The Purpose Of Health Assessment - Case Study Example

Health Assessment Case Study Student’s Name Institutional Affiliation Health Assessment Case-Study Introduction Health assessment is significant in identifying the various problems that the patient has and aid in strategizing the management of these problems. Prioritization of investigations is salient to help identify the immediate dangers that the patient may be facing and attend to those risks before they aggravate (Curtis & Ramsden, 2011). The assessment begins with the identification of the risks and these dangers using the ABCDEFG criterion (Thim, Krarup, Grove, Rhode & Lofgren, 2012). Thereafter, a more thorough comprehensive assessment that enable the examination of the various body systems systematically will be carried out. A focused area of assessment shall be identified and the normal parameters associated with the focused area of assessment described in addition to the deviations from normal observed in the patient and their pathological manifestation. Further areas of investigation shall be identified in addition to risk factors that patient faces. Describe the area of focused assessment to be considered for Mr Saunders stating the rationale for such. Mr. Saunders presents speaking in short sentences with 28 breaths/min. His blood oxygen saturation is 90% measured in room air. Respiratory wheeze is evident together with the use of accessory muscles. These findings indicate impaired respiration or a defect in the cardiovascular system (Thim et al., 2012). ABCDEFG is a pneumonic that is used in the stepwise assessment of this patient prioritizing airway, breathing and circulation before the rest to handle life-threatening conditions first (Lake, Moss & Deke, 2009). ABCDEFG means “airways, breathing, circulation, disability, exposure, fluid and glucose” assessment (Morris & Fletcher, 2009). Mr. Saunders airways shall be examined by visual inspection, listening and feeling (Thim et al., 2012). Inspection shall allow identification of any airway obstruction signs such as swelling in the mouth or neck. Listening allows the identification of restricted airway movement while feeling enables perception of air movement through touch. Breathing assessment includes looking at the movement of the chest to ascertain normal movement, symmetry and use of accessory respiratory muscles; listening to noisy breathing, and the patient's conversation to identify any incomplete sentences; and feeling for the tracheal position (Thim et al., 2012). Assessment of circulation entails looking at the patient’s skin colour for any cyanosis and paleness, assessing venous pressure; listening for heart sounds and whether the patient has complaints such as dizziness and headache; feeling for the patient’s quality and rate of peripheral pulses and feeling the limbs to assess any changes in temperature (Thim et al., 2012). Assessing disability entails examining the patient's consciousness level, facial symmetry, and any other abnormal or absent body movement. In addition, the pupils' equality in size and reactivity to light should be assessed too. Disability assessment also entails listening for any slurred speech, patient's orientation to time, place and person, and his response to pain and external stimuli. Assessing exposure requires observing or looking for any bleeding and its source and any hidden wounds, listening for bowel sound movement and inquiring about history of exposure to loud noise, and feeling the abdomen of the patient for clues relating to the patient's condition (Morris &Fletcher, 2009). Fluid status assessment entails listening for any thirst complaints from the patient and feeling the turgidity of the skin. Glucose status assessment involves examining blood glucose concentration and signs of hypoglycaemia such as decrease in consciousness level, listening for abnormal orientation to time and place and feeling for diaphoresis on the skin (Morris & Fletcher, 2009). Based on the ABCDEFG findings, specific systems shall then be examined which include the neurological, respiratory and cardiovascular system to identify specific aetiology of the presenting symptoms. Neurological assessment involves assessment of the patient's cognitive status. Specifically, the ear shall be assessed for conduction losses which shall include the use of the Rinne test to ascertain whether the hearing loss is