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CNA112 Clinical Reasoning Editing and Proof Reading Services
This is a solution of CNA112 clinical reasoning assignment help in which discuss health assessment and physical examination, professional practice, critical thinking and analysis provision and coordination of care collaborative and therapeutic practice.
A 24 year old female patient is reported to emergency room with complain of increased work of breathing and high temperature since last 3 days. She has a known history of asthma and her medical history also includes management of asthmatic symptoms with mild dose of salbutamol. Patient is coughing green coloured sputum and she is suffering from severe breathlessness in all positions. From the given signs and symptoms there are a few differential diagnosis identified like pneumonia, lung abscess, Lower Respiratory tract infection, Pulmonary oedema because of abscess etc. A nursing professional is required to take care of patient during the diagnosis procedure as well as treatment part and also ensure that all vital signs of patient are properly monitored. In order to ensure a safe and effective nursing care it is required by the nursing professionals that they base their practice on latest evidences of research studies and follow the protocol of treatment as recommended and prescribed by the consulting physician.
Body of Essay
Process of information gathered from the patient and different diagnostic tests is very important in final diagnosis and treatment planning part. In this case patient is suffering from breathlessness and green coloured sputum is coughed by her. She has history of asthma. On inspection it was observed that patient is having difficulty in breathing in resting position as well and her accessory muscle movement is also observed in breathing which indicates a severe reduction in breathing capacity and it would be much easier for patient is she is assisted in her breathing through artificial respiration (McLuckie, 2009).
On palpitation it was observed that patient’s body is slightly warm and she is suffering from midline asymmetrical expansion of lungs and chest cavity as well. These signs indicate that there is an underlying cause of breathlessness.
On percussion of chest cavity dullness was noted on the lower base of the left lung and it indicates that an abscess is present at the base of the lung or there is a chance of pleural effusion in patient which is causing dullness on palpation at base of lungs. It is also experienced on palpation that a resonance note is heard on palpation of right lung. On auscultation coarse crackles are also heard on the left side of lungs while diminished sounds were heard on lower base of the lungs. From the clinical signs and symptoms this condition is having a higher probability of pleural effusion because of an abscess or lung infection. This is also known as educative pleural effusion which is caused by infection of the lower respiratory tract, lung infection, abscess formation etc (Cunha, 2010).
Vital signs of patient are as follows BP is 130/80 which is slightly above normal systolic, pulse is radial and G + 2 Pulse and her heart beats are highly elevated to 110 beats per minute and they are irregular as well. Her oxygen saturation level is 93.2 percent in room air pressure and her body temperature is slightly elevated to 38.1 degree Celsius. All the signs indicate that patient is suffering from an underlying disorder or disease and breathlessness and other clinical symptoms are just exuberated clinical signs.
From all the information gathered about patient there is some relevant information like presence of dullness on palpation of lower left lung base. Very critical information for diagnosis was presence of green coloured sputum on coughing which indicates presence of infected region or pus in lungs and respiratory tract. Patient’s earlier history of asthma also indicates that patient might be into a high risk group. There are some information which is not very relevant for diagnosis purpose and that information if not included in consideration and development of this essay (Wong, 2009).
There are certain investigation which is needed further to confirm the diagnosis. First would be the radiograph of lungs and area which is infected or filled with pleural diffusion would be opaque in radiograph which healthy region would not have any white opaqueness. Further investigation includes a culture of the sputum and microbiological analysis of the sputum sample to confirm the type of infection in patient. An ultra sonography of the infection region can also help in establishing the boundaries of area which is affected by pleural diffusion.
Detectable clinical signs like stony dullness and difficulty in breathing even in resting position indicates that there is accumulation of more than 300 ml of fluid in patient’s lung cavity and presence of green sputum indicate that an infection is present in lungs. Both clinical signs are classical signs of pleural effusion in patient and they can be confirmed through a chest x ray. Signs and symptoms are also related with the elevated pulse rate which is often seen in patient suffering from infection and toxins released by infection in blood streams (Joseph, et al. 2001).
As a nursing professional it is very important that all the other differential diagnosis is eliminated gradually and final diagnosis is confirmed. A nursing professional should also take care of the chances of cross infection by patient as her final diagnosis is not yet confirmed. Pneumonia is still a very much possibility in this case except the fact that sharp stabbing pain which is a classical sign of pneumonia is missing. Rest of signs and symptoms do link up for pneumonia infection.
Likely picture of patient from the information gathered that patient would be prescribed a broad spectrum antibiotic while usage of oxygen can be done for artificial respiration. An intercostals drain or thoracentosis can be prescribed for draining of accumulated fluid if fluid persists even after 3 days of treatment initiation (Ware and Matthay, 2005).
In conclusion it can be said that first nursing priority now is to ensure that patient is able to breathe easily and her air way is secure and maintained. Ensuring airway maintenance can be done using respiratory masks etc. Second nursing priority is to make sure that patient should be exerting to a minimal and she should be talking as much rest as possible. It is very difficult for nurses to maintain a treatment course unless a confirmed diagnosis is present, still by the time investigations are completed a broad and general treatment and support is priority of nurses.
Cunha, B. (2010). Pneumonia essentials (3rd ed.). Sudbury, MA: Physicians' Press. ISBN 0763772208.
Joseph J, Badrinath P, Basran GS, Sahn SA (2001). "Is the pleural fluid transudate or exudate? A revisit of the diagnostic criteria". Thorax 56 (11): 867–70
McLuckie, A. (2009). Respiratory disease and its management. New York: Springer. p. 51.
Ware LB, Matthay MA (2005). "Clinical practice. Acute pulmonary edema". N. Engl. J. Med. 353 (26): 2788–96
Wong, CL, (2009). "Does this patient have a pleural effusion?". JAMA 301 (3): 309–17.