CH.3 Cardiopulmonary Symptoms

Question 1

Symptoms

Answer 1

–subjective
–patient description
–Measured by patient perception
–example: paint, shortness of breath, cough

Question 2

Signs

Answer 2

–objective
–measurable
–assessed values
–example: heart rate, blood pressure, respiratory rate

Question 3

Assess symptoms to determine

Answer 3

–seriousness of problem
–potential underlying cause of problem
–effectiveness of treatment

Question 4

Primary symptoms of cardiopulmonary disorders

Answer 4

–cough
–sputum production
–hemoptysis
–shortness of breath (dyspnea)
–chest pain

Question 5

Cough

Answer 5

–one of the most common symptoms seen in patients with pulmonary disease
–Protective reflex
–Stimulation of receptors: pharynx, larynx, trachea, large bronchi, lung, and visceral pleura
–Cause by: inflammatory, mechanical, chemical, or thermal stimulation of cough receptor
–Key to determine etiology is careful history, physical examination and CXR

Question 6

Possible cause of Cough: Inflammatory

Answer 6

–infection, lung abscess, drug reaction, allergy, edema, hyperemia, collagen, vascular disease

Question 7

Possible causes of Cough: Mechanical

Answer 7

–Inhaled dusts, suction, catheter, food

Question 8

Possible causes of Cough: Obstructive

Answer 8

–foreign bodies, aspirations of nasal secretions, tumor or granulomas within or around the lungs, aortic aneurysm

Question 9

Possible cause of Cough: Airway wall tension

Answer 9

–pulmonary edema, atelectasis, fibrosis, chronic interstitial pneumonitis

Question 10

Possible causes of Cough: Chemical

Answer 10

–inhaled irritant gases
–fumes
–smoke

Question 11

Possible cause of Cough: Temperature

Answer 11

–inhales hot or cold air

Question 12

Possible causes of Cough: Ear

Answer 12

–tactile pressure in the ear canal

Question 13

Cough: Afferent pathway

Answer 13

–vagus, phrenic, glossopharyngeal, and trigeminal

Question 14

Cough: Efferent Pathway

Answer 14

–smooth muscles of larynx and tracheobronchial tree via phrenic, spinal nerves

Question 15

Cough: Phases

Answer 15

–Inspiratory
–Compression
–Expiratory

Question 16

Reduced effectiveness of cough

Answer 16

–weakness of inspiratory or expiratory muscles
–inability of the glottis to open or close correctly
–obstruction, collapsibility, or alteration in shape or contours of the airway
–decrease in lung recoil (emphysema)
–abnormal quantity or quality of mucus production (thick sputum)

Question 17

Acute disease

Answer 17

–sudden onset
–severe, short course
–self-limiting: viral infection

Question 18

Chronic disease

Answer 18

–persistent
–last more than 3 weeks
-Causes
–Postnasal drip: most common
–Asthma
–COPD exacerbation
–Allergic Rhinitis
–GERD
–Chronic bronchitis
–Bronchiectasis
–Left Heart Failure: CHF, pulmonary edema

Question 19

Paroxysmal disease

Answer 19

–periodic
–prolonged, forceful episodes

Question 20

Associated symptoms of cough

Answer 20

–wheezing
–stridor
–chest pain
–dyspnea

Question 21

Complications of Cough

Answer 21

–torn chest muscle
–rib fracture
–disruption of surgical wounds
–Pneumothorax or Pneumomediastinum
–syncope
–arrhythmia
–esophageal rupture
–urinary incontinence

Question 22

Sputum Production

Answer 22

–secretions from tracheobronchial tree, pharynx, mouth, sinuses, nose
–upper airways

Question 23

Phlegm

Answer 23

–secretions from lungs and tracheibronchial tree

Question 24

Components

Answer 24

–mucus, cellular debris, microorganisms, blood, pus, foreign particles

Question 25

Normal sputum 100 mL/day

Answer 25

–upward displacement via wavelike motion of cilia until swallowed

Question 26

Abnormal Sputum Production: Bronchorrhea

Answer 26

–more that 100 mL per day
-Excessive production by inflamed glands
–caused by: infection, cigarette smoking, allergies
–Describe: color, quantity, consistency, odor, time of day, presence of blood

Question 27

Hemoptysis

Answer 27

–Expectoration of sputum containing blood: from streaking to frank bleeding
-Causes:
–Bronchopulmonary
–Cardiovascular
–Hematologic
–Systemic Disorders
–Tuberculosis or fungal infections

Question 28

Appearance of Sputum: clear, colorless

Answer 28

–normal

Question 29

Appearance of Sputum: Black

Answer 29

–smoke
–coal dust inhalation

Question 30

Appearance of Sputum: Brownish

Answer 30

–cigarette smoker

Question 31

Appearance of Sputum: Frothy white or pink

Answer 31

–pulmonary edema
–CHF

Question 32

Appearance of Sputum: Blood-streaked or hemoptysis

Answer 32

–tuberculosis
–chronic bronchitis
–abscess

Question 33

Hemoptysis

Answer 33

-Amount:
–Massive hemoptysis: 400 mL/3 h or 600 mL/ 24 h
–emergency condition
–cancer, tuberculosis, bronchiectasis, trauma
–Streak: pulmonary infection, lung cancer, and thromboemboli
-Odor
–Color
–Acuteness

Question 34

Hematemesis

Answer 34

–vomited blood
-determine source
–Oropharynx: swallowed from respiratory tract
–Esophagus or Stomach: alcoholism or cirrhosis of liver

Question 35

Shortness of Breath (SOB)

Answer 35

–Most distressing symptom of respiratory disease
–single most important factor limiting ability to function
–cardinal symptoms

Question 36

Dyspnea

Answer 36

–subjective experience of breathing discomfort
-Components:
–sensory input to cerebral cortex
–Perceptions of the sensation: breathless, short-winded, and feeling of suffaction

Question 37

Dyspnea Scoring Systems

Answer 37

–Scale of 0 (no SOB) to 10 (max SOB)
–Visual analog scales (kids)
–Modified Borg scale
–ATS SOB scale
–UCSD SOB questionnaire

Question 38

Causes, Types, and Clinical Presentation of Dyspnea

Answer 38

-WOB abnormally high for the given level of exertion
–asthma and pneumonia
-Ventilatory capacity is reduced
–neuromuscular disease
-Drive to breath is elevated
–hypoxemia, acidosis, exercise

Question 39

cardiac and circulatory

Answer 39

–inadequate supply of oxygen to tissues
–primarily during exercise

Question 40

Psychogenic

Answer 40

–panic disorder
–not related to exertion

Question 41

Hyperventilation

Answer 41

–rate, depth exceeds body’s metabolic need
–results in hypocapnia and decreases cerebral blood flow

Question 42

Acute Dyspnea: children

Answer 42

–asthma
–bronchiolitis
–croup
–epiglottitis

Question 43

Acute Dyspnea: Adult

Answer 43

–pulmonary embolism
–asthma
–pneumonia
–pneumothorax
–pulmonary edema
–hyperventilation
–panic disorder

Question 44

Chronic Dyspnea

Answer 44

–COPD
–CHF