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PHTY205 > Wk 11: Clinical Reasoning > Flashcards

Wk 11: Clinical Reasoning Flashcards

1
Q

how do we ascertain patient sings & symptoms ?

A
  1. history taking (subjective exam)
  2. physical assessment (objective exam)
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2
Q

SUBJECTIVE EXAM
what do you consider ?

A

patients status
e.g.
- pre-op, post op
- inpatient, outpatient
- planned admission, via ambulance/ ED

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3
Q

SUBJECTIVE EXAM
What do the details depend on?

A

information obtainable from other sources, e.g. medical records, admission notes etc

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4
Q

SUBJECTIVE EXAM
components

A

HPC, PMHx, Soc Hx, Meds, Ex tol, etc

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5
Q

SUBJECTIVE EXAM
what are you questionning for?

A

cardioresp symptoms

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6
Q

OBJECTIVE EXAMINATION
components

A

– (Nursing/bedside charts)
– Observation
– Palpation
– Auscultation
– Cough
– Spirometry (if appropriate)
– CXR (review CXR + read report if available)
– Interpret investigations/other information

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7
Q

Investigations that inform our CR

A
  • Thoracic imaging – CXR, CT, MRI, CTPA
  • Pulmonary function testing
  • Arterial Blood Gases
  • Blood tests
  • Sputum culture (+ nasopharyngeal aspirates)
  • Bronchoscopy
  • Respiratory muscle strength
  • Exercise testing
  • Sleep studies
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8
Q

what are other cardiac investigations?

A

12 lead ECG
myocardial perfusions scans, exercise stress testing

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9
Q

other neurological investigations?

A
  • EEG (measures electrical activity in the brain)
  • nerve conduction testing
  • intracranial pressure (ICP)
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10
Q

other skeletal investigations

A

PET scans , BMD scans

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11
Q

what does a sputum M/C/S identify?

A

pathological organisms in sputum in order to direct appropriate therapy

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12
Q

what are some examples of pathological organisms in sputum?

A

– Bacterial pathogen causing infection
* Pneumonia
* Cystic fibrosis & bronchiectasis
– Fungal infection
– Tuberculosis (TB)
* 3 consecutive samples to be negative for acid fast bacilli

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13
Q

what does “M/C/S” stand for?

A

microbiology, culture, and sensitivity

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14
Q

how do you induce sputum?

A
  • Inhale hypertonic saline to 7% in order to facilitate
    the production of a sputum sample
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15
Q

what is induced sputum used for?

A

diagnosis of TB or Pneumocystis Carinii Pneumonia (PCP)

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16
Q

what are naso-pharyngeal samples used to identify?

A

– Influenza types (influenza A, H1N1)
– Respiratory Syncytial Virus (RSV), or
– Bordetella pertussis (whooping cough)

17
Q

what is a bronchoscopy test

A

invasive test done under GA / sedation

18
Q

how is a bronchoscopy conducted?

A

Bronchoscope is passed down the trachea into the
large airways

19
Q

how can a bronchoscopy be used?

A
  1. diagnostically
  2. therapeutically
20
Q

how can a bronchoscopy help with diagnosis?

A

– Visualise airway anatomy
– Look for airway inflammation, malignancy, secretion
retention, reasons for unexplained, chronic cough
– Enable fine needle biopsy

21
Q

what is Bronchoscopic alveolar lavage (BAL)?

A

a procedure done during a bronchoscopy for therapeutic purposes. (saline washes the airway and is then sucked in by the tube)

22
Q

what meds for asthma

A

bronchodilators

23
Q

COPD meds

A

bronchodilators + steroids (inhaled, IV)

24
Q

CF meds

A

drugs that change rheology of sputum, hypertonic saline
(can also fit onto some airway clearance devices)

25
Q

post-op patients: meds

A

analgesics

26
Q

how do you measure a patient’s participation restriction (ICF)?

A

QoL measures

27
Q

how do you measure a patient’s ICF activity limitations

A

activity measures

28
Q

how do you measure a patient’s ICF impairments?

A

o Reduced Gas Movement
* O2 movement +/- CO2 movement
o Reduced Secretion Movement
* MCC +/- Cough (air flow clearance)

29
Q

treatment goals

A
  • Reversal of impairment
    – Eg, to increase O2
    gas movement to the left lower lobe
  • Signs and symptoms (compensatory)
    – Eg, to reduce breathlessness
  • Prophylactic
    – Eg to prevent postoperative pulmonary complications
30
Q

Rx options to improve gas movement

A

– Deep breathing exercises
– Positioning (specific and upright)
– Exercise/mobilisation

31
Q

Rx options to improve secretion movement

A

– GAD / MGAD
– Percussion/vibration/shaking
– PEP & OPEP devices
– FET, ACBT
– Cough/huff (+/- wound support/overpressure)
– Exercise/mobilisation

32
Q

Rx options to relieve dyspnoea/improve respiratory muscle function

A

– Relaxed breathing
– Positioning (eg LFP, upper limb bracing)
– Purse Lips Breathing

33
Q

patient & carer education with Rx

A

– Pre-operative education
– Discharge planning
– Exercise prescription

34
Q

what do you assess in Rx?

A
  • effectiveness of Rx (reversal of impairments)
  • other patient problems e.g. participation restriction/ activity limitation

PHTY205 (5 decks)

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