Alternative Writing Assignment
Chamberlain College of Nursing
NR 509: Advance Physical Assessment
Alternative Writing Assignment
Family
... [Show More] Nurse Practitioners must have keen assessment skills in order to provide efficient care and the best possible outcome to the population in which they care for. Having a profound understanding of the body systems that require assessment as well as the abnormalities that can occur will assess the nurse practitioner in gathering subjective and objective health assessment. Adaption of assessment skills and patient history is key for a family nurse practitioner as they will care for various populations including , pediatric, adult, pregnancy, and geriatric.
Body System
The body system that will be discussed in this week’s alternative assignment will be respiratory system. The respiratory system plays a vital role in maintaining hemostasis of the body. The respiratory system is also the primary site in which oxygen and carbon dioxide perform the gas exchange. This process is crucial to all the fundamental functions in the human body.
Physiology
Thorough knowledge of the anatomy and the physiology of the respiratory system is necessary in management of the respiratory system. The lungs being the primary organ responsible for gas exchange of oxygen and carbon dioxide. Blood gathers the oxygen from the lungs, then carries it to various parts of the body where metabolic process occurs. During cell metabolism, red blood cells collect the carbon dioxide ,transporting it back into the lungs and exits through exhalation. Oxygen enters the body through the nose and mouth during inhalation. Two tubes carrying the air into both the left and right levels are the trachea which branches into the bronchi. Cilia lines the bronchial tubes, cilia moving back and forth filtering foreign material for the respiratory system. Mucus, a sticky fluid collects dust, bacteria, and other environmental substance that has invaded the lungs. Mucus is dislodged through; sneezing, spitting, coughing, or swallowing. The bronchial tubes lead to the left and right lungs. The right lung has three lobes while the left lung only has two lobes due to the space occupied by the heart. Alveoli located at the terminal end of the lobes is where the primary gas exchange takes place.
Health History Questions
Taking a proper health assessment starts with handwashing and appropriate personal protective equipment that may be applicable to the respiratory system such as droplet or airborne precautions. The next step would be introduction, the provider should provide name, credentials, and role in the healthcare team. Then the provider will ask questions that will be beneficial in assessing the repertory system. Subjective data is a description of symptoms from the patient’s point of view . Such clinical data will be taken into consideration without prejudice or bias from the provider. What brought you in today? How frequent is the cough or shortness of breath? How long has the cough been lasting? When did the cough start? Does the cough wake you up at night? Have you noticed wheezing? Are you coughing up anything, such as blood? Does anything trigger the cough? Does anything relieve the cough? Are you able to do your daily activities? During the assessment observe if the patient is using their accessory muscle. Do they appear fatigue or discomfort when answering questions? The inability to answer in full sentences is a telltale sign of respiratory distress. How are they seated on the exam table?
Objective Data
Objective data refers to the clinical information obtained by the healthcare provider which are measurable and can be obtained by conducting a physical examination. This process includes, inspection, palpation, percussion. Auscultation. Inspected the respiratory system begins with observation of the skin color, moisture, turgor, and temperature . Skin should be warm and dry with a uniform complexion that is consistent to the patient’s ethic background. The provider should pay attention to the facial expression which should be relaxed with no signs of distress. If the patient appears to be using their accessory muscle to assist with breathing that could be a sign that the patient may be in respiratory distress, as seen in asthma patients. . Inspection of nail beds, mouth and lips are crucial clues when assessing the patient for respiratory concerns. Cyanosis of nailbeds, mouth/lips and clubbing of fingertips could be an indicator of chronic hypoxia as experienced in patients with chronic pulmonary obstructive disease (COPD). Also observe the patient’s posture , which is the body’s mechanism in improving lung function but may also be a sign of respiratory distress. Normal respiratory rate (RR) for adults is 14 to 20 breathes a minute, hence, the importance of observing the patient’s RR. Observing the shape and symmetrical equal rise and fall of the chest . Unilateral rising and falling of the chest could be indication of flail chest after trauma.
Palpation is the next step in assessing the respiratory system. Examine the anterior and posterior chest by utilizing the palm of your hands. The provider examines the trachea size, shape tenderness and if it is midline. The patient should not complain of tenderness, discomfort, and there shouldn’t be any type of palpable masses. The nurse practitioner can also place their hands in the intercostal spaces and have the patient repeat words ninety-nine to assess for tactile fremitus. If crackling feeling to the skin is noted, subcutaneous emphysema may be present.
