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426 PHYSICAL EXAMINATION
A. Anterior view
B. Posterior view
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UNIT 2
When assessing the thorax, it is helpful to envision it as a rectangular box, with
the four sides being the anterior, posterior, right lateral and left lateral thoraxes.
Figure 13.5 illustrates the imaginary thoracic lines on each of the four sides. These
landmarks are helpful in discussing clinical ndings.
CLINICAL REASONING
Practice tip: Identifying thoracic landmarks
> Anterior
• Sternum
• Clavicles
• Nipples
• Suprasternal notch: With the nger pad of the index nger, feel in the midsternal line
above the manubrium; the depression is the suprasternal notch.
• Angle of Louis (or manubriosternal junction or sternal angle): With the nger pads,
feel for the suprasternal notch and move your nger pads down the sternum until they
reach a horizontal ridge (the junction of the manubrium and the body of the sternum);
this is the angle of Louis (or
landmark and serves as a convenient reference point for counting the ribs and ICSs
(the rst rib is difcult to palpate).
•
Costal angle: Place your right nger pads on the bottom of the consumer’s anterior
left rib cage (10th rib); place your left nger pads on the bottom of the anterior right rib
cage (10th rib); move both hands horizontally towards the sternum until they meet in the
midsternal line; the angle formed by the intersection of the ribs creates the costal angle.
> Posterior
• Vertebra prominens: Flex the neck forwards; palpate the posterior spinous processes.
If two processes are palpable, the superior process is C7 (vertebra prominens) and
the inferior is T1; this landmark is useful in counting ribs to the level of T4. Beyond T4
the spinous processes project obliquely and no longer correspond to the rib of the
same number as the vertebral process.
• Inferior angle of scapula: Locate the inferior border of the scapula; this level
corresponds to the seventh rib or seventh ICS.
• Spine
• Twelfth rib: Palpate the lower thorax in the scapular line. Move your hand laterally to
palpate the free tip of the 12th rib.
sternal angle).The second rib articulates with this
Right midclavicular line
Right anterior
axillary line
Midsternal
line
FIGURE 13.5 Imaginary thoracic lines
Left midclavicular line
Left anterior
axillary line
Left scapular line
Midspinal
or vertebral
line
Left
posterior
axillary line
Right scapular line
Right
posterior
axillary line
RESPIRATORY 427
C. Right lateral view
D. Left lateral view
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FIGURE 13.5 continued>>
CHAPTER 13
Anterior
axillary line
Midaxillary line
Posterior
axillary line
Pleura
Each lung is encased in a serous sac, or pleura. The parietal pleura lines the
chest wall and the superior surface of the diaphragm. The
external surface of the lungs. Usually, a small amount of uid is found in the space
between these two pleurae; this uid prevents the pleurae from rubbing against each
other and acts as a cushioning agent for the lungs.
visceral pleura lines the
Mediastinum
The mediastinum, or interpleural space, is the area between the right and
left lungs. It extends from the sternum to the spinal column and contains the
heart, great vessels, trachea, oesophagus and lymph vessels. The only respiratory
structures in the mediastinum are the trachea and the pulmonary vasculature.
The trachea is a bromuscular hollow tube located in the anterior thorax in the
median plane. It is 11 to 13cm in length and 2 to 3cm in width. The trachea lies
anterior to the oesophagus.
Anterior
axillary line
Midaxillary line
Posterior
axillary line
Bronchi
The trachea bifurcates into the left and right mainstem bronchi at the level of the
fourth or fth vertebral process posteriorly and the sternal angle anteriorly. The
right main bronchus is wider, shorter and more vertical than the left. This anatomic
difference is critical because it makes the right main bronchus more susceptible to
aspiration and endotracheal intubation. The main bronchi further divide into lobar
or secondary bronchi. Each lobar bronchus supplies a lobe of the lung. The bronchi
transport gases as well as trap foreign particles in their mucus. Cilia aid in sweeping
the foreign particles upwards in the respiratory tract for possible elimination.
