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Cardio theory > 1. Subjective an objective assessment > Flashcards

1. Subjective an objective assessment Flashcards

1
Q

What are 4 key cardiorespiratory symptoms in a subjective assessment that you need premorbid and current information about?

A
  1. Cough and sputum
  2. Pain
  3. Exercise tolerance and mobility
  4. Breathlessness
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2
Q

What information do you need about cough?

A

Usual vs Current
* Presence or absence
* Occurrence? Intermittent/night time/ throughout the day
* Productive or non productive

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3
Q

What information do you need about sputum?

A
  1. Amount
  2. Colour
  3. Viscosity

Use the word mucus to patients - less jargon

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4
Q

What information do you need about social history?

A
  • 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?
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5
Q

What details of previous physiotherapy do you need to ask the patient?

A
  • Understaning of what physiotherapy does?
  • Understand management of their condition or find out what self-management techniques they currently use?
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6
Q

Name 3 points to address when concluding an interview

A
  1. Patient goals
  2. Discharge planning
  3. Possible patient problems
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7
Q

Normal values: temperature

A

36.5-37.5

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8
Q

Normal values: heart rate

A

60-100bpm

Bradycardic <60
Tachycardic >100

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9
Q

Normal values: blood pressure

A

Between 95/60 and 140/90

Hypertension >145/95
Hypotension <90/60

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10
Q

What is orthostatic intolerance

A

BP drop during upright posture

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11
Q

Normal values: respiratory rate

A

12-16 breaths/min

Tachypnoea >20 breaths/min
Bradypnoea <10 breaths/min

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12
Q

What are the 3 components of patient observation?

A
  • Look
  • Feel
  • Listen
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13
Q

Look and feel

What components are you looking for when assessing breathing pattern?

A
  • 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)
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14
Q

Types of breathing sounds on auscultation?

A
  • Normal breath sounds
  • Absent breath sounds
  • Bronchial breath sounds
  • Crackles (small or large)
  • Wheese
  • Pleural rub (creaking, squeaking or rubbing)
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15
Q

Types of breathing sounds on auscultation?

A
  • Normal breath sounds
  • Absent breath sounds
  • Bronchial breath sounds
  • Crackles (small or large)
  • Wheese
  • Pleural rub (creaking, squeaking or rubbing)
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16
Q

What do fine crackles indicate?

A
  • Pulmonary edema
  • Pulmonary fibrosis
  • Pneumonia
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17
Q

What do coarse crackles indicate?

A

consolidation or sputum retention

18
Q

What do bronchial breath sounds indicate?

A

consolidation

19
Q

List 7 components of physical examination

A
  1. Review chart and test results
  2. Observe environment
  3. General observation (non-chest)
  4. Chest observation and palpation/breathlessness
  5. Auscultation
  6. Cough and sputum
  7. Functional assessment
20
Q

List the 8 cardiorespiratroy problems

A
  1. Pain
  2. Mobility
  3. Reduced exercise tolerance
  4. Low lung volumes
  5. Impaired gas exchange
  6. Dyspnoea/increased WOB
21
Q

List the 8 cardiorespiratroy problems

A
  1. Pain
  2. Mobility
  3. Reduced exercise tolerance
  4. Low lung volumes
  5. Impaired gas exchange
  6. Dyspnoea/increased WOB
22
Q

What clinical findings might you expect for impaired airway clearance?

A
  1. Increased sputum production
  2. Change in sputum colour
  3. Coarse crackles on auscultation
  4. CXR consolidation
  5. Difficulty coughing
23
Q

What pathologies would cause impaired airway clearance?

A
  • CF
  • Bronchiectasis
  • COPD exacerbation
  • Pneumonia
  • Post-operative pulmonary complications with sputum
  • Neuromuscular condition
24
Q

What are the contributing factors of impaired airway clearance?

A
  • Impaired mucociliary clearance
  • Ineffective cough (due to pain)
  • Increased sputum amount or changed mucus composition
25
Q

What might be clinical findings for low lung volumes?

A
  • CXR collapse
  • Reduced breath sounds on ausc.
  • Reduced SpO2
  • Weak cough
  • Reduced chest epansion
26
Q

What are clinical examples of low lung volumes?

A
  • General anesthetic from surgery
  • Supine position
  • # ribs
  • Pleural effusion
  • Pneumothorax
27
Q

What are the contributing factors to low lung volumes?

A
  • Reduced FRC
  • Increased CC
  • Reduced lung compliance
  • Pain
  • Diaphragm dysfunction
28
Q

List the 5 factors affecting FRC

A
  • Body size
  • Gender
  • Diaphragmatic muscle tone
  • Posture
  • Lung disease
29
Q

Define closing capacity

A

The volume at which small airways in the dependent region begin to close

30
Q

Define closing capacity

A

The volume at which small airways in the dependent region begin to close.

Airway closure = reduced ventilation = V/Q mismatch = hypoxaemia

31
Q

What is the relationship between FRC, age and CC

A

FRC remains with age and closing capacity increases with age.

32
Q

What factors decrease FRC?

A
  • Supine posture
  • Anesthesia
  • Abdominal pain
  • Obesity
33
Q

What factors increase closing capacity?

A
  • Age
  • Smoking
  • Pulmonary oedema
34
Q

What causes decreased FRC following GA?

A
  • Reduced abdominal muscle tone
  • Reduced phrenic nerve acitvity (reduces diaphragm tone)
  • Reduced lung compliance (stiffer and harder to inflate)
  • Diaphragmatic dysfunctions
35
Q

What is the effect of GA on sputum/clearance?

A
  • Increased mucus viscosity
  • Cilia stop moving after 90 mins of anesthesia - reduced mucociliary clearance
  • Drying of airway secretions
36
Q

What is the effect of GA on coughing?

A
  • Cough reflex dampened by sedation
  • Strength of cough impaired by low lung volumes and inability to generate intra abdominal pressure
37
Q

Name 3 factors contributing to development of PPC?

A
  • Atelectasis
  • Ineffective cough
  • Impaired mucociliary clearance
38
Q

Define atelectasis

A

Small airway collapse

39
Q

What are the clinical signs and symptoms of PPC?

4 or more must be present for diagnosis

A
  • 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
40
Q

What are preoperative risk factors for PPC?

A
  • Respiratory or cardiac co-morbidities
  • Obesity
  • Age
  • Current smoker
  • Poor pre-morbid mobility and exercise tolerance
  • Immunocompromised
  • Emergency vs elective surgery
41
Q

What are perioperative risk factors for PPC?

A
  • Type of surgery
  • length of snesthesia
  • Pain
  • Immobility
  • Surgical complications
  • Lack of education about preventative measures
  • ICU admission
42
Q

What are the main treatment goals of postoperative physiotherapy?

A
  • Improve lung volumes
  • Enhance airway clearance
  • Increase mobility
  • Prepare and optimise for discharge

Cardio theory (4 decks)

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