On Functional Murmurs: a Further
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Respiratory Examination Cardiac Examination Is an Essential Part of the Respiratory Assessment and Vice Versa
Respiratory examination Cardiac examination is an essential part of the respiratory assessment and vice versa. # Subject steps Pictures Notes Preparation: Pre-exam Checklist: A Very important. WIPE Be the one. 1 Wash your hands. Wash your hands in Introduce yourself to the patient, confirm front of the examiner or bring a sanitizer with 2 patient’s ID, explain the examination & you. take consent. Positioning of the patient and his/her (Position the patient in a 3 1 2 Privacy. 90 degree sitting position) and uncover Exposure. full exposure of the trunk. his/her upper body. 4 (if you could not, tell the examiner from the beginning). 3 4 Examination: General appearance: B (ABC2DEVs) Appearance: young, middle aged, or old, Begin by observing the and looks generally ill or well. patient's general health from the end of the bed. Observe the patient's general appearance (age, Around the bed I can't state of health, nutritional status and any other see any medications, obvious signs e.g. jaundice, cyanosis, O2 mask, or chest dyspnea). 1 tube(look at the lateral sides of chest wall), metered dose inhalers, and the presence of a sputum mug. 2 Body built: normal, thin, or obese The patient looks comfortable and he doesn't appear short of breath and he doesn't obviously use accessory muscles or any heard Connections: such as nasal cannula wheezes. To determine this, check for: (mention the medications), nasogastric Dyspnea: Assess the rate, depth, and regularity of the patient's 3 tube, oxygen mask, canals or nebulizer, breathing by counting the respiratory rate, range (16–25 breaths Holter monitor, I.V. -
Visual Examination
Visual Examination • Consider the impact of chest shape on the respiratory condition of the patient – Barrel chest – Kyphosis – Scoliosis – Pectus excavatum (funnel chest) – Pectus carinatum Visual Assessment of Thorax • Thoracic scars from previous surgery • Chest symmetry • Use of accessory muscles • Bruising • In drawing of ribs • Flail segment www.nejm.org/doi/full/10.1056/NEJMicm0904437 • Paradoxical breathing /seesaw breathing • Pursed lip breathing • Nasal flaring Palpation • For vibration of secretion • Surgical emphysema • Symmetry of chest movement • Tactile vocal fremitus • Check for a tracheal tug • Palpate Nodes http://www.ncbi.nlm.nih.gov/books/NBK368/ https://m.youtube.com/watch?v=uzgdaJCf0Mk Auscultation • Is there any air entry? • Differentiate – Normal vesicular sounds – Bronchial breathing – Wheeze – Distinguish crackles • Fine • Coarse • During inspiration or expiration • Profuse or scanty – Absent sounds – Vocal resonance http://www.easyauscultation.com/lung-sounds.aspx Percussion • Tapping of the middle phalanx of the left middle finger with the right middle finger • Sounds should be resonant but may be – Hyper resonant – Dull – Stony Dull http://stanfordmedicine25.stanford.edu/the25/pulmonary.html Pathological Expansion Mediastinal Percussion Breath Further Process Displacement Note Sounds Examination Consolidation Reduced on None Dull Bronchial affected side breathing Vocal resonance Whispering pectoriloquy Collapse Reduced on Towards Dull Reduced None affected side affected side Pleural Reduced on Towards Stony dull Reduced/ Occasional rub effusion affected side opposite side Absent Empyema Asthma Reduced None Resonant Normal/ Wheeze throughout Reduced COPD Reduced None Resonant/ Normal/ Wheeze throughout Hyper-resonant Reduced Pulmonary Normal or None Normal Normal Bibasal crepitations Fibrosis reduced throughout Pneumothorax Reduced on Towards Hyper-resonant Reduced/ None affected side opposite side Absent http://www.cram.com/flashcards/test/lung-sounds-886428 sign up and test yourself.. -
THE DUBLIN MEDICAL SCHOOL and ITS INFLUENCE UPON MEDICINE in AMERICA1 by DAVID RIESMAN, M.D
