Discussion: Nursing Assessment

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.

Normal respiration 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 failure 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 a lot 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

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

LopesWrite Policy                                   

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

• Communication is so very important. There are multiple ways to communicate with me:
• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
• Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.