Chapter 14 Dains Dyspnea

S4

atrial gallop in children indicatees stressed heart and HF. in adults-HTN, MI, CAD causing HF.

Emergent Conditions manifested by Dyspnea: status asthmaticus

can develop from URI, allergies, inhalation of fumes. Caused by bronchial smooth muscle consriction, mucosal edema, excessive mucus production. Sx-breathlessnes, wheezing, coughing. Absence of wheezing in a child is severe.

Nonemergent Conditions manifested by dyspnea: anemia

dyspnea on exertion, light headed, fatigue, palpitations, exam-pallor and tachycardia

Nonemergent Conditions manifested by dyspnea: hyperventilation syndrome

dyspnea, light headed, palpitations, paresthesias. exam-reslessness, anxiety

Nonemergent Conditions manifested by dyspnea: Pneumonia

dyspnea, pleuritic chest pain, cough w/greenish or rust sputum, fever, chills. children-irritability, feeding problems, lack of playfulness. exam-fever, tachycardia, tachypnea, inspiratory crackles, asynchronous breathing, tactile fremitus, dull percussion, bronchophony.

Nonemergent Conditions manifested by dyspnea: heart failiure

exam-alt LOC, anxiety, JVD, tachypean, rales, rhonchi, tachycardia, displaced point of maximum impulse, S3, S4, ascites. children-sweating on forehead, upper lip.

edema in infants:

occurs as hepatomegaly and periorbital or flank edema

Emergent Conditions manifested by Dyspnea: croup

parainfluenza infection. preceded by URI sx. gradual onset, hoarse, seal barck cough and fever.

Nonemergent Conditions manifested by dyspnea: asthma

paroxysmal cough, audible wheeze, dyspnea. exam-restless, tachypnea, accessory muscles, intercostal retraction, decreased tactile fremitus, decreased breath sounds.

Status asthmaticus:

progressive bronchospasm in children that does not respond to pharmacological intervention. Can have fever, increased pulse and respirations. Wheezing is not heard from lack of air movement.

Emergent Conditions manifested by Dyspnea: anaphylaxis

pruritic rash, feeling of warmth, wheezing, fatigue, light headed, dyspnea. Angioedema, tachypnea, clammy skin, hypotension, wheezes, tachycardia.

Emergent Conditions manifested by Dyspnea: acute epiglottitis

serious, life threatening. Caused by h. influenzae. Rapid onset with stridor, high fever, drooling, muffled voice, sore throat. may be anxious and sitting forward.

Pallor of sclera or nail beds:

severe anemia

increased expiratory effort suggests disease in the ______ airways.

small airways or lower respiratory tract.

Emergent Conditions manifested by Dyspnea: FB aspiration

sudden and unexpected onset of cough. Partial obstruction can cause stridor, cyanosis, labored respirations, wheezing. Lateral neck/chest xray.

Emergent Conditions manifested by Dyspnea: Pulmonary Embolus

sx-severe dyspnea, cough, fever, hemoptysis, CP. hx of DVT or immobilization. Wells score to assess probability of PE.

Pulmonary embolism:

sx: acute distress SOB localized pleuritic chest pain apprehension bloody sputum diaphoresis fever increased risk->60 years old, pulmonary HTN, CHF, chronic lung disease, ischemic heart disease, stroke, cancer.

Nonemergent Conditions manifested by dyspnea: vascular ring

tracheal compression from vascular anomalies in infants. main symptom-soft inspiratory stridor with expiratory wheeze. Brassy cough and difficulty swallowing.

Increased inspiratory effort suggests disease in the________ airways

upper

Emergent Conditions manifested by Dyspnea: Bacterial tracheitis

usually secondary infection to s. aures and or influenzae. Inflames trachea. subglottic lesion and mimics croup. high fever, toxic appearance, copies purulent sputum.

S3

ventricular gallop and early sign of HF.

True dyspnea:

1. increased awareness of normal breathing (hyperventilation) 2. increase in work of breathing (airway obstruction) 3. abnormalities in ventilatory system (neuro disorders, chest wall abnormalities).

Labs and diagnostics

Pulse ox. (Children 95-98normal, 90-95, 85-90, <85 severe) CXR ECG Echo Hgb and Hct Spirometry Ct CTA D-dimer CBC BUN/Creatinine ABG Sputum culture

Nonemergent Conditions manifested by dyspnea: poor physical conditioning

SOB w/exertion. palpitations, excessive weight, sedentary.

Nonemergent Conditions manifested by dyspnea: COPD

frequent cough worse in the morning, sputum clear to yellow, decrease exercise tolerance, mild to moderate fatigue. exam-rapid shallow respirations, reddish complexion, increased AP diameter, accessory muscle use, pursed lip breathing, decreased tactile fremitus, hyperresonance, distant breath sounds, prolonged expiration wheezes, muffled heart sounds.

Emergent Conditions manifested by Dyspnea: pneumothorax

history of blunt trauma cystic fibrosis spontaneous (usually tall, thin males ages 15-30) sx-sudden severe chest pain and dyspnea.

negative intrathoracic pressure is associated with:

increased afterload and low SBP.

Emergent Conditions manifested by Dyspnea: Botulism

ingestino in inadequately cooked food or improperly canned food. Sx-within hours, weakness, respiratory dyspnea and failure with visual problems. infants-constipation, increased weakness, listless.

Common cause of acute-onset dyspnea:

left ventricular dysfunction.

Wheezing is common with:

lower respiratory tract disorders that cause inflammation, infection, or bronchoconstriction such as asthma an bronchitis.

Nonemergent Conditions manifested by dyspnea: bronchomalacia

most common cause of persistent stridor in infancy. Onset within 4 weeks. Predominantly inspiratory.