Overview
- IPMA:
* Inspection
* Palpation
* Measure
* Auscultation - Functional Mobility
- Dyspnea
IPMA: Inspection
- Lines and value on monitor (HR, RR, SpO2, BP)
- Position of patient
Start from top to bottom
Head - Facial expression: comfort vs pain
- Orientation level: time, place, person
- Speech: Slurred, SOB when speaking
- Skin: pallor, cyanosis, scars
- Lips: color, purse lip breathing
- Nose: nasal flair
Neck
* Acessory muscle use
* Jugular vein distention
–>sit at 45 deg & turn their head left
–>pulsing in internal jugular vein= right atrium associate with central venous pressure
IPMA: Inspection (Cont)
Chest
* Scars
* Chest wall deformities: barrel chest, pigeon chest, kyphosis, scoliosis
* Muscle wasting
* Type of breather: apical, diaphragmatic, accessory muscle use, intercostal indwelling
* Chest movement/breathing pattern, E.g.
–>Eupnea: normal (12-20 bpm)
–>Tachypnea: rapid breathing
–>Hyperpnea: inc. deapth and rate of breathing to meet inc. metabolic demand of body tissues (during exercise)
–>Bradypnea
–>Cheyne stokes: hyperpnea–>apnea
–>Apnea: pauses
Limbs
* Skin color: pallor, cynosis
* Skin integrity: gangrene, ulcers
* Finger Clubbing
* Swelling/edema: location/amount
Cough
* Weak vs Strong
* Painless vs painful
* Productive vs non-productive
* Sputum
–>Colour
- White: normal
- Yellow/Green: infection
- Brown: old blood
- Red/Pink: new blood
–>Smell: purulent
–>Amount
–>Texture: Thick vs viscous
IPMA: Palpation
- Chest wall expansion- provide a rough estimate of chest wall expansion using palm of hands
- Instruct Pt to take deep breaths on inspiration & expiration
- Note differences of movements of thumbs from one side to the other
- Compare right vs left sides - Tactile fremitius- Feeling for vibrations under the hand–>indicate retained secretions
- Assessed at the same time with chest wall expansion palpaition - Percussion- extend finger over an intercostal space with one hand and tap middlfe phalange with opposite finger and listen to lung sounds
- Normal = resonant
- Abnormal
–>Dull: consolidation (pneumonia, atelectasis), pleural fluids (pleural effusion), pulmonary edema
–>Hyper-resonant: hyperinflation (COPD, acute asthma attack, pneumothorax) - Periphery palpation
* Assess temp of both hands and feet
–>Feel with the back of my hand over several location along feet, lower legs as well as hands and arms bilateral
- Capillary refill
–>Compress nail bed and release it
–>Normal color should retrain wihtin 2 seconds
–>Perform on both hands and feet bilaterally - Check for pitting edema in distal extremities
–>Gently press thumbs over dorsal feet & hand bilaterally using slow, steady pressure
–>If pitting edema is present, an indentation will retain where you pressed
IPMA: Measure
- Measure vital signs to gather a basline status of my Pt
1. Respiratory rate - Normal=12-20
- Counting the no. of chest rises and falls in 15 seconds x 4 = breaths/min
- Blood pressure
* Normal= 120/80
* Taken with arm resting at heart level
Avoid taking BP in a limb if: Lymphedema, Mastectomy, Affected side of stroke, IV catheter in that limb - Heart rate
* Normal= 60-100
* Site: at the wrist using radial artery
–>Other options: neck (carotid artery), groin (femoral artery), knee (popliteal artery), ankle (post. tibial artery), foot (dorsalis pedis artery)
* Counting the number of pulses palpated in 15s x 4 = BPM
IPMA: Auscultation
- Listen to lung sounds
- 11 spots on the front & 14 spots on the back
- Auscultate directly over the ski & avoid bony area
- Cue Pt to breath in/out through their mouth & encourage slow, deep breaths
- Check for dizziness every 2-3 breaths and break as needed
- Compare side to side
Why IPMA is important?
With cardiorespiratory conditions, it is improtant to understand the Pt’s cardiorespiratory status and monitor for changes during treatment
Collecting information using IPMA will allow me to determine which treatment is best given their status and allow me to monitor changes over time
E.g. Pt with low SpO2 and secretions noted during palpation and ausculation would benefit from secretion removal during their treatment
Functional Mobility
Depending on the severity of deconditioning–> Obtain information on the following:
- Mobility
* bed mobility, transfers, amublation (gait assessment), stairs)
–>how much assistance is required
(ind./min./mod/max) - Endurance
* 6-minute walk test
* 10-meter walk test - Balance
- BERG balance measure (or parts of BBS e.g. SLS, tandem stance, standing eyes closed)
- Timed up and Go
Why functional mobility is important?
If the case is presenting a Pt with mobility-related deficits due to their cardiorespiratory condition,
assessing their mobility status will allow me to determine their current function.
This will provide me with a baseline from which to monitof change.
It will also help me formulate a treatment plan which is patient-specific based on their needs
Dyspnea
Dyspnea scale (at rest and during exercise)
- Sing, talk, gasp scale–>level of dyspnea indicated by underlined word under ‘the way you feel while exerting’
- Modified BORG scale
Why dyspnea level is important?
Monitoring their level of dyspnea is important to ensure that during session, the Pt does not over-exert themselves
Monitoring dyspnea will ensure they are workign within their capacity.
The information will also help the Pt understand what makes them more breathless so they can pace and plan once discharged from the hospital
