Respiratory Disorders
Abnormal breathing patterns
Kussmaul Respirations: always deep and most often rapid breathing-
caused by metabolic acidosis
Cheyne-Stokes: regular with periods of apnea followed by crescendo-
decrescendo sequence- caused by brain damage, drugs, heart failure
Sigh: occasional deep, audible sigh that punctuates a regular
respiratory pattern- caused by emotional distress or hypoventilation
Biot: varying depth and interrupted by periods of apnea but lack the
regular repetitive pattern- caused by increased intracranial
hypertension, drugs, brain damage
Tachypnea: RR of 25 or more per minute
Bradypnea: RR of 12 or less
Hyperpnea: deeper and more rapid at rest
Adventitious breath sounds
Crackles: heard on inspiration; high or low pitched and short in
duration; caused by air flowing by fluid. Coarse, medium, or fine;
early, mid-, or late-inspiratory
o Significance: Atelectasis, bronchiectasis, congestive heart
failure, pulmonary fibrosis
Rhonchi: low pitched and more prolonged; caused by air passing over
solid or thick secretion
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Wheezes: heard during inspiration or expiration, continuous and high
pitched; caused by air flowing through constricted passageways
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Friction rubs: dry, cracking, rubbing, and low pitched; caused by
inflammation of pleural or pericardial tissue. Loud, grating; late
inspiratory–early expiratory
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Cough
Upper Airway Cough syndrome
o Chronic cough caused by postnasal drainage
, o Throat clearing, drainage on posterior pharynx, hyperemia, and
cobblestoning of posterior pharynx, negative chest examination
Asthma
o Chronic condition that involves inflammation of the airways
o Intermittent sensation chest tightness, nonproductive cough,
SOB, and wheezing
o Diagnostic studies: Pulmonary function tests or spirometry;
FEV1; bronchodilators help
Chronic Obstructive Pulmonary Disease (COPD)
o Most commonly caused by smoking or alpha-1 antitrypsin
deficiency
o Usually made up of problems: chronic bronchitis and
emphysema
o Progressive, with little reversibility
o Common symptoms: chronic cough and dyspnea
Worse on exertion
o Lung sounds diminished, barrel chest
o Diagnostic studies: Spirometry: FVC, FEV1, and FEV1/FVC ratio
The percentage of predicted FEV provides further
differentiation; this value varies from greater than 80% for
stage I (mild) to less than 80%, less than 50%, and less
than 30% for stages II (moderate), III (severe), and IV
(very severe), respectively.
Chest radiographs reveal hyperinflation of the lungs with
flattened diaphragm and should be used to confirm but
not diagnose a patient with COPD.
Pneumonia
o Inflammation and consolidation of lung tissue
o Cough with fever, malaise, shaking chills, rigors, and chest
discomfort
o signs and symptoms vary a great deal but may include cough
with sputum production, fever, and pleuritic chest pain; flushed
appearance; confusion; crackles over the affected lung, rhonchi,
diminished breath sounds, or pleural friction; dullness on
percussion over the affected lung, decreased tactile and vocal
fremitus, grunting, nasal flaring, tachypnea
o There is uneven fremitus, and the area over the consolidation
percusses dully. On auscultation, there are bronchial breath
, sounds, often with crackles. Bronchophony, egophony, and
whispered pectoriloquy are often present.
o Diagnosis: chest film with area of infiltrate
CURB-65: determine if it warrants hospitalization
Acute Bronchitis
o Cough (may persist for several weeks after initial infection
resolves), fever, malaise, chest discomfort, chills, and headache
o There may be wheezes and/or rhonchi on auscultation, which
disappear or alter with cough effort. Fremitus is equal, and
there is no egophony.
o Chest x-ray to rule out pneumonia.
o Bronchitis (acute, chronic): cough; fever with chills; muscle
aches; nasal congestion; sore throat, sputum production; history
of smoking; normal breath sounds or diffuse crackles/rhonchi;
injected pharynx; mild dyspnea
Bronchiectasis
o Dilation of one or more bronchi
o Chronic, productive cough; sputum is mucopurulent; SOB,
wheezing, fatigue, possibly hemoptysis; rhonchi and/or
wheezing; in advanced disease clubbing and cyanosis may be
present
o Diagnosis: chest films reveal linear marking, atelectasis and
pulmonary cysts; confirm with CT
Tuberculosis
o history of exposure; may be symptom free
o cough with or without sputum; fatigue; fever; night sweats;
anorexia; pleuritic chest pain; crackles on auscultation;
tachypnea; decreased breath sounds
o Diagnosis: Plain chest films reveal hilar adenopathy and
multilobular granulomas, particularly of the upper lungs;
sputum acid-fast bacilli;
Pharmacological and ACE inhibitor induced cough
o Dry and intractable cough and worse at night
Shortness of Breath and Dyspnea
Pleural Effusion
o involve an abnormal collection of fluid in the pleural space.
