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Final Respiratory Decision Making Tree

This document provides guidance on assessing and treating patients with respiratory issues through a decision tree process. It involves: 1. Considering the patient's diagnosis and expected examination findings based on if they have an obstructive or restrictive lung disease. 2. Performing a general observation of the patient noting factors like posture, breathing patterns, and signs of discomfort. 3. Conducting an examination involving listening to the lungs, feeling vibration over the chest, and percussion to evaluate breath sounds and lung consolidation. 4. Determining appropriate interventions like airway clearance techniques, breathing exercises, and positioning strategies based on examination findings and the patient's diagnosis and impairments.

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344 views

Final Respiratory Decision Making Tree

This document provides guidance on assessing and treating patients with respiratory issues through a decision tree process. It involves: 1. Considering the patient's diagnosis and expected examination findings based on if they have an obstructive or restrictive lung disease. 2. Performing a general observation of the patient noting factors like posture, breathing patterns, and signs of discomfort. 3. Conducting an examination involving listening to the lungs, feeling vibration over the chest, and percussion to evaluate breath sounds and lung consolidation. 4. Determining appropriate interventions like airway clearance techniques, breathing exercises, and positioning strategies based on examination findings and the patient's diagnosis and impairments.

Uploaded by

api-265667433
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Respiratory Decision Making Tree

Instructions: Each page of this document has a different section of the examination and subsequent treatment for varying respiratory diagnoses. Begin
with reviewing the case and patient diagnosis, and then proceed to the general observation, examination, and interventions. Prior to moving on to the
next section, stop and reflect on the patient case and the findings based on the examination findings or intervention response.
1. Read case: Consider the patient diagnosis within the case and paint a picture in your mind; what would the patient look like and what other
information can you pull from it? Do they have an obstructive or restrictive lung disease and what would expect to find?
2. General Observation: Consider each dark blue point. What applies to your case and patient diagnosis and why? From your observation, what do
you expect to find during the examination?
3. Examination: Proceed with the examination techniques and summarize your findings. What are the impairments noted and what interventions
do you anticipate will be appropriate based on your findings?
4. Interventions: How will you address your findings thus far? Consider the implications of having a restrictive vs. obstructive lung disease.
Consider whether there are secretions, impaired breathing, impaired gas exchange and what needs to be addressed first, second, etc. For
example, work on airway clearance first to improve ventilation.

Things to consider based on Case/Diagnosis:


1. Restrictive Lung Diseases: impaired ability to take full inspiratory breath due to stiffness in the lungs, stiffness of the chest wall, weak muscles,
or damaged nerves resulting in a decreased lung volume, an increased work of breathing, and inadequate ventilation and/or oxygenation.
Includes interstitial lung disease (pulmonary fibrosis), obesity, scoliosis, muscular dystrophy, ALS, PD, etc.
2. Obstructive Lung Diseases: impaired ability to take full expiratory breath due to inflamed and easily collapsible airways causing obstruction to
airflow. Includes COPD, asthma, bronchiectasis, CF, etc.
3. SCI: High level injury may involve the diaphragm muscles. If diaphragm, intercostals, and abdominal muscles are impaired will need to teach
accessory muscle breathing strategies. SCI level also gives you an idea of how much they can assist you with coughing and breathing strategies
based on which muscles are still innervated (C5-biceps, C6-wrist ext, C7-triceps, T6-12 abdominals; quad vs para).
4. MD, MS: restrictive lung disease, overall muscle weakness and wasting leads to decreased ability to contract muscles to expand the ribs to
bring air in. Work on training the weak muscles to improve gas exchange and ventilation.
5. PD: restrictive lung disease, see above. Also associated with impaired posture and inability to use accessory muscles for ventilation. Teach
posture and positional strategies to create a mix of accessory and diaphragmatic ventilation.
6. COPD, Asthma: obstructive lung disease with air trapping. May show signs of distress and cyanosis. Teach posture and positional strategies to
maximize ventilation. Also teach strategies to enhance expiration. At risk for developing lung infections, so also may need to treat for
secretions as well.

General

Posture

Jugular Vein
Distention

Phonation

Signs of
Discomfort

Configuration of
Thorax

Color of Lips &


Face

Facial grimacing, nasal


flaring, pursed lip
breathing, look of
apprehension, paleness,
sweating

Barrel Chest,
kyphoscoliosis,
Pectus excavatum,
Pectus carinatum

Central Cyanosis:
poor gas exchange
in lungs

Peripheral
Edema
Cough/Cough
Production

How often?
Productive? Color?

Breathing
Pattern
Normal:
1. Rise in
Abdomen
2. Lateral Costal
Expansion
3. Upper chest
rises superior-

Upper Accessory Breathing:


Pecs (Pect N, C6/7/8), SCM (Spinal Acc
N), Scalenes (Ventral Rami C4-8),
Trapezius (Spinal Acc N)

Paradoxical

Abdominal

Upper

Weak diaphragm (Phrenic N


C3/4/5) and intercostals
(intercostal N, Ext for
inspiration, Int for expiration).
Abdominals may be involved
(thoracoabdominal N, T6-12)

Asymmetri

Shallow

Hemiparesi

High tone;
Painful
Conditions

Inspection of Fingers
& Nail Beds

Digital
Clubbing

Peripheral
Cyanosis: low
CO to distal ext.

Examination

Lung
Auscultations

Stridor
Vesicular
Bronchial
Tracheal

Adventitious
Sounds

Abnormal

Normal

Decreased

Increased/
Bronchial

ARDS,
Asthma,
COPD,
Pleural
Effusion,

Consolidatio
n (fluid,
blood, pus)

Absent

Atelectasis,
Pleural
Effusion,
Pneomothora
x

Crackles

Early Ins:
bronchitis,
emph,
asthma
Late Ins:
ILD, PE, HF

Asthma,
COPD, HF,
PE

Resona
nt

Secretions
in large
airways

Severe
airway
constrictio
n-911!

Tactile Fremitus

Mediate
Percussion
Normal
Sounds

Rhonchi

Wheeze

Abnormal

Normal: equal
vibration
throughout

Hyperresonant:
Tympanic:
Flat, Dull: tumor,
emphysema,
dense
-4 Stages of
Teach pneumothorax
COPD, Asthma Diaphragmatic
or severe emph.Teach Accessory
Effective
consolidation
costophreni

Percussion
Cough
c
&
-Short
sitting
-Anterior
Vibration,
Are all
self-assist
chest
ACBT,
AD,
secretions
Teach
Pt can
do Coughing Pt
cant do
-Long
sitting
compressio
Acapella
removed?
Technique
Is airway
clearance
Is
there
impaired
Ye
independent
independen
self-assist
N
N
n
Ye
Ye

Strategies:
mm Breathing:
-Repatterning
Posterior
-Pectoralis
Anterior pelvic
High RR,pelvic
c/o
Decreased
mobility
-Sniffing
tilt
andupper
-SCM
and
tilt
and
SOB,
in
chest
wall,
Impaired Breathing
-Lateral
Costal
Interventions
shoulders
IR.
Scalenes
shoulders
accessory
upper
chest ER.
Pattern/
Strategy
Abnormal
Breath
Are Secretions
N
Breathing
Quiet and low
-Trapezius
Louder and

Inc Vibration: Inc


Consolidation
Dec Vibration: Inc
Air

Chest Wall
Excursion
SL, supine,
prone; towel Posture
Positionin
grolls, a/p pelvicTraining?
Is there impaired

High
Relaxati
RR/
on Tech.

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