Respiratory - Assessments Flashcards
What is the rationale for “Sitting the patient up to increase lung expansion”
In doing this we are increasing ventilation hence increasing gas exchange in the lungs.
What are the 7 things that we can clinically observe when thinking about a patient with a respiratory issue?
Respiratory rate Breath sounds Accessory muscles Positioning Neurological changes Skin Sputum
What are we observing in terms of the Respiratory rate when we are assessing a patient?
Tachypnoea/bradypnoea Orthopnoea Dyspnoea and Rhythm & Depth
What is Tachypnoea?
abnormally rapid breathing.
What is bradypnoea?
abnormally slow breathing.
What is orthopnoea?
Orthopnea is the sensation of breathlessness that affects a person when they are lying down and subsides in other positions, such as standing or sitting up.
What is Dyspnoea?
difficult or laboured breathing that is self reported by the patient
What types of breath sounds are we listening for during a respiratory assessment?
Wheeze Crackles Stidor (a harsh or grating sound) Reduced air entry Cough
What are the accessory muscles that we are observing during a respiratory assessment?
Sternocleidomastoid Scalenes Trapezius Pectoralis minor/major Abdominals
What 3 things are we assessing under “positioning” when doing a repiratory assessment?
Upright - What is the patient breathing like when they are sitting upright
Tripod - What is the patient breathing like in this position
Chest symmetry - Palpation of the chest expansion during breathing + general observations
We should also be observing which position are the patient is naturally resting in.
What are some neurological changes that we may observe in a patient with a respiratory problem?
Anxiety, agitation, confusion, drowsiness, and pain.
Why might a patient with respiratory distress be experiencing neurological issues?
Their may not be enough Oxygen going to the brain
What factors related to the skin are we assessing during a respiratory assessment?
Diaphoresis Pallor Cyanosis Flushing and Digital clubbing
If we notice cyanosis what is an important factor to assess?
Cyanosis is the blue tinging of the skin so assess capillary refill of peripherals.
What type of factors are we assessing when looking at sputum?
Colour, odour, and haemoptysis
What is the acronym we use to assess the 5 Signs of respiratory distress?
DiapHRaGM
Diap = Diaphoresis (clammy) H = Hypoxia Ra = Respiratory rate (above 24 is a strong clinical indication) G = Gasping (Where RR starts to drop) M = Accessory muscle use (are both sides of the chest moving equally?)
What are the 4 things we can clinically measure with a respiratory patient?
- Respiratory rate, depth and pattern
- Work of breathing (WOB)
- Peak flow measurement
- Specialist tests
What is a peak flow measurement test?
Peak flow is a simple measurement of how quickly you can blow air out of your lungs. Normal adult peak flow scores range between around 400 and 700 litres per minute
What can we use a peak flow measurement for?
as a baseline and to measure the effectiveness of interventions (useful for diagnosing asthma)
What are 4 specialist tests used for assessing the respiratory system?
CXR
Spirometry
CT/MRI
ABG
What is a CXR test?
Chest X-Ray
Chest X-rays produce images of your heart, lungs, blood vessels, airways, and the bones of your chest and spine. Chest X-rays can also reveal fluid in or around your lungs or air surrounding a lung
What is a spirometry?
Spirometry is the most common of the pulmonary function tests. It measures lung function, specifically the amount and/or speed of air that can be inhaled and exhaled
What is a CT?
A CT scan, also known as computed tomography scan is a medical imaging technique used in radiology to obtain detailed internal images of the body noninvasively for diagnostic purposes.
What is an MRI?
Magnetic resonance imaging is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body.
What is an ABG?
An arterial blood gas (ABG) test measures the oxygen and carbon dioxide levels in your blood as well your blood’s pH balance.
What is involved in the rapid assessment?
A - Airway B - Breathing C - Circulation D - Disability E - Environment
Thinking about the rapid assessment, what do we assess under the “A”
Patency
Is the patients airway open?
Is there any obstruction? (partial or complete)
Is the patient under any respiratory threat?
What does patency mean?
the quality or state of being open or unobstructed evaluating arterial patency.
What are some causes of obstruction?
Issues with the tounge Vomit Issues with the Epiglottis Uvulitis Secretions Inflammation Neurological impairment Or a Foreign body
What are the two main classes of interventions for “Airway” with the aim of: ensuring airway patency and allowing for maximum air entry
Positioning and Clear secretions
Whats involved in the intervention: positioning - for a patient in respiratory distress?
- Maintain head and neck alignment (chin tilt and jaw thrust)
- Consider elevating head of bed/side positioning in OSA
- Recovery position `
These are done to ensure airway patency and allow for maximum air entry
Whats involved in the intervention: clearing secretions - for a patient in respiratory distress?
- Encourage airway clearance with coughing
- Consider suctioning (if the pt cant cough it up on their own)
- Promote hydration to thin secretions for expectoration (spitting)
This is done to ensure airway patency and allow for maximum air entry
Threat to a patients airway patency = what?
A threat to their life
Thinking about the rapid assessment, what do we assess under the “B”
General appearance, positioning, level of activity, chest, supplemental oxygen use, posterior chest auscultation, and percussion.
What are we looking for under general appearance for breathing?
WOB: Rate, depth, pattern, accessory muscle use, nasal flaring/pursed lips, and cough
Colour and moisture of skin
What are we assessing for in terms of positioning and the patients breathing?
Supine/erect (Whats their breathing like in these positions) Tripod position (whats their breathing like in this position)
What do we assess under “chest” in terms of the patients breathing?
AP- anterior-posterior measurement: meaning from front to back
Symmetry
Paradox - diaphragm moves in the opposite direction than it should when you’re inhaling and exhaling.
What do we assess under “Level of activity” in terms of the patients breathing
What the patient is doing (are they able to preform usual tasks or not)
What do we assess under “Supplemental oxygen use” when considering the patients breathing?
Is a Nasal cannula being used?
Is Airvo being used?
Is a CPAP/BiPAP machine being used?
What is involved in “Posterior chest auscultation” in terms of assessing the patients breathing?
Air entry, quality of breath sounds, wheezing, crackles, and adventitious sounds.
What is involved in “Percussion” in terms of assessing the patients breathing?
Resonance, hyper resonance, and dullness
What are the 6 main classes of interventions for “Breathing” with a patient with respiratory distress?
Positioning, cough techniques, administering prescribed medications, physiotherapy referral, secretions, and anxiety reduction
Whats involved in the intervention “Positioning” for the patients breathing?
Sitting the patient upright
Supporting the patient with pillows if required
Mobilise as able
Regular turns/repositioning
These are done to maximise air entry to enable optimal gas exchange
Whats involved in the intervention “Cough techniques” for the patients breathing?
Huff coughing
Incentive spirometry
Deep Breathing
These are done to maximise air entry to enable optimal gas exchange
Whats involved in the intervention “Administer prescribed medications” for the patients breathing?
Bronchodilators (inhalers with spacer) and Provide Oxygen.
This is done to maximise air entry to enable optimal gas exchange
Whats involved in the intervention “Physio Referral” for the patients breathing?
Patient education and to loosen secretions.
This is done to maximise air entry to enable optimal gas exchange.
Whats involved in the intervention “Secretions” for the patients breathing?
Promote hydration to thin secretions and consider humidification of O2.
This is done to maximise air entry to enable optimal gas exchange.
Whats involved in the intervention “Anxiety reduction” for the patients breathing?
Education and reassurance to reduce respiratory effort and an SNS response. I.e to maximise air entry to enable optimal gas exchange.
