CVR - assessment

Question 1

What is included in a CVR subjective assessment?

Answer 1

• HPC
• PMH
• DH
• SH

Question 2

What are 5 signs of respiratory disease?

Answer 2

Cough
Dyspnoea
Sputum
Wheeze
Chest pain

Question 3

Describe the Medical Research Council (MRC) Dyspnoea scale

Answer 3

1 = not troubled by breathlessness, except during strenuous exercise
2 = short of breath when hurrying, or up a slight hill
3 = walks slower than others on level ground
4 = stops for breath after walking 100m
5 = too breathless to leave the house, or breathless when dressing and undressing

Question 4

What is a cough, what can it cause and how would you assess it?

Answer 4

A protective reflex which aims to remove secretions or foreign bodies from the airways
Chronic coughing can cause stress urinary incontinence
Assessment:
- cough effectiveness and strength
- productive or dry
- severity

Question 5

What is sputum, how much do normal adults produce a day and how would you assess it?

Answer 5

The excess of tracheobronchial secretion, cleared from the airways by coughing
Normal adults produce 100ml daily
Assessment:
- sputum volume
- sputum colour
- viscosity and ease of expectoration (spitting)
- smell

Question 6

What causes a wheeze and what does the sound relate to?

Answer 6

Whistling sound produced by turbulent airflow through narrowed airways, normally heard during late inspiration and expiration
Pitch of the wheeze is related to the degree of the narrowing. High pitch = more narrow

Monophonic (single pitch) wheeze caused by a single airway narrowing

Question 7

What is included in a CVR objective assessment?

Answer 7

ABCDE approach:
 Airway
 Breathing
 Cardiac
 Disability
 Exposure

Question 8

What do you look at for the airway section of a subjective assessment?

Answer 8

Is the patient self-ventilating
Is the airway patent (do they have a normal voice)
Palpation of the trachea
- central = normal
- deviated to one side = indicated an underlying mediastinal shift

Question 9

What do you look for in the breathing section of a subjective assessment?

Answer 9

Look, Listen, Feel
Look:
- observation of patient and chest
- breathing pattern
- breathing rate (check their “pulse”)
- observation of bucket and pump handle motion
- cough assessment (peak flow meter, aim=270l/min)
Listen:
- breath sounds and added sounds
- percussion note (tap your finger on the lungs)
- vocal resonance (repeat “ninety-nine, normal= indistinct and unintelligible)
Feel:
- Thoracic expansion (3-5cm is normal displacement)
- Vocal fremitus (palpate over lungs and repeat “ninety-nine”)

Question 10

What do you look at for the cardiac section of a subjective assessment?

Answer 10

• Heart rate = 60-100bpm
• Blood pressure = 95/60 to 140/90mmHg
• Temperature (ear) = 35.7-38.0 degrees
• Fluid balance (fluid intake vs output)

Question 11

What do you look at for the disability section of a subjective assessment?

Answer 11

• Level of consciousness (AVPU scale):
• Alert
• responsive to Voice
• responsive to Pain
• Unresponsive

Question 12

What do you look at for the exposure section of a subjective assessment?

Answer 12

• Head to toe examination
• BMI
• Any MSK or neuro problems
• Hands:
• finger clubbing
• tremor
• Ankles:
• swelling (bilateral)