Feb 23, 2024 NURS 6512 Assignment Assessment of the Heart, Lungs, and Peripheral Vascular System
NURS 6512 Assignment Assessment of the Heart, Lungs, and Peripheral Vascular System
NURS 6512 Assignment Assessment of the Heart, Lungs, and Peripheral Vascular System
Diagnostic Test/Labs
An electrocardiogram is required as the clinical manifestations displayed lead to the patient potentially suffering from a cardiovascular condition. A chest x-ray is required to reveal any abnormalities in the chest region and in the underlying organs of the chest region that could be causing the symptoms. Lab values on CBC are also required to determine the WBC if it’s a bacterial or viral condition causing the symptoms. Lipid profile test is also required since the patient was diagnosed with high cholesterol it would determine if the levels could be causing the symptoms. Echocardiogram could be required to determine if there could be an observable abnormality in the heart causing the symptoms. An exercise stress test is required as the patient reported symptoms are aggravated when conducting physical activity.
Pharmacology: diltiazem 30mg 6 hourly prescription is required as it would help manage his hypertension and also angina that the patient could be suffering from until the angina is controlled. Nitroglycerin when needed should also be added. The patient should also continue with previous prescriptions. Patient education: Patient should also undergo health education on diet modification and importance of a healthy diet. Referrals: patient should also consult with a vascular surgeon to see deliberate on potential interventions.
ASSESSMENT
Differential diagnosis
Coronary artery disease: this is due presence of a damage in the major blood vessels of the heart could be caused by occurrence of a plaque that narrows the vessels and limits blood flow to the heart. This is a potential diagnosis as the patient present with chest pain and the lifestyle patient has reported such as eating red meat are in line in what is found in patient with this condition (Hinkle & Cheever, 2014).
Pericarditis: this is a condition that occurs due to swelling and irritation of the structure that surrounds the heart the pericardium. It could be due to a viral infection and manifests with a sharp chest pain hence it being a potential diagnosis as the patient presents with the same (McCance & Huether, 2019).
Congestive heart failure: this is whereby the heart is unable to pump enough blood to the organs that require it. The clinical manifestations include pain in the chest area and probable weight gain hence placing it as a potential diagnosis as the patient also presented with this (Hinkle & Cheever, 2014).
Hypertension: this is a possible differential diagnosis since the patient was previously diagnosed with it whereby his blood pressure was higher than normal and if there was poor management of the condition it could lead to the clinical manifestations the patient presented with (McCance & Huether, 2019).
Hypercholesterolemia: the patient was previously diagnosed with this whereby his cholesterol levels were higher than normal hence if this condition complicated it could have led to cholesterol accumulating in the blood and limiting blood flow which could have then affected the heart and causing the symptoms the patient presented with such as chest pain (Hinkle & Cheever, 2014).
Priority diagnosis: coronary artery disease.
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References
McCance, K. L., Huether, S. E., BRASHERS, V. L., & ROTE, N. S. (2019). Pathophysiology: The biologic basic for diseases in adults and children (No. ed. 8). Elsevier.
Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
Cardiovascular disease (CVD) is the largest cause of death worldwide. Accounting for 610,000
NURS 6512 Assignment Assessment of the Heart, Lungs, and Peripheral Vascular System
deaths annually (CDC, 2017), CVD frequently goes unnoticed until it is too late. Early detection and prevention measures can save the lives of many patients who have CVD. Conducting an assessment of the heart, lungs, and peripheral vascular system is one of the first steps that can be taken to detect CVD and many more conditions that may occur in the thorax or chest area.
This week, you will evaluate abnormal findings in the area of the chest and lungs. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system.
Learning Objectives
Students will:
Evaluate abnormal cardiac and respiratory findings
Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system
Evaluate chest X-Ray and ECG imaging
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 14, “Chest and Lungs”This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs.
Chapter 15, “Heart”The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.
