RC111 Ch16-Patient Bedside Assessment-Lecture Notes
Introduction to Patient Bedside Assessment
Importance of having the textbook available during lecture for references.
Encourage students to jot down questions for a live Q&A session.
Key Terms
Emphasis on mastering vocabulary to facilitate effective and professional communication in healthcare settings.
Importance of understanding key terms in transition to a healthcare profession, which may feel like learning a new language.
Learning Objectives
Ability to describe the necessity of patient interviews.
Distinction between social and personal spaces during interviews.
Understanding factors influencing communication between respiratory therapists (RTs) and patients.
Differentiate between signs and symptoms.
Listing five neutral questions used to elicit information about patient symptoms.
Acknowledge how function can negatively impact breathing.
Understanding that the knowledge gained will be relevant throughout the semester and beyond, ensuring lifelong application in the health field.
Introduction to the Bedside Assessment
Define bedside assessment as the process of interviewing and examining a patient.
Key to assessing disease signs and symptoms and evaluating treatment effects.
Importance of initial assessments to identify diagnoses and evaluate ongoing effects of treatments.
Context of Clinical Decisions
Clinical assessments guide physicians in therapy decisions based on accurate information.
Hierarchical understanding of roles in patient care involving doctors and RTs.
Doctors are seen as decision makers (like quarterbacks in a team), while RTs and other healthcare professionals support with implementation and information gathering.
Importance of proper patient assessment for timely interventions and recommendations, emphasizing reliance on RTs’ expertise, especially in complex cases.
Components of the Initial Patient Assessment
Mention of physical examination and medical history as primary data sources:
Medical history captures past health issues (e.g., asthma, smoking status).
Physical examination involves direct assessments like checking vital signs and breath sounds.
Diagnostic Process
Emphasis that RTs do not diagnose but recognize signs and symptoms for doctor’s evaluation.
Definition of differential diagnosis: a process involving many diseases with overlapping symptoms where the exact cause is unclear.
Signs vs. Symptoms
Signs: Objective manifestations of illness (measurable, e.g., heart rate).
Symptoms: Subjective sensations reported by the patient (e.g., feeling short of breath).
Importance of Rapport and Information Gathering
Establishing rapport is essential for gathering complete medical histories.
Comfort encourages honesty; patients may provide more detailed information if they feel at ease.
Quality of information impacts the efficacy of diagnosis and treatment.
Principles of Effective Interviewing
Interviewing is the process of collecting relevant patient information.
Factors affecting communication:
Sensory factors: Uncomfortable settings may hinder effective communication.
Emotional factors: Anxiety or embarrassment may impede openness.
Environmental factors: Conversations should take place in private settings conducive to disclosure.
Cultural factors: Awareness of cultural differences can shape patient responses and willingness to share.
Interviewing Techniques
Use social space (4-12 feet) for introduction and personal space (2-4 feet) during questioning.
Encourage open communication through neutral rather than leading questions.
Avoid binary (yes/no) questions to promote detailed responses.
Best practices include:
Asking about symptom onset, severity, and situations that exacerbate symptoms.
Approach should be informed by knowledge of diseased states to make informed interventions.
Common Cardiopulmonary Terms
Dyspnea: Subjective sensation of breathing discomfort. Most significant symptom RTs assess and treat.
Breathlessness: Urge to breathe that can occur despite adequate ventilation.
Paroxysmal nocturnal dyspnea: Dyspnea triggered by the reclining position, often in congestive heart failure patients.
Platypnea: Dyspnea triggered by sitting up. Common in post-pneumonectomy patients and those with chronic liver disease.
Orthopnea: Oxygen desaturation when lying down; often assessed in CHF patients who may need multiple pillows at night for comfort.
Trepopnea: Dyspnea when lying on one side; often improves when the patient adopts a different position due to issues with lung perfusion.
Cheyne-Stokes respiration: Irregular type of breathing; breaths increase and decrease in depth and rate with periods of apnea; commonly seen in patients with heart failure or significant brain injury.
Kussmaul's respiration: Deep and fast respirations; often associated with metabolic acidosis, particularly in diabetic ketoacidosis, as the body attempts to eliminate excess carbon dioxide.
Biot respiration: Chaotic breathing pattern characterized by frequent irregularity in both rate and tidal volume that eventually deteriorates to agonal breathing and terminal apnea. Occurs when there’s damage to the medulla or pons caused by stroke or trauma.
Agonal Breathing: Intermittent prolonged gasps that occur before apnea; typically indicative of an impending respiratory arrest and is commonly observed in patients nearing end-of-life or experiencing severe hypoxia.
Apneustic Breathing: Prolonged inspiratory pause at full inspiration typically lasting for 2-3 seconds. It indicates damage to the lower pons.
Central Neurogenic hyperventilation: Persistent hyperventilation driven by abnormal neurological activity in the brain; associated with midbrain and upper pons damage.
Central Neurogenic hypoventilation: A condition characterized by under-respiratory effort and is associated with damage to the lower brainstem, leading to inadequate ventilation despite the need for oxygenation.
Cardiopulmonary System Overview
The intertwining of the cardiovascular and pulmonary systems necessitates their integrated assessment due to their functional dependence.
Emphasis that changes in one system inherently affect the other.
List of further cardiopulmonary symptoms and assessment techniques are hinted at in further reading materials as crucial tools for RTs in practice.