Patient Assessment & Diagnostic Vocabulary

Dyspnea & Breathing Terminology

• Increased drive to breathe / dyspnea triggers: hypoxemia, acidosis, high fever (not hypocapnia)
• Orthopnea: difficult breathing while reclining
• Platypnea: shortness of breath when upright
• Pursed-lip exhalation (COPD): promotes more complete lung emptying

Cough & Sputum

• Cough effectiveness least affected by pulmonary vascular resistance
• Dry, non-productive cough: commonly pulmonary fibrosis
• Phlegm: tracheobronchial secretions uncontaminated by oral flora
• Purulent sputum: contains pus
• Hemoptysis: blood-streaked sputum

Vital Signs & Temperature

• Fever → more rapid respiratory rate
• Hypothermia most often due to cold exposure (rectal temp ≈ core)
• Tachycardia least likely with hypothermia; common with hypotension, pain, fever
• Pulsus paradoxus frequently seen in acute asthma

Cardiovascular & Circulatory Signs

• Chest pain from coronary blockage: angina
• Pedal edema most commonly from heart failure
• Central cyanosis ⇒ respiratory failure
• Hypotension causes: heart failure, hypovolemia, peripheral vasodilation
• Jugular venous distention usually indicates right-sided heart failure

Breathing Patterns & Disorders

• Tachypnea causes: hypoxemia, exercise, metabolic acidosis
• Irregular breathing with long apneas ⇒ central nervous system disorder (Biot’s)
• Cheyne-Stokes: crescendo–decrescendo depth & rate, then apnea
• Retractions signify increased work of breathing
• Severe atelectasis → rapid, shallow breaths
• Asthma: prolonged exhalation
• Diabetic ketoacidosis: Kussmaul breathing
• Hoover’s sign: inward movement of lower costal margins on inspiration (severe COPD)

Chest Wall & Tracheal Position

• Trachea shifts toward side of volume loss: e.g., right upper-lobe atelectasis → shift right
• Barrel chest characteristic of emphysema

Miscellaneous

• Diaphoresis linked to fever, severe stress, acute anxiety (not hemoptysis)
• Least likely tachycardia trigger: hypothermia