Advanced Health Assessment Discussion

Advanced Health Assessment Discussion

Discussions

Topic 3 DQ1

Chronic obstructive pulmonary disease (COPD) is a group of chronic progressive respiratory conditions that obstructs the airway. Emphysema and chronic bronchitis are known examples of COPD (Bollmeier & Hartmann, 2020). Notably, chronic exposure to environmental irritants such as cigarette smoke and dust and genetic deficiency of alpha-1-antitrypsin (AAT)are known risk factors for COPD. Unlike chronic bronchitis, which causes inflammation of the airway with increased sputum production, emphysema destroys the alveoli, thus, impairing gaseous exchange leading to the accumulation of carbon dioxide in the body with depletion of oxygen (Leap et al., 2021)Advanced Health Assessment Discussion. However, both conditions impair respiration and present characteristic features from history and physical examination.

PLACE YOUR ORDER HERE NOW

While assessing health history in COPD patients, the common complaints include shortness of breath during activity or at rest, chronic productive cough, fatigue, wheezing, weight loss, chest tightness, and frequent respiratory infections. On physical examination, the patients may present with respiratory distress, inability to complete sentences, lower limb edema, lethargy, confusion, and both peripheral and central cyanosis (Bollmeier & Hartmann, 2020). Furthermore, chest examination may show a barrel-shaped chest, expiratory wheezing, pursed-lip breathing, and use of accessory muscles for breathing. However, it is prudent to understand that other conditions such as heart failure, asthma, lung cancer, and severe pneumonia may mimic signs and symptoms of COPD (Leap et al., 2021)Advanced Health Assessment Discussion. Therefore, additional laboratory and imaging tests should be performed to confirm the diagnosis.

The most vital and initial test for COPD is spirometry. Spirometry assesses the ability of the lungs to exhale by comparing the ratio between forced expiratory volume (FEV) and forced vital capacity (FVC). In the presence of active respiratory symptoms, an FEV1/FVC ratio of less than 0.7% increases COPD probability (Bollmeier & Hartmann, 2020). In addition, assessing lung volumes, pulse oximetry, and six-minute walk tests can be done with spirometry. Nonetheless, other complementary tests, including chest radiography, chest CT scan, arterial blood gases (ABG), and measuring levels of AAT, are applicable.

Chest radiography and CT scan can show features of emphysema as well as rule out other chest problems such as pneumonia and cardiomegaly. On the other hand, ABG measures the amount of oxygen and carbon dioxide to help plan for management, such as initiation of oxygen (Leap et al., 2021)Advanced Health Assessment Discussion. Finally, AAT tests help to rule out AAT deficiency as the cause of COPD.

References

Bollmeier, S. G., & Hartmann, A. P. (2020). Management of chronic obstructive pulmonary disease: A review focusing on exacerbations. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 77(4), 259–268. https://doi.org/10.1093/ajhp/zxz306

Leap, J., Arshad, O., Cheema, T., & Balaan, M. (2021). Pathophysiology of COPD. Critical Care Nursing Quarterly, 44(1), 2–8. https://doi.org/10.1097/CNQ.0000000000000334

Topic 3 reflection.

Taking part in completing the assessment of the respiratory systems has been very helpful in increasing my knowledge as well as preparing me for my future care. From this assessment, I have learned the importance of assessing the chest and making a prompt diagnosis. However, a stepwise method is vital when assessing the chest to avoid confusion. Likewise, I got it challenging to complete the assessment at the beginning. I had to adopt a systematic approach to complete the assessment.

It is critical to take the history, physical examination, and perform diagnostic tests to complete a chest assessment. Patient history should involve the chief complaints, history of presenting complaints, past medical history, social history, review of systems, and summary of the findings (Abulebda et al., 2020)Advanced Health Assessment Discussion. Therefore, healthcare professionals should focus on finding extensive elaborations about the patient’s complaints when assessing respiratory symptoms. For each symptom, more information should focus on the onset, progression, relieving/aggravating factors, severity, and associated symptoms. Furthermore, other systems should be reviewed to determine correlation. Nonetheless, personal and social history, including tobacco exposure and environmental irritants, should be identified in every patient presenting with respiratory symptoms (Abulebda et al., 2020). This will help make a list of differentials for the patient’s problems. Thereafter chest examination should be performed.

