PCP Program 2004 / Respiratory Illness

Disease Process Cause Signs & Symptoms Why It Stands Apart

Chronic Bronchitis Contributing factors are smoking, environmental pollution, chemical inhalation -> resulting in excessive mucous production in the bronchial tree. - Cough with sputum.
- Hypoxia.
- Shortness of breath.
- "Blue Bloater" Patient has probably had the cough most days for 3 months, and had Bronchitis for 2 consecutive years.

Emphysema Breakdown of the alveoli and lung elasticity over a period of time. - Barrel shaped chest.
- Accessory muscle use in breathing.
- Thin in appearance.
- Short of breath even at rest.
- Wheezing and rhonci.
- Pursed lips with inspiration.
- "Pink Puffer" Builds over years, Pt is usually on home oxygen if diagnosed previously.

Asthma Airflow obstruction caused by bronchial muscle contraction, excess mucous production, and inflamed bronchial walls. - Laboured breathing.
- Rapid, loud respirations.
- Wheezing.
- Agitation.
- Diaphoretic.
- Pale.
- Retraction of accessory muscles.
- Rapid breathing.
- Rapid pulse. Usually a history of asthma.

Pneumonia Infection causing inflammation of the bronchioles and alveoli. - Short of breath.
- Sharp pain that can radiate to the backk and shoulders.
- Cough.
- Rales.
- Rhonchi.
- Wheezes.
- Cyanotic.
- Fever.
- Sputum coughed up in yellowish or pink tinge. Usually have not felt good for a few days and have a fever.

Diabetic Ketoacidosis Lack of insulin causes glucose to accumulate in the blood because it can not enter the body cells. - Warm, dry skin.
- Dry mouth.
- ▲ heart rate.
- Thready pulse.
- Postyral.
- Hypotensive.
- Excessive urination.
- Excessive thirst.
- Abdominal pain.
- Nausea.
- Vomiting.
- Acetone breath odor.
- Kussmaul's respirations.
- ▼ LOC. Fruity odor on breath.

Pneumothorax Air enters the pleural space of the lung.
Can be spontaneous or caused by trauma. - Short of breath.
- Chest pain.
- Pale.
- Diaphoretic.
- ▲ heart rate.
- ▲ respiratory rate. Diminished or no lung sounds on the affected side.
Hyperresonance on percussion.

Tension Pneumothorax Build of air in the pleural space of the lung causing pressure to push the affected lung to the other side. - Anxiety.
- Cyanotic.
- SOB.
- ▲ heart rate.
- Low blood pressure.
- JVD.
- Unequal expansion of the chest.
- Subcutaneous emphysema. Diminished breath sounds.
Tracheal shift (late sign).
Hyperresonance.

Hemothorax Accumulation of blood in the pleural space of the lung. - ▲ respiratory rate.
- Labored breathing.
- Cyanotic.
- Low Blood pressure.
- Pale.
- Diaphoretic.
- Rapid, weak pulse.
- Flat neck veins. decreased breath sounds on the affected side.
Dullness to percussion.

Flail Chest Trauma to rib cage causing two or more ribs to break in two or more places. - SOB.
- Pain at site.
- Unstable chest wall.
- Cyanotic.
- Paradoxical movement of the chest.
- ▲ pulse. Unstable chest wall

Sucking Chest Wound

Pericardial Tamponade Usually caused by penetrating trauma to the chest but can be caused by severe blunt trauma. Tears the heart chamber wall allowing blood to leak from the heart. - ▲ heart rate.
- Respiratory distress.
- Cyanosis of the head and upper extremitties.
- Low blood pressure.
- Change in cardiac rhythm. Beck's Triad: Hypotension, JVD and Muffled heart sounds

Pulmonary Contusion Usually caused by rapid deceleration forces that cause the lung to come into contact with the chest wall resulting in ruptured alveoli and hemorrhage. - Hypoxia.
- SOB.
- ▲ heart rate.
- Cough.
- Bloody sputum.
- Anxiety.
- Low blood pressure.

