Before Auscultation Case Study

Throughout the placement of a chest tube, the patient should be assessed for complications of chest tube drainage and for re-expansion of the lung. A nurse should assess the lungs and the thorax for tracheal deviation, nonsymmetrical movement of the chest, emphysema, changes in the pattern of breathing, adventitious lung sounds, and presence of a pneumothorax (tympany).

Check for normal breathing, taking no more than 10 seconds: Look for chest motion, listen for breath sounds, and

compression first then a breath, after 1 minute check for a pulse. Repeat steps if there is no

The first step for a focused exam is a thorough history and physical that should include a detailed timeline of a cough, provoking and alleviating events, sick contacts, travel and any other possible sources for a cough (Goolsby & Grubbs, 2014). The extent of the diagnostic and assessments will be determined by how the patient presents with a cough and how disruptive the cough is for the patient. Auscultating lung sounds can help find the location, type, and severity of the potential source of a cough (Dains, Baumann & Scheibel, 2016). Examining the head, neck and check externally looking for changes in skin tone/color, jugular vein distention, lymph node status, rashes, hair changes, swallowing, symmetry, retraction of the chest wall,

In this situation, I assumed that my patient was dying. Being on a palliative unit, my initial thoughts jumped towards death which resulted in creating unnecessary panic for myself. I took myself for granted as my inner panic caused myself to be in a nervous state, potentially jeopardizing my auscultation technique. My assumption that C.P. was dying came my feelings of worry that she was exhibiting bradypnea and was difficult to awaken, despite my verbal commands and light shaking of her shoulder. As I needed to hear how her lung sounds were, her bradypnea was not sufficient enough for proper auscultation of her lungs. My knowledge base from a previous health assessment class taught me to always listen to the posterior lungs first, as the rationale was that it was less invasive. In this case, I had to

The patient is in an erect position facing the image receptor to result in less heart magnification. Feet should be slightly apart with weight distributed evenly. The chin was raised, and hands are placed on the bilateral hip regions with palms facing out, or having both arms around the bucky. The shoulders should be rolled forward and depressed to down to prevent superimposition of scapulae over the lung field.

The nurse should look at the thorax for the rise and fall with respirations, noting the rate, depth, and pattern (Ignatavicius & Workman, 2013). The nurse should assess the patient’s chest expansion by places their thumbs together on the patient’s back at about the ninth rib. The patient should breathe in and breathe out, the nurse’s thumbs should move out and together symmetrically. If they don’t then there could be pain, trauma, or air in the pleural cavity (Ignatavicius & Workman, 2013). The chest should be palpated for any tenderness, noting any areas that are especially tender to the patient (Ignatavicius & Workman, 2013). The thorax should be percussed for resonance, organs, and diaphragmatic excursion (Ignatavicius & Workman, 2013). The last step is to auscultate the patient for their breath sounds. The nurse should listen to 6 areas in the front, 3 areas on the sides, and 10 areas on the back, making sure to compare side to side. Note any abnormal findings in the patient’s chart (Ignatavicius & Workman, 2013). Normal breath sounds should be identified by their location, intensity, pitch, and duration. Bronchial sounds are heard over the trachea and they are harsh hollow sounds. Bronchovesicular sounds are heard over the branching bronchi, and vesicular sounds are a soft rustling sound heart over the rest of the lung area (Ignatavicius & Workman, 2013). Lung sounds should be described as normal, increased, diminished, or absent (Ignatavicius & Workman,

ing the procedure to the day of discharge from hospital. Chest X ray presentations: chest X ray was done for all

assessment of vital signs (blood pressure (BP), pulse, cardiac monitoring and oxygen saturations should be standard care. If the patient is tachypnoeic or has oxygen saturations n.d.).

Sometimes it might be difficult to get all the patient’s blood pressure readings but if you know a patient suffers from hypertension, orthostatic hypotension, and other cardiovascular disease, as well as kidney disease you should at least try do one or two, especially differencing between systolic and diastolic readings. Doing so can help reassure the blood pressure is accurate to the when the aide took the blood pressure or even if the nurse suspects that a blood pressure reading might be incorrect or inaccurate, or other times to see if a medication took effect. Using evidence based practice on this topic will help support my findings statistically. The article given below demonstrates how taking an automated blood pressure can sometimes be beneficial but easily influenced by movements, on the other hand, manual blood pressure can be more beneficial because you could hear and see from the sphygmomanometer the systolic and diastolic reading. The results of the article came to a conclusion that using both methods the only reading significantly different is the systolic pressure, however, the diastolic pressure was influenced but not as much as the

When observing a radiograph of the chest, specifically at the mediastinal outlines, the trachea should be centered but may be slightly to the right of the mid line. This happens because the trachea passes on the right side of the aorta. If the trachea is not generally centered, it is important to decipher if it because of rotation or pathology. Notice the width of the chest and heart. The heart should not be any larger than half the width of the chest. This is called the cardio-thoracic ratio. While looking at the heart size, observe the location of the heart. Approximately one third of the heart should be towards the right, leaving the other two thirds towards the left of the center. It is critical examine the lungs for any abnormality.

11 & 12 I know how to do chest auscultation symmetrically, right lung has 3 lobes & left lung has 2 lobes, assessing anteriorly then posteriorly

• Allow the chest to return completely to its normal position before the next compression.

In our practice, as the pressure in the cuff is adjusted to fall gradually from above systolic, no sound is heard. Note the pressure at which the first 'tapping' sound is heard. This is the systolic pressure. As the pressure in the bag is reduced further the sound first becomes quieter, then changes to a louder tapping. With further decreases in pressure, the sound changes again from a tapping sound to a blowing noise. The pressure at which this change occurs recorded as the diastolic pressure. Further reduction in cuff pressure leads to the total disappearance of any sound. Posture change definitely affect both arterial blood pressure and pulse rate. After standing for several minutes we obtained 121/84 mm hg for blood pressure and 100 pulse/min for pulse. After reclining for 1 minute, the result come out as expected that both arterial pressure and pulse rate decrease to 120/69 mm Hg with 102 pulse/min.

The upper arm needed to be bare, with any sleeve comfortably rolled up. The blood pressure cuff was be wrapped snugly around the upper arm. The group member putting it on had to pay close attention to the labels on the cuff to ensure it was not inside out or twisted. The lower edge of the cuff was about 1 inch above the bend of the elbow. The cuff was inflated quickly to about 160mm Hg; next, the valve of the cuff was opened slightly, allowing the pressure to slowly fall. A standard stethoscope was used to determine blood pressure. The measurer then placed the bell of the stethoscope firmly on the brachial artery of the arm being measured. As the pressure falls, the reading when the sound of blood pulsing was first heard was recorded. This was the systolic pressure. As the air continued to be let out, the sounds disappeared. The point at which the sound disappeared is recorded. This was the diastolic pressure. Inflating the cuff too slowly or not high enough may cause a false reading. If the valve is loosened too much, blood pressure won’t be measurable. The procedure was done at least two more times for accuracy. These results were then averaged. To measure heart rate, the participant found their pulse on the carotid or radial artery using their index or middle finger. The pulse was counted for 15 seconds and then multiplied by 4 to get an accurate beats per minute estimate. This was also done twice and averaged.