Chest examination should include inspection, palpation, percussion, and auscultation. A quick inspection of chest movements, use of accessory muscles, and features of respiratory address should be picked while interventions are initiated. In addition, percussion and palpation should also pick life-threatening features. Finally, auscultation is paramount in identifying any obstruction or consolidation within the airways. Consequently, some features may be missed during history and physical examination that could potentially cause health concerns. Therefore, nurses should use their clinical expertise and knowledge to complete respiratory assessments and make prompt diagnoses. This will enable them to save lives by offering compassionate care as required by a Christian worldview. Advanced Health Assessment Discussion

Reference

Abulebda, K., Srinivasan, S., Maa, T., Stormorken, A., & Chumpitazi, C. E. (2020). Development, implementation, and evaluation of a faculty development workshop to enhance debriefing skills among novice facilitators. Cureus, 12(2), e6942. https://doi.org/10.7759/cureus.6942 Advanced Health Assessment Discussion

Topic 4 DQ1

Conducting a focused musculoskeletal system and extremities requires the understanding of history, drug history, family, and psychosocial profile. All of these will help in formulating differentials and clinical diagnoses. The details are discussed hereafter.

Past History

Have you had trauma or fractures in the past? Understanding the history of past fractures or accidents will be essential in ruling out any recurring symptoms and help identify any musculoskeletal deformities that may have resulted from the initial injury.  Furthermore, extensive injuries and fractures contribute to many amputations and disabilities.

Are you suffering from any autoimmune condition? The presence of autoimmune disorders such as systemic lupus erythematosus, diabetes mellitus, Grave`s disease, and rheumatoid arthritis, among others, present musculoskeletal symptoms that affect patients (Mishra & Sarkar, 2021)Advanced Health Assessment Discussion. Therefore, they must be ruled out during history and examination.

Are there any birth deformities? Several congenital conditions, including spina bifida, Duchene muscular dystrophy, and arthrogryposis, affect various parts of the musculoskeletal system. Therefore, they should be identified as they determine the treatment modalities.

Drug History

Have you been using steroids? Prolonged use of steroids causes bone loss and osteoporosis and increases the risk of fractures (Gómez-Galán et al., 2021). Stopping steroids can alleviate worsening bone loss and reverse patient symptoms.

Have you been on chemotherapy or exposed to radiation? The use of chemotherapy causes extensive side effects on the bones and other body systems. On bones, it suppresses bone development and causes bone suppression (Mishra & Sarkar, 2021)Advanced Health Assessment Discussion. Bones become weak and are at increased risk for breaking. Alternatively, bone metastasis from primary cancer can further weaken bones.

Family History

Do you have a family history of congenital bone conditions? Some congenital conditions such as achondroplasia, osteogenesis imperfecta, acromegaly, and talipes equinovarus significantly impair bone anatomy and can cause deformities (Gómez-Galán et al., 2021). Early recognition of such conditions is key to reducing misdiagnosis.

Psychosocial Profile

Have you been using any illicit drugs in the past? The use of drugs not only affects the immune system but also affects bone density and synovial fluid. Reduction in immunity increases the risk of musculoskeletal infections and fractures.

References

Gómez-Galán, M., Callejón-Ferre, Á.-J., Díaz-Pérez, M., Carreño-Ortega, Á., & López-Martínez, A. (2021). Risk of musculoskeletal disorders in pepper cultivation workers. EXCLI Journal, 20, 1033–1054. https://doi.org/10.17179/excli2021-3853

Mishra, S., & Sarkar, K. (2021). Work-related musculoskeletal disorders and associated risk factors among urban metropolitan hairdressers in India. Journal of Occupational Health, 63(1), e12200. https://doi.org/10.1002/1348-9585.12200 Advanced Health Assessment Discussion

