W1: MC Flashcards
Define Acute Care
Short-term, specialised care provided in a hospital setting to restore & maintain health
Examples include: ICU, ED, neurological, respiratory, maternity, paeds & aged care
The acute cardiorespiratory team includes patients who are:
- Pre/postoperative
- Have respiratory disease eg COPD, cystic fibrosis, etc
- Are in the ICU/HDU (acute trauma, post-surgical or medical respiratory dysfunction eg haemodynamically unstable)
What is the aim of an acute assessment?
- Seek information eg from medical chart, nursing staff, relatives or carers, ward rounds, medical chart review
- Ask questions
- Do our assessment
Who is weight bearing status particularly important for/who determines it?
Particularly important for people who have had orthopaedic procedures or fractures & determined by surgical team
Define the following weight bearing status:
- NWB: non-weght bearing
- Partial weight bearing
- Touch weight bearing
- Weight bear as tolerated
- NWB: 0%
- PWB - 50%
- TWB: light touch only for balance
- WBAT: as much as needed/no restriction
What is important to address prior to conducting a subjective assessment?
- Introduce yourself /state why you are there
- Obtain consent
- Determine if patient is oriented to time and place
- Start with open ended questions
- Allow the patient to discuss what problems are important to them at the time
What is included in a subjective assessment?
History of presenting condition
Past medical history
Medications
Home environment
Mobility & function
What special questions should be covered?
CSD WHS HC
Cough
Sputum
Dyspnea
Wheeze
Hemoptysis
Smoking history
Home oxygen
Chest pain
Particularly for respiratory presentations what else should be covered:
- Pain
- Falls
- Previous physio intervention
What is a cough?
What should you ask a patient about their cough?
What should you assess in a cough?
A protective reflex that rids the airways of secretions, particulate matter or foreign bodies (can be chronic or acute)
Baseline (do they normally have a cough) & do they cough up sputum
Strength, sound quality (eg dry or moist) & secretion clearance (productive or non-productive)
Healthy adults produce up to how much sputum?
100mL of tracheoronchial secretions each day
What should you ask a patient about their sputum?
Baseline (do they normally cough-up sputum)
The colour (can indicate disease severity)
Volume: how much can they cough up?
Viscosity: how thick are the secretions? Do they need interventions to do so eg nebuliser or can they do it independently
Saliva: description
Clear watery fluid
Mucoid: description & causes
Description: Opalescent or white
Cause: Chronic bronchitis without infection, asthma
Mucopurulente: description & causes
Description: Slightly discoloured, but not frank pus
Cause: bronchiectasis, cystic fibrosis or pneumonia
Purulent: description & causes
Thick viscous
- Yellow
- Dark green/brown
- Rusty
- Red currant jelly
Causes: haemophilius, pseudomonas, pneumoccus, mycoplasma & kiebsiella (bacterial infection)
NOTE:
The term “purulent” describes a type of discharge or fluid that contains pus. Pus is a thick, viscous fluid that results from the body’s inflammatory response to infection. It’s typically yellow, green, or brownish, depending on the type of infection and the specific bacteria involved.
Frothy: description & causes
Pink or white
Cause: pulmonary oedema
Hameoptysis: description & causes
Description: ranging from blood specks to frank blood, old blood (dark brown) - essentially involves coughing up blood
Causes: Infection (tuberculosis, bronchiectasis), infarction/cardiac disease, carcinoma, vasculitis (damage to blood vessels), trauma & coagulation disorders.
Black: description & causes
black specks in mucoid secretions
Causes: smoke inhalation (fires, tobacco, heroin), coal dust
Definition of shortness of breath (ie dyspnoea)
Defined as an uncomfortable and abnormal awareness of breathing
True or false: shortness of breath is pathological if it occurs disproportionate to actiivty/conditions
True
What should you ask a patient about their SOB?
Onset (what causes the SOB?), duration, aggravating and easing factors and quantify the level of breathlessness
What scale is used to quantify dyspnoea?
The modified borg dyspnoea scale
Define a wheeze and what does it indicate?
A whistly sound caused by narrowing of the airways during expiration. Typically indicates an airway obstruction
What may an obstruction in a wheeze be due to?
Bronchospasm (asthma), oedema (heart failure), sputum or foreign bodies
What do the different types of wheezes indicate?
High pitched wheeze = near total obstruction
Fixed monophonic wheeze = single obstructed airway
Polyphonic wheezes (multiple) = widespread narrowing
Localised wheeze = sputum retention
What should you ask a patient about their wheeze?
Baseline
Duration
Aggravating and easing factors
What is haemoptysis?
Presence of blood in sputum
What is frank vs isolated haemoptysis?
