Health Assessment (Peer post replies)

Reply Posts

Respond to your peers’ post and include the following:

· Insight on a solution to an identified peer challenge.

· Resources that may be helpful related to your peers’ post.

POST # 1 Jean

(Jean’s initial Post)

Reflect on the focus area or system(s) for the week.

· What challenges might you anticipate in completing this assessment?

· What differences might you anticipate when assessing patients across the lifespan?

· Share findings from scholarly resources that help in the performance of this assessment.

Heart disease remains the number one cause of mortality in both men and women in the United States (Fritz, 2015), so we can safely say that this is one of the most important system to know and be confident in assessing. The cardiac and lung exam can be very challenging; practitioners can detect critical information that means life or death, that can be missed if they are not well equipped.  Cardiac is not my strong suit and I find it very challenging to recognize the murmurs and grading them, the clicks, the gallops and all the extra sounds that may come; because of that I take every opportunity I get to jump in and listen to my patient’s heart and lungs to familiarize myself with the sounds in order to quickly determine any irregularities. Even something that one may think is minor like knowing when to use the bell or the diaphragm of the stethoscope can be of a challenge. The chest should be auscultated with the diaphragm of the stethoscope throughout the precordium to detect the high-pitched sounds of S1, S2, pericardial friction rubs and murmurs from aortic and mitral regurgitation and the bell is used to detect low pitched sounds of a mitral stenosis murmur and further heart sounds termed S3 and S4 (Scott & MacInnes, 2006).  When it comes to the respiratory assessment, reading a chest x-ray as an advance practice nurse and know how to interpret it comes as my greatest challenge, which I plan to overcome by taking an x-ray class in the summer. 

When assessing patients across lifespan, it is important to recognize the age-related differences that happens. Age-related cardiac changes include reduced arterial compliance and left ventricular diastolic dysfunction, so symptoms can present differently in the older adult than in the younger population.

Obtaining a set of vital signs play a major role in the cardiac and lungs assessment. The pulse and the blood pressure directly relate to the cardiovascular system and can tell you if there’s any blockage or if there’s any circulation issues (Scott & MacInnes, 2006). The Cardiac and lung exam can be intermingled with all the other systems, as if there’s an issue with one, it will reflect on all the others. For example, if there’s circulation issues, there might be some difficulties walking due to shortness of breath and that will reflect on the musculoskeletal system. Patient may be cyanotic if there are some lung issues which will be seen in evaluating the skin and the nails, and there is much more. So, as we can see the heart and the lungs can bring all the other systems together. 

In order to make correct diagnoses, you must inspect, palpate, percuss and auscultate the chest, and also remember to examine the patient’s extremities to assess arterial or venous disorders and symmetry. While palpation of the chest is often overlooked as a source of information regarding the cardiovascular system, the findings can be helpful in making an accurate assessment, palpate over the precordium to find the apical impulse and also to note any thrills, heaves, or fine vibrations (Fitz, 2015). For the respiratory exam, it is important to auscultate for abnormal breath sounds, including reduced intensity, asymmetry, wheezing, stridor, or crackles, even in the absence of a history of wheeze, clinicians should pay close attention to any evidence of this finding on physical examination, and note that wheezing is always abnormal and may represent an inhaled foreign body or other causes of airway obstruction-could be life threatening (Chang & Marchant, 2020).

 

References

Chang, A. B. & Marchant, J.M. (2020). Approach to chronic cough in children. UpToDate. Retrieved from  Approach to chronic cough in children - UpToDate (oclc.org)

Fritz, D. (2015). Cardiac Assessment. Home Healthcare Now, 33(9), 466–472.

Scott C., & MacInnes J.D. (2006). Cardiac assessment. Cardiac patient assessment: putting the patient first. British Journal of Nursing, 15(9), 502–508. https://doi.org/10.12968/bjon.2006.15.9.21091