objective data:
Gathered by clinician (vital signs, CXR, r rays, blood work)
Subjective data;
Patient provided information. (Pain SOB anxious etc)
Social space
4-12 feet
Personal space
2-4 ft
Common questions
When did the symptom start
How severe is it
Where on the body is it
What seems to make it better or worse
Has it occurred before
Dyspnea
Sensation of breathing discomfort by patient
Positional Dypnea types
Orthopnea
Platypnea
Orthodeoxia
Trepopnea
Dyspnea that is triggered when the patient assumes the reclining position
Orthopnea. Common in patients with CHF, mitral valve disease, and superior vena cava syndrome (left side heart failure)
Dyspnea triggered by assuming the upright position
Platypnea. Typically occurs in patients following pneumonectomy and in those with chronic liver disease
Orthodeoxia
Oxygen desaturation on assuming an upright position. Accompanied platypnea
When lying on one side relieves Dyspnea
Trepopnea. Usually associated with either CHF or pleural effusion. (Excess fluid in pleural cavity)