Culmination of the tracheobronchial tree is in the alveoli.
PUTTING IT IN CONTEXT
Assessing for tuberculosis exposure
A new graduate from a bachelor of education course presents to your clinic for a puried
protein derivative (PPD) test and physical examination in order to commence a new
teaching job. He returns 48 hours later and is found to have a positive PPD. He informs you
that 1 year ago, he lived in Haiti on a teaching exchange in one of the local schools. How
would you proceed?
In this situation you should consider the following in the provision of your care.
>>
428 PHYSICAL EXAMINATION
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UNIT 2
>>
The positive reaction assists to identify an individual who may be infected with one of
the organisms of Mycobacterium tuberculosis complex bacilli. The reaction may be due to
any of the mycobacteria infections (M. tuberculosis, M. canetii, M. bovis etc.) or previous
vaccination with BCG – (bacille Calmette-Guérin) (Communicable Diseases Network
Australia, 2022). It is thus important to assess in more detail the person’s previous exposure
to risk factors for tuberculosis (see Health Education box – Risk factors for tuberculosis) and
determine if he has received a BCG vaccination in the past. You would undertake your usual
physical examination, implementing standard and transmission-based precautions drawing
on your knowledge that TB is an airborne infection (transmitted by inhalation of infectious
aerosols) and that most people are unaware of possible TB infection, as they remain
asymptomatic (Refer to Chapter 5: Physical examination techniques) (Australian Technical
Advisory Group on Immunisation, 2018). It will be important to ensure the consumer is aware
of the need to be vigilant about identifying any development of future symptoms. Ensure you
emphasise that the risk of developing TB in the rst 2 years is high post a positive test result
(Communicable Diseases Network Australia, 2022). Public health management should be
obtained from the state/territory or relevant public health authority.
Alveoli
The alveoli are the smallest functional units of the respiratory system. It is
here that gas exchange occurs. It is estimated that approximately 300 million
alveoli are present in each lung. This aerating surface is about equal to 100 times
the body surface area of an adult. Each alveolus has its own blood supply and
lymphatic drainage. Branches of the pulmonary artery carry blood to the capillaries
surrounding the alveoli to be oxygenated. Branches of the pulmonary vein transport
oxygenated blood from the alveoli to the heart.
Diaphragm and muscles of respiration
The diaphragm, which is innervated by the phrenic nerve, is a dome-shaped muscle
that forms the inferior border of the thorax. Anteriorly, its right edge is located at the
fth rib – fth ICS at the MCL. The left dome of the diaphragm is at the sixth rib –
sixth ICS at the MCL. The presence of the liver below the right dome of the diaphragm
accounts for the elevated border on that side. On expiration posteriorly, the diaphragm
is located at the level of the 10th vertebral process, and at T12 on inspiration. Laterally,
the diaphragm is found at the eighth rib at the midaxillary line. The diaphragm is the
principal muscle of respiration. Contraction of the diaphragm leads to an increase in
volume in the thoracic cavity.
The external intercostal muscles are located in the ICS. During inspiration,
the external intercostal muscles elevate the ribs, thus increasing the size of the
thoracic cavity. The internal intercostal muscles draw adjacent ribs together, thereby
decreasing the size of the thoracic cavity during expiration.
Accessory respiratory muscles are used to accommodate increased oxygen demand.
Exercise and some diseases lead to the use of accessory muscles. The accessory muscles
are the scalene, sternocleidomastoid, trapezius and rectus abdominus (
CLINICAL REASONING
Practice tip: Preventing aspiration of uid into the lungs
Aspiration is the inhalation of foreign material into the respiratory tract (e.g. aspiration
of mucus or vomitus).
Aspiration can have signicant health consequences; therefore, you should assess the risk
for consumers and manage them accordingly. These points will help guide your practice:
> Place the at-risk consumer (intoxicated, unconscious) in a side-lying or upright position.
> Ensure the airway is always maintained. If the consumer is lying down and they are
vomiting, ensure their head is to the side, to decrease the chance of aspiration.
