or perspectives

Chapter 16+19: Bedside Assessment of the Patient & Analysis & Monitoring of Gas Exchange

Objectives

• Describe techniques used to obtain data: Techniques are essential for effective patient assessment.

• Discuss clinical application: Data collected through patient interviews and physical examinations inform care planning.

Types of Data

• Subjective Data:

  • Based on personal opinions, feelings, or perspectives (Symptoms).

• Objective Data:

  • Factual, observable, and measurable information (Signs), e.g. gender, age, race.

Data Collection Techniques

• Obtaining Patient Data:

  • Combine patient medical history and physical examination.

  • Interviewing the Patient:

    • Understand interpersonal proximity:

      • Social space (4-12 ft)

      • Personal space (2-4 ft)

    • Use appropriate eye contact.

    • Utilize open-ended or neutral questions.

    • Differentiate between quantifying vs. qualifying data.

Key Concepts in Patient Assessment

• Critical Life Functions:

  • Ventilation: How gas flows through the body.

  • Oxygenation: Adequacy of oxygen reaching tissues and organs.

  • Circulation: Functionality of the cardiovascular system.

  • Perfusion: State of blood flow to various body parts.

Breathing Issues and Terms

• Dyspnea: Breathing discomfort or difficulty correlating with mechanics of breathing.

• Breathlessness: Unpleasant need to breathe faster; can arise from anxiety (e.g., panic attacks).

Physiological Measurements and Ranges

• Normal Ranges:

  • Heart rate: 60-100 bpm

  • Respiratory rate: 16-20 breaths/min

  • Blood pressure: varies with normotensive, hypertensive conditions.

• ABG Ranges:

  • Partial pressure of CO2 (PaCO2): 35-45 mmHg (hypercapnia if > 45).

Recognizing Symptoms

• Abnormal Breathing Patterns:

  • Tachypnea: >20 breaths per min.

  • Orthopnea: Difficulty breathing when lying down, common in heart failure.

  • Platypnea: Trouble breathing when upright.

  • Congestion: Can lead to discomfort in different postures.

• Sputum Characteristics: Important to categorize post-interview.

Physical Examination Techniques

• Inspection: Visual assessment of the patient.

• Palpation: Feeling the body to uncover abnormalities.

• Percussion: Tapping to assess resonances.

• Auscultation: Listening with a stethoscope for body sounds.

Vital Signs and Conditions

• Vital signs serve as a baseline for understanding health status.

• Cardinal Signs: Quantitative measures important in diagnostics.

• Hypertension: Issues related to heart, blood vessels, and blood volume affect blood pressure.

Lung Conditions and Symptoms

• Hypoxia: Inadequate oxygen at tissue level; Hypoxemia: Low oxygen in the blood.

• Respiratory Disorders: COPD, cystic fibrosis, chronic bronchitis, and asthma affect airflow.

• Restriction: Pulmonary fibrosis and kyphoscoliosis contribute to reduced breathability.

• Obstructive Conditions: Signs include retractions where parts of the chest sink in during inhalation.

Abnormal Breathing Patterns

• Paradoxical Breathing: Chest wall sinks in rather than expanding. Commonly seen in conditions like emphysema.

• Fremitus Assessment::

  • Decreased fremitus with excessive fluid or air in the pleural space.

  • Increased fremitus can indicate other conditions.

Sounds Associated with Breathing

• Wheezing: Indicative of lower airway constriction.

• Stridor: Indicates upper airway obstruction.