Topic 4 DQ2

Disorders of the musculoskeletal system are among the most common presentation in healthcare settings. Like other systemic diseases, healthcare providers make a complete assessment of the musculoskeletal system to come up with a diagnosis and provide interventions. Various modalities of interventions include medical therapy, physiotherapy, and education on health promotion and prevention. Unlike medical therapy, which aims to cure the disease, health promotion seeks to improve the quality of life, increase patient knowledge, promote recovery, and prevent future illness. As a result, there is a need to adopt a teaching plan for patients with musculoskeletal conditions. In addition, the devised plan should include risk factors, potential problems, interventions, and prevention strategies to reduce the occurrence of musculoskeletal disorders. Advanced Health Assessment Discussion

The risk factors are either modifiable or non-modifiable. The former include; smoking cigarettes, alcohol consumption, dangerous sports, prolonged sitting in an uncomfortable posture, obesity, increasing stress at the workplace, and use of medications such as steroids and chemotherapy (Roll et al., 2019). On the other hand, the non-modifiable factors include increasing age, being female, and family history of inheritable conditions. Therefore, patients must understand these risk factors and be educated on adopting preventive measures and living a healthy lifestyle. Nonetheless, the known preventive measures include engaging in regular exercise, reducing dietary intake of saturated fats, cessation of smoking, reducing alcohol intake, avoiding dangerous sports, stretching or standing between sitting, avoiding the use of steroids and illicit drugs, and having regular check-ups. Consequently, failure to adopt preventive measures can worsen musculoskeletal disorders leading to various health problems. Advanced Health Assessment Discussion

Musculoskeletal problems can affect the entire system, including muscles, bones, nerves, joints, tendons, ligaments, cartilages, and spinal discs. Various effects that could result include; osteoarthritis, ankylosing spondylitis, gout, and rheumatoid arthritis of joints; sarcopenia of muscles; osteoporosis and fractures of bones, and back pains. Regrettably, these conditions can negatively affect the quality of life as well as result in other health problems such as disability, immobility, chronic pain, and amputation (Roll et al., 2019). Therefore, early recognition and intervention are as crucial as educating patients to take precautionary measures to prevent diseases and improve their quality of life.

Reference

Roll, S. C., Tung, K. D., Chang, H., Sehremelis, T. A., Fukumura, Y. E., Randolph, S., & Forrest, J. L. (2019). Prevention and rehabilitation of musculoskeletal disorders in oral health care professionals: A systematic review. Journal of the American Dental Association (1939), 150(6), 489–502. https://doi.org/10.1016/j.adaj.2019.01.031 Advanced Health Assessment Discussion

Topic 5 DQ1

Eruption of skin growths is a concern to many patients, especially if it interferes with their cosmetic outlook. However, some patients may interpret every skin lesion as cancer which may cause panic, thus prompting them to seek care. Therefore, health care providers must have the ability to differentiate between cancerous and non-cancerous lesions through physical examination and taking history (Shin et al., 2018). Of importance, a physical exam should aim at checking for specific features, including symmetry, borders, color, diameter, size, shape, and evolution of every skin lesion. Furthermore, microscopy and biopsy can be used to classify some skin lesions. The difference between skin lesions is discussed hereafter.

Benign or noncancerous skin lesions are the most common and may be located in either sun-exposed or confined areas of the body. They grow slowly over time without interfering ring with the structure and functioning of normal cells around them. Interestingly, they may stop growing at some time. Besides, they neither ulcerate, form irregular borders nor metastasize to a distant place (Shin et al., 2018)Advanced Health Assessment Discussion. In addition, they can be treated by simple surgical procedures without recurrence. Finally, most of them cannot transform into malignant lesions.

On the other hand, cancerous lesions are common in sun-exposed areas of the skin. Nonetheless, cancerous lesions proliferate over a short period causing interference with surrounding cells in terms of structure and functioning. Furthermore, they may appear pigmented, with irregular borders, ulcerating, and may sometimes bleed (Shin et al., 2018). They bleed because they cause angiogenesis leading to the diversion of blood from other body systems towards them.  Finally, they usually metastasize to other body systems. Therefore, all clinicians must understand this difference when performing inspection and palpation of the lesions. However, when in doubt, the clinician must collect a sample from the lesion and perform microscopy to ascertain the type of the lesion and reduce the risk of misdiagnosis.

