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Year 3: CardioPulm Rehab > Lecture 21: Pulmonary Eval and Assessment > Flashcards

Lecture 21: Pulmonary Eval and Assessment Flashcards

1
Q

what happens in chart review

A

determine important info about pt, medical condition, hx, and indications/contraindications

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2
Q

what happens in subjective interview

A

determine:
- PLOF
- pt goals
- cognition
- barriers to care
- communication
- social hx

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3
Q

what happens with physical exam

A

determine:
- vitals
- cardiorespiratory impairments
- activity tolerance
- limitations
- functional capacity

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4
Q

what happens with patient assessment

A

determine:
- discharge needs
- POC
- frequency of treatment
- interventions

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5
Q

what happens with prognosis/outcome

A

determine prognosis for functional recovery and goal for outcomes

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6
Q

orders give you what sort of info

A

bedrest orders
specific vital ranges
new O2 needs/changing needs
precautions
device precautions/restrictions

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7
Q

medications in EMR give you what info

A

scheduled meds
PRN meds
continuous drips
dosage

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8
Q

medical events in EMR give you what info

A

code/cardiac arrest
sx procedures
device implantation
diagnostics

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9
Q

vital signs in EMR give you what info

A

current, previous, and TRENDS throughout day

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10
Q

surgery info in EMR gives you what info

A

changes to POC
new precautions
planned vs elective
ability to be extubated in OR or PACU

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11
Q

length of sx gives you what info

A

possible impact on cognition

impacts time on mechanical vent post op

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12
Q

DNR/DNI tells you qht

A

Does pt want to be intubated or resuscitated in event of medical emergency

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13
Q

prior documentation tells. you what

A

MD notes: consults, op notes, DC summaries, etc

PT/OT/ST notes

CM notes: PLOF, previous living situation, baseline activity, etc

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14
Q

Intake and output gives you what kind of info

A

info about hydration, kidney function, meds, etc

fluid restrictions

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15
Q

nursing mobility gives you what info

A

OOB to chair

bathroom

ambulation

changes in bed position, turning schedule

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16
Q

premorbid status provides what info

A

EMS notes
ER notes
H&P
prior PT notes

where did pt reside prior to admission

baseline mobility

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17
Q

insurance coverage gives you what info

A

qualification for rehab

post acute PT services

O2 needs

pulm rehab

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18
Q

oxygen delivery in EMR gives you what type of info

A

current, previous, TRENDS during hospital stay

use device for sleep and different one for day?

communication with respiratory therapy on status, options, etc

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19
Q

what types of questions do you want to ask pulmonary patients about their prior level of function

A

home set up

baseline mobility/ADLs; limited by activity tolerance or pull S&S?

baseline activity tolerance; ask specific questions; SOB or fatigue with activity?

use of AD; how is device used with O2 simultaneously?

use of O2; type/amount/frequency; portable or stationary; compliance

falls? trip over O2 device?

types of pulmonary S&S; can you suggest energy conservation ideas?

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20
Q

what do you want to observe about a pulmonary patients posture

A

tripoding
kyphosis/scoliosis/rounded shoulders
supine vs sitting
hyperinflation
body habits

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21
Q

what do you want to observe about a pulmonary patients MSK appearance

A

accessory mm use

mm wasting

cachexia

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22
Q

signs of hypoxemia/hypoxia

A

cyanosis or grayed appearance

pallor/mottling

AMS

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23
Q

what to observe in regard to breathing patterns with pulmonary patients

A

rate/rhythm/effort

cough assessment

sounds

at rest vs during conversation vs activity

mouth open vs mouth closed

24
Q

components of the cough assessment

A

type/description
strength
effectiveness
duration vs frequency
secretion management

25
Q

types/descriptions of coughs

A

productive/wet
- clear discolored secretions can differentiate between pathology and infection
- frothy/foamy secretions indicate pulmonary edema/HF

non-productive/dry

hemoptysis

“barking” or “whooping”

