13.1 Respiratory signs & symptoms Flashcards
(32 cards)
What are common respiratory symptoms?
- Breathlessness
- Cough
- Sputum (production)
- Haemoptysis (coughing up of blood from the respiratory tract)
- Chest pain
What are some questions to ask when someone is experiencing breathlessness?
- Does it affect lungs, heart, brain, muscles
- Is it acute/chronic (onset & severity)
- Is it continuous/episodic
Is hard to find disease severity using breathlessness
What are good scoring tools to use when a patient is breathless?
-
MRC Dyspnoea scale
- INCREASE in score = WORSE
- This scale is used the most
-
ECOG/WHO score
- INCREASE in score = WORSE
- Links more to function
What are some questions to ask if someone has a cough?
- Is the cough acute/chronic
- Is it wet/dry
- What time of day/variability (e.g. different in asthma
- Is there a first cough (e.g. wake up & stand up)
- Is there a relation to speaking/eating/environment/occupation/travel
What are goodd scoring tools to use when someone has a cough?
- VAS scores
-
LCQ (Leicester cough questionnaire)
- Grades when cough occurs
What could be an exacerbating factor of a cough?
ACE inhibitors (end in -pril) = these cause cough
Explain how you’d check the following sputum samples
-
Blood in sputum (red)
- Check for cancer
- Check for any signs of PE (pulmonary embolism)
-
Green
- Could mean poor control of asthma
- Bacterial infection
-
Pseudonomas infection
- Doesn’t respond to antibiotics
What are some questions to ask when someone has haemoptysis?
- Is there blood
- Duration, frequency, amount
- Is massive if lose >250ml in 24 hours
- If blood streaked sputum
- Blood coughed/vomited
- Sputum PURULENCE (increase pus formation = green = infection)
What are the common causes of haemoptysis?
- Pulmonary hypertension
- Severe mitral stenosis
- Decompensated congestive left heart failure
- Pulmonary embolism
- Cancer
How to access someone with chest pain?
Site
Onset
Character (pleuratic = worse when breathing)
Radiation (in back = pancreatitis/aortic dissection)
Alleviating factors (GTN sprays, sitting forward = pericarditis)
Timing
Exacerbating factors (exercise/effort = cardiac), (arm movement/pressing on chest = musculoskeletal)
Severity (1-10)
What are the life threatening causes of chest pain & what are less threatening causes?
Preparation for respiratory exam steps
- Bed at 45 degree angle
- Expose patient’s chest
- DO NOT remove bra (offer blanket)
- Expose legs
What is some respiratory equipment that a patient may have or things that could make respiration worse?
-
Oxygen delivery mask
- Note what type of mask
-
Sputum pot
- Note volume & colour
- Mobility aids
-
Fluid balance
- Check overload/dehydrated
- ECG leads
- Inhalers
- Nebulisers
- Catheters
- Cannulas
- Medication
- Vital signs
- CIGARETTES/VAPING EQUIPMENT
What is clubbing and what test to do to confirm diagnosis?
Clubbing = soft tissue swelling at terminal phalynx of digit
TEST = diamond-shaped window NOT formed = CLUBBING
What are the causes of clubbing?
- Lung cancer
-
Interstitial lung disease
- Large group of diseases that cause scarring (fibrosis) of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream
- Cystic fibrosis
-
Bronchiectasis
- Long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection
What could be the cause of a fine tremor in a respiratory exam?
- Beta-2-agonist
- e.g. salbutamol
What is asterixis and what are the causes of it?
- Is the flapping tremor when arms are out and fingers facing up (30secs)
- CAUSES = CO2 retention due to COPD, uraemia, hepatic encephalopathy
What is a good and bad respiratory rate (& causes)?
-
GOOD
- 12-20bpm
-
BAD
- <12bpm (BRADYPNOEA)
- Causes = opiate overdose
- >20bpm (TACHYPNOEA)
- Causes = acute asthma
- <12bpm (BRADYPNOEA)
Explain some scars that you might see on a respiratory exam
-
Midline sternotomy
- Cardiac valve replacement
- Coronary artery bypass grafts (CABG)
-
Pacemaker
- Infraclavicular scar
- For pacemaker insertion
- Infraclavicular scar
- Anterolateral thoracotomy
-
Posterolateral thoracotomy
- Lobectomy (remove of lobe of organ)
- Pneumotomy (surgical procedure of making an incision into a lung)
- Oesophageal surgery
-
Axillary thorocotomy
- Through 4th/5th intercostal space
- For chest drains
- Through 4th/5th intercostal space
What are some radiotherapy-associated skin changes due to?
- Lung cancer
- Xerosis (dry skin)
- Hyperkeratosis (thickened skin)
- Depigmentation & telangiectasia (widened venules cause threadlike red lines or patterns on the skin)
What are these chest deformities known as?
LEFT = pectus carinatum
RIGHT = pectus excavatum
What is the chest’s appearance on hyperexpansion?
Chest wall appears WIDER and TALLER than normal
What is the cricosternal distance & why would it increase?
- It is the distance between the cricoid cartilage & the sternum
- Do this by palpation of the trachea (say to patient that will be uncomfortable)
- Cricosternal distance may INCREASE due to tension pneumothorax or large pleural effusion
- Causes trachea to DEVIATE towards LOBAR COLLAPSE
How much should the chest wall expand during inspiration and how can you access this?
The chest wall should expand roughly 2cm
