Patient Assessment Flashcards
(35 cards)
OLDCART (Acronym for HPI: History of Present Illness)
- Onset
- Location/Radiation
- Duration
- Character
- Aggravating Factor
- Reliving Factors
- Timing / Severity
This gives a framework for approaching patient complaints in a problem oriented fashion.
Airborne Transmission
PPE: N-95 mask, gloves Patient in negative laminar air flow room. TB Varicella (Chicken pox)
Droplet Transmission
Microorganisms > 0.5µm Generated by coughing, sneezing, talking, and procedures involving suctioning airways, bronchoscopy. Generally limited to a radius of 3ft. from patient. PPE: Gown, surgical mask, gloves.
Vehicle Transmission
transmission of microorganisms via inanimate objects, termed fomites.
Vector transmission
It involves an intermediate host. The host can be an insect, an animal, or a plant. One disease transmitted in this manner is Rocky Mountain spotted fever, which is carried by a tick.
Vital Signs
Temperature (T) Pulse (P) Respiratory Rate (R) Blood Pressure (BP) Pulse oximetry (SpO2)**
Body Temp
Adults: 35.5 to 37.5°C (96 to 99.5°F) Newborn: 36.1 to 37.7°C (97 to 99.9°F) Children: 37.2°C (98.9°F)
Hypoxemia
- abnormally low level of oxygen in the blood
- oxygen deficiency in arterial blood
- hypoxemia can lead to hypoxia: in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level.
- Hypoxemia may cause:
- tachypnea, shortness of breath, headache, restlessness, dizziness, rapid breathing, chest pain, confusion, high blood pressure.
4 classifications of Normal Breath Sounds
Vesicular: low-pitched and soft
Bronchial: loud, higher pitch
Bronchovesicular: combination of vesicular and bronchil
Tracheal: above clavicular notch, harsh and high-pitched.
Vesicular breath sounds (Normal breath sound)
- low-pitched soft sounds.
- whispering or rustling
- inspiratory > expiratory phase.
- no pause between inspiration and expiration.
- sound is heard over the majority of the lung periphery (except over the right apex anteriorly)
- generated by turbulent airflow in the lobar and segmental bronchi.
Bronchial breath sounds (normal)
- loud, higher pitch
- expiratory > inspiratory phase
- short pause b/t phases
- hollow sound
- heard over manubrium of sternum
- generated by turbulent air vibrating in the trachea
Bronchovesicular breath sounds (normal)
- combination of both vesicular and bronchial sounds
- somewhat muted
- NO pause b/t inspiration and expiration
- inspiratory phase = expiration phase in length
- heard over sternum and second intercostal space, b/t scapulae and over right apex of lung
Tracheal breath sounds (normal)
- heard over trachea
- above clavicular notch
- harsh and high pitched
- expiratory > inspiratory phase
- produced by high-velocity turbulent air
Abnormal breath sounds (adventitious sounds)
- Crackles
- Wheezes
- Rhonchi
- Rubs
Wheezes
- caused by bronchoconstriction
- Unilateral wheezes (or monoponic wheeze) could be caused by a foreign body obstruction or a bronchial mass (seen w/lung cancer): treat w/bronchoscope
- Bilateral wheezes: treat w/bonchodilator
- First step may be to get a chest x-ray, then bronchodilator
- If patient starts out diminished but then progresses into audible wheezing, continue bronchodilator therapy.
short-term illnesses like inflammation,bronchiolitis, bronchitis, pneumonia, anaphylaxis, or obstruction.
Long-term illnesses include emphysema, GERD, heart failure, lung cancer or sleep apnea.
fremitus
- a sensation felt by a hand placed on a part of the body (as the chest) that vibrates during speech
Fremitus refers to vibratory tremors that can be felt through the chest by palpation.
To assess for tactile fremitus, ask the patient to say “99” or “blue moon”.
Increased fremitus may indicate compression or consolidation of lung tissue, as occurs in pneumonia.
patient presents with diaphoresis (heavy sweating) and is cool to the touch. What are the possible conditions, and what should the therapist do?
(Diaphoresis = Heavy Sweating)
- CHF (Congestive heart failure)
- Myocardial infarction (described as cold and clammy skin): should order a 12-lead ECG
- Febrile conditions (elevated temp)
- Night-sweats (patients with TB)
Physical Assessment Basic Catergories
- Visual Inspection
- General appearance
- Color
- Chest configuration and condition
- Respiratory Rate and pattern
- Accessory muscle use
- Presence and nature of cough
- Chest movement (symmetry or asymmetry)
- Digital Clubbing
- Venous distension
- Diaphoresis
- Peripheral Edema
- Pressure ulcers
- Bedside Assessment
- Breath sounds (Vesicular or adventitious)
- Pulse
- Ventilation
- Tracheal Palpation
- Blood Pressure
- Heart Sounds
- Intake/Output
- Patient History
- Medical Records
- Physical exam of the crdiopulmonary system
- Exercise Tolerance
- Interview
- Trends in monitoring results
- Skin Testing
- Advanced Directives and DNR orders
- Normal Activity Level
- Work of Breathing
Regarding wheezing, when should you treat a patient with a bronchoscope, and when do you treat with a bronchodilator?
Unilateral wheezes = bronchoscope
Bilateral wheezes = bronchodilator
Rales
(Crackles)
- secretions in middle-sized airway
- treated w/ chest physiotherapy, including postural drainage
- Fine crackles or rales indicates atelectasis, and should be treated w/hyperinflation therapy
- Moist, crepitant rales indicates CHF, and should be treated w/ diuresis
(Coarse Rales)
- secretions in the middle-sized airways
- remedied by suctioning
- low-pitched, intermittant sounds
- early inspiratory
- Course crackles are discontinuous, brief, popping sounds. Similar to the sound of a hook and loop fastener being pulled apart. They have also been described as a bubbling sound. More common during inspiration.
What is the standard treatment for rales?
chest physiotherapy including postural drainage.
Atelectasis
collapse of lung tissue with loss of volume.
Patients may have dyspnea or respiratory failure if atelectasis is extensive. They may also develop pneumonia. Atelectasis is usually asymptomatic, but hypoxemia and pleuritic chest pain may be present in certain cases.
- Location: upper airway obstruction
- Cause: Croup (laryngotracheal bronchitis– steeple sign)
- Sound: loud, high-pitched wheezing sound heard during inspiration
- possible foreign body aspiration
-
Treatment
- MILD = treat w/ cool mist (hydration) or racemic epinephrine
- MODERATE = treat with racemic epinephrine
- SEVERE = intubate, tracheostomy, surgery
- supraglottic swelling (think acute epiglottitis- thumb sign)
- subglottic swelling (think croup)
- If foreign body suspected, perform a bonchoscopy
