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PHTY3250 > L1-2: Cardiorespiratory Physiotherapy Assessment > Flashcards

L1-2: Cardiorespiratory Physiotherapy Assessment Flashcards

1
Q

What are 5 assessments that the physio needs to find out before their assessment?

A
  1. Medical chart
  2. Bed chart
  3. Patient interview
  4. Physical examination
  5. (Medical team)

= Identify the patient’s main problems and determine goals of physiotherapy management

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2
Q

What are 6 pieces of information found in the medical chart? What is important when looking at the medical chart?

A

Ensure I have the correct patient’s chart

  • Cross check for correct chart, bed and patient​
  • Will be found at the hospital station (“nurses” station)
  1. History of presenting condition (HPC)
  2. Previous medical history (PMHx) & Medication history (/ Drug history DHx)
  3. Family history (FHx)
  4. Social history (SHx)
  5. Patient examination
  6. Medical diagnosis & plan
  7. ± Operation notes (Module 2); Special orders

This information will guide assessment and treatment

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3
Q

What are 2 characteristics of “history of presenting condition (HPC)” in the medical chart?

A

Onset and course of episode

  1. Medical (eg. chest infection/exacerbations)
  2. Surgical (eg. removal of stomach)
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4
Q

What are 5 examples of “previous medical history (PMHx) and Management” in the medical chart?

EXAM QUESTION

A
  1. Chronic obstructive pulmonary disease (COPD) (see ILP1)
  2. Asthma (see ILP1)
  3. Cardiovascular disease, Hypertension (see ILP2)
  4. Diabetes (?Type)
  5. Systems review
    • Respiratory, Cardiac, Neurological, Gastrointestinal, Renal…
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5
Q

What are 5 characteristics of “Social history (SH)” in the medical chart?

A
  1. Occupation
  2. Hobbies
  3. Family / support
  4. Home environment
    • Stairs
  5. Functional history
    • Mobility aid
    • Exercise tolerance
      • Eg. Distance before onset of symptoms
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6
Q

What are 5 characteristics of “Patient examination” in the medical chart?

A
  1. Chest X-ray (CXR)
  2. Spirometry (FEV1, FVC)
  3. Sputum analysis
  4. M/C/S (micro, culture and sensitivity)
  5. Electrocardiogram (ECG)
  6. Arterial blood gases (ABG)
  7. Blood results (FBC, ELFTs)
  8. Cardiac enzymes
  9. AFBs (acid fast bacilis) (TB)
  10. Endoscopy, colonoscopy
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7
Q

What are 3 characteristics of “+/- operation notes” in the medical chart?

A
  1. Procedure
  2. Anaesthesia:
    1. Anaesthesia time
    2. Surgical time
    3. Recovery – any events
  3. Management:
    1. Return to ward
    2. Pain relief
    3. Initial post-op course
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8
Q

What are 5 characteristics of “+/- special order” in the medical chart?

A
  1. Physiotherapy (Eg. refer to physiotherapy)
  2. Oxygen therapy (device, flow rate)
  3. Fluid orders (clear, free, thickened, soft, full ; nil by mouth- Possible aspirations)
  4. Pain relief (oral; epidural; IV; PCA, PCEA)
  5. Other specific orders (eg, weight-bearing status)
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9
Q

What are 5 characteristics of “medical plan” in the medical chart?

A
  1. Medications
    1. Dose
    2. Frequency
    3. Route
  2. Consider:
    1. Timing wrt physiotherapy
    2. Side-effects  impact on Ax & Rx
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10
Q

What are 2 characteristics of medical chart enteries (porfolio task, then clinic)?

A
  1. Ensure you explain any physio-specific abbreviations the first time in each chart entry, then you can use the (accepted) abbreviation
  2. Start practicing this skill for simulations, clinical placements & beyond.
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11
Q

What are 7 checklists (pieces of information) in the bed chart? What is important in the bed chart?

A
  1. Vital signs
  2. Pain
  3. Medications
  4. Fluid balance
  5. Blood glucose
  6. Neurological status (eg. GCS)
  7. Nil by Mouth
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12
Q

What are 5 vital signs in the bed chart?