THE DUBLIN MEDICAL SCHOOL AND ITS INFLUENCE UPON MEDICINE IN AMERICA1 By DAVID RIESMAN, M.D. PROFESSOR OF CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA PHILADELPHIA, PA. HE Irish, a mixture of primitive universal genius like Robert Boyle, Ireland pre-Celtic peoples and of Goidelic did not produce a perpetuating body of Celts coming from the European learned men who made their influence felt T continent, developed in the early beyond the confines of the Green Island. Middle Ages, out of their own resources Of the history of Irish medicine in the and untouched in any marked degree by the Middle Ages, little is known and the all-pervading influence of Rome, a remark subject is largely an untilled field. Norman able indigenous culture. In particular they Moore (St. Barth. Hosp. Rep., 1875, it elaborated a native type of Christianity 145) has resuscitated a few of the original which with characteristic energy and manuscripts in the Irish language. Most wandering spirit they carried to Scotland, of them are translations from the works of to Northern England—to Northumbria—to Bernard de Gordon, especially from his France, to Belgium, and to Switzerland. “Lilium Medicinae”; of John of Gaddes- St. Columba, of Iona, and St. Columbanus, den’s “Rosa Anglica”; of the works of of Luxeuil, stand forth as the great militant Avicenna, of A verroes, of Isaac, and of the missionaries of that first flowering period Salernitan School. Much space is given to of Irish civilization. Although they and their the writings of Isidorus. This Isidorus is successors had to succumb to the greater the famous Spanish churchman, bishop might of Latin Christianity,2 they left of Seville, who not only was a master of dotted over Europe a number of large theology but a writer upon every branch of monasteries which became active centers of knowledge of his day. -
Gas Exchange and Respiratory Function
LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 484 Aptara Gas Exchange and 5 Respiratory Function Applying Concepts From NANDA, NIC, • Case Study and NOC A Patient With Impaired Cough Reflex Mrs. Lewis, age 77 years, is admitted to the hospital for left lower lobe pneumonia. Her vital signs are: Temp 100.6°F; HR 90 and regular; B/P: 142/74; Resp. 28. She has a weak cough, diminished breath sounds over the lower left lung field, and coarse rhonchi over the midtracheal area. She can expectorate some sputum, which is thick and grayish green. She has a history of stroke. Secondary to the stroke she has impaired gag and cough reflexes and mild weakness of her left side. She is allowed food and fluids because she can swallow safely if she uses the chin-tuck maneuver. Visit thePoint to view a concept map that illustrates the relationships that exist between the nursing diagnoses, interventions, and outcomes for the patient’s clinical problems. LWBK330-4183G-c21_p484-516.qxd 23/07/2009 02:09 PM Page 485 Aptara Nursing Classifications and Languages NANDA NIC NOC NURSING DIAGNOSES NURSING INTERVENTIONS NURSING OUTCOMES INEFFECTIVE AIRWAY CLEARANCE— RESPIRATORY MONITORING— Return to functional baseline sta- Inability to clear secretions or ob- Collection and analysis of patient tus, stabilization of, or structions from the respiratory data to ensure airway patency improvement in: tract to maintain a clear airway and adequate gas exchange RESPIRATORY STATUS: AIRWAY PATENCY—Extent to which the tracheobronchial passages remain open IMPAIRED GAS -
Chest Auscultation: Presence/Absence and Equality of Normal/Abnormal and Adventitious Breath Sounds and Heart Sounds A