ORDER HERE NOW

Reference

Shin, H., Jeong, H., Park, J., Hong, S., & Choi, Y. (2018). Correlation between cancerous exosomes and protein markers based on surface-enhanced Raman spectroscopy (SERS) and principal component analysis (PCA). ACS Sensors, 3(12), 2637–2643. https://doi.org/10.1021/acssensors.8b01047 Advanced Health Assessment Discussion

Topic 5 DQ 2

Abdominal pain that causes the patient to assume a fetal position must be caused by a serious disease process. It is prudent that the healthcare provider should perform an extensive assessment through history, physical examination, and performing diagnostic tests to make a diagnosis and initiate treatment. However, the patient must be placed in a recovery position in a safe place before beginning the assessment.

Obtaining a complete history of the abdominal pain and other associated feature is the initial pain. While assessing abdominal pain, some specific questions must be asked, including: when did the pain start? Where is it located? What is the character? Are there associated features such as nausea, vomiting, diarrhea, constipation, fever, or chills? What are the relieving/aggravating factors? How severe is pain on a scale of 1-10? Does the pain have any specific timing? In addition, other histories include any information about the last meal, previous occurrence of such symptoms, history of smoking or alcohol drinking, past medical and surgical history, and review of other systems (Vaghef-Davari et al., 2020)Advanced Health Assessment Discussion. Nevertheless, if the patient is a female of reproductive history, then menstrual history, contraceptive history, and symptoms of urinary disease must be elicited. Finally, the important information should be documented before performing the physical and abdominal examination.

To effectively perform an abdominal examination, a systematic approach of inspection, auscultation, percussion, and palpation should be followed (Vaghef-Davari et al., 2020). The patient must lie flat with hands on either side and the abdomen exposed before the start of the examination. During the inspection, the patient’s general condition while inspecting the abdomen for features such as distension, visible abdominal veins, the position of the umbilicus, and any abnormal markings. Auscultation with a stethoscope should follow to listen to bowel sounds. Notably, the absence of bowel sounds could indicate either intestinal obstruction, perforated ulcers, intestinal perforation, or peritonitis. Thereafter, percussion should be performed. Finally, palpation of the abdomen should be performed to elicit any tenderness or any enlarged organs. After all these, documentation should be performed while formulating a list of differentials for the patient`s symptoms.

Reference

Vaghef-Davari, F., Ahmadi-Amoli, H., Sharifi, A., Teymouri, F., & Paprouschi, N. (2020). Approach to acute abdominal pain: Practical algorithms. Advanced Journal of Emergency Medicine, 4(2), e29. https://doi.org/10.22114/ajem.v0i0.272 Advanced Health Assessment Discussion

Topic 5 Reflection.

While beginning the assessment of the skin and abdomen, everything seemed challenging. I got it hard to grasp the concepts of various skin lesions and their meaning. However, this topic allowed me to get back to my reading materials and try to identify all the important information that would be useful in this topic. Interestingly, I was able to use a systematic approach to complete this assignment. I was also able to complete an assessment of a patient with acute abdomen by taking the history of the presenting illness and doing a complete abdominal examination.

Furthermore, during this assessment, I learned a few lessons. First, the differentiation of skin conditions is a vital tool for every healthcare provider. Therefore, a complete physical exam of the skin while focusing on the color, edges, symmetry, pigmentation, and diameters of lesions is paramount (Jones et al., 2019). I found this approach easier to use to identify different lesions. Furthermore, I have used the same approach while examining most patients and my colleagues with impressive results. Therefore, making a correct diagnosis will help in alleviating anxiety, providing reassurance, planning treatment, and follow-up patients.  Furthermore, the approach will enhance the provision of compassionate care according to the Christian worldview while promoting healing.

On the contrary, failure to make the correct diagnosis in the case of the cancerous lesion would delay treatment which will put the patient at risk of developing complications or even having an untimely death. This would be equated to the killing against God’s commandments. Therefore, other approaches such as group discussion, watching videos, and using the internet to search for more information about skin conditions will help improve knowledge and make the correct diagnosis. This would prove mastery of the nursing skills and knowledge that can be used for future care.

