NURS 550: WEEK 3 STUDY GUIDE

NURS 550: WEEK 3 STUDY GUIDE The student should be able to answer the following after completing the required readings for this week of the course: THORAX AND LUNGS 1. Identify the questions you need to ask in a respiratory review of systems (page 12-13 in Bates’) a. Have you ever had any…? i. Cough ii. Sputum (color, quantity; presence of blood or hemoptysis) iii. SOB (Dyspnea) iv. Wheezing v. Pain with a deep breath (pleuritic pain) vi. Last chest x-ray 1. You may wish to include asthma, bronchitis, emphysema, pneumonia & TB 2. Describe the questions you would ask a patient presenting with the following a. Shortness of breath i. Have you had any difficulty breathing?” ii. Find out if the symptoms occur at rest or with exertion iii. How much exertion produces onset? iv. Make every effort to determine its severity based on the patient’s daily activities 1. How many flights of stairs or steps can the patient climb before pausing for breath? 2. What about carrying bags of groceries, vacuums, making the bed? 3. Has SOB altered the pt’s lifestyle & daily activities? How? 4. Carefully elicit timing and setting, any associated symptoms, and relieving or aggravating factors v. Most patient’s relate SOB to their level of activity 1. Anxious patients present a different picture 2. May describe difficulty taking a deep breath 3. Smothering sensation with inability to get enough air 4. Paresthesiassensations of tingling or “pins & needles” around the lips or extremities b. Wheezing i. Have you noticed any musical sounds when you breathe? ii. Wheezing occurs in partial lower airway obstruction from secretions and tissue inflammation in asthma or from a foreign body c. Cough i. Establish duration 1. Acute lasting less than 3 weeks? a. Most common cause: viral URI b. Also consider- acute bronchitis, pneumonia, left-sided heart failure, asthma, foreign body, smoking & ace-inhibitor therapy 2. Subacute lasting 3-8 weeks? a. Post-infectious cough, pertussis, acid reflux, bacterial sinusitis, asthma 3. Chronic lasting more than 8 weeks? a. Postnasal drip asthma, GERD, chronic bronchitis & bronchiectasis ii. Ask if the cough is dry or produces sputum or phlegm 1. Mucoid sputum is translucent, white, or gray & seen in viral infections & cystic fibrosis 2. Purulent sputum is yellow or green & often accompanies bacterial pneumonia iii. Ask the patient to describe the volume or any sputum and its color, odor, and consistency 1. Foul smelling sputum is present in anaerobic lung abscess 2. Thick tenacious sputum is seen is cystic fibrosis iv. To help quantify volume try a multiple-choice question 1. “How much do you think you cough up in 24 hours: a tsp, tbsp, quarter cup, half cup, or cupful?” 2. Large volumes of purulent sputum are present in bronchiectasis and lung abscess v. If possible, ask patient to cough into a tissue; inspect the phlegm, and note its characteristics 1. Symptoms associated with a cough often lead to its cause 2. Diagnostically helpful symptoms include: a. Fever & productive cough in Pneumonia b. Wheezing in Asthma c. Chest pain, dyspnea & orthopnea in Acute Coronary Syndromes 3. Describe a physical examination of the thorax and lungs system (go step-by-step) a. For best results, examine the posterior thorax & lungs with the patient sitting & the anterior thorax & lungs with patient supine b. Inspect, then palpate, percuss & auscultate c. Try to visualize the underlying lobes & compare right lung field to left, carefully noting asymmetries i. With patient sitting, examine posterior thorax & lungs. Patient’s arms should be folded across chest with hands resting, if possible, on the opposite shoulders. This position swings the scapulae laterally & increases access to the lung fields. Then ask patient to lie down.