Intro Unit 5

Why are patient interviews necessary

-To establish patient rapport between the clinician and patient

-To obtain info essential for making diagnosis

-To help monitor changes in the patient's symptoms and response to therapy

Patient Interview techniques

-Introduce yourself in social space (4-12 feet)

-Interview in personal space (2-4 feet)

-Eye contact

-No leading questions; neutral questions

COPD

persistent respiratory symptoms and airflow limitation due to airway and alveolar abnormalities

usually characterized by significant exposure to noxious particles or gases

COPD symptoms

-shortness of breath

-chronic cough & persistent dyspnea

-wheezing & chest tightness

-sputum

asthma

characterized by chronic airway inflammation

Asthma symptoms

-wheezing

-shortness of breath

-chest tightness

-cough

Discontinuous adventitious lung sounds

intermittent crackling

Bubbling sounds of short duration

chronic stridor

Laryngomalacia

vocal fremitus is increased with...

pneumonia and atelectasis

Which diseases mentioned in class are obstructive

COPD

Asthma

CF

how do we diagnose COPD?

spirometry

COPD risk factors

-host factors

-tobacco

-occupation

-indoor/outdoor pollution

Why does asthma make it hard to breathe?

-bronchoconstriction

-airway wall thickening

-increased mucus

what is the most frequent finding during a PE for patients with asthma

wheezing on auscultation (esp on forced expiration)

Cystic Fibrosis

imbalance of ions such as sodium, chloride, bicarbonate into and out of the cell --> leads to thick, viscous secretions

chronic inflammation --> lung damage that leads to irreversible bronchiectasis & respiratory failure

CF PE Findings

-recurrent cough

-increase in the AP diameter of chest due to progressive air tapping

-thick, sticky mucus

-hemoptysis

-wheezing

-salty sweat

-failure to thrive

Interstitial Lung Disease

Disease outside of the lung in the interstitial space. Causes fibrosis.

Interstitial lung diseases causes ___________________ which decreases lung compliance

fibrosis

makes lungs stiff

Patients with interstitial lung diseases complain about...

-dyspnea

-increased WOB

-shallow breathing

-gasping

What clinical findings do we see in Pneumonia

pleuritic chest pain (sharp pain that increases w deep breathing)

vocal fremitus

unilateral reduction in chest expansion

decreased resonance

electrolyte disorders

How do Neuromuscular Diseases effect breathing

the muscles of breathing are not receiving the proper signals to initiate mechanics of breathing

Dyspnea

sensation of breathing discomfort by patient (subjective feeling)

Orthopnea

dyspnea that is triggered when the patient assumes the reclining position

Orthopnea is common in patients with

CHF

mitral valve disease

superior vena cava syndrome

Platypnea:

dyspnea triggered by assuming the upright position

Orthodeoxia

O2 desaturation on assuming upright position

What accompanies platypnea

Orthodeoxia

What is the most common, nonspecific symptom observed in patients with pulmonary disease

cough

what causes a cough

cough receptors in airways are stimulated by inflammation, mucus, foreign material, noxious gases

A chronic cough lasts for _______ weeks or more

8

Characteristics of a Cough

Dry or Loose

Productive or nonproductive

Acute or chronic

if sputum has pulls cells it is said to be _______________

purulent sputum

if the sputum is foul smelling, it is called

fetid sputum

mucoid sputum

translucent, white, or gray sputum

phlegm

mucus from the tracheobronchial tree not contaminated by oral secretion

hemoptysis

coughing up blood or bloody sputum

Massive hemoptysis is more than _______ml/24 hours.

