Basic Cardiorespiratory Assessment and Impairments Flashcards
What are the three components of a cardiorespiratory assessment?
- Pre-interview (information retrieval to assist subjective & objective examinations)
- Interview (subjective examination to get information we lacked in pre-interview stage)
- Physical (objective examination of signs and symptoms to inform us of patient impairments)
What are some SIGNS of respiratory disorders?
- Face/lip colour
- Chest wall shape
- Abnormal breathing pattern
- Abnormal respiratory rate
- Abnormal auscultation sounds
- Cough
- Colour/quality of sputum
- ABGs, CXR, spirometry results
What are some SYMPTOMS of respiratory disorders?
- Breathlessness
- Cough
- Sputum
- Chest pain
- Fatigue
- Wheeze
What are the steps in a physical examination?
- Ventilatory support (oxygen therapy/support)
- Observation (external, face & body)
- Palpation (LBE, AP, & accessory muscle use)
- Cough Ax (strong/weak, moist/dry, effective?, sputum description)
- Auscultation
- CXR, ABGs, spirometry
What is externally observed in the physical examination?
Things outside the patient telling us issues (e.g. bed charts, monitors, vital signs such as BP, HR, RR and SpO2)
What is observed in the face during the physical examination?
We look at signs from the patient telling us issues (e.g. level of consciousness, pained expression, colour of face/lips - pale, nicotine stained, cyanotic, etc.)
What is observed in the body during the physical examination?
- Posture/positioning
- Patient’s weight
- Breathing pattern
- Signs of respiratory distress
- Fingers (clubbing, colour)
- Peripheral oedema
- Scars/incisions
- Attachments
What can you hear during auscultation?
- Breath sounds (normal breath sounds & bronchial breath sounds)
- Normal breath sounds transmitted abnormally (decreased or no breath sounds, bronchial breath sounds in wrong area)
- Abnormal/added sounds (wheeze, crackles, stridor or URTN)
Sounds like, mechanism & interpretation of - normal breath sounds
SOUNDS LIKE: soft, low pitched, quieter lower in lungs, louder during inspiration, inaudible during expiration
MECHANISM: airflow in trachea & airways attenuated from lung tissue, heard over chest wall
INTERPRETATION: normal
Sounds like, mechanism & interpretation of - bronchial breath sounds
SOUNDS LIKE: loud, harsh, high-pitched, hollow, present on inspiration & expiration
MECHANISM: movement of air in & out of trachea and airways
INTERPRETATION: normal over tracheal area, abnormal over chest wall
Sounds like, mechanism & interpretation of - no breath sounds
SOUNDS LIKE: absence of breath sounds
MECHANISM: localised accumulation of air/fluid in pleural space, no airflow entering area of a lung
INTERPRETATION: segmental/total lung collapse, pleural effusion, pneumothorax, obstruction of bronchus
Sounds like, mechanism & interpretation of - decreased breath sounds
SOUNDS LIKE: decreased volume/intensity of normal BS
MECHANISM: decreased gas flow or increased sound attenuation in periphery
INTERPRETATION: shallow breathing, incomplete airway blockage, atelectasis/partial lung collapse, hyperinflation, reduction in transmission of breath sounds
Sounds like, mechanism & interpretation of - abnormal bronchial breath sounds
SOUNDS LIKE: loud, harsh, hollow, present on inspiration & expiration
MECHANISM: tissues btw central airways and chest well are altered - normal bronchial sounds are transmitted and heard over chest wall
INTERPRETATION: consolidation (most common), large cavity on bronchus, dense collapse (only when bronchus is still open)
Sounds like, mechanism & interpretation of - wheeze
SOUNDS LIKE: continuous high or low pitched tones, pronounced on expiration
MECHANISM: oscillation or vibration of air through narrowed walls
INTERPRETATION: secretions, bronchospasm, oedema, tumour, foreign bodies
Sounds like, mechanism & interpretation of - crackles
SOUNDS LIKE:
- Fine: rubbing hair together, discontinuous
- Coarse: popping, cracking, discontinuous
MECHANISM:
- Fine: sudden opening of closed alveoli on inspiration after collapse
- Coarse: movement of air bubbles through secretions
INTERPRETATION:
- Fine: atelectasis, fibrosis, interstitial pulmonary oedema
- Coarse: secretions, resolving pneumonia, pulmonary oedema
- False: subcutaneous emphysema, stethoscope across skin
