Respiratory assessment clinical skills Flashcards
What are some common problems in cardiorespiratory
cough with sputum - productive
changing colour and consistancy of sputum?
wheezing
chest pain
breathlessness/dyspnoea
fatigue
reduced exercise tolerance
anxiety/depression
swelling (pooling of blood)
falling
cyanosis (fingers turning blue)
What approach should be used for an objective assessment
Systematic approach (like A-E)
include:
observations
special tests
auscultation
palpation
scans
xrays
spirometry
What are the key things you should look for during a respiratory objective assessment
appearance
are they using accessory muscles of breathing
chest expansion
proper diaphragm movement
clubbing of hands?
do they need O2 or ventilator
What should you palpate for during a respiratory objective assessment
pump handle and bucket handle motion of the ribs during breathing
ensure chest expansion is equal
What are you listening for during auscultation
normal - inspiration longer than expiration
abnormal - wheeze, crackles, stridor, plural rub
What is the A-E assessment
Airway - is airway open/obstructed and can the pt breathe/talk on their own
breathing - do they need respiratory support and is the rate rhythmical with no visible deformities
circulation - is the skin blue pink or pale? is HR and BP in normal ranges and is the capillary refill time okay
disability - are they alert/in a coma, and can they speak/do they have pain
Exposure - temperature, bleeding, catheters, chest drains
What appears black in xrays?
air
What appears white in xrays?
Fluid, as well as any other dense objects like organs, bones, and vessels
the more dense an object is, the brighter white it is
What appears shiny in xrays?
all metal
What are the A-Gs for performing chest xrays
Alignment - ensuring spinous processes are in the centre of the trachea
Bones - clavicles, spinous processes, scapulas, and ribs are all visible
Cardiac - heart is taking up 1/3 of the xray
Diaphragm - costophrenic right should be higher than the left due to liver position
Expansion @6th rib
Fields -hilum blood vessels
Gadgets - identify any foreign objects to rule out the pathology
How do you identify the first rib in an xray?
look for black semicircle formed above/on the clavicle, the first rib forms the outer rim of the circle
What is the ideal film positioning for an xray and why?
Posterior - Anterior film (Pt faces the xray film and away from the xray source
less magnification of the heart, so more bones and other soft tissue is visible
worst case anterior - posterior film is okay, if the Pt is unable to get into the PA position
What are the points for Auscultation
Apices of lungs (above clavicle)
Superior lobes (2-4th intercostal spaces)
Middle lobe/Lingula lobe (5th rib @midauxilary line)
Lower Lobe/Inferior Lobe (Mid clavicular line and below the inferior border of the scapula)
