Bedside Assessment in Respiratory Therapy

The process of initiating, changing, or discontinuing therapy is dependent on accurate clinical assessments.
Physicians carry the ultimate responsibility for these clinical decisions.
Respiratory Therapists (RTs) play a significant role in clinical decision-making due to the collaborative nature of healthcare.
RTs must develop competent patient assessment skills and integrate findings with the medical record.

Bedside assessment involves interviewing and examining patients to gather signs and symptoms of disease while evaluating treatment effects.
This approach typically presents little risk to patients compared to formal diagnostic tests.
Key Data Sources:
- Physical examination results.
- Patient medical history obtained through interviews and medical record reviews.
- Identifying needs for diagnostic tests based on gathered data.
Repeated use of assessment skills helps care teams determine appropriate therapies and adjust as necessary.

The assessment is conducted to achieve an accurate diagnosis.
Diagnosis: Derived from Greek, meaning ‘to know thoroughly’, is the process of identifying the nature and cause of illness.

Interviewing provides unique patient perspectives and serves three vital functions:
1. Establish rapport between clinician and patient.
2. Gather information crucial for diagnosis.
3. Monitor changes in symptoms and responses to treatment.

Key elements of effective interviewing include:
- Establishing rapport through human communication skills—concern, warmth, empathy.
- Acknowledging that hospitalization often comes with stress; meaningful contact can alleviate this.
Factors Affecting Communication:
- Sensory and emotional factors.
- Environmental variables.
- Cultural values and beliefs of both the RT and the patient.

Effective interviews are unique, influenced by both the RT and patient's background and characteristics.
Interview Structure and Technique:
- Begin with self-introduction and purpose explanation.
- Maintain appropriate distance, starting with socially acceptable space (4 to 12 feet) transitioning to personal space (2 to 4 feet).
- Maintain eye contact and observe nonverbal behaviors.
- Avoid leading questions; use neutral phrasing to elicit accurate responses.
Examples of neutral questions to identify symptom characteristics:
- "When did the symptom start?"
- "How severe is it (on a scale of 1 to 10)?"

Dyspnea:
- Defined as the sensation of breathing discomfort; significant for RT assessment and treatment.
- Dyspnea cannot be inferred from observations and is subjective.
It arises when breathing effort exceeds tidal volume achieved—mechanically defined as abnormal.
The perception of dyspnea balances:
1. Neural drive from the brainstem.
2. Tension in respiratory muscles.
3. Displacement of lungs and chest wall.
Neuro-mechanical Dissociation: Described as an imbalance when neuronal signals governing sensations are disrupted.
- Normal individuals experience dyspnea under unusual circumstances (e.g., restricted breathing).
Measurement of Dyspnea:
- The Modified Borg Dyspnea Scale is frequently used, scoring from 0 (no dyspnea) to 10 (maximum breathing difficulty).
- It can be conducted during daily activities or standardized exercise maneuvers like the Six-minute Walk Test.

A 54-year-old female patient, 2 days post-abdominal surgery, presents with dyspnea, rapid shallow breathing (34 breaths/min), and mild tachycardia (110 beats/min).
Diminished breath sounds and fine, late inspiratory crackles noted upon examination.

The findings suggest lung volume loss leading to dyspnea, likely due to postoperative atelectasis.
Possible differential diagnoses include Congestive Heart Failure (CHF) and pulmonary thromboembolism.

Request a chest radiograph; if atelectasis is confirmed, initiate lung expansion therapy.
If pulmonary embolism is suspected, additional tests like a chest CT scan may be required.