Respiratory Assessment

• NEWS Score

  resp rate

  O2 saturation

  temp

  systolic bp

  heart rate

  consciousness

  each scores 0-3 based on severity, then totalled
• SpO2

  peripheral oxygen saturation

  measure of the amount of O2 carrying Hb in the blood relative to the amount not carrying

  measured w pulse oximeter

  norm value 94-98%

  COPD = 88-92%
• Varying Coughs

  strength

  wet/dry

  productive

  sound

  painful

  causing fatigue
• Sputum

  colour

  consistency

  volume

  blood
• Sputum Colours& Correlating Conditions

  pinl/white frothy - pulmonary oedema

  sticky grey - chronic bronchitis

  yellow/green - infected

  rusty brown - pneumonia

  tenacious plugs - asthma

  blood stained - TB, clotting abnormality, trauma
• Work of Breathing

  resp rate

  shallow breathing

  regular/irregular patterns

  struggling to talk in sentences

  accessory muscle use

  gulping air

  position
• Chest Palpation

  feel for chest expansion

  feel for secretions - tactile fremitis - palpable vibrations
• ABGs

  arterial blood gasses

  evaluation of oxygenation, ventilation + acid-base balance

  can check for respiratory + metabolic issues
• Aucultation

  listening for

  sputum

  quiet air entry

  no air entry

  wheezes

  other sounds - stridor, pleural rub
• Normal Breath Sounds - Vesicular

  quiet, mostly inspiraoty, w a distinctive pause b4 a quieter expiratory phase

  soft + low-pitched w a rustling quality during inspiration + r even softer during expiration

  most commonly auscultates breath sound, heard over most of lung surface
• Normal Breath Sounds - Bronchovesicular

  heard over the 1st + 2nd intercostal spaces + the interscapular area

  the inspiraotry + expiratory phases r roughly equal in length

  they reflect a mixture of the bronchial breath sounds heard near the trachea + the alveoli w the vesicular sound
• Normal Breath Sounds - Bronchial

  normally heard over the manubrium

  expiratory phase is greater than inspiratory

  the expiratory pitch is high + intensity is loud

  hollow, tubular sounds r lower-pitched
• Normal Breath Sounds - Tracheal

  heard directly over the trachea

  inspiratory phase equals the expiratory phase

  sound is v loud + pitch is v high
• Auscultation Points

  listen to both anterior + posterior sides of the chest

  start at apices + work way down, comparing sides

  listen to at least one ventilatory cycle at each position of the chest wall

  note the quality, intesity + duration of the breath sounds

  
• Script Part 1 - Intro & Hand Hygeine

  self-intro

  hand hygeine

  gain consent

  enviro + safety check
• Script Part 1 - Engagment w Therapy & MDT Communication

  check pt's engagement w therapy + alertness

  communication w nurses + doctors (pt notes)

  check flowsheets, drug chart, NEWS

  eating, hydration, bowel movements, mobility aids, freq of mobility
• Script Part 2 (Subjective) - PMH

  co-existing conditions/prev conditions

  hospital visits, freq of visits

  treatments/surgeries

  contradictions in treatments/medications
• Script Part 2 (Subjective) - HPC

  admission date

  current illness/disability/impairment

  date of onset, trigger of onset

  severity = nature of pain/condition

  24 hr cycle
• Script Part 2 (Subjective) - SH

  home enviro - flat/house, floors, stairs, no of bathrooms

  POC - carers, nurses, 24 hr care, freq visits, DLA aids, recovery beds

  baseline/prev mobility

  lifestyle - exercise, smoking + drinking + diet
• Script Part 2 (Subjective) - DH

  inhalers/steroids

  insulin

  nebulisers (delivering medication directly to lungs in fine mist)

  oxygen

  anti-coagulants, blood thinners
• Script Part 2 (Subjective) - Airways

  tracheal alignment, obstuction, secretion
• Script Part 2 (Subjective) - Breathing

  work of breathing

  chest expansion

  breathing rate + pattern

  apical vs diaphragmatic

  audible crackles, rubs, stridor, wheeze

  strength of cough - weak/strong, dry/wet, lots of phlegm...
• Script Part 2 (Subjective) - Circulation

  ABGs - pO2, pCO2, blood pH, bicarbonate

  blood pressure + heart rate

  bloood ox + resp rate

  capillary refill/peripheral perfusion

  drug infusion

  skin tem
• Script Part 2 (Subjective) - Disability

  consciousness

  awakeness

  alertness - time, name, location, age, purpose

  delirium

  ACVPU