Assessment Of Lung Patients

The most important diagnostic steps in patients with pulmonary symptoms make history, physical examination, and in most cases, a chest X-ray recording. Hence the need for further investigations, including lung function tests and blood gas analysis, CT or other imaging techniques thoracic and bronchoscopy can count on. The history of history can often provide evidence of whether symptoms such as dyspnea, chest pain, wheezing, stridor, hemoptysis and cough may be of pulmonary origin. If more than one symptom at the same time, it should be found above all, which is the primary symptom and whether constitutional symptoms such as fever, weight loss and night sweats are also available. Other important information includes occupational and environmental factors of kids, travel and contact history preexisting conditions using prescription and non-prescription drugs or illegal drugs Earlier test results (eg. As tuberculin test, chest x-ray) Medical Examination The examination begins with the acquisition of the general physical appearance. During the welcome and the history of the conversation may include malaise and anxiety, (the inability complete sentences to talk z. B. without pausing there to catch your breath) physical appearance and the impact of speech and movement on the symptoms are observed, useful information provides for pulmonary status. Then carried out inspection, auscultation, percussion and palpation of the thorax. Inspection The inspection should focus on signs of respiratory distress and hypoxia (z. B. restlessness, tachypnea, cyanosis, use of accessory respiratory muscles) indications of possible chronic lung disease (eg. As clubbing, pedal edema) deformities of the chest walls Pathological breathing patterns (eg. B . Cheyne-Stokes respiration, Kussmaul breathing) jugular veins jammed Among the signs of hypoxemia include cyanosis (bluish discoloration of the lips, face or nail bed), which means a low arterial oxygen saturation (<85%). The absence of cyanosis does not exclude hypoxia. Signs of respiratory distress are tachypnea, the use of the respiratory muscles (sternocleidomastoid muscle, intercostal muscles, scalenes) in breathing, intercostal retractions and paradoxical breathing. Patients with COPD sometimes lift their arms against their legs or the examination table while sitting (d. H. Dreifußzeichen-sitting position), in the unconscious attempt to get more influence on the respiratory muscles, and thereby improve their breathing. Entry of the intercostal muscles (the intercostal spaces move inward) is common in infants and in older patients with severe bronchial obstruction before. A paradoxical breathing (inward movement of the abdominal wall during inspiration) indicates weakness or exhaustion of normal respiratory muscles. Among the indications of possible chronic lung disease belong clubbing, barrel chest (the thoracic enlarged anteriorposteriore diameter in some patients with emphysema) and breathing with pursed lip. Drumstick fingers is based on an increase in connective tissue between the nail and bone that leads to a swelling of the finger (or toe) phalanges. The diagnosis is (at> 176 °), in which the nail rises in the side view of the nail bed, or an increase of the quotient of the phalanx diameter (> 1) set based on a magnification of the angle (measuring the drumstick finger). A “sponge-like” structure of the nail bed under the cuticle is a further indication of clubbing. These are observed in patients with lung cancer the most common, but are also an important symptom of chronic lung diseases such as cystic fibrosis and idiopathic pulmonary fibrosis; rare and occur in cyanotic heart disease, chronic infections (eg. as infective endocarditis), stroke, inflammatory bowel disease and liver cirrhosis. Occasionally clubbing in patients with osteoarthropathy, and periostitis (primary or hereditary hypertrophic osteoarthropathy) before; in these cases, they can of skin lesions such as dermal hypertrophy back of the hand (Pachydermoperiostosis), seborrhea and coarsening of facial features are accompanied. Finger clubbing may also occur as a benign hereditary normal variation that can be distinguished from benign clubbing by the lack of pulmonary symptoms or diseases and by the presence of the changes since early childhood (Specification of the patient) of pathological. (.. Editor’s note .: Both angle measurement and the determination of the Phalanx quotient are in German-speaking rather unusual.) Finger clubbing © Springer Science + Business Media var model = {thumbnailUrl: ‘/ – / media / manual / professional / images / ? lang = en & 421_finger_clubbing_slide_21_springer_high_de.jpg thn = 0 & mw = 350 ‘, imageUrl:’ /-/media/manual/professional/images/421_finger_clubbing_slide_21_springer_high_de.jpg?la=de&thn=0 ‘, title:’ finger clubbing ‘, description:’ u003Ca id = “v37893000 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eDieses photo shows a clubbing of the patient . Compared to a normal finger u003c / p u003e u003c / div u003e ‘credits’ © Springer Science + Business Media’

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