Objective assessment 2 Flashcards
chest breathing pattern
depth, chest movement all elements together, in-drawing/ recession of intercostal space- inspiratory effort is so great as it is overcoming resistance, trachea tug, asymmetry, inspiration should be half the length of expiration (1:2)
chest breathing pattern- paradoxical/ hoovers sign
as patients breaths in the diaphragm is felt and doesn’t change shape to draw air in, causing it to slide across its self- bucket handle is not there ribs go inwards rather than out/fail rib
chest breathing pattern-rib fracture
in multiple places- affects inspiration- leads to rib being pulled in as it is no longer attached
skin colour- pale and ruddy
pale- anaemic, low BP
ruddy- retaining Co2, increased RBC- polycythaemia
skin colour- cyanosed
lack of O2, central- lack of oxygen, peripheral
abdomen
in a reclined but not slumped posture- harder to breath in slumped posture, applying a flat hand and palpate gently the abdomen (hand in a rolling motion) just below rib cage, does the abdomen feel soft/ mobile? would the diaphragm be able to decend fully?, look to see if abdomen are impeding
respiratory muscles- inspiration
diaphragm, external intercostals
accessory muscles- sternocleidomastoid, Lat dorsi, scalene, serratus anterior, pec major/minor
respiratory muscles- expiration
passive elastic recoil of lungs
accessory muscles- rectus, abdominis, external/internal obliques, Tr Abd, lowest fibres of iliocostalis, longissimus,, serratus posterior inferior, quadratus lumborum
nasal flaring
dilation of nostrils, mainly seen in children- preferential nasal breathing, attempt to decrease airway resistance- reduce SOB
lines, drips, drains
ensure everything is where it needs to be, and ensure everything is where it needs to be when they leave
oxygen therapy
type- oxygen mask, nasal specs
amount, requirement going up or coming down0 shows respiratory status
quality of voice
loudness, wet sounding- can be cardiac in nature, talking in full sentences- have to take breath? indication of how severe respiratory condition is
audible sounds- crackle/ wheeze
palpation- abdomen,
abdomen- any movement, and distension (inhibits diaphragmatic movement, restrict lung volumes and increase WOB- should be soft and mobile? is the diaphragm able to fully decend?- hand in rolling motion horizontally across the abs
palpation- chest expansion
atypical- hand across/ either side sternum
abdominal- han don upper abdomen just below Xiphi,
lateral costal- both hands either side of ches on lower ribs, both hands on one side (ant and post)
assess pump and buckey handle
palpation- trahcea
where is it in relation to sternal notch- deviation?
2 ways- place index and ring finger on sternocloidamastoid tendon either side of trahcea, use middle finger to palpate trachea
feel space in-between trachea and sternocloidamastoid- should be 1 finger
palpation- tactile fremitus and vocal fremitus
tactile- is the transmission of crackles felt on the outside of chest wall
vocal- measures speech vibrations transmitted through the chest wall. it increases when the underlying tissue is solid (consolidation) in some way, decreases in patients pneumothorax or effusion
palpation- surgical emphysema
air in the subcutaneous tissue of chest, neck or face- gravity dependent- more in face
characteristic crackling touch- more air around under skin, sign of pneumothorax, will reabsorb over time
palpation- scars and response to touch
note previous scars- cardiac or thoracic surgery, injury- link to Sx
does the pattern of breathing alter on palpation
functional ability/ QOL
mixture of questionnaires, occupation- protective equipment used properly?
social history
in-hospital independence
exercise tolerance tests- 6 min walk test
reflects ADL- walk around 2 cones in a corridor, record distance, record HR and oxygen levels, count how many laps, repeat test after intervention
800m minus 5X age is normal value
exercise tolerance tests- incremental shuttle test
less dependent on motivation, walk around 10m oval circuit- walking speed determined by bleeps, gets quicker, test ends when cant complete circuit in time frame
what should be done with all exercise tolerance tests?
test again after intervention- objective marker
exercise tolerance tests- 3 min shuttle walk
if patients cannot coordinate between cones of ISWT , same set up, but how many laps in 3 mins
exercise tolerance tests- endurance shuttle test
10m set up, tend not to use on patients- need VO2 max test, requires lot of calculation, they need to work at 80-% CO2 max, looking at reducing SOB, use more on elite athletes
exercise tolerance tests- chair stand test
count how times a person can stand and sit down in 20 secs
exercise tolerance tests- stair climbing test
count how many steps they can do in 2 mins- more practical, more functional
charts
BP, HR, Temp, oxygen requirement/ saturation, respiratory weight, AVPU, fluid balance, urine output, medication
critical care chart
mode of ventilation, Fi02, heart rhythm, pressure support/ volume control/ airway pressure, TV, PEEP, CVP, GCS/AVPPU, ABG’s, blood chemistry- inflammatory markers
what is mode of ventilation
exactly what ventilator is doing, tell you what is going on with chest, is respiratory function getting better? more/less?
