Bedside Assessment Of The Patient (Egan's 12th Edition Chp.16)

BIGMONEYBOUND“GOLDEN TICKET” This study guide should be throughly examined to make sure all information is correct and correlates with information being covered at your educational institution.BIG MONEY BOUND is not responsible for any incorrect information deemed correct by the reader. Egan’s 12th Edition Chp.16 Study GuideBedside Assessment Of The Patient•Decisions regarding when to initiate, change, or discontinue therapy depend upon accurate clinical assessment. Ultimately physicians are responsible for these decisions. However, because respiratory therapist (RTs) often participate in clinical decision-making, they must develop competent bedside assessment skills.• Bedside assessment is the process of interviewing and examining a patient for signs and symptoms of disease, as well as evaluating the effects of treatment.• Two key data sources are the patients medical history and physical examination.Interviewing The Patient And Taking A Medical HistoryInterviewing provides unique information because it represents the patient’s perspective, and serves the following purpose:1. To establish a rapport between the clinician and patient,2. To obtain information essential for making a diagnosis,3. To help monitor changes in the patient’s symptoms and response to therapy.Principle Of InterviewingInterviewing is the process of gathering relevant information from a patient, an essential element of which involves establishing rapport. Rapport building requires basic human skills of communicating concern, warmth, and empathy.Factors affecting communication between the RT and the patient include the following:• Sensory and emotional factors• Verbal and nonverbal components of the communication process• Cultural values, beliefs, feelings, habits, and preoccupations of both the RT and the patientStructure And Technique For Interviewing• An effective interview makes the patient feel secure enough to talk openly about personal matters• Each interview should begin with patient introducing their self to the patient, and stating the purpose of the visit.• Introductions are done from a social space of 4 to 12 feet from the patient, which is considered “socially appropriate” between strangers and therefore none threatening.• After an introduction is made it is usually appropriate to begin the interview from what is referred to as personal space (2 to 4 feet from the patient). This allow the interview to occur with a normal or soft speaking voice and creates a sense of discretion and intimacy needed for disclosing personal information.• Rapport is further established by positioning yourself at an equal level with the patient. Standing over the patient may cause them to feel intimidated and uneasy. Appropriate eye contact with the patient is essential fo a high-quality interview.• Avoid asking leading questions and instead inquire using a “nondirectional” natural style. For example, asking the patient, “Is your breathing better now?” subtly leads the patient toward a desired response.Common Cardiopulmonary SymptomsDyspneaDyspnea is a general term describing the sensation of breathing discomfort.The term dyspnea specifically refers to difficulty in the mechanical act of breathing. Dyspnea occurs when the effort to breathe is disproportionately greater than the tidal volume achieved. The perception of breathing is a complex balance among three factors:1. The neural drive to breathe coming from the respiratory centers in the brainstem2. The tension developed in the respiratory muscles 3. The corresponding displacement of the lungs and chest wallBreathlessnessBreathlessness is an unpleasant urge to breathe.• Breathlessness can be triggered by acute hypercapnia, acidosis, or hypoxemia.• A normal experience of breathlessness, is the unpleasant “throbbing” sensation induced by breath holding or feeling “winded” during strenuous exercise.• A healthy person can quickly identify the source of breathlessness and arrest the symptoms (exp. stop exercising or holding breathe ). In patients with cardiopulmonary disease dyspnea often occurs at rest.Positional dyspneaDyspnea triggered by reclining is called orthopnea. It commonly occurs in patients with CHF, mitral valve disease, bilateral diaphragm paralysis, and superior vena cava syndrome.• Platypnea is dyspnea triggered by assuming the upright position. It may occur under a variety of conditions: following pneumonectomy, during hypovolemia, in lower cervical spinal injury, and in some patients with chronic liver disease.• Orthodeoxia, which is oxygen desaturation on assuming an upright position.• Trepopnea is dyspnea that occurs when a patient with unilateral lung disease lies with the affected side in the dependent (down) position. Language of dyspnea• Each sensation should be categorized according to specific aspects of breathing: inspiration, expiration, respiratory drive, or lung volume. A remark such as “I feel that may breath stops” reflects a problem with inspiration, whereas the remark “my breath does not go all the way out” suggest a problem with expiration. Statements such as “I can’t catch my breath” suggest elevated respiratory drive.• Patients with asthma frequently complain of chest tightness, whereas patients with interstitial lung disease tend to focus on the sensation of increased work of breathing, shallow breathing, and gasping. Assessing dyspnea in the interview • Severe dyspnea often limits speech to no more than a few words at a time. In this situation, curtail the interview and initiate treatment as soon as possible. • Questions should be brief, structured to elicit a yes or no response, and focus on the quality and intensity of dyspnea.• Once dyspnea subsidies questions can be asked regarding the circumstances surrounding onset and current duration of dyspnea• In patients with chronic cardiopulmonary disease, a detailed and systematic history should cover four major areas during the initial interview:1. What activities of daily living trigger dyspnea? For example, is dyspnea triggered by walking on flat surfaces, by climbing stairs, by bathing, by dressing?2. How much exertion makes the patient stop to catch his or her breath with different activities? Does the patient need to stop after walking up one flight of stairs or one step? Dyspnea provoked by less strenuous activities indicates more advanced disease. 3. Does the quality of dyspnea vary by the type of activity? 4. When did dyspnea first become a common feature of your life? How has it evolved over time? Has dyspnea progressed slowly or rapidly? How long has this progression taken place: over a period