PE Exam One (Part 1)

Coughing is

A protective reflex and a very common symptom seen in patients with pulmonary disease

Cough stimulates which receptors

Pharynx, larynx, trachea, large bronchi, lung, and visceral pleura.

Cough is caused by

Inflammatory, mechanical, chemical, or thermal stimulation of receptors.

Determining cough etiology

Careful history, physical examination, and CXR.

Afferent pathway of cough

Vagus, phrenic, glossopharyngeal, and trigeminal nerves.

Efferent pathway of cough

Smooth muscles of larynx and tracheobronchial tree via phrenic and spinal nerves.

Phases of cough

Inspiratory, compression, and expiratory.

Reduced effectiveness of cough caused by

-Weakness of inspiratory or expiratory muscles

-Inability of the glottis to open or close correctly

-Obstruction, collapsibility, or alteration in shape or contours of the airways

-Decrease in lung recoil (e.g., emphysema)

-Abnormal quantity or quality of mucus production (e.g., thick sputum)

Acute cough

Sudden onset, severe, short course, self-limiting, viral infection.

Chronic cough

Persistent, lasts >3 weeks.

Causes of chronic cough

Postnasal drip (most common), asthma, COPD.

Paroxysmal cough

Periodic with prolonged, forceful episodes.

Associated symptoms of a cough

Wheezing, stridor, chest pain, dyspnea

Recurrent cough

Allergies, asthma

Dry cough

Viral infection, inhalation of irritant

Inadequate or weak cough

Debility, weakness, oversedation, pain

Inspiratory stridor

Croup, epiglottitis, obstruction

Wheezy cough

Bronchospasm, asthma

Paroxysmal cough (often at night) associated with

Asthma, left heart failure

Barking cough

Croup, laryngotracheal bronchitis

Complications of coughing

Torn chest muscle

Rib fractures

Disruption of surgical wounds

Pneumothorax (air in lungs/pleural space) or pneumomediastinum (air in mediastinum)

Syncope (fainting)

Arrhythmia

Esophageal rupture

Urinary incontinence

Sputum

Secretions from tracheobronchial tree, pharynx, mouth, sinuses, nose

Phlegm

Secretions from lungs and tracheobronchial tree

Components of sputum

Mucus, cellular debris, microorganisms, blood, pus, foreign particles

Normal sputum

100 mL/day

Bronchorrhea

More that 100 mL of sputum per day

Excessive production by inflamed glands caused by

Infection, cigarette smoking, allergies

Describe sputum with

Color, Quantity, Consistency, Odor, Time of day, Presence of blood

Clear sputum

normal

Black sputum

smoke/coal inhalation

Brown sputum

cigarette smoker

Frothy white or pink sputum

pulmonary edema or heart failure

Sand or small stone in sputum

Aspiration of foreign materials

Purulent sputum (containing pus)

Infection

Apple green, thick sputum

Haemophilus influenza

Pink, thin blood-streaked sputum

Streptococci or Staphylococci

Red currant jelly sputum

Klebsiellas series

Silicone like cast sputum

Bronchial asthma

Rusty sputum

Pneumococci

Foul odor/fetid sputum

Lung abscess

Mucoid (white, gray and thick) sputum

Emphysema

Hemoptysis

Expectoration of sputum containing blood from streaking to frank bleeding

Causes of hemoptysis

Bronchopulmonary, cardiovascular, hematologic, systemic disorders, tuberculosis, or fungal infections

Which of the following best describes the primary role of a respiratory therapist in patient assessment?

Assisting physicians with diagnostic reasoning and treatment planning

Three main elements of patient centered care

Individualized care, Patient involvement and Provider collaboration

Individulized Care is

Empathetic communication, Respect for pt values and privacy, Sensitivity to cultural values

Patient involvement is

Patient education, Shared decision making, Patient participation in care

Provider collaboration is

Communication, Coordination and Shared Responsibility

Pre-Interaction stage

Review pt chart, make initial pt assessment and clarify your role in pt care

Introductory stage

Introduce yourself, check armband, establish positive rapport, look for resistant behavior and act accordingly

5 Rights

Make sure its the Right patient, drug, dose, route and time

Initial Assessment stage

Brief assessment, determine pt illness, brief physical assessment

Health Insurance Portability and Accountability Act

Passed in 1996 to increase ability to transfer health info from one provider to another

Health Insurance Portability and Accountability Act Title II

took effect in 2003 and made rules for protected health insurance so only approved health care workers have access to PHI

4 to 12 feet from patient is

Social space used during the introductory stage

18 in to 4 feet from patient is

Personal space used during the interview stage

0 to 18 in from patient is

Intimate space used during the physical exam

Having self-awareness means

Having knowledge of one’s cultural beliefs and any stereotypes one might have about a particular group

Having situational awareness means

The ability to recognize misunderstandings with patient provider cultural differences during a pt encounter

Being culturally competent means

Adapting to specific situations by individualizing communication in a way that’s consistent with the patient and families’ values and beliefs

When interviewing a patient

Adress patient by name, check the patient’s armband, undivided interest in patient

True or False: Alternative sources of patient history, such as electronic health records and family members, can be used when patients are unable to provide reliable information.

True

Which of the following best differentiates objective data from subjective data?

Objective data refers to physical exam (signs), while subjective data refers to review of systems (symptoms)

Which type of interview question is most effective for encouraging patients to describe their symptoms in their own words?

Open-ended questions

Systemic diseases frequently have

Respiratory systems

Chief Complain (cc) is

What brought patient into hospital

History of Present Illness (PHI)

Describes chronologically and in detail chief complaint, also the hardest part of history to obtain

Review of Systems

Going through the different organ systems then the patient gives a subjective answer in their own words about whats wrong

PQRST

P: Provocative/palliative (What is the cause, what makes it better/worse)

Q: Quality/quantity (how much is involved, how does it feel)

R: Region/radiation (where does it hurt)

S: Severity/scale (does it interfere with daily activities)

T: Timing (when did it begin)

When looking at family history you should look for

Hereditary diseases, Info on three generations, Presence or absence of most frequently reviewed diseases

Pack Years

Number of packs a day a patient smokes multiplied by number of years patient has smoked

How can you improve patient interviews

Open ended questions at times, Using words the patient uses, Closed questions provide clarification

Patients with lung disease often have

Medical problems in other body systems

Demographic Data

Name, DOB, Adress, Race, Religion etc.

Pertinent Negatives

Negative response to important questions

Pertinent Positives

Positive response to important questions

Common symptoms associated with lung disease

Cough, Dyspnea (SOB), Chest Pain, Wheezing

Each symptom is reviewed in the HPI for it’s

Onset, location in body, severity, quantity, quality, duration, course, aggravating and alleviating factors