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27 Cards in this Set
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clinical manifestations and assessment of respiratory disease A and P by Rogier Egans Wilkens assessment in respiratory care |
Wilkins clinical assessment in RC Chapter 2 and 3 plus questions Egans chapter 15 |
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REviewing the medical record |
Admitting Dx CC(chief complaints) Med Hx Labs Tx Regimen SOAP subjective, objective, assessment, plan |
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SOAP |
Subjective information :what patient or family tells you Objective :What you see, hear, feel (tactile) :observe, measure Assessment :What you understand and think regarding input :derived from the S + O Plan :What course of action based on input :what is the treatment regimen
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Soap |
Eupnea, normal breathing Dyspnea, shortness of breath
Orthopnea, difficulty breathing lying down Platypnea, difficulty breathing sitting up Tachypnea, increased rate of breath, over 20 Bradypnea, decrease rate of breath, less than 10
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4ps |
Pain, position, potty, personal belongings
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Patient interview |
Review H and P, history and physical before you interview :if available Don't Interrupt: Don't be interrupted Privacy :door, curtain closed Listen to what they say Look professional
Smile Don't appear rushed Make eye contact :use cultural awareness Introduce yourself, purpose of visit :use Mr. or Mrs. (Ms.) ::unless directed otherwise Ensure Modesty |
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Patient Interview |
Don't rearrange room without permission Respect confidentiality Be honest regarding Tx, etc Do not volunteer info patient is not yet aware
Listen to pt questions, concerns Educate but don't argue Use different question types to have effective interview :Open :closed :leading
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Cardiopulmonary Symptoms |
Dyspnea (subjective) :sensation of breathing discomfort by ;patient (subjective feeling) Most important symptom RT is called upon to assess and treat Breathlessness :sensation of unpleasant urge to breathe :Can be triggered by acute hypercapnia, acidosis and hypoxemia
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Dyspnea scoring systems |
Scale of 0 (no SOB) to 10 (max SOB) Visual analog scale Modified Borg scale ATS (american thoracic society ) SOB scale UCSD SOB questionnaire
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Cardiopulmonary symptoms |
10 is severe 8 is moderately severe 5 is moderate 2 is slight 0 is no shortness of breath, no dyspnea |
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Cardiopulmonary symptoms |
Dyspnes :subjective experience ::should not be inferred from observing patients breathing pattern Components :Sensory input to cerebral cortex :Perception of the sensation ::"breathless, shortwinded, feeling of suffucation"
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Cardiopulmonary symtoms |
Orthopnea :dyspnea in reclining position, associated with CHF Platypnea :dyspnea in upright position associated with arteriovenous malformation Degree of dyspnea is evaluated by asking about level of exertion at which it occurs
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American thoracic society of shortness of breath scale |
0 to 4 0 is none except with exercise 1 is slight trouble when hurring on the level 2 is moderate and walks more slowly than others 3 severe breathlessness after 100 years 4 too breathless to leave the house |
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Causes, types and clinical presentation of dyspnea |
WOB abnormally high for the given level of exertion :asthma and pneumonia Ventilatory capacity is reduced :neuromuscular disease Drive to breath is elevated :hypoxemia, acidosis, exercise
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Wilkens chart 3-7 |
Clinical types of dyspnea, know them all
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Clinical types of dyspnea |
Cardiac and circulatory :inadequate supply of oxygen to tissues :primarily during exercise Psychogenic :panic disorder :not related to exertion Hyperventilation :rate, depth exceeds bodies metabolic need :leads to hypocapnia and can lead to decreased cerebral blood flow |
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Emphysema |
Patient will have increased AP diameter and will pursed lip breath because of dynamic airway collpase and air trapping. He uses accessory muscles of respiration and is tympanic or hyper tympanic to percussion. He also has profound hypoxemia
Typmanic means drum like sound, versus normal |
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Table 3-8 |
Causes of dyspnea by body system
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Acute and Chronic Dyspnea |
Acute or Recurrent :Children ::Asthma, Bronchiolitis, Croup, epiglottis :Adults ::Pulmonary embolism ::Asthma ::Pneumonia ::Pneumothorax ::Pulmonary edema ::Hyperventilation ::Panic |
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Acute and Chronic dyspnea |
Chronic :most common causes ::COPD ::CHF :Acute on Chronic dyspnea (Dx) ::This would be someone with COPD or CHF that gets pneumonia or pulmonary edema, or has a panic attack |
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Description of Dyspnea |
Paroxysmal Nocturnal dyspnea :Sudden dyspnea when sleeping in the recumbent position :Associated with coughing :Sign of left heart failure, or CHF, or pulmonary edema Orthopnea :Dyspnea when lying down :Associated with left heart failure or CHF
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what causes cor pulmonale O2 is a vaso dialator in the lung and a vaso constrictor in the systemic system CO2 is opposite, its a vasoconstrictor in the lung and a vasodialator in the systemtic system |
O2 and CO2 |
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Description of dyspnea |
Trepopnea :Dyspnea when lying on one side :Unilateral lung disease, pleural effusion Platypnea :difficulty breathing when upright
Orthodeoxia :Hypoxemia in upright position, relieved by returning to a recumbent position, can be caused by postural hypotension
Platypnea and orthodeoxia :Patients with right to left intracardiac shunts or venoarterial shunts
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Table 3-9 |
Terms commonly used to describe breathing |
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Cardiopulmonary symptoms |
Language of dyspnea Ask patient about quality and characteristics of dyspnea :Patients w/ asthma frequently complain of chest tightness :Patients with Iinterstitial lung disese may complain of increased WOB, shallow breathing and gasping :Patients with CHF may complain of feeling suffocated
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Cardiopulmonary symptoms |
Assessing dyspnea during and interview :pay attention to whether patient can speak in full sentences :Questions should be brief and limited to quality and intensity of dyspnea and circumstances of symptom onset :Assessment should correspond with gross examination of patients breathing pattern
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Cardiopulmonary symptoms |
Psychogenic dyspnea: panic disorders and hyperventilation :patients have normal cardiopulmonary function with intense dyspnea and suffocation :May coincide with symptoms, such as chest pain, anxiety, palpitation and paresthesia (tingling) :anxiety often accompanied by breathlessness and hyperventilation |
