RSPT 1101 – Introduction to Respiratory Care

Cardiopulmonary Symptoms

Reference & Reading: Wilkins Chapter 3

Cough

  • One of the most common symptoms associated with lung disease
  • Powerful protective mechanism for the lung and airways
  • Caused by mechanical, chemical, inflammatory, or thermal stimulation of the cough receptors
  • Made up of three phases

1.Inspiratory phase

2.Compression phase

3.Expiratory phase

  • Causes and Clinical Presentation
  • Acute cough
  • Chronic cough
  • Cough also associated with pulmonary problems

Descriptions

  • The type of cough present should be documented using commonly accepted adjectives.

a.Productive

b.Effective

c.Weak

d.Dry

e.Chronic productive

  • Quality, time & setting of cough

a. barking

b. brassy - harsh, dry

c. hoarse

d. wheezy - bronchial

e. chronic productive – bronchopulmonary disease

f. hacking

Sputum Production

  • Sputum
  • Phlegm

Causes and Descriptions – Table 3-3

  • Caused by inflammation of the mucus secreting glands that line the airways
  • Inflammation
  • Sputum described
  • Thick but clear sputum.
  • Pink frothy sputum
  • Thick, purulent (pus-containing) sputum is consistent with infection.
  • Yellow-green
  • Foul odor

Hemoptysis

Causes

  • Persistent strong coughing
  • Acute infection
  • Bronchogenic carcinoma
  • Cardiovascular disease
  • Trauma
  • Anticoagulant therapy

Descriptions

  • Streaky hemoptysis
  • Massive hemoptysis

Hemoptysis versus Hematemesis

  • Blood from the lung
  • Blood from the stomach

Shortness of Breath (Dyspnea)

Dyspnea is a common symptom of patients with lung or cardiac problems.

Subjectiveness of Dyspnea

  • Dyspnea is a subjective complaint
  • The degree of dyspnea may not correlate
  • Dyspnea should always be investigated

Dyspnea Scoring System

  • A variety of scoring systems have developed to help quantify dyspnea at a single point in time to help track changes with treatment.
  • The Modified Borg Scale
  • Many other tools are also available.

Causes, Types, and Clinical Presentation of Dyspnea

  • Dyspnea occurrence
  • The adjectives patients use to describe their dyspnea may correlate with the underlying pathology.
  • Acute dyspnea
  • Chronic dyspnea is almost always progressive.

Descriptions

  • Paroxysmal nocturnal dyspnea (PND) is often seen in CHF patients.
  • Orthopnea
  • Trepopnea
  • Platypnea

Chest Pain

  • Chest pain
  • Angina

Pulmonary Causes of Chest Pain

  • Pleural inflammation
  • Pneumonia, Pulmonary infarction
  • Pleuritic pain
  • Chest wall pain

Descriptions

  • Chest pain from heart disease is often described as aching, squeezing, pressing, or viselike.
  • Patients with pleuritic chest pain. The pain increases with deep breathing.

Dizziness and Fainting (Syncope)

  • Syncope
  • Patients with lung disease who cough very forcefully may experience syncope.

Descriptions

  • Vasovagal syncompe
  • Orthostatic hypotension
  • Cough syncope

Swelling of the Ankles (Dependent Edema)

  • Patients with chronic hypoxemia often develop right heart failure.
  • Dependent Edema – RHF leads to reduced venous return and increased hydrostatic pressure in the peripheral venous blood vessels especially in the dependent tissues (e.g., ankles).
  • Ankle edema

Description

  • Pitting edema

Fever, Chills, and Night Sweats

Descriptions

  • Sustained fever
  • Remittent fever
  • Intermittent fever
  • Fever is a concern because it may signal infection and it increases oxygen consumption.

Fever with Pulmonary Disorders

  • Pneumonia
  • Lung abscess
  • Tuberculosis
  • Empyema
  • Acute bacterial infections

Headache, Altered Mental Status, and Personality Changes

  • Lung disease can lead to headache
  • Sudden changes in personality
  • RTs must be sensitive to personality changes because they may be indicative of acute lung problems in the patient with chronic lung disease.

Snoring

Incidence and Causes

  • Snoring occurs in about 5% to 10% of children and 10% to 30% of adults.
  • Causes of snoring
  • Causes of Obstructive Sleep Apnea
  • Obesity
  • Enlarged tonsils
  • Large tongue
  • Short thick neck
  • Nasal obstruction
  • Alcohol and sleeping medications can also make snoring worse.

Clinical Presentation

  • Patients with obstructive sleep apnea always snore during sleep.
  • OSA patients will complain
  • excessive daytime sleepiness
  • poor concentration skills
  • bedwetting, impotence
  • high blood pressure