Objective Assessment

Question 1

Documentation (7)

Answer 1

Initial impression: Age, height, weight, general appearance.
Vital signs: Pulse rate, RR, Temp., BP.
Head, ears, eyes, nose and throat: inspection.
Neck: inspection and palpation.
Thorax: Lungs: inspection, palpation, auscultation, percussion. Heart: inspection, palpation, auscultation.
Abdomen: inspection, palpation, percussion, auscultation.
Extremities: Inspection and palpation.

Question 2

Body Composition

Answer 2

BMI: kg/(cm2) indicator, not a direct measurement.
Used to screen risks associated with obesity and over weight: Diabetes type II, heart disease, stroke, high BP, premature death.

Question 3

Dyspnea Scales (4)

Answer 3

Rating perceived exertion.
Borg scale: 6-20, mBorg scale: 0-10 associated to intensity of exercise that leads to either dyspnea or muscle fatigue in this moment.
MRC scale: 1-5, mMRC scale: 0-4. Categorizing COPD patients in terms of their disability, how dyspnea affects their ADLs.

Question 4

Vital Signs - Normal Values (6)

Answer 4

New born: RR: 30-50. HR: 80-180. BP: 60/30.
Infant: RR: 20-40. HR: 80-160. BP: 96/60.
Toddler: RR: 20-30. HR: 80-150. BP: 98/64.
School child: RR: 16-24. HR: 75-110. BP: 106/68.
Adolescent: RR: 12-20. HR: 50-100. BP: 114/74.
Adult: RR: 8-12. HR: 60-90. BP: 120/80

Question 5

Respiratory Rate - Tachypnea

Answer 5

Measured for 60 sec, without patient noticing or talking.
>20 per minute. Associated with exertion, fever, hypoxemia, hypercapnia, metabolic acidosis, pulmonary edema and lung fibrosis

Question 6

Respiratory Rate - Bradypnea

Answer 6

<10 per minute. May occur with traumatic brain injury, severe myocardial infarction, hypothermia, anaesthetics, opiate narcotics and overdose.

Question 7

Hypoxemia Classification (SpO2 & PaO2)

Answer 7

Normal: SpO2: >95, PaO2: 80-100.
Mild hypoxemia: Sp02: 90-94, PaO2: 60-79.
Moderate hypoxemia: SpO2: 75-89, PaO2: 40-59.
Severe hypoxemia: SpO2: <75, PaO2: <40.

Question 8

Walking Gait Speed

Answer 8

Vital Sign! can be used to predict mortality.
High risk: <0,15 - <0,6 ms-1
Mild risk: <0,7 - <1,05 ms-1
Low risk: >1,05

Question 9

QoL Scales/Questionnaires (4)

Answer 9

Heart QoL: Chronic heart problems
CAT: COPD assessment test (coughing affects QoL)
SF-36: How much resp. disease affects QoL.
SGRQ: How much resp. disease affects QoL.

Question 10

Thoracic Assessment (6)

Answer 10

Auscultation
Palpation
Percussions
Deformities (Pectus Carinatum, Pectus Scavatum, kyphosis, scoliosis, barrel chest)
Scars
Movement of respiration (RR, breathing pattern, symmetrical scapular movement)

Question 11

Abnormal Breathing Pattern (7)

Answer 11

• Asthmatic breathing (Obstruction, COPD): Prolonged expiration w/ recruitment of abd. muscles.
• Paradoxical breathing: (resp. failure type II) Abdominal: wall moves in on insp. and out on exp. Chest: wall moves in on insp. and out on exp.
• Eupnea, tachypnea, bradypnea, apnoea, cheyne-strokes.

Question 12

Clinical Impression - COPD (Moderate) (8)

Answer 12

Chronic cough
Purulent sputum
Hemoptysis
Mild dyspnea
Cyanosis (hypoxemia)
Peripheral edema
Crackles, wheezing
Prolonged expiration

Question 13

Clinical Impression - COPD (severe) (12)

Answer 13

Resp. failure type II with chronic hypercapnia.
Dyspnea
Minimal cough
Increased ventilation
Pink
Pursed lips
Accessory muscles
Cachexia
Hyperinflation
Decreased breath sounds
Tachypnea
Increased work of breathing

Question 14

Cardiorespiratory Functional Tests (5)

Answer 14

6 minute walking test
CPET: cardiopulmonary exercise test
Isokinetic test
SPPB: Short Physical Performance Battery
TUG: Timed up and Go