Respiratory Assessment: Diagnosis, Testing & Interventions PDF

Definitions =========== - Ventilation: Movement of air in and out of the lungs via inspiration and expiration. Driven by the diaphragm and intercostal muscles. =====================================================================================================================================...

Definitions =========== - Ventilation: Movement of air in and out of the lungs via inspiration and expiration. Driven by the diaphragm and intercostal muscles. ===================================================================================================================================== - Perfusion: The process by which oxygenated blood is delivered to tissues and carbon dioxide is removed. ======================================================================================================= - Respiration: The biochemical exchange of gases at the alveolar and cellular level. ================================================================================== History Taking ============== When assessing a patient\'s respiratory condition, the following focused assessment questions should be included: ================================================================================================================= 1. Current Complaints ================== - Shortness of breath (dyspnea), wheezing, chest tightness, persistent cough, sputum production, fatigue, recent infections. ========================================================================================================================== 2. Signs and Symptoms (Use OPQRST framework) ========================================= - O: When did the symptoms start? Gradual or sudden onset? ======================================================== - P: What makes it better/worse? (e.g., exertion, lying flat, environmental triggers) =================================================================================== - Q: Describe symptoms (e.g., sharp pain, tightness, productive or dry cough). ============================================================================ - R: Where is the discomfort felt? Radiating? =========================================== - S: Rate severity (0-10). ======================== - T: Is it constant or intermittent? Worse at a certain time of day? ================================================================== - U: What does the patient think is the cause? ============================================ 3. Past Medical History ==================== - Chronic respiratory illnesses: Asthma, COPD, pneumonia, CHF, cystic fibrosis, tuberculosis. =========================================================================================== - Previous hospitalizations or need for oxygen therapy. ===================================================== 4. Smoking and Drug Use ==================== - Pack-year history (cigarettes per day x years smoking). ======================================================= - Vaping, illicit drug use (especially inhaled substances like marijuana, methamphetamines, crack cocaine). ========================================================================================================= 5. Allergies ========= - Environmental, food, medication allergies that could exacerbate respiratory conditions. ======================================================================================= 6. Medications =========== - Bronchodilators (Albuterol, Ipratropium). ========================================= - Corticosteroids (Prednisone, Fluticasone). ========================================== - Leukotriene receptor antagonists (Montelukast). =============================================== 7. Family History ============== - History of asthma, COPD, lung cancer, genetic disorders (cystic fibrosis). ========================================================================== 8. Travel, Work, Exposures ======================= - Recent travel to areas endemic for tuberculosis or fungal infections. ===================================================================== - Occupational exposure to dust, chemicals, or irritants. ======================================================= Assessment (Physical Exam) ========================== 1. Inspection ============= - General appearance: Signs of respiratory distress? (nasal flaring, accessory muscle use, tripod positioning) ============================================================================================================ - Cyanosis: Central (lips, tongue) vs. peripheral (fingers, toes). ================================================================ - Nail clubbing: Chronic hypoxia (e.g., COPD, cystic fibrosis). ============================================================= - Shape of the thorax: Barrel chest (COPD), kyphosis, scoliosis affecting lung expansion. ======================================================================================= 2. Palpation ============ - Tracheal deviation: Shift could indicate pneumothorax, pleural effusion. ======================================================================== - Tactile fremitus: Increased in pneumonia, decreased in pleural effusion. ======================================================================== 3. Percussion ============= - Hyperresonance: Pneumothorax or emphysema. ========================================== - Dullness: Pleural effusion or pneumonia. ======================================== 4. Auscultation =============== - Crackles (rales): Fluid overload, pneumonia, CHF. ================================================= - Wheezing: Bronchospasm (asthma, COPD). ====================================== - Stridor: Upper airway obstruction. ================================== - Absent breath sounds: Pneumothorax, pleural effusion. ===================================================== Diagnostic Testing ================== 1. Pulse Oximetry: =============== - Measures oxygen saturation (SpO₂). ================================== - Caution: Unreliable in anemia, CO poisoning. ============================================ 2. Capnography (End-Tidal CO₂ Monitoring): ======================================= - Used in patients on ventilators, post-surgery. ============================================== 3. Arterial Blood Gases (ABGs): ============================ - Assesses oxygenation, ventilation, and acid-base status. ======================================================== - Normal values: ============== - pH: 7.35--7.45 ============== - PaCO₂: 35--45 mmHg ================== - HCO₃⁻: 22--26 mEq/L =================== - PaO₂: 80--100 mmHg ================== 4. Chest X-ray (CXR): ================== - Pneumonia: Consolidation. ========================= - CHF: Pulmonary edema, enlarged heart. ===================================== - Pneumothorax: Absent lung markings. =================================== 5. Sputum Culture: =============== - Identifies bacterial, fungal, or viral infections. ================================================== - Ensure proper collection technique. =================================== 6. Pulmonary Function Tests (PFTs): ================================ - Obstructive diseases (asthma, COPD): Decreased FEV1/FVC ratio. ============================================================== - Restrictive diseases (fibrosis, scoliosis): Decreased lung volume. ================================================================== Respiratory Interventions ========================= 1. Oxygen Therapy ================= - Nasal Cannula (1--6 L/min): Mild hypoxia. ========================================= - Non-Rebreather Mask (10--15 L/min): Severe hypoxia. =================================================== - Venturi Mask: Specific FiO₂ in COPD. ==================================== - BiPAP/CPAP: Non-invasive ventilation. ===================================== - Intubation and Mechanical Ventilation: Severe respiratory failure. ================================================================== 2. Medications & Treatments =========================== - Bronchodilators: ================ - Short-acting beta-agonists (SABAs): Albuterol (rescue inhaler). =============================================================== - Long-acting beta-agonists (LABAs): Salmeterol (maintenance). ============================================================ - Corticosteroids: ================ - Inhaled: Fluticasone. ===================== - Oral/IV: Prednisone, methylprednisolone (for exacerbations). ============================================================ - Mucolytics: Acetylcysteine (CF, chronic bronchitis). ==================================================== - Antibiotics: Pneumonia, bacterial exacerbations of COPD. ======================================================== - Anticoagulants: Pulmonary embolism. =================================== 3. Chest Tube Management ======================== - Monitor drainage: Normal output is \