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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.
17
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/Hyperhidrosis8/10/2019 Ketrampilan Diagnosis Dan Terapi Pasien Dengan Keluhan Respirasi
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Semoga Bermanfaat