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Egan's 11th Ch16

Respiratory Therapy Midland: Bedside Assessment of Patient

QuestionAnswer
What are the purposes of an interview? (3) Establish a rapport, obtain information for diagnosis, monitor any changes in patient condition.
What are guidelines of an effective interview? (4) Giving the patient undivided interest, establishing a professional role, showing respect for the patients beliefs and rights, and using a relaxed conversational style.
What is dyspnea? Any breathing discomfort, or difficulty in breathing.
What can cause breathlessness? Acute Hypercapnia, Acidosis, Hypoxemia
What is breathlessness? An uncomfortable urge to breathe.
How do dyspnea and breathlessness affect the patient emotionally? Not knowing the cause of these sensations can be very distressing and have a profound impact on them.
Which diseases commonly cause orthopnea? CHF, mitral valve disease, and SVC syndrome.
Which diseases or operations cause platypnea? Pneuonectomies and chronic liver disease
Which conditions is Trepopnea associated with? CHF and pleural effusion
What categories should RTs place sensations felt in dyspnea? Problems with: Inspiration, Expiration, Respiratory Drive, Lung Volume
What should an RT pay attention to when assessing dyspnea? Is the patient is able to get enough breath to speak whole sentences? Do they have a history of CardioPulmonary Disease?
What should be done if the patient cannot get enough breath to form full sentences? The initial interview should be curtailed and treatment initiated. Any further questions should be given that they can be answered by 'yes' or 'no'.
In patients with chronic cardiopulmonary disease, what areas should the medical history cover? What daily activities triggers dyspnea? How much exertion is needed before they need to catch their breath? (Less=More advanced disease) Does the discomfort vary with different activities? When did the dyspnea begin and how has it changed?
What is Psychogenic Hyperventilation Syndrome? When a patient with normal pulmonary function complains of dyspnea.
What accounts for 90% of chronic cough? Upper airway cough syndrome (postnasal drip), asthma, and gastroesophageal reflux
What characteristics of a cough should an RT pay attention to? Is it dry or loose? Productive or nonproductive? Is it acute or chronic? Does it occur more frequently at day or night?
What does a dry, nonproductive cough typically signify? Restrictive Lung Diseases: CHF, Cystic Fibrosis
What does a loose, productive cough signify? Inflammatory Obstructive Diseases: Bronchitis and Asthma
What does purluent sputum signify? A bacterial infection
What are the common causes of Hemoptysis? Bronchiectasis, lung abscess, chronic tuberculosis
When does hemoptysis become massive hemoptysis? When total amount of blood coughed up is greater than 300mL.
What is pleuritic chest pain? How is it described? How does it manifest? Pain which occurs laterally or posteriorly on the trunk and worsens on inspiration. It is described as "sharp, stabbing", and manifests through diseases which cause inflammation of visceral pleura.
What is nonpleuritic chest pain? What are some causes? Pain which occurs in the center of the anterior chest, and may radiate towards the shoulder. Most common cause is angina, and others are gastroesophageal reflux, esophageal spasm, and gallbladder disease.
What are some noninfectious causes of fever? (7) Drug reaction, cancer-related malignancies, head trauma, burns, alcoholic cirrhosis, thromboembolic disorders, noninfectious inflammatory diseases.
What does the magnitude of a fever indicate? The virulence of the infection
How could a fever cause tachypnea? Higher temperature->Increased Metabolic Rate->Increased Oxygen Consumption->Higher production of Carbon Dioxide
What is the most common cause of Pedal Edema? Heart Failure
What is pitting edema? Pressure applied to an edemic area will leave an impression whose refill rate and height signify the severity of the edema.
What is weeping edema? Pressure applied to an edemic area will cause fluid to seep out.
How are pack-years calculated? Average Number of Cigarette Packs Smoked Per Day x Number of Years Smoked
What can be inferred from Cachexia? Lack of nutrition increases susceptibility to infection.
What can be inferred from sweating? (5) Fever, acute anxiety, pain, severe stress, increased metabolism
When do you call a patient confused? (4) When they: show slight decrease of consciousness, have slow mental responses, have decreased perception, have incoherent thoughts.
When do you call a patient delirious? (3) When they: Are easily agitated, are irritable, exhibit hallucinations
When do you call a patient lethargic? (3) When they: Are sleepy, arouse easily, responds appropriately when aroused.
When do you call a patient obtunded? (2) When they: awaken only with difficulty, respond appropriately when aroused.
When do you call a patient stuporous? (4) When they: Do not awaken completely, have decreased mental and physical activity, respond to pain and exhibit reflexes, responds slowly when spoken to.
When do you call a patient comatose? (5) When they: Are unconscious, do not respond to stimuli, do not move voluntarily, exhibits possible upper motor neuron reflexes, loses reflexes with prolonged coma.