1. Subjective an objective assessment Flashcards
What are 4 key cardiorespiratory symptoms in a subjective assessment that you need premorbid and current information about?
- Cough and sputum
- Pain
- Exercise tolerance and mobility
- Breathlessness
What information do you need about cough?
Usual vs Current
* Presence or absence
* Occurrence? Intermittent/night time/ throughout the day
* Productive or non productive
What information do you need about sputum?
- Amount
- Colour
- Viscosity
Use the word mucus to patients - less jargon
What information do you need about social history?
- Home environment
- Any home modifications
- Is the patient a carer for someone or do they have a carer?
- Level of independence with ADLs
- Paid work?
What details of previous physiotherapy do you need to ask the patient?
- Understaning of what physiotherapy does?
- Understand management of their condition or find out what self-management techniques they currently use?
Name 3 points to address when concluding an interview
- Patient goals
- Discharge planning
- Possible patient problems
Normal values: temperature
36.5-37.5
Normal values: heart rate
60-100bpm
Bradycardic <60
Tachycardic >100
Normal values: blood pressure
Between 95/60 and 140/90
Hypertension >145/95
Hypotension <90/60
What is orthostatic intolerance
BP drop during upright posture
Normal values: respiratory rate
12-16 breaths/min
Tachypnoea >20 breaths/min
Bradypnoea <10 breaths/min
What are the 3 components of patient observation?
- Look
- Feel
- Listen
Look and feel
What components are you looking for when assessing breathing pattern?
- Pattern/symmetry of movement (feel)
- Use of accessory muscles (look)
- Inspiratory/expiratory ratio (should be 1:2 or 1:3; more time exhaling than inhaling) (look)
- Level of breathlessness (use borg scale)
Types of breathing sounds on auscultation?
- Normal breath sounds
- Absent breath sounds
- Bronchial breath sounds
- Crackles (small or large)
- Wheese
- Pleural rub (creaking, squeaking or rubbing)
Types of breathing sounds on auscultation?
- Normal breath sounds
- Absent breath sounds
- Bronchial breath sounds
- Crackles (small or large)
- Wheese
- Pleural rub (creaking, squeaking or rubbing)
What do fine crackles indicate?
- Pulmonary edema
- Pulmonary fibrosis
- Pneumonia
What do coarse crackles indicate?
consolidation or sputum retention
What do bronchial breath sounds indicate?
consolidation
List 7 components of physical examination
- Review chart and test results
- Observe environment
- General observation (non-chest)
- Chest observation and palpation/breathlessness
- Auscultation
- Cough and sputum
- Functional assessment
List the 8 cardiorespiratroy problems
- Pain
- Mobility
- Reduced exercise tolerance
- Low lung volumes
- Impaired gas exchange
- Dyspnoea/increased WOB
List the 8 cardiorespiratroy problems
- Pain
- Mobility
- Reduced exercise tolerance
- Low lung volumes
- Impaired gas exchange
- Dyspnoea/increased WOB
What clinical findings might you expect for impaired airway clearance?
- Increased sputum production
- Change in sputum colour
- Coarse crackles on auscultation
- CXR consolidation
- Difficulty coughing
What pathologies would cause impaired airway clearance?
- CF
- Bronchiectasis
- COPD exacerbation
- Pneumonia
- Post-operative pulmonary complications with sputum
- Neuromuscular condition
What are the contributing factors of impaired airway clearance?
- Impaired mucociliary clearance
- Ineffective cough (due to pain)
- Increased sputum amount or changed mucus composition
What might be clinical findings for low lung volumes?
- CXR collapse
- Reduced breath sounds on ausc.
- Reduced SpO2
- Weak cough
- Reduced chest epansion
What are clinical examples of low lung volumes?
- General anesthetic from surgery
- Supine position
- # ribs
- Pleural effusion
- Pneumothorax
What are the contributing factors to low lung volumes?
- Reduced FRC
- Increased CC
- Reduced lung compliance
- Pain
- Diaphragm dysfunction
List the 5 factors affecting FRC
- Body size
- Gender
- Diaphragmatic muscle tone
- Posture
- Lung disease
Define closing capacity
The volume at which small airways in the dependent region begin to close
Define closing capacity
The volume at which small airways in the dependent region begin to close.
Airway closure = reduced ventilation = V/Q mismatch = hypoxaemia
What is the relationship between FRC, age and CC
FRC remains with age and closing capacity increases with age.
What factors decrease FRC?
- Supine posture
- Anesthesia
- Abdominal pain
- Obesity
What factors increase closing capacity?
- Age
- Smoking
- Pulmonary oedema
What causes decreased FRC following GA?
- Reduced abdominal muscle tone
- Reduced phrenic nerve acitvity (reduces diaphragm tone)
- Reduced lung compliance (stiffer and harder to inflate)
- Diaphragmatic dysfunctions
What is the effect of GA on sputum/clearance?
- Increased mucus viscosity
- Cilia stop moving after 90 mins of anesthesia - reduced mucociliary clearance
- Drying of airway secretions
What is the effect of GA on coughing?
- Cough reflex dampened by sedation
- Strength of cough impaired by low lung volumes and inability to generate intra abdominal pressure
Name 3 factors contributing to development of PPC?
- Atelectasis
- Ineffective cough
- Impaired mucociliary clearance
Define atelectasis
Small airway collapse
What are the clinical signs and symptoms of PPC?
4 or more must be present for diagnosis
- SpO2 bleow 90%
- CXR - atelectasis or consolidation
- Fever (>38 degrees)
- altered sputum quantity or quality
- Microbial growth in sputum
- Raised WCC or administration of antibiotics
- Medical diagnosis of pneumonia
- Readmission ot ICU with respiratory issues
What are preoperative risk factors for PPC?
- Respiratory or cardiac co-morbidities
- Obesity
- Age
- Current smoker
- Poor pre-morbid mobility and exercise tolerance
- Immunocompromised
- Emergency vs elective surgery
What are perioperative risk factors for PPC?
- Type of surgery
- length of snesthesia
- Pain
- Immobility
- Surgical complications
- Lack of education about preventative measures
- ICU admission
What are the main treatment goals of postoperative physiotherapy?
- Improve lung volumes
- Enhance airway clearance
- Increase mobility
- Prepare and optimise for discharge
