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In order to be able to pinpoint the exact location of the effusion the stethoscope needs to be pressed on the lower, right middle, left middle and upper regions of the chests to understand which lobe of the lung is affected. Therefore the examiner needs to be familiar with the surface projections and use them for comparison between the different locations of the lungs especially for symmetrical positions.
In absence of any fluid the bronchial sounds are loud while in presence of fluid these sounds have a lower intensity. Since the patient is supposed to have an effusion in the right lower lobe therefore while examining her, examination needs to be done on the upper posterior side and listening for a sounds for one entire breathing cycle. In the presence of effusion in the lower right lobe I can expect to hear both discontinuous and continuous creaking or grating sounds produced by mild rubbing of inflamed surfaces and will be heard during both inspiration and expiration (Tuteur, 1990). Asking the patient to cough will not alter the state of the sound sin any way and hence one may say that the pleural surfaces have fluid accumulation. Compared to this area other areas will have normal sounds
The patient is diagnosed with bipolar disorder. However for most people as in the case of the patient’s family, most people are unaware about the difference between bipolar disorder and major depression and hence need to be educated for better diseases and symptom management.
The most important part of the education plan is to make the family understand the basic difference between depression and bipolar disorder. Major depression refers to the condition in which the patient is always in a depressed state and does not enjoy anything and often ahs suicidal tendency. However, bipolar disorder also known as manic-depressive illness has two phases-the manic phase and the depressive phase. In bipolar frequent mood
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