Case Based Pediatrics for Medical Students

b. Where do you think would be the best place to auscultate Caleb’s abnormal heart sound? Explain your answer. The abnormal heart

B. The muscles that help move air in and out of the lungs are severely compromised.

This experiment was carried out as noted about in Procedure 1. The resting heart rate was established and used as a baseline value from which to compare all future deviations. While data could

C) Vibration and sound are used to form words by occluding a valve over the stoma

The head to toe physical assessment is the first step of the nursing process and is a systemic approach of collecting objective (physical) and subjective (mental) data on the patient that will help the nurse formulate nursing diagnoses and plan patient care. It is also used to confirm or question data that was stated in the pt. previous history stated in the charts and to evaluate the effectiveness of the nursing interventions that were carried out on the patient. The main focus of the head-to-toe assessment is to focus on what the patient is currently presenting with; the patient's responses to actual or potential problems.

Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

2. Upon admission to the hospital, Allen’s breathing was rapid and shallow, can you explain why? Pg. 969

 A.directly at the focus of expansion B.straight ahead (but not directly at the focus of expansion) C.at locomotor flow time D.at the psychometric curb

Notifying the physician of the client’s change in blood pressure from 140 to 88 mm Hg systolic

by Nurse J. After five minutes, the diazepam had no effect so Dr.T ordered two milligrams of hydromorphone IVP given at 4:15 in the afternoon. The patient received another two milligrams of hydromorphone IVP and five milligrams diazepam IVP at 4:20 p.m. because Dr.T was not satisfied with the patient’s level of sedation. When the patient appeared to be sedated at 4:25 in the afternoon, the reduction of his left hip took place. At 4:35 p.m., Mr. B’s BP is 110/62 and his oxygen saturation is 92%. The “conscious sedation” policy was not followed. He did not have supplemental oxygen and his ECG and RR were not monitored. Then, Mr.B’s oxygen saturation dropped to 85%. The LPN adjusted the alarm and repeated the BP reading. Nurse J and the LPN were very busy taking care of the other patients during this time. At 4:43 p.m., Mr. B was not breathing, had no pulse, BP is 58/30 and oxygen saturation is 79%. The stat code was called.

Suppose there is a patch call with a patient exhibiting chest pain and the ambulance is five minutes out. In this case, the room is equipped and prepared with all the essential needs for the chest pain patient upon their arrival in the ambulance. After the patient has arrived, the primary nurse on duty receives a report from the Emergency Medical Technician (EMT) that accompanied and provided initial care to the patient in the ambulance. At the same time, the secondary nurse and ERT become technical, or hands on. The patient is administered oxygen, cardiac monitors are placed, an EKG is administered, locks and labs are drawn, normal saline is administered, and a urinalysis is taken along with the patients’ blood glucose level. Each of these tasks is initiated prior to the Emergency Room Medical Doctor (MD) seeing the patient, or at the same time. Emergency

| This is done because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds.

The reason for percussing a chest is to set up vibrations which then become audible. This can then aid to assess areas of varying density. The presence of fluids, solids or air will produce different resonances. Resonant is normal lung sound (Cross and Rimmer, 2007).

Document any abnormal results (lower or higher than normal levels) in the nursing progress notes.

B. Can you hear breathing from the mouth and the nose – can you feel breath on your cheek?