Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 9 views

    COPD-ASTHMA Patient History

    Uploaded by

    nathanaellee92
    This document contains guidance on taking a history and performing an examination for a patient presenting with asthma or COPD. For asthma, it describes asking about triggers, symptoms, use and effectiveness of inhalers. For COPD, it recommends establishing the patient's premorbid condition, exposure history, medications, and impact on daily life. On examination for COPD, it notes vital signs, clubbing, tremors, edema and lung findings. Differentials include infection, asthma and heart failure. Investigations include blood gases, cultures, imaging and pulmonary function tests once stable. Management involves bronchodilators, steroids, antibiotics and oxygen therapy and possibly non-invasive ventilation.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    COPD-ASTHMA Patient History

    Uploaded by

    nathanaellee92
    9 views3 pages
    This document contains guidance on taking a history and performing an examination for a patient presenting with asthma or COPD. For asthma, it describes asking about triggers, symptoms, use and effectiveness of inhalers. For COPD, it recommends establishing the patient's premorbid condition, exposure history, medications, and impact on daily life. On examination for COPD, it notes vital signs, clubbing, tremors, edema and lung findings. Differentials include infection, asthma and heart failure. Investigations include blood gases, cultures, imaging and pulmonary function tests once stable. Management involves bronchodilators, steroids, antibiotics and oxygen therapy and possibly non-invasive ventilation.

    Original Description:

    Global Health

    Original Title

    COPD-ASTHMA Patient history

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document contains guidance on taking a history and performing an examination for a patient presenting with asthma or COPD. For asthma, it describes asking about triggers, symptoms, use and effectiveness of inhalers. For COPD, it recommends establishing the patient's premorbid condition, exposure history, medications, and impact on daily life. On examination for COPD, it notes vital signs, clubbing, tremors, edema and lung findings. Differentials include infection, asthma and heart failure. Investigations include blood gases, cultures, imaging and pulmonary function tests once stable. Management involves bronchodilators, steroids, antibiotics and oxygen therapy and possibly non-invasive ventilation.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    9 views3 pages

    COPD-ASTHMA Patient History

    Uploaded by

    nathanaellee92
    This document contains guidance on taking a history and performing an examination for a patient presenting with asthma or COPD. For asthma, it describes asking about triggers, symptoms, use and effectiveness of inhalers. For COPD, it recommends establishing the patient's premorbid condition, exposure history, medications, and impact on daily life. On examination for COPD, it notes vital signs, clubbing, tremors, edema and lung findings. Differentials include infection, asthma and heart failure. Investigations include blood gases, cultures, imaging and pulmonary function tests once stable. Management involves bronchodilators, steroids, antibiotics and oxygen therapy and possibly non-invasive ventilation.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    History (asthma) SOB when gardening, started noon same day

    A few months – SOB on exertion – usually goes to clinic for a pump


    Started a month ago to get more frequent/worse – sometimes spontaneous but rare (e.g. after a shower,
    in the morning, after a URTI)
    Clueless of what triggers SOB
    Ask about CCF/cardiac symptoms including PND, orthopnea, ET, chest pain and SOB/AMI ss
    Ask open ended qs – enquire about character of SOB + associated respiratory symptoms and their
    frequencies
    Asthma – enquire about time of day, severity of wheeze, exacervation, abiity to speak in
    sentences/trouble in breathing/ cyanosis
    Enqure about cough/hemoptysis
    Cardiac – palpitation, pedal oedema
    Enquire about need for inhalers and compliance
    Enquire about effectiveness of inhalers + HOW SHE USED THEM
    Enquire aout their side effects such as palpitations
    Enquire abou reason for change in inhalers/why she was prescribed brown inhaler
    Enquire about asthma diary
    Enquire about hospitalisations
    Other illnesses related to asthma syndomre
    Physical examination
    Differentials
    Investigations
    Management of patients Intrinsic vs extrinsic asthma
    Must include family hx in asthma – includes skin rash, allergic rhinitis, allergic oncjunctivitis
    History (COPD) 1. PC: SOB
    2. 60 yo female COAD since 2012, actve smoker with 5 d of cough and SOB
    3. SOB – progression, ET (unable to walk up stairs) – enquire about closely related cardiac SS –
    PND.orthopnea
    4. No trigger for cough and SOB
    5. No aggravating factor which would suggest asthma
    6. No features of asthma
    7. Chest pain – nil – pleuritic chest pain, AMI/ costochondritis
    8. Cough – non purulent
    9. No infectious features like fever, chills, rigors
    10. No malignancy features – TRO lung ca
    11. PMH – several admission
    12. No surgeries so far
    13. On Ventolin 2 pf tds and prn
    14. Brodual and fulmicort 1pf bd
    15. Lives in crowded place,15 sticks for 20 years
    16. no sig occupational hazard
    17. no hx of Catopy in family or features of COPD sugg of antitrypsin deficiency
    18. points to also include – a clear description of ET + establish PREMORBID condition –
    ENCOURAGE TO DRAW A GRAPH of SOB against TIME in years/months
    19. explore nature of admissions = were they increasing in freq, length of stay
    20. any hx of INFECTIONS
    21. to add:
    a) physical limitations
    b) social history and living conditions – why did patient manage stairs?
    c) Impact of COPD on daily life
    d) Exposure to passive smoking
    e) >20years of smoking required to have COPD
    f) Systemic review MUST INCLUDE – because need to exclude systemic signs of ILD
    (especially if clubbing, lady, bilateral fine crackles and <20years smoking at a young age)
    g) Patient is already on 2 SABA – hence fine tremors even before nebulizer
    h) Pulmicort – inhaled CS – MUST KNOW DOSE because need to know how mucj to step
    up – take the value BEFORE exacerbation
    i) Interesting note, yellow sptum in asthma may be due to eosinophils not neutrophils hence
    not necc to give ABX
    Physical examination Vitals – BP 170/90, 88% BEFORE NEBULIZER, RR 25 , AFEBRILE , PULSE 120
    After neb = sat 1—with venture 60% oxygen 15L/min, pulse 100
    At presentation = SOB at rest, clubbing, fine tremors (anxiety, beta 2 agonist, hyperthyroidism) vs
    (coarse tremors – CO2 retention) – must try to relate to use of nebulizer to justify fine tremor existence,
    pink peripheries, hyper inflated chest and generalized rhonchi, pedal oedema
    Chronic suppurative condition = clubbing likely; non suppurative COPD = rare to have clubbing
    On examination, SPO2 93% under RA, afebrile (IMPORTANT TO MENTION FOR COPD)
    On examination – alert, pink, good pulse volume, warm peripheries, bibsasal crepitations, pedal oedema
    – crepitations over posterior lobes with pedal oedema (symmetrical, up to midshin, pitting) – a pitting
    oedema is suggestive of vs non pitting oedema

