bedside assessment

70問 • 2年前

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can provide valuable information that will allow for diagnostic decisions to be made at the bedside.

bedside assessment

___________&________-remains a cornerstone of patient evaluation and is a core competency in medical school and postgraduate medical education curricula.

Physical examination and bedside diagnosis-

__________ can be lifesaving in the setting of critical illness.

bedside assessment

process of interviewing and examining a patient for signs and symptoms of disease and the effects of treatment.

bedside assessment

It is a cost-effective way of obtaining patient information about the patient's health status

bedside assessment

Provides initial evidence that something is wrong and often helps establish the severity of the problem.

bedside assessment

In contrast to some diagnostic tests, this techniques are of little risk to the patient.

bedside assessment

2 KEY SOURCES OF PATIENT DATA

Medical history Physical examination

Data gathered initially by __________&_______help identify the need for subsequent diagnostic tests.

interview and physical examination

INTERVIEWING THE PATIENT AND TAKING A MEDICAL HISTORY 1-3

1. To establish rapport between the clinician and patient. 2. To obtain essential diagnostic information. 3. To help monitor changes in the patient's symptoms and response to therapy.

FACTORS THAT AFFECT COMMUNICATION

1. Sensory and emotional factors 2. Environmental factors 3. Verbal and nonverbal components of the communication process 4. Cultural and other internal values, beliefs, feelings, habits, and preoccupations of both the health care professional and the patient.

● "sensation of breathing discomfort" ● the most important symptom that the RT is called on to assess and treat

DYSPNEA

2 Causes of Dyspnea:

a. Physical b. Psychological

is a subjective experience and should NOT be inferred from observing the patient's breathing pattern.

dyspnea

is also used specifically to describe difficulty in the mechanical act of breathing.

dyspnea

● is the specific sensation of an unpleasant urge to breathe.

BREATHLESSNESS

- the conscious perception of intense neural discharge to the respiratory muscles. ● can be triggered by acute hypercapnia and acidosis and by hypoxemia.

breathlessness

A normal experience of ________ is the unpleasant throbbing sensation that accompanies prolonged breath holding or feeling "winded" during strenuous physical exercise.

breathlessness

two types of edema

weeping edema - leakage pitting edema - hole

3 positional dyspnea

orthopnea platypnea trepopnea

dyspnea present when the patient assumes a reclining position.

orthopnea

orthopnea is common in patients with ______________, it apparently caused by sudden increase in venous return that occurs when reclining

congestive failure (CHF)

orthopnea is also a symptom of ________ ___________ ______

is also a symptom of bilateral diaphragmatic paralysis.

dyspnea in upright position

platypnea

platypnea is an unusual symptom may accompany ______________ in the lung: _______________(hepatopulmonary syndrome) and some hereditary conditions.

arteriovenous malformations chronic liver disease

platypnea may be accompanied by ________→ oxygen desaturation on assuming an upright position.

orthodeoxia

shortness of breath when lying on one side (lateral recumbent position) ● relieved by lying on opposite side

trepopnea

causes of trepopnea

unilateral lung disease CHF

complain of chest tightness

patient with asthma

sensations of increased work of breathing, shallow breathing and gasping.

patient with ILD

unique in frequently feeling suffocated

patient with CHF

is a 0 to 10 rated numerical score used to measure dyspnea as reported by the patient during submaximal exercise

MODIFIED BORG SCALE

is routinely administered during six-minute walk testing (6MWT)

modified Borg scale

one of the most common and frequently used measures to assess disease severity in PAH.

modified Borg scale

Intensity of dyspnea can be documented using a __________ or _________

numeric intensity or visual scale.

_______ ________ _______: perplexing situations in which patients with normal cardiopulmonary function complex complain of intense dyspnea or suffocation and it is associated with panic disorders.

Psychogenic hyperventilation syndrome

in psychogenic dyspnea: panic disorder and hyperventilation hyperventilation may coincide with other symptoms: ______,_______,_______ and _______ (sensation of tingling and numbness in the extremities that often accompanies respiratory alkalosis)

chest pain, anxiety, palpitations and paresthesia

Anxiety often is accompanied by _________ and ________. The resulting RA amplifies the sensation of breathlessness and provokes more anxiety, increasing the intensity of hyperventilation.

breathlessness and hyperventilation

NON-INVASIVE PHYSICAL EXAMINATION

1. Inspection (visual examination) 2. Palpation (touching) 3. Percussion (tapping) 4. Auscultation (listening to stethoscope)

Several indicators are important in assessing the patient's overall appearance including the: 1 2 3 4 5

patient's level of consciousness, facial expression, level of anxiety or distress, positioning and personal hygiene.

are signs of general ill health and malnutrition.

WEAKNESS AND EMACIATION (CACHEXIA)

can indicate fever, pain, severe stress, increased metabolism or acute anxiety

diaphoresis

refers to the condition where an excessive sweating or perspiration is due to medical, pharmacological, or health reasons not necessarily for thermoregulation.

diaphoresis

may help reveal pain or anxiety

facial expressions

can also help in evaluating alertness, mood, general character and mental capacity

facial expressions

what grade?

grade?

grade

grade?

grade

● may be useful in assessing the severity of the problem and the patient's response to it.

PATIENT POSITION

a position where a person sits or stands leaning forward and supports the upper body with hands on knees or other surface

tripod position

indicators can help determine both the duration and the impact of the illness on a patient's daily activity.

PERSONAL HYGIENE

LEVEL OF CONSCIOUSNESS ● If a patient appears conscious, the RT should assess the patient's orientation to time, place, person and situation-called evaluating ________.

SENSORIUM

If the patient is alert who can correctly tell the interviewer the current date, location, his or her name and situation- is said to be________ and the patient's sensorium is _____.

"oriented x4" normal

If a patient is not alert, the _______ is assessed.

LOC (level of consciousness)

__________ _________may occur with poor cerebral blood flow (ex hypotension) or when poorly oxygenated blood perfuses the brain.

Depressed consciousness

If hypoxia worsens, the patient may become _______.

comatose

______________________- also may occur in chronic degenerative brain disorders, as a side effect of certain medications and in case of drug overdose.

Abnormal consciousness

what are the level of consciousness

confused lethargic stuporous delirious obtunded comatose

● is used to describe the level of consciousness in an individual.

GLASGOW COMA SCALE (GCS)

It is often used to gauge the severity of an acute brain injury due to trauma or medical cause.

GLASGOW COMA SCALE

The test is simple, reliable, and correlates well with outcomes following brain injury.

GLASGOW COMA SCALE

It is composed of 3 domains which are assessed separately and given numerical scores

Glasgow coma scale

The lowest possible GCS; this indicates a patient is wholly unresponsive.

The point of intubation; any patient with an 8 or lower is strongly considered for intubation, as they are unlikely to maintain a patent airway.

The highest GCS score; a patient who opens their eyes spontaneously, is oriented and alert, and obeys commands has a GCS of 15.

-an abnormal rigidity, arms, and legs held straight out, toes pointed downward, head and neck arched backward

Decerebrate (extensor) posture

_____________an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bent and held on the chest.

Decorticate (flexor) posture

community-acquired acute pneumonia

Monica Ramos · 21問 · 3年前

community-acquired acute pneumonia