Figure 13.6).
>>
RESPIRATORY 429
A. Anterior view.
B. Posterior view.
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> Consumers receiving intermittent tube feedings should be placed in an upright position
during the feeding and for 30 minutes after feeding; individuals receiving continuous tube
feedings should be placed in an upright position at all times.
> Delay tube feeding if the gastric residual is signicant (amount varies per individual and
per amount of usual feeding), and communicate/document this.
> Suction oropharynx of consumers with tracheostomies prior to deation of their cuff.
CHAPTER 13
Scalene
External
intercostal
FIGURE 13.6 Muscles of respiration
Sternocleidomastoid
Pectoralis
minor
Rectus
abdominis
Serratus
anterior
Internal
intercostal
Transversus
thoracis
Diaphragm
PHYSIOLOGY
Ventilation
The primary function of the respiratory system is to deliver oxygen to the lungs
and to remove carbon dioxide from the lungs. The breathing process includes
inspiratory and expiratory phases. During inspiration, the pressure inside the
lungs becomes subatmospheric when the diaphragm and external intercostal
muscles contract. The diaphragm lowers and the ribs elevate, thus increasing
the intrapulmonic volume. As a result of the negative intra-alveolar pressure,
atmospheric air is pulled into the respiratory tract until intra-alveolar pressure
equals atmospheric pressure. The lungs increase in size with the air.
Expiration is a passive process and occurs more rapidly than inspiration. During
expiration, the diaphragm and external intercostal muscles relax, decreasing the
volume of the thoracic cavity. The diaphragm rises. The intrapulmonic volume
decreases and the intrapulmonic pressure increases above the atmospheric pressure.
The lungs possess elastic recoil capabilities that allow air to be expelled until
intrapulmonic pressure equals atmospheric pressure.
Serratus posterior
superior
Serratus posterior
inferior
External respiration
External respiration is the process by which gases are exchanged between the
lungs and the pulmonary vasculature. Oxygen diffuses from the alveoli into the
blood, and carbon dioxide diffuses from the blood to the alveoli. Diffusion is a
passive process in which gases move across a membrane from an area of higher
concentration to an area of lower concentration. In the lungs, the membrane is the
alveolar–capillary network.
430 PHYSICAL EXAMINATION
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UNIT 2
Internal respiration
Internal respiration is the process by which gases are exchanged between the
pulmonary vasculature and the body’s tissues. Oxygen from the lungs diffuses from
the blood into body tissue. Carbon dioxide diffuses from the tissue into the blood
and is then carried back to the right side of the heart for reoxygenation.
Control of breathing
Control of breathing is inuenced by neural and chemical factors. The pons
and medulla are the central nervous system structures primarily responsible for
involuntary respiration. The stimulus for breathing is an increased carbon dioxide
level, a decreased oxygen level, or an increased blood pH level.
HEALTH EDUCATION
Risk factors for tuberculosis
Tuberculosis (TB) is a notiable and signicant health issue that represents a global and
national public health threat. In Australia and New Zealand numbers are low and relatively
stable; in Australia there are approximately 1200 cases per year (Australian Technical
Advisory Group on Immunisation, 2018; Australian Government Department of Health, 2018).
In New Zealand incidence is also stable, with approximately 300 cases per year (Ministry
of Health/Manatù Hauora, 2022b). Guidelines are available for the control of TB. It is
spread airborne via droplet nuclei into the respiratory tract. The following are risk factors
for contracting pulmonary tuberculosis and should be considered in gathering health
assessment data:
> Living with or being in close contact with others who have active TB
> Malnourishment
> Immunosuppressed status
> Homelessness, including living in shelters
> Imprisonment, due to close living quarters
> Residing in a nursing home, hospice etc. due to close living quarters
> Working with high-risk consumers
> Chronic diseases leading to decreased resistance
> Immigration from countries with tuberculosis prevalence
> Being a migrant farming/rural worker
> Positive tuberculin skin test
Health education is a key to minimising the spread of tuberculosis.
