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define respiratory impairments (CR model)
• gas movement impairments: a. O2 movement: localized: atelectasis generalized: decreased FRC b. CO2 movement: always generalized -> hypoventilation • secretion movement impairments: MCC dysfunction: mucus or cilia issues ineffective cough: neuro/muscle weakness or pain
examples of O2 localized and O2 generalised impairment
localized: RLL atelectasis generalized: pulmonary fibrosis
example of CO2 impairment
obesity hypoventilation
example of MCC impairment
CF
what is a symptom
subjective, self-reported. feelings noticed by the pt
what is a sign
noticed by others, can be done via objective test
what is a relevant finding
something you need to consider which may influence hypothesis generation, may have caused the disease
Symptoms of a patient with a respiratory disorder
• dyspnoea • wheeze • cough • pain
signs of a pt with respiratory disorder
• observation (eg. colour, shape, abnormalities) • investigations (ABG, CXR, PFT) • ausultation • listening to their cough
examples of relevant findings for respiratory problems
• older age • medications • smoking history • past intervention strategies • multimorbidities • main diagnosis
limitations of CXR
• provides 2D view of a 3D structure • standard CXR is done in a PA • requires multiple CXR to visualize structures
what is a CXR
• non-invasive • low radiation investigation • good to diagnose conditions, for pre op assessments, to assess effectiveness of therapies
what to look for on a CXR
• technical details (name, date, time, MRN, side marker indicating view) • film quality (clavicle equalness, level of inspiration - should be taken on full inspiration) • exposure (should see IV discs) • location of bones (heart 1/3 R, 2/3 L) • soft tissue structures (trachea,heart,boarders) • diaphgram • lungs
what would you see on a lung collapse/atelectasis CXR
• opacity (whiteness) due to loss of air • smaller lung due to loss of air in the lung overall • ribcage moves towards mediastinum • structures move towards areas of lung collapse
what is lung collapse/loss of volume/atelectasis
the result of loss of air in a lung or part of the lung with subsequent volume loss and increased density
what is consolidation
alveoli filled with fluid, indicating pneumonia
what would you see on a consolidation CXR
Opacity (whiteness); - Lung is solid because air spaces are filled with fluid - Opacity may be anatomically delineated (lobar pneumonia) or patchy (bronchopneumonia) No loss of volume
what is hyperinflation
increased lung volumes
what would you see on a hyperinflation CXR
Increase lucency (blackness) = lungs contain more air, loss of lung tissue (less lung markings) Increased volume = low, flat diaphragm (loss of dome), obtuse (less acute) costo and cardiophrenic angles, increased rib spaces, posterior ribs more horizontal Elongated heart
what is acute pulmonary oedema
Fluid accumulation in the extra-vascular spaces of the lung (ie interstitium and or alveoli)
what would you see on a acute pulmonary oedema CXR
Increased opacity +- septal lines (kerley B lines) +- cardiomegaly (where heart failure is the cause) +- pleural effusions
what is pleural effusion
fluid in the pleural space
what would you see on a pleural effusion CXR
Increased opacity Blunting of the costophrenic angles (meniscus) May be unilateral or bilateral depending on cause Characteristic ovoid/elliptical appearance on lateral view +- features of the causal condition (heart failure) Bilateral pleural effusion; loss of costophrenic angles, meniscus sign
what is pneumothorax
air in the pleural space (b/w the visceral and parietal pleura)