Flashcards in Physical Assessment Deck (41):
Why and how do we perform a thorough physical assessment?
- Define patient's problems accurately
- History will guide scope of assessment
- Requires sound theoretical base in order to synthesise info from appropriate sources, i.e. anatomy/physiology, characteristics/limitations of assessment tools
What vital sign is the most accurate predictor of somebody who is deteriorating?
What are the cardiovascular values?
Normal heart rate: 60-100bpm
What are the temperature values?
Normal: 36.5-37.5 degrees celsius
Fever/pyrexia: Elevation in body temp above 37.5 (febrile)
What is associated with every 0.6 degree rise in body temperature?
A 10% increase in oxygen consumption
What are the respiratory rate values?
Normal: 12-20 breaths/min
Tachypnoea: >25 breaths/min
Bradypnoea: <10 breaths/min
What is the only vital sign that can be voluntarily altered?
What is a trick for measuring respiratory rate accurately?
Tell the patient you're measuring their pulse
What are the 4 main components of physical assessment?
Observation (end of bed assessment)
Auscultation (what you hear)
What information can you gain from observation?
- Physical location (ICU vs ward)
- Monitoring & attachments (oxygen, liners, catheters, drains)
- General appearance
- Level of consciousness
What are patients with reduced level of consciousness at risk of?
Aspiration (things other than air getting into airways) and retention of pulmonary secretions
What are the 4 levels of consciousness?
- Unconscious (by still responsive)
- Semiconscious (drifting in and out)
- Obtunded (unconscious, not responsive)
What are some of the causes of reduced level of consciousness?
- CO2 narcosis (very high levels of CO2)
- Brain injury
What are the 3 components of the Glasgow Coma Scale?
Eye opening, verbal response, motor response
What is cachexia?
When a person is completely skin and bones, opposite of obesity
What general appearance features should you look for?
- Cachexia vs obesity
- Barrel shaped chest (hyperinflation)
- Pectus excavatum/ pectus carinatum
Where does the sternal line run?
From jugular notch down to the belly button
How does the chest normally expand with each breath?
Symmetrical increase in the AP, vertical and transverse diameters
What are the accessory muscles of respiration?
What is paradoxical respiration (diaphragm paralysis)?
When the diaphragm isn't working correctly and the rib cage moves abnormally
What is Hoover's sign?
Inward movement of lower rib cage during inspiration
What is pursed lip breathing usually a sign of?
Someone who is having trouble breathing, e.g. severe COPD
What is the normal inspiration to expiration ratio (I:E ratio)?
1:1.5 to 1:2
What is orthopnoea?
Breathlessness when lying flat
When is hyperpnoea (increased ventilation) normal?
What is Cheyne-Stokes respiration?
A pattern of crescendo-decrescendo breathing interspersing apnoeas (absence of breathing for a period of time)
What does cyanosis (blueishness) indicate and where should you look for it?
Low oxygen in the blood, fingers, lips and tongue
What is clubbing?
Loss of the nail bed and flattening of pad on fingers/toes, usually seen in chronic respiratory diseases e.g. CF
What can lower limb oedema indicate?
Right heart failure or left ventricular failure
What are the 3 main reasons for respiratory palpation?
1) Chest wall movement
2) Respiratory muscle activity
3) Detecting fremitus (vibration of sputum)
When does lateral basal expansion tend to be reduced?
In the presence of lung collapse
What are normal breath sounds produced by?
Turbulence in the airways filtered through the normal lung tissue to the chest wall
What may decreased lung sounds indicate?
- Lung collapse
- Underlying airway damage (e.g. emphysema)
- Something in pleural space
What may abnormal bronchial breath sounds indicate?
Anything that amplifies sound
- Alveoli filled with fluid
- Large areas of collapse
- Lung mass (tumour)
What are the 5 types of breath sounds?
- Abnormal bronchial breath sounds
- Added sounds
What are two types of added sounds?
What are the two types of crackles?
- Coarse: Sputum, changes with cough/movement
- Fine: Acute pulmonary oedema (widespread fluid throughout alveoli, doesn't change with cough/movement) OR re-opening of collapsed alveoli (velcro sound)
Why do wheezes occur and what are the two kinds?
Narrowing of airways; monophonic or polyphonic
What are some of the causes of wheezes?
- Bronchoconstriction (e.g. asthma)
- Foreign body
What elements of a cough should be assessed?
- Strength (strong/moderate/weak)
- Moist or dry
- Productive or non-productive