ASSESSMENT: TAKING THE CONSUMER’S HEALTH HISTORY
Assessment is the rst phase of the nursing process, and involves collecting
subjective information about the consumer’s health status in order to identify
consumer problem areas to focus on.
Subjective data is most frequently collected during a health history and serves as
the starting point for the health professional to base the depth of their assessment
on. The sections for the health history include:
> Consumer prole
> Chief complaint (explained systematically using variations of location, quality,
quantity, associated manifestations, aggravating factors, alleviating factors,
setting and timing. This is a variation on the PQRST assessment mnemonic you
may use for other conditions such as pain assessment)
>>
RESPIRATORY 431
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>>
> Past health history (including medical history, surgical history, allergies,
medications, injuries and accidents, special needs and childhood illnesses)
> Family health history
Social history (including alcohol, tobacco and drug use, sexual practice, work
>
and home environment, hobbies and leisure activities, stress and culture).
The example health history provided identies scope for questioning the
consumer about their health for this specic body system.
HEALTH HISTORY
CHAPTER 13
CONSUMER
PROFILE
CHIEF COMPLAINT
The respiratory health history provides insight into the link between a consumer’s life and lifestyle and respiratory
information and pathology.
range in years.
AGE
SEX FEMALE Lung cancer, sarcoidosis, COPD, inuenza, SARS and pneumonia
CULTURAL
BACKGROUND
Common chief complaints for the respiratory system are dened, and information on the characteristics of each sign or
symptom is provided.
1. DYSPNOEA Subjective feeling of shortness of breath (SOB)
2. COUGH Stimulation of afferent vagal endings, helps clean the airway of extraneous material by producing
Diseases that are age-, sex- and race-specic for the thorax and lungs are listed with approximate commencing age
> Bronchiectasis (birth–20)
> Cystic brosis (birth–30)
> Pneumothorax (20–40)
> Sarcoidosis (30–40)
> Chronic bronchitis (>35)
> Pneumonia (>60)
> Emphysema (50–60)
> Idiopathic pulmonary brosis (60–70)
> Asthma
> Lung cancer
> Severe Acute Respiratory Syndromes (SARS, e.g. coronavirus)
MALE Lung cancer, COPD, idiopathic pulmonary brosis, pneumothorax,
inuenza, SARS, pneumonia and asthma
ABORIGINAL AND
TORRES STRAIT
ISLANDERS, NEW
ZEALAND MAORI
CAUCASIAN Cystic brosis
QUANTITY The number of steps that can be climbed before SOB occurs, distance that
ASSOCIATED
MANIFESTATIONS
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
TIMING Night-time (paroxysmal nocturnal dyspnoea)
a sudden, forceful and noisy expulsion of air from the lungs
QUALITY Dry, wet, hacking, barking, congested, harsh, brassy, high-pitched,
COPD, pneumonia, inuenza and SARS, asthma (most common cause of
hospitalisation in Māori), lung cancer, COPD, bronchiectasis
can be walked, number of pillows needed to sleep comfortably
Palpitations, leg pain, faintness, anxiety, fatigue, cough, sputum, wheezing,
diaphoresis, cyanosis, pain, fever
Smoking, exercise, poorly ventilated rooms, cold weather, wind
Sit the consumer upright and use pillows to support (helpful with
orthopnoea). Examples of well-known positions are semi-Fowler, Fowler
positions. Try side-lying position, tripod position, fresh air, medications
(e.g. bronchodilators), supplemental oxygen, resting
whooping, bubbling, productive/nonproductive
>>
432 PHYSICAL EXAMINATION
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>>
HEALTH HISTORY
ASSOCIATED
UNIT 2
3. SPUTUM Substance produced by the respiratory tract that can be expectorated or swallowed; it is
MANIFESTATIONS
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING Temperature and humidity of environment, exertion
TIMING Winter, early morning, bedtime, middle of the night, after eating, prior to
composed of mucus, blood, purulent material, microorganisms, cellular debris and, occasionally,
foreign objects
QUALITY > Colour: white or clear, purulent, blood-tinged, yellow or green, mucoid,
QUANTITY Normal daily sputum production is 60–90mL (normally this is not
ASSOCIATED
MANIFESTATIONS
SOB, wheezing, sputum, pleuritic pain, chest pain, fever, haemoptysis,
coryza, anxiety, diaphoresis, gastro-oesophageal reux disease (GORD)
symptoms, postnasal drip, hoarseness
Position of consumer, exposure to noxious stimuli, exercise
Medications (e.g. nebuliser, inhaler, cough suppressant medications,
steroids), humidity, cool air, cool liquids
fainting, continuous
rust, black, pink
> Consistency: thick, thin, moderate; frothy – separates into layers
> Odour: malodorous
expectorated); small, moderate, copious
Cough, fever, dyspnoea
PAST HEALTH
HISTORY
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING When person is asleep, exposure to an allergen
TIMING Early morning
4. CHEST PAIN Pain can have a pulmonary, cardiac, gastrointestinal or musculoskeletal aetiology. Chapter 14
differentiates the types of chest pain.
