Physical Assessment and Application of Clinical Judgment - Coursework Example

? Assignment II: work; Physical Assessment and Application of Clinical Judgment Physical Assessment and Application of Clinical Judgment Case Study 1: Obtaining a prioritized health history requires interpersonal and professional skills. In taking the health history, the first thing will be asking questions on shortness of breath. Such questions seek to get information about the time the patient first experienced the condition, the frequency of the condition, the extent and severity of the condition whenever it occurs, the far that the patient walks or climb before having to stop because of the shortness of breath (Beaman, 2011). Firstly, the patient should be asked about the details of the shortness of breath by defining the symptoms as well as finding how long the patient has been in that condition. Some of the main variables to identify in the symptoms include onset time, location, severity, duration, radiation and quality. Secondly, there would be the establishment of the history of symptom obtained through talking to the patient about the frequency of short breath. This may uncover the pattern in the symptom presentation and may help determine any respiratory problem if the patient reports regular physical exertion. Thirdly, there will be discussion on pre-existing patient's condition in order to obtain a comprehensive medical history about the patient. Any information on hospitalizations of the patient enhances determination of factors that can result or contribute to breathing difficulties. At this point, the medications should be discussed since some drugs may result side effects, including the shortness of breath. The other questions will involve the eating habits. For coughing, the patient should be asked the frequency of coughing and the duration of coughing. The information on the blood or mucus and the color can necessitate getting of some information. The patient will then be asked how the obesity condition affects the life quality like disrupted routines (Beaman, 2011). Physical examination may involve first determining the BMI and examining the body clearly. Secondly, the lungs must be examined. This involved determination of the body weight, temperature and the body mass index (BMI) that entails measuring the height in order to enhance the determination of the effects of weight of the health condition. Also, this would involve listening to lungs and heart beat using stethoscope. Checking of the signs of blood backing up in the neck veins may facilitate determination of cor pulmonale disorder of the heart. Then there should be a full cardiac examination that involves listening to the six sections of the heart with the diaphragm and the bell of the stethoscope. This may reveal underlying cardiac condition like murmur which results from incompetent heart valve. Thereafter, the respiratory rate of the patient must be measured to enhance quantification of the shortness of breath. The normal respiratory rate for an adult ranges from 12-18 breaths per minute and the extent of deviation from the normal rate indicates the severity of the patient’s breathing condition (Utian, 2004). Pressing the abdomen enhances determination of abdominal palpation. The lips and fingers must be assessed for cyanosis while fingers must be checked for any clubbing. Physical examination might be a little painful, especially the abdominal palpation. Prioritized health history and physical assessment enhances diagnosis, and must be performed on a regular basis as they may reveal risk factors that suggest increased risk. The physical risks will enhance assessment of severity of conditions such as the inability of completing full sentences without having to take a breath (Beaman, 2011). A prioritized history and assessment of the heart enhances the exclusion of heart diseases associated or, which may result into a similar situation. Based on the assessments above, two interventions that I would prioritize include heart and lung interventions; heart failure and pulmonary hypertension for the lungs. Heart failure results from failure of heart to pump blood due to narrowing of the arteries. Pulmonary hypertension refers to the high blood pressure affecting the arteries in the lungs. This may result from narrowing of arteries and capillaries making it hard for the blood flow. The two conditions characterize obese conditions and must be first assessed. Therefore, intervention must address comorbidities, eating habits, patterns of exercise and the nutritional needs. This enhances improvement of functional independence and health by physical therapists in an effort of alleviating the health consequences. The evaluation of the effectiveness of intervention happens through perceiving the quality of life and through the of NANDA International classification in measuring changes from the baseline diagnosis after administration of the intervention (Beaman, 2011). Case Study 2: First the patient takes the TPA anti-clot drug to reduce any bleeding and clotting in the brain which resulted from the accident. The injection of the drug takes place in the veins. Also, aspirin and heparin may be administered to enhance blood thinning. The patient may experience Ineffective cerebral Tissue Perfusion due to bleeding, and the nursing diagnosis should maintain the adequate perfusion of the cerebral tissue. The evaluation criteria involve maintenance of the awareness level, evaluating any stable vital signs and ensuring no increases in ICT (Beaman, 2011). The intervention entails recording or monitoring the neurological status, monitoring the vital signs, evaluating the pupil, recording the shape and size, as well as putting the head in an elevated position and maintaining a bed rest state. The intervention of the external fixation at the lower extremity happens through holding the back portion of the ex-fit and avoids lifting up the ex-fit especially if the skin clings to ex-fit. The ex-fit rods hold the fracture in position. Being a child, the nursing plan will involve breaking the bone and applying the ex-fit. Thereafter turning the ex-fit knobs allow for more growth of the bone. On the other hand, chest contusion diagnosis will involve administering the oxygen through nasal cannula or face mask and suctioning. This unblocks any mucus or blood in the chest. Also, a chest tube is critical in removing air or fluid around the chest. The nursing outcome classification (NOC), nursing interventions classification (NIC) and NANDA enhance the representation of relationships among the nursing diagnoses, outcomes and interventions. These enhance feasibility of nursing care by providing standardized delivery of treatment to the patients. In the current case study, NIC and NOC enhance documenting the outcomes of the patients’ EMR during the end of every shift. This enhances formulation of the plan of