fine crackles are soft, high pitch

fine crackles are soft, high pitch

Discussion 1

Discussion Question 1

Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.

First question I failed to ask Mr. Hall was whether he have had any treatment for his cough. It is always important to ask about self-treatment patient may have tried and the response. Determine what the patient has done to minimize the symptoms including whether he has altered normal activity or taken any medication prescribed or OTC(Goolsby and Grubbs, p.207). Second question was whether he has had a cough like this one before. The quality of symptoms is important. For cough the potential qualities includes whether the cough is mild and tickling or sharp and paroxysmal, it is also necessary to determine the exact location to the symptoms and whether patient has noticed any radiation to other sites and how it relates to respiration (Goolsby and Grubbs, pag 207)

Discussion Question 2

Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.

I did not auscultate the anterior and posterior chest in the correct order. Auscultation is the most important technique to assess air flow through the tracheobronquial tree. According to (Bickley. 2017). Using patter from percussion should be follow to auscultate moving from one side to the other and comparing symmetric areas of the lungs. Listen to at least one full breast in each location. I did not document right the adventitious sound heard when assessing Mr. Hall’s right lung. The correct documentation should be coarsed crackles, which are somewhat louder, lower in pitch, while fine crackles are soft, high pitch(Brickley.2017)

Discussion Question 3

Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.

I found out that the patient had coarse crackles in his right lung during the auscultation of the breath sounds. According to Bickley (2017), the origin of coarse crackles is at the period of early inspiration. Then they proceed during the biphasic period through the expiration with a specific popping sound. Their characteristic feature is that the change in a body position does not cause any variation in the crackles and they can be heard in all lung regions. Fine crackles last for a shorter period of time and have higher frequency. Besides, coarse crackles get to the mouth, and they disappear or transform while coughing. Having obtained this result, I used it as a finding that indicated pneumonia as a diagnosis. Goolsby (2014) claimed that consolidation caused by the increase in breath sounds throughout the peripheral regions of lungs can indicate having pneumonia. According to Bickley (2017), the reason for crackles may be either lung parenchyma abnormalities, in particular pulmonary fibrosis, pneumonia, atelectasis, interstitial lung disease, heart failure, or problems with the airways, in particular bronchiectasis, bronchitis, or other ones.

Discussion Question 4

Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.

I did not indicate Crackles in the RLL in my differential diagnosis although I noted it during the physical assessment. This abnormal finding is important as it implies having diagnostic testing and obligatory follow-up. The non-musical sounds of crackles may be of different types: early inspiratory, biphasic, or late. The patient had a characteristic popping sound for coarse crackles, which was evident on his physical anterior and posterior assessment and RLL (Bickley et al., 2017). The cause of coarse crackles can be gas boluses which pass through opening and closing airways. It is a symptom in the patients who have bronchiectasis, COPD, heart failure, pneumonia, or asthma (Bickley et al., 2017).

Discussion Question 5

Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.

I missed Pneumonia community acquired as an important differential diagnosis. Pneumonia involve inflammation and consolidation of lung tissues. It’s broadly categorized by whether if occurs outside the hospital(Community adquired pneumonia), or within the hospital(Nosocomial, or hospital adquired pneumonia).The symptoms of pneumonia are quite varied. Usually the patient complaint of cough associated with fever, malaise, shaking chills, rigor and chest discomfort. Abnormal vital signs include tachycardia and tachypnea and fever. There is uneven fremitus and the area over the consolidation percusses dull. On auscultation there are bronchial breath sound, often with crackles.(Goolsby and Grubbs. P. 214)

Discussion 2

Discussion Question 1

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