The various components of the past health history are linked to thorax and lung pathology and related
information.
MEDICAL
HISTORY
SURGICAL
HISTORY
ALLERGIES Asthma is the predominant manifestation of allergies in the consumer with respiratory conditions.
RESPIRATORYSPECIFIC
NONRESPIRATORYSPECIFIC
Lobectomy, pneumonectomy, tracheostomy, wedge resection, bronchoscopy, chest
tube insertion
Hypersensitivity to drugs, food, pets, dust, cigarette smoke, perfume or pollen should be closely
scrutinised. In addition, any common signs of allergies, such as cough, sneeze and sinusitis,
should be closely evaluated.
Exposure to allergens, smoking
Medications (e.g. guaifenesin), liquids
Asthma, bronchitis, croup, frequent colds, cystic brosis, emphysema,
epiglottitis, pleurisy, pneumonia, pneumothorax, pulmonary oedema,
pulmonary embolus, lung cancer, tuberculosis, pertussis, COPD, pleural
effusion, bronchiectasis, intubation, conrmed or suspected SARS
Lupus, drug-induced respiratory pathology, rheumatoid arthritis, congenital
musculoskeletal chest defects, severe scoliosis, multiple sclerosis,
amyotrophic lateral sclerosis
MEDICATIONS Beta agonists, inhaled corticosteroids, anticholinergics, mast cell stabilisers, leukotriene receptor
antagonists, antibiotics, bronchodilators, cough expectorant, cough suppressant, oxygen, steroids
>>
RESPIRATORY 433
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>>
HEALTH HISTORY
COMMUNICABLE
DISEASES
INJURIES AND
ACCIDENTS
CHILDHOOD
ILLNESSES
FAMILY HEALTH
HISTORY
SOCIAL HISTORY The components of the social history are linked to respiratory factors and pathology.
Respiratory diseases that are familial are listed:
Allergies, alpha1-antitrypsin deciency, asthma, bronchiectasis, cancer, cystic brosis, emphysema, sarcoidosis, TB,
pulmonary emboli, COVID-19
ALCOHOL USE Decreases efciency of lung defence mechanisms, predisposes to aspiration pneumonia;
TOBACCO USE Cigarette smoking is the primary risk factor for chronic bronchitis, emphysema and lung cancer,
DRUG USE
TRAVEL HISTORY
> Common cold (head cold): sneezing, coughing
> Tuberculosis (TB): pulmonary brosis and calcication
> Flu: pneumonia
> AIDS: Pneumocystis carinii pneumonia
> Hantavirus: bilateral pulmonary inltrates, respiratory failure (low incidence in Australia)
> COVID-19: cough, difculty breathing, SOB
Chest trauma, near drowning
Pertussis and measles: bronchiectasis
consumers with carbon dioxide retention are more sensitive to the depressant effect of alcohol
as well as other disorders
> Heroin: pulmonary oedema
> Barbiturates or narcotic overdose: respiratory depression
> Cocaine: tachypnoea
> Prolonged exposure to conned space with recirculated air (e.g. aeroplane)
> TB (South-East Asia): poor sanitation and rural conditions
> Pneumonic plague (India): carried by nuclei droplets
CHAPTER 13
WORK
ENVIRONMENT
HOME
ENVIRONMENT
Repeated exposure to materials in the workplace can create respiratory complications that range
from minor problems to life-threatening events. Numerous categories of respiratory diseases have
been identied from repeated exposure to toxic substances. These diseases are listed along with
the industries and agents related to them.
