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Chest Assessment

Chest Assessment. Read through the chart for past medical history and reasons for the present admission. Is the present admission for some other cause other than cardiopulmonary or is this a re-admission for a long standing chronic condition ? . Read the psychosocial history patient’s age

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Chest Assessment

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  1. Chest Assessment

  2. Read through the chart for past medical history and reasons for the present admission.

  3. Is the present admission for some other cause other than cardiopulmonary or is this a re-admission for a long standing chronic condition ?

  4. Read the psychosocial history • patient’s age • marital status • supportive family (SW’s report) • will there be at-home care or will it involve some level of post-acute institutional care ?

  5. Look at the x-ray results : • Diffuse spider webbing ? • Egg-shell calcifications present ? • Is the cardiac image obscured ? • Are there spots on the lungs ? • Are fractures present ? • Fluid lines present ?

  6. Left Pneumothorax

  7. CWP - Black Lung

  8. Flail Chest

  9. Cancer - Tumor In Right Lung

  10. Read the pulmonary function test results • chronic obstructive lung disease • restrictive lung disease • occupational lung disease

  11. Chronic Obstructive Disease • asthma • bronchitis • emphysema • bronchiectasis

  12. Restrictive Lung Disease • sarcoidosis • tuberculosis • pneumonia • ARDS • IRDS • Valley Fever

  13. Occupational Lung Disease • psiticosis • byssinosis - white lung • CWP - black lung • silicosis • asbestosis • pidgeon breeders disease

  14. Read the blood gas report • Is the patient acidotic ? • Is the patient alkalotic ? • Has the patient metabolically compensated ?

  15. Normal Blood Gas Values • pH = 7.35 - 7.45 • PO2 = 80 - 100 mm Hg • PCO2 = 36 - 44 mm Hg • HCO3 = 22 - 26 mEq/L

  16. Read the bacteriology lab report for any infective organisms • gram positive bacteria • gram negative bacteria • yeast infections • HIV +

  17. Gram Positive Bacteria : • staphylococcus - osteomyelitis • streptococcus - septicemia • clostridium - gangrene

  18. Gram Negative Bacteria • salmonella - food poisoning • shigella - dysentery • klebsiella - pneumonia • pseudomonas - deep infections

  19. Hemaglobin & Hematocrit okay ? • Hemaglobin : females - 13-14 g/dl males - 15 -16 g/dl • Hematocrit : females - 32 - 42 % males - 42 - 52 %

  20. Briefly review the reports by the various services : • respiratory therapy • physician’s progress notes • social worker’s report • nurses notes

  21. Patient Evaluation • Smoking History ? • S.O.B. & when did it start ? • Occupation ? Return to work ? • Is the patient ambulatory ?

  22. Do they use portable oxygen ? • Are there positions of comfort ? • Talk Test

  23. Physical Exam • Auscultate the lungs : • adventitious sounds • rales • rhonchi • pleural friction rub • stridor

  24. Chest measurements - bilateral excursion - rib flare ? - ant/post movement of the chest ? • Breathing patterns • See-Saw breathing • diaphragmatic breathing • apical breathing

  25. Double cough ? • Productive cough ? • Quantity of sputum • Color of sputum • Vocal fremitus ?

  26. Patient’s color ? • CO2 narcosis - redness of skin • hypoxemia - cyanosis - blue cast • Mediate percussion • Surgical scars ?

  27. Chest deformations ? • Pectus excavatum • Pectus carinatum • cavitations • barrel chest

  28. Rate & depth of respiration • Dyspnic ? • Tachypnic ? • Nasal flaring ? • Accessory muscle use ?

  29. Can the patient perform self-care ? • Can they roll in bed and come to sitting ? • Can they transfer into a chair ?

  30. Can they walk in the room or out into the hall ? • Do they need supplemental oxygen at rest and during ADL’s or during exercise ?

  31. Does the patient have pitting edema in the lower extremities ? • 1+, 2+, 3+, 4+ • CHF • renal failure • metastatic cancer

  32. Patient Case Study # 1 • 82 y/o Caucasian female • Admitted for observation to EROU (23-hour stay): • falling • c/o of pain in chest and hip • PT consult : evaluation for level of medical care

  33. Social History • Living alone in a rented apt. at Meridian Point - minor assisted living contract • Because of falling hx., Meridian Point would take her into their full assisted living units if she was admitted for 3 days at FMC

  34. Family lives in Flagstaff, Az. • Family expressing reluctance about having her move in with them for companion care

  35. Medical History • Fractured radius in Jan, 1999 • Fractured right femur in August, 1994 • Bilateral mastectomy - Cancer - 1980 • Pneumonia - 1980, 1990, 1996 • Negative for diabetes

  36. Medical Findings • CT scan of thorax, pelvis WNL • CT scan of brain showed atrophy - WNL • X-Ray of chest showed some diffuse cloudiness in L > R - no masses

  37. Physical Therapy Exam • ROM - WNL for all extremities • Strength - 4/5 for age • Gait - 125 ft without LOB w/ FWW • Transfers - SBA ---> min assist • Orientation - 3/3

  38. Oximetry - SaO2 - 86% on 2 L/min as per nasal cannula • Blood Pressure - 156/88 • Heart Rate - 98 bpm

  39. Breathing - diaphragmatic • Resp. rate - 18/min & shallow • Talk test - normal • No vocal fremitus present

  40. Fever - 102° F • Subjective Symptoms : “I feel fine - I want to go home.”

  41. Auscultation Of Thorax • mild crackles - left lingula, R middle lobe • medium crackles - bilateral anterior, lateral and posterior basilar BP segments • all other BP segments clear

  42. Recommendations ? • Discharge to home with family for 24-hour companion care ? • Admission to hospital for 3 days and then to assisted living at Meridian Point ? • Back to Meridian Point and independent apartment living ?

  43. Patient Case Study # 2 • 51 year old Native American female • Admitted to the hospital for : • inebriated pedestrian vs car • fractured right and left tibia and fibula in the distal 1/3 of both LE’s • fractured C3-C4 stable and non-displaced

  44. multiple abrasions and lacerations • closed head injury • aspiration pneumonia

  45. Physical Therapy Order : • Mobilize the patient - NWB on BLE’s • Functional activities

  46. Social History • Lives with her daughter in Tolani Lake, Az. She herds cattle on a small ranch • Has a significant ETOH hx. • Has a significant psychiatric hx. • Has a significant spouse abuse hx. • Is now divorced

  47. Medical History : • Repeated ETOH detox admissions to Aspen Hills - ‘92, ‘93, ‘95, ‘98 • Significant for appendicitis in ‘84 • Significant for hypertension • Significant for COPD (asthma) • Significant for hyperlipidemia • Significant for CAD - report of occasional angina on hard exertion

  48. Physical Therapy Findings • Full ROM in all uneffected joints and extremities • Strength is WNL in BUE’s (5/5) BLE’s not tested

  49. Bronchovesicular breath sounds in the bilateral posterior and lateral basilar bronchopulmonary segments of the bilateral lower lobes • A Monarch UE GXT was given - physical work capacity was Fair

  50. BP at rest = 150/92 • BP at SLGXT = 212/100 • HR at rest = 78 BPM • HR at SLGXT = 168 BPM • Max METs obtained = 8.5

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