Thorax and Lungs Flashcards
What questions do we ask about a cough?
- When did it start
- Gradual or sudden
- How long have you had it
- How often do you cough, does it wake you at night
What is the difference between acute and chronic coughs
- Acute: Lasts 2-3 weeks
- Chronic: more than 2 months
What can the time that coughing occurs mean?
- Throughout day: acute illness
- Afternoon/evening: exposure to irritant at work
- Nigh: postnasal drip, sinusitis
- Early Morning: chronic brachial inflammation in smokers
What would lead to diagnosis of bronchitis?
A history of productive cough for 3 months of the year, for 2 years in a row
What can green phlegm mean?
Viral or bacterial infection
What are 4 types of sputum and what do they mean?
White/Clear Mucoid: cold, bronchitis and viral infections
Yellow/Green” bacterial infections
Rust Coloured: TB, pneumococcal pneumonia
Pink/Frothy: pulmonary edema, sympathomimetic medications
If a patient characterizes their cough as: hacking, dry, barking, hoarse, congested or bubbling, what does it mean
Hacking: mycoplasma pneumonia
Dry: Early heart failure
Barking: Croup
Congested: cold, bronchitis and pneumonia
Why do we ask: What treatment have they tried (i.e. prescription or over the counter, position change, etc)
To assess effectiveness of coping strategies
What is our goal when asking “ ever had shortness of breath? What brings it on? How severe and how long does it last”
To determine how much activity precipitates the shortness of breath specifically
What is orthopnea?
Difficulty breathing in supine, state how many pillows needed
What is paroxysmal nocturnal dyspnea?
Awakening from sleep with shortness of breath and needing to be upright to achieve comfort
What condition causes night sweats?
Diaphoresis
What is cyanosis?
Blueish colourish
Why would you ask whether the coughing attacks seem to be related to food, pollen, animals, etc
Asthma attacks may be associated with a specific allergen, extreme cold or anxiety
Why do we ask about chest pain and where it occurs?
Chest pain in thoracic origin occurs with muscle soreness from coughing or inflammation of pleura overlying pneumonia
What do we need to be aware of when asking about chest pain?
Whether it is muscle soreness or if it cardiac origin or heartburn from stomach acid
If patient answers yes to “past history of breathing trouble, bronchitis, emphysema, asthma or pneumonia”, what should we consider?
Sequelae: a condition that is a consequence of a previous disease or injury
Why do we ask if patient has had any unusually frequent or severe colds
Because most people have had some colds, it is more effective to ask about number or severity
Why would we ask if patient has family history of asthma, allergies or TB?
To assess for possible risk factors
In regards to lungs/thorax, what do we ask about smoking?
- If they smoke cigarettes or cigars
- What age they started
- How many packs smoked per day
- How many years of smoking
In regards to smoking, how should we address it to better the situation?
Instead of telling them that they should quit (like they already know), assess smoking behaviour, and ways to modify daily smoking activities, identify triggers and to manage withdrawl
What environmental hazards can affect breathing?
Pollution exposure
What is extrinisic allergic alveolitis
Farmers lung due to grain and pesticide inhalation
What disease are coal miners at risk for? Stone cutters, miners and potters?
- pneumoconiosis
- silicosis
Why would we assess self-care measures in regards to environmental factors?
To see how they protect their lungs (mask, ventilators, monitor exposure)
What symptoms does carbon monoxide produce? Sulphur Dioxide?
- dizziness, headache and fatigue
- cough, congestion
Why do we ask older adults if they experience any shortness of breath/fatigue with daily activities?
Older adults respiratory system is less efficient, giving them less tolerance for activity
Why do we ask older adults to tell us about their usual amount of physical activity
They have reduced capacity to perform exercise because of pulmonary function deficits
Sedentary/bedridden people at risk for respiratory dysfunction
Why do we ask older adults if they have chest pain with breathing?
Some feel pleuritic pain less intensely than younger adults
What should we consider when older adults answer yes to chest pain after coughing
If precisely localized and sharp, consider fractured rib or muscle injury
