CP Symptoms

PATIENT Assessment

Cardiopulmonary Symptoms

Overview of Cardiopulmonary Assessment

  • Assessment involves gathering information about symptoms affecting the heart and lungs.

  • Symptoms can vary in intensity and characteristics.

Questions for Describing Symptoms (OLD CART Mnemonic)

  • Onset: When did it start? Was it sudden (acute) or gradual?

  • Location: Where is the symptom located, and does it spread?

  • Duration: How long does the symptom last? Is it periodic or constant? Has it occurred before?

  • Characteristics: How does it feel, sound, or look? What is the intensity? Rate it on an appropriate scale. Does it interfere with activities of daily living (ADLs)?

  • Associated Manifestations: Are other symptoms linked? Examples include pain, sweating, nausea, and vomiting (N/V).

  • Relieving and Aggravating Factors: What factors make it worse or better?

  • Treatment: Any medications taken for this symptom?

DYSPNEA

Understanding Dyspnea

  • Definition: Dyspnea is the subjective experience of breathing discomfort that varies in intensity, described as breathlessness, short-windedness, suffocation, or air hunger.

  • Important Note: Never assume a patient with tachypnea (rapid breathing) has dyspnea without further assessment.

Dyspnea Assessment

  • Distinguish between acute or chronic dyspnea.

  • Identify types: recurrent, progressive, paroxysmal, positional, or episodic.

  • Positioning Symptoms:

    • Orthopnea: Dyspnea that occurs when lying flat.

    • Platypnea: Dyspnea that occurs when upright and is relieved by lying down.

Table 3.9: Causes and Characteristics of Shortness of Breath

  • Asthma:

    • Type of dyspnea: Acute

    • Associated symptoms: Cough indicating asthmatic bronchitis

    • Precipitating factors: Allergies, noxious fumes, exercise, respiratory tract infection

    • Usual findings: Bilateral wheezing, prolonged expiration.

  • Pneumothorax:

    • Type: Acute onset

    • Symptoms: Dyspnea may be exertional and/or worsens at night; sudden sharp pleuritic pain

    • Factors: Exposure to cold, certain medications like β-blockers.

  • Pulmonary Emboli:

    • Type: Acute onset

    • Symptoms: Chest pain, faintness, loss of consciousness

    • Factors: Prolonged lying down; risk in women using birth control pills who smoke.

  • Pulmonary Edema:

    • Type: Acute onset

    • Symptoms: Dyspnea on minimal exertion; hyperventilation and anxiety may be episodic.

  • Congestive Heart Failure:

    • Type: Chronic dyspnea with gradual onset; dyspnea on exertion.

    • Symptoms: Orthopnea, paroxysmal nocturnal dyspnea (PND), lightheadedness, palpitations, tingling around mouth and extremities.

  • Chronic Bronchitis:

    • Type: Chronic dyspnea

    • Symptoms: Persistent productive cough; dyspnea usually not present at rest.

COUGH

Overview of Cough

  • The most common symptom seen in patients with pulmonary disease; cough is a non-specific symptom.

  • A cough can be triggered by various types of stimulation and may have one or multiple causes.

  • Coughing can provoke further complications.

Types of Cough Duration:

  • Acute: sudden onset, typically lasting less than 3 weeks.

  • Chronic: persistent and troublesome lasting over 3 weeks.

  • Paroxysmal: periodic, encompassing prolonged, forceful episodes.

Table 3.1: Possible Causes of Cough

Receptor Stimulation

  • Inflammatory: Infection, lung abscess, drug reaction, allergy, edema, hyperemia, collagen vascular disease, radiotherapy, pneumoconiosis, tuberculosis.

  • Mechanical: Inhaled dusts, suction catheters, food.

  • Obstructive: Foreign bodies, aspirations of nasal secretions, tumors or granulomas within or around the lung, aortic aneurysm.

  • Chemical: Pulmonary edema, atelectasis, fibrosis, chronic interstitial pneumonitis.

  • Temperature: Inhaled irritant gases, fumes, smoke, hot or cold air.

  • Tactile Pressure: Tactile pressure in the ear canal causing Arnold nerve response or from otitis media.

Cough Assessment Parameters

  • Productive or Non-Productive: Distinguishes whether cough expels mucus.

  • Types: Congested, Loose, Dry.

  • Pain: Presence or absence of pain during cough.