References

Jones, A., Woods, M., & Malhotra, K. (2019). Critical examination of skincare self-management in lymphoedema. British Journal of Community Nursing, 24(Sup10), S6–S10. https://doi.org/10.12968/bjcn.2019.24.Sup10.S6 Advanced Health Assessment Discussion

Topic 6 DQ1

Delirium is an acute but serious mental disturbance that prompts many patients, especially the elderly, to visit the emergency department. The disturbance interferes with cognition, consciousness, and the patient’s attention (Sidoli et al., 2022). As a result, most patients present with confusion, memory loss, disturbances in the thinking process, and experiencing delusions. These features could also present in dementia which interferes with memory without clouding consciousness. However, symptoms of delirium fluctuate with time and are worse at night (Sidoli et al., 2022)Advanced Health Assessment Discussion. Therefore, the attending physician must be able to differentiate between these two and identify the cause. Fortunately, delirium is reversible if the cause is identified and treated.

Various causes of dementia exist. They include emotional distress, fever, intoxication, liver diseases, chronic terminal illness, metabolic imbalances, dehydration, pain, sleep deprivation, and certain medications. The common medications that cause delirium include benzodiazepines, anticholinergics, and high doses of narcotics (Wilson et al., 2020). Therefore, while taking history in patients with delirium, all the causes must be ruled out. Furthermore, if certain medications are thought to cause the symptoms, then medication history should be obtained from both the patient and the relative or other people accompanying the patient. Therefore, specific questions must be asked, including; what medication? When was it started? What is the dosage? And what other medications are being taken? Furthermore, it is important to list all the medications the patient has been taking because polypharmacy may cause specific drug interactions that could worsen or cause delirium (Wilson et al., 2020)Advanced Health Assessment Discussion. More so, elderly patients are at risk of delirium from medications due to derangement in their pharmacodynamic and pharmacokinetic interaction with drugs. Thereafter, a physical examination should be performed.

The physical exam begins with the general appearance of the patient. Features of interest include jaundice that could indicate a hepatic or biliary disease; cyanosis that could indicate a respiratory problem or cardiac abnormalities; level of consciousness (LOC)using the Glasgow coma scale because delirium may impair LOC, and lower limb edema indicating either renal, malnutrition, cardiac, or hepatic disease (Sidoli et al., 2022). In addition, the hydration status should be checked to rule out dehydration as a cause of delirium. In addition, vital signs, including pulse rate, respiratory rate, blood pressure, and temperature must be checked to rule out other causes of delirium such as heart failure, pulmonary edema, hypertension or hypotension, and infections that could cause delirium. Finally, mental status assessment should be conducted.

References

Sidoli, C., Zambon, A., Tassistro, E., Rossi, E., Mossello, E., Inzitari, M., Cherubini, A., Marengoni, A., Morandi, A., Bellelli, G., & on behalf of the Italian Study Group on Delirium. (2022). Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study. Aging Clinical and Experimental Research. https://doi.org/10.1007/s40520-022-02099-8

Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020). Delirium. Nature Reviews. Disease Primers, 6(1), 90. https://doi.org/10.1038/s41572-020-00223-4 Advanced Health Assessment Discussion

Topic 6 DQ 2

Various patient populations present to the healthcare with special concerns that require complete assessment. My population of choice is pregnant women. I chose this because pregnancy is a special yet stressful moment in a woman`s life. Pregnancy presents with various changes ranging from hormonal imbalances to emotional disturbances and, eventually, the pain of delivery (Yale et al., 2022). As a result, proper assessment through history taking and physical examination are paramount in every pregnancy to identify health concerns as well as promptly address them.

History taking should focus on finding out the progress of current pregnancy, previous encounters, and psychological needs. Nonetheless, a systematic approach is recommended. While assessing the progress of the pregnancy, the examiner should ask about the chief complaint, history of presenting illness, past medical history, family and social history, obstetric and gynecological history, review of the system, and summary of important findings (Yale et al., 2022). Arguably, finding all the history will help in making a clinical diagnosis. Moreover, interrogating the chief complaints and past gynecological history should be done thoroughly. If there was previous bad obstetric history, there is an increased chance of recurrence of the previous episodes in the present pregnancy.

