STUDY - Technical - New Dacian's Medicine
Cough
(Classical / Allopathic Medicine)
Resonant, brassy,
and harsh, a barking cough indicates edema of the larynx and
surrounding tissue. Because children's airways are smaller in
diameter than those of adults, edema can rapidly lead to
airway occlusion - a life-threatening emergency.
A nonproductive
cough is a noisy, forceful expulsion of air from the lungs
that don't yield sputum or blood. A nonproductive cough not
only is ineffective but can also cause damage, such as airway
collapse or rupture of alveoli or blebs. A nonproductive cough
that later becomes productive is a classic sign of progressive
respiratory disease.
A nonproductive
cough may occur in paroxysms and can worsen by becoming more
frequent. An acute cough has a sudden onset and may be
self-limiting; a cough that persists beyond 3 months is
considered chronic and, in many cases, results from cigarette
smoking.
A productive cough
is a sudden, forceful, noisy expulsion of air that contains
sputum, blood, or both. (The sputum's color, consistency, and
odor provide important clues about the patient's condition.)
Productive coughing can occur as a single cough or as
paroxysmal coughing and can be voluntarily induced, although
it's usually a reflexive response to stimulation of the airway
mucosa.
Productive
coughing commonly results from an acute or chronic
cardiovascular or respiratory infection that causes
inflammation, edema, and increased mucus production in the
airways. The most common cause of chronic productive coughing
is cigarette smoking, which produces mucoid sputum ranging in
color from clear to yellow to brown.
HISTORY:
Ask the patient when the cough began and whether body position, time of day, or specific activity affects it. Try to determine if the cough is related to smoking or an environmental irritant.
Ask the patient to describe the cough. Is it harsh, brassy, dry, or hacking?
Ask the patient about the frequency and intensity of coughing. If he has pain associated with coughing, breathing, or activity, when did it begin? Where is it located? If the patient is a child, ask the parents when the cough began and what signs and symptoms accompanied it. Has he had previous episodes of coughing? Did his condition improve with exposure to cold air?
Review the patient's medical history for recent or chronic illness (especially a cardiovascular, pulmonary, or GI disorder), allergies, cancer, surgery, and trauma.
Ask the patient about hypersensitivity to drugs, foods, pets, dust, or pollen.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Ask the patient about recent changes in schedule or dosages. Also, ask the patient about alcohol intake.
Ask the patient about recent changes in appetite, weight, exercise tolerance, or energy level and recent exposure to irritating fumes, chemicals, smoke, or infectious persons.
If the patient has a productive cough, ask him how much sputum he's coughing up each day, at what time of day, and if he has noticed an increase in sputum production since his coughing began. Also, ask about the color, odor, and consistency of the sputum.
Ask the patient when the cough began and whether body position, time of day, or specific activity affects it. Try to determine if the cough is related to smoking or an environmental irritant.
Ask the patient to describe the cough. Is it harsh, brassy, dry, or hacking?
Ask the patient about the frequency and intensity of coughing. If he has pain associated with coughing, breathing, or activity, when did it begin? Where is it located? If the patient is a child, ask the parents when the cough began and what signs and symptoms accompanied it. Has he had previous episodes of coughing? Did his condition improve with exposure to cold air?
Review the patient's medical history for recent or chronic illness (especially a cardiovascular, pulmonary, or GI disorder), allergies, cancer, surgery, and trauma.
Ask the patient about hypersensitivity to drugs, foods, pets, dust, or pollen.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Ask the patient about recent changes in schedule or dosages. Also, ask the patient about alcohol intake.
Ask the patient about recent changes in appetite, weight, exercise tolerance, or energy level and recent exposure to irritating fumes, chemicals, smoke, or infectious persons.
If the patient has a productive cough, ask him how much sputum he's coughing up each day, at what time of day, and if he has noticed an increase in sputum production since his coughing began. Also, ask about the color, odor, and consistency of the sputum.
PHYSICAL
ASSESSMENT:
Observe the patient's general appearance and manner. Note whether he's cyanotic or has clubbed fingers or peripheral edema.
Take the patient's vital signs. Check the depth and rhythm of his respirations, and note if wheezing or “crowing” noises occur with breathing.
Inspect the patient's neck for distended veins and tracheal deviation, and palpate for masses or enlarged lymph nodes.
Examine the patient's chest. Note retractions or accessory muscle use. Percuss for dullness, tympany, or flatness. Auscultate for wheezing, crackles, rhonchi, pleural friction rubs, and decreased or absent breath sounds.
Observe the patient's general appearance and manner. Note whether he's cyanotic or has clubbed fingers or peripheral edema.
Take the patient's vital signs. Check the depth and rhythm of his respirations, and note if wheezing or “crowing” noises occur with breathing.
Inspect the patient's neck for distended veins and tracheal deviation, and palpate for masses or enlarged lymph nodes.
Examine the patient's chest. Note retractions or accessory muscle use. Percuss for dullness, tympany, or flatness. Auscultate for wheezing, crackles, rhonchi, pleural friction rubs, and decreased or absent breath sounds.
SPECIAL
CONSIDERATIONS:
A patient with a productive cough can develop acute respiratory distress from thick or excessive secretions, bronchospasm, or fatigue, so examine him before you take his history. Avoid taking measures to suppress a productive cough because retention of sputum may interfere with alveolar aeration or impair pulmonary resistance to infection.
A patient with a productive cough can develop acute respiratory distress from thick or excessive secretions, bronchospasm, or fatigue, so examine him before you take his history. Avoid taking measures to suppress a productive cough because retention of sputum may interfere with alveolar aeration or impair pulmonary resistance to infection.
PEDIATRIC
POINTERS:
Sudden onset of paroxysmal nonproductive coughing may indicate aspiration of a foreign body - a common danger in children, especially those between ages 6 months and 4 years.
Causes of nonproductive coughing in infants and children include asthma, bacterial pneumonia, acute bronchiolitis, acute otitis media, measles, cystic fibrosis, life-threatening pertussis, and airway hyperactivity, stress, emotional stimulation, or attention-seeking behavior.
Sudden onset of paroxysmal nonproductive coughing may indicate aspiration of a foreign body - a common danger in children, especially those between ages 6 months and 4 years.
Causes of nonproductive coughing in infants and children include asthma, bacterial pneumonia, acute bronchiolitis, acute otitis media, measles, cystic fibrosis, life-threatening pertussis, and airway hyperactivity, stress, emotional stimulation, or attention-seeking behavior.
AGING ISSUES:
Always ask an elderly patient about a cough because it may be an indication of serious acute or chronic illness.
Always ask an elderly patient about a cough because it may be an indication of serious acute or chronic illness.
PATIENT
COUNSELING:
Encourage the patient who smokes to quit. Teach the patient how to breathe deeply and cough effectively. Teach the patient and his family how to perform chest percussion to loosen secretions.
Encourage the patient who smokes to quit. Teach the patient how to breathe deeply and cough effectively. Teach the patient and his family how to perform chest percussion to loosen secretions.
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)