Transcript ASSESSMENT OF THE RESPIRATORY PATIENT

Assessment of Respiratory System
Anatomy of Respiratory System
•Nasopharynx
•Larynx
•Trachea
•Bronchi
•Bronchioles
•Alveoli
Initial Respiratory Survey
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Observe the patient’s breathing pattern
 Rate (normal vs. increased/decreased)
 Depth (shallow vs. deep)
 Effort (any sign of accessory muscle use,
inspect neck)
Assess the patient’s color
 cyanosis
Normal Respiratory Rates
Infant 30-60
 Toddler 24-40
 Preschooler 22-34
 School-age child 18-30
 Adolescent 12-16
 Adult 10-20
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SUBJECTIVE ASSESSMENT
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Fever
Peripheral Oedema
Sleep
Stress Incontinence
Functional ability
Disease awareness
Previous physiotherapy
Collateral from nursing staff/family.
SUBJECTIVE ASSESSMENT
Using the headings below, write some questions that you could use to
find out or confirm the subjective information that you need to
know:
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Pain
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Exercise tolerance
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Wheeze
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Cough & sputum
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Sleep
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Functional ability
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Disease awareness
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Previous physiotherapy
Relevant History
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Any chronic conditions
 Asthma, COPD, CHF, DM
Exposure to new medication
 Inhibitor
Recent change in diet
 Peanuts, Strawberries
Substance abuse/Overdose
 Opioid abuse, ASA toxicity (aspirin)
Prior DVT.
Recent trauma to chest
OBJECTIVE ASSESSMENT
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Observe Chart
Drug Kardex
General observation
Oxygen therapy
Breathing pattern
Palpation
Auscultation
Percussion
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CXR analysis
Mobility
Exercise tolerance
Spirometry
ABG
Other investigations
Standardised outcome
measures
Inspection
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Note the shape of the chest and the way it moves
 Deformities or asymmetry
Increased AP diameter in COPD
 Abnormal retractions of interspaces during respiration
 Lower interspaces, supraclavicular in acute asthma
exacerbation
 Impaired respiratory movement
 Flail Chest and paradoxical movement with rib
fractures.
Percussion
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Helps to identify if underlying tissues are airfilled, fluid-filled, or solid
 Hyperextend middle finger of either hand and
press against chest wall
 Strike with flexed middle finger of opposite
hand
Always percuss symmetrically on chest wall
Percussion Notes
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Flatness
 Thigh
Dullness
 Liver
Resonance
 Lung
Hyperresonance
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Tympany
 Stomach, puffed cheek
Percussion
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Dullness replaces resonance when fluid or solid tissue
replaces air containing lung
 Pleural Effusions
 Hemothorax
 Tumor
Unilateral Hyperresonance
 Pneumothorax
Generalized Hyperresonance
 COPD
Breath Sounds
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Normal
 Tracheal
 Bronchial
 Bronchovesicular
 Vesicular
Abnormal
 Absent/Decreased
 Bronchial
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Adventitious
 Crackles (Rales)
 Wheeze
 Rhonchi
 Stridor
 Pleural Rub
Causes of Decreased or Absent
Breath Sounds
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Asthma
COPD
Pleural Effusion
Pneumothorax
Atelectasis
Common Respiratory Disorders
Pneumonia
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Community-acquired pneumonia
Hospital-acquired pneumonia
Bacteria
Viruses
Mycoplasma
Fungi
Chemical
Pneumonia
is an inflammatory response to the uncontrolled
multiplication of microorganisms invading the
lower respiratory tract.
Pneumonia
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Studies
 CXR, sputum culture, bronchoalveolar lavage
Management
 Antibiotics, oxygen, pulmonary toilet
Supportive care
 Nutrition, hydration, rest
Prevention
 Pneumococcal and influenza vaccines
Pleural Effusion
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Accumulation of pleural fluid secondary to increased
fluid formation
 Increased capillary permeability
 Deceased colloid osmotic pressure of the blood
 Increased intrapleural negative pressure
 Impaired lymphatic drainage
 Increased pressure in the capillaries or lymphatics
Assessment of Pleural Fluid
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H/P finding
 Shortness of breath, chest pain
 Tachypnea, hypoxemia, pleural rub
Diagnostic studies
 CXR – lateral decubitus
 Thoracentesis
Pneumothorax
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Sudden onset of pleuritic chest pain
 Dyspnea, shortness of breath, increased work
of breathing
Diagnostic test
 CXR
Management
 Oxygen
 Possible placement of chest tube
Pulmonary Embolism
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Part of a deep vein thrombosis that has traveled
and lodged in the pulmonary arteries
Severity depends on the extent of occlusion
Mismatch of ventilation and perfusion
Testing
 A pulmonary angiogram
Management
 Anticoagulation
COPD
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History
 Exposure to risk factors, co-morbidities,
current medical treatment (beta blockers)
Tests
 Spirometry, ABGs
Management
 Oxygen, education, drug therapy, nutrition,
exercise, surgical intervention
Asthma
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A chronic inflammatory disease of the airways
Airway hyper responsiveness
Variable airway obstruction
Resolves spontaneously or after using a
bronchodilator
Asthma
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Testing
 Spirometry
 Pulmonary function testing
Management
 Education, prevent exacerbation, optimize
pharmacotherapy
Acute Respiratory Failure
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A sudden and life–threatening deterioration in
gas exchange
Type I – Acute hypoxemic respiratory failure
Type II - Acute hypercapnic respiratory failure
Type III – Combined hypoxemic and
hypercapnic failure
Acute Respiratory Failure
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Tests
 ABGs, CXR, CT, thoracentesis
Management
 Correction of gases, oxygen therapy
 Reversal of any narcotics
 Possible mechanical ventilation