conductive, sensorineural or both (Sogebi, 2013; Blumenfeld, 2010). Respiratory assessment shall proceed systemically commencing with inspection, then palpation and percussion and finally auscultation shall aid in localising the problems (Massey & Meredith, 2010). Cardiovascular assessment shall also entail inspection to reveal scar signs and pulsatile apex beat, and auscultation to reveal heart rates and sounds to determine if they are normal of abnormal (Morris & Fletcher, 2009). Other cardiovascular assessment areas include pulses assessment for discrepancies and blood pressure reading. • Describe the normal assessment parameters of the assessment identified in the previous question The normal assessment findings will reveal normal expected parameters for a patient of a given age. Patent airways will give normal breath sounds such as bronchial/tracheal breath sounds commonly heard in large airways, and vesicular breath sounds heard in the chest. Bronchial sounds are heard best during exhalation with vesicular sounds been less audible (White, Duncan & Baumle, 2011). The respiratory rate should be between 12 to 18 breaths/min, and the pattern should be regular and unlabored (Creticos et al., 2008). Tracheal position should be symmetrical on palpation in the suprasternal notch. The patient's skin color should be his natural color, his blood pressure would be between 90/60 and 120/80, heart rate would be within 60 to 100 beats per minute (Morris & Fletcher, 2009). The patient should be able to identify himself including the date of the day. Pupils should be responsive to light equally. The patient should be well hydrated without complaints of thirst and signs of excessive sweating (Thim et al., 2012). For normal hearing, airway conduction should be better than bone conduction (Blumenfeld, 2010). Describe how Mr Saunders’s presentation deviates from these normal assessment parameters explaining the Pathophysiological developments associated with each relevant symptom presented in the above case study Mr. Saunder's hearing is said to be impaired moderately. His hearing loss is highly likely to be acquired given his moderately advanced age (Sanders & Gillig, 2010). The possible causes are exposure to extreme noise, otosclerosis, otitis media, cerumen impaction and Meniere's disease (Sanders & Gillig, 2010). He might have a conduction hearing loss where the bone conduction capacity exceeds air conduction or a sensorineural hearing loss hence the use of hearing aids (Blumenfeld, 2010). Mr., Saunders was exposed to a lot of early spring wind rich in environmental allergens such as pollen from pollinating plants that probably precipitated the asthmatic exacerbation. These allergens are inhaled alongside air into the respiratory tract epithelium where they are recognized as antigens. Allergen bound to respiratory epithelium are processed and bind to immunoglobin E. The allergen-specific IgE antibodies are the main triggers of subsequent inflammatory response (Khachi, Meynell & Murphy, 2014). These antibodies stimulate the release of inflammatory mediators from mast cells. The mediators are commonly implicated in bronchospasm characteristic of an asthmatic attack. Bronchospasm together with the narrowed bronchial lumen due to accumulating fluids, mucus and inflammatory mediated smooth muscle hypertrophy result in obstructed and impaired airflow in the lungs hence the wheezing sounds (Morris, 2014). Impaired airflow in turn limits the availability of oxygen and elimination of carbon dioxide during gaseous exchange. His respiratory rate is also elevated at 28 breaths/min. The elevation is as a result of the hypoxia detected by the respiratory center that triggers tachypnoea (Bateman et al., 2008). Inadequate oxygenation resulting from impaired gaseous exchange is manifested by a low oxyhaemoglobin saturation of 90% (Kaufman, 2011). The use of accessory muscles of expiration signifies labored breathing in an attempt to enhance pulmonary oxygenation. The patient speaks in short sentences because of decreased airflow during exhalation due to obstructed airflow in the bronchial tree (Doeing & Solway, 2013). Mr Saunders presents with a history of asthma, from your research on asthma identify any further areas to be Investigated and what further assessment needs to be conducted to collect more data and Relationship the exist between pieces of assessment to enable