Observation

Question 1

What should you do before observing the patient?

Answer 1

Talk to the nurses see how the patient is doing

Check patients notes for previous assessments and interventions

Checks NEWS score

Question 2

What are you looking at with first impressions?

Answer 2

Level of distress (general/respiratory)

Level of coniousness

Any supporting adjuncts (O2/ventilation/lines/drains/leads)

Colour

Are they mobile

Are they obese

Are they unkempt e.g. are they dressed

Question 3

What peripheral signs should you be looking for?

Answer 3

Clubbing of fingers and toes

Peripheral oedema - sacral area and ankles

Jugular venous pressure

Question 4

What are the chest markings when observing the chest?

Answer 4

Oblique fissure T3 posterior to 6th costochondral junction anterior

Horizontal fissure (Right) 4th costochondral junction to mid axillary line

Diaphragm 6th rib anterior, 8th rib mid axillary line, T10 post

Apices of both upper lobes extend 2.5 cms above clavicles

Trachea bifurcates just below manubriosternal junction

Question 5

What chest shape abnormalities may you see when observing the chest?

Answer 5

Kyphosis

Kyphoscoliosis

Pectus exacatum (sunken chest)

Pectus carinatum (pigeon chest)

Hyperinflation (ribs elevated to horizontal - increase AP chest diameter)

Question 6

What signs are you looking for when observing breathing pattern?

Answer 6

Inspiratory:Expiratory ratio
Inspiration is active and expiration is passive
Normal = 1:1.5-1.2
Prolonged expiration = 1:3-1:4

Apnoea - no breath for > 10 secs

Pursed lip breathing

Cheyne-Stokes respiration - cycles of breathing moving from shallow to deep breaths (cardiac damage)

Question 7

What signs are you looking for when observing chest movement?

Answer 7

Use of accessory muscles during inspiration and expiration

Question 8

What areas of the chest do you palpate?

Answer 8

Both hands anteriorly on chest

Both hand posteriorly

Both hands laterally

1 hand on chest and 1 hand on stomach

1 hand anterior chest and 1 hand posterior chest

Question 9

What signs are you looking for with chest palpation?

Answer 9

Equal chest expansion

Diaphragmatic breathing

Paradoxial breathing

Breathing rate

Surgical emphysema

Question 10

What may you observe regarding colour?

Answer 10

Pallor = florid face
Anaemia, reduced cardiac output or hypovolaemic shock

Cyanosis = blue colouration
Unsaturated haemoglobin in the blood due to respiratory or circulatory disorders

Peripheral cyanosis = Fingers, toes, earlobes
Circulatory problems, cold environment or pathology e.g. peripheral vascular disease

Central cyanosis - mouth, lips, tip of tongue
Gas exchange problem