Chapter 3: Cardiopulmonary

Question 1

Symptoms

Answer 1

• Subjective
• Patient description
• Measured by patient perception
• Ex. pain, shortness of breath, cough

Question 2

Signs

Answer 2

• objective
• measurable
• assessed values
• ex. heart rate, blood pressure, respiratory rate

Question 3

Primary symptoms of cardiopulmonary disorders

Answer 3

1. cough
2. sputum production
3. hemoptysis
4. shortness of breath (SOB) (dyspnea)
5. chest pain

Question 4

Cough

Answer 4

• protective reflex

- stimulation of receptors (pharynx, larynx, trachea,a bronchi, lung and visceral pleura)

Question 5

Acute cough

Answer 5

• sudden onset
• severe, short course
• self limiting (viral infection)

Question 6

Chronic cough

Answer 6

• persistent
• last > 3 weeks
• causes:
• postnasal drip
• asthma
• COPD exacerbation
• allergic rhinitis
• GERD
• chronic bronchitis
• bronchiectasis
• left heart failure

Question 7

Paroxysmal

Answer 7

• periodic

- prolonged, forceful episodes (comes and goes)

Question 8

Associated symptoms of cough

Answer 8

• wheezing
• stridor
• chest pain
• dyspnea

Question 9

clear, colorless, like egg white

Answer 9

normal sputum

Question 10

black

Answer 10

smoke or coal dust inhalation

Question 11

brownish

Answer 11

cigarette smoker

Question 12

frothy white or pink

Answer 12

pulmonary edema

Question 13

sand or small stone

Answer 13

aspiration of foreign material, broncholithiasis

Question 14

purulent

Answer 14

purulent - contains pus

- infection of pneumonia

Question 15

apple-green, thick

Answer 15

haemophilus influenzae

Question 16

pink, thin, blood-streaked

Answer 16

streptococci or staphylococci

Question 17

red current jelly

Answer 17

klebsiella species

Question 18

rusty

Answer 18

pneumococci

Question 19

yellow or green copious

Answer 19

pseudomonas species pneumonia, advanced chronic bronchitis, bronchiectases (separates into layers)

Question 20

foul odor (fetid)

Answer 20

lung abscess, aspiration, anaerobic infections, bronchiectasis

Question 21

mucoid (white-gray and thick)

Answer 21

emphysema, pulomonary tuberculosis, early chornic bronchitis, neoplasma, asthma

Question 22

grayish

Answer 22

legionnaires disease

Question 23

mucopurulent

Answer 23

infection, pneumonia, cystic fibrosis

Question 24

blood-streaked or hemoptysis (frankly bloody)

Answer 24

bronchogenic carcinoma, tuberculosis, chronic bronchitis, coagulopathy, pulmonary contusion or abscess

Question 25

silicone-like casts

Answer 25

bronchial asthma

Question 26

hemoptysis

Answer 26

- coughing up blood | - expectoration of sputum containing blood (streaking to frank bleeding)

Question 27

causes of hemoptysis

Answer 27

- bronchopulmonary - cardiovascular - hematologic - systemic disorders - tuberculosis or fungal infections

Question 28

what to look for in hemoptyis

Answer 28

amount, odor, color, acuteness

Question 29

hematemesis

Answer 29

- vomited blood - determine source: 1. oropharynx (swallowed from respiratory tract) 2. esophagus or stomach (alcoholism or cirrhosis of liver)

Question 30

differences between hemoptysis and hematemesis

Answer 30

``` hemoptysis: - cardiopulmonary disease - coughed up from lungs/chest dyspnea, pain or tickling sensation in chest - alkaline - sputum - may be present (froth) - bright red color ``` ``` Hematemesis: - gastrointestinal disease vomited from stomach - nausea, pain referred to stomach - acidic - food - froth absent - dark, clotted, coffee grounds ```

Question 31

SOB

Answer 31

shortness of breath - most distressing symptom of respiratory disease - single most important factor limiting ability to function - cardinal symptom of cardiac disease

Question 32

dyspnea

Answer 32

- subjective experience of breathing discomfort - components: - sensory input to cerebral cortex - perception of the sensation (breathless, short-winded, feeling of suffocation)

Question 33

causes of dyspnea

Answer 33

- WOB abnormally high for the given level of exertion (asthma and pneumonia) - ventilatory capacity is reduced (neuromuscular disease) - drive to breath is elevated (hypoxia, acidosis, exercise)

Question 34

clinical types of dyspnea

Answer 34

1. cardiac and circulatory (inadequate supply of oxygen to tissues, primary during exercise) 2. psychogenic (panic disorder, not related to exertion) 3. hyperventilation (rate, depth exceeds bodys metabolic need, results in hypocapnia and decreased cerebral blood flow)

Question 35

dependant edema

Answer 35

- soft tissue swelling from abnormal accumulation of fluid - bilateral peripheral edema - most often occurs in ankles and lower legs - most often caused by right and left heart failure - right heart failure often caused by cor pulmonale

Question 36

fever with pulmonary disease

Answer 36

1. pulmonary infections - lung abscess, empyema, tuberculosis, pneumonia - remittent fever in mycoplasma pneumonia, legionaaires disease, acute viral infections 2. infections with no fever - high dose corticosteroids - immunosuppressants - immunocomprimised (leukemia, AIDS)

Question 37

headache is a manifestation of...

Answer 37

cerebral hypoxia and hypercapnia | --> lung disease and high altitute

Question 38

personality changes in advanced pulmonary disorders

Answer 38

- forgetfulness, inability to concentrate, anxiety, irritability

Question 39

altered mental status in hypercapania

Answer 39

from affected alertness to coma

Question 40

sleep deprivation...

Answer 40

COPD, CHF, neuromusular disorders, etc.

Question 41

snoring and apnea incidence and causes

Answer 41

- 10-12% children - 10-30% adults - peak at age 50 to 59 (male), 60-64 (female) - obesity is one of the most common causes of snoring and sleep apnea - OSA is a common cause of obesity

Question 42

complex presentation of CHF

Answer 42

1. dilated pupils 2. skin pale, gray, cyanotic 3. orthopnea 4. crackles, wheeze 5. decreased BP 6. nausea and vomiting 7. ascites 8. dependant pitting edema 9. anxiety 10. falling O2 sat 11. confusion 12. jugular vein distension 13. infarct 14. fatigue 15. s3 gallop, tachycardia 16. enlarged spleen and liver 17 decreased urine output 18. weak pulse, cool, moist skin