02-respiratory system assessment
DESCRIPTION
sistem respirasiTRANSCRIPT
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Respiratory System Assessment
Dr Abdelhaleem Bella
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The hardest conviction to get into
the mind of a beginner is that the
education upon which he is engaged
is not a college course...but a life
course, for which the work of a
few years under teachers is but a
preparation.
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The Basic
• Medicine is learned at the bedside and not in the classroom
• Practice makes perfect
• Rapport AND NURS ( Name + Understanding+ Respect+ Support)
• Start with open ended questions , frequent summary, clarify conclude .
• Anatomical , Physiological ,Aetiological and Impact
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HISTORY
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Introduction : General Info
Summary
HPI
SH
PSH Drugs
Presenting Complaint
PMH
SR
FH
PH
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Common Symptoms
1. Cough 2. Sputum 3. Dyspnea 4. Wheeze 5. Chest Pain 6. Snoring and EDS 7. Hoarseness 8. Hemoptysis` 9. General : Fever , Sweating, Wt Loss, Appetite
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When the Patient Has Cough .
1 How long have you had the cough? 2 Do you cough up anything? What? How much? 3 Have you had sinus problems? 4 Is the sputum clear or discoloured? Is there any blood in the
sputum? 5 Have you had high temperatures? 6 Does coughing occur particularly at night (acid reflux)? 7 Have you become short of breath? 8 Have you had lung problems in the past? 9 Have you been a smoker? Do you still smoke? 10 Have you noticed wheezing?-Asthma, chronic obstructive
pulmonary disease (COPD)? 11 Do you take any tablets?-ACE inhibitors
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Cough Duration
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Cough Character
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When the patient complains of Breathlessness
1 How long have you been short of breath? Has it come on quickly? 2 How much exercise can you do before your shortness of breath stops
you or slows you down? Can you walk up a flight of stairs? 3 Have you been woken at night by breathlessness or had to sleep
sitting up?-Paroxysmal nocturnal dyspnoea (PND), orthopnoea 4 Have you had heart or lung problems in the past? 5 Have you had a temperature? 6 Do you smoke? 7 Is there a feeling of tightness in the chest when you feel breathless?-
Angina 8 Do you get wheezy in the chest? Cough? 9 Is the feeling really one of difficulty getting a satisfying breath?-Anxiety 10 Is it painful to take a big breath?-Pleurisy or pericarditis 11 Did the shortness of breath come on very quickly or
instantaneously?-Pulmonary embolus (very quick onset) or pneumothorax (instantaneous onset)
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Dyspnea And Onset+
Duration
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Dyspnea Extra
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EXAMINATION
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General Appearance: Blue Bloaters and Pink Puffers
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Sputum
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Pattern of Breathing
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Hand Examination: Cyanosis
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Nail :Staining
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Diabetes mellitus Amyloidosis Median/ulnar nerve injury; Thermal injury; and Jaundice. Consider yellow nail syndrome if a patient has lymphedema and bronchiectasis.
Nails : Yellow Nails
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A, Schamroth sign. In the absence of clubbing, opposition of the index fingers nail to nail creates a diamond-shaped window (arrowhead). In clubbed fingers, the loss of the profile angle because of the increase in tissue at the nail bed causes obliteration of this space (arrowhead). B, Distal phalangeal finger depth (DPD)/interphalangeal finger depth (IPD) represents the phalangeal depth ratio. In normal fingers, the IPD is greater than the DPD. In clubbing, this relationship is reversed
Nails : Clubbing
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Nails : Clubbing and possible disease
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Nails: Clubbing
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‘nail clubbing’, ‘drumstick fingers’, ‘Water-glass nails’ for the resemblance and ‘Hippocratic fingers
1. Periungual erythema and softening of the nail bed (spongy feeling on palpation)
2. Increase in the normal 160-165o angle between the nail bed and proximal nail fold (Lovibond’s angle) (Figure 2)
3. Increase nail curvature (secondary to the increase Lovibond’s angle)
4. Enlargement giving the drumstick appearance hypertrophic osteoarthropathy(HOA) characterised by
periostitis of long bones and pain. It is also referred to as ‘Piérre Marié-Bamberger syndrome’.
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Hand : Flapping Tremor
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Central Cyanosis : Lips
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Face : Congestion
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Face: Horner Syndrome
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Cervical Lymph Nodes
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CHEST
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Chest : Inspection ,distended Veins
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Chest Inspection: Pectus Carinatum
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Chest Inspection : Pectus Excavatum
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Chest Inspection : Scars
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Chest Inspection : Scars
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Chest Inspection : Scars
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Chest Inspection : Scars
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Chest Inspection: Barrel
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Chest Inspection : Kyphoscoliosis
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Harrison Sulcus and asso signs
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Palpating the Trachea
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Inspection : chest expansion
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Palpation: Chest Movement
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Percussion
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Sequence
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Percussion Notes
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Auscultation
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Auscultation: Breath sounds
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Auscultation : Breath Sounds
Bronchial :Heard over the trachea and mainstem bronchi (2nd-4th intercostal spaces either side of the sternum anteriorly and 3rd-6th intercostal spaces along the vertebrae posteriorly). The sounds are described as tubular and harsh. Also known as tracheal breath sounds. Bronchovesicular :Heard over the major bronchi below the clavicles in the upper of the chest anteriorly. Bronchovesicular sounds heard over the peripheral lung denote pathology. The sounds are described as medium-pitched and continuous throughout inspiration and expiration. Vesicular : Heard over the peripheral lung. Described as soft and low- pitched. Best heard on inspiration. Diminished :Heard with shallow breathing; normal in obese patients with excessive adipose tissue and during pregnancy. Can also indicate an obstructed airway, partial or total lung collapse, or chronic lung disease.
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Pathophysiology and Clinical Signs
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FURTHER SYSTEM EXAMINATIONS
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INVESTIGATIONS
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“Learn to love the freedom of the student life, only too quickly to pass away; the absence of the coarser cares of after days, the joy in comradeship, the delight in new work, the happiness in knowing that you are making progress. Once only can you enjoy these pleasures.”
Osler W. The Master-Word in Medicine. In: Aequanimitas, With Other Addresses to Medical Students, Nurses and Practitioners of Medicine.3rd ed. New York: McGraw-Hill Book Company, 1932: 362.
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INVESTIGATIONS
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Normal Female CXR
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Peak Flow Meter
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Pulmonary Function Test
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SUMMARY & CONCLUSION
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http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/IMAGES/CD-LungSounds/mac/cugell-07july11.swf
http://www.stethographics.com/main/physiology_ls_introduction.html
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