A patient with a nosebleed at night could wake up with hemoptysis in the morningSometimes difficult to determine origin. Those with a history of slcoholism or cirrhosis may cause nausea and vomiting. This could be introduced into the lungs(aspiration) and cause the symptom of hemoptysis. Conversely, when there is bronchopulmonary bleeding at night, the patient could swallow the blood and vomit in the morning.
For that level of exertion neuromuscular disease Hypoxemia, exercise
If you have ever seen Mom flare her nostrils when she gets mad… this is for a different kind of distress.
The Parietal Pleura is the serous membrane that lines the inner chest wall. This and the chest wall are filled with pain fibers unlike the inner tissue of the lungs. Those existing conditions may not hurt, such as tumors, however the inflammation may cause a tearing or sharp pain.
Obstruction of blood flow to the heart, reducing oxygen transport to the rest of the body Hypovolemia, or low volume, causes a decrease in available blood or Hemoglobin . Hypocapnia, few and shallow breaths, can be caused by sedation or OD
When those fluids start to back up, it can cause right heart failure, fluid can overload the lungs causing respiratory distress.
The contents of the stomach can be an irritant on the lungs and cause exacerbation of asthma or other lung conditions
Most common in children, cough may indicate asthmatic bronchitis Pneumothorax is the presence of air within the pleural space. This space is the ling of the lung and the lining of the chest wall. This normally has no air. This can happen during mechanical ventilation and trauma such as in the following video
Coughing Afternoon or - Exposure to Evening irritants Associated with Position Change - Bronchiectasis, Left Associated with Heart Failure, Eating or Drinking GERD - Aspiration, Neromuscular Diseases
Sputum Production Cause ◦ Mucus Glands (Most often) Characteristics ◦ Color (clear, green, yellow, blood tinged) ◦ Consistency (thin, thick, viscous, tenacious, frothy) ◦ Odor ◦ Quantity ◦ Time of day
Hemoptysis Coughing up blood streaked or bloody sputum Hemoptysis is not Hematemesis
Dyspnea Shortness of Breath (SOB) Respiratory and cardinal symptom of Cardiac Hematologic, metabolic, chemical, neurologic, psycogenic, mechanical
Dyspnea Work of Breathing (WOB) abnormally high Ventilatory capacity is reduced Drive to breath is elevated
Signs of Difficulty Breathing Tripod ◦ Support arms on a stationary object Accessory Muscles ◦ Intercostal Muscles ◦ Supraclavicular ◦ Subscapular
Signs of Difficulty Breathing Cyanosis ◦ Central ◦ Acrocyanosis
Chest Pain (Angina) Cardinal Symptom of Heart Disease Variation ◦ Classic symptoms: Left sided arm, jaw, shoulder, back pain or pressure ◦ Center of the chest ◦ Radiating to Back and Legs ◦ Nausea ◦ Vomiting ◦ Dizziness
Tension Pneumothorax Diminished breath sounds Tachycardia, Hypertension Immediate Decompression of the Chest ◦ 18 gauge needle ◦ Over second rib on the anterior aspect of chest ◦ Rush of air through the needle ◦ Remain in place until more conventional chest tube is inserted ◦ Patient should become more stable quickly
Causes Foreign Body Aspiration Stridor, Wheeze, Retractions Pulmonary Emboli Chest Pain, Arrhythmias, Tachypnea, Wheezing Pulmonary Edema Dyspnea on exertion, Crackles at bases of lungs
Remember One of the most important things… LOOK at your patient
References Wilkins, Robert L.; Stoller, James K.; Kacmarek, Robert M. 2009. Fundamental’s of Respiratory Care. Ninth Ed. Mosby Elsevier