Northwest Community EMS System Continuing Education: January 2012 RESPIRATORY ASSESSMENT Independent Study Materials Connie J. Mattera, M.S., R.N., EMT-P COGNITIVE OBJECTIVES Upon completion of the class, independent study materials and post-test question bank, each participant will independently do the following with a degree of accuracy that meets or exceeds the standards established for their scope of practice: 1. Integrate complex knowledge of pulmonary anatomy, physiology, & pathophysiology to sequence the steps of an organized physical exam using four maneuvers of assessment (inspection, palpation, percussion, and auscultation) and appropriate technique for patients of all ages. (National EMS Education Standards) 2. Integrate assessment findings in pts who present w/ respiratory distress to form an accurate field impression. This includes developing a list of differential diagnoses using higher order thinking and critical reasoning. (National EMS Education Standards) 3. Describe the signs and symptoms of compromised ventilations/inadequate gas exchange. 4. Recognize the three immediate life-threatening thoracic injuries that must be detected and resuscitated during the “B” portion of the primary assessment. 5. Explain the difference between pulse oximetry and capnography monitoring and the type of information that can be obtained from each of them. 6. Compare and contrast those patients who need supplemental oxygen and those that would be harmed by hyperoxia, giving an explanation of the risks associated with each. 7. Select the correct oxygen delivery device and liter flow to support ventilations and oxygenation in a patient with ventilatory distress, impaired gas exchange or ineffective breathing patterns including those patients who benefit from CPAP. 8. Explain the components to obtain when assessing a patient history using SAMPLE and OPQRST. -
Prognosis in Bronchiectasis
Arch Dis Child: first published as 10.1136/adc.6.31.1 on 1 February 1931. Downloaded from PROGNOSIS IN BRONCHIECTASIS BY LEONARD FINDLAY, M.D., D.Sc., M.R.C.P., Physician, East London Hospital for Children, Shadwell, and STANLEY GRAHAM, M.D., Physician, Royal Hospital for Sick Children, Glasgow. In 1927, we published in this journal' a communication embodying the results of our experience of bronchiectasis in childhood. We then expressed doubt regarding the correctness of the view held by some authors that the condition is curable. Nobecourt2, for example, in support of Hutinel3, has stated that recovery not infrequently does take place. This, he thinks, is brought about by the dilatation of the bronchi ceasing to increase, and, as the lung grows, the bronchi ultimately coming to have the normal proportions. Hutinel believed that the younger the age at which the bronchiectasis appeared the more likely was a cure to result. Thursfield and Paterson4 more recently have re-affirmed this favourable prognostic outlook. So far as we could see at the time of our first analysis the condition tended to get worse. From a study of the post-mortem material it was difficult, if not impossible, to understand how recovery could take place. Many of the lungs had the naked-eye appearance of a sponge or a hydatidiform mole. Naturally, of course, the post-mortem examples would be the most severe, though it is only fair to state that in several cases death had resulted from operative inter- ference and not in consequence of advancing pulmonary involvement. -
Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and Their Teaching in Academia
James Madison University JMU Scholarly Commons Physician Assistant Capstones The Graduate School Fall 12-14-2018 Community-acquired pneumonia in adults: Diagnostic reliability of physical examination techniques and their teaching in academia Amber Tordoff James Madison University Lauren A. Williams James Madison University Follow this and additional works at: https://commons.lib.jmu.edu/pacapstones Part of the Bacteria Commons, Bacterial Infections and Mycoses Commons, Diagnosis Commons, Investigative Techniques Commons, Medical Pathology Commons, Respiratory Tract Diseases Commons, Virus Diseases Commons, and the Viruses Commons Recommended Citation Tordoff AL, Williams LA. Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and their Teaching in Academia. JMU Scholarly Commons Physician Assistant Capstones. https://commons.lib.jmu.edu/pacapstones/44/. Published December 12, 2018. This Presentation is brought to you for free and open access by the The Graduate School at JMU Scholarly Commons. It has been accepted for inclusion in Physician Assistant Capstones by an authorized administrator of JMU Scholarly Commons. For more information, please contact [email protected]. Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and their Teaching in Academia Amber Tordoff, PA-S and Lauren Williams, PA-S, James Madison University, Harrisonburg, Virginia _____________________________________________________________________________________ ABSTRACT Background: -
