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Chronic cough throughout day (smoker’s cough).Sputum-clear and colorless, may be frothy.Loss of appetite if breathing through the mouth.Shortness of breath-especially on exertion.Wheezing, shortness of breath, chest tightness, and cough are classic symptoms that also lead to weight loss, muscle loss, and difficulty with daily activities. At first, there may be little to no symptoms with COPD however, because it is a chronic and progressive disease of deteriorating lung capacity and air flow, symptoms inevitably develop and worsen. The classic symptom of COPD is shortness of breath. ABGs, EKG, echocardiogram, TB test, and chest CT may reveal other causative factors. The ratio of FEV1 and FVC of less than 0.70 is diagnostically positive for COPD. It should be done before and after a bronchodilator to determine improvement and diagnosis of FEV1. Spirometry is the gold standard for diagnosing COPD and pulmonary function tests it easily performed in a clinical setting and should be done as a baseline for diagnosis and management of the disease. Pallor, cyanosis, and decreased orientation may reveal hypoxia. The lungs should be assessed for absence of ventricular sounds found in COPD and increased vocal fremitus (vibration) and egophony (resonance) due to air trapping.
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Advanced disease may show distended neck veins, whereas an early case of COPD may show very few clinical signs. *For those who favor mnemonics, the eight dimensions of a medical problem can be easily recalled using OLDCARTS (onset, location/radiation, duration, character, aggravating factors, reliving factors, timing and severity).Ĭonduct a general inspection that includes skin color, amount of respiratory effort, and an increase in anterior-posterior (AP) chest diameter. An examination of sputum should observe for pink froth (seen in pulmonary edema) or presence of blood (possible TB).
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For a physical exam, in additional to the standard vital signs, a focused assessment should be done on the lungs and breathing pattern, and adventitious sounds (Glass, 2014). A thorough history is helpful by asking the OLDCARTS* questions and including questions about smoking history, other diseases such as asthma, and alleviating and aggravating factors. Review of the subjective data in a history asks about onset, duration, course of symptoms, food patterns, smoking, and medications. This is the classic “pink puffer.” Diagnosis and Evaluation of COPDĪs noted earlier, diagnosis begins by taking a thorough medical history, including exposures to environmental pollutants and resultant symptoms. Flushed skin, barrel chest (increased anterior to posterior chest diameter), clubbed fingers, decreased libido, thin wasted appearance, and wheezing during exertion are classic.
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Because of the difficulty breathing, caloric expenditure is increased, causing weight loss in addition, there can be a lack of appetite that focuses on breathing rather than cooking, chewing, and eating. Symptoms for emphysema are similar to chronic bronchitis but with gradual exertional dyspnea and weight loss. Rhonchi (rattling) in the chest, wheezing, rapid respirations, fatigue, headache, loss of appetitive, fever, myalgias, and arthralgias are commonly seen. A clinical symptom is worsening cough with white or yellow sputum that has become more viscous. A history of cough, lack of energy, and chest irritation can begin the questioning of types and causes of cough. The diagnosis of chronic bronchitis is made initially with the reported symptoms of a persistent productive cough for at least 2 consecutive months within 2 years. With a constant struggle to breathe, the accessory muscles (internal and external intercostals) and abdominal muscles are forced to engage and often pull the chest inward, resulting in pectus excavatum (pigeon chest). Upon physical exam of those with childhood asthma and chronic respiratory illness, such as emphysema, the anterior thorax may appear pigeon-shaped or retracted. Clinical symptoms include wheezing, recurrent cough (worse at night and early morning), recurrent shortness of breath, and chest tightness with moderate activity. A history of difficulty breathing, shortness of breath after exercise, or exposure to environmental triggers can help identify the development of asthma.