Objective assessment 2

Question 1

chest breathing pattern

Answer 1

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)

Question 2

chest breathing pattern- paradoxical/ hoovers sign

Answer 2

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

Question 3

chest breathing pattern-rib fracture

Answer 3

in multiple places- affects inspiration- leads to rib being pulled in as it is no longer attached

Question 4

skin colour- pale and ruddy

Answer 4

pale- anaemic, low BP

ruddy- retaining Co2, increased RBC- polycythaemia

Question 5

skin colour- cyanosed

Answer 5

lack of O2, central- lack of oxygen, peripheral

Question 6

abdomen

Answer 6

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

Question 7

respiratory muscles- inspiration

Answer 7

diaphragm, external intercostals

accessory muscles- sternocleidomastoid, Lat dorsi, scalene, serratus anterior, pec major/minor

Question 8

respiratory muscles- expiration

Answer 8

passive elastic recoil of lungs
accessory muscles- rectus, abdominis, external/internal obliques, Tr Abd, lowest fibres of iliocostalis, longissimus,, serratus posterior inferior, quadratus lumborum

Question 9

nasal flaring

Answer 9

dilation of nostrils, mainly seen in children- preferential nasal breathing, attempt to decrease airway resistance- reduce SOB

Question 10

lines, drips, drains

Answer 10

ensure everything is where it needs to be, and ensure everything is where it needs to be when they leave

Question 11

oxygen therapy

Answer 11

type- oxygen mask, nasal specs

amount, requirement going up or coming down0 shows respiratory status

Question 12

quality of voice

Answer 12

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

Question 13

palpation- abdomen,

Answer 13

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

Question 14

palpation- chest expansion

Answer 14

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

Question 15

palpation- trahcea

Answer 15

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

Question 16

palpation- tactile fremitus and vocal fremitus

Answer 16

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

Question 17

palpation- surgical emphysema

Answer 17

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

Question 18

palpation- scars and response to touch

Answer 18

note previous scars- cardiac or thoracic surgery, injury- link to Sx
does the pattern of breathing alter on palpation

Question 19

functional ability/ QOL

Answer 19

mixture of questionnaires, occupation- protective equipment used properly?
social history
in-hospital independence

Question 20

exercise tolerance tests- 6 min walk test

Answer 20

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

Question 21

exercise tolerance tests- incremental shuttle test

Answer 21

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

Question 22

what should be done with all exercise tolerance tests?

Answer 22

test again after intervention- objective marker

Question 23

exercise tolerance tests- 3 min shuttle walk

Answer 23

if patients cannot coordinate between cones of ISWT , same set up, but how many laps in 3 mins

Question 24

exercise tolerance tests- endurance shuttle test

Answer 24

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

Question 25

exercise tolerance tests- chair stand test

Answer 25

count how times a person can stand and sit down in 20 secs

Question 26

exercise tolerance tests- stair climbing test

Answer 26

count how many steps they can do in 2 mins- more practical, more functional

Question 27

charts

Answer 27

BP, HR, Temp, oxygen requirement/ saturation, respiratory weight, AVPU, fluid balance, urine output, medication

Question 28

critical care chart

Answer 28

mode of ventilation, Fi02, heart rhythm, pressure support/ volume control/ airway pressure, TV, PEEP, CVP, GCS/AVPPU, ABG’s, blood chemistry- inflammatory markers

Question 29

what is mode of ventilation

Answer 29

exactly what ventilator is doing, tell you what is going on with chest, is respiratory function getting better? more/less?