    MUST INCLUDE FALPPING TREMORS


    Note: ABG is only required if after neb, still less than 92%

    IF SUSPECT RIGH SIDED HEART FAIL, PLEASE DO HEPATOMEGALY

    If see bilateral ankle oedema – must TRO DVT + detect displaced apex + mention JVP
    Differentials 1. infective exacerbation of COPD
    2. asthma – inquire if reversal vs irreversible; or is there a clear deterioration in lung function ;
    baseline lung practical function
    3. pneumonia
    4. bronchiectasis
    5. CCF
    Investigations 1. ABG – normal pH, P02 hypoxic at 60%, normal CO2 (TYPE 1 RESP F), bicarb normal –
    compensated respiratory acidosis
    2. Cultures – blood and sputum + smear
    3. CXR
    4. Continuous CT – bullae and emphysema – more accurate depiction than CXR; continuous CT
    is better ;high resolution CT is usually for ILD to get a clear picture – but a continuous CT is
    good enough for COPD
    5. BNP
    6. TROPONIN –to detect silent MI leading to CCF hence a rise in troponin (though not as high as
    in MI)
    7. ECHO
    8. ECG –TRO ischemic, rhythyic
    9. SPIROMETRY
    10. Baseline FBC (raised WCC – 25 – INFECTION/SEPTIC), RP,LFT ( mild liver congestion)
    11. Raised lactate – 2.1 mmol/L
    12. RP – normal
    Hence, need to suspect sepsis – raised HR, LACTATE, WCC
    13. PEFR pre ned 150 – post neb 170 (height 160cm) – hence, WAY LOWER than expected for a
    woman of her height and age – IN PERCENTAGE (400-150/400) = 65% reduction iei only at
    35% of normal – hence SEVRE COPD based on GOLD
    14. PEFR is not a very accurate predictor of severity – but based on GOLD grades, PEFR is used
    – hence based on GOLD, she is moderately severe – this is important to determinte what initial
    treatment of COPD to use or when to upgrade tx
    15. Spirometry/lung function test SHOULD NOT BE DONE DURING AECOPD – only basic PEFR.
    This is bc it will be less accurate.
    16. To assess severity of COPD in patient using pulmonary test/spiro – give MAXIMUM OPTIMAL
    TREATMENT FIRST UNTIL STABLE, THEN ONLY MEASURE – hence at this point in time,
    just do PEFR only
    Management of patients 1. PROLONGED EXPIRATORY PHASE ON OBSTRUCTIVE DISEASE (seen in athma, COPD)
    – if consolidation such as TB/pnm then expiratory phase is SHORT
    2. BODE INDEX
    3. GOLD CLASS
    4. Working diagnosis = infective exacerbation of COPD with septic picture
    5. Acute mgmt.:
    a) Nebulized bronchodilator – 1st line inhaled SABA +/- SAMA (or if inadeq add theiphyll)
    b) Oral pred or IV hydrocort
    c) Oral/IV abx – target pseudomonas, HIB and PCC
    d) O2 therapy aim SpO2 88-92%
    e) Nebulized saline to allow expectoration
    f) Chest physiotx
    g) +/- non invasive ventilation [arterial pH<7.35 and/or Pco2 > 6.5KpA)
    h) +/- INTUBATION AND MECHANICAL VENTILATION IF APPROPRIATE
    6. This patient was given ben salbut twice, combinet once, IV hydrocot 200 stat s/c bricanyl
    (terbutaline) stat, oxygen thx via venture mask 40% and IV ceftriaxone 2g (initially started on
    tazocin) stat
    7. Then maintenance mgmt. by IPR:
    a) IV ceftria 2g stat and QID
    b) IV aminophylline 250tds
    c) Nebulized combinet 4 hourly
    d) PCV one shot (but if younger than 60, PCV every 5 years)

    You might also like