101: Egan's 16 (1)

Vocabulary flashcards generated from lecture notes detailing clinical assessments, patient history, symptoms, vital signs, and physical examination findings in respiratory care.

Bedside Assessment

The process of interviewing and examining patients for signs and symptoms of disease and evaluating the effects of treatment.

Diagnosis

The process of identifying the nature and cause of an illness.

Differential Diagnosis

A term used when signs and symptoms are shared by many diseases and the exact cause is unclear.

Signs

Objective manifestations of illness, such as laboratory work or physical data.

Symptoms

Subjective sensations or experiences of an illness reported by the patient, such as shortness of breath.

Social Space

A distance of $4$ to $12\,\text{feet}$ between the clinician and the patient during an interview.

Personal Space

A distance of $2$ to $4\,\text{feet}$ between the clinician and the patient.

Dyspnea

Shortness of breath; the most common symptom a respiratory therapist is called upon to assess and treat.

Breathlessness

The sensation of an unpleasant urge to breathe.

Borg Scale

A rating scale for dyspnea ranging from $0$ (no dyspnea) to $10$ (severe dyspnea).

Orthopnea

Dyspnea experienced when a patient is lying down (supine).

Platypnea

Dyspnea experienced when a patient is sitting upright.

Orthodeoxia

Oxygen desaturation that occurs upon assuming an upright position, accompanying platypnea.

Trepopnea

Dyspnea that is relieved by lying on one side.

Psychogenic Hyperventilation Syndrome

A condition in which patients with normal cardiopulmonary function complain of intense dyspnea and suffocation.

Cough

The most common, nonspecific symptom observed in patients with pulmonary disease, occurring when airway cough receptors are stimulated.

Chronic Cough

A cough lasting $8\,\text{weeks}$ or longer.

Upper Airway Cough Syndrome (UACS)

The condition formally known as postnasal drip.

Mucus

A general, productive fluid made in many parts of the body.

Sputum

Mucus from the lower airways that is expectorated through the mouth.

Phlegm

Mucus from the tracheobronchial tree that is not contaminated by oral secretions.

Purulent Sputum

Sputum containing pus cells.

Fetid Sputum

Sputum that is foul-smelling.

Hemoptysis

Coughing up blood or blood-streaked sputum from the lungs.

Hematemesis

Vomiting blood from the gastrointestinal tract.

Massive Hemoptysis

Coughing up more than $300\,\text{mL}$ of blood over $24\,\text{hours}$, commonly caused by bronchiectasis, lung abscess, or tuberculosis.

Pleuritic Chest Pain

Sharp pain located laterally or posteriorly that increases with deep breathing.

Nonpleuritic Chest Pain

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

Fever

A body temperature greater than $38.3\,^\circ\text{C}$ or $101\,^\circ\text{F}$.

Pedal Edema

Swelling of the lower extremities, most often caused by heart failure.

Pitting Edema

A subcategory of pedal edema where an indentation mark is left on the skin after pressure is applied.

Weeping Edema

A subcategory of pedal edema where a small fluid leak occurs at the point where pressure is applied.

Hypoxemic Lung Disease

The inability of the respiratory system to maintain an adequate blood oxygen level to preserve normal organ function.

Pack-Years

A measure of smoking history calculated as packs smoked per day multiplied by the number of years smoked.

Physical Examination

The four sequential steps for evaluating a patient: Inspection (visually examining), Palpation (touching), Percussion (tapping), and Auscultation (listening with a stethoscope).

Sensorium

The aspect of consciousness where the mind is responsible for orientation to time, place, person, and situation.

Hyperthermia / Hyperpyrexia

Terms defined as increased body temperature.

Hypothermia

Decreased body temperature, most commonly caused by prolonged exposure to cold.

Tachycardia

An adult heart rate greater than $100\,\text{beats/min}$.

Bradycardia

An adult heart rate less than $60\,\text{beats/min}$.

Tachypnea

A respiratory rate greater than $20\,\text{breaths/min}$.

Bradypnea

A respiratory rate less than $10\,\text{breaths/min}$.

Systolic Pressure

The peak force exerted in the major arteries during contraction of the left ventricle, normally $90$ to $140\,\text{mm Hg}$.

Diastolic Pressure

The force remaining in the major arteries after relaxation of the ventricles, normally $60$ to $90\,\text{mm Hg}$.

Pulse Pressure

The numerical difference between systolic and diastolic blood pressure, normally $30$ to $40\,\text{mm Hg}$.

Hypertension

Blood pressure persistently greater than $140/90\,\text{mm Hg}$.

Hypotension

Systolic BP < 90 mm Hg or mean arterial pressure < 65 mm Hg

Shock

The inadequate delivery of $O_2$ and nutrients to vital organs relative to their metabolic demands.

Cyanosis

A blue-ish skin discoloration that indicates respiratory failure due to low oxygen levels.

Pursed-Lip Breathing

Exhalation through puckered lips to slow down breathing and keep alveoli open, commonly used by COPD patients to prevent collapse of small airways.

Jugular Venous Distention (JVD)

Enlargement of the jugular veins observed in patients with congestive heart failure and cor pulmonale caused by blood backing up.

Barrel Chest

An abnormal anteroposterior chest configuration commonly associated with emphysema.

