assessing the respiratory patient Flashcards by Aoife O'Connor

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

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

-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

How well did you know this?

Not at all

Perfectly

what are examples of precautions with resp patients?

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

How well did you know this?

Not at all

Perfectly

what are the most common symptoms for a resp patient?

-cough
-wheeze
-chest pain
-SOB
-sputum

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

what is dyspnoea?

when the awareness of breathing is unpleasant and uncomfortable

How well did you know this?

Not at all

Perfectly

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

-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

How well did you know this?

Not at all

Perfectly

what is orthopnoea?

the sensation of breathlessness in the recumbent position

How well did you know this?

Not at all

Perfectly

what is paroxysmal nocturnal dyspnoea?

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

How well did you know this?

Not at all

Perfectly

what scale measures breathlessness?

modified Borg dyspnea scale

How well did you know this?

Not at all

Perfectly

what is a cough?

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

How well did you know this?

Not at all

Perfectly

what are the benefits / effects of coughing?

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

How well did you know this?

Not at all

Perfectly

what are important considerations to take into account about cough?

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

How well did you know this?

Not at all

Perfectly

what is dry cough associated with?

early stages of pneumonia

How well did you know this?

Not at all

Perfectly

what is a moist cough associated with?

occurs in RTI, COPD, bronchiectasis

How well did you know this?

Not at all

Perfectly

what are important subjective questions to ask about cough?

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

How well did you know this?

Not at all

Perfectly

what are important subjective questions to ask about sputum?

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

How well did you know this?

Not at all

Perfectly

what is haemoptysis?

presence of blood in sputum

How well did you know this?

Not at all

Perfectly

what is frank haemoptysis?

fresh blood in the sputum

How well did you know this?

Not at all

Perfectly

what does pink frothy sputum indicate?

heart failure and pulmonary oedema

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

what is pulmonary oedema?

-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)

what is plastic bronchitis?

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

what is wheeze?

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

what is a stridor?

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

what is chest pain caused by in a resp patient?

-MSK -cardiac -pleural or tracheal inflammation

what are subjective questions to ask about chest pain?

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

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

-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

what kind of things do you do in a resp objective assessment ?

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

what is the A-E assessment ?

-airway -breathing -circulation -disability -exposure

what are you looking at for airways?

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

what are you looking at breathing?

-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

what is pectus excavatum?

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

what is pectus carinatum?

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

what is hoovers sign?

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

what is tactile fremitus?

a vibrating sensation felt by a hand placed on chest

what us laboured breathing?

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

what is PLB (hoovers sign)?

what is paradoxical breathing?

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

what is cheyne stokes?

- an abnormal pattern -heavy breathing followed by shallow breathing -can indicate end of life

what are you looking for with circulation?

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

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

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

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

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

what are other objective tests?

-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

what are the different lung volumes in a PFT?

- FVC -FEV1 FEV1/FVC -PEF

how is peak cough flow measured?

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

what are ABGs?

arterial blood gas test -oxygen, CO2, PH

why is lactate important to measure in resp patient?

-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

what is CRP?

C reactive protein -detects inflammation in the body

what is an outcome measure?

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