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1. Subjective an objective assessment Flashcards

1
Q

What are 4 key cardiorespiratory symptoms in a subjective assessment that you need premorbid and current information about?

A
  1. Cough and sputum
  2. Pain
  3. Exercise tolerance and mobility
  4. Breathlessness
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2
Q

What information do you need about cough?

A

Usual vs Current
* Presence or absence
* Occurrence? Intermittent/night time/ throughout the day
* Productive or non productive

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3
Q

What information do you need about sputum?

A
  1. Amount
  2. Colour
  3. Viscosity

Use the word mucus to patients - less jargon

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4
Q

What information do you need about social history?

A
  • Home environment
  • Any home modifications
  • Is the patient a carer for someone or do they have a carer?
  • Level of independence with ADLs
  • Paid work?
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5
Q

What details of previous physiotherapy do you need to ask the patient?

A
  • Understaning of what physiotherapy does?
  • Understand management of their condition or find out what self-management techniques they currently use?
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6
Q

Name 3 points to address when concluding an interview

A
  1. Patient goals
  2. Discharge planning
  3. Possible patient problems
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7
Q

Normal values: temperature

A

36.5-37.5

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8
Q

Normal values: heart rate

A

60-100bpm

Bradycardic <60
Tachycardic >100

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9
Q

Normal values: blood pressure

A

Between 95/60 and 140/90

Hypertension >145/95
Hypotension <90/60

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10
Q

What is orthostatic intolerance

A

BP drop during upright posture

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11
Q

Normal values: respiratory rate

A

12-16 breaths/min

Tachypnoea >20 breaths/min
Bradypnoea <10 breaths/min

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12
Q

What are the 3 components of patient observation?

A
  • Look
  • Feel
  • Listen
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13
Q

Look and feel

What components are you looking for when assessing breathing pattern?

A
  • Pattern/symmetry of movement (feel)
  • Use of accessory muscles (look)
  • Inspiratory/expiratory ratio (should be 1:2 or 1:3; more time exhaling than inhaling) (look)
  • Level of breathlessness (use borg scale)
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14
Q

Types of breathing sounds on auscultation?

A
  • Normal breath sounds
  • Absent breath sounds
  • Bronchial breath sounds
  • Crackles (small or large)
  • Wheese
  • Pleural rub (creaking, squeaking or rubbing)
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15
Q

Types of breathing sounds on auscultation?

A
  • Normal breath sounds
  • Absent breath sounds
  • Bronchial breath sounds
  • Crackles (small or large)
  • Wheese
  • Pleural rub (creaking, squeaking or rubbing)
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16
Q

What do fine crackles indicate?

A
  • Pulmonary edema
  • Pulmonary fibrosis
  • Pneumonia
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17
Q

What do coarse crackles indicate?

A

consolidation or sputum retention

18
Q

What do bronchial breath sounds indicate?

A

consolidation

19
Q

List 7 components of physical examination

A
  1. Review chart and test results
  2. Observe environment
  3. General observation (non-chest)
  4. Chest observation and palpation/breathlessness
  5. Auscultation
  6. Cough and sputum
  7. Functional assessment
20
Q

List the 8 cardiorespiratroy problems

A
  1. Pain
  2. Mobility
  3. Reduced exercise tolerance
  4. Low lung volumes
  5. Impaired gas exchange
  6. Dyspnoea/increased WOB
21
Q

List the 8 cardiorespiratroy problems

A
  1. Pain
  2. Mobility
  3. Reduced exercise tolerance
  4. Low lung volumes
  5. Impaired gas exchange
  6. Dyspnoea/increased WOB
22
Q

What clinical findings might you expect for impaired airway clearance?

A
  1. Increased sputum production
  2. Change in sputum colour
  3. Coarse crackles on auscultation
  4. CXR consolidation
  5. Difficulty coughing
23
Q

What pathologies would cause impaired airway clearance?

A
  • CF
  • Bronchiectasis
  • COPD exacerbation
  • Pneumonia
  • Post-operative pulmonary complications with sputum
  • Neuromuscular condition
24
Q

What are the contributing factors of impaired airway clearance?

A
  • Impaired mucociliary clearance
  • Ineffective cough (due to pain)
  • Increased sputum amount or changed mucus composition
25
What might be clinical findings for low lung volumes?
* CXR collapse * Reduced breath sounds on ausc. * Reduced SpO2 * Weak cough * Reduced chest epansion
26
What are clinical examples of low lung volumes?
* General anesthetic from surgery * Supine position * # ribs * Pleural effusion * Pneumothorax
27
What are the contributing factors to low lung volumes?
* Reduced FRC * Increased CC * Reduced lung compliance * Pain * Diaphragm dysfunction
28
List the 5 factors affecting FRC
* Body size * Gender * Diaphragmatic muscle tone * Posture * Lung disease
29
Define closing capacity
The volume at which small airways in the dependent region begin to close
30
Define closing capacity
The volume at which small airways in the dependent region begin to close. Airway closure = reduced ventilation = V/Q mismatch = hypoxaemia
31
What is the relationship between FRC, age and CC
FRC remains with age and closing capacity increases with age.
32
What factors decrease FRC?
* Supine posture * Anesthesia * Abdominal pain * Obesity
33
What factors increase closing capacity?
* Age * Smoking * Pulmonary oedema
34
What causes decreased FRC following GA?
* Reduced abdominal muscle tone * Reduced phrenic nerve acitvity (reduces diaphragm tone) * Reduced lung compliance (stiffer and harder to inflate) * Diaphragmatic dysfunctions
35
What is the effect of GA on sputum/clearance?
* Increased mucus viscosity * Cilia stop moving after 90 mins of anesthesia - reduced mucociliary clearance * Drying of airway secretions
36
What is the effect of GA on coughing?
* Cough reflex dampened by sedation * Strength of cough impaired by low lung volumes and inability to generate intra abdominal pressure
37
Name 3 factors contributing to development of PPC?
* Atelectasis * Ineffective cough * Impaired mucociliary clearance
38
Define atelectasis
Small airway collapse
39
What are the clinical signs and symptoms of PPC? | 4 or more must be present for diagnosis
* SpO2 bleow 90% * CXR - atelectasis or consolidation * Fever (>38 degrees) * altered sputum quantity or quality * Microbial growth in sputum * Raised WCC or administration of antibiotics * Medical diagnosis of pneumonia * Readmission ot ICU with respiratory issues
40
What are preoperative risk factors for PPC?
* Respiratory or cardiac co-morbidities * Obesity * Age * Current smoker * Poor pre-morbid mobility and exercise tolerance * Immunocompromised * Emergency vs elective surgery
41
What are perioperative risk factors for PPC?
* Type of surgery * length of snesthesia * Pain * Immobility * Surgical complications * Lack of education about preventative measures * ICU admission
42
What are the main treatment goals of postoperative physiotherapy?
* Improve lung volumes * Enhance airway clearance * Increase mobility * Prepare and optimise for discharge

Cardio theory (4 decks)

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