Nursing Assessment

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Week 3 discussion

An anxious patient is having rapid and shallow breathing. After a few moments, he complains of a tingling sensation.

What could be the causes of this tingling sensation?

What are the various patterns of respiration and their significance?

Ethnicity and culture influence risk factors for heart disease. Do you agree? Why or why not?

What is the technique of percussion and palpation of the chest wall for tenderness, symmetry, bulges, fremitus, and thoracic expansion? Explain.

Would you anticipate hearing hyper-resonance on a patient with a history of tobacco use? Why or why not?

What are the mechanics of breathing with reference to lung borders and the anatomical structure of the lungs and diaphragm?

The patient is having rapid and shallow breathing because of a decrease in Co2 in the blood to the extremities. The patient is experiencing hyperventilation. This could be a result of a panic attack or cardiac related.

Norml respirations between 12-20 breaths/min. The chest expands and falls with a normal and even rate and rhythm Tachypnea: Respiratory rate that is above 20 breath/min. Some things that can cause this change is fever, pain, anxiety, respiratory issues. Bradypnea: Respiratory rate below 12 breaths per/min. Some causes of this could be certain medications such as narcotics or sedatives. Cheyene Stokes: Deep shallow breathing with periods of apnea. This could be in relation to renal faluire or drug overdose. African Americans are at a higher risk for devoloping heart disease due to genetics. Yes, I do agree because African Americans consume alot of sodium in their diet, and are geneticly sensitive to salt consumption which causes an increase in blood volume and raises blood pressure.

Palpitation: Stand behind the patient and place your thumbs at the 10 th rib. Your hands will be out with thumbs touching. You can ask your patient to take a deep breath and you would watch for symmetry movement on your thumbs. During this point in the examination you will ask the patient to say ninety-nine as you bring your hands down along the sides of chest. You should have the same type of vibration throughout as you make your way down. To feel for bulges you would assess both posteriorly and anteriorly. You would use the tips of your fingers and gently palpate the area below the breast tissue. Percussion: You can perform the anterior assessment this way with your patient lying down. Then, strike the finger placed on the patient’s skin with the end of the middle finger of your dominant hand. You are listening and feeling for differences.

For someone that has a history of tobacco use, I would anticipate hyper resonance because tobacco use can cause emphysema or COPD. The action of breathing in and out is due to changes of pressure within the thorax, in comparison with the outside. This action is also known as external respiration . When we inhale the intercostal muscles (between the ribs) and diaphragm contract to expand the chest cavity. The diaphragm flattens and moves downwards and the intercostal muscles move the rib cage upwards and out. This increase in size decreases the internal air pressure and air from the outside (at a now higher pressure that inside the thorax) rushes into the lungs to equalise the pressures. When we exhale the diaphragm and intercostal muscles relax and return to their resting positions. This reduces the size of the thoracic cavity, thereby increasing the pressure and forcing air out of the lungs

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