Advanced Health Assessment

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Advanced Health Assessment

• Pulmonary Assessment

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General Considerations

• Pulmonary Disease Unable to oxygenate or
  eliminate carbon dioxide
• 5700 liters of blood 11,400 liters of air per
  24 hours

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Epidemiology

• Over 80,000 deaths annually from chronic lung
  disease
• Over 5 million with pulmonary disability
• Lung center leading cause of death from cancer
  in U.S.

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Common Pulmonary Disorders

• Asthma
• COPD
• Pneumonia
• Lung Cancer

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Croup Syndromes

• Laryngotracheobronchitis (LTB)
• Acute Spasmodic Laryngitis
• Acute Epiglottitis
• Retropharyngeal Abscess
• Acute Bacterial Tracheitis

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Assessment Structures Function

• General survey
• Upper Airway
• Middle Airway
• Lower Airway
• Retractions (use of accessory muscles)

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Structures Functions to Consider

• Nose
• Trachea Bronchi (Carina)
• Diaphragm
• Bronchioles
• Pleural Cavity Visceral Parietal pleura
• Lungs

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Evaluation History

• Length of time
• Quality
• Sputum characteristics (cough)
• Associated symptoms
• Relieving - exacerbating factors

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Evaluation History

• Family History
• Job
• Environmental History
• Assessment of function - limitations
• Smoking history
• Cough, Change in cough

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Terms

• Dyspnea
• Tachypnea
• Hyperventilation

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Terms

• Hypoxia
• Hypercarbia

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Terms

• Cheyne-Stokes
• Sleep apnea
• CNS lesion
• Severe cardiopulmonary disease
• Kussmaul
• Diabetic ketoacidosis

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Terms

• Agonal
• Paroxysmal Nocturnal Dyspnea
• Orthopnea

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Evaluation Exam

• Inspection Look
• Palpation Feel (fremitus - toy boat 99)
• Percussion Normal, dull, resonant
• Auscultation Use good stethoscope

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Evaluation Exam

• Inspection Look
• Palpation Feel (tactile fremitus)
• Percussion Normal, dull, resonant
• Auscultation Use good stethoscope

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Evaluation Exam

• Listen
• Rales
• Wheeze
• Rhonchi
• Rub
• Decreased breath sounds
• Stridor

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Respiratory Distress(Pediatric)

• Tachypnea RR gt40
• Retractions dyspnea
• Grunting
• Flaring nares
• Anxiety air hunger
• Inspiratory stridor

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Severe Distress

• Drooling
• Dysphagia
• Dysphonia
• Agitation
• Sniff position
• Cyanosis may be late sign

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Other Transmitted Sounds Heard Through Lungs

• Increased bronchial sounds
• Bronchophony (vocal fremitus)
• Whispered pectoriloquy (vocal fremitus)
• Egophony (vocal fremitus)

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Differential Diagnosis

• Normal
• Pneumonia

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Pneumonia

• Viral
• Bacterial
• Atypical
• Age specified

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Pneumonia

• Neonatal
• Infants
• 5-10 years
• gt 40 years

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Pneumonia

• Aspiration
• HIV

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Bronchitis

• Lungs clear
• History of sputum cough

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Bronchiolitis

• gt 5 years of age
• Respiratory Syncytial Virus
• Adenovirus
• Parainfluenza

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Bronchiolitis

• Adolescents/Adults
• Most viral or atypical

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Croup LTB

• Peak 6 months - 2 years
• Viral
• Mild fever
• Inspiratory stridor
• Barking cough

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Spasmodic Croup

• Laryngitis
• Peak 1-4 years
• Unknown etiology - mild URI HX
• Sudden occurrence
• Low or no fever
• Inspiratory stridor

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Acute Epiglottitis

• Medical Emergency
• Peak 1-8 years
• Bacterial
• Rapid onset
• High fever
• Toxic

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Acute Epiglottitis

• Cherry Red epiglottis
• Severe respiratory distress
• Potential for airway obstruction
• Do not examine throat, unless prepared to intubate

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Acute Bacterial Tracheitis

• Inflammation of Trachea
• LTB worsens, in spite of therapy
• High Fever
• Toxic
• Purulend secretions

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Retro pharyngeal Abscess

• Abscess of pharyngeal area
• Potential airway obstruction
• High fever
• Toxic
• Onset more gradual
• Peak 1 -3 years

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COPD

• Asthma wheezes, delayed expiration, accessory
  muscles
• Emphysema hyperresonant, gtAP diameter, pursed
  lips
• Chronic bronchitis sputum history

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Atelectasis

• Post-op
• Decreased breath sounds

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Tuberculosis

• History of night sweats
• Chills
• Sputum
• R/O exposure

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Abscess

• History of sweats
• Chills
• Immunocompromised
• Previous infections

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Pulmonary Edema

• Rales
• Orthopnea
• PND
• R/O CHF

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Cancer

• Primary (Smokers)
• Change in cough
• SOB
• Metastatic
• Weight loss
• SOB

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Pneumothorax

• Acute SOB
• Absent breath sounds
• Hyperresonant to percussion

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Hemothorax

• R/O trauma
• Dull to percussion
• Absent breath sounds

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Adult RespiratoryDistress Syndrome

• Very Ill
• Shock lung

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Infant RespiratoryDistress Syndrome

• Hyaline Membrane Disease
• Prematurity

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Pleuritic Pain

• Viral /or trauma etiology

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Musculoskeletal Pain

• History of trauma
• Over-use

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Pleuritic Pain

• Inflammation of pleural membranes
• Sharp, knife-like pain
• Splinting
• May have pleural friction rub

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Effusion

• Severe pulmonary edema
• Cancer
• Trauma

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Diagnostic Tests

• CBC
• X-Ray
• IV Studies

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Case Studies