26
Q

what to look at with strength of cough

A

does cough become more productive with abdominal splinting

27
Q

what to look at with cough effectiveness

A

does coughing change their exam or symptoms

28
Q

interpretation/dx of productive cough

A

bacterial PNA

obstructive disease

29
Q

non-productive cough interpretation/dx

A

viral PNA

IPF

smoking

30
Q

purulent cough interpretation

A

bronchiectasis

chronic bronchitis

fungal PNA

31
Q

blood tinged cough interpretation

A

TB
cancer
early fibrosis

32
Q

blood predominant cough interpretation

A

alveolar hemorrhage, PE, UGIB

33
Q

“brassy” cough interpretation

A

alveolar hemorrhage

PE

UGIB

34
Q

frothy cough interpretation

A

HF
pulmonary edema

35
Q

violent cough interpretation

A

foreign body aspiration

choking

36
Q

barking/”whooping” cough interpretation

A

pertussis

37
Q

what to palpate with pulmonary pts

A

mm of ventilation
chest wall mobility
thoracic cavity mechanics
tactile fremitus
- vibration caused by retained secretions or abnormal air movement
- can be made worse with speaking or coughing
- wide variety of presentations

38
Q

mediate percussion evaluates what

A

lung density and diaphragmatic excursion

39
Q

what 3 normal sounds can be produced with mediate percussion

A

normal = lung tissue and resonance is normal

dull = “thud” or dense resonance felt over area of fluid consolidation or non-aerated tissue

tympanic = loud, hollow resonance felt over area of hyperinflation

40
Q

technique for mediate percussion

A

middle finger of non-dominant hand placed flat on chest wall in IC space

middle finger of dominant hand strikes the finger on the chest wall in rapid succession

41
Q

describe lung auscultation

A

diaphragm is best for hearing normal sounds

bell is best for hearing abnormal

performed over entire lung space in systemic manner, anteriorly then posterior

at least 1 breath should be auscultated in each bronchopulmonary segment

normal sounds are created by the turbulence in air flow

42
Q

which lung has the cardiac notch

A

left

43
Q

describe bronchial auscultations (normal)

A

heard over tracheobronchial tree

louder/high pitched than vesicular

louder during exhalation but still heard at the end of inhalation

44
Q

describe bronchiovesicular auscultations (normal)

A

heard over mainstem and segmental bronchi OR between shoulder blades

softer versions of bronchial auscultation

heard equally during inhalation and exhalation

45
Q

describe vesicular auscultation (normal)

A

heard through all lung fields

soft, lower pitched

louder during inglantoion but still heard at beginning of exhalation

46
Q

another name for abnormal breath sounds/lung auscultation

A

aka adventitious lung sounds

47
Q

possible causes of abnormal breath sounds

A

increased tissue density increases sound transmission (water carries sound better than air)

consolidative pathology creates stronger/louder sounds (i.e. PNA, tumors)

areas of hyperinflation greater weaker/softer sounds (i.e. emphysema)

areas without air movement create no sound at all (i.e. pneumothorax, obstructive atelectasis)

48
Q

what is whispered pectoriloquy

A

whispered words (usually counting) are heard loudly in presence of fluid consolidation

normally would not be heard during auscultation

49
Q

what is bronchophony

A

normal volume words/numbers are heard louder than normal in the presence of fluid consolidation

normally would be heard at a normal volume

50
Q

what is egophony

A

high pitched “nasal” sound transmitted through areas of fluid consolidation

“EEE” sounds like “AAA”

normally “EEE” sounds like “EEE”

51
Q

describe a wheeze

A

continuous musical sound

more common to heard during exhalation from airway obstruction

wheezing with inhalation indicates a more severe obstruction

must differentiate between expiratory wheeze and inspiratory wheeze to differentiate pathology

52
Q

describe a rhonchi

A

continuous lower pitch than wheezing

heard during inhalation and exhalation

caused by copious airway secretions

53
Q

describe stridor

A

continuous high pitched sound

higher intensity than wheezing

severe upper airway obstruction

can be caused by edema, anaphylactic allergic reaction, tumor burden, bleeding, choking, recent extubation, etc

54
Q

describe crackles (rales)

A

discontinuous sound

sounds like brief bursts of popping bubbles, velcro ripping apart, wood burning

most common during inhalation as a result from sudden opening of closed airway

other causes:
- bronchitis
- atelectasis
- pulmonary edema
- fibrosis

55
Q

describe pleural rub

A

either continuous or discontinuous

sounds like pieces of leather or sandpaper rubbing together

indications inflammation of pleura

heard best at lower lateral chest wall

usually accompanied by pain

56
Q
A

Year 3: CardioPulm Rehab (20 decks)

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