A
  1. Temperature (normal ~37°)
  2. Heart rate (normal ~60-100 beats/min)
    • Bradycardia <60 beats/min
    • Tachycardia >100 beats/min
  3. Blood pressure (normal ~120/80)
    • Hypotension ≤ 90/60
    • Hypertension ≥ 140/90
  4. Respiratory rate (normal ~12-16 breaths/min)
    • Bradypnoea <10 breaths/min
    • Tachypnoea >20 breaths/min
  5. Oxygen:
    • Fractional concentration (FiO2) via device (ie, np, MVM)
      • ~21% (room air)
      • Can have possible nose prongs for icreased FiO2
    • Saturation, ie via pulse oximetry (SpO2)
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13
Q

What are 4 example “medication” for Bed chart?

A
  1. Respiratory
    • Eg.bronco-dilator = ~20-40mins (optimal window)
  2. Cardiac
  3. Analgesic
  4. Antiemetic

Consider:

  1. timing wrt physiotherapy
  2. side effects –> impact on Ax & Rx
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14
Q

What are 4 characteristics of “fluid balance” for Bed chart?

A
  1. Fluid IN – eg. water, IV
  2. Fluid OUT – eg. urine
  3. Balance over 24 hours
  4. Consider trend
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15
Q

What is a characteristic of “blood glucose” for Bed chart?

A

Aim for 4-6mmol/L

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16
Q

What are 3 characteristics of “haemoglobin” for Bed chart?

A
  1. Men 13-18 g/dL
  2. Women 11.5-16 g/dL
  3. *<7 requires transfusion; avoid mobilisation
    • ​Indicators Haemoglobin is too low = at risk of fainting​
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17
Q

What is a characteristic of “neurological status” for Bed chart?

A
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18
Q

Normal respiratory rate (breath) =_____ - _____

Normal body temperature = ______˚ (>____˚ high, ____˚ near death)

A

12-16

37; 38; 40

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19
Q

What are the 4 characteristics of patient interview? What are the 4 purposes of patient interview?

A
  1. What do I already know from the pt’s medical records?
  2. What do I need to clarify, or gather further info about from the pt?
  3. Will this info influence my Ax & / or Mx?
  4. Do I need to ask this question NOW?
  • Why do I need to ask each question?
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20
Q

What are 7 pieces of information found in the patient interview? What is important when looking at the patient interview?

A
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21
Q

What are 2 characteristics of “patient’s main concerns” in the patient interview?

A

Generally, start with open-ended questions, eg:

  1. “What do you feel is your main concern?”
  2. “What troubles you most?”

[This question is approached differently post-surgery]

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22
Q

What are 5 key topics in the patient interview?

EXAM QUESTION

A
  1. Breathlessness
  2. Cough
  3. Sputum (+ Haemoptysis)
  4. Wheeze
  5. Chest pain

*Be flexible to suit patient’s presentation

*Compare current to usual where relevant

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23
Q

What are 4 post-surgery concerns in the patient interview?

A
  1. Dizziness
  2. Drowsiness
  3. Nausea
  4. Vomiting
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24
Q

What are 4 epidural concerns in the patient interview?

A
  1. Pins and needles
  2. Numbness
  3. Weakness
  4. Heaviness
  5. Headache
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25
Q

What is important when comparing the 5 respiratory key topics?

A

Compare current to usual

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26
Q

What are 4 characteristics of “1. breathlessness/dyspnoea (respiratory)” in the patient interview?

EXAM QUESTION

A

SOB; WOB (Work of Breathing)

  1. Aggs , Eases
  2. Positions of ease- (can encourage patient to use)
  3. Distance; stairs

“Short of breath or huffed” is main concern

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27
Q

What is aspiration? Which lung is it common in?

A

inhaling food or drink

  • Most common in R lung (R bronchi is more vertical)
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28
Q

What are 4 characteristics of “2. cough (respiratory)” in the patient interview?

