NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 

NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System
Sample Answer for NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System Included After Question

Cardiovascular disease (CVD) is the largest cause of death worldwide. Accounting for 800,000 deaths annually, CVD frequently goes unnoticed until it is too late. Early detection and prevention measures can save the lives of many patients who have CVD. Conducting an assessment of the heart, lungs, and peripheral vascular system is one of the first steps that can be taken to detect CVD and many more conditions that may occur in the thorax, or chest area. 

This week, you will evaluate abnormal findings in the area of the chest and lungs. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system. 

Learning Objectives 

Students will: 

Evaluate abnormal cardiac and respiratory findings 
Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system 

Photo Credit: ANDRZEJ WOJCICKI/Science Photo Library/Getty Images 

NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System
Learning Resources  
Required Readings 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. 

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. 

Chapter 13, “Chest and Lungs” (pp. 260-293)  

This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs. 

Chapter 14, “Heart” (pp. 294-331)  

The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart. 

Chapter 15, “Blood Vessels” (pp. 332-349)  

This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders. 

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby. 

Chapter 8, “Chest Pain” (pp. 81–96)  

This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first determining whether the patient is in a life-threatening condition. It includes questions that can help pinpoint the type and severity of pain and then describes how to perform a physical examination. Finally, the authors outline potential laboratory and diagnostic studies. 

Chapter 11, “Cough” (pp. 118-147)  

A cough is a very common symptom in patients and usually indicates a minor health problem. This chapter focuses on how to determine the cause of the cough through asking questions and performing a physical exam. 

Chapter 14, “Dyspnea” (pp. 159–173)  

The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for determining the cause of the problem through evaluation of the patient’s history, through physical examination, and through additional laboratory and diagnostic tests. 

Chapter 26, “Palpitations” (pp. 310-317)  

This chapter describes the different causes of heart palpitations and details how the specific cause in a patient can be determined. 

Chapter 33, “Syncope” (pp. 390-397)  

This chapter focuses on syncope, or loss of consciousness. The authors describe the difficulty of ascertaining the cause, because the patient is usually seen after the loss of consciousness has happened. The chapter includes information on potential causes and the symptoms of each. 

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis. 

Chapter 8, “Outpatient Charting and Communications” (pp. 173-188) 

Note: Download these Adult Examination Checklists and Physical Exam Summaries to use during your practice cardiac and respiratory examination. 

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Blood vessels. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. 

This Blood Vessels Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/ 

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for cardiovascular assessment. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. 

This Adult Examination Checklist: Guide for Cardiovascular Assessment was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/ 

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for chest and lung assessment. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. 

This Adult Examination Checklist: Guide for Chest and Lung Assessment was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/ 

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Chest and lungs. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. 

This Chest and Lungs Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/ 

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Heart. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. 

This Heart Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/ 

McCabe, C., & Wiggins, J. (2010a). Differential diagnosis of respiratory disease part 1. Practice Nurse, 40(1), 35–41. 

Retrieved from the Walden Library databases. 

This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions. 

McCabe, C., & Wiggins, J. (2010b). Differential diagnosis of respiratory diseases part 2. Practice Nurse, 40(2), 33–41. 

Retrieved from the Walden Library databases. 

The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations. 

SkillStat Learning, Inc. (2014). The 6 second ECG. Retrieved from http://www.skillstat.com/tools/ecg-simulator#/-home 

This interactive website allows you to explore common cardiac rhythms. It also offers the Six Second ECG game so you can practice identifying rhythms. 

University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html 

This website provides an introduction to radiology and imaging. For this week, focus on cardiac radiography and chest radiology. 

Required Media 

Laureate Education. (Producer). (2012). Advanced health assessment and diagnostic reasoning. Baltimore, MD: Author. 

Note: You will use the case studies presented in the media, Advanced Health Assessment and Diagnostic Reasoning, to complete this week’s Discussion. 

Online media for Seidel’s Guide to Physical Examination 

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 13, 14, and 15 that relate to the assessment of the heart, lungs, and peripheral vascular system. Refer to Week 4 for access instructions on https://evolve.elsevier.com/. 

Optional Resources 

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical. 

Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 1, “Chest Wall, Pulmonary, and Cardiovascular Systems,” pp. 302–433)  

Note: Section 2 of this chapter will be addressed in Week 10.  

This section of Chapter 8 describes the anatomy of the chest wall, pulmonary, and cardiovascular systems. Section 1 also explains how to properly conduct examinations of these areas. 

Discussion: Assessing the Heart, Lungs, and Peripheral Vascular System 

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack? 

In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities. 

In this Discussion, you will consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted. 

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.  

