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RCV 1 - physio > assessing the respiratory patient > Flashcards

assessing the respiratory patient Flashcards

1
Q

what kind of information are you looking for in the history of present complaint in the subjective?

A

-chest of symptoms - sudden vs slow pattern
-frequency: daily, weekly, monthly
- severity- mild,moderate,severe
-fever?

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2
Q

what kind of information are you looking for in the past medical history ?

A

-any previous admissions
-chronic disorders eg COPD, asthma or bad chest
-measles or whooping cough?
-weight loss?
-allergies

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3
Q

what kind of information are you looking for in drug history in the subjective assessment of the resp patient?

A

-prescribed medication - compliance?
-oral contraceptive increases risk of PE
-long term oxygen therapy?
-ambulatory oxygen therapy (O2 for when you are active)

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4
Q

what kind of information are we looking for in the social history in the subjective exam of a resp pt?

A

-smoking history - pack history
-alcohol
-occupational therapy - nb high risk jobs like builder
-pets?
-housing
-home supports eg care package
-stairs do they get SOB on stairs?
-baseline functional status
-hobbies
-FAMILY HISTORY - eg genetic diseases, TB, covid, genetic etc

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5
Q

what are examples of precautions with resp patients?

A
  • MRSA, TB, covid
    -rib fractures
    -metastatic disease
    -lines/ attachments
    -post op precautions
  • WB status
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6
Q

what are the most common symptoms for a resp patient?

A

-cough
-wheeze
-chest pain
-SOB
-sputum

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7
Q

what are the 5 questions you always ask a resp patient?

A

-do you have breathlessness
-do you have a cough
-are you coughing up sputum
-are you wheezing?
-chest pain ?

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8
Q

what is dyspnoea?

A

when the awareness of breathing is unpleasant and uncomfortable

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9
Q

what are the subjective q’s you ask in relation to breathlessness?

A

-duration
-sensation
-severity- how severe is it?
-aggs and eases - eg positioning might ease SOB, aggs movement?
-time course - sudden or slow onset
-associated features eg urinary incontinence

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10
Q

what is orthopnoea?

A

the sensation of breathlessness in the recumbent position

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11
Q

what is paroxysmal nocturnal dyspnoea?

A

-a sensation of SOB that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position

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12
Q

what scale measures breathlessness?

A

modified Borg dyspnea scale

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13
Q

what is a cough?

A

a basic protective mechanism
-any stimulation of receptors located in pharynx, larynx or bronchi may induce a cough

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14
Q

what are the benefits / effects of coughing?

A

-expelling sputum and inhaled irritants
-can cause bronchospasm, exhaustion

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15
Q

what are important considerations to take into account about cough?

A

-urinary incontience - do you feel like you leak a bit when you cough
-bone density - constant coughing can cause rib fractures
-hernias

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16
Q

what is dry cough associated with?

A

early stages of pneumonia

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17
Q

what is a moist cough associated with?

A

occurs in RTI, COPD, bronchiectasis

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18
Q

what are important subjective questions to ask about cough?

A

-when?
-aggs/eases
-changes in character
-freq
-moist or dry?
-wheezy
-productive - producing sputum
-non productive - nothing coming up

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19
Q

what are important subjective questions to ask about sputum?

A

-colour
-consistency
-volume/quantity eg teaspoon,tablespoon,egg cup
-frequency of expectoration

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20
Q

what is haemoptysis?

A

presence of blood in sputum

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21
Q

what is frank haemoptysis?

A

fresh blood in the sputum

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22
Q

what does pink frothy sputum indicate?

A

heart failure and pulmonary oedema

23
Q

what are the different colours of sputum and what does it mean?

A
24
Q

what is pulmonary oedema?

A

-when the heart is not able to pump blood properly, blood can then back up into the veins that circulate blood through the lungs
-then the pressure in these bv’s increase and cause fluid to fill into the air spaces (alveoli)

25
Q

what is plastic bronchitis?

A

-build up of mucous in your lungs that look similar to tree branches

26
Q

what is wheeze?

A

symptomatic manifestation of disease process that causes an airflow obstruction or narrowing

27
Q

what is a stridor?