> Silicosis: glassmaking, tunnelling, stonecutting, mineral mining, insulation work, quarrying,
cement work, ceramics, foundry work, semiconductor manufacturing
> Asbestosis: mining, shipbuilding, construction
> Coal worker’s pneumoconiosis: coal mining
> Pneumoconiosis: tin and aluminium production, welding, insecticide manufacturing, rubber
industry, fertiliser industry, ceramics, cosmetic industry
> Occupational asthma: electroplating, grain working, woodworking, photography, printing,
baking, painting
> Chronic bronchitis: coal mining, welding, re ghting
> Byssinosis: cotton mill dust, ax
> Extrinsic allergic alveolitis (hypersensitivity pneumonia): animal hair, contamination of air
conditioning or heating systems, mouldy hay, mouldy grains, mouldy dust, sugarcane
> Toxic gases and fumes: welding, cigarette smoke, auto exhaust, chemical industries,
reghting, hair spray, snifng glue
> Pulmonary neoplasms: radon gas, mustard gas, printing ink, asbestos, chromium (from chrome
plating, stainless steel welding)
> Pneumonitis: furniture polish, petroleum or kerosene ingestion; mineral oil, olive oil and milk aspiration
> SARS-CoV-2: airborne transmission associated with inability to physically distance, inadequate
ventilation, inappropriate PPE
> Air pollution, cigarette smoke, wood-burning stoves, gas stoves and heaters, kerosene heaters,
radon gas, pet hair and dandruff
> Tropical diseases such as melioidosis, dengue haemorrhagic fever, scrub typhus, leptospirosis,
salmonellosis, penicilliosis marneffei, malaria, amoebiasis, paragonimiasis, strongyloidiasis,
gnathostomiasis, trinchinellosis, schistosomiasis, echinococcosis
>>
434 PHYSICAL EXAMINATION
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HEALTH HISTORY
HOBBIES
UNIT 2
AND LEISURE
ACTIVITIES
STRESS Asthma can be exacerbated by stress.
ECONOMIC
STATUS
Birds (bird breeder’s lung), mushroom growers (mushroom grower’s lung), scuba diving (lung
rupture, oxygen toxicity, decompression sickness), high-altitude activities (skiing, climbing:
pulmonary oedema and pulmonary embolus)
Poor sanitation and densely populated areas are ideal conditions for the spread of TB
and COVID-19.
Person-centred health education
When conducting a health assessment, opportunities for the provision of personcentred health education will arise. This is a signicant consideration in relation to
the assessment process for examination of the thorax and lungs. These occasions
are identied as individualised education and may generate further data that can
be added to the assessment. All education given should be documented so that in
future, health professionals can assess the impact of previous information provided
to the consumer. (Refer to Chapter 1 for initiating health education.) Refer to the
following examples.
INDIVIDUALISED HEALTH EDUCATION INTERVENTIONS
Assessing the consumer for the following health-related activities can assist in identifying the
need for education about these factors. This information provides a bridge between the health
maintenance activities and respiratory function.
