Tympanic Membrane and Thyroid Gland

Using the South University Online Library or the Internet, research the tympanic membrane and the thyroid gland. Based on your findings, create a 5- to 6-page Microsoft Word document that includes:

• Information about a minimum of two health assessment histories.
• The possible findings for the tympanic membrane.
• Information on how to examine the thyroid gland using both the anterior and posterior methods.
• A concise note in the subjective, objective, assessment, and plan (SOAP) format with each patient’s encountered findings.
  • For a review of SOAP notes:
  • SOAP Documentaion
  • Information about laboratory tests that may be used for screening clients and the expected normal levels for each test.

Support your responses with examples.

On a separate references page, cite all sources using APA format.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.

 

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week2 discussion

Breathing, Heart, and Lungs

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?

Citations should conform to APA guidelines.

 

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 WEEK 3 discussion

Tam……

Breathing, Heart, and Lungs

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

1)What could be the causes of this tingling sensation?

Anxiety can increase in those patients that are already having rapid and shallow breathing. Hyperventilation added to this can cause the tingling sensation due to a decrease in C02.

2)What are the various patterns of respiration and their significance?

Normal respirations are 10-20 is also called sigh rate, depth is 500-800ml “air moving in and out with each respiration, pattern is even”. (Jarvis 2016 pg. 442). “These values increase as a normal response to exercise, fear, or fever”. (Jarvis 2016 pg. 442).

Tachypnea Hyperventilation Rapid is shallow breathing. Has an increased rate greater than 24 per minute. This rate can increase with respiratory insufficiency, alkalosis, pleurisy, pneumonia, pleurisy, diabetic ketoacidosis, salicylate overdose, hepatic coma and lesions of the midbrain and alteration in blood gas concentration, but it a normal response to fever, fear, or exercise.

Bradypnea Hypoventilation: Slow breathing. Is a decreased but regular rate less than 10 per minute. Can be caused by drugs, increased intracranial pressure and diabetic coma.

 “An irregular shallow pattern caused by an overdose of narcotics or anesthetics” (Jarvis 2016 pg. 442). It may also occur with conscious splinting of the chest to avoid respiratory pain and with prolonged bed rest.

Cheyne-Stokes Respiration: “respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing”. (Jarvis 2016 pg. 442). Breathing periods are 30-45 seconds with about 20 second period of apnea. Common causes are severe heart failure, renal failure, meningitis, drug overdose, and increased intracranial pressure.

Biot Respiration is similar to Cheyne-Stokes respiration, except that the pattern is irregular and seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis.

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

Heart disease knows no ethnic/culture. Some risk factors that cause heart disease is obesity, tobacco use and high cholesterol. These are modifiable. In other words, most of these can be prevented. High blood pressure is mainly in the Africa American culture and for some of them, blood pressure can be prevented or at least controlled. If not controlled, it can lead to heart disease.

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

To palpate the chest wall, place your hands on the anterolateral wall with your thumbs along the coast margins with hands pointing toward the xiphoid process. You ask the patient to take a deep breath while watching your thumbs move apart symmetrically and take note of the smooth chest expansion with your fingers. “Any limitation in thoracic expansion is easier to detect on the anterior chest because greater range of motion exists with breathing here” (Jarvis 2016 pg. 432).

To assess tactile fremitus, began palpating over the lung apices in the supraclavicular areas comparing vibrations from one side to the other as the person repeats the words ninety-nine.

You then palpate the anterior chest wall looking for tenderness or detect any superficial lumps or masses. Note the skin mobility, turgor, temperature and moisture.

With percussion of the chest, you start at the apices in the supraclavicular area, going to the interspaces, comparing one side with the other, going in a downward motion, down the anterior chest.

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

Yes. Hyperresonance is found when too much air is present like in emphysema which is caused from tobacco use.

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

Inspiration is the breathing in air into the lungs, the chest wall increases in size. When it is expelled it is caused expiration. This is the mechanical action of breathing. Expansion and contraction. There are four major functions of the respiratory system. Supplying oxygen to the body for energy production, removing carbon dioxide as a waste product of energy reactions, maintaining homeostasis of arterial blood and maintain heat exchange.

 

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Professorr

How about our pediatric pt. Juvenile Idiopathic Arthritis or JIA is a disease that is Idiopathic, or a disease that has no defined cause. And lastly, this is an Arthritic disease, or a condition that causes the inflammation of fluid fill joints. With the suspicion of possible JIA, as the nurse, what additional question should be asked during the health history, along with possible labs to order, to assist with r/o the possible diagnosis of JIA?  

 

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  1……..A patient is admitted to the unit. He is a diabetic on chronic hemodialysis. He has an Arteriovenous (A-V) graft, which is annulated each time he undergoes dialysis treatments. You notice an area on his graft arm that is red and warm to the touch. He states that he has had this on his arm for several weeks. He asked the dialysis staff about the area, but they told him to apply warm compresses to the site. The staff at the dialysis center continues to use the graft, but they are careful to avoid the area when they cannulate for his treatments. Now the patient presents with extreme low back pain, fever, nausea, and swelling of his lower extremities. On checking his fasting serum glucose, you notice that the reading is 159 (Normal fasting blood glucose range 64 to 110 mg/dl), and his white blood cell count is 36,000 (normal range is 4,500-10,000 white blood cells/mcl). He states that his sugars were normally well controlled, but in the past ten days he seems to be requiring more insulin.

• How would you proceed with this patient?
• What could be the underlying problem?

2……..This patient presents with an AV graft that is red and warm to touch.  He probably has cellulitis.  Cellulitis is a bacterial infection that can be staphylococcal or streptococcal in nature (Eden, 2014).  It is often marked by a reddened skin area that is warm-hot to touch.  For this patient, his WBC is already elevated at 36,000,  and he now presents with nausea and vomiting, fever, back pain, and lower extremity swelling. What started out as a local infection has now probably spread and become more systemic.  I would get a set of vital signs first. It is known that he is febrile; an accurate temperature would be important to know how high it is. It may require an antipyretic, like Tylenol or Ibuprofen. An elevated heart rate would be a normal finding for one with a fever. A low blood pressure would be an indicator of how aggressive the medical staff should respond. This patient could be on the verge of becoming septic; this would need to be ruled out. Additional labs would need to be drawn: Lactic acid ( used as an indicator for sepsis), blood cultures x 2 sets, chemistry panel, with magnesium and phosphorus. This is a renal patient; a baseline evaluation of his renal function and electrolytes would need to be established. A CBC has already been done.  This patient would definitely need antibiotics; once the blood cultures are drawn he could be started on a broad spectrum antibiotic.  Along with the vital signs, I would get a weight on the patient.  This is a renal patient who is presenting with edema to his legs. This could be due to his poor renal function, or it could be due to some other underlying cause. I probably would start the patient on a “gentle” rehydration bolus of IV fluids. Again, this is a renal patient. If this patient has not been feeling well, his oral intake may have been poor and he could have become dehydrated. This patient also complains of pain. A pain assessment would be performed. This patient would also be given analgesic for his pain as well as an anti-emetic for his nausea. Another consideration would be to place a vascular catheter to use until the AV graft could be further assessed for infection. A nephrologist or vascular surgeon would need to be consulted for that. Lastly, this patient’s blood sugars would need to be monitored and treated. It is normal response for a diabetic’s blood sugar to rise during an illness; consequently, his insulin requirements may increase as well.

 

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