MON 2011 - Slide 5 - E. Furlong / S. Faithfull - Choice: Assessment during therapy - Key skills workshop 1: "on treatment" review
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Similar to MON 2011 - Slide 5 - E. Furlong / S. Faithfull - Choice: Assessment during therapy - Key skills workshop 1: "on treatment" review
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MON 2011 - Slide 5 - E. Furlong / S. Faithfull - Choice: Assessment during therapy - Key skills workshop 1: "on treatment" review
- 1. Assessment during therapy: Key skills workshop ‘on treatment’ review Eileen Furlong ESO-EONS Masterclass
- 2. Eileen Furlong ESO-EONS Masterclass “ As far as Edward Bear knew, it was the only way of coming downstairs, although he sometimes felt there was another way, if only he could stop bumping for a moment and think about it” (AA Milne)
- 5. The objective for this session is to teach you skills to be able to: Describe and perform the techniques used in respiratory assessment Describe and identify normal and abnormal assessment findings Respiratory Assessment Review respiratory anatomy & physiology & history taking
- 6. Respiratory Anatomy & Physiology Anatomy Physiology Pulmonary gas exchange
- 18. Case Scenario Eileen Furlong ESO-EONS Masterclass
- 29. Right lower lobe consolidation
- 31. Eileen Furlong ESO-EONS Masterclass Do you see the Dalmatian in the picture? • Clinical experience sometimes prevents seeing the right picture • Now that you see it, can you try to not see it? • Experience can result in ideas that are difficult to change
- 32. Eileen Furlong ESO-EONS Masterclass
Editor's Notes
- The thoracic cavity = 12 pairs of ribs that connect in the posterior thorax to the vertebral bodies of the spinal column. In the anterior thorax, the first 7 pairs of ribs are attached to the sternum or breastbone by cartilage. The lower 5 ribs do not attach to the sternum. The 8 th , 9 th , and 10 th ribs are attached to each other by costal cartilage. The 11 th and 12 th ribs , known as “floating ribs,” are not attached in any way to the sternum; they move up and down in the anterior chest, allowing for full chest expansion. The angle of Louis (also called the sternal angle) is a useful place to start counting ribs, which helps localize a respiratory finding horizontally . If you find the sternal notch, walk your fingers down the manubrium a few centimeters until you feel a distinct bony ridge. This is the sternal angle. The 2nd rib is continuous with the sternal angle; slide your finger down to localize the 2nd intercostal space. The angle of Louis also marks the site of bifurcation of the trachea into the right and left main bronchi and corresponds with the upper border of the atria of the heart. Reference lines help pinpoint findings vertically . For example, the major division ("fissure") between lobes in the anterior chest crosses the 5th rib in midaxillary line and terminates at the 6th rib in the midclavicular line
- Cough is a reflex response to stimuli that irritate receptors in the trachea larynx and large bronchi – dust, sputum, extreme hot or cold air, inflammation of mucosa, tumour or enlarged lymph nodes, cough may also be cardiovascular in origin (LVF), viral infection, bronchitis bilateral sinusitis, gastro oesophageal reflux Cough and sputum production ( Chapter 38 ) are common to obstructive, inflammatory, infectious, and neoplastic pulmonary processes, as well as cardiac diseases and disorders of the ears, nose, and throat. Cough is a normal defense mechanism of the respiratory tract, but when increased in severity or frequency, cough can be a cause of disease as well as an indicator of disease. Sputum production reflects the presence of inflammatory, infectious or neoplastic disease in the airways or pulmonary parenchyma. The amount and character of sputum provide the physician with helpful clues to distinguish among possible etiologies. Hemoptysis ( Chapter 39 ) is never normal and can be a warning of a serious or even life-threatening respiratory disorder. Hemoptysis must be differentiated from hematemesis and from simple epistaxis, and must be quantified in terms of volume per 24 hours for adequate assessment
- the subjective sensation of difficulty in breathing, is probably the most common respiratory complaint and cannot be differentiated at first glance from dyspnea due to cardiac disease, neuromuscular weakness, or simple obesity. Dyspnea should always be quantified as to how much exertion is necessary to produce the sensation of breathlessness Wheezing and asthma ( Chapter 37 ) point to the presence of an obstructive airway process but may be seen in heart failure as well. Wheezing may result from airway reactivity, airway narrowing, airway obstruction, compression, tumors, aspirated foreign bodies, as well as a variety of biochemical and immunologic insults. The time course of wheezing complaints and history of precipitating causes provide important information for interpretation
- Proliferation and edema of connective tissue result in loss of the normal angle between the skin and nail plate and excessive sponginess of the nail base. Clubbing is usually acquired and is associated with certain cardiopulmonary and gastrointestinal disorders, but may occur in congenital or familial forms. Acropachy is an alternative term for clubbing. Acquired clubbing is often reversible when the associated condition is treated successfully. Two signs are characteristic of early clubbing: the "floating nail" sign and the "profile" sign.
- Palpation Posterior chest wall 1 . level of clavicle 2. 2nd intercostal space 3. 4th intercostal space 4. 6th intercostal space Palmer surface of hand and finger pads – to assess size, consistency, texture of a mass, depressions, bulges, paradoxical movements, temperature, tenderness or surgical emphysema Dorsal surface - to assess vibrations
- Percussion of the thorax attempts to assess the state of the pulmonary parenchyma, whether it is filled normally with air, consolidated or hyperinflated. Percussion may also detect obliteration of the pleural space by fluid (pleural effusion) or by air (pneumothorax). Percussion notes are described as normal or resonant, tympanitic, and dull
- Palpation Anterior chest wall 1 . 2nd intercostal space 2. 4th intercostal space 6th intercostal space Tactile fremitus -palpable vibrations transmitted through the bronchopulmonary tree to the chest wall during speech. Fremitus is decreased when Voice is soft When transmission of voice sounds from larynx to surface of chest wall is impeded due to e.g fibrosis,pleural effusion ,pneumothorax Method Use ball of hand or ulnar surface of hand Compare right and left side of chest simultaneously Ask patient to repeat “99” as each point is palpated