Pectus Carinatum

An abnormal protrusion of the sternum.

Pectus Excavatum

A depression of part or the entire sternum, which can produce a restrictive lung defect.

Kyphosis

A spinal deformity characterized by an abnormal anteroposterior curvature of the spine.

Scoliosis

A spinal deformity characterized by a lateral curvature of the spine.

Kyphoscoliosis

A combination of kyphosis and scoliosis that can cause a severe restrictive lung defect due to poor lung expansion.

Diaphragm

The primary muscle responsible for breathing.

Patient Data

1. Medical History

2. Physical Examination

Purposes of the interview

1. To establish rapport between the clinician and patient

2. To obtain information essential for making a diagnosis

3. To help monitor changes in the patient’s symptoms and response to therapy

Patient Symptoms

1. When did the symptom start

2. How severe it is (can be scale from 1 to 10)

3. Where on the body is it

4. What seems to make it better or worse

5. Has it occurred before( if so, how long did it last)

Characteristics of Cough

1. Dry or Loose

2. Productive or nonproductive

3. Acute or Chronic

4. Whether it occurs more frequently at particular times (day or night)

Medical Record

All respiratory care procedures are supported by a physician order that is current, clearly written, and complete

Chief Complaint (CC) / History of Present Illness (HPI)

explains the current medical problems

Past Medical History (PMI)

details the patient's previous health conditions, surgeries, and treatments.

General Appearance Evaluate

1. Level of Consciousness

2. Facial Expression

3. Level of anxiety or distress

4. Body Positioning

5. Personal Hygiene

Vital Signs

1. Body Temperature

2. Pulse Rate

3. Respiratory Rate

4. Blood Pressure

Pulse Rate Evaluate

1. Rate

2. Rhythm

3. Strength

Pulsus Paradoxus

A “significant” decrease in pulse strength (>10 mm Hg) during spontaneous inspiration

Pulsus Alternans

An alternating succession of strong and weak pulses that may indicate heart failure

Nasal Flaring

often seen in infants with respiratory distress - increased Work of Breathing

Cyanosis

indicates respiratory failure due to low oxygen levels associated with a physically bluish discoloration

Pursed-lip Breathing

A technique used to improve ventilation by slowing down the breathing rate. chronic obstructive pulmonary disease (COPD)

Inspection of the Chest

1. The thoracic configuration

2. The pattern and effort of breathing

3. Expansion and symmetry of the chest

Bilateral vs Unilateral Chest Expansion

Bilateral decreases means it affects both sides while Unilateral decreases means it affects only one side

Common causes of Work of Breathing

1. Narrowed airways

2. “Stiff Lungs”

3. A stiff chest wall

Retractions

inward sinking of the chest wall during inspiration

Typical abnormal breathing patterns

1. rapid, shallow breathing pattern

2. relatively brief inspiratory phase with an abnormally prolonged exhalation characterized by pronounced, sustained abdominal muscular contraction

Tracheal Tugging

The downward movement of the thyroid cartilage toward the chest during inspiration

Apnea

No breathing

Apneustic Breathing

deep, gasping inspiration with brief, partial expiration that may indicate brain injury

Ataxic Breathing

completely irregular breathing pattern with variable periods of apnea caused by damage to medulla

Asthmatic Breathing

prolonged exhalation with recruitment of abdominal muscles caused by obstruction to airflow out of the lungs

Biot Breathing

clustering of rapid, shallow breaths coupled with regular or irregular periods of apnea caused by damage to medulla or pons

Cheyne-Stokes respiration

irregular type of breathing; breaths increase and decrease in depth and rate with periods of apnea caused by CHF or brain injury

Kussmaul Breathing

deep and fast respirations caused by metabolic acidosis

Abdominal Paradox

abdominal wall moves inward or inspiration and outward on expiration due to diaphrgmatic fatigue or paralysis

Chest Paradox

part or all of the chest wall moves in with inhalation and out with exhalation caused by chest trauma with multiple rib or sternal fractures

Paradoxical Breathing

Abdominal paradox and Chest paradox

Periodic Breathing

breathing oscillates between periods of rapid, deep breathing and slow, shallow breathing without periods of apnea caused by severe damage to the central nervous system, also seen in patients with CHF

Diaphragmatic Acute Fatigue Signs

1. Tachypnea

2. Diaphragm and rib cage muscles take turns powering breathing

3. abdominal paradox occurs with complete diaphragmatic fatigue

Chest Palpation

the art of touching the chest wall to evaluate underlying structure and function

Vocal and Tactile Fremitus

increased with pneumonia and atelectasis (consolidation) and is reduced with emphysema, pneumothorax, and pleural effusion

Percussion Resonances

1. Normal

2. Increased - hyper, emphysema or pneumothorax (air)

3. Decreased - dull, pneumonia or pleural effusion (consolidation)

Dull Resonance

increased lung tissue

Hyper Resonance

more air

Tracheal Breath Sounds

heard directly over trachea, created by turbulent flow;

Bronchovesicular Breath Sounds

heard over sternum; softer and slightly lower in pitch

Vesicular Breath Sounds

heard over lung parenchyma; very soft and low pitched

Lobes

3 on right

2 on left