Information Gathering - ANSWER-1. Visuals
2. Bedside
3. Basic Labs
4. Special Tests
Visuals (Level 1) - ANSWER-Inspection: General appearance
Appearance of chest
Respiratory pattern/rate
Sensorium
Posture
Patient color
Bedside Assessment (Level 2) - ANSWER-Symptoms
HPI
Medical/Family hx
Advance directives
Vital signs
Tracheal position
Chest percussion
Temperature
Capnography
Oximetry
ECG monitor
Transcutaneous monitoring
Reflexes, ROM, Cap refill, Hemodynamic monitoring
Basic Lab Tests (Level 3) - ANSWER-ABGs
CBC
12 lead ECG
Electrolytes
CXR
Special Tests (Level 4) - ANSWER-Sputum C&S
Urinalysis
Blood culture
Volumes, flowrates, Pre-Post bronchodilator
CT scan, MRI, PET scan
Lateral neck, lateral decubitus
Bronchoscopy
Stress testing Echocardiogram
Art lines, ICP
Sweat Chloride
V/Q scan
ELISA test, Edrophonium Test, APGAR score, Cardiac enzymes
Polysomnography
GCS
Sweat Chloride Test - ANSWER-Recommended to establish a diagnosis of CF
>60 mEq/L is considered a positive test for cystic fibrosis
ELISA Test - ANSWER-Test commonly used to detect the presence of antibodies to specific infectious agents, such as HIV
Edrophonium Chloride (Tensilon) Test - ANSWER-A rapid-acting, short-lasting cholinesterase inhibitor indicated for the diagnosis of myasthenia gravis
Emphysema (Type A COPD): Pink Puffer - ANSWER-Primary Assessment:
Thin, underweight
Tobacco use hx
Mucoid secretions
Dyspnea, pursed-lip breathing
Often reddish skin
Clubbing in late stage
Hyperresonant/Tympanic
Diminished BS/prolonged expiration
Secondary Assessment:
Translucent lung fields
Depressed/flattened diaphragm
Decreased flowrates and DLCO
Increased RBC, Hb, and Hct in late stages
Normal sputum
Treatment:
Low flow O2
Bronchial hygiene
Smoking cessation
Pulmonary Rehab
Annual flu vaccines
Chronic Bronchitis (Type B COPD): Blue Bloater - ANSWER-Primary Assessment:
Stocky, overweight
Tobacco use hx