-
What doing physical examination- obs what are you looking for?
- - general appearance
- - colour
- - clubbing
- - acessory mm use
- - posture
- - chest shape
- - breathing pattern
- - attachments
-
Physical obs what must u ensure before you start?
- - pt comfortable
- - verbal consent
- - thoracic and abdomen are visible
- - explain what you are going to do
- - what you are looking for
- - warn pt if they feel any unusual sensations to tell you
- - make sure you wash your hands before you start
-
Physio assessment
- - date, time, physiotherapy
- - subjective- ask pt, comfort, pain, doing exercises
- - objective- pt position, where they are, LOC, alter and cooperation
- attachments- IV, IDC, draining, in situ, O2 levels and how delivered
-
What are you looking for when you observe a pts general appearance?
- - comfort
- - posture
- - LOC
- - body- chest size, weight
-
What are you looking for when you observe a pts colour?
- - blue- cyanosis
- - yellow
- - grey/ white- low blood
- - red- febrile
- - bruises
-
What are you looking for when you observe a pts clubbing?
- - no angle between nail bed and finger
- - chronic condition- no sure why
-
What are you looking for when you observe a pts accessory mm use?
- - traps
- - scalenes
- - SCM
- - activity
- - hypertrophy- constrant increase WOB
- - do in quiet breathing
-
What are you looking for when you observe a pts posture?
- - sitting
- - supine
- - standing
- - walking around ward
-
What are you looking for when you observe a pts shest shape?
- - see if they have
- - barrel chest
- - kyphosis
- - pes excarvatium- funnel chest
- - pes caranirum- pigeon chest
-
What are you looking for when you observe a pts breathing pattern?
- - how the pt is talking
- - use of shoulders
- - are they hunched over
- - look for movt of abdomen (belly mm use for asthma pts- cant get air out)
-
What are you looking for when you observe a pts attachments?
- - O2
- - drains
- - central lines
- - NGT
- - IDC
- - IV
- - calf compressors
- - monitors
-
What are you palpating on physical examination of the chest?
- -accessory mm
- - soft tissues
- - tracheal position
- - percussion note
- - vocal fremitis
- - chest expansion
-
WHat do you have to note when you are physical examinating a patient with palpation?
- - make sure pt is comfy
- - ensure verbal consent
- - make sure thorax and abs are visible
- - explain what you are going to do
- - what you are looking for
- - warn pt if they feel unusal to let you know
- - wash hands
-
What are you looking for when you palpate soft tissue?
- - swelling
- - subcutaneous emphysemia
-
What are you looking for when you palpate tracheal position?
- - palpate by putting index finger in suprasternal notch on each side and feeling the outline of the trachea
- - note deviation to one side or the other
- - if there is a mass occupying space will push trachea to the other side
- - collapse on a side will pull trachea to that side
-
Percussion note
- - dont need to know
- - place index or middle finger of non dom hand over an intercostal space, tap the DP with indexc or middle finger of the other hand. Listen for the sound generated. Move the hands from apices to bases
- - air, liquid or solid in lungs
- - percus intercostal space
-
Vocal fremitis
- - PHYSIO dont need to no
- - hands place symmetrically over both lungs and moved from the apices to the bases.
- - ask pt to say 99
- - note vibrationfelt as pt speaks
- - vibration decrease has hands move towards bases
- -note tenderness
- - increase with fluid in lungs
-
LBE
- - thumbs should touch
- - meet in the middle
- - front move- 6-8cm
- - back move- 3-5 cm
-
When obs expiration
- - view front on
- - expiration should be twice as long as inspiration
- - when obs from back want scap out of the way
-
Kussmaul breathing
- short rapid breathing
-
Chest expansion technique
- - LBE/ ab movement
- - hands either side of the thorax
- - hands covering the diaphragmatic area and part of the abdomen
- - thumbs facing inwards
- - ask pt to take a normal breath in
- - palpate chest movement
- - ask pt to tak a deep breath in
- - palpate chest movt
-
Physical examination listening- what are you listening for?
- - breathing
- - ausculation
- - cough
-
Techniques you need to practive
- - measure RR- 15 sec- pretend to be taking pulse
- -palpate accessory mm- both at rest and DB
- - vocal fremitis- solid fel more vibration
- - percussion note-compare sides
- - LBE in DB and QB
- - cough describe
|
|