Chest and Lung Examination
Chest and Lung Examination Statement of Goals Understand and perform a complete examination of the normal chest and lungs. Learning Objectives A. Locate the bony landmarks of the normal chest: • Ribs and costal margin, numbering ribs and interspaces • Clavicle • Sternum, sternal angle and suprasternal notch • Scapula B. Define the vertical "lines" used to designate chest wall locations. Use the bony landmarks and conventional vertical "lines" when describing a specific area of the chest wall. • Midsternal line • Midclavicular line • Anterior, mid and posterior axillary lines • Scapular line • Vertebral line C. Describe the location of the trachea, mainstem bronchi, lobes of the lungs and pleurae with respect to the surface anatomy of the chest. D. Prepare for an effective and comfortable examination of the chest and lungs by positioning and draping the patient. Communicate with the patient during the exam to enlist the patient’s cooperation. E. Describe and perform inspection of the chest including the following: • Rate, rhythm, depth, and effort of breathing • Shape and movement of the chest F. Describe and perform palpation of the chest including the following: • Identify tender areas • Chest expansion • Tactile fremitus G. Describe and perform percussion of the chest, distinguishing a dull sound (below the diaphragm) from a resonant sound (over normal lung.) Use percussion to demonstrate symmetric resonance of the lung fields and to measure diaphragmatic excursion. H. Describe and perform auscultation of the lungs including the following: • Symmetric examination of the lung fields, posterior and anterior. • Normal breath sounds (vesicular, bronchovesicular, bronchial and tracheal), their usual locations and their characteristics. I. Define terms for three common adventitious lung sounds: • Wheezes are high pitched, continuous hissing or whistling sounds. -
Physical Diagnosis the Pulmonary Exam What Should We Know About the Examination of the Chest?
PHYSICAL DIAGNOSIS THE PULMONARY EXAM WHAT SHOULD WE KNOW ABOUT THE EXAMINATION OF THE CHEST? • LANDMARKS • PERTINENT VOCABULARY • SYMPTOMS • SIGNS • HOW TO PERFORM AN EXAM • HOW TO PRESENT THE INFORMATION • HOW TO FORMULATE A DIFFERENTIAL DIAGNOSIS IMPORTANT TOPOGRAPHY OF THE CHEST TOPOGRAPHY OF THE BACK LOOK AT THE PATIENT • RESPIRATORY DISTRESS • ANXIOUS • CLUTCHING • ACCESSORY MUSCLES •CYANOSIS • GASPING • STRIDOR • CLUBBING TYPES OF BODY HABITUS WHAT IS A BARRELL CHEST? • THORACIC INDEX – RATIO OF THE ANTERIORPOSTERIOR TO LATERAL DIAMETER NORMAL 0.70 – 0.75 IN ADULTS - >0.9 IS CONSIDERED ABNORMAL • NORMALS - ILLUSION •COPD AM J MED 25:13-22,1958 PURSED – LIPS BREATHING • COPD – DECREASES DYSPNEA • DECREASES RR • INCREASES TIDAL VOLUME • DECREASES WORK OF BREATHING CHEST 101:75-78, 1992 WHITE NOISE (NOISY BREATHING) • THIS NOISE CAN BE HEARD AT THE BEDSIDE WITHOUT THE STETHOSCOPE • LACKS A MUSICAL PITCH • AIR TURBULENCE CAUSED BY NARROWED AIRWAYS • CHRONIC BRONCHITIS CHEST 73:399-412, 1978 RESPIRATORY ALTERNANS • NORMALLY BOTH CHEST AND ABDOMEN RISE DURING INSPIRATION • PARADOXICAL RESPIRATION IMPLIES THAT DURING INSPIRATION THE CHEST RISES AND THE ABDOMEN COLLAPSES • IMPENDING MUSCLE FATIGUE DO NOT FORGET THE TRACHEA • TRACHEAL DEVIATION • AUSCULTATE - STRIDOR • TRACHEAL TUG (OLIVERS SIGN) – DOWNWARD DISPLACEMENT OF THE CRICOID CARTILAGE WITH VENTRICULAR CONTRACTION – OBSERVED IN PATIENTS WITH AN AORTIC ARCH ANEURYSM • TRACHEAL TUG (CAMPBELL’S SIGN) – DOWNWARD DISPACEMENT OF THE THYROID CARTILAGE DURING INSPIRATION – SEEN IN PATIENTS -
Nursing Care in Pediatric Respiratory Disease Nursing Care in Pediatric Respiratory Disease
