OBJECTIVE ASSESSMENT Flashcards
Typical format for recording
INITIAL IMPRESSION
- Age, height, weight, sensorium & general appearance
VITAL SIGNS
- Pulse rate, respiratory rate, temperature & blood pressure
HEAD, EARS, EYES, NOSE & THROAT
- Inspection findings
NECK
- Inspection & palpation findings
THORAX
- Lungs: Inspection, palpation, percussion & auscultation findings - Heart: Inspection, palpation & auscultation findings
ABDOMEN
- Inspection, palpation, percussion & auscultation findings
EXTREMITIES
- Inspection & palpation findings
BODY COMPOSITION: def of BMI + formule & types of disease
BMI = measurement of person’s weight with respect to his or her height
= Indicator not a direct measurement of person’s total body fat
- Often (not always), correlates with total body fat => BMI score increases, so does person’s total body fat
BMI = Kg / (cm2)
- Used by healthcare professionals to screen risks associated with obesity & overweight
- type 2 diabetes
- heart disease
- stroke
- high blood pressure
- certain cancers
- gallbladder disease
- sleep apnea & snoring
- premature death
- osteoarthritis & joint disease
DYSPNEA RATING PERCEIVED EXERTION: ≠ scale
Borg scale & modified borg scale
MRC & mMRC
MRC: MRC dyspnea scale = simple & valid method of categorizing patients with COPD in terms of their disability that could be used to complement FEV1 in classification of COPD severity
From bottom to top
Schema for description
≠ vital signs
Heart rate, pulse oximetry, respiratory rate, blood pressure & gait speed test
RESPIRATORY RATE: normal values, clinical application & interpretation
NV: 12-16 breaths/min
CA: - Counted by watching abdomen or chest wall move out & in
- Possible to place hand on patient’s abdomen to confirm breathing rate - Patient should be unaware that respiratory rate being counted
I: - Tachypnea = respiratory rate greater than 20 breaths/min. Rapid respiratory rates associated with exertion, fever, hypoxemia, hypercarbia, metabolic acidosis, anxiety, pulmonary oedema, lung fibrosis & pain
- Respiratory rate of less than 10 breaths/min = bradypnea & occur with traumatic brain injury, severe myocardial infarction, hypothermia, anaesthetics, opiate narcotics & recreational drug overdoses
LEVEL OF OXYGENATION: PULSE OXIMETRY: normal values, clinical application, interpretation, reading, description, limitations
NV: 95-100%
CA: - Monitoring respiratory status (gas- exchange)
- Can provide early warning of hypoxemia
- Pulse oximetry reliable in titrating fractional inspired oxygen concentration (FIO2) in patients requiring mechanical ventilation
- Used as surrogate for ratio of PaO2 to FIO2
Haemoglobin Oxygen Saturation (Background)
- Oximeters operate based on principle of ≠ absorption & light emission of T & R configurations
- Oximeter uses electronic processor & pair of small light-emitting diodes (LEDs) facing photodiode through translucent part of patient’s body, usually fingertip or earlobe
- One LED is red, with wavelength of 660 nm & other infrared, with wavelength of 940 nm
- Light absorption at these wavelengths differs significantly between blood loaded with oxygen & blood lacking oxygen
- Oxygenated haemoglobin absorbs more infrared light, allowing more red light to pass through
- Deoxygenated haemoglobin allows more infrared light to pass through & absorbs more red light
I: Normal arterial oxygen saturation ranges between 97% and 99%
- Some people, especially long-term smokers, may typically have SpO2 between 93% and 95%.
- Readings of 90% or less indicate that patient could present hypoxemia (must be confirmed by Arterial Blood Gas Analyzes)
- Important to remember that pulse oximeters measure & calculate oxygen saturation of haemoglobin in blood, not arterial blood’s current oxygen pressure (PaO2)
- Possible to correlates SpO2 with PaO2, if patient breathing in room air (FIO2 21%)
R: Remove any jewellery or fingernail polish on your finger if measuring from location Ensure hand is warm, relaxed & below heart level if attaching device here
Place device on your finger, earlobe, or toe
Keep device on for as long as needed to monitor your pulse & oxygen saturation
Do measurements in ≠ settings:
- At rest
- In ≠ positions (if patient has been in bed for long time) - During physical activities (walking, standing)
- During exertion (exercise or exercise testing)
D: Pulse oximeter = device usually (not always) placed on fingertip
- Uses light beams (infrared) to estimate oxygen saturation of blood & pulse rate
- Oxygen saturation gives information about amount of oxygen carried in blood (Haemoglobin) - Non-invasive
L: It doesn’t measure:
- Dyshemoglobins (not binded hemoglobines) - Carboxyhemoglobin
- Methemoglobin
Factors influencing results: Dyes, Low perfusion state, Skin pigmentation, Anaemia, Nail polish, Motion artefact, Limited knowledge of technique
Normal values for each vital signs
Schema
QUALITY OF LIFE: def + ≠ questionnaires
D: Multidimensional construct comprised of physical, mental & social facets & ability to perform everyday activities including social & occupational aspects of one’s life
T: heart QoL, CAT: COPD assessment test, SF-36, SGRQ
THORACIC ASSESSMENT: 3 ≠ parts & description of each, deformations & fctal effects
- Shape (inspection)
- Movement frequency (Resp. Frequency)
- Movement quality (physiologic)
DEFORMITIES
- Pectus Carinatum - Pectus Scavatum - Kyphosis
FUNCTIONAL EFFECTS
- Restriction - Obstruction
Abnormal breathing pattern
Picture
Inspection: ≠ parts
Skin, color & fingers
Subcutaneous emphysema: def
= generation or infiltration of air underneath dermal layers of skin. Subcutaneous air may be benign symptom or indication of deeper, more concerning pathologic disease state
Clinical portrait of heart failure
Picture
Clinical impression: questions & nail clubbing
- What is global impression of patient
- How does he sit? Bend over? Arms supported? - Presence of cyanosis?
- Nail clubbing?
- Muscle atrophy & edema present?
- Use of accessory muscles?
- Nose flaring?
Nail clubbing:
= Manifestation of cardiopulmonary disease Infiltrative or interstitial lung disease, bronchiectasis, cancers, congenital heart disease.
=> not specific for COPD
Clinical impression: 2 ≠ patterns
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