300

What causes Massive Hemoptysis

Bronchiectasis

Lung abscess

Acute/chronic TB

nonmassive hemoptysis

Common causes include: infection of airway, tuberculosis, trauma, & pulmonary embolism

normal lung sounds

audible vibrations primarily generated by turbulent airflow in the larger airways

low frequency sounds

Abnormal lung sounds

wheezing, crackles and silent chest

adventitious lung sounds

What are the 2 types of adventitious lung sounds

Discontinuous

Continuous

continuous adventitious lung sounds

Wheezes

wheezing heard in the upper airway is also known as

stridor

a breath sound is considered abnormal if heard over.....

peripheral lung regions

a breath sound is diminished when...

when sound intensity @ site of generation is reduced due to shallow/ slow breathing

or

when sound transmission through lung or chest wall is decreased (COPD/asthma)

which lung sound is most consistent with airway obstruction

wheezing

Monophonic wheezing

indicates one airway is affected

Polyphonic wheezing

indicates many airways are involved

stridor

strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx

what are the 4 types of stridor

chronic

acute

inspiratory

expiratory

acute stridor

croup

inspiratory stridor

narrowing above glottis

expiratory stridor

narrowing of lower trachea

which lung sound is identified if airflow moves secretions or fluid in airways

coarse crackles

which lung sound is caused by the sudden opening of small airways in lung deep breathing

fine crackles

Pulm fibrosis and atelectasis

what provides the first clue to AEs to treatments

vital signs

which vital signs are taken frequently

body temp

pulse rate

RR

BP

what is the normal body temp

98.6 F or 37 C

hyperthermia/hyperpyrexia

increased temp

hypothermia

decreased body temperature

where do we measure body temp

mouth

axilla

ear

rectum

which measurement of body temp is the most accurate

rectum

where do we typically palpate to find Pulse Rate

radial artery

normal adult pulse rate

60-100 bpm

Tachycardia

HR > 100 bpm

Bradycardia

HR

Pulses paradoxus

a significant decrease in pulse strength during spontaneous inspiration (>10 mmHg)

which type of patients would we see pulses paradoxus

-acute obstructive pulmonary disease

-asthma attack

pulsus alternans

alternating strong and weak pulses

which type of patients would we see pulses alternans

left side heart failure

not related to respiratory disease

resting adult RR

12-18 breaths/min

Tachypnea

RR > 20 breaths per min

exertion, fever, hypoxemia, hypercarbia, metabolic acidosis, anxiety

bradypnea

RR

systolic pressure

peak force exerted in the major arteries during contraction of the left ventricle

normal systolic blood pressure

90-140 mmHg

120 is ideal

Diastolic pressure

the force in the major arteries remaining after relaxation of the ventricles

normal diastolic blood pressure

60-90 mm Hg

80 is ideal

Pulse pressure

systolic pressure - diastolic pressure

normal pulse pressure range

30-40 mm Hg

Hypertension

BP persistently >140/90

Hypotension

SBP

BP shock

inadequate delivery of O2 and nutrients to the vital organs relative to their metabolic demand

SBP

how do we treat BP shock

fluids

blood products

vasoactive drugs

levels of consciousness

confusion

delirious

lethargic

obtunded

stuporous

comatose

(box 16.6)

2 types of chest pain

pleuritic and nonpleuritic

which type of chestpain is located laterally or posteriorly. it results in sharp pain and increases with deep breathing

pleuritic chest pain

pneumonia& pulm. embolism

which type of chest pain is located in the center of the chest and may radiate to shoulder or arm. it is not affected by breathing

nonpleuritic chest pain

angina, gastroesophageal reflux

Angina

chest pain

List several indicators to assess a patient's overall (general) appearance.

- level of consciousness

-facial expression

-level of anxiety/ distress

-body positioning

-personal hygiene

what affects level of consciousness

poor cerebral blood flow

Nasal flaring is often seen in infants with _________ _______________

respiratory distress (increase WOB)

jugular venous distension (JVD)

a notable prominence of the jugular vein when the patient is seated at a 45 degree angle

what is the most common cause for JVD

patients with CHF and cor pulmonale

barrel chest

abnormal rounded chest cavity

increased AP diameter

barrel chest is associated with

emphysema

pectus carinatum

abnormal protrusion of sternum

(breastbone pushed out)

pectus excavatum

Depression of part or entire sternum, which can produce a restrictive lung defect

(breastbone pushed in)

kyphosis

spinal deformity in which the spine has an abnormal AP curvature

"hunchback"

scoliosis

spinal deformity in which the spine has a lateral curvature