Sleep Obstructive sleep apnoea: absence of inspiratory muscle activation;
upper airway occlusion
COPD or neuromuscular disease: nocturnal oxygen desaturation caused
by hypoventilation without apnoea
Diet Obesity: chronic hypoventilation, obstructive sleep apnoea (e.g. due to
Pickwickian syndrome)
Exercise Regular exercise improves pulmonary function
Use of safety devices Wear a mask when exposed to toxic substances, other occupational
precautions as mandated by Occupational Health and Safety
workplace legislation
Health check-ups Respiratory rate, lung auscultation, chest X-ray, sputum culture
and sensitivity, pulmonary function test, TB testing, inuenza and
pneumococcal vaccines, immunotherapy (allergy shots),
SARS-CoV-2 testing
PUTTING IT IN CONTEXT
COVID-19
On 11 March 2020, the World Health Organization declared the Severe Acute Respiratory
Syndrome Coronavirus (SARS CoV-2), which causes coronavirus disease 2019 (COVID-19),
a worldwide pandemic. From 2020, healthcare systems and healthcare professionals
worldwide have coordinated signicant changes to their environments and management
of persons requiring care. The evidence to support clinical policy and practice, based
on high-quality research, is still emerging. Therefore, the information included in the
text is correct at the time of publication; however, we acknowledge the rapidly changing
evidence related to COVID-19. Epidemiological reports suggest 80% of COVID-19 cases will
experience mild or moderate disease that does not require medical intervention. However,
20% of COVID-19 cases will experience severe disease requiring hospital treatment. Severe
or fatal outcomes are common in older persons, or those with co-morbid conditions.
>>
RESPIRATORY 435
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COVID-19 affects many body systems. Persons with COVID-19 may present with a wide
array of symptoms. Mild symptoms may include cough, sore throat, pyrexia, diarrhoea,
headache, myalgia or arthralgia, fatigue, anosmia and ageusia.
The presence of anosmia or ageusia may be a useful red ag for COVID-19
(Struyf et al., 2021).
In addition to the burden of acute COVID-19 on healthcare systems and professionals,
evidence suggests large numbers of persons experience post COVID infection. Post COVID
infection is known as post COVID syndrome, post-acute COVID or long COVID. There is
currently no Australian or international denition for the range of symptoms experienced
following an acute COVID infection.
Post COVID infection signs and symptoms may include:
> pulmonary symptoms (cough, shortness of breath)
> neurological symptoms (fatigue, headache, cognitive dysfunction, sleep disturbance,
anosmia, paraesthesia)
> hair loss
> skin conditions
> renal disease
> thromboembolism
> psychological symptoms (anxiety, depression, mood swings)
> cardiac symptoms (chest pain)
> musculoskeletal symptoms (non-specic pain, myalgia)
> fever (low-grade fevers)
> reduced activity and functional level
> reduced nutritional status and weight loss
> post-intensive care syndrome (PICS).
Currently, there is limited evidence supporting effective management of post COVID
infection. Goals of care currently include effective, culturally appropriate communication,
coordinated primary care, support wellbeing, exclude serious complications, manage red
ag symptoms (RACGP, 2021).
Austr alian Gover nment Depa rtment of H ealth (20 22); Aust ralian Natio nal COVID -19 Clinical Evide nce Taskfor ce
(202 2, 9 May, p. 770) ; Ministry o f Health/ Manatù Hau ora (202 2c, 6 May); R ACGP (20 21, December )
CHAPTER 13
PUTTING IT IN CONTEXT
Inhalants
You are conducting a history on a new 19-year-old consumer in the student health centre of
the local university. The consumer has a history of asthma and needs a rell of her shortacting bronchodilator. The individual denies using tobacco but admits to inhaling some
substances at recent parties. You ask her to tell you more about this practice when she
says, ‘I have said too much. I never should have brought it up. I just want a prescription for
my asthma medication and I will leave.’ How should you proceed?
Such a situation may provide an opportunity for the nurse to highlight the deleterious
effects of short- and long-term illegal drug use. It may be possible to provide written
materials or the details of an online website/s if the person is not keen to discuss the
situation. Nurses are often placed in situations that provide opportunities to deliver key
health updates and this should be enacted when the situation arises.
Соседние файлы в папке Библиотека им академика М.И. Перельмана