Nursing Care in Pediatric Respiratory Disease Nursing Care in Pediatric Respiratory Disease Edited by Concettina (Tina) Tolomeo, DNP, APRN, FNP-BC, AE-C Nurse Practitioner Director, Program Development Yale University School of Medicine Department of Pediatrics Section of Respiratory Medicine New Haven, CT A John Wiley & Sons, Inc., Publication This edition first published 2012 © 2012 by John Wiley & Sons, Inc. Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons Inc., The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 2121 State Avenue, Ames, Iowa 50014-8300, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-0-8138-1768-2/2012. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. -
Wisconsin Standardized Intermediate Curriculum December 2012 Wisconsin Department of Health Services
Wisconsin Standardized Intermediate Curriculum December 2012 Wisconsin Department of Health Services This page is intentionally blank. 2012 – Wisconsin Intermediate Curriculum Table of Contents 0.0 – INTRODUCTION .......................................................................................................................................................... 13 0.1 – WISCONSIN INTERMEDIATE PROGRAM OUTCOMES ............................................................................................. 13 0.2 – CURRICULUM BACKGROUND AND EMS TRAINING CENTER ADAPTATION ....................................................... 13 0.3 – PROGRAM PREREQUISITES / PRESUMPTION OF PREREQUISITE EDUCATION .................................................. 13 0.4 – WISCONSIN 2012 INTERMEDIATE CURRICULUM COMMITTEE MEMBERS ...................................................... 14 0.5 – COURSE STRUCTURE AND TOPICAL HOUR GUIDELINES ...................................................................................... 14 0.6 – CLINICAL AND FIELD EXPERIENCES, MINIMUM HOURS AND COMPETENCY REQUIREMENTS ....................... 16 1.0 – PREPARATORY ............................................................................................................................................................ 20 1.1 – EMS SYSTEMS ............................................................................................................................................................. 20 1.1.1 - Quality Improvement .......................................................................................................................................... -
Pulmonary and Thorax Exam FACILITATOR & STUDENT COPY
PATIENT CENTERED MEDICINE - 1 PCM-1 Physical Exam Skills Session: Pulmonary and Thorax Exam FACILITATOR & STUDENT COPY GOALS & OUTCOMES: 1. To introduce basic examination techniques of the thorax and the pulmonary system and stress the applied physiology as well as to review the applied anatomy. 2. To introduce the use of the stethoscope ASSIGNMENTS DUE FOR THIS SESSION: 1. Bates' Guide to Physical Examination and History Taking. 11th Edition. The Thorax and Lungs: Anatomy and Physiology, pp. 293-299, Techniques of Examination, pp. 305-318. 2. PCM Basic Examination- Details: View: Lung Video and Thorax Video Review the Using Diagnostic Equipment video 3. Bring your stethoscope with you to learn its use in the pulmonary exam ASSIGNMENTS DUE FOR NEXT WEEK: 1) Practice the skills learned on friends, family, pets, etc. SESSION ACTIVITIES: SUGGESTED TIMELINE: 1) Watch the high yield demonstration with course 45 minutes faculty in lecture hall as a group. 2) Examine each other in small groups guided by 60 minutes faculty. Thorax/Pulmonary Exam Page 1 of 6 BACKGROUND – TO BE READ BEFORE COMING TO THE SMALL GROUP This session is a continuation of the physical exam sessions representing a collaborative effort between the two courses Patient Centered Medicine 1 and Structure of the Human Body. Process: 1. Meet in the lecture hall for the high yield demonstration. 2. Then you will have an assigned time at which to report to the clinical skills center. Typically, there are three waves of assigned times usually 1:00 p.m., 2:00 p.m. and 3:00 p.m.