Assesment of COPD patients Flashcards
What things would you check before Examining the COPD patient?
- Medical notes (if available depending on setting e.g. hospital vs community care.
- Referral letter
- Drug chart
- TPR chart
- CXR
- SaO2
- ABG’S
Why do you check the drug chart of COPD patients.?
- Side effects e.g. Dizziness, bone weakness (steroids) etc.
- Pain relief because some drugs can open up your airways, so you may wish to time therapy alongside the medication.
- Beta blockers (slow HR)
- Anticoagulants
- Bronchodilators
- O2 therapy
- Corticosteroids
What considerations are there before meeting the patient?
- Relevant medical information
- Nursing handover (if in-patient)
- Translator
What history are you collecting during the subjective?
- History of present condition (HOPC)
- Past medical history (PMH)
- Drug history (DH)
- Social history (SH)
hobbies etc… - Family history (FH)
- Home set up
- Employment
- Caring responsibilities
- Smoking history
What information are you collecting during the objective assessment?
General observation
- TPR chart = (temperature, pulse, respiration; used especially in recording a patient’s vital signs on a medical chart)
- Signs of malnourishment or obesity
- Sign of pain
- Signs of breathlessness
- Supplemental O2
- Hands; always ask to look at a persons hands, check for; Tremor, nicotine stains, clubbing and if they flap their hands a lot, that’s a sign of high CO2 levels.
What is the ABCDE approach you should follow during objective assessments?
Airway Breathing Circulation Disability Exposure
What do you do for your objective assessment when checking Airways?
Observation -Self ventilating or artificial -Swelling of the tongue - Cyanosis Palpation/feel -Place hands over mouth or airway Listen; Is the airway clear? Wheeze shows narrowing, stridor which is harsh obstructive sound like Darth Vader, grunting, snoring.
What do you do for your objective assessment when checking Breathing? Observation Palpation Listen Measure
Observation -Normal chest shape/symmetry -Breathing pattern -Able to speak - length of sentences - Use of accessory mm - Pursed lip breathing; It maintains the positive pressure in the chest and prevents lung collapse. Palpation - Tracheal position - Surgical emphysema Listen - Speech - Quality of cough - Percussion note - Chest auscultation - Vocal resonance Measure - Respiratory rate - O2 saturation - Fraction of inspired oxygen (FiO2) - Arterial blood gases (ABG's) - Lung function test - Breathlessness measured via; Borg/MRC scale - Thoracic imaging CXR
What is the MRC scale?
MRC Grade. FUNCTIONAL ABILITY / BREATHLESSNESS SCALE. It is clinically helpful to assess breathlessness using MRC grading of 1 to 5. This is a validated measure of disease severity irrespective of patient’s FEV1.
Describe each grade of the MRC scale.
(The grading is shown on the slides at 0-4 but most online sources show the same scale but on a 1-5. just be aware of this variation)
In the answer I’ve used 1-5.
1- Not troubled by B except with strenuous exercise.
2- Troubled by B when hurrying on the level or walking up a slight hill.
3- Walks slower than the average person of the same age due to breathlessness, or has to stop for breath when walking at own pace.
4- Stops for breath after walking about 100yds or after a few mins on the level.
5- Too breathless to leave the house or breathless when dressing/undressing.
What is the modified BORG scale?
he Modified Borg Dyspnoea Scale is most commonly used to assess symptoms of breathlessness. Despite being a subjective measure of exercise intensity, RPE (Rating of perceived exertion) scales provide valuable information when used correctly.
What is the BORG scale (e.g. 0= nothing at all.. 1=?)
0= Nothing at all 0.5= Very very slight 1= Very slight 2= Slight 3= Moderate 4= Somewhat severe 5= Severe 6= 7= Very severe 8= 9= Very very severe 10= Maximal
What is the measurement of exercise capacity?
Same as bleep test but much slower beeps and only for 10 metres.
What is sputum that is a clear, watery fluid known as and what does it indicate?
Saliva, normal.
What is sputum that is clear/white known as, and what is it caused by?
Mucoid, and is caused by Chronic bronchitis (no infection)
What is sputum that is Pale yellow sputum known as, and what causes this?
Mucopurulent, caused by Bronchiectasis, Cystic Fibrosis (CF), Pneumonia
What is sputum that is thick, viscous: yellow, dark green, rusty sputum known as and what causes this?
Purulent, caused by infection - Haemophilus, pseudomonas, pneumococcus.
What is sputum that is Pink or white sputum known as and what causes this?
Frothy, and is caused by Pulmonary oedema.
What is sputum that is ranging from blood specks to frank blood known as and what causes this?
Haemoptysis, and is caused by Infection, MI, Ca, TB, Trauma.
What is sputum that is black specs in mucoid secretions known as and what causes this?
Black, and is caused by Smoke inhalation.
How much is a “normal” amount of sputum to produce in a day?
10-100ml
During an objective assessment of the chest (for circulation) what would you be looking for and feeling for?
Observation, Feel, Measure.
Observation - General; pale, sweating, lips dry or moist - Skin turgor - Peripheral Oedema - JVP - Urine Feel - Temperature - Peripheral pulse Measure - Body temperature - ECG - BP
During an objective assessment of the chest (for Disability) what would you be looking for and feeling for?
Observation, Feel, Measure.
Observation -LOC, cognitive ability - Glasgow coma scale (GCS) - Pupil response Feel Measure - Neuro examination - Blood glucose - Intracranial pressure - Function - QOL
How is quality of life assessed?
- CAT score
- Chronic Respiratory Disease Questionnaire (CRDQ)
- Dyspnoea
- Fatigue
- Mastery
- Emotion
During an objective assessment (for exposure) what would you be looking for and feeling for?
Observation, Feel, Measure.
Observation - Skin colour and condition; Cyanosis - Limb exposure; Deformity and wasting - Eyes; Anaemia, jaundice - Nutrition; - support. Hands; - Fine tremor bronchodilators - Coarse tremor (flap) – CO2 retention with flushed face and peripheries - Nicotine staining - Clubbing of fingers Measure -Weight; BMI (Kg/m2) - Investigations
What are the causes of clubbing?
Lung disease - Infective - Fibrotic - malignant Cardiac disease - Congenital - Bacterial endocarditis Other - Familial - Cirrhosis - GI disease
What is cyanosis?
Blue discoloration of the skin. Central cyanosis indicates reduced O2 carrying capacity of the circulation.
