what does a bedside assessment involve
-pt interview
-pt examination for sign and symptoms of disease
-effects of treatment
what is the purpose of an interview
- to establish rapport
-obtain information essential for making a diagnosis
-help monitor changes in the pt symptoms and response to therapy
factors affecting communication b/w Rt and PT
- sensory and emotional factors
- environmental factors
- verbal and non verbal componentes of the communication process’
- cultural and other internal values, beliefs, feelings, habits and preoccupations of both RT and Pt
what are the interview questons that should be asked during pre-assessment of PFT
1.Do you have pulmonary disease history?
2.Do you have smoking history if so how long and how many packs a day?
3.Do you have a cough? If so is it constant intermittent or always
4.Are you experiencing SOB?
5.Do you take any pulmonary or cardiac medications?
6.Any occupational exposures?
7.Have you been coughing up sputum? If so, how often and how much?
what are the bedside assessment guidelines
1.Introduce yourself in social space (4-12ft)
2.Interview in personal space (2-4 ft)
3.Use appropriate eye contact
4.Assume physical position at same level as pt
5.Avoid using leading questions, use neutral questions
6.Make pt feel comfortable and answer any questions
how to perform a bedside assessment before pft
1.Coach pt through procedure
2.Gather all data before initiating test
3.Perform a quick assessment on pt
4.Good rule of thumb: Obtain baseline of spo2 and RR before beginning
5.Monitor their WOB
6.ABGs are essential for a PFT report any abnormal findings to MD asap
what is a PFT
essential for evaluating how well the lungs are performing gas exchange
what are the 3 categories of PFT measuring
- dynamic flow rates of gases through the airways
-how fast air is moving in and out of lungs - lung volumes and capacities
-how much air lungs can hold and whether there are restrictions in lung expansion - ability of the lungs to diffuse gases
-how well O2 moves into the blood stream and CO2 moves out
what is the purpose of the PFT
- Identify and quantify changes in pulmonary function
2.To evaluate need and quantify therapeutic effectiveness
3.To perform epidemiologic surveillance for pulmonary disease
4.To assess pt for risk of postoperative complications
5.To determine pulmonary disabilities
what are the contraindications to PFT
1.Pt with acute unstable cardiopulmonary problems
-Recent heart attack, severe respiratory distress
2.Pt who have nausea and who are vomiting
3.Test for pt who have had recent cataract removal surgery should be delayed
4.Pt with dementia or confusion may not achieve optimal or repeatable results
5.In pt who are acutely ill or who have recently smoked a cig, test validity of measuring the forced vital capacity (FVC) may be hindered
what are the two major catergories of pulmonary diseases
obstructive
restrictive
what is an obstructive disease
primary problem= increased air way resistance (flow)
ex. Asthma, chronic bronchitis, emphysema
what is a restrictive disease
decrease lung compliance or lung volume or both- lung stiff or cant expand
ex. pulmonary fibrosis and neuromuscular disease
what are the two type measuring devices in a pft
1.measure volume- spirometers
(how much air pt can inhale/exhale & how quickly they can do it)
2.measures flow- pneumotachometers
(track rate at which air is moving through the airways about potential obstructions or flow restrictions in lungs)
what are the 3 general principles that should be considered when testing of pulmonary function
- test sensitivity and specificity
-address the test ability to detect presence or absence of disease - validity
-ability to measure what is intended to measure - reliability
-consistency, never report test results that are invalid or unreliable
what are key factors needed to obtain data
1.pt can be sitting or standing, watch out for lightheadedness especially during MVV
2. nose clips must be worn
3. tight seal around mouth piece
4. the test is completely effort dependent
what are the 3 basic pulmonary function test?
- spirometry
2.lung volumes - diffusing capacity
what is spirometry
common test: pulmonary mechanics
-Pt effort dependent:careful instruction
1.several key measurements looked at during spirometery
-Forced vital capacity (FVC)
-Forced expiratory volume in 1 second (FEV1)
-other forced epiratory flow measuements
-maximum voluntary ventilation (MVV)
what is forced vital capacity (FVC)
and what is the FVC maneuver
total amount of air a pt can exhale forcefully and rapidly as possible after a maximum inspiration (deep breath in)
-FVC maneuver : pt is instructed to take maximal inspiration followed by maximal expiration
-3 attempts
-used to indentify :obstructive diseases
what is FEV1
how much air a pt can exhale in the first second of that forced breath
-key indicator of airway obstruction
-lower values suggest airway obstruction
what is maximum voluntary ventilation
-test the overall endurance of the respiratory muscles and the lungs ability to move air quickly and efficiently
what flows are measured during the FVC maneuver
-FEV1
-FEV1/FVC
-FEF200-1200
-FEF 25-75
-PEFR
what does FEV1/FVC ratio mean
calculated by dividing largest FEV1 by Largest FVC
- distinguishes obstructive vs restrictive
-reduced=obstructive
what is FEF200-1200
average flow rate early FVC maneuver