For instance, complaints such as vaginal bleeding, convulsions, reduced fetal movement and per vaginal discharge during pregnancy are obstetric emergencies that require prompt intervention, otherwise, both the mother and the fetus would be in danger (Fox et al., 2019)Advanced Health Assessment Discussion. Furthermore, life-threatening conditions such as pre-eclampsia, antepartum hemorrhage, premature rupture of membrane, and pelvic infections should be identified and managed effectively.

In addition, physical examination should focus on general health conditions and systematic abdominal examination, termed Leopold`s maneuver. Features of the disease process such as edema, jaundice, cyanosis, reduced capillary refill, and fine tremors should be identified. In Leopold’s maneuver, various parameters are assessed. Such include fundal height, fetal lie, fetal presentation, and fetal heart rate (Fox et al., 2019). All these are useful in monitoring pregnancy as well as planning for delivery. Finally, any fetal distress or abnormalities may be revealed during history and physical examination.

References

Fox, R., Kitt, J., Leeson, P., Aye, C. Y. L., & Lewandowski, A. J. (2019). Preeclampsia: Risk factors, diagnosis, management, and the cardiovascular impact on the offspring. Journal of Clinical Medicine, 8(10), 1625. https://doi.org/10.3390/jcm8101625

Yale, S., Tekiner, H., & Yale, E. S. (2022). Physical examination and appendiceal signs during pregnancy. Cureus, 14(2), e22164. https://doi.org/10.7759/cureus.22164

Topic 7 DQ 1

Anytime a patient presents to me with chest pain and diaphoretic, I take keen into listening to their history as well as conducting a proper physical examination. This is because such symptoms present in various conditions ranging from simple bacterial pneumonia to life-threatening ones such as myocardial infarction, dissecting aortic aneurysm, pericarditis, or acute coronary syndrome (Harskamp et al., 2019). Furthermore, complications of some systemic diseases such as diabetic ketoacidosis from diabetes mellitus could present with such symptoms. Also, with a recent surge in the Covid-19 pandemic, most patients present chest pain and diaphoresis as major complaints (Oliver et al., 2020)Advanced Health Assessment Discussion. Therefore, a complete history and physical examination would aid in making a correct diagnosis and plan for treatment.

Specific questions must be asked in the history.

1. When did the pain start? This will help to differentiate between acute and chronic pain.
2. What worsens the pain? Pain that is worse during activity could mean a cardiac problem
3. Where is the pain located? Pain that affects the entire chest is likely to be a respiratory problem. Cardiac pain tends to be confined to the left side of the chest (Harskamp et al., 2019).
4. Does the pain radiate anywhere? Pain that radiates from the upper left arm is typical of myocardial infarction.
5. What relieves the pain? Cardiac-related pain is relieved by rest (Oliver et al., 2020).
6. Do you have any underlying conditions? The presence of underlying conditions such as DM and COPD could cause chest pain and diaphoresis.
7. Have you been taking any medications?
8. When did you last take alcohol? Alcohol withdrawal or intoxication could present with the same symptoms (Harskamp et al., 2019)Advanced Health Assessment Discussion.
9. What other associated symptoms do you experience? The presence of other symptoms such as fever, cough, and difficulty in breathing could indicate an infectious process.

After the complete history, a complete respiratory and cardiac examination should follow.  The respiratory examination would follow the format of inspection, percussion, and auscultation. During the inspection, the nature and effort used in respiration are assessed. A resonant percussion note symbolizes a healthy lung, while a dull percussion note would present a pathology in the lungs, such as fluids or reduced air entry (Harskamp et al., 2019)Advanced Health Assessment Discussion. Furthermore, during auscultation, the quality of air entry and other abnormal sounds such as wheeze, rhonchi, and crepitations should be assessed. Finally, the cardiac examination should focus on identifying any cardiac murmurs or pleural rubs to rule out cardiac pathologies that cause chest pain.