Cerebral Herniation Syndrome Sudden rise in intracranial pressure from trauma to the head. - Pupil dilation.
- Outward deviation of the eye on the sidde of the injury.
- Paralysis on the opposite side of the iinjury.
- Decerebrate posturing.
- ▲ blood pressure.
- Low pulse rate.
- Irregular respirations Cushings Triad: ▲ blood pressure, ▼ pulse rate, Irregular respirations

Hyperventilation Syndrome Many causes - Abnormal deep or rapid breathing.
- Chest pain.
- Carpal pedal spasm.
- Tingling. Tingling and carpal pedal spasm

Pulmonary Embolism Blockage of a pulmonary artery by a clot or other foreign material. - Dyspnea.
- Sharp chest pain.
- Anxiety.
- Syncope.
- ▼ blood pressure.
- Diaphoretic.
- ▲ heart rate.
- Fever.
- JVD.
- Wheezing, rales and rhonchi. Sudden onset. Past history of prolonged resting ( ie: after surgery )

Epiglottitis Rapid onset bacterial infection of the epiglottis causing swelling and edema. - Sore throat.
- Pain on swallowing.
- High fever.
- Muffled voice.
- Drooling.
- Have to sit upright.
- Protruding tongue.
- Hypoxic. Rapid onset, drooling.
Usually occurs only in children (3-7 y/o).

Croup Viral infection of the upper airway. - Low grade fever.
- Recent illness of respiratory tract inffection.
- Barking cough.
- SOB.
Slow onset, barking cough.
Usually occurs only in childen (6 mos-4 y/o).

Hypoglycemia Low blood sugar levels that can be caused by many different factors. - Nervousness.
- Trembling.
- Irritability.
- Psychotic behaviour.
- Weakness.
- Confusion.
- Appears intoxicated.
- Weak, rapid pulse.
- Cold, clammy skin.
- Drowsiness. Blood sugar reading below 3.1 mmol/L

