Ketrampilan Diagnosis Dan Terapi Pasien Dengan Keluhan Respirasi

8/10/2019 Ketrampilan Diagnosis Dan Terapi Pasien Dengan Keluhan Respirasi

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Ketrampilan Tatalaksana Pasien

dengan Keluhan Respirasi

Triwahju Astuti


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Major symptoms

Cough

Sputum

Haemoptysis

Dyspnoe (acute, progressive, paroxysmal)

Wheeze

Fever

Hoarseness

Night sweats


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Cough & sputum

Common presenting respiratory symptom

Deep inspiration is followed by explosiveexpirationflow rates of air in the tracheaapproach the speed of sound during a forcefullcough

Cleared of secretions and foreign bodies

The duration of cough is important

Acute bronchitis or pneumonia : associated withfever & other symptoms of respiratory tractinfection


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Asthma : Chronic cough associated with

wheezing, sometimes just cough alone

Oesophageal reflux, acid irriation of the lungs

& the use of ACE inhibitors : irritating chronic

dry cough

Bronchiectasis : chronic cough with productive

of large volume of purulent sputum


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Barking quality: inflamation of the epiglottis

Loud & brassy cough: tracheal compression bytumor

Hollow sound - bovine cough: recurrent

laryngeal nerve palsy, because the vocal cords

are unable to close completely

Worse at night is sugestive of asthma or heart

failure

Immediately after eating or drinking: tracheo-

oesophageal fistula or oesophageal reflux


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Type of sputum produced

Large volume of purulent (yellow or green)

sputum: bronchiectasis or lobar pneumonia

Foul smelling dark-coloured sputum: lung

abscess with anaerobic organisms

Pink frothy: pulmonary oedema


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A simplified overview of the assessment and management of thecommon causes of acute cough (< 3 weeks)


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A simplified overview of the assessment and management of

prolonged acute cough (38 weeks)


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A simplified overview

of the assessment and

management of the

common causes of

chronic cough

(> 8 weeks)


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Haemoptysis

Expectoration of blood from the respiratory tract

It can range from blood-streaking of sputum to thepresence of gross blood in the absence of any

accompanying sputum

Massive hemoptysisis variably defined as the

expectoration of >100 to > 600 mL over a 24-hour

period, Massive hemoptysis can result in

suffocation, risk for large aspiration, airway

obstruction, or hypotension Exsanguinating hemoptysis is enough bleeding

to threaten life by blood loss itself

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Causes of haemoptysis

Bronchitis

Bronchial carcinoma

Pulmonary infarctionBronchiectasis

Cystic fibrosis

Lung abscess

Pneumonia

Tuberculosis

Foreign body

Goodpasturess syndrome: pulmonary haemorrhage,glomerulonephritis, antibody to basement membrane

antigens

Rupture of a mucosal blood vessel after vigorous coughing

Respiratory

Mitral stenosis (severe)

Acute left ventricular failureCardiovascular

Bleeding diastheses


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Dyspnea

Distressing sensation of difficult, labored, orunpleasant breathing.

The word distressing is very important to this

definition since labored or difficult breathing maybe encountered by healthy individuals whileexercising.

It does not qualify as dyspnea because it may not

be perceived as distressing.

The sensation is often poorly or vaguelydescribed by patients.

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C f d


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Causes of dyspnoea

Respiratory

1. Airway disease :

Chronic bronchitis & emphysema,

Asthma, Bronchiectasis, Cystic fibrosis,Laryngeal or Pharyngeal tumor, Bilateral

cord palsy , Tracheal obstruction orstenosis , Tracheomalacia,

Cricoarytenoid rheumatoid arthritis

2. Parenchymal disease

- Pneumonia , Alergic alveolitis, Sarcoidosis, Fibrosis & difuse alveolitis, Obliterative

bronchiolitis , Difuse infections, Respiratorydistress syndrome , Infiltrative & metastatic