EXAM QUESTION

A
  1. Frequency
    • Daytime
    • Nocturnal
    • After eating / drinking (= aspiration)
    • Acute / chronic
  2. Effectiveness
    • Pain
    • Weakness
  3. Productive / non-productive
    • Productive = producing phlegm (either coughing out or swallowed)
    • Non-productive = no phlegm coughed up
  4. Quality
    • Wet / dry
    • Wheezy; raspy; bark-like…
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29
Q

What are 5 characteristics of “3. sputum (respiratory)” in the patient interview?

EXAM QUESTION

A

Quantity

  1. Small, moderate, copious …
  2. Teaspoon, tablespoon, cup …

Quality

  1. Consistency
    1. Eg. thick, thin, watery, plug/cast…
  2. Colour
    1. Eg. clear, cream, yellow, green, brown
    2. Haemoptysis (blood in sputum): streaks (Part of sputum of body) vs frank (Fresh blood)
  3. ±Odour (where appropriate)
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30
Q

What is the difference between “secretions” vs “sputum” vs “mucus” vs “phlegm”?

A

“secretions”

  • While still in the body (lungs)

“sputum”

  • Once coughed out

“mucus” vs “phlegm”

  • Used for patients (lay term)
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31
Q

What is a characteristic of “4. wheezing (respiratory)” in the patient interview? (N/A)

EXAM QUESTION

A

Wheezing

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32
Q

What are 8 characteristics of “5. chest pain (respiratory)” in the patient interview?

EXAM QUESTION

A
  • At rest vs with movement / cough:
    1. Area
    2. Type: sharp, dull, blunt…
    3. Severity (VAS)
    4. History
  • Other MS / body pain (we treat the whole person, not just their lungs)
    1. Pulmonary
    2. Neuro-Musculoskeletal
    3. Cardiac
    4. Mediastinal
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33
Q

What are 5 specific questions in the patient interview?

A
  1. Asthma
    1. Previous hospital admission
    2. Previous ICU admission
    3. Action plan: medication / management
  2. Recent URTI (upper respiratory tract infection)
  3. Smoking History
    1. Pack years
    2. If / when ceased
  4. ± Alcohol consumption
  5. ± Incontinence “When you cough, do you find that you leak some urine?”)
    • Be sensitive (usually for patients with chronic cough)
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34
Q

What are 3 specific questions for chronic obstructive pulmonary disease (COPD)? What are the 5 management for COPD?

A
  1. Last exacerbation
  2. Change in symptoms
  3. Cough
    • Sputum: quality, quantity

Management:

  1. COPD-X
  2. Physiotherapy
  3. Medications
  4. Supplemental O 2 use
  5. Exercise program
  6. Preferences
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35
Q

What are 3 specific questions for Diabetes?

A
  1. Type
  2. Management
  3. Sensation in feet
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36
Q

What are 5 specific questions for ischaemic heart disease (IHD)?

A
  1. Angina
    1. History
    2. Area of pain/sensation
    3. Precipitating factors
    4. Exercise tolerance
  2. Management ; medications (timing)
    1. What do they do when they have angina?
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37
Q

What are 3 specific questions for peripheral vascular disease (PVD)?

A
  1. Claudication
    • Pain when walking (how long it takes before pain from walking)
  2. Sensation in feet
  3. Management ; skin care
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38
Q

What is pack years for cigarettes?

A

1 pack ≈ 20 cigarettes

Number of pack years = packs per day x years

Eg. “1 pack per day, for 40 years”

  • = 1 x 40
  • = 40 pack years

OR

  • = (cigarettes per day x years) / 20

Eg. “15 cigarettes per day for 40 years”

  • = (15 x 40) / 20
  • = 30 pack years
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39
Q

What are 4 characteristics of social history in patient interview?

A
  1. Home situation
    1. House
    2. Nursing home
    3. Retirement village
  2. Level of assistance
    1. Meals
    2. Home cares
    3. eg BlueCare, family, neighbour
  3. Access, environment
    1. Stairs / rail
  4. Hobbies
    1. Sedentary VS active
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40
Q

What are 4 characteristics of functional history in patient interview?