Percussion is performed when by the provider places their finger of their non-dominant hand on the chest of the patient and strikes the outstretched middle finger with their dominant hand. At this time the nurse practitioner is listening for dullness, tympani, and hyper resonance. If pneumonia is expected the provider will hear dullness, Hyper resonance can be an indicative of inflated lungs such as a patient with COPD.
The last step in assessing the respiratory system is auscultation by use of a stethoscope. The provider should ask the patient to take deep breathes through their mouth while sitting straight up. This allows the provider proper aeration of the lung fields during auscultation. Using the diaphragm of the stethoscope the provider should assess over the apices of the lungs, alternating from side to side all the way down to the bases of the left and right anterior and posterior lungs. The provider should be auscultating for adventitious sounds in all fields of the lungs. Crackles, fluid in the lungs, if heard on examination could be indication of pneumonia or fluid overload as seen in pulmonary edema. Wheezing, a musical whistling sound is often heard in asthmatic patients. Rhonchi, course rattling lung sounds are production of fluid in the narrow bronchi. High-pitched lung sounds, stridor, usually is an caused by partial airway obstruction resulting in a medical emergency.
Special Procedures
Test that may be performed in an office setting is a spirometry. This test allows the provider to assess the inspiratory and expiratory volume of the patient. It can be useful in identifying asthma. Spirometry is cost effective and aids in decreasing delays in treatment. Often patients are non -complainant with following up with specialist due to not being convenient. Ability to perform these techniques in an office setting can improve patient satisfaction, while improving compliance with care.
Adaptation of Physical Assessment
Special patient population require different assessment techniques in order to determine important information for the diagnosis. Special population include, infant, pediatric, pregnancy, and geriatric.
Infant/Pediatric
The parents will be the primary source of information when assessing an infant. It will be important to build rapport with the parent as well as the infant/pediatric. Ask the parents of any episodes of respiratory distress, cyanosis of the lips/mouth, apnea , if any smokers in the house, did they carry to full term. Ask the parents if there is any history of asthma, if there is a history it will be important to ask the treatment, effectiveness, and compliant.
Pregnancy
Pregnancy does not usually have an effect on the respiratory system (LoMauro & Aliverti, 2015). Pulmonary embolism may be found in pregnant woman due to the pregnancy placing the woman in hypercouguable states. Woman with preexisting lung disease should plan their pregnancy and be counseled. Pregnant woman must do what is best for their fetus, certain treatments may be altered or stopped . The provider should make proper referrals regarding the well-being of fetus and mother.
Geriatric
When assessing the geri-population it is crucial to ask about immunization such as flu and pneumonia. Ask about any change in the ability to perform daily activities, any feeling of fatigue, any change in sleeping habits, are they stacking pillows, night sweats, assess weight changes, and any swelling to the extremities.
Major Disease Process
Asthma is a long -term disease that affects the lungs by intermittently inflaming and narrowing the airways. When the airway become inflamed and narrow the patient will experience shortness of breath, chest tightness, coughing and wheezing. Asthma affects the pediatric population the most, children 17 years of age and younger male and female of all ethnic backgrounds. Environment triggers including, cold, smoke, dust, cats, and chemicals can trigger an exacerbation of asthma cause hyperactivity response of airway by producing excessive amounts of mucus and becoming more edematous leading to narrowing of the airways resulting in hypoxia. Although pediatric population is highest risk of asthma diagnosis, the provider must be mindful with elderly population as asthma is often misdiagnosed and not treated appropriately ( Battaglla, Benfante, Spatafora, & Scichilone,2016).
Conclusion
Respiration is an effortless and involuntary process. The respiratory system is prone to variety of disease. A thorough understanding of the anatomy and physiology of the respiratory system of all populations is crucial in provided the best possible outcome for the patient. Combining subjective and objective information, along with knowledge of the disease process and treatments. Will allow the nurse practitioner to perform a skillful assessment, proper diagnosis and treatment.
References
Battaglia, S., Benfante, A., Spatafora, M., & Scichilone, N. (2016). Asthma in the elderly: a different disease?. Breathe (Sheffield, England), 12(1), 18–28. https://doi.org/10.1183/20734735.002816
LoMauro, A., & Aliverti, A. (2015). Respiratory physiology of pregnancy: Physiology masterclass. Breathe (Sheffield, England), 11(4), 297–301. https://doi.org/10.1183/20734735.008615 [Show Less]