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Objective Resp. Assessment - Coggle Diagram
Objective Resp. Assessment
Objective Data
Physical Exam of Lungs & Thorax
Palpate: asymmetrical chest wall movement, tenderness, lumps. skin texture
Percuss: low pitched hollow sound= normal air-filled healthy lungs. Hyper resonant sound= pneumothorax or severe emphysema. Dull sound = pleural effusion, atelectasis, consolidation or solid tissue
Inspect: Breathlessness/Dyspnoea, Orthopnoea, Cough, Haemoptysis, >sputum, chest pain, wheeze, clubbing of fingers, cyanosis
Auscultate: wheezes (high pitched mainly heard on expiration due to bronchospasm), crackles (high pitched soft popping sound on inspiration, secretions in airway), pleural friction rub (grating sound)
Breathlessness/ Dysponea
subjective sensation of SOB, perceived & interpreted by the pt.
Causes:
Pathology- Resp. Disorders, Cardiac Disorders, Obesity, Anaemia
Psychological - Anxiety/Depression
Physiological- Exercise, High altitude
Pharmacological- Drug induced resp. disorders
Assessing Severity: (Borg Breathlessness Assessment Scale 0-10)
How far can you walk upstairs without stopping?
Do you feel breathless when washing or dressing?
Do you feel breathless @ rest?
Orthnopoea
Difficulty breathing in all positions except sitting upright.
Cough
Causes: cigarette smoke, dust, infections, gaso-oesphageal reflux, ACE inhibitors
Assessing:
Pattern- Is it occasional, regular or paroxysmal?
Has it changed over time?
Quality of Cough:
Dry (URTI)- cardiac or drug related.
Hoarse (URT)- croup.
Moist/ Productive (LRTI)- infection.
Dry Brassy- tracheal lesion
Barking- inspiratory whooping cough or pertussis
Bubbling- CCF, pulmonary oedema
Haemoptysis- 'coughing up of blood'. Can be caused by bronchial carcinoma, pulmonary embolism, TB, pneumonia, chronic bronchitis, nose bleed
Occasional: irritant
Positional: post nasal drip cough
Regular: chronic inflammatory condition
Exercised induced cough: exertional asthma
Evening cough: stress/asthma
Paroxysmal cough: sudden outburst of uncontrollable coughing- TB, pertussis
Sputum Production
Chronic sputum production over 3 mnths- 2 yrs = chronic bronchitis
Chest Pain
Types: Sharpe, stabbing, dull aching, persistent
Symptom of: pneumonia, pulmonary embolism, pleurisy, lung cancer
Questions to ask: site, mode of onset, character, intensity, radiation, precipitating aggravating & relieving factors, response to analgesia
Obtuse Signs of Resp. Disorders
Weight loss- emphysema or carcinoma
Ankle swelling- corpulomale (r sided heart failure, 2ndry lung disease)
Hoarseness- smoking, URTI, inhaled steroids
Signs of Chronic Hypoxia
Central cyanosis
Peripheral cyanosis
Clubbing fingernails
Breathing patterns
Tachypnoea- rapid shallow breathing, normal rhythm. >21 BPM. cause; anxiety, pulmonary embolism/ oedema, infection, pain
Hyperventilation- fast, deep respirations. Cause: CVA, exercise, late stage diabetic ketone acidosis
Bradypnoea- slow normal depth & rhythm. <12 BPM, cause neurological or electrolyte disturbance, infection, response to pain on inspiration, sedation or analgesics
Hypoventilation- shallow irregular respirations. Cause: neurological cond., brainstem injury, brain tumour, sleep apnoea
Thoracic Structures & Movement
Tracheal deviation
Barrel chest (emphysema)
Unilateral absence of chest movement
Funnel chest (Occ. hazard, rickets, Marfane syndrome)
Paradoxical movement (flail chest)
Kyphoscoliosis (s-shaped curve of the spine)