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RESP Symptoms

Signs & Examples Subjective. Patient description. Measured by patient perception. Examples: pain, cough, SOB
Symptoms & Examples Objective. Measurable. Assessed values. Examples: heart rate, blood pressure, respiratory rate.
What are the primary symptoms of cardiopulmonary disorders? 1. Cough 2. Sputum Production 3. Hemoptysis 4. Shortness of breath (dyspnea) 5. Chest pain
Cough Is a protective reflex. You have a stimulation of receptors: pharynx, larynx, large bronchi, lung and visceral pleura
Cough is caused by: inflammatory, mechanical, chemical, or thermal stimulation of cough receptors
Possible causes of inflammatory stimulation: Infection, lung abscess, drug reaction, allergy.
Possible causes of mechanical stimulation: Inhaled dust, suction catheter, food
Possible causes of obstructive stimulation: Foreign bodies, aspirations of nasal secretions, tumor
Possible causes of chemical stimulation: Inhaled irritant gases, fumes, smoke
Possible causes of temperature stimulation: Inhaled hot or cold air
Two pathways of cough: 1. Afferent Pathway - vagus, phrenic, glossopharyngeal, trigeminal nerves. 2. Efferent Pathway - smooth muscles of larynx and tracheobronchial tree via phrenic, spinal nerves
Phases of Cough: 1. Inspiratory 2. Compression 3. Expiratory
Reduced effectiveness of cough: Weakness of inspiratory/expiratory muscles. Inability of glottis to open/close correctly. Obstruction/alteration of shape of the airways. Decrease in lung recoil (emphysema). Abnormal quality of mucus.
Acute Clinical Presentation: Sudden onset. Severe. Self-limiting (viral infection)
Chronic Clinical Presentation and Causes: Persistent. Lasts > 3 weeks. Causes = asthma, COPD, GERD, chronic bronchitis, allergic rhinitis
Paroxysmal Clinical Presentation: Periodic. Prolonged, forceful episodes.
Associated Symptoms of Cough 1. Wheezing 2. Stridor 3. Chest Pain 4. Dyspnea
Complications of Cough: 1. Torn Chest Muscle 2. Rib Fracture 3. Disruption of Surgical Wounds 4. Syncope 5. Arrhythmia 6. Esophageal Rupture 7. Incontinence (Urinary) 8. Pneumothorax
Sputum Production: 1. Sputum: secretions from tracheobronchial tree, pharynx, mouth, sinuses, nose 2. Phlegm: secretions from lungs and tracheobronchial tree
Components of Sputum Mucus, cell debris, microorganisms, blood, pus, foreign particles
Normal Sputum Production: 100 mL/day
Abnormal Sputum Production excessive production by inflamed glands. Caused by: infection, smoking, allergies
Hemoptysis Sputum containing blood. (streaking to frank bleeding)
What causes hemoptysis? (5) 1. Bronchopulmonary 2. Cardiovascular 3. Hematologic 4. Systemic disorders 5. Tuberculosis/fungal infection
Description of Hemoptysis 1. Amount: MASSIVE - 400 ml/3h or 600 ml/24h (emergency condition - cancer, TB, trauma). STREAKY - pulmonary infection, lung cancer, thromboemboli. 2. Odor 3. Color 4. Acuteness
Hematemesis Vomited blood. 1. Oropharynx - swallowed from respiratory tract 2. Esophagus/Stomach - alcoholism or cirrhosis of liver
Shortness of Breath Cardinal symptom of cardiac distress, most distressing symptom
Dyspnea Subjective breathing discomfort. Sensory input to cerebral cortex.
Dyspnea Scoring Systems Scale of 0 (no SOB) to 10 (max SOB). Visual Analog Scale. Modified Borg Scale. ATS SOB Scale. UCSD SOB Questionnaire.
Clinical Presentations of Dyspnea 1. WOB abnormally high. 2. Ventilatory capacity reduced 3.Drive to breathe is elevated
Clinical Types of Dyspnea (1) 1. Cardiac/Circulatory - inadequate supply of O2 to tissues (during exercise)
Clinical Types of Dyspnea (2) 2. Psychogenic - panic disorder, not related to exertion.
