Respiratory Assessment

Question 1

What are the different aspects of patient history?

Answer 1

Presenting complaint - PC
• History of presenting complaint - HxPC
• Past medical history - PMHx
• Drug history - DHx
• Social history - SHx
• Family history - FHx

Question 2

History of present complaint acronym:

Answer 2

Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbating/relieving factors
Severity

Question 3

What come under PMHX & DHx?

Answer 3

Diagnosed medical problems
• Hospital admissions
• Surgical history
• Prescribed drugs
• Over the counter (OTC) medications
• Herbal medications
• Illicit drug use
• Allergies

Question 4

What comes under social history/family history?

Answer 4

Support needs (carers etc)
• Mobility
• Smoking history
• Alcohol consumption
• Occupation
• Travel
• Family medical conditions (parents, siblings)
• Any premature death of relatives?

Question 5

What checks should you do upon first contact of patient?

Answer 5

Take a pulse - what does it tell vou?
Rate, rhythm, depth
• Temperature
• Perfusion - check the capillary refill
• Nicotine stains?
• Clubbing of the fingers?
• Hydration
• Legs

Question 6

What should you do upon resp inspection?

Answer 6

Respiratory rate, depth, effort
• Symmetry
• Scars
• Bruising/injuries
• Colour
• Accessory muscle use

Question 7

Palpation: (resp assessment)

Answer 7

• Tenderness
• Symmetry
• Masses
• Equal chest rise

Question 8

Percussion: (resp assessment)

Answer 8

• Tapping the chest wall to assist diagnosis
• Listening for resonance - hyper or hypo
• Hyper-resonance - excessive air in
pleural space/lung
• Hypo-resonance - indicates
fluid/consolidation in lung/pleural space

Question 9

what is Peak Flow (PEF) and what is it used for?

Answer 9

• Measurement of the force of expiration
• Used in the long-term monitoring of asthma
• Check “best of three” reading, and compare to patient’s normal level (or expected level found in JRCALC)
• PEF <33% = life threatening asthma
• PEF <50% = acute severe asthma

Question 10

What is End Tidal Carbon Dioxide (EtCO2) and what is it used for?

Answer 10

• Capnography (and capnometry)
provides quick feedback on the gas exchange process.
• Provides a measurement of expired
CO2.
• Provides feedback on tube placement in ALS, feedback on cardiac output, ventilations and cellular metabolism
• Normal value = 4.6 - 6.0 kPa 35 - 45mmhg)

Question 11

All red flags for breathing:

Answer 11

.Accessory Muscle use
.Inability to complete a sentence
.Respiratory exhaustion
.Loss of wheeze w/o them improving
.Stridor
.Pallor/cyanosis
.Confusion/reduced GCS
.Bradypnoea[<10>], Tachypnoea[>29]
.Reduced/absent breathing sounds
.Low Sp02(<92 on air)(<95 on oxygen)
.Reduced peak flow(<33% of pt best)
.Hypercapnia(ETCO2 >6.7kpa)
.Initially tachycardic then bradycardic
.Arrhythmias
.Hypotension (peri-arrest sign)

Question 12

What is used in asthma management?

Answer 12

• Oxygen
• Salbutamol
• Ipratropium bromide (Atrovent)
• Hydrocortisone
• Adrenaline

Question 13

What is COPD?

Answer 13

Chronic Obstructive Pulmonary Disease
• Umbrella term for chronic bronchitis and emphysema
• Progressive disease causing breathing difficulties and cough
• Frequent chest infections
• Often caused by smoking

Question 14

What are pack years?

Answer 14

Pack years are used to measure a person’s exposure to tobacco. This is used to assess their risk of developing lung cancer.

Example:
1 pack a day X 30 years = 30 pack years

Question 15

What are Pulmonary Embolism risk factors?

Answer 15

Surgery
• Trauma
• Pregnancy
• Contraceptive pill/ HRT
• Cancer/ cancer treatment
• Prolonged immobilisation/ travel
• Obesity
• History of DVT/ PE

Question 16

Hyperventilation Syndrome Management:

Answer 16

• Control the breathing
• Calm environment
• Coach breathing
• Distraction - see if the patient will talk to you, or if they are able to slowly sip on a glass of water
• Provide reassurance
• Thorough history
• Thorough assessment
• Referral/transport needed?