References

Harskamp, R. E., Laeven, S. C., Himmelreich, J. C., Lucassen, W. A. M., & van Weert, H. C. P. M. (2019). Chest pain in general practice: a systematic review of prediction rules. BMJ Open, 9(2), e027081. https://doi.org/10.1136/bmjopen-2018-027081

Oliver, G., Reynard, C., Morris, N., & Body, R. (2020). Can emergency physician gestalt “rule in” or “rule out” acute coronary syndrome: Validation in a multicenter prospective diagnostic cohort study. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 27(1), 24–30. https://doi.org/10.1111/acem.13836 Advanced Health Assessment Discussion

Topic 7 DQ2

Pain is the most common symptom that brings patients to the hospital. Some are severe to warrant admission, while others are treated as an outpatient. Pain from either cardiac or cancer origin tends to be the worst hurting patients (Cluxton, 2019). Such pain requires urgent admission with the administration of stronger pain killers. Arguably, pain is a subjective symptom that only the patient understands. Furthermore, healthcare providers use rating scales to determine the severity of pain and determine the course of treatment. In addition, the management of pain starts with non-pharmacological methods such as ice, yoga, and relaxation, with a combination of simple pain medications such as non-steroidal anti-inflammatory agents (NSAIDs) to stronger medications such as opioids (Patnode et al., 2020)Advanced Health Assessment Discussion. However, despite opioids offering immediate pain relief, they are associated with other side effects such as respiratory depression, dependence, and addiction. Therefore, a complete assessment of patients with pain is necessary before deciding on the method of intervention.

The patient who calls complaining of pain should be assessed. The clinician should find out more features about the pain, including onset, location, character, associated features, relieving/aggravating factors, the timing of pain, and the severity. Nonetheless, the clinician should ask the patient to rate their pain on a scale of 1 to 10 to determine severe pain. Alternatively, observing the patient`s behavior to pain would help assess the severity. However, the healthcare providers must be wary of patients` behavior as some could be hysteric. After the assessment, non-pharmacological pain management can be initiated while monitoring the patient. In case the pain persists, NSAIDs should be started. Thereafter, a combination of NSAIDs and acetaminophen should be tried with continuous monitoring until the therapeutic dose is achieved (Cluxton, 2019). However, if all the attempts fail, then opioids can be initiated while monitoring for side effects until the pain is under control. The aim is to alleviate patient suffering while preventing dependence or abuse of pain medications.

References

Cluxton, C. (2019). The challenge of cancer pain assessment. The Ulster Medical Journal, 88(1), 43–46. https://pubmed.ncbi.nlm.nih.gov/30675079/

Patnode, C. D., Perdue, L. A., Rossom, R. C., Rushkin, M. C., Redmond, N., Thomas, R. G., & Lin, J. S. (2020). Screening for cognitive impairment in older adults: An evidence update for the U.s. preventive services task force [internet]. https://pubmed.ncbi.nlm.nih.gov/32129963/ Advanced Health Assessment Discussion

Topic 8 DQ 1

Unconsciousness is a clinical scenario when the patient loses awareness of their surroundings and can barely control their respiratory system or other body systems. In addition, there are many causes of unconsciousness, including sepsis, poisoning, alcohol intoxication, metabolic disturbances, and head injury, among other causes (Gäble et al., 2020). Therefore, systematic assessment of unconscious patients aims at identifying life-threatening conditions while offering time intervention to reverse to the conscious state. I will use a systematic approach while assessing the unconscious patient.

To begin with, I will make sure I assess the surroundings of the patient for my safety and that of the patient. This will include checking for any bottles of drugs or poison to ascertain if the patient could have poisoned themselves (Cooksley et al., 2018). Then I will shout for help while proceeding to stimulate the patient by applying a sternal rub or calling their name. However, in the absence of response, I will continue to assess the airway, breathing, circulation, disability, and exposure (ABCDE)Advanced Health Assessment Discussion.

