STUDY - Technical - New Dacian's Medicine
breath,
abnormal (Classical / Allopathic Medicine)
Ammonia breath
odor - commonly described as urinous or “fishy” breath -
typically occurs in those with end-stage chronic renal
failure. This sign improves slightly after hemodialysis and
persists throughout the course of the disorder but isn't of
great concern.
Fecal breath odor
typically accompanies fecal vomiting associated with a
long-standing intestinal obstruction or gastrojejunocolic
fistula. It represents an important late diagnostic clue to a
potentially life-threatening GI disorder because complete
obstruction of any part of the bowel, if untreated, can cause
death within hours from vascular collapse and shock.
Fruity breath odor
results from respiratory elimination of excess acetone. This
sign characteristically occurs in those with ketoacidosis - a
potentially life-threatening condition that requires immediate
treatment to prevent severe dehydration, irreversible coma,
and death.
HISTORY:
If you detect ammonia breath odor:
- Ask the patient if he has experienced a metallic taste, loss of smell, increased thirst, heartburn, difficulty swallowing, loss of appetite at the sight of food, and early-morning vomiting.
- Ask the patient about his bowel habits. Has he had melenic stools or constipation?
If you detect fecal breath odor:
- Ask the patient about previous abdominal surgery, appetite, and abdominal pain. If he's having pain, have him describe its onset, duration, and location. Is the pain intense, persistent, or spasmodic?
- Have the patient describe his normal bowel habits, especially noting constipation, diarrhea, or leakage of stool. Ask when the patient's last bowel movement occurred, and have him describe the stool's color and consistency.
If you detect a fruity breath odor:
- Ask the patient about changes in his breathing pattern.
- Ask the patient if he's experienced increased thirst, frequent urination, weight loss, fatigue, or abdominal pain.
- Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching.
- If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy.
- If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.
If you detect ammonia breath odor:
- Ask the patient if he has experienced a metallic taste, loss of smell, increased thirst, heartburn, difficulty swallowing, loss of appetite at the sight of food, and early-morning vomiting.
- Ask the patient about his bowel habits. Has he had melenic stools or constipation?
If you detect fecal breath odor:
- Ask the patient about previous abdominal surgery, appetite, and abdominal pain. If he's having pain, have him describe its onset, duration, and location. Is the pain intense, persistent, or spasmodic?
- Have the patient describe his normal bowel habits, especially noting constipation, diarrhea, or leakage of stool. Ask when the patient's last bowel movement occurred, and have him describe the stool's color and consistency.
If you detect a fruity breath odor:
- Ask the patient about changes in his breathing pattern.
- Ask the patient if he's experienced increased thirst, frequent urination, weight loss, fatigue, or abdominal pain.
- Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching.
- If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy.
- If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.
PHYSICAL
ASSESSMENT:
If you detect ammonia breath odor:
- inspect the patient's oral cavity for bleeding, swollen gums or tongue, and ulceration with drainage.
If you detect a fecal breath odor:
- take the patient's vital signs, watching for indications of hypertension; hypotension; tachycardia; tachypnea; cool, clammy skin; and altered mental status
- auscultate for bowel sounds
- inspect the abdomen, noting contour and surgical scars, and measure abdominal girth to provide baseline data for subsequent assessment of distention
- palpate for tenderness, distention, and rigidity
- percuss for tympany, indicating a gas-filled bowel, and dullness, indicating fluid.
If you detect fruity breath odor:
- check for Kussmaul's respirations
- examine the patient's level of consciousness.
If you detect ammonia breath odor:
- inspect the patient's oral cavity for bleeding, swollen gums or tongue, and ulceration with drainage.
If you detect a fecal breath odor:
- take the patient's vital signs, watching for indications of hypertension; hypotension; tachycardia; tachypnea; cool, clammy skin; and altered mental status
- auscultate for bowel sounds
- inspect the abdomen, noting contour and surgical scars, and measure abdominal girth to provide baseline data for subsequent assessment of distention
- palpate for tenderness, distention, and rigidity
- percuss for tympany, indicating a gas-filled bowel, and dullness, indicating fluid.
If you detect fruity breath odor:
- check for Kussmaul's respirations
- examine the patient's level of consciousness.
SPECIAL
CONSIDERATIONS:
Ammonia odor is offensive to others, but the patient may become accustomed to it. Remind him to perform frequent mouth care.
Ammonia odor is offensive to others, but the patient may become accustomed to it. Remind him to perform frequent mouth care.
PEDIATRIC
POINTERS:
Carefully monitor the child with fecal breath odor for fluid and electrolyte imbalance because dehydration can occur rapidly from persistent vomiting.
Fruity breath odor in an infant or a child usually stems from uncontrolled diabetes mellitus. Ketoacidosis develops rapidly in this age-group because of low glycogen reserves.
Carefully monitor the child with fecal breath odor for fluid and electrolyte imbalance because dehydration can occur rapidly from persistent vomiting.
Fruity breath odor in an infant or a child usually stems from uncontrolled diabetes mellitus. Ketoacidosis develops rapidly in this age-group because of low glycogen reserves.
AGING ISSUES:
Elderly patients may have poor oral hygiene, increased dental caries, decreased salivary function with dryness, and poor dietary intake. In addition, many of them take multiple drugs. Consider all of these factors when evaluating an elderly patient with mouth odor.
Elderly patients may have poor oral hygiene, increased dental caries, decreased salivary function with dryness, and poor dietary intake. In addition, many of them take multiple drugs. Consider all of these factors when evaluating an elderly patient with mouth odor.
PATIENT
COUNSELING:
Teach the patient appropriate oral hygiene and make appropriate referrals. Involve the patient in various aspects of treatment, such as dietary and drug therapies.
Teach the patient appropriate oral hygiene and make appropriate referrals. Involve the patient in various aspects of treatment, such as dietary and drug therapies.
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)