NURS8026 1st Edition Exam 1 Study Guide1. Pathophysiology of cough2. Activation occurs through inflammatory,mechanical, chemical and themal stimulation.3. Mucocillary mechanism lining the tracheobronchial tree sweps mucus and matter up thepharynx where it is swallowed or expectorated4. In the presence of infection or inflammation the function is often impaired 5. The volume of secretion may overwhelm it6. Coughing serves as protective function to clear debrit.7. Cough Centre in the brain: MedullaStimulunts for cough are:Inflammatory: exposure os superficial sensory nerves with upper nad lower airwayMechenical: foregin object, impacted mucopurulent material, post-Nasal dripsChemical: gastric acid, chlorine gas,irritants reducing or oxidizing agentThermal: cold or hot air exposureAcute Cough: less than 8 weeks. Self-limited viral upper respiratory infection Acute bronchitis, pneumonia, sinusitis, allergic rhinitis,bordetella pertussis90% of patients w/chronic cough who are nonsmokers have 1or more of the following1. ÷ Postnasal drip- 41%2. ÷ Asthma -24%3. ÷ GERD- 21%4. ÷ Chronic bronchitis- 5%5. ÷ ACE use (up to 30% will develop cough) ~women, nonsmokers, Chinese ancestryCobble-stoning of pharyngeal buccal mucosa seen with post-nasal drip helpful differentialDetermining Differential Diagnosis : Chronic: longer than 8 weeks÷ Lung cancer÷ Interstitial lung disease÷ Bronchiectasis÷ Lung abscess÷ TB÷ Recurrent aspiration÷ Aspirated foreign body÷ CHF÷ MedicationsCough differential list for pediatric population1. URI2. Allergic Rhinitis3. Asthma4. Bronchiolitis-A viral infection (RSV) that can cause wheezing, coughing and difficulty breathing, especially in young children(2-12)months5. Bronchitis6. Cough variant asthma-a form of cough with asthma, no wheezing, nonproductive coughworst at night, may be made worse by exercise and cold air, may be seasonal7. Croup: 6mth-3yrs, late fall and winter, caused my parainfluenza virus, RSV and more rarely the influenza virus or adenovirus, “barking seal at night8. Cystic fibrosis9. Irritant related to exposure10. Pneumonia11. Psychogenic cough: a chronic dry, hacking cough seen in adolescence who have lot of stress, disappear when sleeping.Diagnostic Approach for cough: History: most important with acute & chronic. leads to correct diagnosis in 88% ‐100%– Risk Factors:• Smoking, second‐hand smoke. Smoking is the ni.1 cause of chronic cough.• Exposures: sick individuals, environment, viral, bacterial, chemical• Medications (ACE, beta/alpha blockers & BB eye gtts)– Rhinitis medicamentosa‐ occurs w/ vasoconstrictors, reserpine ,hydralazine, clonidine, prazosin, BCP• Women have a more sensitive cough reflex than men– Smoking : Cigarette smoking related to number of cigarettes smoked – 25% who smoke 1/2ppd – >50% who smoke 2 ppd have chronic cough • Low‐grade chronic bronchitis r/t tobacco (smokers do not often seek medical attention) • Induces cough – Direct irritant on tracheobronchial cough receptors – Causing an inflammatory response w/in mucosal lining• Smoking cessation – Dramatic decrease in cough, one study showed 77%resolution, 17% improvement, most improvement came w/in 1 monthDiagnostic Approach: History of P I – Character of cough • Superficial/Deep • Wet/Dry • Painful – Duration • Moments • Spasms • Persistent– Timing • At night? • With exercise? • Setting? • After meals? • Seasonal? • Exposures? – Sputum production • Amount • Color • OdorExacerbating / alleviating factors: Exposures, OTC medications – Associated symptoms • Hemoptysis • Involuntary wt loss • Wheezing • Chronic postnasal drip • Chest pain • Frequent throat clearing • Heartburn • Fever, chills, night sweatsAcute Conditions: URTI – Common cold, pharyngitis, sinusitis – Most common human disease average adult 2‐4x/yr – 5 billion $ spent/yr in US – 22 million absences from school in children – 6 different viral families1. Rhinovirus: most common (100 strains) 30‐40% 2. Corona virus3. Respiratory synctal virus (RSV)4. Adenovirus: (47 strains) 10 – 15%5. Parainfluenza virus6. Influenza virus – Hardy remain infectitious for up to 3 hours after drying on hard surfacesURI Transmission – Viral shedding 1st 3 days – Hand‐hand most common form (*10 second handshake), hand‐nose, hand –eye, sneezing velocity goes 3 feet @ 500mph – Aerosolized large particles take prolonged exposure (hours) – Kissing has 8% infection rate • S/S – 1‐3 day incubation – Nasal discharge – Sneezing – Sore throat – Headache – Cough – Myalgias – Low grade‐ feverPhysical Findings • Mucopurulent nasal discharge • Nasal mucosa redness & swelling, lymphadenopathy • Lung sounds normal – Diagnostic tests: only if have a red, purulent pharyngeal component :Throat culture, MonospotCough is always abnormal may present with associated symptoms Timing of cough is very importing If somebody coughing at night while sleeping –Could be GERDIf If somebody coughing when go out in cold or new environment, seasonal-could be AsthmaNeed to know color, order and amount of sputumWhat is the characteristics of coughSuperficial cough- could be Upper respiratory infectionDeep cough-could be pneumonia or bronchitisCough with sputum, weey just-sign of infectionDry hacking cough –chemical or mechanical stumilantCough with chest pain –cause by pneumonia coughWhat makes cough well and what makes cough worstIf patient say “cough get worst when I go out, eels better when I stay inside House”-Could be AsthmaHave you take any medicine? -to know if OCT medication working.Hemopmosis and wt loss- could me TBAlso, Medicine like ACE inhibitors cause caught. Involuntary wt.lossPostnal drip-allergies reactionAssociated symptoms is very important in diagnosis of diseases.URI is the most common disease, Causes by1. Rhinovirus is the most common2. Adenovirus (children)3. RSV4. Physical findings; lungs sounds are normalAcute Conditions- Pneumonia Patho : Acute inflammation of terminal airways, due to infection • 3 mechanisms: aspiration, aerosolization, hematogenous spread • Microbial etiology dependent on demographics– Risk factors for children1) The very young 2) live with a smoker3) have asthma or another medical condition affecting the lungs (like cystic fibrosis)4) are taking a medicine long‐term that affects the immune system 5) were a very premature