To prepare: 

With regard to the case study you were assigned: 

Review this week’s Learning Resources and consider the insights they provide. 
Consider what history would be necessary to collect from the patient. 
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? 
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. 

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 6”) with “Review of Case Study” identifying the number of the case study you were assigned. 

By Day 3 

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.  

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! 

Read a selection of your colleagues’ responses. 

By Day 6 

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning. 

Submission and Grading Information 

Grading Criteria  

To access your rubric: 

Week 7 Discussion Rubric 

Post by Day 3 and Respond by Day 6 

To participate in this Discussion: 

Week 7 Discussion 

 Assignment (Optional): Practice Assessment: Cardiac and Respiratory Examination 

It is crucial to diagnose cardiac and respiratory conditions early due to the critical nature of these organs. Before a condition can be diagnosed, an examination must be conducted. Properly conducting a cardiac and respiratory examination requires detailed knowledge of the examination procedure and experience in performing this assessment. 

In preparation for the Head-to-Toe Physical Assessment Video due in Week 10, it is recommended that you practice performing a cardiac and respiratory examination this week. 

Note: This is an optional practice physical assessment. You do not have to capture a video of this assessment, as no submission is required. 

To prepare: 
Arrange an appropriate time and setting with your volunteer “patient” to perform a cardiac and respiratory examination. 
Download and review the Cardiac and Respiratory Checklists provided in this week’s Learning Resources. 
Ensure that you have a stethoscope to perform the examination. 
To complete: 
Perform the cardiac and respiratory examination. Be sure to cover all of the areas listed in the checklist and to use the equipment appropriately. 

Looking Ahead: Skin, Hair, and Nails, and HEENT Physical Assessment Video 

In Week 8, you will videotape yourself conducting a skin, hair, and nails, and HEENT physical assessment. 

By Day 7 of Week 8 

This video is due. Refer to Week 8 for additional guidance. 

Week in Review 

This week, you properly applied health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system. In addition, you evaluated abnormal cardiac and respiratory findings using the patient’s history and potential abnormal findings. You also recommended appropriate exams/diagnostic tests to determine causes and abnormalities. 

Next week, you will explore how to accurately assess the abdomen and gastrointestinal system. 

A Sample Answer For the Assignment: NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 
Title: NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 

Episodic/Focused SOAP Note Template 

Patient Information: 

Initials: MM                   Age: 65             Sex: Male         Race: Caucasian 

CC (chief complaint): Shortness of breath 

HPI: MM is a 65 year old Caucasian male that comes to the clinic complaining of shortness of breath for the last few days. MM states that his shortness of breath is getting worse and he is tired all the time. MM states he has shortness of breath all the time and is coughing up clear phlegm.  

Current Medications: None, was taking diuretic but has stopped taking it. 

Allergies: Iodine, seafood 

PMHx: Up to date on all shots, flu shot last year 10/18 

Soc Hx: Retired school teacher, married for 40 years, current smoker (down to 3 cigarettes a day) 

Fam Hx: Mother- HTN, Asthma, Father- CHF, does not know medical history of grandparents. 

ROS:  

GENERAL:  5 pound weight gain in a week, increasing fatigue, no fever or chills  

HEENT: Head: No headaches, Eyes:  No visual loss or blurred vision. Ears, Nose, Throat:  No drainage, hearing loss, or sore throat.  

SKIN:  Cool and dry, no rash 

CARDIOVASCULAR:  No chest pain or discomfort, edema noted to bilateral legs. 

RESPIRATORY:  Cough producing clear phlegm, constant shortness of breath 

GASTROINTESTINAL:  No nausea, vomiting, or diarrhea 

GENITOURINARY:  No burning or discomfort on urination.  

NEUROLOGICAL:  No numbness or tingling.  

MUSCULOSKELETAL:  No muscle or back pain. 

HEMATOLOGIC:  No bleeding or bruising. 

LYMPHATICS:  No enlarged nodes.  

PSYCHIATRIC:  No history of depression or anxiety. 

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia. 

ALLERGIES:  Allergic to iodine and seafood. 

Physical exam: Vital signs- BP 162/90, HR 94, RR 20, Temp 97.9m Ht 6’0, Wt 210 

General: MM is a 65 year old male, A&O x4, , calm and cooperative upon interview.  

Head: Normal size and position, facial features symmetrical. 

Eyes: Visual acuity 20/20 using Snellen chart, Eyes symmetrical, No nystagmus noted. 

Neurological: Alert and oriented to person, place, time, and situation. Fluent in English language, thoughts and responses appropriate.  

