RESPIRATORY ASSESSMENT JENNY CASEY RESPIRATORY SERVICES LEAD ACE

RESPIRATORY ASSESSMENT JENNY CASEY RESPIRATORY SERVICES LEAD ACE

What does respiratory assessment involve?

Subjective Assessment Objective Assessment Inspection, palpation, percussion and auscultation Identification of main problem(s)

Presenting Condition (PC) History Presenting Condition (HPC) Past Medical History (PMH) Family history (FH) Drug History (DH) Social History (SH) Ford et al (2005) Problem Orientated

Why are you seeing them? Have they been referred by gp Recent hospital admission Worsening symptoms associated with infection. Presenting Condition (PC)

When are they better? When are they worse? Timing including onset, duration and frequency Setting in which they occur Aggravating and relieving factors HPC - Symptoms

Frequency of chest problems (infection per year needing treatment) Other medical history ( Heart Failure, anaemia associated with SOB Other conditions (NB Rheumatic lung, scoliosis) Can alter structure of rib cage. Past Medical History (PMH)

Respiratory medication (inhalers, nebulisers, theophylline, steroids, Oxygen)) Other medication Over the counter medication Elicit Drugs Allergies Drug History (DH)

Where they live, who they live with Smoking history (pack years) Impact on life Alcohol Occupational history General appearance (unkempt) Children Social History (SH)

CXR Sputum culture Blood test (FBC, CRP. WBC) Blood gas Investigations

Systems Approach: General Observation Respiratory Cardiovascular Renal Liver, GI, CNS etc Assessment

Colour Respiratory rate (distressed breathing?) Pain LOC Initial observation

Temperature Nails (clubbing,spoon nails, capillary refill, nicotine stains, peripheral cyanosis) Tremor,Flap Hands

Temperature Pulse Respiration rate Blood pressure Oxygen saturation levels. Observation

Shape; barrel, pigeon, hyperinflated, kyphosis, scoliosis, malnutrition, accessory muscle use, posture Scars; thoracotomy, sternotomy, mastectomy Drains; pigtail, intercostal, suction Abnormal signs; spider nevi, prominent vascular markings, bruising Chest observation

Accessory muscle use Pursed lip breathing Forced expiration Work of breathing Tracheal tug Respirations

Listen Wheeze, crackles, stridor, patient communication Smell Pseudomonas infections Respirations

Symmetry Movement / expansion Tenderness; muscular, rib fractures Surgical emphysema Tactile fremitus Percussion Palpation

Palpable vibrations Voice sounds transmitted through patent bronchi to lung tissue to chest wall Ulnar edge of hand on chest Ask patient to say ahh or 99 Symmetry is normal Decreased due to obstruction, effusion, emphysema, pneumothorax Tactile Fremitus

Place one hand on the chest wall with the middle finger in the intercostal space Strike the middle phalanx sharply with the of the tip of the middle finger Movement should come from the wrist Compare both sides Work from resonant areas to non Always compare side to side Percussion Note

Breath sounds Normally throughout 6 th rib anteriorly 8 th rib laterally 10 th rib posteriorly Need to visualise underlying lobes Auscultation

Added sounds Crackles (crepitations) Wheezes (rhonchi) Bronchial breathing Pleural rub Auscultation

Inspiration longer than expiration Normally only hear the first third of expiration Normal breath sounds vary between individual and within individuals Auscultation

Problem Orientated Medical Records (POMR) Subjective Assessment Objective Assessment Inspection, palpation, percussion and auscultation Respiratory Assessment

Hough A (2001) Physiotherapy in Respiratory Care Cheltenham: Nelson Thornes Middleton S & Middleton PG (2002) Assessment and Investigation of patients problems In: Pryor JA & Prasad SA (eds) Physiotherapy for Respiratory and Cardiac Problems Edinburgh: Churchill Livingstone UCLA (n.d.) The Auscultation Assistant Online at: http://www.med.ucla.edu/wilkes/lungintro.htm [Accessed on 08 Oct 2012] References

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