Clinical Types of Dyspnea (3) 3. Hyperventilation - rate/depth exceeds body's metabolic need (results in hypocapnia/decreased cerebral blood flow)
Paroxysmal Nocturnal Dyspnea (PND) Sudden dyspnea when sleeping (recumbent position), associated with coughing, sign of left heart failure
Orthopnea Dyspnea when lying down, associated with left heart failure
Trepopnea Dyspnea when lying on ONE side, unilateral lung disease/pleural effusion
Platypnea Dyspnea when in upright position - seen in patients with right-to-left intracardiac shunts or venoarterial shunts.
Orthodeoxia Hypoxemia in upright position, relieved in recumbent position - seen in patients with right-to-left intracardiac shunts or venoarterial shunts.
Causes of Chest Pain Cardiac ischemia, inflammation of thorax/abdomen, musculoskeletal disorders/trauma/anxiety, referred pain from indigestion
Cardinal Symptom of Heart Disease Angina
Pleuritic Pain Inspiratory, sharp, and abrupt onset. Worsens with cough, sneeze, hiccup, laughter. Increases with pressure/movement.
Chest Wall Pain Intercostal/pectoral muscles, well localized.
Dizziness/Fainting (Syncope) Temporary loss of consciousness because of reduced cerebral blood flow and O2.
Causes of Dizziness/Fainting Thrombosis, embolism, atherosclerotic obstruction. Pulmonary embolism, coughing, hypoxia, hypocapnia.
Most common type of Syncope Vasovagal - loss of peripheral venous tone
Orthostatic Hypotension (Dizziness/Fainting) Sudden drop in BP when standing, dizziness, blurred vision, weakness, dehydration.
Carotid Sinus Syncope Hypersensitive carotid sinus - slows pulse rate, decreases BP
Tussive Syncope Caused by strong coughing - seen mostly in men with COPD, obesity, smoking history, frequent use of alcohol
Edema Soft tissue swelling from fluid accumulation.
Bilaterial Peripheral Edema Ankles/lower legs, caused by right/left heart failure - right heart failure often caused by cor pulmonale
Euthermia 97F to 99.5F; 36C to 37.5C
Causes for Fever Hot environment, dehydration, drugs, rxn to chemicals, infection, malignancy, etc
Intermittent Fever Daily elevation with a return to normal or subnormal between spikes
Remittent Fever Continuously elevated with wide, usually diurnal variations - In patients with Legionnaire's Disease, Acute viral Infections, and Mycoplasma Pneumonia.
Relapsing Fever Reoccurring in bouts of several days with periods of normal temps.
Fever and Pulmonary Infections Lung abscesses, empyema, TB, pneumonia.
Infections with NO Fever High-dose corticosteroids, immunosuppressants, Immunocompromised.
Headache as a manifestation of? Cerebral hypoxia and hypercapnia - lung disease, high altitude
Altered Mental State in? Hypercapnia - from affected alertness to coma.
Personality Changes in? Pulmonary Disorders - forgetfulness, inability to concentrate, anxiety, irritability
Snoring Serious concern with apnea. Children - 10% to 12%; Adults - 10% to 30%.
Excessive Daytime Sleepiness Occupational Accidents, Motor Vehicle Accidents, Loss of employment, Social dysfunction.
GERD Heartburn/regurgitation. Gastroesophageal Reflux more then TWO times per week = GERD.
Assess symptoms to determine: Seriousness of problem, potential underlying cause, effectiveness of treatment
Key to determine etiology: careful history, CXR, physical exam
Sputum, describe? color, odor, quantity, quality, time of day, blood, consistency
Frequent causes of hemoptysis: TB, acute/chronic bronchitis, bronchogenic carcinoma, bronchiectasis
Hemoptysis from? cardiopulmonary, coughed up from lungs/chest
Hematemesis from? gastrointestinal, vomited from stomach
Apnea not breathing for more than 20 sec
Eupnea Normal rate of breathing
+1 edema rapid
+2 edema 10-15 sec
+3 edema 1-2 min
+4 edema >2 min
High grade fever > 101 (38.2C)
Low grade fever 99.5-101 (37.5-38.2C)
Created by: hbcole10