A

inspiratory wheeze suggestive of a large airway narrowing or upper airway obstruction MEDICAL EMERGENCY NB
-may have object in upper resp or tumours

28
Q

what is chest pain caused by in a resp patient?

A

-MSK
-cardiac
-pleural or tracheal inflammation

29
Q

what are subjective questions to ask about chest pain?

A

-any pain?
-types of pain?
-location of pain?
-aggs / eases
-rate on NRS

30
Q

what are examines of further subjective questions to ask a resp patient?

A

-fever?
-peripheral oedema
-sleep - well rested in am, sleepy during the day etc?
-stress incontinence - always ask
-functional ability - baseline vs present
-disease awareness
-previous physiotherapy - effect? / opinion

31
Q

what three things do you do in objective assessment ?

A

vitals - temp, BP, HR, spo2, HR
general observation - position, hands, tremors, attachments
-resp objective assessment - auscultation, palpation, expansion, cough
-analysis of bloods & X-ray - ABGs, CXR
-standard outcome measures - CAT, BORG, BCAA

32
Q

what is the A-E assessment ?

A

-airway
-breathing
-circulation
-disability
-exposure

33
Q

what are you looking at for airways?

A

-is the airway patient?
-listen - can you hear any gurgling or stridor

34
Q

what are you looking at breathing?

A

-look at how they are breathing
-use of accessory muscles
-chest shape
-movement and pattern
-nasal flaring
-purse lip breathing
-resp rate and SP02
-hands on chest and cheek for chest expansion

35
Q

what is pectus excavatum?

A

-occurs when the breastbone pushes inward
-most common wall of chest wall deformity

36
Q

what is pectus carinatum?

A

-also known as pigeon chest
-the breastbone and ribs protrude outwards

37
Q

what is hoovers sign?

A

the inward motion of the lower lateral rib cage with inspiration
-considered to be a sign of severe disease in COPD

38
Q

what is tactile fremitus?

A

a vibrating sensation felt by a hand placed on chest

39
Q

what us laboured breathing?

A

-increased effort to breathe
-can see the use of accessory muscles
-eg during anxiety, COPD, asthma or other lung conditions

40
Q

what is PLB (hoovers sign)?

A
41
Q

what is paradoxical breathing?

A

-when the abdomen is sucked in on inspiration as the ineffective diaphragm is pulled up by he negative pressure generated in the chest

42
Q

what is cheyne stokes?

A
  • an abnormal pattern
    -heavy breathing followed by shallow breathing
    -can indicate end of life
43
Q

what are you looking for with circulation?

A

-complexion
-cyanosis (blue/grey colour)
-jugular venous pressure - protrude
-sweating
-HR & BP
-urine output
-blood sugar levels
-cold hands or feet

44
Q

what are you looking for in disability of the resp patient?

A
  • look - level of consciousness , are they alert
    -listen - voice
    -feel - measure strength and range of motion
45
Q

what do you look for in exposure of the resp patient?

A

-injuries
-surgical wounds
-drains eg chest drain
-contrandicatuons or interventions

46
Q

what are other objective tests?

A

-PFTS
-exercise test eg 6 min walk test
-peak cough flow
-blood tests eg ABGs, full blood count etc
-chest xray
-vital signs eg BP, temp etc

47
Q

what are the different lung volumes in a PFT?

A
  • FVC
    -FEV1
    FEV1/FVC
    -PEF
48
Q

how is peak cough flow measured?

A

-unassisted / assisted task
-patient takes a maximal deep breath in, applies mask firmly around face and cough as and as possible into the mask

49
Q

what are ABGs?

A

arterial blood gas test
-oxygen, CO2, PH

50
Q

why is lactate important to measure in resp patient?

A

-if there is excess lactate - it can mean lack of oxygen (ie hypoxia)
-presence of a condition that causes of increased lactate production
-presence of a condition that causes a decreased clearance of lactate from the blood

51
Q

what is CRP?

A

C reactive protein
-detects inflammation in the body

52
Q

what is an outcome measure?

A

a tool used to assess a pts current status and monitor interventions for efficacy by repetition of the tool
eg 6 min walk test, BORG, vitals

53
Q
A

RCV 1 - physio (16 decks)

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