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RESP SYSTEM DEN303 > Resp history and exam > Flashcards

Resp history and exam Flashcards

1
Q

What questions to ask in a resp exam?

A 
Sob - MCR scale, triggers
History of sudden wheeze/sob - triggers
Cough - dry/productive, sputum colour
Haemoptysis - chest pain
PND - orthopnea, SOA
Courses of abx and oral CS in 12/12
GORD - hayfever and eczema
Admissions to ED/hospital/IDU
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2
Q

What is the MRC breathlessness scale?

A 
1 = no breathlessness except on exercise
2 = SOB when hurrying 
3 = Walks slower than most people
4 = Stops for breath after 100yrs 
5 = too breathless to leave house
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3
Q

What drug history to ask?

A 
Allergies inc aspirin sensitivity
Inhalers
Anticoagulants
Oxygen use
Nebulisers
Confirm med histories
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4
Q

Social history?

A 
Occupation
Smoking Hx
Alcohol consumption
Pets/birds
Asbestos
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5
Q

How to take their med history linking to resp conditions?

A

Asthma - sob/wheeze/cough - triggers, affects young and middle aged
COPD - sob/wheeze on exertion/cough, >35yrs;smokers
Bronchiectasis - chronic sputum production
PE - sob/pleuritic pain/may be on warfarin
IDL (lung disease) - occasional dry cough/may be on steroids/immunosuppressants

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6
Q

Symptoms of OSA?

A

Daytime somnolence
Own CPAP machine; supplemental O2
Resp muscle weakness

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7
Q

Lung cancer symptoms?

A 
Weight loss
SOB
Cough +/- haemoptysis
Chest pain
Extra-pulmonary symptoms 
If post chemoRx
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8
Q

How to take a drug history?

A 
Inhalers for asthma and COPD only
SABA nebules for severe asthma
Oral steroids for immunosuppression in severe asthma and ILD processes
Amiodarone and methotrexate 
Warfarin and rivaroxaban/apixaban
Aspirin/NSAID hypersensitivity
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9
Q

What questions to ask the pt?

A 
Exacerbation of chronic lung disease
Increased breathlessness
Worsening cough
More sputum production
Change in sputum colour
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10
Q

How to do a general inspection for a resp exam?

A 
At end of the chair:
Is the patient comfortable?
What is the respiratory rate?	14-16/min
Is there cyansosis?			
Peripheral +/- central?		 
Accessory muscles being used?
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11
Q

What is cyanosis?

A

Blue discolouration of peripheries +/- tongue

Tongue reflects deoxygenated blood
SpO2 <90% with obvious cyanosis (with normal Hb)

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12
Q

What muscles to examine during a resp exam?

A

Accessory muscles
Sternomastoids
Platysma
Strap muscles

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13
Q

What does an audible wheeze indicate?

A

Asthma/COPD/Vocal cord dysfunction

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14
Q

What does stridor indicate?

A

Upper airway obstruction emergency

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15
Q

What does hoarseness indicate?

A

Recurrent laryngeal nerve injury and cancer

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16
Q

What pulse should be checked?

A

Radial pulse

>100bpm = underlying disease relating to anxiety

17
Q

What to inspect regarding hands?

A

Clubbing - cancer, bronchiectasis/fibrosis
Flapping tremor - severe CO2 retention
Wasting of muscles of hands
(Bilateral - cachexia associated with COPD, cancer, motor neurone disease
Unilateral - compression of lower brachial plexus

18
Q

How to examine the face?

A 
Pallor - check conjunctiva for anaemia
Tongue colour 
Lung abscess or pneumonia due to carious tooth
Obese = risk of ventilatory failure
Moon face - chronic oral steroid use
19
Q

How to identify the unwell pt?

A

Is the Airway patent?
How is the Breathing? RR/SpO2/Chest mvmt/cyanosis/
How is the circulation? Pulse/BP/peripheral circulation
How is the neurological status? (Disability/GCS

20
Q

Signs of an unwell pt?

A 
Respiratory rate>20/min
Difficulty completing sentences
Using accessory muscles
Cyanosis
Audible Wheeze
21
Q

How to treat asthma?

A

If PEF<75% give Short Acting Brochodilator
Give 4 puffs (inhaler) via spacer
Give 2 puffs/2mins & assess response up to 10puffs
or
Salbutamol 5mg nebuliser (ideally by 6l/min O2)

Consider oral steroids
Consider immediate referral to GP/walk-in centre/999

22
Q

How to treat COPD?

A

If sob/wheezy
Give (salbutamol) ventolin 5mg dose & (ipratropium bromide) 500mcg via nebuliser driven (not via oxygen)
If nebuliser not to hand – administer 4 puffs of short acting beta agonist via spacer
Less likely COPD patients to develop acute bronchospasm post dental intervention compared to asthma patients
Consider referring immediately to GP/walk-in centre/999

If infective exacerbation (LRTI)
Aminopenicillin
Tetracycline
Macrolide

Oral course of prednisolone (if dyspnea impact on daily life)

GP review/refer to A&E/walk-in centre

23
Q

How to give oxygen?

A

Initial = nasal cannulae 2-6 l/min or simple face mask 5-10l/min
Pt not at risk of hypercapnic resp failure who have saturation <85% = reservoir mask at 10-15l/min
Recommended initial O2 saturation rate = 94-98%

RESP SYSTEM DEN303 (7 decks)

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