Hemodynamic Monitoring - Chapter 3 - Pulmonary System Assessment PDF

HEMODYNAMIC MONITORING CHAPTER 3: Physical Assessment of the Pulmonary System  Overview of Physical Assessment Monitors must be considered and adjunct to patient evaluation and should never replace frequent bedside physical assessments. Patient who are non-...

HEMODYNAMIC MONITORING CHAPTER 3: Physical Assessment of the Pulmonary System  Overview of Physical Assessment Monitors must be considered and adjunct to patient evaluation and should never replace frequent bedside physical assessments. Patient who are non-responsive should always be spoken to as if conscious and offered brief, simple explanations about what is being done. This is especially important if: Family, friends, other staff in the room Patient’s level of sedation is uncertain  Transcultural Considerations Language or dialect differences may require the use of an interpreter Need to overcome ethnocentrism The belief that one’s own way of life is the most desirable and acceptable Intubated patient may require the use of: Communication board Pen and paper Good non-verbal communication Address the patient's healthcare needs first Remember that patient are in a vulnerable state Show empathy and provide excellent patient care  Cough Evaluation of sputum Copious, thick, *2mucoid, greyish-white, translucent = COPD, Smokers *1 *3 Purulent, foul smelling, yellow, brown, green, mucoid = Bronchopulmonary bacterial infections, possible Bronchiectasis if chronic in nature. Rusty, golden yellow = Pneumococcal pneumonia Clear, white mucoid = Asthma, allergies Eosinophils in sputum may cause sputum to appear purulent Hemoptysis Sputum that is grossly bloody, blood streaked, pink, small clots Odorless, frothy, peach colored = Acute cardiopulmonary edema Recurrent bloody sputum = Severe pulmonary hypertension  Tracheoinnominate Fistula Potentially fatal complication of tracheostomy Positioning of the tracheostomy tube against the innominate artery result sin pulsatile movement of the tracheostomy tube Will result in tracheal wall erosion Tracheostomy tube should be quickly repositioned  Dyspnea Normal minute ventilation (VE): 4-6 L/min Dyspnea Maximal ventilatory capacity: 200 L/min Related to pulmonary disease Airflow limitations: Asthma, Increased RAW (PIP – Pplat) Reduced CL (∆V / ∆P): Atelectasis, ARDS, Pulmonary Fibrosis Conditions that resist lung expansion: Pneumothorax, Pleural Effusion, Inflammation) Increase in physiologic VD: Pulmonary Embolism Respiratory muscle fatigue: Exercise, COPD exacerbation  Asymmetry of Chest Movement Pleural Effusion Unilateral v. bilateral Obstruction of major bronchus Right mainstem intubation Mucus plugs Neuromuscular abnormalities G.B. M.G. Pneumothorax Hemothorax Severe atelectasis  Abnormal Breathing Patterns With respiratory muscle fatigue, as the chest rises during inspiration, the abdomen is sucked in With respiratory muscle fatigue, during exhalation the abdomen moves out as the chest falls These are often rapid, uncoordinated respiratory movements  Cyanosis Diffuse blueish coloration of the skin and mucous membranes, especially the: Nail beds Lips Nose Earlobes Deoxygenated hemoglobin (AKA reduced or desaturated hemoglobin) imparts a blueish color to the blood Occurs when PaO2 nears 50 mm Hg, SpO2 80%  Central Cyanosis Occurs when blood leaving the left ventricle is poorly oxygenated. Caused by: Inadequate oxygenation of blood by the lungs Anything that causes poor perfusion Evident at the nail beds, earlobes, nose, under the tongue Skin over the entire body is usually warm  Peripheral Cyanosis Blood leaving the left ventricle is adequately oxygenated but becomes desaturated in the peripheral systemic circulation. Occurs when blood stagnated in vasoconstricted peripheral arterioles because of: Cold environments Excessive sympathetic nervous system stimulation die to anxiety or circulatory failure Evident at nail beds, earlobes, nose Mucous membranes under the tongue remain pink as these vascular beds rarely vasoconstrict Skin is typically cold, cyanosis will resolve as the body is warmed  Generalized Edema Most commonly observed in the feet and ankles May occur as a consequence of: Renal disease Metabolic disease Cardiac disease COPD Right ventricular failure due to pulmonary disease Cor Pulmonale  Subcutaneous Emphysema Air in the subcutaneous tissue indicative of an pulmonary air leak Evidenced as swelling in the chest area Palpation produces a crackling sensation Rice crispies, small bubble wrap Poses a threat to the patient if it is significant enough around the throat to compress and occlude the airway and/or blood vessels It is a warning of air leak and risk of future/current pneumothorax  Posturing Patient with respiratory difficulty prefer to: Sit up rather than lie down Grasp objects with their hands or rest their arms on a stationary object Tripod position or “tripoding” *1Activated muscles of inspiration Upright position will allow for increased VT due to greater diaphragmatic descent  Diagnostic Percussion Used to determine the density or consistency of the underlying lung by evaluating the sounds produced when the chest wall is tapped Technique   SOUND QUALITY CLINICAL CORELATIONS Resonance Loud Sound heard over healthy, well aerated Low in pitch (deep) lungs Hyperresonan Very loud Occurs when the amount of air in the ce Lower in pitch (deeper) than thorax is increased such as with resonance emphysema or pneumothorax Tympany Musical Tension pneumothorax Clear Increased air under pressure Hollow tone Pitch is usually high Dullness Soft intensity Occurs when lung is not well aerated as Medium in pitch with: Short duration Consolidation Dampened quality (Flat) Atelectasis Collapse Fibrosis Tumor  Tracheal Position Assessed when shifting of the mediastinal structures is suspected Technique: Place the tip of your index finger gently into the suprasternal notch Locate the trachea and assess if deviation towards either side is present Increase or volume or pressure on one side of the thorax shifts the trachea and mediastinal structures to the opposite side. Tension pneumothorax, Hemothorax, Pleural Effusion Decrease in lung volume shifts the trachea and mediastinal toward the affected side Atelectasis, Consolidation, Lobectomy  Auscultation of Breath Sounds Know how to do this and what different breath sounds indicate