  • Effort: Evaluate strength of cough - strong or weak.

  • Distinctive Sounds:

    • Barking - indicative of croup.

    • Harsh & dry - problems with larynx, infections, tumors, asthma.

    • Wheezing - bronchial disorders.

    • Hacking - common in smoking, nervous habits, viral infections.

    • Whooping - associated with certain infections.

Descriptions of a Cough

  • Types:

    • Acute (lasting < 3 weeks) or recurrent (in adults).

    • Chronic productive or nonproductive (lasting > 3 weeks).

    • Dry or progressing from dry to productive.

  • Associated Symptoms by Type:

    • Postnasal drip; allergies; viral infections; bronchiectasis; chronic bronchitis; asthma; etc.

SPUTUM

Overview of Sputum

  • Sputum refers to the substance expelled from the tracheobronchial tree, pharynx, mouth, sinuses, and nose.

  • Phlegm is specifically secretions from the lungs and tracheobronchial tree, typically uncontaminated by oral secretions.

  • Excessive sputum production is most often caused by inflammation of mucous glands in the tracheobronchial tree, triggered by smoking, infections, and allergies.

Sputum Assessment

Key Assessment Parameters:

  • Amount (e.g., scant vs. copious)

  • Color:

    • Clear - Normal

    • White or pink & frothy - indicative of pulmonary edema

    • Mucoid - thick, whitish-gray, or clear

    • Purulent - contains pus, varying colors

    • Bloody - associated with pulmonary embolus

    • Blood streaked - indicative of pneumonia, lung abscess, tuberculosis

    • Brown - common with cigarette smoking

    • Black - related to smoke, coal dust exposure

  • Consistency and Smell (if applicable): Fetid refers to foul-smelling sputum.

Table 3.3: Presumptive Sputum Analysis

  • Clear, colorless like egg white - normal.

  • Black - smoke or coal dust inhalation.

  • Brownish - common with cigarette smoking.

  • Frothy white or pink - pulmonary edema.

  • Purulent (contains pus) - indicative of infection or pneumonia.

  • Pink, thin, blood-streaked - suggests aspiration of foreign material.

  • Rusty - could be indicative of certain types of pneumonia.

Hemoptysis

  • Definition: Hemoptysis refers to the expectoration of bloody or blood-streaked sputum. The site of bleeding could be anywhere within the respiratory tract.

  • Massive hemoptysis: Defined as the expulsion of 400ml in 3 hours or 600ml in 24 hours (with blood clots).

Box 3.1: Notable Causes of Hemoptysis

Frequent Causes:

  • Acute bronchitis with severe coughing

  • Bronchogenic carcinoma

  • Bronchiectasis

  • Chronic bronchitis

  • Tuberculosis

Less Frequent Causes:

  • Pulmonary: Aspiration of a foreign body, bronchoarterial fistula, broncholithiasis, deep mycotic infections, metastatic carcinoma, pulmonary abscess, pulmonary embolism, infarction.

  • Cardiopulmonary: Arteriovenous malformation, mitral stenosis, cardiac pulmonary edema, pulmonary hypertension.

CHEST PAIN

Characteristics of Chest Pain

  • Pleuritic Pain: Sharp, stabbing pain worsened by breathing.

  • Cardiac pain (angina): Dull, achy, crushing, or pressure sensations.

  • Chest Wall Pain: Pain localized to the chest wall with potential rib involvement.

  • Mediastinal Pain: Burning or tearing sensations during breathing.

SYMPTOMS THAT CAN AFFECT CARDIOPULMONARY STATUS

  • Syncope: Temporary loss of consciousness due to reduced cerebral blood flow. Medication history and prior medical issues can be factors.

  • Edema: Swelling from fluid accumulation, often gravity-dependent in extremities.

    • Right heart failure: Causes localized edema in organs (e.g., pulmonary edema).

    • Left heart failure/congestive heart failure: Systemic effects.

  • Neurological Symptoms: Altered mental status due to hypoxemia (decreased oxygen) and hypercapnia (increased carbon dioxide).

  • Sleep Habits: Evaluate for conditions like obstructive sleep apnea based on symptoms of excessive daytime sleepiness and snoring.

  • Gastroesophageal Reflux Disease (GERD): Symptoms of abnormal reflux of gastric contents can lead to related respiratory issues, with conditions exacerbated by obesity, pregnancy, and smoking.