Assessments

Question 1

Auscultation

Answer 1

2. Make sure the patient is sitting upright in a relaxed position, where this is possible.
3. You should then instruct the patient to breathe a little deeper than normal through the mouth.
4. The bell/diaphragm of the stethoscope is then placed against the chest wall.
5. Auscultation of the lungs should be systematic, including all lobes of the anterior, lateral and posterior chest.
6. The examiner should begin at the top, compare side with side and work towards the lung bases.
7. The examiner should listen to at least one ventilatory cycle at each position of the chest wall.

Sounds-
crackles = mucus (associated with bronchiectasis or resolving pneumonia)
- wheezes = inflammation and narrowing of bronchial tubes
- absent breath sounds = shallow breathing, airway obstruction, hyperinflation

Question 2

ABG analysis
- Normal PO2
- Normal CO2
- Normal HCO3
- Normal pH
- Normal Base excess
-Normal WBC
-Normal CRP
- Normal Hb
- Type 1 respiratory failure
- Type 2 respiratory failure
- Acidosis
- Alkalosis

Answer 2

PO2 10-13 kPa
PCO2 4-6 kPa
HCO3 22-26
pH 7.35-7.45
BE +2–2
WBC 4.5-11
CRP less than 1
Hb 12-18 (high= chronic hypoxia, low= anaemia)

Type 1- hypoxia with normal PCO2
Type 2- hypoxia with raised PCO2

Acidosis- pH <7.35, PCO2 >45, HCO3 <22
Alkalosis- ph >7.45, PCO2<35, HCO3 >26

Question 3

A-E assessment

Answer 3

A – patent = no obstruction, oxygen mask – medical treatment of hypoxia, airway support (ET tube via mouth or tracheostomy via neck) – ETT and ventilation often occur together, T is commonly used to wean ventilation as can occur alone or together
B – ventilation can be invasive or non-invasive, spo2 (95%+ normal, 88-92 normal for COPD), RR (12-16 normal, 20+ is first sign of respiratory deterioration and indicates increased WOB), ausc – BSTO = breath sounds throughout (see above section), FiO2 = fraction of inspired oxygen = concentration of oxygen in the gas mixture, fremitus (vibration felt on chest wall while speaking or coughing), ABGs (see above section)
C – CRT of less than 2 seconds is normal (over = circulatory insufficiency (such as shock) or dehydration), HR (60-100bpm is normal), BP (120/80 is normal, 140/90 is high, 170/100 very high), cyanosis = when your skin, lips or nails turn blue due to a lack of oxygen in your blood
D – WCC and CRP (see ABGs), AVPU (alert, voice (responds to verbal stimulus), pain (responds to pain stimulus), unresponsive), GCS (eye response, motor response, verbal response – max score of 15), normal fasting blood glucose concentration are between 3.9-5.6 mmol/L
E – Temperature, attachments (catheter, IVs, blood pressure monitor), rashes, wounds, skin changes, casts, positioning (upright, slumped)

Question 4

Neuro assessment

Answer 4

• Hi, I’m Bethany, one of the student physiotherapists, what would you like to be called? Are you okay if I just do a bit of an assessment on you?
• Just some questions to get started- do you know where you are? Do you know why you are here? Do you know what time of day it is? Month? Year?
• check dermatomes (light touch, sharp touch, two point distinction) Head to toe- medial to lateral
• check myotomes
  -check strength (push against me)
  -coordination (finger to nose)
  -Proprioception (identify/copy the movement)

Question 5

Muscle tone assessment

Answer 5

Rigidity= two way stiffness
Spasticity= 1 way stiffness, velocity dependant

1. Patient sitting for upper limb, supine for lower limb
2. Therapist hands - often one to stabilise part of limb and one to guide movement
3. Slow movement through PROM across the 2 movements at the joint e.g. flexion and extension (2-3 repetitions)
4. Quick movements beginning in the position of the muscles you wish to test (2-3 repetitions)
5. Using weight transfer to aid movements especially for heavy limbs

Question 6

4 stage balance test

Answer 6

• feet together
• half tandem stand
• tandem stand
• stand on one leg

ask them to hold each position for 10 seconds. Use a stopwatch to time them in each position and write down the time they achieve in each position before moving their feet

Question 7

Scapulo-humeral rhythm assessment

Answer 7

First 30º shoulder elevation= mainly glenohumeral
After first 30º shoulder elevation, 2:1 ratio of glenohumeral to scapulothoracic movement
Scapulohumeral rhythm can be observed by palpating the scapula’s position as a person elevates the shoulder. Scapular landmarks for palpation are the base of the spine and the inferior angle

preserves the length-tension relationships of glenohumeral muscles and prevents impingement between the humerus and the acromion