Chapter 16 Egans Flashcards
Bedside Assessment
Process of interviewing and examining a patient for signs and symptoms of disease, as well as evaluating the effects of treatment
Diagnosis
Process of identifying the nature and cause of illness
Signs
Objective manifestation of illness
Symptoms
Subjective experience of some aspects of an illlness
Interviewing Purposes
1) Establish rapport between the clinician and patient
2) Obtain info essential for making a diagnosis
3) Help monitor changes in the patients symptoms and response to therapy
Intoduction
Social Space: 4-12ft
Personal Space: 2-4ft
Then get level with patient
Factors affecting communication
~Sensory/Emotional factors
~Environmental factors
~ Verbal/nonverbal components of the communication process
~Cultural
Dyspnea (Difficulty in the mechanical of breathing)
Orthopnea-Dyspnea caused by reclining
~CHF
Platypnea-Dyspnea triggered by assuming upright position
Orthodeoxia-O2 desaturation on assuming an upright position
Trepopnea-Dyspnea from patients with unilateral lung disease lies with the affected side in the dependent position
Breathlessness
The unpleasant urge to breathe
~Triggered by acute hypercapnia, acidosis, or hypoxemia
4 major areas for interviewing for dyspnea
1) What activities of daily living trigger dyspnea?
2) How much exertion makes the patient stop to catch their breath with different activities?
3) Does the quality of dyspnea vary by the type of activity?
4) When did it first become a common future of your life?
Effectiveness of cough depends on
1) Ability to take a deep breath
2) Lung elastic recoil
3) Expiratory muscle strength
4) Level of airway resistance
Restrictive lung diseases
CHF, pulmonary fibrosis
Sputum Production
Phlegm-Mucus from lungs not contaminated
Sputum-Expectorated from mouth
Purulent-Sputum containing pus
Fetid-Sputum that’s foul smelling
Hemoptysis-Coughing up blood
Massive hemoptysis- >300ml in 24 hours
Non-massive hemoptysis- pneumonia, TB, lung cancer, pulmonary embolism
Hematemesis
Blood vomited from the gastrointestinal tract that often occurs in patients with gastrointestinal diseases
Chest Pain
Pleuritic-Located laterally or posteriorly
Non-Pleuritic- Center of the chest that may radiate
Angina- Non-pleuritic chest pain brought on by exertions or stress and is associated with coronary artery occlusion
Pedal Edema- Swelling in lower extremities
Pitting edema- When finger pressure is applied and indention stays
Weeping edema- When applied pressure causes a fluid leak
~ Right-sided/left-sided heart failure
Fun Fact
Chronic hypoxemia causes severe pulmonary vasoconstriction and pulmonary hypertension
Chief complaint
Detailed, systematic account of the patient’s major complaints written by a physician after the postadmission interview
Advance Directive
The patient has formalized his or her wishes for resuscitative efforts