Pulmonary Disease

• Comorbid factors
  • Emphysema
  • Frequent ER visits
  • Frequent respiratory infections
  • Hypercapnia
  • Hypoxemia at rest on supplemental oxygen
  • Increased hospitalizations
  • Oxygen dependent
  • Poor response to bronchodilators
  • Right heart failure (cor pulmonale)
  • Severe lung disease
  • Smoking history
  • Tracheostomy
• Labs/tests indicative of increased disease
  • Echocardiogram documentation
  • EKG documentation
  • FEV1 after bronchodilation less than 30% predicted
  • MRI/CT scan or chest x-ray documentation
  • Oxygen saturation less than 89% on supplemental oxygen
  • pCO2 greater than 50 mm Hg
  • pO2 less than 56 mm Hg
  • Serial decrease of FEV1 greather than 40 ml/year
• Respiratory Signs/Symptoms
  • Abdominal respirations
  • Accessory muscle use for respiration
  • Apnea
  • Cheyne-stokes respirations
  • Cough (productive, purulent sputum, dry, nonproductive, severe)
  • Cyanosis
  • Depressed diaphragm
  • Decreased functional capacity/fatigue
  • Diminished breath sounds
  • Disabling dyspnea on exertion or at rest
  • Increased expiratory phase
  • Kussmal respirations
  • Pulmonary hyperinflation/barrel-chest
  • Pursed-lip breathing
  • Resting tachycardia >100/min or tachypnea
  • Slow forced expirations
  • Steroid therapy
  • Supraclavicular retractions
  • Substernal retractions
  • Wheezing