Practical exam layout

• Part 1:

  1. explain pathophys of disease
  2. ask pts how breathless they are on scale of 1 to 10 - subjective assessment, ask what makes breathlessness worse
  3. ask pts how much sputum they produce and the colour of the sputum, ask if theres any blood - subjective assessment
  4. auscultate pts chest, must take top of, breathing in and out of mouth, listen for 2 breaths on upper chest of one side, then the other side, then listen to axillary region of each side, then lower lobes posteriorly - explain the sounds you can hear
  5. palpate chest to see if you can feel palpable secretions
• Part 2:

  1. GAP
  2. Airway clearance techniques - ACBT - minimum 10 mins, max 30 mins
  3. breathing control - reduce dyspnoea, promote relaxation, prevent hyperventilation, do more if patient breathless
  4. thoracic expansion exercises - increase TV, recruit collateral channels, get air behind secretion, can also recruit lungs - do 2 to 5 times, do more if patient is not as breathless
  5. back to breathing control
  6. forced expiration technique such as huff to mobilise and remove secretion - can be low inspiratory huff (distal mobilisation) or high inspiratory huff (proximal mobilisation/removal) - do 2
• Part 3:

  1. if airway clearance isnt effective add manual techniques
  2. percussion - cant do on bare skin - 4 deep breaths whilst slapping upper chest - sends vibrations to dislodge secretions from airway walls
  3. shaking - shake upper chest during expiration - increases expiratory flowrate to remove sputum of airway walls
  4. explain other possible GAP
  5. if ACBT and manual techniques not effective, can use IPPB
  6. lastly compare pts breathlessness, sputum production, reascultate, repalpate