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Cardiopulmonary
Symptoms
Cough
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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
Cough
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Stimulated by reflexes in
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Pharynx
Larynx
Trachea
Large airways (carina)
Cough
Made up of four phases
1.
Stimulus
2.
Inspiratory phase
Opening of Glottis
Contraction of diaphragm
3.
Compression phase
Closure of glottis
Relaxation of diaphragm
Accessory muscles contract
4.
Expiratory phase
Opening of glottis
Explosive release of trapped intrathoracic air
Causes and Clinical Presentation
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Acute cough most often associated
with viral infection of the upper airway
Chronic cough often associated with
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Postnasal drip
Asthma
COPD
Gastroesophageal reflux (GERD)
Left ventricular failure
Descriptions
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The type of cough present should be
documented using commonly
accepted adjectives
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Productive—mucus is produced with the
cough
Effective—a strong cough
Weak—ineffective
Dry—no secretions present
Chronic productive—patient produces
phlegm most days for at least 3 weeks
Characteristics
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Barking
Brassy (horse)
Wheezy (high pitched) sometimes
called a “tight cough”
Hacking (usually chronic from
smoking)
Time of day when cough is most
prevalent is important
Sputum Production
Sputum is the mucus
expelled from the
tracheobronchial tree that
has been contaminated by
the mouth
Phlegm is the term used to
describe mucus strictly
from the tracheobronchial
tree
Causes and Descriptions
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Caused by inflammation of the mucus secreting
glands that line the airways
Inflammation from
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Infection
Cigarette smoke
Allergies
Sputum should be described by
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Color
Consistency
Quantity
Odor
Presence of blood
Causes and Descriptions
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Thick but clear sputum is consistent
with dehydration
Pink frothy sputum is consistent with
pulmonary edema
Thick, purulent (pus-containing)
sputum is consistent with infection
Hemoptysis
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Causes
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Tuberculosis
Persistent strong coughing
Acute infection
Bronchogenic carcinoma
Cardiovascular disease
Trauma
Anticoagulant therapy
Descriptions
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Streaky hemoptysis refers to bloodtinged sputum
Massive hemoptysis refers to more
than 400 mL of blood in 3 hours or 600
mL in 24 hours.
Hematemesis
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Determining if the blood is from the
lung versus the stomach is important
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Blood from the lung is often associated
with pulmonary symptoms
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Blood from the stomach is associated
with GI symptoms
Shortness of Breath (Dyspnea)
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Dyspnea is a common symptom of patients
with lung or cardiac problems
Dyspnea is a subjective complaint that
varies with pathologic and psychologic
variables
The degree of dyspnea may not correlate
with objective measures of impairment
Dyspnea should always be investigated
even if initial tests are normal
Dyspnea
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Dyspnea occurs when
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increased WOB
increased drive to breath
decreased ventilatory capacity
Types of Dyspnea
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Physiologic
Cardiac
Circulatory
Chemical
Central
Psychogenic
Descriptors
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Apnea – Cessation of breathing
Dyspnea- Patients expression of SOB
Eupnea- Normal
Bradypnea- Slow
Tachypnea- Fast
Hypopnea- Decreased depth
Hyperpnea Increase depth
Descriptors
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Platypnea- Dyspnea sitting up
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Orthopnea- Dyspnea reclining position
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common in CHF secondary to pooling of
fluid in lungs during sleep.
Hyperventilation
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Common in CHF
Paroxysmal nocturnal dyspnea (PND)
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Can be caused by patent foramen ovale
Can only be described by ABG
Hypoventilation
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Can only be described by ABG
Questions to Assess Dyspnea
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When
How
What
What else happens
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Cynosis
Cough
How much can you do before dyspnea
Exposures
Chest Pain
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Chest pain is the cardinal symptom of
heart disease
Chest pain may be seen in patients
with lung disease when the pleural
lining is abnormal
Classic chest pain associated with
heart disease is known as angina, and
it signals a medical emergency
Pulmonary Chest Pain
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Pain associated with lung disease is
most often the result of pleural
inflammation
Pneumonia and pulmonary infarction
may cause pleural pain
Descriptions
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Chest pain from heart disease is often
described as aching, squeezing,
pressing, or viselike
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Often increases with exercise
Patients with pleuritic chest pain may
be leaning toward one side and
describe the pain as stabbing or
burning.
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Often state the pain increases with deep
Dizziness and Fainting
(Syncope)
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Syncope is a temporary loss of
consciousness due to reduced blood flow
and oxygen to the brain
Syncope is caused by a large variety of
disorders from something as simple as
dehydration to serious cerebral thrombosis
Patients with lung disease who cough very
forcefully may experience syncope
Swelling of the Ankles
(Dependent Edema)
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Patients with chronic hypoxemia often develop
right heart failure
Right heart failure 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 thus can be a sign of chronic lung
disease
Ankle edema may also simply be a sign of heart
disease not associated with lung disease
Fever / Chills
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Sustained fever is a continuously elevated fever
that varies little during a 24-hour period
Remittent fever is continuously elevated but has
larger variations and spikes in a 24-hour period
Intermittent fever refers to spikes in body
temperature cycling with periods of normal or
subnormal temperatures
Fever is a concern because it may signal infection
and it increases oxygen consumption
Fever with Pulmonary
Disorders
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Pneumonia
Lung abscess
Tuberculosis
Empyema
A lack of fever does not rule out
infection.
Headache, Altered Mental
Status, and Personality
Changes
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Lung disease can lead to headache when
chronic hypoxemia or hypercarbia is present
Sudden changes in personality are common
in patients with chronic lung disease and
may be due to hypoxia, medications, or
psychologic issues
RTs must be sensitive to personality
changes because they may be indicative of
acute lung problems in the patient with
chronic lung disease
Snoring
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Snoring occurs in about 5% to 10% of children and
10% to 30% of adults
Snoring is caused by excessive narrowing of the
upper airway with breathing during sleep
Obesity is the most common cause of obstructive
sleep apnea
Enlarged tonsils, a large tongue, a short thick neck,
and nasal obstruction may contribute to the upper
airway narrowing during sleep
Alcohol and sleeping medications can also make
snoring worse
Clinical Presentation
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Patients with obstructive sleep apnea
always snore during sleep
OSA patients will complain of
excessive daytime sleepiness because
their sleep continuity is abnormal
OSA patients may also complain of
poor concentration skills, bedwetting,
impotence, high blood pressure, and
other complaints
Case Study
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68 y/o male cc chest pain and DOE
dyspnea on exertion. Smokes 1.5 ppd
x 40years. General appearance- Mildly
obese, cyanotic in extremities and
dyspnic.
Case Study
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Physical exam shows increase AP
diameter, HR 108, RR 22 with
prolonged expiratory time, BP 160/95,
and a temp of 39c. Auscultation
reveals diminished breath sounds
bilaterally but more so in the right
lower lobe.
Case Study
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Palpation shows decrease chest
expansion on right and slight tracheal
deviation to the right. Percussion
shows hyper resonance throughout
except for RLL. Patient does not
exhibit increased tactile fremitus.
Case Study
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Patient states that he coughs up about
two table spoons of thick green mucus
in the morning and more throughout
the day and has had chills at night for
a week.