Effusions are usually secondary to another condition, such as
malignancy, heart failure, cirrhosis, trauma, and infections.
, o Dyspnea, cough, pain, malaise and fever
o decreased lung sounds, dullness over the effusion, decreased
fremitus, egophony, and whispered pectoriloquy.
o Diagnosis: chest films- fluid collection as an increased area of
density, blunting of the costophrenic angle, and elevation of the
hemidiaphragm
Pulmonary Embolism
o Life-threatening stemming from venous thrombi
o History of immobility, DVT
o Dyspnea, pleuritic chest pain
o Diagnosis: Plain chest films are usually normal but may reveal
atelectasis, pleural effusion, or infiltrates. Ventilation/perfusion
scanning reveals a perfusion defect and should be used if
intravenous contrast media is contraindicated. A CT pulmonary
angiogram has high sensitivity and specificity for PE and should
be ordered to visualize narrowing of blocked blood vessels, if
there is concern for pulmonary embolism. A D-dimer blood test
can be helpful, although it is nonspecific.
Restrictive Lung Disease
o Examination reveals restricted respiratory excursion and, often,
basilar crackles.
o Pneumonitis, pulmonary fibrosis, and sarcoidosis, as well as
extrinsic causes, such as kyphosis or obesity
o diagnosis: spirometry- decreased FEV1, total lung capacity and
FVC; normal ratio
Pneumothorax
o Air in pleural cavity
o Sudden onset SOB with chest pain; decreased fremitus and
increased hyperresonance on affected side; lung sounds are
diminished or absent
o Diagnosis: chest films
Adult Respiratory Distress Syndrome
o Pulmonary inflammation, increased membrane permeability, and
edema
o Acute onset SOB, cough, and white or frothy sputum;
tachycardia, tachypnea, and dyspnea at rest
o Diagnosis: hypoxemia with abnormal blood gases, b-type
natriuretic peptide
Foreign body aspiration
Abnormal breathing patterns
Kussmaul Respirations: always deep and most often rapid breathing-
caused by metabolic acidosis
Cheyne-Stokes: regular with periods of apnea followed by crescendo-
decrescendo sequence- caused by brain damage, drugs, heart failure
Sigh: occasional deep, audible sigh that punctuates a regular
respiratory pattern- caused by emotional distress or hypoventilation
Biot: varying depth and interrupted by periods of apnea but lack the
regular repetitive pattern- caused by increased intracranial
hypertension, drugs, brain damage
Tachypnea: RR of 25 or more per minute
Bradypnea: RR of 12 or less
Hyperpnea: deeper and more rapid at rest
Adventitious breath sounds
Crackles: heard on inspiration; high or low pitched and short in
duration; caused by air flowing by fluid. Coarse, medium, or fine;
early, mid-, or late-inspiratory
o Significance: Atelectasis, bronchiectasis, congestive heart
failure, pulmonary fibrosis
Rhonchi: low pitched and more prolonged; caused by air passing over
solid or thick secretion
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Wheezes: heard during inspiration or expiration, continuous and high
pitched; caused by air flowing through constricted passageways
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Friction rubs: dry, cracking, rubbing, and low pitched; caused by
inflammation of pleural or pericardial tissue. Loud, grating; late
inspiratory–early expiratory
o COPD, acute and chronic bronchitis, asthma, bronchiectasis,
pneumonia
Cough
Upper Airway Cough syndrome
o Chronic cough caused by postnasal drainage
, o Throat clearing, drainage on posterior pharynx, hyperemia, and
cobblestoning of posterior pharynx, negative chest examination
Asthma
o Chronic condition that involves inflammation of the airways
o Intermittent sensation chest tightness, nonproductive cough,
SOB, and wheezing
o Diagnostic studies: Pulmonary function tests or spirometry;
FEV1; bronchodilators help
Chronic Obstructive Pulmonary Disease (COPD)
o Most commonly caused by smoking or alpha-1 antitrypsin
deficiency
o Usually made up of problems: chronic bronchitis and
emphysema
o Progressive, with little reversibility
o Common symptoms: chronic cough and dyspnea
Worse on exertion
o Lung sounds diminished, barrel chest
o Diagnostic studies: Spirometry: FVC, FEV1, and FEV1/FVC ratio
The percentage of predicted FEV provides further
differentiation; this value varies from greater than 80% for
stage I (mild) to less than 80%, less than 50%, and less
than 30% for stages II (moderate), III (severe), and IV
(very severe), respectively.
