SAS 11

• Dyspnea is air hunger, a nonpainful but uncomfortable awareness of breathing that is inappropriate to the level of exertion, commonly termed shortness of breath.
• Dyspnea can result from pulmonary or cardiac disease.
• Sudden onset of dyspnea may indicate anaphylaxis, pulmonary embolism, spontaneous pneumothorax, or anxiety.
• Cough is typically a reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi.
• Coughing may be caused by inflammation of the respiratory mucosa or tension in the air passages from a tumor or enlarged peribronchial lymph nodes.
• Patients with asthma may experience a cough without wheezing.
• The narrowed airways trigger a cough on expiration as the patient tries to fully exhale the trapped air.
• Cough can be a symptom of left-sided heart failure.
• Viral upper respiratory infections are the most common cause of acute cough; other causes include acute bronchitis, pneumonia, asthma, or foreign body.
• A patient with the presence of crackles in the lung area upon auscultation of the nurse has a type of cardiac disease, such as atherosclerosis or right-sided heart failure.
• Nurse Ikumi is admitting a patient who is complaining of shortness of breath and cough and has noticed that the patient’s chest is barrel-shaped, suggesting chronic smoking.
• During the history of present illness, a patient named Subaru is complaining of a dry cough for less than 3 weeks and is currently suspected for COVID-19.
• Nurse Alice is auscultating a 4-year old patient who is suffering from pneumonia and has heard a high-pitched inspiratory sound, which she must document as stridor.
• A normal percussion note that a nurse must percuss must be dull.
• Pleural effusion is the accumulation of fluid in the pleural space.
• A deformity of the thorax where the sternum is displaced anteriorly, increasing the anteroposterior diameter, and the costal cartilages adjacent to the protruding sternum are depressed is termed as pigeon chest.
• During the inspection of the patient’s sputum, a nurse has noticed some blood streaks on it, which is termed as hemoptysis.
• Nurse Hisako is assessing a patient with asthma and expects to hear wheezing from this patient.
• Postinfectious cough, bacterial sinusitis, or asthma in subacute cough; postnasal drip, asthma, gastroesophageal reflux, chronic bronchitis, bronchiectasis in chronic cough.
• Mucoid sputum is translucent, white or grey; purulent sputum is yellowish or greenish.
• An acute cough lasts < 3 weeks, subacute 3 to 8 weeks, and chronic > 8 weeks.
• Chest pain may be caused by cardiac, respiratory, gastrointestinal, or musculoskeletal etiologies.
• Lung tissue itself has no pain fibers.
• Pain in lung conditions, such as pneumonia or pulmonary infarction, usually arises from inflammation of the adjacent parietal pleura.
• Sources of chest pain are listed below.
• Crackles may be from abnormalities of the lungs (pneumonia, fibrosis, early congestive heart failure) or of the airways (bronchitis, bronchiectasis).
• Stridor is a loud, high pitched crowing sound that is heard upon inhalation.
• Dullness replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussion fingers.
• Generalized hyperresonance may be heard over the hyperinflated lungs of COPD or asthma, but is not a reliable sign.
• Rhonchi suggest secretions in large airways.
• Alternate percussing one side of the chest and then the other at each level in a ladder-like pattern.
• Adventitious breath sounds are extra, or superimposed, sounds that are heard over the usual breath sounds.
• Funnel Chest is a condition where there is depression in the lower portion of the sternum, due to compression of the heart and great vessels.
• Bronchial breath sounds are louder and higher in pitch, with a short silence between inspiratory and expiratory sounds.
• Healthy lungs are resonant.
• Vesicular breath sounds are soft and low pitched, are heard through inspiration, continue without pause through expiration, and then fade away about one third of the way through expiration.
• While the patient keeps both arms crossed in front of the chest, percuss the thorax in symmetric locations from the apex to the base.
• Wheezes suggest narrowed airways, as in asthma, COPD, or bronchitis.
• Examples of conditions that cause dullness include lobar pneumonia, in which the pleural accumulations of serous fluid (pleural effusion), blood (hemothorax), pus (empyema), fibrous tissue, or tumor are present.
• Unilateral hyperresonance suggests a large pneumothorax or possibly a large air-filled bulla in the lung.