Dealing with the Patient
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What are the two types of chest pain?
- Type if chest pain
- Made worse by breathing
- Sharp in nature
- Located laterally and posteriorly on chest wall
- Associated with diseases that affect lining of the lung ( pheumothorax, pulmonary embolism, pneumonia)
- Type of chest pain
- Not affected by respiratory efforts
- Dull pressure sensation
- Located centrally in chest
- Assiciated with ischemic heart disease
- Noticible production is a sign of disease of airway
- Most common cause is smoking (also caused by asthma and pheumonia)
How is sputum described?
- Mucoid- clear/thick (airway diseases without infection
- Fetid- foul smell
- Purulent- pus (bacterial infection)
- Copious- large amounts (most often seen in bronchiectasis)
- Most frequent symptom (caused by stimulation of cough receptors from mechanical, chemical, inflammatory and thermal sources)
- Usually associated with airway disease (found in acute upper respiratory infection, asthma, bronchitis)
What should you ask about a cough?
- When and how often
- How severe
What are the most common symptoms of patients with cardiopulmonary disease?
- Sputum production
- Chest pain
What to ask about dyspnea?
- When, where and why?
- Rate 1 to 10
- History of disease
- Stable or worsening
What to ask about sputum?
Recent changes in color and amount
- Caused by infections disease
- 20-30% of the time cause is undetermined
- Chronic hemoptysis can be caused by chronic disease
- When associated with bronchitis- harmeless
- When associated with carcinoma-life threatening
- Abnormal rise in body temperature due to disease (usually due to an infection)
- Common respiratory problem associated with fever (viral infection, bacterial bronchitis, bacterial pneumonia, fungal infections, tuberculosis)
- Caused by narrow airways due to constriction or obstruction
- Associated with SOB, cough, sputum
- Commonly found in asthmatics, congestive heart failure, bronchitis
What are the four basic vital signs?
- Heart rate
- Respiratory rate
- Blood pressure
- Body temperature
What is considered the fifth vital sign?
What are different breathing patterns?
- Abdominal paradox due to diaphragm fatigue
- Biot's respiration due to increased intracranial pressure
- Cheyne-Stokes due to CHF or CNS disorder
- Kussmal's due to metabolic acidosis
- Apneustic due to brain damage
- Paradoxical respirations due to chest trauma, diaphragm paralysis, muscle fatigue
- Asthmatic due to obstruction of airflow out of lungs
Degree of symmetrical expansion
Other things to look for when assessing the patient
- jugular venous distention
- digital clubbing
- pursed lip breathing
- Complete blood count:
- leukocytosis (increased WBC)
- leukopenia (decreases WBC)
- total bicarb
Data collected via a lab
- cardiac enzymes
- ABG (arteriole blood gas)
- pulmonary function testing
types of patient records
- traditional chart
- problem oriented medical record (POMR)
- computer documentation
what do traditional chars include?
- admission sheet
- physician's order sheet
- progress notes
- history and physical examination data
- medication sheet
- respiratory care sheet
- nurses' admission info
- nursing care plans
Most common POMR
What does SOAP mean?
- Subjective (feeling by the patient/nonmeasurable)
- Objective (measureable tests like bp, rr, temp etc.)
What does IER mean in SOAPIER note?
Health care associated infections
- infection that patients aquire during a course of recieving medical treatment
PPE for Concact
Gloves and gown
PPE for Droplet
Gloves, gown, mask
PPE for airborne
Gloves, gown, goggles, n95
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