Diagnostic results:  

CXR- useful to identify underlying causes of shortness of breath 

Blood work- to monitor patient’s lab values in order to make a diagnosis 

EKG- to monitor the patient’s heart rhythm 

A.
Differential Diagnoses: 

CHF- With the patient’s shortness of breath, weight gain, and edema in lower legs, the patient most likely has a diagnosis of CHF  

COPD- this could be the cause of patient’s shortness of breath, but would not account for weight gain or edema that the patient is experiencing. 

Lung cancer- patient is a current smoker that has tried to quit unsuccessfully. This could be causing his shortness of breath, but does not coincide with other symptoms patient has. 

Pulmonary edema- could be cause of patient’s shortness of breath and is often associated with cardiovascular diagnosis.  

Pneumonia- could be cause of patient’s shortness of breath, but would not account for other symptoms. Patient is also coughing up only clear phlegm, which doesn’t suggest infection.  

References 

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 health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby. 

http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6512/CH/mm/health_assessment/docs/Exam_Result_Scenario_1.pdf 

A Sample Answer 2 For the Assignment: NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 
Title: NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 

Patient Initials: KK               Age: 60                       Gender: M 

Chief Complaint (CC): “I had severe chest pain this weekend.” 

History of Present Illness (HPI): Patient is a 60-year-old Caucasian male with a PMH significant for schizophrenia presenting to the clinic today for ER follow-up.  Client has been evaluated at the ER 3 times this past weekend for chest pain.  In reviewing ER reports, labs (CBC, CMP, Troponins, and D-Dimer) and diagnostics (EKG, CXR) were within normal findings He reports experiencing chest pain Saturday and Sunday, “like an elephant was sitting on my chest,” with accompanying shortness of breath.  He reports chest pain was relieved with administration of lorazepam given at the ER.  He is requesting something for his anxiety today. 

Medications: Haldol 50mg IM q2weeks, fluoxetine 20mg qd, Tramadol 50mg q6h PRN. 

Allergies: Cogentin, Nabumetone 

Past Medical History (PMH): Schizophrenia, Major Depressive Disorder, Sciatica.  Hospitalization for pneumonia in 2014, Inpatient behavioral health x5; last in 2010. 

Past Surgical History (PSH): Appendectomy in 1974. 

Sexual/Reproductive History:  Heterosexual, sexually inactive for the last 10 years. 

Personal/Social History: Hx of methamphetamine abuse; denies current usage, Current smoker of 1 ppd, denies etoh intake, single, resides alone, has in home services 2-4 hours per week. 

Immunization History: Tdap 2014, flu 2019, pneumo 2019 

Significant Family History: father died of a heart attack, mother schizophrenia and committed suicide, two brothers and one sister with schizophrenia. 

Lifestyle: Walks in the community daily, reports support systems of friends and social service agencies, two brothers and one sister no contact, they live out of the state, receives SSDI. 

Review of Systems:  

HEENT: Negative for headache, eye drainage, ear pain, congestion, sore throat. 

Neck: Negative for neck pain. 

Breasts: Negative. 

Respiratory: Shortness of breath, positive for cough with sputum production, unknown color, “I swallow it.” 

Cardiovascular/Peripheral Vascular: Positive for intermittent chest pain; currently 4/10 

Gastrointestinal: Negative for abdominal pain, nausea, vomiting. 

Genitourinary: Negative for dysuria, frequency, and urgency. 

Musculoskeletal: Negative for back pain. 

Psychiatric: Schizophrenia.  Negative for confusion, hallucinations, self-injury, or suicidal ideas. 

Neurological: Negative for dizziness, weakness, numbness. 

Skin: Negative for rash. 

Hematologic: Negative. 

Endocrine: Negative. 

Allergic/Immunologic: Negative. 

OBJECTIVE DATA:  

Physical Exam:  

Vital signs: BP 126/84, HR 74, R 26, Sp02 95% RA, Ht 5’9’’, Wt 180 lbs., BMI 26.58. 

General: He is alert and oriented to person, place, time, and event.  He appears well-developed and well-nourished, dressed appropriately for the weather, smells of cigarette smoke. 

HEENT: Normocephalic and atraumatic, conjunctivae without redness or drainage, ears without drainage and tympanic membrane is pearly pink, nose without drainage, throat is red without exudate. 

Neck: Normal range of motion, neck supple and midline 

Chest: symmetrical chest movements, nasal flaring 

Lungs: Rhonchi that clears with cough, prolonged expiration, smokers cough. 

Heart: Normal rate, regular rhythm, normal heart sounds, pulses present and palpable 

Abdomen: No distention, soft, no tenderness or guarding. 

Musculoskeletal: Slow shuffled gait with hunched posture. 

Neurological: Alert and oriented to person, place, time, and event; exhibits normal muscle tone. 