identification of a specific problem. Spirometry and peak expiratory flow rate are other investigations that would be significant for the patient to assess the capacity and flow of air in the lungs and extent of airway restriction. Other relevant investigations include arterial blood gas (ABG) analysis (Corbo, Bijur, Lahn & Gallagher, 2005; Verma & Roach, 2010). The test measures the partial pressures of oxygen and carbondioxide, pH, bicarbonates and oxygen saturation. Partial pressure of oxygen reveals the oxygen pressure dissolved in blood as a measure of the effectiveness of gaseous exchange in the lungs and pulmonary capillaries. Partial pressure of carbondioxide measures blood carbondioxide content, and it is an indicator of the efficiency of the lungs to excrete carbon dioxide. pH and bicarbonate blood levels signify the blood's acidity that may correlate with lung excretion of bicarbonate ions via carbondioxide (Verma & Rouch, 2010). This test may aid in revealing life-threatening levels of hypercarbia and hypoxemia that occur after prolonged hypoventilation. It is especially significant when a patient’s oxygen saturation remains below 92% (Pluddemann, Thompson & Price, 2011). Hypercarbia may necessitate the use of mechanical ventilation to support the patient's inadequate ventilation (Morris, 2014). Chest radiography is also significant in excluding other possible differential diagnosis and other pulmonary diseases such as pneumonia, allergic bronchopulmonary aspergillosis, sarcoidosis, and pneumothorax (Morris, 2014). Identify potential risk factors that could contribute to Mr Saunders experiencing asthma in the future. A primary risk factor that may predispose the patient to future attacks is exposure to environmental allergens. Allergens such as pollen and dusts in addition to environmental irritants such as strong fumes, noxious gases including sulfur dioxide, and passive smoke are potential future triggers of an asthmatic attack in James (Subbarao, Mandhane & Sears, 2009). Change in weather patterns with exposure to cold air or dry wind laden with microparticles and environmental allergens are also potential triggers of an exacerbation (Khachi, Meynell & Murphy, 2014). Conclusion Health assessment guides the identification of patient's symptoms and signs and aids in coming up with a diagnosis. During the assessment, priority is given to life-threatening symptoms based on ABCDEF pneumonic and a comprehensive, systematic assessment is done focusing on systems possibly implicated in the patient's problem and identifying any abnormalities. Other investigations are significant in ruling out possible differential diagnosis. Identified risk factors for the patient's diagnosis are useful in informing preventive management. References Bateman, E.D., Hurd, S.S., Barnes, P.J., Bousquet, J., Drazen, J.M., FitzGerald, M., ... & Zar, H.J. (2008). Global strategy for asthma management and prevention: GINA executive summary. European Respiratory Journal, 31(1), 143-178. Blumenfeld, H. (2010). Neuroanatomy through clinical cases. Hearing and vestibular sense. 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International Journal of Nursing Practice, 49(4), 561-573. Massey, D.J. & Meredith, T. (2010). Respiratory assessment 1: Why do it and how do it. British Journal of Cardiac Nursing, 5(11), 537-541. Morris, F. & Fletcher, A. (2009). ABC of emergency differential diagnosis. West Sussex: Blackwell Publishing Ltd. Morris, M.J. (2014). Asthma. Retrieved from http://emedicine.medscape.com/article/296301-overview#aw2aab6b2b1aa Pluddemann, A., Thompson, M. & Price, C. (2011). Pulse oximetry in primary care: primary care diagnostic technology update. British Journal of General Practice, 61(586), 358-359. Sanders, R.D. & Gillig, P.M. (2010). Cranial nerve VII. Hearing and vestibular functions. Psychiatry, 7(3), 17-22. Sogebi, O.S. (2013). Assessment of the risk factors for hearing loss in adult Nigerian population. Nigerian Medical Journal, 54(4), 244-249. Subbarao, P., Mandhane, P.J. & Sears, M.R. (2009). Asthma: epidemiology, etiology and risk factors. Canadian Medical Association Journal, 181(9), e181-e190. Verma, A.K. & Roach, P. (2010). The interpretation of arterial blood gases. Australian Prescriber, 33(4), 124-129. White, L. Duncan, G. & Baumle, W. (2011). Foundations of basic nursing (3rd ed.). Clifton Park, NY: Delmar Cengage Learning. Read More