Week 8 - Basic CR Assess./Impairments Flashcards
Major CR assessments, Vital signs, Resp. signs/symptoms, Objective exam,
3 main parts to a CR Assessment
pre-interview, subjective exam, + objective exam
Info gathered in the pre-interview
-Current/past history
-Social history (smoking, occupation, social support)
Meds
-Present condition (lab reports- ABG’s[pao2, HCO3 etc.], vitals, cardiac test, CXR)
-Provisional Diagnosis(PDx)- brief summary of condition by DR.
-Plan
Subjective exam info
Gain details on history + symptoms (something that the patient experiences, complains of or feels)
Objective exam info
Provides a group of signs (a physical manifestation of a disease/obj. measure)
- Ventilatory support/SaO2, Observation, Palpation, Auscultation, Cough, CXR, Spirometry, ABG’s
Ventilatory Support + SpO2
What needs to be assessed & what should we note when measuring Sp02
Assess’ need for oxygen therapy/define resp. impairments
When measuring Sp02 always note: level of oxygen/type [N/p or mask]
Sign: SpO2 (range, what is it, how is it measured)
- 95-100%
- Measures % of HB that is bound w/ O2 & the O2 carrying capacity of blood
- Measured via pulse oximeter (Sp02) or blood sample (Sa02)
Observation (Face)
Level of consciousness
Expression (pain/distress)
Colour
Cyanosis (colour of face)
What is the symptom + what is it caused by + what does it correlate with?
Blue-ish appearance of skin/mucus membranes
- Caused by low 02 in tissues near skin surface, correlates w/ low Sp02 (<85%)
Observation (Body- posture)
supine, SOOB, leaning fwd., RIB(resting in bed)
HR ( normal range/comments)
- 60-100bpm
- > 100 = tachycardia
- <60 = brachycardia
BP (normal range)
- 100-140 (SBP)
- 60-90 (DBP)
High BP
> 140/90 - hypertension
Low BP
< 100/60 - hypotension
RR (normal range/comments)
- 12-16 b/min
- High (tachypnoea) (>20breaths/min) - rapid/shallow breaths
- increased RR + depth = Hypernoea - rapid/deep breaths, hyperventilation
Temp (normal range)
36.5-37.4 (afebrile)
Low grade fever
37.5-38.2
Febrile
fever - indicates infection
High grade fever
> 38.2 febrile
Observation- Chest wall shape:
Normal/Barrel(rib cage staying partially expanded due to COPD)
Pigeon(middle chest sticking out) / funnel (caved in chest)
Scoliosis/kyphosis
Observation (Breathing pattern + Rate)
consequences of rapid/shallow breathing = decreased alveolar ventilation (decreased fresh gas reaching alveoli + increase in old gas remaining in lungs)
decrease Pa02, increased PaC02
Observation (Fingers-Peripheral Cyanosis)
Symptom + causes
Blue-ish fingers/toes
Causes: low O2 saturation or inadequate circulation (low CO/DVT)
Observation (Fingers- Clubbing)
Symptom/what is it/what is it commonly seen in
Nail bed (Concave–> convex)
- Bulbous enlargement of the soft tissue of terminal phalanx of the digit.
- Commonly seen in diseases of heart + lungs that result in less O2 in the blood.
Observation (Peripheral Oedema)
What causes it/what is it a sign of?
Observable swelling from fluid accumulation in body tissues
- Peripheral/pedal (lower body swelling) + sacral(in the back) oedema can be a sign of R sided heart failure.
Objective (Palpation)
- Movement pattern/what else do you palpate?
Common breathing: (compare L/R)
- Lateral Basal Expansion (LBE)
- AP movement
- Abdominal movement
Trachea (secretions vibrating thru chest wall
Accessory mm use (palpable/tactile fremitus)
Auscultation (Normal Breath Sounds)
Mechanism/where is it heard/sounds/inspiration
- Mechanism: Airflow in the trachea/larger airways, lessened by lung tissue in periphery.
- Heard over the chest wall
- Sounds: soft, low pitched / quieter as you descend the lungs
- Inspiration is longer(2x) + louder than expiration
Auscultation (Bronchial Breath Sounds)
Mechanism/sound/normal v abnormal
- Mechanism: movement of air in/out of trachea/larger airways.
- Sound: Loud, harsh, high-pitched, hollow (present on inspir./expir.)
