Week 1 Flashcards
What is normal blood pressure
between 95/60 and 145/90 mmHg
what is hypertension
Over 145/90mmHg
normal respiratory rate
12-16 breaths a minute
What is Tachypnoea
Respiratory rate higher than 20 breaths a minute
What is Bradypneoa
Respiratory rate of less than 10 breaths a minute
What is pectus carinatum
pigeon chest - sternum protrudes anteriorly
What is pectus excavatum
funnel chest- sternum is depressed inwards
Normal temperature
36.5-37.5 degrees
What is SpO2
oxygen saturation
is an estimate of arterial oxygen saturation, or SaO2, which refers to the amount of oxygenated haemoglobin in the blood. Haemoglobin is a protein that carries oxygen in the blood
what is FiO2
Fractional concentration
stands for Fraction of Inspired Oxygen; it is a fraction of the amount of oxygen a patient is inhaling produced by an oxygen device such as a nasal cannula or mask. Different devices deliver different amounts of oxygen to the patient.
What is Dyspnoea
shortness of breath
What to include in your checklist for patient interview
Patient main problem dyspnoea cough, sputum, wheezing pain PMHx Function, Mobility SHx Specific question
What are the 5 main symptoms of respiratory disease
Dyspnoea Cough Sputum and haemoptysis Wheeze Chest Pain
What should be enquired about in regards to symptoms
duration
severity
pattern
associated factors
What can cause dyspnoea (short of breath)
anaemia
neuromuscular disorders
metabolic disorders
psychological factors - anxiety
Important information to gain for dyspnoea
duration - time since onset or duration of the present symptoms, frequency
severity - relative to the recent and past events, getting better or worse
pattern - seasonal or daily
associated factors- including precipitants, agg factors, eas factors, associated symptoms, positions of ease , distance mobilised, stairs
Characteristics of a cough
a cough is a protective reflex that can be caused by inflammation, irritation, habit or excess secretions. Coughing is a difficult symptom for patients to describe due to the fact that they don’t see it’s significance
What to include in your cough checklist
frequency
- daytime
- nocturnal
- after eating or drinking
- acute/chronic
Effectiveness
- weak/strong
- productive/non-productive
- pain affected
Quality
- wet/dry
- wheezy, raspy, bark like, tight
COMPARE CURRENT TO USUAL
What is haemoptysis
coughing up blood
complications associated with cough
fractured ribs
hernias
incontinence
embarrassing
What is sputum
excess tracheobronchial secretions cleared by huffing or coughing may contain -mucus -cellular debris -microorganisms -blood -foreign particles
Sputum checklist
quantity
- small, moderate, copious
- Tsp, tbls, 1/4 cup etc
Quality - consistency - thick think, watery plug colour -haemoptysis Odour COMPARE CURRENT TO USUAL
What to include in PMHx
Specific questions - smoking history (pack years) (if/when ceased) Alcohol consumption previous respiratory condition/infections - medication - precious Rx - including physio - hospitalisation
Incontinence
headaches
peripheral oedema
What special questions to ask
Post operatively
- nausea
- dizziness
- drowsy
- drowsy
- vomiting
- Pain
condition specific
Clubbing
common in chronic cystic fibrosis**
Note: clubbing disappears in CF patients after lung transplant
What is the Glasgow Coma Scale
Used for Neurological Observation
- Eye opening
- Best verbal response
- Best motor response
Which are the 4 ‘class’ of the New York Heart Association (NYHA) classification of breathlessness
Class 1 (mild) - No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
Class 2 (mild) - Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
Class 3 (moderate) - Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class 4 (severe) - Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.
What is the Borg Scale
RPE Scale Method
0-10 used for respiratory conditions
6-20 used for cardiac conditions - coincides with heartbeat (60-200)
What is a wheeze
A whistling or musical sound produced by turbulent airflow through narrowed airways.
What is Bradycardia
Heartrate
What is Tachycardia
Heartrate >100 beats/min
What is normal heart rate
60-‐100 beats/min
Chest pain in respiratory patients usually originates from
Musculoskeletal, pleural or tracheal inflammation
Cause of clubbing
Lung disease
Cardiac Disease
Other - like familial
What is cyanosis
Bluish discolouration of the skin caused by hypoxemia
- Increased haemoglobin not bound to oxygen
How to calculate Pack Year History
(cigarettes per day x years smoked) / 20 = # pack years
What is Subcutaneous emphysema
When gas or air is in the layer under the skin of chest wall
What is percussion
an assessment technique which produces sounds by the examiner tapping on the patient’s chest wall.
Normal aerated lung gives ‘resonance’
Consolidated lung sounds ‘dull’
What is fremitus
Vibratory tremors that can be felt through the chest by palpation.
What is Auscultation
The process of listening to and interpreting sounds produced in the thorax
Common causes of crackles heard through auscultation
Coarse, early inspiratory - Bronchiectasis - Bronchitis ***Coarse = when bronchioles open –Thought to represent the passage of a bolus of gas through a lightly closed, fluid filled airway, which opens intermitently when the upstream gas pressure rises
Fine, late inspiratory
- Pulmonary odema
- Pulmonary fibrosis
***Fine = when alveoli and respiratory bronchioles open
–Generated at the alveolar level by the sudden equalisation of gas pressure between 2 compartments – when a closed section of the airway suddenly opens
Causes of increased breath sounds
-Bronchial Breathing
Cause of decreased breath sounds
–Pneumothorax/haemothorax –Pleural effusions –Atelectasis –Hyperinflated –Decreased air entry –obesity
Expiratory wheezes only
- bronchospasm
- actue asthma
Inspiratory and expiratory wheezes
from airway obstructions ie oedema, foreign objects, mucous, tumours.
