VI.

Clinical Signs and Symptoms/ Physical Disabilities/ Impairments

Sign or Symptom
Anorexia, weakness, fatigue,
weight loss

Bradycardia
Breath sounds

Bronchial breath sounds

Chest expansion (focal or

generalized)

Chest pain

Coma, convulsions
Confusion, concentration,
restlessness, irritability
Cough

Crackles, or rales

Cyanosis
Diaphoresis

Digital clubbing

Common Pulmonary Causes

Chronic respiratory disease
(probably caused by " work of
breathing), pulmonary infection
Profound hypoxemia
Atelectasis, emphysema, fibrosis,
pleural effusion, pneumothorax,
local bronchial occlusion,
hypoventilation of any cause,
diaphragmatic paralysis, obesity
Consolidation, tumor, fibrosis in
close approximation to a patent
bronchus
Pulmonary consolidation, fibrosis,
atelectasis, pleural effusion,
pneumothorax, obesity,
kyphoscoliosis, obstructive lung
disease, respiratory muscle
weakness
Pleurisy, pneumonia, cancer,
tuberculosis, pulmonary emboli or
infarction, pneumothorax, violent
coughing, rib fracture or other
trauma, tracheobronchial
infection, inhalation of noxious
fumes, intercostal neuritis,
pulmonary hypertension
Rapid PaCO2
Hypoxemia, hypercapnia

Stimulation of airway mucosal

irritant receptors by inflammation,
secretions, foreign bodies,
chemical substances, and
intrabronchial masses

Dullness to percussion

Dyspnea, shortness of breath

(SOB) (air hunger)

Interstitial fibrosis, atelectasis,

pulmonary edema, COPD
Hypoxemia
Infection (fever), sympathetic

Fever

Hemoptysis (expectoration of
bloody or bloodstreaked
secretions)

Hypercapnia (PaCO2)

Hypoxemia (PaO2)

Mediastinal shift

Toward affected side

Away from affected side

Nasal secretions
Orthopnea (SOB when
recumbent)

Paroxysmal nocturnal
dyspnea (PND), or awakening
with SOB in the middle of the
night
Pleural friction rub

Resonance to percussion

nervous system activity (e.g.,

anxiety concerning SOB), night
sweats (unknown mechanism)
Unknown; seen in bronchogenic
carcinoma, chronic infections
(empyema, lung abscess,
bronchiectasis, cystic fibrosis),
interstitial pulmonary fibrosis,
hepatopulmonary syndrome, and
right-to-left shunting (pulmonary
arteriovenous malformations)
Pleural effusion, lobar
consolidation, lobar or whole lung
atelectasis
Acute onset: Pulmonary embolism,
pneumothorax, acute asthma,
pulmonary congestion caused by
CHF, pneumonia, upper airway
obstruction
Subacute or chronic: Airflow
limitation/COPD, lung volume,
impaired gas exchange, # lung
compliance (e.g., pneumonia,
congestion, atelectasis, pleural
effusion, pulmonary fibrosis),
chest wall compliance (e.g.,
kyphoscoliosis, obesity,
neuromuscular impairment), "
oxygen consumption (as with
exertion)
Pulmonary infection, tissue
degeneration, trauma
Acute exacerbation of chronic
bronchitis, bronchial carcinoma,
tuberculosis, bronchiectasis,
pulmonary hypertension,
pulmonary infarction, pneumonia
(especially pneumococcal)
Ventilationperfusion
mismatching, alveolar
hypoventilation, pulmonary
arteriovenous malformations
Ventilationperfusion

Resonance to percussion

Rhonchi, wheezes
Sputum production

Stridor

Tachycardia
Tachypnea

Vocal fremitus

Vocal fremitus

Wheezes

mismatching, diffusion defect,

alveolar hypoventilation,
pulmonary arteriovenous
malformations, FIO2 (e.g.,
altitude)
Severe kyphoscoliosis (toward
side of compressed lung)
Pulmonary fibrosis, atelectasis,
lobectomy or pneumonectomy
Pneumothorax, pleural effusion,
hyperinflation of one lung caused
by checkvalve obstruction of a
bronchus
Infection, irritants, allergens
Paralysis of both hemidiaphragms,
pulmonary edema
Pooling of secretions, gravityinduced # lung volumes, sleepinduced airflow resistance
Irritation of the pleurae (e.g.,
pneumonia, pleurisy)
Pneumothorax, emphysema,
chronic bronchitis, possibly acute
asthma
Atelectasis, consolidation, fibrosis,
pleural effusion
Secretions in airway(s)
Pulmonary suppuration, lung
abscess, acute or chronic
bronchitis, bronchiectasis,
neoplasm, pulmonary edema,
pneumonia
Narrowing of the glottis, trachea,
or major bronchi, as by foreign
body aspiration, external
compression by tumor, or tumor
within the airways
Hypoxemia
Pneumonia, pulmonary edema,
pulmonary infarction, diffuse
pulmonary fibrosis

Consolidation, just above level of

pleural effusion
Asthma, atelectasis, COPD,
fibrosis, pleural effusion,
pneumothorax, obesity, chest
musculature
Narrowing of a bronchus (e.g.,
bronchoconstriction, stenosis, "
secretions, edema, inflammation,
tumor, foreign body aspiration)