Ketrampilan Tatalaksana Pasien

dengan Keluhan Respirasi

Triwahju Astuti

Major symptoms

Cough
Sputum
Haemoptysis
Dyspnoe (acute, progressive, paroxysmal)
Wheeze
Fever
Hoarseness
Night sweats

Cough & sputum

Common presenting respiratory symptom
Deep inspiration is followed by explosive
expiration flow rates of air in the trachea
approach the speed of sound during a forcefull
cough
Cleared of secretions and foreign bodies
The duration of cough is important
Acute bronchitis or pneumonia : associated with
fever & other symptoms of respiratory tract
infection

 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

 Barking quality: inflamation of the epiglottis

Loud & brassy cough: tracheal compression by
tumor
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: tracheooesophageal fistula or oesophageal reflux

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

A simplified overview of the assessment and management of the

common causes of acute cough (< 3 weeks)

A simplified overview of the assessment and management of

prolonged acute cough (38 weeks)

A simplified overview
of the assessment and
management of the
common causes of
chronic cough
(> 8 weeks)

Haemoptysis
Expectoration of blood from the respiratory tract
It can range from blood-streaking of sputum to the
presence of gross blood in the absence of any
accompanying sputum
Massive hemoptysis is 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

Respiratory

Cardiovascular

Bleeding diastheses

Bronchitis
Bronchial carcinoma
Pulmonary infarction
Bronchiectasis
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

Mitral stenosis (severe)

Acute left ventricular failure

16

Dyspnea
Distressing sensation of difficult, labored, or
unpleasant breathing.
The word distressing is very important to this
definition since labored or difficult breathing may
be encountered by healthy individuals while
exercising.
It does not qualify as dyspnea because it may not
be perceived as distressing.
The sensation is often poorly or vaguely
described by patients.
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Causes of dyspnoea
Respiratory

Cardiac

Anemia

1. Airway disease :
Chronic bronchitis & emphysema,
Asthma, Bronchiectasis, Cystic fibrosis,
Laryngeal or Pharyngeal tumor, Bilateral
cord palsy , Tracheal obstruction or
stenosis , Tracheomalacia,
Cricoarytenoid rheumatoid arthritis
2. Parenchymal disease
- Pneumonia , Alergic alveolitis, Sarcoidosis
, Fibrosis & difuse alveolitis, Obliterative
bronchiolitis , Difuse infections, Respiratory
distress syndrome , Infiltrative & metastatic
tumor , Pneumoconiosis , Pneumothorax
3. Pulmonary circulation
- Pulmonary embolism, Chronoc
thromboembolic 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 diaphragmatic
paralysis

Left ventricular
failure, Mitral valve
disease,
Cardiomyopathy,
Pericardial effusion or
Constrictive
pericarditis,
Intracardiac shunt

Non-cardio

respiratory
Psychogenic,
acidosis
(compensatory
respiratory
alkalosis),
hypothalamic
lesions

Abnormal patterns of breathing

Type of breathing
Sleep apnoea - cessation of airflow for more
than 10 seconds more than 10 times a night
during sleep
Cheyne Stokes breathing - periodes of apnoea
alternate with periodes of hyperpnoea. This is due
to a delay in the medullary chemoreceptor response
to blood gas changes

Cause (s)
Obstructive (e.g. Obesity with upper
airway narrowing, enlarge tonsil,
pharyngeal soft tissue changes in
acromegaly or hypothyroidism)
Left ventricular failure, brain damage
(e.g. Trauma, cerebral harmorrhage),
high altitude

Kussmauls breathing (air hunger) - deep, rapid Metabolic acidosis (e.g. Diabetes
respiration due to stimulation of the
mellitus, chronic renal failure)
respiratory centre
Hyperventilation, which result in alkalosis and
Anxiety
tetany
Ataxic (Biot) breathing irregular in timing and
Brainstem damage
depth
Apneustic breathing - a post inspiratory
pause in breathing
Paradoxical respiration the abdomen sucks
inward with inspiration (it normally pouches
outward due to diaphragmatic descent)

Brain pontin damage

Diaphragmatic paralysis

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

Fever
Mouth > 37,3 C
Rectum > 37,7 C

Types of Fever
Type

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

Hoarseness

Recurrent laryngeal nerve palsy

Carcinoma of the lung
Laryngeal carcinoma
Commonest cause: laryngitis

Night Sweats
Sleep hyperhidrosis, or night sweats, is the
occurrence of excessive sweating (hyperhidrosis
and focal hyperhidrosis) during sleep.
The bacteria themselves may also be releasing
fever-causing signals the hypothalamus resets
body 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 of
the peptide signalling molecules triggering
night sweats.
Monocytes are a significant source of TNF-.

Semoga Bermanfaat