1. What data deviates from normal findings, suggesting a need for further investigation? Please include reasons why the data needs further investigation.
The patient is likely suffering from COPD (chronic obstructive pulmonary disease)/ emphysema Therefore, the cyanosis around the lips and nail beds are out of place. The again wheeze and rhonchi are combined to sibilant rhonchi. They should have stated sibilant wheezes which is high pitched and shrill sounding breath sounds while the rhonchi is the opposite. It is difficult to determine if it was sibilant wheeze or rhonchi.
2. What additional questions could the RN ask to clarify symptoms? Please be sure to include the rationale for each question
The patent should be asked if she has ever been diagnosed with the deficiency in Alpha-1-antitrypsin because the Alpha-1-antitrypsin is responsible for destroying the trypsin that can damage the lung tissues. Without the Alpha-1-antitrypsin, the patients body cannot combat the destruction caused by trypsin. Once the trypsin is released into the lung, the lung tissues are slowly wasted (Ehrenfeld, &, Cannesson, 2013).
The patient should also be asked to clarify if the lives in or near an industrial area where air pollution or toxic chemical are prevalent. The toxins can induce or aggravate emphysema and COPD. The nurse should also ask the patient if she has ever had any form of ingenious injection with the cornstarch for any reason because cornstarch can be very dangerous or toxic to the patients lung tissue. Additionally, the patient should be asked if she has relatives with emphysema because emphysema is hereditary (Lindh, et al, 2013)..
The interview must also include question about the nature of coughs. For example, if the patient caught, the duration of the cough, and the time other day when the cough occurs. Is the cough dry or productive, the factors that worsen the cough as well as those that relieve the cough? Any form of fever, or chest pain. Any form of congestion in the breathing system especially the nose, illness or even injuries that might have affected the breathing system., for example, continuous persistent caught may be as a result of respiratory infection, while night time coughs may be caused by chronic bronchitis or smoking. If the cough its productive then he case may be due to mycoplasma pneumonia.
Finally, the patient should be asked if they have ever had other immune deficiencies in their life. For example, pneumocystis carini usually leads to lung inflammation. Other diseases such as Ehlers-Danlos Syndrome should be determined because with Ehlers-Danlos Syndrome, the normally elastic tissue in the body causes alveoli collapse. Chest X-ray and CT scan of the chest- this will help determine if there are traces of bulla or holes on the surface of the patients lung. The X ray will also help determine if the lung tissue damage is severe. Arterial blood gas test- this test will be conducted to determine the level of oxygen and carbon dioxide in the patients blood. The test will also help determine the efficiency of the lung.
Oxymetry will also be conducted to help the confirm the patients reporting on the need for supplemental oxygen while the same patient will also be subjected to spirometery test to help in evaluating how the body responds to the medication administered in vapor form (White, 2014). The nurse should examine the chest to determine if there are chest pains. The nurse can ask the nature of pain whether sharp or stabbing, the location of the pain in the chest as well as if it hurts more. For example, the pleuristic chest pain is relatively sharper pain usually experienced when one breathes in and is mainly localism on one side of the chest. If the patient is having chest pain then it may be caused by the inflammation of the patients parietal pleura.
Finally, sputum test and a sputum culture are recommended to help the nurse determine the actual cause of the condition. For example, the sputum may be colored with blood in it, may be thick, purulent, or even frothy. The nurse must determine the nature of sputum as the result may lead to a different differential diagnosis (Hamid, Shannon, &, Martin, 2005).
3. Which systems should you examine? Please list the physical findings in each area.
The heart- Emphysema can affect the heart as it increases the blood pressures, causes the heart to enlarge and may lead to heart failure. As the air enter the alveoli through the bronchial tree, the alveoli expands and the oxygen molecules is transferred to the red blood cells as they are moved to supply the body with oxygenated blood. The deoxygenated blood is transferred to the alveoli to be exhaled with the emphysema; the air sac (alveoli) is inflamed and tends to lose it6s elasticity thereby reducing he oxygen content in the blood. The alveoli cannot expel the air from the lungs and inhale oxygen rich air thereby damaging the heart. With the emphysema, the alveoli are damaged, and the arteries becomes narrow forcing the heart to pump faster, and harder raising arterial blood pressure resulting into pulmonary hypertension pulmonary muscle hypertrophy. Additionally, when the oxygen level in the blood declines, heart failure ensue because of added stress causing a buildup of body fluids in the patients body.
Lindh W., Pooler, M., Tamparo D., Dahl M., &, Morris J. (2013). Delmar's Comprehensive Medical Assisting: Administrative and Clinical Competencies. 5th Ed. Cengage Learning, White, G. (2014). Equipment theory for respiratory care. 5th ed. Cengage Learning,.
Ehrenfeld, J., &, Cannesson M., (2013). Monitoring Technologies in Acute Care Environments: A Comprehensive Guide to Patient Monitoring Technology. Springer Science & Business Media
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