A
  1. ADLs, employment, school, hobbies…
  2. Exercise tolerance:
    1. Regular exercise
    2. Distance
      1. Flat
      2. Incline
      3. Stairs
  3. Use of aids (if relevant)
    1. Inside home
    2. Community ambulation
  4. Use of supplemental O2 (if relevant)
    1. Duration of use (ie, 24hr vs with activity)
    2. Mode of delivery (eg. nasal prongs, mask)
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41
Q

What are 5 tips in patient interview?

A
  1. Wait! Why am I asking each Q?
  2. Prioritise depending on presentation
  3. Be flexible - modify to suit patient presentation / responses; closed vs open Qs
  4. Conversational approach
  5. LISTEN
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42
Q

What is the Top to Toe approach for the physical examination?

A

Start at the head and follow to the bottom (feet)

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43
Q

What are the 6 characteristics of the physical examination?

A
  1. Observation
    1. General; Environment; Attachments
    2. Patient –> Respiratory, Circulatory
  2. Palpation
  3. Auscultation
  4. Cough
  5. Lower limbs
  6. Specific assessmen
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44
Q

What are the 9 characteristics of general observation in the physical examination?

A
  1. Position ; Posture
  2. Facial expression
    • eg. grimace; drowsy vs alert
  3. Speech pattern (?SOB)
  4. Level of consciousness
  5. Attachments
  6. Body shape
  7. Muscle tone
  8. Colour (lips, limbs, tips)
    • – eg. cyanosed, flushed, pallor
  9. Digital clubbing, peripheral oedema

Then move onto specific respiratory & circulatory observation

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45
Q

What are the 9 characteristics of attachment observation in the physical examination?

A
  1. Oxygen
    • Nasal prongs; mask
    • Flow rate
  2. Nasogastric tube (NGT)
  3. IV lines, medications
    • Location (eg. peripheral; central)
  4. Analgesia (PCA, epidural, PCEA)
  5. Monitoring (eg. ECG leads)
  6. Intercostal catheter (ICC)
  7. Wound drains
  8. Indwelling catheter (IDC)
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46
Q

What are the 3 overall functions of attachments? What are the 3 Ds?

A
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47
Q

What are 2 characteristics of the patient’s hands in observation in physical examination?

A
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48
Q

What are 5 respiratory observations in the physical examination?

A
  1. Respiratory rate (Table 2.3)
  2. Chest shape
  3. Breathing pattern: movement & symmetry (Table 2.3)
  4. Accessory muscle use
  5. Paradoxical movement
    • Eg:
      1. Intercostal drawing
      2. Jugular notch
      3. Hoover’s sign
      4. Respiratory alternans
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49
Q

What are the 3 types of chest shapes (observation)?

50
Q

What is a barrel chest (chest shape)?

51
Q

What are the 4 types of breathing patterns?

A
  1. Upper
    • Apical, elevatory
  2. Mid
    • Lateral expansion, flaring
  3. Lower
    • Lateral expansion, basal flaring, anterior movement
  4. Abdominal
    • Anterior displacement
52
Q

What are the 2 objects that can be used to describe breathing patterns? How do they work?

53
Q

What are 2 signs of increasing work of breathing (WOB)?

A
  1. Hoover’s sign
  2. Increased accessory muscle use
54
Q

What does increased/excessive use of accessory repsiratory muscles look like?

55
Q

What are the 2 things you have to do before “placing your hands on the patient”? What are the 2Cs?

EXAM QUESTION

56
Q

Where is hand placement when doing palpation of the chest (3 options)?

A
  1. Bilaterally at ribs 7 to 10 (bucket handle- Most amount of bucket handling movement)
  2. or anterior at opening of subcostal angle
  3. +/- AP (sternum, Thx spine) (pump handle)
57
Q

What are 4 features to palpate for in the chest?

A
  1. Movement & symmetry
    1. Bibasal expansion
    2. Apical
  2. Temperature
  3. Fremitus
    • Retained secretions (crackkling and virbation under Physio’s hands)
  4. +/- Subcutaneous emphysema
    • Air enters subcutaenously (under the skin) (eg. bubble wrap)
    • If the air is black –> can see black spot on skin
58
Q

What is Auscultation?

A

Listening to sounds within the thorax (lung or heart)

59
Q

What are the 3 anterior surface anatomy landmarks of the thoracic cage?