Frank = significant amounts of blood. Can be life threatening and may require bronchial artery embolisation/surgery.
Isolated (tinged or streaked) = May be the initial sign of bronchogenic carcinoma
True or false: patients with chronic infective lung diseases may suffer from recurrent haemoptysis?
True
What is the relationship between smoking and cancer?
Linear
What should you determine regarding smoking for a patient?
Work out their pack year smoking Hx (packs/day x years smoked)
Need to ask about: history ie have they ever smoked?, duration, amount, cessation
Vaping: studies have suggested…
What should you ask about?
Multiple pro-inflammatory effects on the respiratory system increased airway resistance, impaired response to infection and impaired mucociliary clearance
Device & frequency
Home oxygen supplementation
- Prescribed by?
- Must not have been smoking for?
- Need to ask patient about?
- Respiratory specialist
- 4 weeks
- Time, dosage, etc
Where does chest pain generally originate from?
- Musculoskeletal, cardiac, pleural or tracheal inflammation
Chest pain: what is stable angina?
Discomfort that comes on with activity and dissipates with rest
Chest pain: what is unstable angina?
Discomfort that comes on with increasing activity that does not abate with rest?
Chest pain: myocardial infarction: define
Chest pain where areas of the lung experience death due to inadequate oxygen supply.
What should you ask a chest pain patient about?
Onset (how long have they had it, have they had it previously?) & location (where is the pain - is it localised or referred?
Major signs of heart attacks in women vs men
Women: chest pain, nausea, pain or discomfort in jaw/neck/back, pain or discomfort in the arm/shoulder & shortness of breath
Men: Chest pain, pain or discomfort in arm/shoulder & SOB
Difference: men don’t have nausea and pain in the jaw/neck/back
In a bed side assessment what observations are made
Note: step 1 of a bed side assessment is observation.
Includes identifying potential hazards, patients position & appearance, interaction with the environment, equipment and patient monitoring
What are the vital signs?
Respiratory rate
Heart rate
Blood pressure
Temperature
Oxygen saturation
Consciousness
Respiratory rate (Vital signs)
- What is it?
- Normal
- Other classifications
- Number of breaths a person breaths per minute
- 12-20 breaths/minute
- Tachypnoea: rapid breathing & bradypnoea: slow breathing
Heart rate (pulse rate) - Vital signs
- What is it?
- Normal
- Other classifications
- How many times the heart beats per minute
- 60-100bpm (adults)
- Tachycardia (>100bpm ie fast heart rate), Bradycardia (<60bpm ie slow heart rate)
Blood pressure (vital sign)
- What is it?
- Normal
- Other classifications
- Indicates the pressure of the blood moving through the arteries as the heart pumps blood throughout the body
- 120/80 or 130/85
- Hypertension (>140/90): increase in blood pressure which may mean your heart is working hard to deliver oxygenated blood to key organs
- Hypotension (<90/60): decrease in blood pressure which may mean the pumping pressure of the heart is not sufficient to deliver key organs with oxygenated blood
Temperature (vital sign)
- What is it?
- Normal
- Other classifications
- A measure of how well the body can make and remove heat
- 36.5-37.2
- Hypothermia (< 35 degrees), hyperthermia/fever (high temp - may indicate infection)
O2 sat (Vital sign)
- What is it?
- How is it measured
- Normal
- Severe level?
- Provides an indication of the amount of 02 in a patients blood. Measured with pulse oximetry
- 95-100%
- <90% is very severe and requires urgent medical review
Consciousness (Vital sign)
- What is it?
- how is it assessed?
- Indication of neurological function
- Assessed with ACVPU or glasgow coma scale
Consciousness (vital sign): ACVPU - What is it?
- Alert: is the person awake and responsive?
- Confusion: can they answer simple questions or are they confused and disoriented?
- Voice: do they response to voice, either verbally or physically?
- Pain: do they respond to physical stimulus
- Unresponsive: is the person unconscious
**ANYTHING less than an A is a problem. Seek medical help
Consciousness (vital sign): Glasgow Coma Scale. What are the 3 behaviours? What is the best response/comatose client or totally unresponsive classified as?
- Eye opening, best verbal response, best motor response
- Best response = 15, comatose client = 8 or less and totally unresponsive is less than 3
Ideally where should vital signs fall within?
The white part of the graph. Yellow is a warning ie increased concern, doctor should come review, and red = deteriorating
What is included in an objective assessment?
Active/passive ROM
Muscle length
Muscle strength
Neurological assessment
Functional eg bed mobility, sit to stand, stairs, walking, etc
**Required to determine level of assistance required, need for any equipment, treatment goals, provide recommendations to nursing/allied health & to plan for discharge
