Respiratory Assessment Case Study with Lung Sounds!!

[gwenith]

I have found what has to be the BEST case study for respiratory assessment!! It even has lung sounds (really really juicy ones too:p)

Trouble is - no answers

So I figure we can all have a go. You don't have to answer every question - you need only have a go at one or two or none and just lurk. You don't have to get 100% - in fact it might be good for the newer people to omit something or have something not quite right so that someone else can pick up on something too. Play devils advocate if you will.

There is no wrong answers just some that will be more right than others.

When enough people have had a turn at answering I will post answers that I have researched and validated.

[gwenith, BSN, RN]

Angie is the only one to have had a crack at the lung sounds and what she said is pretty darn good. However because the inspiratory/expiratory noise that is heard is low pitched and not high pitched I would opt for calling it rhonchi and not a wheeze. Anyone want to add an opinion???

Don't be shy - you can disagree, agree whatever!!! There is no right or wrong here.

[KibbsRNstudent]

This is fun!

[UM Review RN, ASN, RN]

However because the inspiratory/expiratory noise that is heard is low pitched and not high pitched I would opt for calling it rhonchi and not a wheeze

From what the RTs have taught me (always make close friends with Respiratory Therapists, they have so much knowledge!), there are different types of wheezes. Rhonchi is more of a snoring sound. If I had to say I heard rhonchi at all, I'd probaby say that was more in the left side than the right, but then too, you have to remember my ears aren't all what they should be, either.

Maybe later when I get a few moments to think, I'll take a crack at those ABGs, but realistically, if this was my patient, we'd have already tubed him and gotten him sent to the unit on the grounds of Respiratory Distress.

[presC.]

thanks so much for sharing these informative links GWENITH :) i need to develop my assessment technique, esp. this one.

and Angie O'Plasty, RN.. now i have the idea. thanks for the tip about (always make close friends with Respiratory Therapists, they have so much knowledge!),

[gwenith, BSN, RN]

Okay I have to ask for help here but I have been trying to find the pathophysiological rationale for the big nose and big ears that the patient in the picture has and so, so many COPD patients have. I am sure I have seen an explanation somewhere;)

[UM Review RN, ASN, RN]

Never really noticed that before, but now that you mention it....

Do you think it has something to do with their general thinness and the fact that the nose and ears never stop growing throughout the person's lifetime?

[gwenith, BSN, RN]

I think it is the same mechanism that underlies the finger clubbing but be durned if I can find an explanation.

The Merck Manual was real helpful on this

Finger Clubbing

Finger clubbing is an enlargement of the tips of the fingers or toes and a loss of the angle where the nails emerge.

Finger clubbing occurs when the amount of soft tissue beneath the nailbeds increases. The reason this increase occurs is not clear, but clubbing seems to occur with some pulmonary disorders (lung cancer, lung abscess, bronchiectasis), but not with others (pneumonia, asthma, emphysema). Finger clubbing also occurs with some congenital heart diseases or, in some cases, may be inherited and not indicate any disease.

http://www.merck.com/mmhe/sec04/ch039/ch039b.html#sec04-ch039-ch039b-96

[UM Review RN, ASN, RN]

Maybe it's from all the steroid use?

[purplemania, BSN, RN]

He has JVD and pale extremeties

[P_RN, ADN, RN]

I think the ears and nose keep on growing. You see it in healthy elderly people also.

Oh, Grandpa, what big ears you have.

"The sense of hearing and sense of smellbecome less acute with the passing years --which makes one wonder if there's any con-nection between those losses and the fact thatears and noses continue to grow throughoutlife! I recently polled orhinolaryngologists (ear,nose, and throat doctors) in Los Angeles tomake sure that this statement is true. Not only is it true, but one doctor offered an even morefascinating fact-hair continues to grow for ashort time after death.

http://64.233.161.104/search?q=cache:Pt8YTUs0ATYJ:media.wiley.com/product_data/excerpt/90/07645246/0764524690.pdf+big+ears+long+nose+in+elderly&hl=en

That's a PDF file, but read it in HTML. Excellent article.

[gwenith, BSN, RN]

Thanks Pat:chuckle

He has JVD and pale extremeties

And the prize goes to Purplemania!!! For leading us into the next step which is assessing the Cor Pulmonale.

For those who have taken the time to read through some of the links provided so far - I will ask Do you think this patient is showing signs and symptoms of Cor Pulmonale???

[UM Review RN, ASN, RN]

That'd be the chronic type as opposed to the acute, right?