A
  1. Sternal angle – 2nd costal cartilage
  2. Nipple – 4th intercostal space (males)
  3. Xiphoid – 6th intercostal space
60
Q

What are the 2 posterior surface anatomy landmarks of the thoracic cage?

A
  1. Spine of scapula – T3
  2. Inferior angle of scapula – T7
61
Q

What are the 3 lobes of the RIGHT lung?

A
  1. Upper lobe (apical, ant, post)
  2. Middle lobe
  3. Lower lobe (ant, lat, post, apical)
62
Q

What are the 2 lobes of the LEFT lung?

A
  1. Upper lobe (apical, ant, post, lingular)
  2. Lower lobe (ant, lat, post, apical)
63
Q

What are the 2 fissures of the lungs?

A
  1. Horizontal fissure
  2. Oblique fissure
64
Q

What are 4 characteristics of the horizontal fissure of the lung?

A
  1. R only
  2. Separates upper from middle lobe
    1. Ant: 4th intercostal space @ sternum
    2. Lat: oblique fissure
65
Q

What are 6 characteristics of the oblique fissure of the lung?

A
  1. R and L
  2. Separates lower from upper/mid lobe
  3. Line connecting…
    1. Ant: 6th costochondral junction
    2. Lat: 4th intercostal space
    3. Post: T2 / 3
66
Q

What are 3 actions of the diaphragm on deep inspiration?

A
  1. Anteriorly = 6th rib
  2. Laterally = 8th rib
  3. Posteriorly = 10th rib

[*higher on R than L]

67
Q

Why is the diaphragm higher on right instead of left?

A
  1. Heart on L (pushing down on L)
  2. Liver on R (pushing up on R)
68
Q

What are muscles of inspiration and expiration?

69
Q

What are 4 features of lung sounds of auscultation?

A
  1. Breath sounds (BS) ; normal, “vesicular”
  2. Bronchial breath sounds (BB)
  3. Added / adventitious sounds (AS)
    1. Wheeze
    2. Stridor
    3. Crackles
  4. (Voice sounds – n/a)
70
Q

What does normal breath sounds?

71
Q

What are breath sounds like over a pleural effusion?

72
Q

What are breath sounds with Localised ↓ BS intensity?

73
Q

What are breath sounds with Generalised ↓ BS intensity?

74
Q

What are breath sounds with Bronchial breathing (BB)?

75
Q

What are 3 added/adventitious sounds (AS) in auscultation?

A
  1. Wheeze
  2. Stridor
  3. Crackles
76
Q

What is wheezing as added sounds in auscultation?

A

Vibration or flutter of (almost) touching opposing sides of the airway

  • eg: spasm, oedema, mucus, tumor, foreign body
77
Q

_____ and _____ of the wheeze are complex. What are 2 characteristics?

A

Intensity; pitch

  1. Physical properties of the airway wall
  2. Nature of airflow
78
Q

What are 2 pressure gradients in airways (intrathoracic- within thorax) of wheezing as added sounds in ascultation?

A
  1. During inspiration => airways open, wheeze less likely / less intense
  2. During expiration => airways narrower, wheeze more likely / more intense
    • On exhale (lung are vibrating while they touch)
79
Q

What is synchronous wheezing as added sounds in ascultation?

A

when airways obstruct at the same time - eg late in normal forced expiration

80
Q

What is asynchronous and multiple wheezing as added sounds in ascultation?

A

arise from different airways obstructing at different phases of the respiratory cycle

81
Q

Do patients with severe airflow obstruction have wheezing?

A
  • Patients with severe airflow obstruction with rigid non-compressible airways may not wheeze
  • Patients with severe obstruction with asthma have decreased airflow, this can result in no noise being produced (ie, no wheeze)
82
Q

When is wheezing ominous?

A

It is ominous if a previously marked wheeze disappears - (ie, indicates there is no longer sufficient airflow to generate wheeze sound)

83
Q

What are 5 characteristics of wheezing as added sounds for ascultation?