Chapter 16, “Blood Vessels”This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487) (specifically focus on pp. 480–481)
Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)
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Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 8, “Chest Pain”This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first determining whether the patient is in a life-threatening condition. It includes questions that can help pinpoint the type and severity of pain and then describes how to perform a physical examination. Finally, the authors outline potential laboratory and diagnostic studies.
Chapter 11, “Cough”A cough is a very common symptom in patients and usually indicates a minor health problem. This chapter focuses on how to determine the cause of the cough by asking questions and performing a physical exam.
Chapter 14, “Dyspnea”The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for determining the cause of the problem through evaluation of the patient’s history, through physical examination, and through additional laboratory and diagnostic tests.
Chapter 26, “Palpitations”This chapter describes the different causes of heart palpitations and details how the specific cause in a patient can be determined.
Chapter 33, “Syncope”This chapter focuses on syncope, or loss of consciousness. The authors describe the difficulty of ascertaining the cause, because the patient is usually seen after the loss of consciousness has happened. The chapter includes information on potential causes and the symptoms of each.
Note: Download the Student Checklists and Key Points to use during your practice cardiac and respiratory examination.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Chest and lungs: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Heart: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P., Holt, H. L., … Losina, E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12(1), 78–85.
This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.
Smuck, M., Kao, M., Brar, N., Martinez-Ith, A., Choi, J., & Tomkins-Lane, C. C. (2014). Does physical activity influence the relationship between low back pain and obesity? The Spine Journal, 14(2), 209–216. doi:10.1016/j.spinee.2013.11.010
Shiri, R., Solovieva , S., Husgafvel-Pursiainen, K., Telama, R., Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E. (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis & Rheumatism, 42(6), 640–650. doi:10.1016/j.semarthrit.2012.09.002
McCabe, C., & Wiggins, J. (2010a). Differential diagnosis of respiratory disease part 1. Practice Nurse, 40(1), 35–41.
This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions.
McCabe, C., & Wiggins, J. (2010b). Differential diagnosis of respiratory diseases part 2. Practice Nurse, 40(2), 33–41.
The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations.
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain (Word document)
Use this template to complete your Assignment 1 for this week.
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 1, “Chest Wall, Pulmonary, and Cardiovascular Systems,” pp. 302–433)Note:Section 2 of this chapter will be addressed in Week 10.This section of Chapter 8 describes the anatomy of the chest wall, pulmonary, and cardiovascular systems. Section 1 also explains how to properly conduct examinations of these areas.
Required Media (click to expand/reduce)
Advanced Health Assessment and Diagnostic Reasoning
Thoughtful, reasoned questioning leads from initial complaint to diagnosis in these three scenarios.Note: Close the viewing window after the intro segment and after each diagnosis segment to view the menu. (12m)
Photo Credit:Provided courtesy of the Laureate International Network of Universities.
Assessment of the Heart, Lungs, and Peripheral Vascular System – Week 7 (28m)
SkillStat Learning, Inc. (2019). The 6 second ECG. Retrieved from http://www.skillstat.com/tools/ecg-simulator#/-home
This interactive website allows you to explore common cardiac rhythms. It also offers the Six Second ECG game so you can practice identifying rhythms.
Online media for Seidel’s Guide to Physical Examination
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 13 and 14 that relate to the assessment of the chest, heart, and lungs. Refer to Week 4 for access instructions on https://evolve.elsevier.com/
Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System
Photo Credit: [Squaredpixels]/[E+]/Getty Images
Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?
In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.
In this DCE Assignment, you will conduct a focused exam related to chest pain using the simulation too, Shadow Health. Consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.
To Prepare
Review this week’s Learning Resources and the Advanced Health Assessment and Diagnostic Reasoning media program and consider the insights they provide related to heart, lungs, and peripheral vascular system.
Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation with the Shadow Health platform. Review the examples also provided.
