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Assessment of Respiratory System Anatomy of Respiratory System •Nasopharynx •Larynx •Trachea •Bronchi •Bronchioles •Alveoli Initial Respiratory Survey Observe the patient’s breathing pattern Rate (normal vs. increased/decreased) Depth (shallow vs. deep) Effort (any sign of accessory muscle use, inspect neck) Assess the patient’s color cyanosis Normal Respiratory Rates Infant 30-60 Toddler 24-40 Preschooler 22-34 School-age child 18-30 Adolescent 12-16 Adult 10-20 SUBJECTIVE ASSESSMENT Fever Peripheral Oedema Sleep Stress Incontinence Functional ability Disease awareness Previous physiotherapy Collateral from nursing staff/family. SUBJECTIVE ASSESSMENT Using the headings below, write some questions that you could use to find out or confirm the subjective information that you need to know: • Pain • Exercise tolerance • Wheeze • Cough & sputum • Sleep • Functional ability • Disease awareness • Previous physiotherapy Relevant History Any chronic conditions Asthma, COPD, CHF, DM Exposure to new medication Inhibitor Recent change in diet Peanuts, Strawberries Substance abuse/Overdose Opioid abuse, ASA toxicity (aspirin) Prior DVT. Recent trauma to chest OBJECTIVE ASSESSMENT Observe Chart Drug Kardex General observation Oxygen therapy Breathing pattern Palpation Auscultation Percussion CXR analysis Mobility Exercise tolerance Spirometry ABG Other investigations Standardised outcome measures Inspection Note the shape of the chest and the way it moves Deformities or asymmetry Increased AP diameter in COPD Abnormal retractions of interspaces during respiration Lower interspaces, supraclavicular in acute asthma exacerbation Impaired respiratory movement Flail Chest and paradoxical movement with rib fractures. Percussion Helps to identify if underlying tissues are airfilled, fluid-filled, or solid Hyperextend middle finger of either hand and press against chest wall Strike with flexed middle finger of opposite hand Always percuss symmetrically on chest wall Percussion Notes Flatness Thigh Dullness Liver Resonance Lung Hyperresonance None Tympany Stomach, puffed cheek Percussion Dullness replaces resonance when fluid or solid tissue replaces air containing lung Pleural Effusions Hemothorax Tumor Unilateral Hyperresonance Pneumothorax Generalized Hyperresonance COPD Breath Sounds Normal Tracheal Bronchial Bronchovesicular Vesicular Abnormal Absent/Decreased Bronchial Adventitious Crackles (Rales) Wheeze Rhonchi Stridor Pleural Rub Causes of Decreased or Absent Breath Sounds Asthma COPD Pleural Effusion Pneumothorax Atelectasis Common Respiratory Disorders Pneumonia Community-acquired pneumonia Hospital-acquired pneumonia Bacteria Viruses Mycoplasma Fungi Chemical Pneumonia is an inflammatory response to the uncontrolled multiplication of microorganisms invading the lower respiratory tract. Pneumonia Studies CXR, sputum culture, bronchoalveolar lavage Management Antibiotics, oxygen, pulmonary toilet Supportive care Nutrition, hydration, rest Prevention Pneumococcal and influenza vaccines Pleural Effusion Accumulation of pleural fluid secondary to increased fluid formation Increased capillary permeability Deceased colloid osmotic pressure of the blood Increased intrapleural negative pressure Impaired lymphatic drainage Increased pressure in the capillaries or lymphatics Assessment of Pleural Fluid H/P finding Shortness of breath, chest pain Tachypnea, hypoxemia, pleural rub Diagnostic studies CXR – lateral decubitus Thoracentesis Pneumothorax Sudden onset of pleuritic chest pain Dyspnea, shortness of breath, increased work of breathing Diagnostic test CXR Management Oxygen Possible placement of chest tube Pulmonary Embolism Part of a deep vein thrombosis that has traveled and lodged in the pulmonary arteries Severity depends on the extent of occlusion Mismatch of ventilation and perfusion Testing A pulmonary angiogram Management Anticoagulation COPD History Exposure to risk factors, co-morbidities, current medical treatment (beta blockers) Tests Spirometry, ABGs Management Oxygen, education, drug therapy, nutrition, exercise, surgical intervention Asthma A chronic inflammatory disease of the airways Airway hyper responsiveness Variable airway obstruction Resolves spontaneously or after using a bronchodilator Asthma Testing Spirometry Pulmonary function testing Management Education, prevent exacerbation, optimize pharmacotherapy Acute Respiratory Failure A sudden and life–threatening deterioration in gas exchange Type I – Acute hypoxemic respiratory failure Type II - Acute hypercapnic respiratory failure Type III – Combined hypoxemic and hypercapnic failure Acute Respiratory Failure Tests ABGs, CXR, CT, thoracentesis Management Correction of gases, oxygen therapy Reversal of any narcotics Possible mechanical ventilation