Special Questions in Assessment

Question 1

Cough

Answer 1

A protective reflex that rids the airways of secretions, particulate matter or foreign bodies.
Patients may have a chronic cough or an acute cough – various causes
Need to ask the patient about:
Baseline – Do they normally have a cough
Productivity- Do they normally cough up sputum?

Cough Assessment:
Strength: weak, moderate, strong
Sound quality: dry or moist
Secretion clearance: productive or non-productive (NP) – if productive, can comment on volume & viscosity

Question 2

Sputum

Answer 2

Healthy adults produces up to 100 mL of tracheobronchial secretions each day
When someone is unwell or has a chronic respiratory condition, they may produce excess tracheobronchial secretions which need to be cleared from the lungs by coughing/huffing
Need to ask the patient about:
Baseline – Do they normally cough up sputum?
The colour: can indicate disease severity
Volume: how much is someone able to cough up? Estimate using tablespoons/teaspoons, how many time a day
Viscosity: how thick are the secretions? Is someone able to cough up the secretions independently? Or do they need some interventions to help? Nebulisers, Physiotherapy ect.

Question 3

Shortness of breath (SOB/dyspnoea)

Answer 3

Defined as an uncomfortable and abnormal awareness of breathing
“I can’t get air in”, “I feel breathless”
Pathological if it occurs disproportionate to activity/conditions
Can occur during activity or at rest, or even in different positions (lying down)
Need to ask patient about:
Onset – what causes SOB
Duration – how long does it last?
Aggravating and easing factors- What makes it worse? What makes it better?
Quantify the level of breathlessness
Modified borg scale used to quantify SOB

Question 4

Wheeze

Answer 4

A whistly sound causes by narrowing of the airways during expiration
Often indicates airway obstruction
Obstruction may be due to bronchospasm (asthma), oedema (heart failure) sputum, foreign bodies.
High pitched wheeze = near total obstruction
Fixed monophonic wheeze = single obstructed airway
Polyphonic wheezes (multiple) widespread narrowing
Localised wheeze = sputum retention
Need to ask patient about:
Baseline – Do they normally have a wheeze?
Duration – is it constant or intermittent? How long does it take to settle down
Aggravating and easing factors- What makes it worse? What makes it better?

Question 5

Haemoptysis

Answer 5

Refers to the presence of blood in the sputum.
Frank haemoptysis (significant amounts of blood) can be life threatening that may require bronchial artery embolisation or surgery
Isolated haemoptysis (tinged or streaked) may be the initial sign of bronchogenic carcinoma
Patients with chronic infective lung diseases may suffer from recurrent haemoptysis (e.g. CF, bronchiectasis)
Need to ask the patient about:
Baseline – Do they normally have haemoptysis?
Volume: How much have they coughed up?

Question 6

Vaping

Answer 6

Real concern: Accessibility, Frequency, Incorrect labelling of ingredients
E-cigarette or Vaping Use-Associated Lung Injury (EVALI)- idiopathic lung injury
Studies have suggested multiple pro-inflammatory effects on the respiratory system increased airway resistance, impaired response to infectionand impaired mucociliary clearance. (Jonas, 2022)

Need to ask the patient about
Device: What device are they using?
Frequency: How many times a day?

Question 7

Smoking status and history

Answer 7

Patients may be current smokers or a previous smoker
There is a linear relationship between pack years and risk of cancer
Approx 20 cigarettes in a pack
Work out their pack year smoking Hx ( = pck/day x years smoked)
2 pck/day for 30 years= ?
Need to ask the patient about
History: Have you ever smoked?
Duration: How long for?
Amount: How many cigarettes a day?
Cessation: When did you stop?

Question 8

Home oxygen (O2) supplementation

Answer 8

Many patients with chronic respiratory disease may need to have continuous or intermittent oxygen supplementation at home to help with breathing.
Prescribed by respiratory specialists
Patients must not have been smoking for a minimum of four weeks. Requirement that patients should continue not to smoke
Safety and effectiveness of treatment

Need to ask the patient about:
Time: How long have they been on home oxygen for?
Dosage: How many litres and hours do they require home oxygen for?
Ie: 2L for 16 hours a day.

Question 9

Chest Pain

Answer 9

Chest pain in usually originates from musculoskeletal, cardiac, pleural or tracheal inflammation
Stable angina: discomfort that that comes on with activity and dissipates with rest.
Unstable angina: discomfort that comes on with increasing activity that does not abate with rest
Myocardial infarctions (heart attacks): chest pain where areas of the lung experience death due to inadequate oxygen supply.
Need to ask the patient about:
Onset: How long have they had it for? Have they had it previously?
Location: Where is the pain? Is it localized or referred?

Question 10

What 4 main areas form the problem list for acute care?

Answer 10

Oxygen (O2) movement impairment eg: positioning, breathing exercises, walking

Carbon Dioxide (CO2) movement impairment eg: relaxation, breathing exercises

Secretion Clearance impairment eg: breathing exercises (ACBT), devices, manual percussions/vibrations, walking

Mobility impairment eg: strength exercises, functional retraining and walking,