Review the DCE (Shadow Health) Documentation Template for Focused Exam: Chest Pain found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
Review the Week 7 DCE Focused Exam: Chest Pain Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
Consider what history would be necessary to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
DCE Focused Exam: Chest Pain Assignment:
Complete the following in Shadow Health:
Cardiovascular Concept Lab (Required)
Respiratory(Recommended but not required)
Cardiovascular (Recommended but not required)
Episodic/Focused Note for Focused Exam (Required): Chest Pain
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 7 Day 7 deadline.
Submission and Grading Information
By Day 7 of Week 7
Complete your Focused Exam: Chest Pain DCE Assignment in Shadow Health via the Shadow Health link in Blackboard.
Once you complete your Assignment in Shadow Health, you will need to download your lab pass and upload it to the corresponding Assignment in Blackboard for your faculty review.
(Note: Please save your lab pass as “LastName_FirstName_AssignmentName”.) You can find instructions for downloading your lab pass here: https://link.shadowhealth.com/download-lab-pass
Review the Week 7 DCE Health History Assessment Rubric, provided in the Assignment submission area, for details on completing the Assignment.
Once you submit your Documentation Notes to Shadow Health, make sure to add your documentation to the Documentation Note Template and submit it into your Assignment submission link below.
Complete the Code of Conduct Acknowledgement.
Grading Criteria
To access your rubric:
Week 7 Assignment 1 DCE Rubric
Submit Your Assignment by Day 7 of Week 7
To submit your Lab Pass:
Week 7 Lab Pass
To participate in this Assignment:
Week 7 Documentation Notes for Assignment 1
To Submit your Student Acknowledgement:
Click here and follow the instructions to confirm you have complied with Walden University’s Code of Conduct including the expectations for academic integrity while completing the Shadow Health Assessment.
Assignment 2: Lab Assignment (Optional): Practice Assessment: Cardiac and Respiratory Examination
It is crucial to diagnose cardiac and respiratory conditions early due to the critical nature of these organs. Before a condition can be diagnosed, an examination must be conducted. Properly conducting a cardiac and respiratory examination requires detailed knowledge of the examination procedure and experience in performing this assessment.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing a cardiac and respiratory examination this week.
Note: This is an optional practice physical assessment.
To Prepare
Arrange an appropriate time and setting with your volunteer “patient” to perform a cardiac and respiratory examination.
Download and review the Cardiac and Respiratory Checklists provided in this week’s Learning Resources as well as review the Seidel’s Guide to Physical Examination online media.
Ensure that you have a stethoscope to perform the examination.
Optional Lab Assignment
Perform the cardiac and respiratory examination. Be sure to cover all of the areas listed in the checklist and to use the equipment appropriately.
What’s Coming Up in Week 8?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will explore how to accurately assess the musculoskeletal system.
Week 8 Required Media
Photo Credit: [fergregory]/[iStock / Getty Images Plus]/Getty Images
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.
Next Week
To go to the next week:
Week 8
Name: Mr. J.M. Age: 38 years Sex: Male
SUBJECTIVE DATA:
Chief Complaint (CC): “I have sporadic chest pain”
History of Present Illness (HPI): Mr. J.M. is a 38-year-old African American male who presented to the emergency department with complaints of sporadic chest pain for the last one month. The pain is usually centrally located and radiates to the left arm. He has experienced 3 episodes since the last month with each episode lasting several minutes. Currently, the pain is at 0 on a scale of zero to 10 although it is generally at 5 at its worst. The pain is characteristically uncomfortable and tight. It is aggravated by activities such as climbing stairs and yardwork while brief episodes of rest relieve the pain. He has not taken any medications for the pain.
Medications: Reports taking Lopressor 100mg PO once daily for hypertension and Lipitor 20mg PO once daily for hyperlipidemia as well as fish oil 1000mg PO twice daily.
Allergies: None
Past Medical History (PMH): Reports hypertension and hypercholesterolemia. No previous hospitalizations or blood transfusions. De
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