Assessingthe Heart, Lungs, and Peripheral Vascular System
Assessingthe Heart, Lungs, and Peripheral Vascular System
Aftertaking the biodata, which includes the name, age, gender andresidence of the patients, it is important to note the primarypresenting complaints with its duration using the patient’s exactwords. If it is more than one complaint, they should be arranged inchronological order from the earliest to the latest complaint.
Thehistory of the presenting illness (HPI) should follow the SOCRATESformat to describe any presenting complaint where applicable. Thisincludes the sight, onset, character, relieving and aggravatingfactors, temporal patterns, associated conditions and lastly severityof the complaints. Ask about the presence of pain, with itsdescription following the above format. Additionally, ask for thepresence of a cough, with information on its duration, whether it isproductive and color of sputum. Other clinical presentations to beasked include hemoptysis, wheezing, fever, shortness of breath withthe duration and timing noted, any reported episode of fainting, anyfatigue, confusion, anxiety, memory impairment and the effects ofexercise activity on their condition and the progression of thecondition to check if it is worsening or improving over time. Checkif the patient needs to use pillows in order to sleep at night anddetermine the number. Ask for similar illnesses in the family, anyhistory of comorbidities such as hypertension, diabetes, thyroiddisease, previous myocardial infarction, valvular heart disease andsubstance abuse. Ask for any history of allergies. Additionally,information on their past medical history is necessary. This includesa history of any surgery or admission and the medication given duringthis period. Occupational history is important since asthma can belinked to an allergen in the workplace. Ask about the use of alcoholand tobacco consumption. Lastly, a review of all the systems exceptthe respiratory system is important(Huether & McCance, 2012, n.p).
Thevital signs should be checked, which include the body temperature,breathing rate, blood pressure and pulse. The character of the pulseshould be explained in terms of the presence of all the pulses, rate,character, volume, rhythm and presence of a collapsing pulse. Ongeneral examination, palmar pallor, peripheral and central cyanosis,conjunctival pallor, jaundice, jugular venous pressure (especially inadvanced chronic lung disease) and peripheral edema should bechecked.
Onobservation of the cardiovascular and respiratory system, one shouldcheck the movement of the chest with respiration and use of accessorymuscles of respiration. Check for assisted breathing through the useof pursed lips. Check for symmetry of the chest and any presence ofintercostal recession (the Hover sign). Additionally, check forsubcostal indrawing and the presence of any scars or marks on thechest.
Onpalpation, check for the centrality of the trachea, any tenderness ormasses. Check for vocal fremitus. Locate the apex beat. Check for theactivity of the precordium. Palpate for any thrills and heaves.
Onpercussion, check for resonance, hyperresonance or dullness of thechest. On auscultation, determine whether there is an equal airwayflow on both sides and assess the duration of expiration, check forbreath sounds and added sounds, wheezes and rhonchi. Check for theheart sounds and describe them. Check for any murmurs and describethem (Ball,Dains, Flynn, Solomon & Stewart, 2015, n.p)
Thisincludes a complete blood count to assess for the presence of anyinfection, altered hemodynamics such as polycythemia. A urinalysiswill check for proteinuria associated with cardiovascular disease.Perform a blood urea and nitrogen test (BUN) which will assess renalperfusion. Perform a random blood sugar to rule out diabetes. Performa liver function test (FT) to check any possible effect of a cardiaccondition on the liver. Arterial Blood Gas Analysis (ABGs), sputumculture and evaluation, pulse oximetry assessment pulmonary functiontest, serum chemistries to assess the levels of sodium, potassium andmagnesium. An assessment of a six-minute walking distance can also behelpful in predicting the extent of the disease. Also, check forserum immunoglobulin E, blood and sputum eosinophils to rule outasthma. Additional tests include a chest X-ray and computertomography, electrocardiography and lastly allergy skin test to ruleout asthma (Dains, Baumann & Scheibel, 2016, n.p).
Analtered complete blood count may reveal anemia or the presence of aninfection that is affecting pulmonary function. Proteinuria afterurinalysis indicates a possible heart failure. Altered BUN indicatesreduced renal perfusion secondary to heart failure. Elevated liverenzymes may indicate hepatic dysfunction secondary to cardiacfailure. Patients with progressing chronic pulmonary obstructivedisease usually have polycythemia. Fatal levels of hypoxemia andhypercapnia may be revealed through ABGs in asthma and chronicpulmonary diseases due to inefficient gaseous exchange andhypoventilation. Pulse oximetry assessment is also used to excludehypoxemia in acute asthma. Levels of sodium should be assessedbecause patients with COPD retain sodium. Diuretics used in theseconditions also reduce potassium levels. Therefore, the levels shouldbe monitored closely. Walking over a small distance for six minutesis an important indicator of the extent of the disease and acts as apredictor of the mortality rate. A two-dimensional echocardiographyscreens for right ventricular systolic function and pulmonaryarterial systolic pressure, although it is necessary to introducecardiac catheterization formally for accurate confirmation of thediagnosis in COPD. Chest radiography gives more information on theextent of damage to the chest and the abnormal structure of thechest, which includes the presence of infiltrations andconsolidations. A skin allergy test is useful to rule out asthma,same as a serum immunoglobulin E test (Arcangelo & Peterson,2013, n.p).
Allergicand Environmental Asthma
ChronicObstructive Pulmonary Disease (COPD)
Arcangelo,V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics foradvanced practice: A practical approach (3rd ed.). Ambler, PA:Lippincott Williams & Wilkins.
Ball,J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R.W. (2015). Seidel`s guide to physical examination (8th ed.). St.Louis, MO: Elsevier Mosby.
Dains,J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced healthassessment and clinical diagnosis in primary care (5th ed.). St.Louis, MO: Elsevier Mosby.
Huether,S. E., & McCance, K. L. (2012). Understanding pathophysiology(Laureate custom ed.). St. Louis, MO: Mosby.