The ABCDE approach is a quick response method for life-saving interventions used in trauma series and emergency settings (Cooksley et al., 2018). While assessing the airway, I will look, listen, and feel for breaths. I will look at the mouth for any secretions or objects in the mouth, then remove or suction to open the airway. I will further open the airway by performing both head-tilt chin-lift and jaw-thrust maneuvers. In case the airway is significantly impaired, I will insert endotracheal intubation to secure the airway. Then I will assess breathing by determining the respiratory rate, breath sounds, and oxygen saturation. If the saturation is less than 90%, I will start the patient on oxygen to improve the oxygenation status of the body (Gäble et al., 2020)Advanced Health Assessment Discussion.

I will then proceed to assess circulation and hemorrhage. This will include determining blood pressure, capillary refill, heart rate, and assessing for any bleeding areas. I will then insert an intravenous line and start fluids if there are features of dehydration. Furthermore, I will arrest any bleeding areas by applying pressure. After this, I will continue to assess for disability and exposure. This will include determining the GCS, blood sugar levels, and pupillary reaction to light. I will assess and determine if the patient requires any drugs such as dextrose or epinephrine. After all this, I hope to have stabilized the patient and allowed them to regain their consciousness. However, I will continue monitoring the patient to determine if the patient needs admission into the intensive care unit for stabilization.

References

Cooksley, T., Rose, S., & Holland, M. (2018). A systematic approach to the unconscious patient. Clinical Medicine (London, England), 18(1), 88–92. https://doi.org/10.7861/clinmedicine.18-1-88

Gäble, A., Hebebrand, J., Armbruster, M., Mück, F., Berndt, M., Kumle, B., Fink, U., & Wirth, S. (2020). Update polytrauma and computed tomography in ongoing resuscitation: ABCDE and “diagnose first what kills first”: ABCDE and „diagnose first what kills first”. Der Radiologe, 60(3), 247–257. https://doi.org/10.1007/s00117-019-00633-w Advanced Health Assessment Discussion

Topic 8 DQ2

Hyperkaliemia is a term used to describe the increased potassium levels in the blood.  Various etiologies are used to explain the origin of hyperkalemia, including impaired excretion of potassium due to chronic kidney failure, increased intake of potassium-containing meals, diabetes, heart failure, and potassium-sparing diuretics such as spironolactone, and massive muscle destruction from burns or major trauma (Hunter & Bailey, 2019). Clinically, features of hyperkalemia are non-specific and can easily be missed unless confirmed by laboratory tests. Consequently, failure to identify and treat hyperkalemia can lead to systemic complications from head to toe. Therefore, it is prudent to perform a head-to-toe assessment on patients with hyperkalemia to determine any complications and offer interventions.

PLACE YOUR ORDER NOW

To begin with, I will assess the neurologic functions and orientation. This is because hyperkalemia can cause confusion which could interfere with patient orientation and functions.  After CNS examination, I will assess the respiratory system. Assessment will include inspection, auscultation, ABGs, and chest radiography. This is vital because hyperkalemia can cause chest pain and respiratory distress. This can help prevent imminent death.

Thereafter, I will perform a cardiovascular examination through auscultation and electrocardiogram (ECG). A cardiac examination is essential because hyperkalemia causes a cardiac arrhythmia, leading to cardiac arrest (Hunter & Bailey, 2019)Advanced Health Assessment Discussion. While performing ECG, the presence of widened QRS complex, peaked T wave, absent P wave, and elevated ST segment are typical features of hyperkalemia. Therefore, early intervention would be required to prevent cardiac arrest.

Furthermore, I will insert a urinary catheter to assess the renal function and carry out blood work for urea and electrolytes to assess the functioning of the kidneys.  This is essential because hyperkalemia can impair renal function leading to toxicity. Finally, I will assess the musculoskeletal system. This will be achieved by assessing muscle power, tone, and range of movement. This is because hyperkalemia may cause muscle paralysis and muscle weakness.

References

Hunter, R. W., & Bailey, M. A. (2019). Hyperkalemia: pathophysiology, risk factors, and consequences. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association – European Renal Association, 34(Suppl 3), iii2–iii11. https://doi.org/10.1093/ndt/gfz20 Advanced Health Assessment Discussion