Cardiorespiratory

Question 1

PC + HPC

Answer 1

What? 
Since when?
Progression?
How often? 
Aggs?
- exercises
- positions
Eases?
- exercises 
- positions
- meds
- breathing techniques
Pattern of symptoms?
- linkage
- worse at any time of day
- affecting sleep
Best day vs worst day

Question 2

Main symptoms

Answer 2

> Breathlessness (patient perceived)
- at rest/on exertion
wheeze (indicates obstruction)
- higher pitch = higher up (stridor)
Cough
- effective/productive
- incontinence?
Sputum
- colour/thickness/smell/blood - may indicate infection
(green = infection, pink/frothy may indicate oedema)
- are they concerned
Pain
- angina - arm/jaw radiation
- sharp pain on deep breath/cough (pleuritic pain)
- can it be reproduce by movement/palpation (MSK based)
- alleviated by meds/rest (shows probably not MI)
exercise tolerance/fatigue

Question 3

PMH

Answer 3

> respiratory conditions
cardiac problems e.g. blood pressure/arrhythmia
cancer
surgeries - mainly thoracic/cardiac/abdominal
THREADS

Question 4

previous treatments/investigations

Answer 4

> breathing techniques
> relaxation
> X-ray
> blood tests
> microbiology

Thoughts on previous treatment

Question 5

Drug history

Answer 5

> smoker?
> 02 needed?
> inhaler- technique
> blood thinners
> steroids - osteoporosis risk
> angina - meds

Do they work

Question 6

Social history

Answer 6

> living situation (stairs/toilet)
- coping?
> work - factory/mine/smoke
- managing? 
> pets - birds/parrots
> carers/ dependents
- coping? their health if family?
> ADL's - what are they and how are they impacted 
> hobbies - how are they impacted
> psychosocial implications - isolated/depressed/anxious

Question 7

Goals

Answer 7

> Smart

> patient led

Question 8

Objective

Answer 8

> obs
- shortness of breath
- cough
- wheeze
- colour
> palp
- pain
- temp 
> RoM 
- thorax
- other areas if problematic
> test 
- auscultation 
- inspiration/expiration
- muscle strength in bed to check mobility 
> function
-  cv fitness
- mobility

Question 9

Conditions

• Cystic fibrosis
• COPD
• Asthma
• Emphysema
• Bronchitis
• Bronchiectasis

Answer 9

> CF
- genetic condition effecting water/salt transport from cells leading to mucus build up in lungs
COPD
- inflammation/narrowing/damage of airways
Asthma
- inflammation/swelling of airways - makes them v. sensitive
Emphysema
- damage to alveoli
bronchitis
- infection of bronchi
Bronchiectasis
- abnormal widening of airways (mucus build up)

Question 10

Special tests

Answer 10

> stethoscope auscultation
- crackle may indicate fluid
- wheeze - collapsed/obstructed airways
> Pulse oximetry
- o2 sats

Question 11

Outcome measures

Answer 11

> cough
- cough questionnaire
> fe1 
- forced expiration
> cv fitness
- vo2 max, 6minute walk test