MODULE 3 SHORTNESS OF BREATH Group 2 Tutor: dr. Risky Akaputra, SpP Group Name: 1. Endah Zakiyah A 2013730031 2. Ghani M Sardjono 2013730042 three. Indri Parameswari 2013730054 4. Hansa Eka Pratiwi 2013730044 five. Irma Juliana 2013730056 6. M.Badar Wiguna 2013730061 7. Michael Yazid R.D. 2013730066 8. Moh.Reza Aulia 2013730069 9. M.Syaikhul Islam2013730064 10. Beautiful Uswatun 2013730053 11. M.Basri 2013730061
SCENARIO TWO A 60-year-old man arrives at the clinic with complaints of shortness of breath accompanied by sound, coughing using sputum that is poly and greenish in color. Other complaints that feel colds, fever, weakness & insomnia at night Patients with a history of pulmonary TB treatment three years yll for 6 months and have been declared cured. Patients used a history of smoking and had quit approximately 3 years ago with the Brinkman Index. On physical inspection of auscultation, the sound of wheezing additional breath is obtained.
Brinkman Index: Brinkman index is a measure of value for an individual smoking, calculated in more detail using the way the average amount of cigarettes smoked in one day X length of smoking in a year.
Key words / sentences 60-year-old man, complaining of a breath accompanied by sound, coughing using greenish-colored phlegm. Other complaints are colds, chills, weakness, insomnia at night. Had lung TB three years ago, after 6 months of treatment cured. Have a history of smoking and have quit 3 years ago. At auscultation there is a wheezing sound.
Mind Map Men 60 th Anamnesi s
KU :shortness of breath, cough with green phlegm RPS :p ilek, fever, weakness, and difficulty sleeping at night RPD: TB three years later cured R.Psycho: smoking three years later
Question 1. What does it mean to use tightness and what is the classification? How is patomekanism according to tightness? 2. What etiology can cause tightness? three. Describe the clinical imagery that accompanies tightness! 4. What is the inspection mindset in patients using primary complaints of shortness of breath? five. What is the difference between shortness of breath accompanied by wheezing using shortness of breath without accompanied by wheezing? 6. What is the relationship of psychosocial history using patient complaints in scenarios? 7. Why in patients in a scenario as difficult as sleeping only at night? Why is sputum in patients green? 8. How does pathogenesis in TB relate to patient complaints? 9. What is the interaction of the heavy brinkman index using the patient’s condition? What is the interaction of age with the respiratory system? 10. What is DD in the scenario? 11. What is the management of the scenario?
Explain the definition of tightness and explain kalisification and patomekanism according to tightness?
Definition of Dyspnea or Tightness Breathlessness Is a complaint that often requires emergency treatment but the intensity and level can be a sense of discomfort in the chest that can improve itself; who need a breath donation that focuses up to the fatal. It is a feeling of difficulty breathing and is the primary sign of cardiopulmonary disease. Usually complain of shortness of breathing or feeling suffocated. In normal people, there can also be shortness of breath after completing physical activities in out-of-sync levels.
Classification of Dyspnea Scale Tightness
No difficulty breathing except using strenuous activity
There is difficulty breathing, shortness of breath when in a hurry or time walking to zenit ramps
Walk slower than most people of the same age because they have difficulty breathing or have to stop walking to breathe.
Stop walking after 90 meters (100 yards) to breathe or finish walking a few minutes.
Too difficult to breathe if leaving the residence or difficulty breathing when using or
Physiological factors, when exercising requires more poly O₂ but lung work is still normal as usual, it will occur tightness.
Disease factor: Bronchospasm Smooth muscles in the bronchi contract, thus narrowing the respiratory tract. So it can cause tightness in the respiratory tract
Edema of the mucosa Swelling or accumulation of fluid in the mucosa, so that the mucosa as large & airways are obstructed.
Thick mucous hypersecresy Mucous produced by mucosa excessively & viscous able to cover the airway
two. What etiology can cause tightness?