- Normal when heard over tracheal wall
- ABNORMAL when heard over chest wall (lung tissue getting consolidated)
Auscultation (Normal breath sounds abnormally transmitted [decreased])
Mechanism/sound/interpretation
- Mechanism: decreased gas flow causes less sound/ increased sound in periphery [something blocking]
- Sound: decreased volume/intensity of normal BS
Auscultation (Normal breath sounds abnormally transmitted [NO breath sound])
Mechanism
- Mechanism: localised accumulation of air or fluid in the pleural space OR bronchus supplying an area of lung is obstructed..
Auscultation (Normal breath sounds abnormally transmitted [BBS])
Why does it happen? + sound
- Tissues between the central airways + the chest wall are altered so that they conduct sound very well.
- Sound: loud, harsh, + hollow (preset on inspir/expir. w/ gap in betw)
Auscultation (Wheeze)
Mechanism/sound
- Mechanism: Oscillation or vibration of airflow thru narrowed opposing airway walls.
- Sound: Continuous, high/low pitches musical tones.
More pronounced on expiration (takes longer to expire out)
Auscultation (Crackles)
Sounds + early/late
- Sounds: popping, crackling sound, discontinuous
More common on INSPIR.
early - bronchioles open
late - resp. bronchioles + alveoli open.
Fine crackles interpretation
Atelectasis (partial lung collapse)
Fibrosis
Interstitial pulmonary oedema (fluid accumulates in the air sacs of the lungs)
Oedema
Coarse crackles interpretation
Presence of secretions in airways
Resolving pneumonia
Pulmonary Oedema
False crackles interpretaiton
Subcutaneous emphysema
Stethoscope moving across hair on skin
Auscultation (Upper Respiratory Tract/Transmitted Noises (URTNs)
Mechanism/sound/interpretation
- Mechanism: Air moving past secretions in the upper airways, which is transmitted throughout the chest wall
- Sound: Loud crackling, bubbling noise
- Interpretation: Excessive/ retained secretions in upper airways
Auscultation (STRIDOR)
Mechanism/sound/interpretation
- Mechanism: obstructed trachea/larynx
- Sound: Inspiratory noise heard loudest over trachea / heard via steth.
- Interpretation: MEDICAL EMERGENCY - UPPER AIRWAY OBSTRUCTION
Objective (Cough)
Types
- Moist v dry: tells us about secretions in airway
- Strong v weak: Weak due to resp. mm/pain
- Effectively expel?
- Productive of sputum: colour, volume, viscosity.
Lung movement (secretion)
Cough, mucociliary clearance
Gas movement (secretion)
CO2 movement, O2 movement
Paradoxical breathing (Hoover’s sign)
Causes the chest to contract during inhalation + expand during exhalation (normal breathing does the opp.)
Intercostal in-drawing (retraction/recession)
Due to partial blockage in the upper airway/small airways in lungs + air can’t flow freely, pressure in this part of the body decreases.
Pursed lip breathing
Increases use of diaphragm + decreases accessory mm recruitment
- Though to prevent tightness in airway by providing resistance to expiration.
Tracheal tug
Downward pull of the trachea/larynx
Midline laparotomy
Abdominal surgery, impacts use of abdomen when breathing
Thoracotomy
Opening into thorax, unable to sit upright, may cut into intercostals, making it painful on movement of ribcage.
Tactile fremitus
Secretions vibrating thru the chest wall - reduced secretion movement
Interpretation of (Normal breath sounds abnormally transmitted [decreased])
- Interpretation: shallow breathing, incomplete blockage of airway, atelectasis (partial lung collapse), hyperinflation, pleural abnormalities (effusion, thickening, pneumothorax)
Interpretation of (Normal breath sounds abnormally transmitted [NO breath sound])
- Interpretation: segmental/total lung collapse, pleural abnormalities, carcinoma (cancer that begins in tissue that lines the inner or outer surfaces of the body) /large sputum plug.
Interpretation of (Normal breath sounds abnormally transmitted [BBS])
Interpretation:
-Consolidation or large mass
large cavity
- UL collapse (w/ bronchus open/obstructed)
-LL collapse (only when bronchus is still open to transmit -the sound)
Interpretation of Wheeze:
- Interpretation: secretions, bronchospasm, oedema, tumour/foreign bodies.
Mechanism of fine crackles:
- Mechanism (Fine): Sudden opening of closed small airways + alveoli on inspir., after collapsing due to fluid/lack of aeration during expir.
Mechanism of coarse crackles:
- Mechanism (coarse): Movement of air bubbles thru secretions.
