STUDY - Technical - New Dacian's Medicine
Cyanosis
(Classical / Allopathic Medicine)
Cyanosis - a
bluish or bluish-black discoloration of the skin and mucous
membranes - results from an excessive concentration of
unoxygenated hemoglobin in the blood. This common sign may
develop abruptly or gradually. It can be classified as central
or peripheral, although the two types may coexist.
Central cyanosis
reflects inadequate oxygenation of systemic arterial blood
caused by right-to-left cardiac shunting, pulmonary disease,
or hematologic disorders. It may occur anywhere on the skin
and also on the mucous membranes of the mouth, lips, and
conjunctiva.
Peripheral
cyanosis reflects sluggish peripheral circulation caused by
vasoconstriction, reduced cardiac output, or vascular
occlusion. It may be widespread or may occur locally in one
extremity; however, it doesn't affect mucous membranes.
Although cyanosis
is an important sign of cardiovascular and pulmonary
disorders, it isn't always an accurate gauge of oxygenation.
Several factors contribute to its development: hemoglobin
level and oxygen saturation, cardiac output, and partial
pressure of oxygen (PO2). Cyanosis is usually
undetectable until the oxygen saturation of hemoglobin falls
below 80%.
ALERT:
If the patient displays sudden, localized cyanosis and other signs of arterial occlusion:
- protect the affected limb from injury
- don't massage the limb.
If the patient displays central cyanosis stemming from a pulmonary disorder or shock:
- maintain the airway
- obtain pulse oximetry or arterial blood gas analysis and administer oxygen
- institute emergency measures, if necessary.
If the patient's cyanosis accompanies less-acute conditions, perform a focused assessment.
If the patient displays sudden, localized cyanosis and other signs of arterial occlusion:
- protect the affected limb from injury
- don't massage the limb.
If the patient displays central cyanosis stemming from a pulmonary disorder or shock:
- maintain the airway
- obtain pulse oximetry or arterial blood gas analysis and administer oxygen
- institute emergency measures, if necessary.
If the patient's cyanosis accompanies less-acute conditions, perform a focused assessment.
HISTORY:
Ask the patient when he first noticed the cyanosis. Does it subside and recur? Is it aggravated by cold, smoking, or stress? Is it alleviated by massage or rewarming?
Ask the patient about headaches, dizziness, or blurred vision.
Ask the patient about pain in the arms and legs (especially with walking) and about abnormal sensations, such as numbness, tingling, and coldness.
Ask the patient about chest pain, its severity, and any aggravating and alleviating factors.
Ask the patient if he has a cough. If so, is it productive? Ask the patient to describe the sputum.
Ask the patient about sleep apnea. Does he sleep with his head propped up on pillows?
Review the patient's medical history for a cardiac, pulmonary, or hematologic disorder or previous surgery.
Ask the patient when he first noticed the cyanosis. Does it subside and recur? Is it aggravated by cold, smoking, or stress? Is it alleviated by massage or rewarming?
Ask the patient about headaches, dizziness, or blurred vision.
Ask the patient about pain in the arms and legs (especially with walking) and about abnormal sensations, such as numbness, tingling, and coldness.
Ask the patient about chest pain, its severity, and any aggravating and alleviating factors.
Ask the patient if he has a cough. If so, is it productive? Ask the patient to describe the sputum.
Ask the patient about sleep apnea. Does he sleep with his head propped up on pillows?
Review the patient's medical history for a cardiac, pulmonary, or hematologic disorder or previous surgery.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Inspect the skin and mucous membranes to determine the extent of cyanosis. Check the skin for coolness, pallor, redness, pain, and ulceration. Also, note clubbing.
Evaluate the patient's level of consciousness, and test his motor strength.
Palpate peripheral pulses and test capillary refill time. Note the temperature of the extremities and any edema.
Auscultate heart rate and rhythm, and note gallops and murmurs.
Auscultate the abdominal aorta and femoral arteries to detect bruits.
Evaluate respiratory rate and rhythm. Check for nasal flaring and use of accessory muscles. Inspect for asymmetrical chest expansion or barrel chest. Percuss the lungs for dullness or hyper resonance, and auscultate for decreased or adventitious breath sounds.
Take the patient's vital signs.
Inspect the skin and mucous membranes to determine the extent of cyanosis. Check the skin for coolness, pallor, redness, pain, and ulceration. Also, note clubbing.
Evaluate the patient's level of consciousness, and test his motor strength.
Palpate peripheral pulses and test capillary refill time. Note the temperature of the extremities and any edema.
Auscultate heart rate and rhythm, and note gallops and murmurs.
Auscultate the abdominal aorta and femoral arteries to detect bruits.
Evaluate respiratory rate and rhythm. Check for nasal flaring and use of accessory muscles. Inspect for asymmetrical chest expansion or barrel chest. Percuss the lungs for dullness or hyper resonance, and auscultate for decreased or adventitious breath sounds.
SPECIAL
CONSIDERATIONS:
Provide supplemental oxygen to relieve shortness of breath and decrease cyanosis. However, deliver small doses (2 L/minute) to patients with chronic obstructive pulmonary disease (COPD), who may retain carbon dioxide.
Provide supplemental oxygen to relieve shortness of breath and decrease cyanosis. However, deliver small doses (2 L/minute) to patients with chronic obstructive pulmonary disease (COPD), who may retain carbon dioxide.
PEDIATRIC
POINTERS:
Central cyanosis may result from cystic fibrosis, asthma, airway obstruction by a foreign body, acute laryngotracheobronchitis, or epiglottitis.
Cyanosis may result from a congenital heart defect, such as transposition of the great vessels, that cause right-to-left intracardiac shunting.
In children, circumoral cyanosis may precede generalized cyanosis.
Acrocyanosis may occur in infants because of excessive crying or exposure to cold.
Central cyanosis may result from cystic fibrosis, asthma, airway obstruction by a foreign body, acute laryngotracheobronchitis, or epiglottitis.
Cyanosis may result from a congenital heart defect, such as transposition of the great vessels, that cause right-to-left intracardiac shunting.
In children, circumoral cyanosis may precede generalized cyanosis.
Acrocyanosis may occur in infants because of excessive crying or exposure to cold.
AGING ISSUES:
Because elderly patients have reduced tissue perfusion, peripheral cyanosis can present even with a slight decrease in cardiac output or systemic blood pressure.
Because elderly patients have reduced tissue perfusion, peripheral cyanosis can present even with a slight decrease in cardiac output or systemic blood pressure.
PATIENT
COUNSELING:
Teach patients with chronic cardiopulmonary disease, such as heart failure or COPD, to recognize cyanosis as a sign of severe disease and to get immediate medical attention when it occurs.
Teach patients with chronic cardiopulmonary disease, such as heart failure or COPD, to recognize cyanosis as a sign of severe disease and to get immediate medical attention when it occurs.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)