Generic causes of dyspnea: Cardiovascular system: heart failure Respiratory system: COPD, pulmonary parenchyma disease, pulmonary hypertension, severe kiphospholiosis, mechanical factors outside the lungs (ascites, obesity, pleural effusion) Psychological (anxiety) Hematology (lack of chronic blood)
Causes of acute dyspnea: left heart failure, bronchospasm, pulmonary embolism, anxiety
three. Describe the clinical imagery that accompanies tightness!
The accompanying clinical picture of tightness 1. Wheezing
What is the inspection mindset in patients with KU dyspnea?
Mohamad Syaikhul Islam 2013730064
Anamnesis Sensation quality, time of appearance, Persistent/Intermittent Position
Generic State : Smooth Speech, Additional Muscle, Color Vital Signs : Takipnea, Pulsus paradoxus, Chest Oximetry : Wheezing, Rongki, hyperinflation, weakening of breath, heart hyperinflation: JVP, precordial impulse, Gallop, Murmur of Extremeity: Edema, Cyanosis
Assessing Heart Size, Assessing signs of heart failure Assessing Hyperinflation Assessing penumonia, interstitial lung disease, pleural effusion
Suspected Low Cardiac Output, Ischemia Myocardial Pulmonary Disease
Suspected abnormalities in the respiratory pump or gas exchange
High cardiac output high output suspects
ECG and Echocardiogram to assess left ventricular function &pulmonary artery pressure
Lung function tests – if diffusion capacity is reduced, consider assessing a CT angiogram to assess interstitial pulmonary disease and pulmonary embolism
Hematocrit and thyroid function tests
five. What is the difference between shortness of breath accompanied by wheezing with shortness of breath without wheezing?
Wheezing: a continuous sound, higher tone than other breath sounds, shortness of musical nature, caused by the narrowing of the small airway. Because air passes through a narrowing, wheezing can occur, both at the time of the idea of mapun when expiration. Narrowing of the airway can wheezing due to excessive secretion, smooth muscle constriction, mucosal edema, tumors, as well as foreign objects Wheezing can also appear when doing rather strenuous activities. If wheezing is preceded by a cough on the day of sleep, it may be caused by esophageal reflux aspiration. Wheezung can also be caused by central venous pooling the impact of heart failure.
Tightness is a subjective sign of the patient’s desire to increase efforts to get breathing air. Because it is subjective, dyspnea cannot be measured. Dyspnea complaints are not always without accompanied by disease, wheezing is not uncommon to occur in a healthy state but there is still psychological stress. Like pain, dyspnea as a symptom of subjective nature, its severity is influenced by the patient’s response, sensitivity (sensitivity) and emotional condition.
Djojodibroto, Dermanto. 2007. Respirology (Respiratory Medicine). Jakarta: EGC Medical Book.
What does psychosocial history have to do with patient complaints in the scenario?
The components of cigarette smoke stimulate changes in the mucous-producing cells of the bronchi. In addition, the cilia lining the bronchi are paralyzed or dysfunctional and metaplasia. These changes in the cells producing mucus and cilia interfere with the mucoocic escalator system & causing a buildup of viscous mucus at large quantities – difficult to spew from the airway. Mucus serves as a nursery of infectious microorganisms and as highly purulent. Inflammation arises that causes tissue edema. The ventilation process is mainly obstructed. The onset of impact hypercapnia based on elongated expiration and difficult to do due to thick mucus and the presence of inflammation.
The components of cigarette smoke also stimulate chronic inflammation of the lungs. Inflammatory mediators progressively damage the supporting structures in the lungs. Due to the loss of elasticity of the airways and the collapse of the alveolus, the window is reduced. The airways collapse especially in expiration because normal respiration occurs the impact of passive recoil (recoil) of the lung after inspiration. Thus, if there is no passive recoil, then the air will be trapped inside the lungs and airways collapse.