Objective - Observation

Question 1

Components of Objective

Answer 1

> Observation
> Palpation
> Auscultation
> Chest X-rays/ Imaging
> Pulmonary Function Tests
> Pulse Oximetry 
> Arterial Blood Gases
> Functional Ability (QoL)
> Exercise tolerance
> Charts

Question 2

Eyes

Answer 2

> Pallor (anaemia) - not pink enough
Plethora (high Hb) - v. pink
Jaundice (liver/blood disorders involving calcium levels) - yellow
Drooping (horner’s syndrome? = lung cancer)
Oedema - fluid retention

Question 3

Hands

Answer 3

> Flapping tremor on wrist extension - too much CO2
Fine tremor = general shaking even at rest - drug related
Wastage (can indicate cancer)
Clubbing (hold index fingers nail to nail - loss of window)
- Cardiac in nature e.g congenital heart diseases or bacterial endocarditis
- Lung diseases e.g infective/fibrotic/malignant
Nicotine stains
Cyanosis (blue or white) - poor circulation
Temperature - hot and cold
(may indicate infection, too much CO2)

Question 4

Mouth

Answer 4

> dry/dehydrated (will affect sputum clearance)
hydrated
Cyanosis - blue = lack of O2
Pursed lip breathing (affects pressures - longer exhalation so greater O2 retention)

Question 5

Oedema

Answer 5

> Peripheral
Pitting - been there for a while - doesn’t bounce back out

*Not only due to respiratory conditions (but may add to global picture

Question 6

Position

Answer 6

> Slumped in bed/chair - can they adjust from uncomfortable position
Position of ease - e.g hands on knees
Fixing - hands resting to free up accessory muscles to aid respiration

Question 7

Chest

Answer 7

> Curve (Scoliosis, kyphosis, kyphoscoliosis) - will affect ability of lungs to inflate
Pectus Excavatum - funnel chest (caved in)
Pectus Carinatum - Pigeon chest (pushed out)
Barrell/hyperinflated - chronic lung disease

*May not cause a problem but will affect our ability to deal with one

+ Shortness of breath (linked to position, pursed lip breathing and accessory muscle use)
- are they able to talk in full sentences or do they have to pause?

Question 8

Skin

Answer 8

> Pale - anaemia or low bp
Red/ruddy - retaining CO2 or increased RBC levels (could indicate chronic lung disease)
Cyanosed (blue) - lack of O2 (central or peripheral)

Question 9

Abdomen

Answer 9

> will alter ability of diaphragm to descend downwards
Distended
- Pregnancy
- Obesity
- Surgery
- Constipation
Should feel marshmallowy - sit patient up to remove pressure on diaphragm

Question 10

Nasal Flaring

Answer 10

> Dilation of nostrils - decreases airways resistance

mainly seen in children up until ~ 3 yrs of age

Question 11

Voice

Answer 11

> Volume (quiet is less effortful)
Wet sounding (sputum related but gurgling may indicate cardiac issue or fluid on lungs)
Full sentences or pauses (SoB) - idea of severity
Audible sounds (crackles/wheezes)

Question 12

Components of observation

Answer 12

> Position
> Lines/drips/drains - same position on leaving 
> Skin + oedema
> Eyes 
> Nose - nasal flairing 
> Mouth 
> Voice 
> Accessory muscles - neck 
> Chest 
> Breathing mechanics + oxygen 
> Abdomen 
> Hands

Question 13

Oxygen

Answer 13

> type (nasal/mask)
Amount
going up/down - indicates patient status