Chest radiographs reveal hyperinflation of the lungs with
flattened diaphragm and should be used to confirm but
not diagnose a patient with COPD.
Pneumonia
o Inflammation and consolidation of lung tissue
o Cough with fever, malaise, shaking chills, rigors, and chest
discomfort
o signs and symptoms vary a great deal but may include cough
with sputum production, fever, and pleuritic chest pain; flushed
appearance; confusion; crackles over the affected lung, rhonchi,
diminished breath sounds, or pleural friction; dullness on
percussion over the affected lung, decreased tactile and vocal
fremitus, grunting, nasal flaring, tachypnea
o There is uneven fremitus, and the area over the consolidation
percusses dully. On auscultation, there are bronchial breath
, sounds, often with crackles. Bronchophony, egophony, and
whispered pectoriloquy are often present.
o Diagnosis: chest film with area of infiltrate
CURB-65: determine if it warrants hospitalization
Acute Bronchitis
o Cough (may persist for several weeks after initial infection
resolves), fever, malaise, chest discomfort, chills, and headache
o There may be wheezes and/or rhonchi on auscultation, which
disappear or alter with cough effort. Fremitus is equal, and
there is no egophony.
o Chest x-ray to rule out pneumonia.
o Bronchitis (acute, chronic): cough; fever with chills; muscle
aches; nasal congestion; sore throat, sputum production; history
of smoking; normal breath sounds or diffuse crackles/rhonchi;
injected pharynx; mild dyspnea
Bronchiectasis
o Dilation of one or more bronchi
o Chronic, productive cough; sputum is mucopurulent; SOB,
wheezing, fatigue, possibly hemoptysis; rhonchi and/or
wheezing; in advanced disease clubbing and cyanosis may be
present
o Diagnosis: chest films reveal linear marking, atelectasis and
pulmonary cysts; confirm with CT
Tuberculosis
o history of exposure; may be symptom free
o cough with or without sputum; fatigue; fever; night sweats;
anorexia; pleuritic chest pain; crackles on auscultation;
tachypnea; decreased breath sounds
o Diagnosis: Plain chest films reveal hilar adenopathy and
multilobular granulomas, particularly of the upper lungs;
sputum acid-fast bacilli;
Pharmacological and ACE inhibitor induced cough
o Dry and intractable cough and worse at night
Shortness of Breath and Dyspnea
Pleural Effusion
o involve an abnormal collection of fluid in the pleural space.
Effusions are usually secondary to another condition, such as
malignancy, heart failure, cirrhosis, trauma, and infections.
, o Dyspnea, cough, pain, malaise and fever
o decreased lung sounds, dullness over the effusion, decreased
fremitus, egophony, and whispered pectoriloquy.
o Diagnosis: chest films- fluid collection as an increased area of
density, blunting of the costophrenic angle, and elevation of the
hemidiaphragm
Pulmonary Embolism
o Life-threatening stemming from venous thrombi
o History of immobility, DVT
o Dyspnea, pleuritic chest pain
o Diagnosis: Plain chest films are usually normal but may reveal
atelectasis, pleural effusion, or infiltrates. Ventilation/perfusion
scanning reveals a perfusion defect and should be used if
intravenous contrast media is contraindicated. A CT pulmonary
angiogram has high sensitivity and specificity for PE and should
be ordered to visualize narrowing of blocked blood vessels, if
there is concern for pulmonary embolism. A D-dimer blood test
can be helpful, although it is nonspecific.
Restrictive Lung Disease
o Examination reveals restricted respiratory excursion and, often,
basilar crackles.
o Pneumonitis, pulmonary fibrosis, and sarcoidosis, as well as
extrinsic causes, such as kyphosis or obesity
o diagnosis: spirometry- decreased FEV1, total lung capacity and
FVC; normal ratio
Pneumothorax
o Air in pleural cavity
o Sudden onset SOB with chest pain; decreased fremitus and
increased hyperresonance on affected side; lung sounds are
diminished or absent
o Diagnosis: chest films
Adult Respiratory Distress Syndrome
o Pulmonary inflammation, increased membrane permeability, and
edema
o Acute onset SOB, cough, and white or frothy sputum;
tachycardia, tachypnea, and dyspnea at rest
o Diagnosis: hypoxemia with abnormal blood gases, b-type
natriuretic peptide
Foreign body aspiration
