ALTERNATIVE WRITING ASSIGNMENT 2

Running head: ALTERNATIVE WRITING ASSIGNMENT 1

Alternative Writing Assignment Stephen A. Lepak Chamberlain College of Nursing NR 509 Advanced Physical Assessment

ALTERNATIVE WRITING ASSIGNMENT 2

Alternative Writing Assignment Family nurse practitioners must have finely-tuned assessment skills to provide high quality and efficient care to the populations they care for. Having a thorough understanding of the patient’s body systems as well as the abnormalities that can occur will help the nurse practitioner gather information from the subjective and objective assessments more easily. A special adaptation of assessment skills and a historical evaluation ought to be performed for various populations including pediatric, pregnant, and geriatric patients. The purpose of this assignment is to identify and articulate advanced assessment health history and physical examination techniques which are relevant to a focused body system, differentiate normal and abnormal findings concerning a disease or condition that impacts the body system, and adopt advanced assessment skills, if necessary, to suit the needs of specific patient populations.Body System The specific body system that will be discussed in this assignment will be the respiratory system. The respiratory system is the primary site for gas exchange which helps the body obtain oxygen and dispose of carbon dioxide. The process is critical for all bodily functions.Physiology The main organs responsible for gas exchange of oxygen and carbon dioxide include the lungs. Blood collects oxygen from the lungs and transports it to various parts of the body where it facilitates various metabolic processes. During the process of cell metabolism, the red blood cells collect carbon dioxide and transport it back to the lungs where an exchange with oxygen occurs and carbon dioxide is released via exhalation. Inhalation is the process whereby oxygen enters through the nose or mouth and travels through the trachea. The trachea is branched into two bronchi. The bronchi are two tubes that transport air to and from each lung. The bronchial

ALTERNATIVE WRITING ASSIGNMENT 3

tubes are lined with cilia. Cilia move back and forth which help filter foreign material from the respiratory system. The bronchial tubes lead to the lobes of the lungs. The right lung has three lobes and the left has two (West 2018). At the terminal end of the lobes are alveoli which are the sites where gas exchange occurs. Mucus which is a sticky fluid collects dust, bacteria, and other matter preventing these foreign materials from entering the lungs. Mucus is expelled from the body by sneezing, coughing, spitting, or swallowing.Health History Questions Taking a proper health history examination should start with hand washing and any other isolation techniques that may apply to the respiratory system such as airborne or droplet precautions. The next step in the health history examination would be to introduce one's self to the patient. Providing one’s name, credentials, and role within the care team. Questions that would be useful when taking a respiratory history include; can you please describe the nature of your problem? How has this condition impacted your activities? How often does the cough occur? For how long has the cough occurred? Has your condition worsened or improved? What home remedies have you used? Do you have any allergies? Do you smoke? What your profession? Do you have a family history of respiratory problems? During all aspects of the assessment, observe for fatigue or discomfort especially when the patient is trying to speak as a patient's inability to complete a full sentence is an ominous sign of impending respiratory distress.Objective Data After the subjective data is collected the examiner will move on to the objective data collection portion which includes inspection, palpation, percussion, and auscultation. Inspection of the respiratory system will usually begin with observation of facial expressions, skin color,

ALTERNATIVE WRITING ASSIGNMENT 4

moisture levels, and skin temperatures. Facial expressions should be relaxed with no signs of distress. If a patient consciously tries to breathe, it could be a sign that the patient is experiencing respiratory distress. Inspection of nail beds, lips and mouth are also important clues when assessing the respiratory system. Cyanosis of the fingernails could be a secondary symptom of respiratory issues. Clubbing of the fingernails could be indicative of chronic forms of hypoxia such as those experienced by patients with chronic obstructive pulmonary disease. Inspecting the neck is also important since the healthcare giver can observe the use of the accessory muscles of breathing, revealing any signs of active respiratory distress. Another important factor to observe is the patient's posture. The bending forward posture typified with arms on the knees is called tripod posture. The posture is the body's mechanism to improve lung function but is a sign of active respiratory distress in most patients. Observing the respiratory rate is important as the normal respiratory rate for adults is 14 to 20 breaths per minute. Also, it is critical to observe the shape of the chest for symmetrical equal chest rise and fall. An abnormal finding, for instance, unilateral rising and falling of the chest are indicative of flail chest after a trauma.Palpation involves examining the trachea. The examiner should note that it occurs at the midline. Palpation of the anterior and posterior chest can be performed with the palms of both hands. The chest should not be tender, the patient should not complain of pain, and there should be no visible or palpable masses. A crackling feel to the skin is called subcutaneous emphysema also known as crepitus which refers to where the air is introduced into the subcutaneous tissue.The examiner can also place hands on the intercostal spaces and have the patient repeat the words ninety-nine to assess tactile fremitus.Percussion of the chest wall would be the next step in the assessment of the respiratory system. Percussion is performed by striking the outstretched middle finger of the non-dominant