A
  1. Synchronous: when airways obstruct at the same time - eg late in normal forced expiration
  2. Asynchronous and multiple: arise from different airways obstructing at different phases of the respiratory cycle
  3. Patients with severe airflow obstruction with rigid non-compressible airways may not wheeze
  4. Patients with severe obstruction with asthma have decreased airflow, this can result in no noise being produced (ie, no wheeze)
  5. It is ominous if a previously marked wheeze disappears - (ie, indicates there is no longer sufficient airflow to generate wheeze sound)
84
Q

What are 5 characteristics of stridor as added sounds for ascultation?

A
  1. Extrathoracic (outside thorax, eg trachea)
  2. More marked on inspiration
  3. Occurs with croup, laryngeal oedema, tracheal stenosis
  4. Heard at mouth and over the trachea rather than over chest
  5. Extrathoracic airways have opposite pressure gradient
    • – Diameter = decreased on inspiration and increased on expiration
85
Q

What are 3 characteristics of crackles/(rales/creps) as added sounds for ascultation?

A

Coarse crackles (like thunder)

  1. usually indicate secretions, or diffuse small airways disease
  2. during inspiration or expiration
  3. absence of crackles does not mean absence of secretions (crackles only heard if velocity of airflow is adequate and breath sounds are audible)
86
Q

What is fine end inspiratory crackles as added sounds for ascultation?

A

usually indicates atelectasis (see L4-5) = sudden opening of distal airways due to equalisation of pressure

87
Q

What is fine crackles as added sounds for ascultation?

A

(like velcro):

  • eg diffuse interstitial pulmonary fibrosis, left heart failure
88
Q

What are 4 observations of cough?

A
  1. Strength – Weak, Fair, Strong
  2. Dry / Moist
  3. Effective / Ineffective
  4. Productive / Non-productive
    • Sputum expectorated
89
Q

What is “secretions” vs “sputum” vs “mucus” vs “phlegm”?

90
Q

What are 7 observations of the LL (lower limb) for cardiorespiratory assessment?

A
  1. Oedema
  2. Deep venous thrombosis (DVT)
    1. Colour
    2. Temperature
    3. Palpation
    4. Homan’s sign
  3. Circulation
    • Dorsalis pedis, Posterior tibial
  4. Peripheral perfusion
  5. Skin integrity
  6. Musculoskeletal: ROM, strength
  7. Neurological: sensation, tone
91
Q

What are 5 observations of bed mobility for cardiorespiratory assessment?

A
  1. Rolling
  2. Getting out of bed
  3. Sit to stand
  4. Transfers
  5. Gait
    • Manual assistance
    • Aid
92
Q

What are 3 observations of balance for cardiorespiratory assessment?

A
  1. Sitting balance
  2. Standing balance
  3. Higher level as appropriate
93
Q

What are 5 specific assessment for cardioresp.? What are 3 other measures to consider?

A
  1. Pulse Oximetry
  2. Epidural
  3. Exercise capacity
  4. Quality of life
  5. Dyspnoea scales / questionnaire

lifespan, neuro, musculoskeletal

94
Q

What are 2 specific assessment of pulse oximetry?

A
  1. SpO2, HR
  2. At rest ; with exertion
    • On supplemental O2, vs on room air (ORA)
95
Q

What are 3 specific assessments of epidural?

A
  1. P/I – P&N, numbness, weakness, heaviness, headache, pain at site
  2. Sensation – Light touch, +/- sharp/blunt, +/- hot/cold
  3. Muscle strength:
    1. – Quads
  4. – Dorsiflexors
  5. – +/- Hip flexors
96
Q

What is a specific assessment of exercise capacity?

A

Eg. 6MWT, ISWT

97
Q

What is a specific assessment of quality of life?

A

Eg. St George Respiratory Disease;

  • Cystic Fibrosis Questionnaire
98
Q

What is a specific assessment of dyspnoea scales/questionnaires?

A

Eg. Borg RPB

  • Medical Research Council
99
Q

What are 3 key points of the cardiorespiratory physical examination?

A
  1. “Top to Toe” approach
  2. Be flexible to suit patient’s presentation
    • – Eg, if SOB / drowsy / in pain / surgeon’s protocol…
  3. Aim to minimise discomfort and number of position changes
100
Q

What are 4 cardiorespiratory assessment tools?

