U Assessment

HISTORY. Establish a history of dyspnea, determining if it has increased over time. Ask if the dyspnea is extreme during exertion and present even during rest. Determine if the patient has experienced anorexia, weight loss, and weakness. Ask if the patient has had a cough and, if so, for how long. Determine if there are signs of oxygen deficiency; ask significant others if the patient has been restless or confused or has experienced changes in mental status. Ask if the patient lives or works in a highly polluted area. Establish cigarette smoking habits, including how long, how many, and whether they are unfiltered. Elicit a history of family pulmonary disease or frequent childhood pulmonary infections.

PHYSICAL EXAMINATION. Inspect the patient for a decreased muscle mass and increased anteroposterior diameter (also known as barrel chest). Observe respirations for the use of accessory muscles, such as the sternocleidomastoid and pectoral muscles, as well as pursed-lip

312 Emphysema breathing during expiration. Assess the patient's respirations for rate, rhythm, and quality. Inspect the patient for neck vein distension or liver congestion. Note signs of oxygen deficiency, such as restlessness, changes in mental status, confusion, and tachycardia.

A cough may be present during the later stages of the disease; the small amount of sputum it produces is usually mucoid. Upon palpation, note decreased tactile fremitus. Percussion may elicit a diffusely hyper-resonant sound. Auscultate for decreased or absent breath sounds, distant heart sounds, wheezes, and possibly crackles. Examine the patient for peripheral cyanosis or clubbing of the fingers.

PSYCHOSOCIAL. Patients with emphysema may be anxious or restless, depending on the degree of dyspnea they are experiencing. Emphysema may necessitate role or occupational changes that could lead to depression. Assess the patient's emotional, financial, and social resources to determine if they are available to the patient to help cope with a chronic disease.

Diagnostic Highlights

0 0

Post a comment