Assessment Flashcards
What to check prior to Subjective Ax?
Background Information gathering:
Look in the notes and speak to nursing staff to get key information & clarify indications for physiotherapy:
- Relevant Medical history, diagnoses, investigations, current drugs and treatment to date
- Be aware of any history that could impact physiotherapy decisions?
- Observation charts for temperature/BP/HR/RR/SP02/ABGs
General questions:
- How is patient feeling today
- Emotional status
- Symptoms
- Fatigue
- Specific problems
- Are they eating/drinking sleeping well
What to check and ask about in PC?
Cough:
- constant ‘v’ intermittent?
- Aggs & eases?
- AGGS = what brings it on: infection, smoking, moving, exertion, lying down, eating and drinking (issue with swallow)?
- Is it persistent, painful, productive of sputum or dry and irritating
- sputum type, amount, colour, consistency?
- Sputum Colour
- Mucoid- Clear like raw egg white, grey or white
- Purulent:- containing puss so opaque – yellow or green
- Pink and frothy - Pulmonary Oedema
- Consistency
- Stringy
- Plugs
- Thick
- frothy
- Quantity in mls, teaspoons, egg cup full or cup full
- Smell/taste
- Contains blood - haemoptysis of unknown origin - Ca or less sinister burst capillaries
- frequency and duration
- Acute/chronic
- Is it effective
- Does it happen at night (links with lying down) (Asthma/GORD)
- OM = Leicester Cough Questionnaire *
Wheeze:
- what brings it on/relieves it?
- time of day?
- frequency and duration
Breathlessness:
- Aggs & eases
- position?
- what brings it on?
- constant ‘v’ intermittent?
- frequency and duration
Low O2: – when?
Pain:
think SOB, psychological element to SOB, post op or non respiratory in origin?
Fatigue
What to ask and check in HPC
When did it start?
Gradual or sudden onset?
Post illness or exposure?
Is it getting better or worse?
Any previous treatment?
What to check in PMH
Respiratory diseases?
Heart or lung surgery?
General questions e.g. epilepsy, diabetes etc?
What to ask/check in Ix
CXR’s, PFT’s, MRI, CT, sputum cultures, SWT.
What to check in DH
Inhalers, nebs, steroids, pain killers, O2 (how much, what type).
What to ask/check in SH
Smoker:
- how much, how long and what? pack years = packs/day X smoking years
- if ex-smoker when did they give up?
- passive?
Mobility: in relation to SOB/exercise tolerance.
Occupation: miner, foundry, bar? And generally
FH: genetic link with any respiratory diseases?
What to think about in documentation
- Physical problems
- Psychological problems
- Social problems
- Potential problems – E.G. Risk of postoperative pulmonary complications
- Number each problem
- Prioritise the problems - the most serious and active problems first
- Active problems require intervention, inactive problems may need monitoring
- Record date when they become active and then when inactive
What are the common Physiotherapy problems
Respiratory muscle dysfunction
Reduced strength or endurance; Becomes a physiotherapy problem when patient presents with dyspnoea, impaired A/W clearance or inability to wean from mechanical ventilation.
Dyspnoea (SOBOE/SOBAR)
Breathlessness; Reflects higher WOB
Impaired gas exchange
V/Q mismatch
Increased Work of breathing (WOB)
the amount of muscle activity required to overcome the elastic (lung tissue, chest wall, abdominal compartments) and resistive ((airways, flow rates) elements of the respiratory system. The oxygen cost of breathing.
Decreased Exercise Tolerance
Reflects High WOB and/or reduced CV fitness
Airflow limitation
Abnormal resistance or obstruction to airflow.
Usually occurs together with other PT problems i.e. dyspnoea, decreased ex tol, impaired A/W clearance.
Can be caused by probs in the airways → partial/total occlusion of lumen (mucus/inhaled foreign body/tumour
Probs in airway wall
- Bronchospasm
- Smooth muscle hypertrophy & hyperplasia
- Inflammation of mucosa(asthma/IECOPD))
- Hypertrophy of mucus glands(CB)
- Thickened bronchial wall(CB/A)
- Dilatin/destruction of wall (CF & non CF Brectasis)
- Causes outside A/W
- Loss of radial traction due to ↓ elastic recoil (E).
- Compression (enlarged lymph nodes/tumour.
Abnormal breathing pattern
Abnormalities of breathing pattern, rarely occur in isolation and are commonly associated with other patient problems such as dyspnoea, airflow limitation. Resolution of the associated problem may lead to more normal breathing pattern. E.G. = reduced lung volume →low vt and high RR. Irregular Br Pattern PLB, abdominal paradox are other egs of abnormal breathing pattern that can be modified with treatment that focusses on the primary cause.
MSK Dysfunction
Pain
What are the common Acute Physiotherapy problems
Impaired airway clearance/ sputum retention
Loss of / Reduced Lung Volume
Dyspnoea (SOBAR/SOBOE)
Impaired gas exchange
↑Work of breathing
Other factors of Physiotherapy problems
Other factors not directly related to the cardiopulmonary system such as:
- Poor self-management skills
- Co morbidities
- Incontinence
- Communication needs and difficulties
- Psychological barriers
Why is the Ax key
In order to:
- Identify patients who need referral to the medical team for review
- Identify patients who need referrals to other MDT members
- Determine if patients can be safely managed at home or need to be admitted
- Identify social /medical support that might be needed
- Identify patient/service user goals to improve mobility, function, social participation
- Assess suitability for cardiac/pulmonary rehabilitation
What makes a good intervention
As Patients often present with more than one problem amenable to PT:
- Strategies to address as many problems as possible
- Use best available evidence and practice
- Collaborate with individual
- Focus on self -management where appropriate and possible
