Question

Using the following case study answer the questions,

A 76 year old male presents to the emergency department with shortness of breath and difficulty sleeping lying down.

Physical examination reveals a well nourished obese male with SOB with speaking and any exertion. Blood pressure is 160/90 and pulse is 90. Lungs- diminished in bilateral bases. Cardiovascular examination reveals a swooshing sound heard best over the 2nd ICS, RSB. The patient complains that SOB became much worse when he was asked to lie flat on the examination table. States a 71bs. weight gain in one week.  Productive cough that is clear to pink foamy sputum.

1. Distinguish normal from abnormal, and subjective and objective findings and list each. Link abnormal findings with common pathologic conditions.

2. Sequence disease processes.  (What caused what?)

3. Perform an assessment:

10 pertinent health history questions you would ask.

10 pertinent physical assessments would you perform.

Answer 1

1. Normal findings:-

Subjective:-

• ​​​​​​​​76 year old (age)

Objective:-

• pulse-90

2. Abnormal findings:-

Subjective:-

• Shortness of breath
• Difficulty sleeping lying down
• 7 pounds weight gain
• SOB become worser on lying down

Objective:-

• BP- 160/90
• Lungs diminished bilaterally
• Swooshing sound heard over 2nd ICS, RSB
• Productive cough with clear to pink foamy sputum

3. Pathological conditions:-

• Shortness of breath –dyspnea
• 7 pounds weight gain –fluid retention
• SOB become worser on lying down –orthopnea
• BP- 160/90 –hypertension
• Lungs diminished bilaterally – pleural effusion
• Swooshing sound heard over 2nd ICS, RSB – murmur
• Productive cough with clear to pink foamy sputum – pulmonary oedema

4. Sequence disease process:-

1. Aortic stenosis
2. Left sided heart failure
3. Pulmonary oedema
4. Right sided heart failure

5. Health history:-

1. ​​​​​​​Chest pain (nature, location, radiation)
2. Breathlessness
3. Palpitations
4. Syncope
5. Associated cough
6. Drugs or medications
7. Past history of raised BP
8. Abdominal discomfort
9. Lifestyle (obesity, smoking)
10. Family history

6. Physical assessment:-

1. Built (general)
2. Cyanosis
3. Clubbing
4. Pulse (rate, rythym)
5. Check BP
6. Look to see if the chest wall is deformed (eg, funnel chest) and moves equally (inequality of expansion is usually due to respiratory disease)
7. Check respiratory rate
8. Observe and palpate the trachea
9. Feel over the anterior chest wall for any thrills associated with cardiac murmurs.
10. Auscultation of the heart.