tumor , Pneumoconiosis , Pneumothorax

3. Pulmonary circulation

- Pulmonary embolism, Chronocthromboembolic pulmonary hypertension,

Pulmonary arteriovenous malformation,

Pulmonary arteritis

4. Chest wall and Pleura

- Effusion or massive ascites, pleural tumor, fractured

ribs, ankylosisng spondylitis, kyphoscoliosis,

neuromuscular diseases, bilateral diaphragmaticparalysis

Cardiac

Left ventricularfailure, Mitral valve

disease,Cardiomyopathy,

Pericardial effusion orConstrictive

pericarditis,Intracardiac shunt

Anemia Non-cardio

respiratory

Psychogenic,

acidosis(compensatory

respiratory

alkalosis),hypothalamic

lesions

Abnormal patterns of breathing


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Abnormal patterns of breathing

Obstructive (e.g. Obesity with upper

airway narrowing, enlarge tonsil,

pharyngeal soft tissue changes inacromegaly or hypothyroidism)

Sleep apnoea - cessation of airflow for more

than 10 seconds more than 10 times a nightduring sleep

Left ventricular failure, brain damage

(e.g. Trauma, cerebral harmorrhage),

high altitude

CheyneStokes breathing - periodes of apnoeaalternate with periodes of hyperpnoea. This is due

to a delay in the medullary chemoreceptor response

to blood gas changes

Metabolic acidosis (e.g. Diabetes

mellitus, chronic renal failure)

Kussmauls breathing (air hunger) - deep, rapid

respiration due to stimulation of therespiratory centre

AnxietyHyperventilation, which result in alkalosis and

tetany

Brainstem damage

Ataxic (Biot) breathingirregular in timing and

depth

Brain pontin damageApneustic breathing - a postinspiratory

pause in breathing

Diaphragmatic paralysisParadoxical respirationthe abdomen sucks

inward with inspiration (it normally pouches

outward due to diaphragmatic descent)

Type of breathing Cause (s)


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Wheezing

Continuous whistling noise during breathing

Asthma or chronic airflow limitation, airway

obstruction by foreign body or tumor

Ussually maximal during expiration

Accompanied by prolonged expiration


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Fever

Mouth > 37,3 C

Rectum > 37,7 C

T f F


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Types of FeverType Character Examples

Continued Does not remit Typhoid fever, typhus, drug

fever, malignant

hyperthermia

Intermitten Temperature flls to normal

each day

Pyogenic infections,

lymphomas, milliary

tuberculosis

Remittent Daily fluctuation > 2C,

temperature does not

return to normal

Not characteristic of any

particular disease

Relapsing Temperature returns to

normal for days before

rising again

Malaria :

Tertian-3day pattern, fever

peaks every other day

(Plasmodium vivax, P.

Ovale); Quartan-4 day

pattern, fever peaks every

3rd day (P. Malariae)

Lympoma

Pyogenic infection


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Hoarseness

Recurrent laryngeal nerve palsy

Carcinoma of the lung

Laryngeal carcinoma

Commonest cause: laryngitis


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Night Sweats

Sleep hyperhidrosis, or night sweats, is the

occurrence of excessive sweating (hyperhidrosisand focal hyperhidrosis) during sleep.

The bacteria themselves may also be releasing

fever-causing signals

the hypothalamus resetsbody temperature to a higher level for a while.Later, body temperature is returned to normal,and the extra heat is lost by sweating.

Tumour necrosis factor alpha (TNF-) is one ofthe peptide signalling molecules triggeringnight sweats.

Monocytes are a significant source of TNF-.
http://en.wikipedia.org/wiki/Hyperhidrosishttp://en.wikipedia.org/wiki/Focal_hyperhidrosishttp://en.wikipedia.org/wiki/Sleephttp://en.wikipedia.org/wiki/Sleephttp://en.wikipedia.org/wiki/Focal_hyperhidrosishttp://en.wikipedia.org/wiki/Hyperhidrosis


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Ketrampilan Diagnosis Dan Terapi Pasien Dengan Keluhan Respirasi

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