wk 1: respiratory impairment ax

Question 1

Steps

Answer 1

1. Pt Interview (P/I): Medical and Bed Chart
2. Physical Examination (P/E)
   - observe
   - palp
   - Auscultation
   - cough
   - sputum
   - Neural (LL)
   - Mobility
   - Specific Ax

Question 2

Patient Interview

¬ Patients Main Concern

Answer 2

o **Post-surgery concerns (Nausea, Dizziness, Drowsiness, Vomiting)
o **Epidural concerns (P&N, Numbness, Weakness, Heaviness, Headache)

Question 3

¬ Respiratory (P/I)

Answer 3

o 1) Breathlessness (WOB: Aggravating, Easing, Distance)
o 2) Cough (Frequency, Effectiveness, Productiveness, Quality)
o 3) Sputum + Haemoptysis (Quantity, Quality, Odour, Streaking/Haemoptysis)
o 4) Wheeze
o 5) Chest Pain (Rest, Movement, Cough, Area, Quality, Severity, History, Other MS Pain)

Question 4

¬ Specific Questions (ask when relevant)

Answer 4

o Asthma (Previous admission, ICU admission, Action plan/Management)
o COPD (Last exacerbation, Change in symptoms, Cough, Management)
o Diabetes (Type, Management, Sensation in feet)
o Ischaemic Heart Disease (Angina: History, Pain area, Precipitating factors, Exercise tolerance; Management)
o Peripheral Vascular Disease (Claudication, Sensation in feet, Management, Skin care)
o Recent URTI
o Smoking history (Pack years, If/When Ceased)
o Alcohol Consumption
o Incontinence

Question 5

Social Hx (P/I)

Answer 5

o Home situation (House, RACF)
o Level of assistance (Meals, Home carers, Neighbours)
o Access/Environment (Stairs/Railing)
o Hobbies

Question 6

Functional History (P/I)

Answer 6

o ADL’s, Employment, School, Hobbies

o Exercise tolerance (Regular distance: Flat, Incline, Stairs; Use of aids; Supplemental O2

Question 7

¬ Observation (top to toe)

P/E)

Answer 7

o	Oxygen
o	Nasogastric tube [NGT]
o	IV lines, medications
o	Analgesia (PCA, epidural, PCEA)
o	Monitoring
o	Intercostal catheter
o	Wound drains
o	Indwelling catheter [IDC]

Question 8

¬ GENERAL observation

P/E)

Answer 8

o	Position, posture
o	Facial expression
o	Speech pattern (SOB)
o	Level of consciousness
o	Attachments
o	Body shape
o	Muscle tone
o	Colour
o	Digital clubbing, peripheral oedema

Question 9

¬ Respiratory Observation

P/E)

Answer 9

o Respiratory rate
o Chest shape (Pectus carinatum, Pectus excavatum, Barrel chest)
o Breathing pattern (Movement & Symmetry: Upper-elevatory, Mid-flaring, Lower-expansion, Abdominal)
o Accessory muscle use
o Paradoxical movement (Intercostal drawing, Jugular notch, Hoover’s sign, Respiratory alterations)

Question 10

¬ Palpation: Chest

P/E)

Answer 10

o Hand placement:
♣ Bilateral, knuckles at ribs 7 to 10
♣ Or anterior at opening of subcostal angle HELPS WITH LABOURED BREATHING?
♣ +/- AP (sternum and thoracic spine)

o	Palpate:
♣	Movement and Symmetry (Bibasal expansion, Apical)
♣	Temperature
♣	Fremitus
♣	+/- Subcutaneous Emphysema