A
  1. Spirometry
  2. ECG
  3. CXR
  4. ABGs
101
Q

What is spirometry?

102
Q

What are static lung volumes?

103
Q

What are 3 impairments in spirometry?

A
  1. Obstruction
  2. Restriction
  3. Mixed defect
104
Q

What is spirometry for obstruction, restriction and mixed graphs?

105
Q

What is obstruction as a spirometry impairment? What are 3 characteristics?

A

Airflow limitation – unable to blow out quickly

  1. Low FEV1 and FEV1/FVC
  2. eg Asthma ; COPD
  3. Reversibility: assesses improvement with therapy
    • Improvement in FEV1 &/or FVC = positive response to bronchodilators:
      • ≥ 12% from baseline &
      • ≥ 200 ml from baseline
106
Q

What is restriction as a spirometry impairment? What are 2 characteristics?

A

External limit to inspiration – small lungs

  1. Low FVC (and TLC)
  2. eg Fibrosis, pleural/chest wall disease, weak inspiratory muscles
107
Q

What is mixed defect as a spirometry impairment? What is a characteristic?

A

Small lungs and unable to blow out quickly

  1. Low FEV1 and FEV1/FVC plus low FVC (and TLC)
108
Q

What is the P wave in ECG?

109
Q

What is the QRS complex in ECG?

110
Q

What is the T wave in ECG?

111
Q

What is atrial flutter in ECG?

112
Q

What is ventricular ectopics in ECG?

113
Q

What are 13 outcome measures as reassessment?

A
  1. Observation (eg: RR, pattern)
  2. Palpation (eg: movement, symmetry)
  3. Auscultation (BS, AS)
  4. Cough ( / cry - infants)
  5. Sputum – quality, quantity
  6. Pulse oximetry (SpO2, HR)
  7. CXR
  8. RFTs
  9. Exercise testing (eg. 6MWT)
  10. Oxygen requirements
  11. No. of hospital admissions; LOS
  12. Days off school / work / sport
  13. QoL
114
Q

What is the ISOBAR framework?

115
Q

What are 7 problem/s does this patient have that I can treat?

A
  1. Impaired airway clearance
  2. Dyspnoea
  3. Decreased exercise tolerance / mobility levels
  4. Reduced lung volume
  5. Impaired gas exchange
  6. Airflow limitation
  7. Respiratory muscle dysfunction
116
Q

What are 6 clinical problem solving features of the cardiorespiratory assessment?

A
  1. Problem (what problem/s does this patient have that I can treat?)
    1. Impaired airway clearance
    2. Dyspnoea
    3. Decreased exercise tolerance / mobility levels
    4. Reduced lung volume
    5. Impaired gas exchange
    6. Airflow limitation
    7. Respiratory muscle dysfunction
  2. Evidence (how do I know this problem exists? ie, Ax findings)
  3. Pathophysiological cause (what causes this problem?)
  4. Management & rationale (what can I do to help improve this problem, & why have I selected this approach?)
  5. Outcome measures (how will I know if this Mx is working?)
    • Special considerations (what do I need to think about before assessing / treating this patient?)

This framework will be developed throughout this course.

117
Q

What are 3 treatment plans for the cardiorespiratory system?

A
  1. Respiratory system:
    1. Ventilation
    2. Airway clearance
  2. Circulatory system:
    1. Circulation
  3. Musculoskeletal:
    1. Bed mobility
    2. Mobilisation
    3. Functional mobility
118
Q

What are 2 treatment plans for the respiratory system?

A
  1. Ventilation
  2. Airway clearance
119
Q

What is a treatment plan for the circulatory system?

120
Q

What are 3 treatment plans for the musculoskeletal system?

A
  1. Bed mobility
  2. Mobilisation
  3. Functional mobility
121
Q

What are 5 consultations of all available information for the cardiorespiratory assessment?

A
  1. Medical chart
  2. Bed chart
  3. Patient interview
  4. Physical examination
  5. (Medical team)
  • Be flexible to suit patient’s presentation
  • Identify the patient’s main problems and determine the goals of physiotherapy management

PHTY3250 (20 decks)

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