Clinical Reasoning

Question 1

1. Clinical Scenario: Using Inspection, Palpation, Percussion, and Auscultation for Lung Disease Assessment

Answer 1

• Inspection: Look for signs of respiratory distress (e.g., retractions, cyanosis, or increased work of breathing). Observe the symmetry of chest movement, use of accessory muscles, and overall posture.
• Palpation: Assess for symmetric chest expansion and tactile fremitus. Reduced expansion on one side or absent fremitus could indicate a pneumothorax or lung collapse.
• Percussion: Identify areas of dullness (indicating fluid or consolidation, such as in pneumonia) or hyper-resonance (suggesting air trapping, such as in emphysema).
• Auscultation: Listen for abnormal breath sounds like crackles (indicative of fluid or infection), wheezes (suggestive of airway narrowing), or absence of sounds (which might indicate a collapsed lung).

Question 2

2. PQRSTIUA for Shortness of Breath

Answer 2

P (Provokes): What makes it worse? Activity, lying down?
Q (Quality): Can you describe how it feels? Tightness, gasping?
R (Radiates): Does it spread to other areas, like the chest or throat?
S (Severity): On a scale of 1-10, how bad is it?
T (Timing): When did it start? Is it constant or intermittent?
I (Impact): How does it affect your daily life?
U (Understanding): What do you think is causing this?
A (Associated symptoms): Do you have a cough, fever, or chest pain?
Use respiratory history to look for risk factors like smoking, allergies, or previous respiratory conditions. Review system questions: Cough, sputum production, fever, exposure to irritants, or history of heart disease.

Question 3

3. One-Sided Chest Expansion During Palpation

Answer 3

Interpretation: Could indicate pneumothorax, pleural effusion, or lung collapse.
Next Steps: Perform percussion (dullness vs. hyper-resonance) and auscultation (absent or decreased breath sounds on the affected side). Order imaging (e.g., chest X-ray) if available.
Further Findings: Inspect for tracheal deviation, assess oxygen saturation, and evaluate for signs of respiratory distress.

Question 4

4. Dullness on One Side and Resonance on the Other

Answer 4

Interpretation: Dullness suggests fluid (pleural effusion, pneumonia) or tissue (lung consolidation, tumor). Resonance indicates air-filled lung.
Conditions: Pleural effusion, lobar pneumonia, or atelectasis.
Next Steps: Confirm findings with auscultation and further testing like imaging.

Question 5

5. Crackles in Suspected Pneumonia

Answer 5

Significance: Crackles indicate fluid in alveoli, often due to infection or inflammation.
Care Plan: Prioritize oxygenation, administer prescribed antibiotics, and monitor oxygen saturation and respiratory rate.
Interventions: Position patient upright, encourage incentive spirometry, promote hydration, and monitor for worsening symptoms.

Question 6

6. COPD Patient Follow-Up with O2 Sat 92% and RR 26

Answer 6

Additional Assessments: Check for use of accessory muscles, auscultate breath sounds, assess sputum production, and review adherence to medications.
Interventions: Teach pursed-lip breathing, administer bronchodilators if prescribed, and review oxygen therapy use. Address anxiety related to breathing.
Follow-Up: Schedule pulmonary function tests and regular check-ins.
Self-Management: Encourage smoking cessation, use of rescue and maintenance inhalers, physical activity, and recognizing early signs of exacerbation.

Question 7

7. Patient with Respiratory Distress (Retractions and Cyanosis)

Answer 7

Further Assessment: Measure oxygen saturation, listen for abnormal breath sounds, inspect for nasal flaring or tracheal deviation.
Prioritized Actions: Administer oxygen, position the patient upright, and initiate rapid response protocols.
Communication: Use SBAR (Situation, Background, Assessment, Recommendation) to inform the physician: “Patient is in respiratory distress with retractions, cyanosis, and O2 saturation of [value].”

Question 8

8. Documenting Asthma Assessment

Answer 8

Findings: “Wheezing noted bilaterally, respiratory rate 22 breaths/min, O2 sat 94%, patient reports intermittent chest tightness worsened by exercise.”
Impression: “Asthma exacerbation likely due to allergen exposure.”
Interventions: Administered short-acting bronchodilator, educated on allergen avoidance.
Plan: Monitor response to treatment, reassess in 30 minutes, follow-up with PCP in one week.
Follow-Up: Reinforce medication adherence and trigger management.

Question 9

9. Education for COPD Home Management

Answer 9

Smoking Cessation: Emphasize its importance in slowing disease progression.
Inhaler Use: Teach proper technique.
Oxygen Therapy: Instruct on safe use.
Symptom Recognition: Identify early signs of exacerbation.
Lifestyle Modifications: Promote regular exercise and balanced nutrition.
Motivational Interviewing: Explore barriers and reinforce the patient’s goals (e.g., “What’s most important for you to improve your health?”).

Question 10

10. Ongoing Care for Chronic Asthma

Answer 10

Monitoring: Regular assessment of peak flow, symptom diary, and triggers.
Care Plan Adjustments: Tailor medication based on control levels; step up or down therapy per guidelines.
Motivational Interviewing: Explore adherence barriers and collaboratively set goals. For instance, “What helps you remember to use your inhaler regularly?”
Long-Term Strategies: Promote vaccinations (flu, pneumonia), trigger avoidance, and a written asthma action plan.