*Disease Process*	*Cause*	*Signs & Symptoms*	*Why It Stands Apart*

Chronic Bronchitis	Contributing factors are smoking, environmental pollution, chemical inhalation -> resulting in excessive mucous production in the bronchial tree.	- Cough with sputum. - Hypoxia. - Shortness of breath. - "Blue Bloater"	Patient has probably had the cough most days for 3 months, and had Bronchitis for 2 consecutive years.
Emphysema	Breakdown of the alveoli and lung elasticity over a period of time.	- Barrel shaped chest. - Accessory muscle use in breathing. - Thin in appearance. - Short of breath even at rest. - Wheezing and rhonci. - Pursed lips with inspiration. - "Pink Puffer"	Builds over years, Pt is usually on home oxygen if diagnosed previously.
Asthma	Airflow obstruction caused by bronchial muscle contraction, excess mucous production, and inflamed bronchial walls.	- Laboured breathing. - Rapid, loud respirations. - Wheezing. - Agitation. - Diaphoretic. - Pale. - Retraction of accessory muscles. - Rapid breathing. - Rapid pulse.	Usually a history of asthma.
Pneumonia	Infection causing inflammation of the bronchioles and alveoli.	- Short of breath. - Sharp pain that can radiate to the backk and shoulders. - Cough. - Rales. - Rhonchi. - Wheezes. - Cyanotic. - Fever. - Sputum coughed up in yellowish or pink tinge.	Usually have not felt good for a few days and have a fever.
Diabetic Ketoacidosis	Lack of insulin causes glucose to accumulate in the blood because it can not enter the body cells.	- Warm, dry skin. - Dry mouth. - ▲ heart rate. - Thready pulse. - Postyral. - Hypotensive. - Excessive urination. - Excessive thirst. - Abdominal pain. - Nausea. - Vomiting. - Acetone breath odor. - Kussmaul's respirations. - ▼ LOC.	Fruity odor on breath.
Pneumothorax	Air enters the pleural space of the lung. Can be spontaneous or caused by trauma.	- Short of breath. - Chest pain. - Pale. - Diaphoretic. - ▲ heart rate. - ▲ respiratory rate.	Diminished or no lung sounds on the affected side. Hyperresonance on percussion.
Tension Pneumothorax	Build of air in the pleural space of the lung causing pressure to push the affected lung to the other side.	- Anxiety. - Cyanotic. - SOB. - ▲ heart rate. - Low blood pressure. - JVD. - Unequal expansion of the chest. - Subcutaneous emphysema.	Diminished breath sounds. Tracheal shift (late sign). Hyperresonance.
Hemothorax	Accumulation of blood in the pleural space of the lung.	- ▲ respiratory rate. - Labored breathing. - Cyanotic. - Low Blood pressure. - Pale. - Diaphoretic. - Rapid, weak pulse. - Flat neck veins.	decreased breath sounds on the affected side. Dullness to percussion.
Flail Chest	Trauma to rib cage causing two or more ribs to break in two or more places.	- SOB. - Pain at site. - Unstable chest wall. - Cyanotic. - Paradoxical movement of the chest. - ▲ pulse.	Unstable chest wall
Sucking Chest Wound
Pericardial Tamponade	Usually caused by penetrating trauma to the chest but can be caused by severe blunt trauma. Tears the heart chamber wall allowing blood to leak from the heart.	- ▲ heart rate. - Respiratory distress. - Cyanosis of the head and upper extremitties. - Low blood pressure. - Change in cardiac rhythm.	Beck's Triad: Hypotension, JVD and Muffled heart sounds
Pulmonary Contusion	Usually caused by rapid deceleration forces that cause the lung to come into contact with the chest wall resulting in ruptured alveoli and hemorrhage.	- Hypoxia. - SOB. - ▲ heart rate. - Cough. - Bloody sputum. - Anxiety. - Low blood pressure.
Cerebral Herniation Syndrome	Sudden rise in intracranial pressure from trauma to the head.	- Pupil dilation. - Outward deviation of the eye on the sidde of the injury. - Paralysis on the opposite side of the iinjury. - Decerebrate posturing. - ▲ blood pressure. - Low pulse rate. - Irregular respirations	Cushings Triad: ▲ blood pressure, ▼ pulse rate, Irregular respirations
Hyperventilation Syndrome	Many causes	- Abnormal deep or rapid breathing. - Chest pain. - Carpal pedal spasm. - Tingling.	Tingling and carpal pedal spasm
Pulmonary Embolism	Blockage of a pulmonary artery by a clot or other foreign material.	- Dyspnea. - Sharp chest pain. - Anxiety. - Syncope. - ▼ blood pressure. - Diaphoretic. - ▲ heart rate. - Fever. - JVD. - Wheezing, rales and rhonchi.	Sudden onset. Past history of prolonged resting ( ie: after surgery )
Epiglottitis	Rapid onset bacterial infection of the epiglottis causing swelling and edema.	- Sore throat. - Pain on swallowing. - High fever. - Muffled voice. - Drooling. - Have to sit upright. - Protruding tongue. - Hypoxic.	Rapid onset, drooling. Usually occurs only in children (3-7 y/o).
Croup	Viral infection of the upper airway.	- Low grade fever. - Recent illness of respiratory tract inffection. - Barking cough. - SOB.	Slow onset, barking cough. Usually occurs only in childen (6 mos-4 y/o).
Hypoglycemia	Low blood sugar levels that can be caused by many different factors.	- Nervousness. - Trembling. - Irritability. - Psychotic behaviour. - Weakness. - Confusion. - Appears intoxicated. - Weak, rapid pulse. - Cold, clammy skin. - Drowsiness.	Blood sugar reading below 3.1 mmol/L

▲ = increasing; ▼ = decreasing.