Objective Assessment

• Objective Assessment:

  • This is the examination of the patient by you using:
  • Your own observational skills
  • Patient charts/monitors (obs)
  • Examination of the patient
• General Appearance:

  • Pain?
  • Distress?
  • Fatigue?
  • Nutritional status / musculature
  • Abdomen distension
  • Conscious level
• What might cause a reduction in your conscious level?

  • Opiate OD e.g. morphine, heroin
  • Retained CO2 (CO2 narcosis)
  • Neurological event
• Colour of the Patient:

  • Central/peripheral cyanosis
  • Pallor (paediatrics)
  • Plethoric (red-faced – may indicate polycythaemia)
• Look at a patient’s hands!

  • Tremor
  • CO2 flap / bounding pulse / warm peripheries
  • Nicotine stains
  • Finger clubbing
• Chest Shape and Incisions

  • Barrel chest
  • Kyphoscoliosis
  • Pectus excavatum
  • Pectus carinatum
  • Incisions – thoracotomy, sternotomy
• Breathing Pattern

  • Accessory muscles (being used or hypertrophied?)
  • Soft tissue recession
  • Prolonged expiration (normal I:E ratio is 1:2)
  • Active expiration
  • Pursed lip breathing
• Palpation of the Chest

  • Tactile fremitus
  • palpable secretions
  • Chest expansion
  • good lower thoracic movement
  • equal R and L
  • Subcutaneous emphysema
  • Air in subcutaneous tissues of the chest, neck or face
• Auscultation

  • Breath sounds
  • Added sounds
• Chest X-Ray

  • Always look at and analyse a recent chest x-ray
  • Compare with previous x-rays
• Sputum

  • You need to take the lid off the sputum pot and have a good look!
  • Colour, volume, viscosity and smell
• Cough

  • Ask the patient to cough so that you can objectively assess it
  • Dry/productive
  • Effective/ineffective
• Cough: If ineffective – why is it ineffective?

  • adequate tidal volume
  • tenacious secretions / volume of secretions
  • depression of CNS
  • pain
  • inspiratory / expiratory muscle weakness
  • confusion
  • glottic function
• Apparatus - Have they got:

  • Venflon (IV fluids/meds)
  • Arterial line
  • Intercostal drains (ICD)
  • Urinary catheter
• Apparatus:

  • Nasogastric tube (NGT)
  • Oxygen
  • Patient Controlled Analgesia (PCA)