assessing the respiratory patient Flashcards
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?
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
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)
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
what are examples of precautions with resp patients?
- MRSA, TB, covid
-rib fractures
-metastatic disease
-lines/ attachments
-post op precautions - WB status
what are the most common symptoms for a resp patient?
-cough
-wheeze
-chest pain
-SOB
-sputum
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 ?
what is dyspnoea?
when the awareness of breathing is unpleasant and uncomfortable
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
what is orthopnoea?
the sensation of breathlessness in the recumbent position
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
what scale measures breathlessness?
modified Borg dyspnea scale
what is a cough?
a basic protective mechanism
-any stimulation of receptors located in pharynx, larynx or bronchi may induce a cough
what are the benefits / effects of coughing?
-expelling sputum and inhaled irritants
-can cause bronchospasm, exhaustion
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
what is dry cough associated with?
early stages of pneumonia
what is a moist cough associated with?
occurs in RTI, COPD, bronchiectasis
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
what are important subjective questions to ask about sputum?
-colour
-consistency
-volume/quantity eg teaspoon,tablespoon,egg cup
-frequency of expectoration
what is haemoptysis?
presence of blood in sputum
what is frank haemoptysis?
fresh blood in the sputum
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
