Assessment

Question 1

subjective - respiratory symptoms

Answer 1

1. breathlessness
2. Cough
3. sputum
4. Wheeze
5. Chest pain

Question 2

Breathlessness

PND

orthopnoea

Answer 2

When the awareness of breathing is unpleasant an uncomfortable the term dyspnoea is used

Duration, severity, aggravating and easing factors

Symptom of cardiac and respiratory disease

Paroxysmal nocturnal dyspnoea (PND): is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position

Orthopnoea: is the sensation of breathlessness in the recumbent position, relieved by sitting or standing.

Question 3

Cough

Answer 3

• effective?
  productive?
  dry?

Question 4

Sputum

Answer 4

Healthy adult can produce up to 100ml of tracheobronchial secretions daily and cleared subconsciously

Colour
Consistency
Volume (teaspoon, tablespoon, egg cup)

Odour signifies infection

Haemoptysis is the presence of blood in the sputum. Frank haemoptysis is fresh blood.

Pink frothy sputum: left sided heart failure

Question 5

Wheeze

Answer 5

whistling sound produced by turbulent airflow through narrowed airways
persistent/ intermittent
related to allergies/ exercise, dust, allergies
Expiratory or inspiratory

Question 6

Chest pain

Answer 6

In cardiorespiratory patients is usually originates from musculoskeletal, cardiac, pleural or tracheal inflammation as the lung parenchyma and small airways do not contain pain fibre innervation.

Question 7

A B C D

Answer 7

Airways - look: do they have an artifical airway
listen: can you hear any gurgling

Breathing: 
look: how are they breathing, use of accessory muscles, chest shape, movement and pattern, purse lip breathing, nasal flaring
- barrel chest
- pectus excavatum
- kyphosis 
- paradoxical abdominal movement.
- hoovers sign
listen: auscultation, percussion, cough. Respiratory rate.
Increased resonance. (gas trapping)
- emphysema, pneumothorax 
Decreased resonance (dull)
- effusion/ consolidatoin.

• feel: chest expansion, fremitus, subcutaneous air

Circulation: look - complexion, cyanosis, jugular venous pressure, ankle oedema
feel cold hands, peripheral pulse.

Disability: look
listen: speech feel: measure strength, range of motion

Question 8

Other objective assessment

Answer 8

PFTs
exercise tests
blood tests
chest x ray
vital signs: heart rate, blood pressure, temperature, respiratory rate, oxygenation (Sp02)
National Early Warning Score (NEWS)
Identify Situation Background Assessment Recommendation

Question 9

Other factors to consider

Answer 9

Incisions 
drips 
urine output 
level of consciousness 
medication
timing of feed 
humidification

Question 10

finger clubbing

Answer 10

chronic pulmonary diseases

reverses with lung transplant