What to include in Ax
background information Medical chart
Bed chart
Subjective assessment
Physical assessment
What’s included in the meds chart
Important to ensure you have the correct paCents chart • This informaCon will guide assessment and treatment • Checklist – PresenCng condiCon – Past medical Hx – Social Hx – FuncConal Hx – InvesCgaCons – Medical Management – +/- Surgical notes or Special orders
What is included in bed chart
Busy chart •
Includes:
– Observation Chart – Medication chart – Pain chart
– Fluid balance
– Neurological – GCS
– Blood glucose sliding scale – normal 4-8mmol/L – Falls risk Ax
– Nursing care plans
what to consider with meds
MedicaCons • Lots of different medicaCons • Examples – Cardiac – Respiratory – Analgesic – AnCemeCc • Consider – Timing – Side effects
what to explore with pain
Checklist – At rest, with movement/cough – Area – Type • Sharp, dull, blunt – Severity • VAS – History
PMHx
Specific Questions – ask were relevant • Smoking History – Pack years – If/when ceased • Alcohol consumption • Previous respiratory conditions/infections – If any – MedicaCon – Previous Rx – including physio – Hospitalisation previously • Incontinence • Headaches • Peripheral oedema
pack year Hx
1 pack = 20 cigarettes
• Number of pack years = packs per day x years
• 1 pack smoked per day for 40 years = 40 pack yrs
• Or
• (cigarettes per day x yrs) / 20
• (15cigsx40yrs)/20=30packyears
functional ability
Important • Checklist
– ADL’s
– Employment/Hobbies – Exercise Tolerance
• Regular exercise
• Distance mobilised – Flat, incline, stairs
• Use of aides
– Inside home
– Community ambulaCon • Use of supplemental O2
– DuraCon of use – Mode of delivery
Special questions
• Post operaCvely – Nausea
– Dizziness – Drowsy – VomiCng – Pain
• CondiCon specific
Subjective Ax should include
patient's main problems dyspnoea Cough, sputum, wheeze pain PMHx function, mobility SHx Specific Questions
Objective
observation
auscultation
palpation
cough and sputum
what to include in observation - environment
environment -– Attachments • Oxygen – mode of delivery and concentration • IV lines and medications • Analgesia (PCA, epidural) • Indwelling catheter (IDC) • Nasogastric tube (NG tube) • Intercostal Catheter (ICC) • Wound drains
Oxygen
- Nasal prongs
- Hudson mask
- Non-rebreather mask
- Venturi mask
- High flow humidified oxygen • Endotracheal tube (ETT)
- Tracheostomy
Observation on the patient
– Posture – in bed/siTng – Facial expression – fa/gue, pain etc – Speech paEern (SOB) – Level of consciousness (GCS) – Body Shape – Muscle tone – Colour – cyanosed, flushed, pallor – Peripheral – clubbing, oedema – Jugular venous pressure (JVP) – Respiratory Rate (RR) – Pursed lip breathing
Observations - chest
– Shape
– Breathing pattern – Chest movement – Accessory muscle use – Paradoxical movements
What to include on palpation
• Hand placement – Bilaterally at ribs 7-10 – Antero-posterior at sternum and thoracic spine • Palpa/ng for: – Movement (quality, quan/ty, symmetry) • Bibasal expansion • Apical – Temperature – Fremitus – Subcutaneous emphysema
Auscultation
- Process of listening to and interpreting the sounds produced within the thorax
- Use to verify observed and palpated findings before and after treatment.
- “Breathe in and out through your mouth, slightly deeper than usual”
- Position – high sittng
- Stethoscope to skin contact
decreased breath sounds could be the result of
– Pneumothorax/ haemothorax – Pleural effusions – Atelectasis – Hyperinflated – Decreased air entry – obesity
added sounds include
- Wheezes
- Crackles (fine or coarse) • Stridor
- Rubs
- Transmitted sounds
- Surgical emphysema
Wheezes
- Generated by the vibration of the walls of a narrowed airway.
- Pitch is determined by the diameter and elasticity of the airway
- Expiratory wheezes – bronchospasm
- Inspiration and expiration wheezes – from airway obstructions ie oedema, foreign objects, mucous, tumours.
Crackles
• Discon/nuous, short, explosive sounds • Fine
– Generated at the alveolar level by the sudden equalisa/on of gas pressure between 2 compartments – when a closed sec/on of the airway suddenly opens
• Coarse
– Thought to represent the passage of a bolus of gas
through a lightly closed, fluid filled airway, which opens intermittently when the upstream gas pressure rises
cough and sputum
• Strength – Weak, fair, strong • Wet / Dry • Effective / non-effective • Productive / non-productive – Sputum expectorated (table 1.1 Pryor and Prasad page 4) • Quality • Quantity
