Evaluation of the Lungs and Thorax

There are several ways to examine lungs and thoracic cavity. The easiest method is simple observation. Noting if there are accessory muscles are used, cyanosis present, deformities of the thoracic cavity, audible noises with respiration, and delays in inspiration or expiration call all give clues as to the patient’s respiratory status (Bickley, 2017).

Palpation is the next method of examination. When palpating the thoracic cavity, feel tender areas. Crepitus is a clue that air has leaked into the subcutaneous tissue. The clinician should test for expansions by placing both hands on the patient’s back. The thumbs should be located at the tenth rib and the fingers should be loosely parallel to each other and on the lateral portion of the rib cage. As the patient breaths the clinician’s hands should apart in an equal manner (Bickley, 2017).

Percussion is another important tool. While percussion does not help with lesions deep in the thoracic cavity, it does allow for the clinician to understand whether air, fluid, or a solid mass lies five to seven centimeters bellowed the percussed area (Bickley, 2017).

Auscultation is an excellent skill for a clinician. Every clinician should know the different adventitious lung sounds and their clinical significance (Bickley, 2017).

Factors that Influence Change in the Evaluation

Patient history, presenting symptoms, and abnormal findings, all help guide a physical assessment.  Some common thoracic and lung presenting symptoms include pain in the chest, back, and substernally, shortness of breath or wheezing, as well as a cough with or without hemoptysis (Bickley, 2017).

An asthmatic patient should be evaluated to make sure there is no wheeze present, that they are not frequently short of breath and using their rescue inhaler, and that they have not lost lung function (Cramer, Davidson, & Alic, 2015; Bickley, 2017).

Pain in the thoracic cavity can be cardiac, gastric, pneumonia, anxiety, or even a lesion on the lung (Frey, 2015; Bickley, 2017). Patient history and a focused assessment can help narrow down a diagnosis and treatment plan (Bickley, 2017).

References

Bickley, L. S. (2017). Bates’ Guide to Physical Examination and History Taking, 12th Edition. [Vitalsource]. Retrieved from https://online.vitalsource.com/#/books/9781496354709

Cramer, D. A., Davidson, T., & Alic, M. (2015). Asthma. In J. L. Longe (Ed.), The Gale Encyclopedia of Medicine (5th ed., Vol. 1, pp. 545-553). Farmington Hills, MI: Gale. Retrieved from http://link.galegroup.com.prx-herzing.lirn.net/apps/doc/CX3623300200/GVRL?u=lirn50909&sid=GVRL&xid=644b6d6a

Frey, R. J. (2015). Lung Abscess. In J. L. Longe (Ed.), The Gale Encyclopedia of Medicine (5th ed., Vol. 5, pp. 3088-3091). Farmington Hills, MI: Gale. Retrieved from http://link.galegroup.com.prx-herzing.lirn.net/apps/doc/CX3623301121/GVRL?u=lirn50909&sid=GVRL&xid=f4e0f075

 

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI?

Project 1 week 1

  

Time Management

This assignment is about you. It is an assessment of your abilities and traits.

This assignment will help you figure out what style of leadership you have been following and whether this style works for you.

Through this assignment, you will find the various approaches of leadership that complement each other. There is no one theory that describes the only way to be an effective leader. Each theory focuses on different issues, but they all help you to better understand how to become a successful leader.

use the following link to access the Time Management Assessment: Time Management Assessment This is the web site that needs to be link http://literacynet.org/icans/chapter03/timemgmt.html

Based on your research and understanding, create a paper in a 3- to 4-page Microsoft Word document that:

Incorporates your time management self-assessment information and the concepts learned this week (leadership theories, leadership versus management, professional nursing organizations, and time management.

Includes identification of one leadership theory, which you feel best describes your leadership style.

Includes a comparison between leadership and management

Includes a suggestion on how to apply this week’s concepts to the work environment

APA format need references too.

· Leadership Theories 

• Autocratic (Authoritarian): The      autocratic leader dictates to the group the task to be accomplished, and      the method to be followed. This style is used when time is short and the      leader is the most knowledgeable person on the team with regards to the      task at hand.
• Participative (Democratic):      Participative leaders include the group in the decision−making process.      This style is most appropriate when everyone in the group has knowledge      about the subject, like when working with a group of experts. The leader,      however, retains the ability to make the final decision.

Delegative (Free Reign): Also known as laissez faire, meaning—to not get involved in the affairs of others, a delegative leader allows the individuals in the group to make independent decisions, although the leader will be held responsible for the decisions made. It is best to not supervise educated people,  

 

Complete “The VARK Questionnaire: How Do I Learn Best?”

http://vark-learn.com/the-vark-questionnaire/

1. Click “OK” to receive your questionnaire scores.
2. Once you have determined your preferred learning style, review the corresponding link to view your learning preference.
3. Review the other learning styles: visual, aural, read/write, kinesthetic, and multimodal (listed on the VARK Questionnaire Results page).
4. Compare your preferred learning strategies to the identified strategies for your preferred learning style.
5. Appraise how this awareness of learning attributes influences your perceptions of teaching and learning.

In a paper (750-1,000 words), summarize your analysis of this exercise. Include the following:

1. Provide a summary of your learning style.
2. List your preferred learning strategies.
3. Compare your preferred learning strategies to the identified strategies for your preferred learning style.
4. Discuss how the awareness of individual learning styles, preferences and strategies influence teaching (those who are in a position to teach) and learning (those who are in a position to learn).
5. Cite a minimum of three references in the paper.