care through monitoring the progress throughout the care episode as well as collecting the statistics for evaluating the outcome of the effectiveness of the healthcare facility (Utian, 2004). Case Study 3: Typical history of the acute knee injury results in ACL tears. The medical history for the knee injury involves asking questions before the physical examination. These include the time of the injury and place with acute pain. The position of the leg during the injury; whether flexed or extended enhances determination of the critical information. The health profession must ask on the cause of the injury; external force like direct blow. The information on the time of the onset of pain; whether immediate or after, is critical. The stability of the knee joint and the ability to walk after the injury is vital. The physician must enquire on the time the pain swelling started, and duration taken by patient to feel the pain. The health history acts as the foundation for administration of physical examination (Utian, 2004). The diagnosis of ACL involves two tests during the physical examination. Firstly, Lachman exam involves pulling forward the tibia and stabilizing femur, and this leads to abnormal translations. Secondly, the pivot shift involves rotating the tibia internally and flexing the knee so as to demonstrate the rotational knee instability with the deficient ACL. The test assesses the translation between the femur and tibia. This involves patient lying flat on the back, with the head under support of the pillow to enhance relaxation. Thereafter, positioning of the knee takes place at 15 to 39 degrees of knee bending. The examiner must hold the thigh and the upper leg below the knee joint after which anterior translation happens. At the onset, swelling may be minimal, but due to bleeding in the knee joint, after some hours the pain increases (Beaman, 2011). Also, X-rays examine the avulsion of the small bone fragment from lateral tibia. After suspecting an ACL, imaging must be ordered, and X-rays rule out the knee mal-alignment. The MRI performance necessitates identification of other ligaments within the knee, meniscus and cartilage. The knee must be inspected for any redness, deformity, skin changes or swelling. The knee should be checked for palpation as well as testing for the flexibility of the muscles. The knee ligaments checked include the varus and valgus tests that check the lateral and medial ligaments. The posterior drawer test assesses posterior cruciate ligaments. The anterior drawer test checks for the ACL where the patient lies on the table. Pivot test may be effective in ACL tests, but its effectiveness only occur after administration of anesthesia. However, in this case, the condition is post-anesthetic; hence the assessment interventions prioritized involve neumascular training and used of preventive injury (Utian, 2004). The effectiveness of neumascular training can be evaluated using athletes where one group undergoes training while the other acts as a positive control group. The intervention may be carried out for six weeks, thrice per week. The rate of injury at the end of training must be evaluated to get the difference between injuries when training, and injuries without training. Preventive injury intervention reduces the ACL injuries. The effectiveness can be evaluated through a retrospective epidemiological study. This involves use of preventive ACL measures in one group and not using the measures in the other group, and comparing the outcomes. Case Study 4: A directed health history facilitates administration of critical care to the patient suffering from cellulitis. This is because the patient may or may not relate the trauma episodes which preceded the symptoms. Cellulitis develops several days after the trauma. The condition results in rapid pain or insignificant progression like atrial fibrillation, which must be promptly managed. In case the patient recalls any trauma episode, the clinician must ask about the circumstances which surrounded the incidents which might have elicited clues on the etiology. For instance, the obesity conditions could result in pulmonary emboli. Identification of specific inciting causes enhances identification of the likely pathogens as well as influencing the choice of appropriate antibiotic therapy. The patient must be questioned on the eating habits and patterns of exercise. The past medical history must focus on the presence of comorbid conditions that increase the risks for cellulitis. This causes diabetes type 2 and other chronic diseases such as pulmonary emboli (Beaman, 2011). The surgical history should include the recent procedures that resulted in ankle surgery. Severe bacteria cellulitis may be as a result of postsurgical complication during the recovery from ankle surgery. Alternatively, the remote surgical history of the lymph node dissection can predispose the patient to cellulitis several years after surgery because of the lymphatic occlusion. The impairment of lymphatic edema and drainage also predisposes to the ankle cellulitis due to resection of the saphenous vein for the coronary by-pass. Furthermore, the indwelling IV catheters may predispose the patient to infection. On the other hand, physical assessment must focus on concerned area. The non-purulent cellulitis involves four infection signs. These include swellings, pain, warmth and erythema. The physical findings help in identification of likely pathogens and enhance the assessment of severity of infection to facilitate the administration of appropriate treatment. The assessment checks for the condition of the involved sites; hotness, swollen or tenderness. The borders must not be sharply demarcated or elevated. The regional lymphadenopathy must be present. The cellulitis characterized by changes in color such as violaceous indicates serious conditions (Beaman, 2011). Two interventions prioritized for this case study include the oral antibiotics and vibration therapy. The oral antibiotics prove to be more effective than antibiotics injected in the veins. The effectiveness of these interventions can be evaluated by administering the antibiotics to patients using different methods; orally, injection into the veins, and injection into the muscles. The doctor should check the response of the antibiotic to determine its effectiveness three days after the initial administration. This should be evaluated within 14 days. The symptoms should disappear after few days, failure to which the patient may be hospitalized for intravenous administration (Utian, 2004). References Beaman, N. (2011). Pearson's comprehensive medical assisting: Administrative and clinical competencies. Upper Saddle River, NJ: Pearson. Utian, W. (2004). Development and clinical application of guidelines, consensus opinions, and position statements ? the need for clinical judgment beyond the evidence. Menopause, 11(6), 583-84. Read More