COPD (Respiratory disorders) Questions

[John]

COPD (Respiratory disorders)

SOBOE / SOBOR

How long have you been SOB?

Grading dyspnea 0/10

What causes this and stops it

Do you have chest pain? (PQRST)

Pain on inspiration / expiration  

 

A cough

Productive, has it changed recently, what makes it better / worse?

            Haemoptysis

Sputum

colour, has it changed recently, have you coughed up any blood/

Wheezing

when do you wheeze, what makes you wheeze, can others hear it,

what makes it better / worse?

General fatigue and weakness

Hx of disorders

asthma, emphysema, allergies, smoker, pneumonia, etc.

Life style patterns

smoking, work exposure.

Psychosocial factor

Family Hx

Orientated, distressed

Speak words 2-3 sentences

Use of accessory muscles to breathe

Clubbing of the fingers (capillary refill)

Diaphoresis

Medications

 =============================

Subjective data 

Dyspnoes

 

Sudden dyspnoea

            Pneumothorax

            Acute respiratory obstraction

            ARDS

    pulmonary embolism

Orthopnoea (inability to breathe easily except in an upright position)

            COPD

Noise breathing

            A tumour or foreign body

The presence of both inspiratory and expiratory wheezing

            Asthma if the pt does not have heart failure

Cough

 

A dry, irritative cough:

            Upper respiratory track infection of viral origin

            A side effect of ACE inhibitor therapy

Irritative and high-pitched cough

            Laryngotracheitis

A brassy cough

            Tracheal lesions

A severe or changing cough

            Bronchogenic carcinoma

Pleuritic chest pain accompanying coughing

            Pleural or chest wall (musculoskeletal) involvement

Coughing at night

            The onset of left sided heart failure

            Bronchial asthma

A cough in the morning with sputum

            Bronchitis

Coughing after intake

            Aspiration of material into the tracheobronchial tree

A cough recent onset

            An acute infection

Sputum production

A profuse amount of purulent sputum (thick and yellow, green, or rust-colored)

Change in color of the sputum

            A bacterial infection

Thin mucoid sputum frequently

            Viral bronchitis

A gradual increase of sputum over time

            Chronic bronchitis or bronchiectasis

Pink-tinged mucoid sputum

            Lung tumour

Produse, frothy, pink material, often wellin gup into the throat

            Pulmonary edema

Foul smelling sputum and bad breath

            Lung abscess, bronchiectasis or infection caused by fusospirochetal

Chest pain

Pneumonia

Pulmonary embolism with lung infarction

Pleurisy

            Sharp, like “the stabbing of a knife”, intermittent

Bronchogenic carcinoma

            Dull, aching, persistent

Wheezing

Bronchoconstriction or airway narrowing

            A high-pitched, musical sound heard mainly on expiration

Clubbing the finger

            Chronic lung infections

    Malignancies of the lungs

Haemoptysis

            Sudden, intermittent or continuous

Cyanosis

====================================

Objective data

Chest configuration

            Barrel chest

            Funnel chest

            Pigeon chest

            Kyphoscoliosis

Breathing pattern and respiratory rate

            Eupnoea          normal breathing (12-18)

            Bradycardia     slow breathing

                                 ICP, brain injury, drug overdose

            Tachypnoea     rapid breathing

                                 Pneumonia, pulmonary edema, metabolic acidosis, septicaemia

                                 Severe pain, rib fracture

            Hypoventilation

                                 Shallow, irregular breathing

            Hypepnoea      increase in depth of respiration

            Hyperventilation

                                Increase in depth and rate

        that results in lowered arterial PCP2 level

                                Kussmaul’s respiration (diabetic or renal origin)

            Apnea            cessation of breathing

            Cheyne-strokes respiration

                                 Altering episodes of apnoes

                                 Heart failure and damage to the respiratory centre

                                 Drug induced tumour, gtrauma

Thoracic auscultation

            Breath sounds diminished or absent

                        Airflow is decreases by bronchial obstruction (atelectasis)

                        Fluid (pleural effusion) or tissue (obesity)

            Often completely inaudible, expiratory phase is prolonged        

                        Emphysema

            Bronchial or bronchovestibular sounds

                        Pneumonia, heart failure

            Adventitious sounds

                        Crackles

                        Wheeze         

Thoracic percussion

Thoracic palpation

            Skin legions subcutaneous masses

            Deeper masses or generalized flank or rib discomfort

            Movement normally symmetry