After reading this chapter you will be able to: 1. To establish a rapport between the clinician and patient 2. To obtain essential diagnostic information 3. To help monitor changes in the patient’s symptoms and response to therapy For these reasons, interviewing is a crucial aspect of general patient assessment. • Sensory and emotional factors • Verbal and nonverbal components of the communication process • Cultural and other internal values, beliefs, feelings, habits, and preoccupations of both the health care professional and the patient Because of the above-listed factors, no two interviews are the same. 1. The neural drive to breathe 2. The tension developed in the respiratory muscles 3. The corresponding displacement of the lungs and chest wall 1. The RT should ask what activities of daily living tend to trigger episodes of dyspnea. For example, is dyspnea triggered by walking on flat surfaces, by climbing stairs, by bathing, by dressing? 2. The RT should ask how much exertion is required for the patient to stop to catch his or her breath with different activities. Does the patient need to stop after walking up one flight of stairs or one step? Dyspnea provoked by less strenuous activities indicates more advanced disease. 3. The RT should ask whether the quality or the sensation of breathing discomfort varies with different activities. 4. To gain a better understanding of the patient’s history, the RT should ask the patient to recall when dyspnea first began and how it has evolved over time. Has dyspnea progressed slowly or rapidly? How long has this progression taken place: over a period of months or years? Has there been a dramatic change in the intensity of dyspnea over recent months, weeks, days, or even within the past few hours? Important characteristics of the patient’s cough to identify include whether it is dry or loose, productive or nonproductive, and acute or chronic and whether it occurs more frequently at particular times (i.e., day or night). Knowledge of such details may help in determining the cause of the cough. A dry, nonproductive cough is typical for restrictive lung diseases such as CHF or pulmonary fibrosis. A loose, productive cough is more often associated with inflammatory obstructive diseases such as bronchitis and asthma. The most common cause of an acute, self-limited cough is a viral infection of the upper airway. Common causes of chronic coughing include asthma, postnasal drip, chronic bronchitis, and gastroesophageal reflux,1 although combinations of these often exist.2 Cough is also associated with the use of certain medications for hypertension (e.g., angiotensin-converting enzyme inhibitors).3 It was believed for many years that there was a link between fever and atelectasis in postoperative surgical patients. However, more recent evidence has shown no link between the formation of atelectasis and the development of fever (>101.3° F [>38.5° C]) during the first 72 hours after surgery.4
Bedside Assessment of the Patient
Describe why patient interviews are necessary and the appropriate techniques for conducting an interview.
Identify abnormalities in lung function associated with common pulmonary symptoms.
Identify breathing patterns associated with underlying pulmonary disease.
Differentiate between dyspnea and breathlessness.
Identify terms used to describe normal and abnormal lung sounds.
Describe the mechanisms responsible for normal and abnormal lung sounds.
Explain why it is necessary to examine the precordium, abdomen, and extremities in patients with cardiopulmonary disease.
Describe some common abnormalities found during the examination of the precordium, abdomen, and extremities in patients with cardiopulmonary disease.
Interviewing the Patient and Taking a Medical History
Principles of Interviewing
Common Cardiopulmonary Symptoms
Dyspnea
Assessing Dyspnea in the Interview
Cough
Fever
Bedside Assessment of the Patient
