If Tina had mentioned that she was just diagnosed with pneumonia, what would you have expected to find during percussion?
Correct: In a patient with pneumonia, dull percussion sounds are anticipated over areas of diffuse infiltrate (accumulation of fluid and by-products of inflammation).
– Dullness (Correct Response)
If the results of Tina’s pulse oximetry had been 97%, which of the following would have been true?
Correct: Pulse oximetry measures the percentage of hemoglobin molecules that are filled with oxygen. Oxygen-saturated hemoglobin absorbs light wavelengths differently than unsaturated hemoglobin. The oximeter emits light and reads the extent of wavelength absorption.
– Partial pressure O2 = 97%
– Unbound oxygen level = 97%
– PaO2 = 97%
– Arterial hemoglobin saturation = 97% (Correct Response)
Suppose that, during your lung exam on Tina, you had heard bronchial breath sounds in the left lower lung posteriorly. What would you have suspected based on this finding?
Correct: The presence of increased breath sounds indicates lung consolidation (fluid-filled alveoli) or pleural effusion (fluid accumulation in the pleural space) because fluid transmits sounds better than air. This finding is usually accompanied by abnormal transmitted voice sounds and increased tactile fremitus.
– Normal lung exam
– Fluid-filled region of the lung (Correct Response)
– Narrowed upper airways secondary to asthma
Suppose that while auscultating, you assessed a few scattered expiratory wheezes. Why would this be an expected finding for a patient with Tina’s history?
Student Response: Because Tina has a history of asthma, it is common for her to have intermittent wheezes. With chronic asthma, the airways become restricted as a consequence of recurrent inflammation and excessive mucus production, resulting in wheezing and other symptoms of respiratory distress.
Model Note: Scattered wheezes are to be expected because of Tina’s history of asthma. Asthma is a chronic condition in which hyperreactive airways become narrowed by recurring inflammation and excess mucus production, which results in wheezing.
When you observe a patient like Tina throughout an exam, there are many ways to determine whether a patient is experiencing respiratory distress. Identify one indicator of respiratory distress that can be assessed through observation alone.
Student Response: Aspects of respiratory distress that may be seen include the use of auxiliary muscles, audible breathing, gurgling or wheezing, higher respiratory rate, blue coloring surrounding the lips or nails, rhinorrhea, chest retractions, perspiration, and a tripod body orientation.
Model Note: Observable signs of respiratory distress include accessory muscle use, audible respirations, grunting or wheezing, increased respiratory rate, bluish coloration around the lips or fingernails, nasal flaring, chest retractions, sweating, tripod body positioning, and inability to speak in full sentences.
Describe how you would assess Tina for dyspnea.
Student Response: In order to determine if a patient has dyspnea, the practitioner needs to inquire about the patient’s breathing patterns. This includes asking whether they experience shortness of breath or difficulties breathing. If dyspnea is discovered, make certain to inquire about the commencement, environmental or physical variables that contribute to relapses, duration, body alignment, sleep disruptions, and factors that alleviate the symptoms of dyspnea.
Model Note: Dyspnea is a subjective complaint that must be elicited by asking the patient about her breathing. Ask your patient, “Do you ever have shortness of breath or difficulty breathing?” If dyspnea is detected, be sure to ask about onset, environmental or physical factors related to exacerbations, duration, body positioning, sleep disturbances, and relieving factors.