RET 1024 Introduction to Respiratory Therapy

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RET 1024Introduction to Respiratory Therapy

• Module 4.0
• Bedside Assessment of the Patient

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Beside Assessment of the Patient

• RTs are playing an increasing roll in the
  clinical decision-making process when it comes to
  initiating, adjusting, or discontinuing
  respiratory therapy.

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Bedside Assessment of the Patient

• As never before, RTs need to develop competent
  beside assessment skills in order gather and
  interpret relevant patient data

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Bedside Assessment of the Patient

• Bedside assessment is the process of
  interviewing the patient and examining the
  patient for signs and symptoms of disease and the
  effects of treatment

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Bedside Assessment of the Patient

• Two key sources of patient data
• Medical History
• Physical Examination

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Bedside Assessment of the Patient

• Interviewing Taking a Medical History
• Provides patient perspective
• Subjective information
• Establishes rapport between clinician and patient
• Facilitates the sharing of information and future
  evaluation and treatment plans
• Obtains essential diagnostic information
• Objective information
• Monitors changes in the patients symptoms and
  response to therapy

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Bedside Assessment of the Patient

• Interview skills are an art form that takes
  time and experience to develop
• T. Des Jardins, G. Burton

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Bedside Assessment of the Patient

• Patient interviews requires
• A genuine concern for others
• Empathy
• The ability to view the world from the patients
  perspective feeling with the patient
• The ability to listen
• Active
• Requires complete attention
• Preoccupation equates to missed information
• Includes observation of body language
• Facial expressions
• Eye movement
• Pain grimaces
• Restlessness
• Sighing

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Bedside Assessment of the Patient

• Structure and Technique for Interviewing
• Introduction
• Self and purpose of visit
• Observe social space 4 12 feet away from
  patient
• Ensure privacy
• Pull curtains if in semi-private room
• Partially close door of room

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Bedside Assessment of the Patient

• Structure and Technique for Interviewing
• Begin interview
• Move closer to patient
• Observe personal space 2 4 feet
• Assume physical position at same level of patient
  (pull up a chair next to the bed)
• Use appropriate eye contact
• Review Guidelines for Effective Patient
  Interviewing Egans Fundamentals of Respiratory
  Care, Eighth Edition, Ch. 14

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Bedside Assessment of the Patient

• Structure and Technique for Interviewing
• Ask questions that identify common characteristic
  of symptoms
• When did it start?
• How severe is it? (Rated on a scale of 1-10)
• Where on the body is it?
• What seems to make it better or worse?
• Has it occurred before? If so, how long did it
  last?

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Bedside Assessment of the Patient

• Structure and Technique for Interviewing
• The best interview techniques are of no value if
  the interviewer is not knowledgeable about the
  pathophysiology and characteristics of the more
  common cardiopulmonary symptoms

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Dyspnea shortness of breath as defined by the
  patient
• Patients sense that their work of breathing is
  excessive for their level of activity

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Dyspnea
• Shortness of breath becomes a concern when the
  drive to breathe is excessive or when the work of
  breathing increases

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Dyspnea
• Drive to breathe is excessive
• Hypoxemia
• Acidosis
• Fever
• Exercise
• Anxiety

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Dyspnea
• Increased work of breathing
• Narrowed airways, e.g.,
• Asthma
• Bronchitis
• Lung become difficult to expand, e.g.,
• Pneumonia
• Pulmonary edema
• Chest wall abnormality

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Dyspnea
• Positional
• Reclining Orthopnea
• CHF
• Bilateral diaphragmatic paralysis
• Upright - Platypnea

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Dyspnea
• Patients description of their dyspnea
• My chest is tight
• My breathing is too fast
• I feel like Im suffocating

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Cough
• Most common symptom in patients with pulmonary
  disease
• Occurs when cough receptors are stimulated
• Inflammation
• Mucus
• Foreign materials
• Noxious gases

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Cough
• Characteristics
• Dry or loose
• Productive or nonproductive
• Acute or chronic
• During day or night

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Bedside Assessment of the Patient
Dry, loose, productive ?
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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Sputum Production
• Airway disease may cause mucus production
• Phlegm mucus from the tracheobronchial tree,
  not contaminated by oral secretions
• Sputum mucus from the lung but passes through
  the mouth

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Sputum Production
• Terminology associated the sputum
• Purulent sputum that contains pus (bacterial
  infection thick, colored, sticky)
• Fetid foul smelling sputum
• Mucoid clear, thick sputum

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Sputum Production
• Recent changes in the color, viscosity, or
  quantity or sputum produced are often signs of
  infection and must be documented and reported to
  the physician

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Hemoptysis coughing up blood or blood-streaked
  sputum from the lungs
• Massive - gt 300 ml over 24 hours
• Bronchiectasis
• Lung abscess
• Acute or old tuberculosis
• Nonmassive - lt 300 ml over 24 hours
• Infection of airways
• Lung cancer
• Tuberculosis
• Trauma
• Pulmonary embolism

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Chest Pain
• Pleuritic
• Caused by diseases of the lung that cause pleural
  lining of the lung to become inflamed, e.g.,
  pneumonia
• Located laterally or posteriorly
• Worsens with deep breath
• Sharp, stabbing type pain

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Chest Pain
• Nonpleuritic
• Common causes angina, gastroesophageal reflux,
  esophageal spasm, chest wall pain
  (costochondritis, and gall bladder disease
• Located in the center of the anterior chest, may
  radiate to the shoulder
• Not effected by breathing
• Described as dull ache or pressure

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Fever
• Common with infection of airways or lungs
• Viral
• Bacterial
• Causes increased metabolic rate
• ? oxygen consumption
• ? CO2 production
• Tachypnea
• May cause respiratory failure

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Bedside Assessment of the Patient

• Common Cardiopulmonary Symptoms
• Pedal Edema swelling of the lower extremities
• Right-sided heart failure (cor pulmonale)
• Chronic left-sided heart failure with resultant
  right-sided heart failure
• Kidney disease
• Liver disease

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Bedside Assessment of the Patient

• Pitting Edema
• Firmly depress the skin for 5 seconds then
  release
• Normal no indentation
• May see some pitting if person has been standing
  all day or is pregnant
• If pitting is present
• Subjective scale
• 1 (mild, slight depression)
• 4 (severe, deep depression)

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Bedside Assessment of the Patient

• Medical History
• Healthcare practitioners must be familiar with
  the medial history of the patients they are
  treating
• Signs and symptoms the patient exhibited on
  admission
• Reason for therapy

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Bedside Assessment of the Patient

• Medical History
• Chief complaint (admitting diagnosis)
• History of present illness
• Past medical history
• Major illness
• Surgeries
• Hospitalization
• Allergies
• Health-related habits

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Bedside Assessment of the Patient

• Medical History
• Social / environmental history
• Familial / Genetic links to disease
• Occupational links to disease
• Gas / Chemical fumes
• Dusts
• Review of systems
• Head-to-toe review of all body systems
• Done by physician
• Documented in History Physical