Skin: No pallor, warm, dry, intact; no rash.  Skin between fingers is yellow.   

Psychiatric: He appears anxious, answers questions appropriately, good eye contact. 

Additional diagnostics needed: Sputum culture and pulmonary function tests 

ASSESSMENT:  

Bronchitis: Hacking cough that becomes productive, afebrile, adventitious breath sounds that clears with cough, smoker.  Order sputum culture and PFTs as chest radiography shows normal findings.  Order rescue inhaler and nicotine patches as Client verbalizes wanting to stop smoking. 

Pneumonia: Client has history of pneumonia, positive for tachypnea, noisy cough, sputum production; however, currently afebrile and heart rate is within normal limits (physical findings in pneumonia: irritability, fever, tachycardia, tachypnea, inspiratory crackles, asynchronous breathing, pleuritic chest pain, sputum is yellow, green, red in color).  Pneumonia needs ruled out.  

Anxiety: Client reports symptom of chest pain was relieved with lorazepam when administered at ER.  I am declining his request for Rx lorazepam today; he will need to follow-up with his mental health provider. 

GERD: Client educated to reduce meal size, avoid high-fat meals, avoid alcohol, stop smoking, wait 3 hours to lay down after eating to prevent aggravating factors. 

Costochondritis: pain along sternal border that increases with deep breathing, URI, or physical activity, normal breath sounds. 

A Sample Answer 3 For the Assignment: NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 
Title: NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 

Episodic/Focused SOAP Note  

Patient Information: 

J.H., 60yrs, M, Caucasian  

CC (chief complaint): J.H. complains of chest pain all the time. SOB.  States that he is having pain now.  States that taking a full breath makes the pain worse. “pain is really sharp, and it hurts real bad. I just want to get a deep breath in and it feels like my heart is racing” States that nothing makes it better.  

HPI:60-year-old Caucasian male c/o chest pain described as sharp that gets worse when taken a breath. SOB. Chest pain and SOB started a few days ago.  Coughing up blood x1 this morning. Right leg with some edema, redness, and tender to touch. Went on a vacation and was sitting on a plane for 8 hours. Just return a few days ago. Has not taken any medications. 9/10 on a pain scale.   

Current Medications: none 

Allergies: NKA 

PMHx: had pneumonia in 2018.  

Soc Hx: retired Navy sailor. Married. Smokes 3 cigarettes per day. Social drinker. Drinks one 6oz glass of Rum and Coke at events and once every other week, usually on Saturdays. Has one son age 32years old. Live in a suburban area in a one-story home with his wife. Has house alarm and smoke detectors. Wears seatbelt while in a motor vehicle.  

Fam Hx: Father deceased 45 years of age at the time of death. Cause of death cardiac arrest. Mother deceased at age 55 years of age. Cause of death breast cancer. One sister age58 healthy. One son 32 years old in the Navy.  

ROS:  

GENERAL: Stable weight of 210lbs, no fever, chills, weakness, or fatigue. anxious 

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or a sore throat. Positive for a cough with blood.  

SKIN:  No rash or itching. Cool and diaphoretic. 

CARDIOVASCULAR:  chest pain, tachycardic, HR112, Heart rate is irregular with good S1, S2; no S3 or S4; no murmur.  Right calf with 2+ edema, erythema; warmth and tenderness on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally.  

RESPIRATORY: SOB. Respiratory rate: 32, labored. Oxygen saturation: 90% on room air.   

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. 

GENITOURINARY:  No burning on urination.   

NEUROLOGICAL:  Alert and oriented to time, place, and person. No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. 

MUSCULOSKELETAL: pain in right calf. Edema and redness in the right calf. Left calf without pain, redness, and edema.  

HEMATOLOGIC:  No anemia, bleeding or bruising. Blood noted in sputum.  

LYMPHATICS:  No enlarged nodes. No history of splenectomy. 

PSYCHIATRIC:  No history of depression or anxiety. 

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia. 

ALLERGIES:  No history of asthma, hives, eczema or rhinitis. 

Physical exam: Temp: 97.9 oral. B/P148/88. HR 112. Heart rate is irregular with good S1, S2; no S3 or S4; no murmur.  Right calf with 2+ edema, erythema; warmth and tenderness on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally.   Thorax and lungs: Thorax symmetrical; diminished breath sounds right middle and lower lobes; no rales, rhonchi, or wheezes; breath sounds vesicular with no adventitious sounds left lung. Abdomen: Protuberant with normoactive bowel sounds auscultated x4 quadrants. 

Diagnostic results: VQ Scan: Ventilation-perfusion evaluates the airflow (ventilation) and blood flow (perfusion) in the lungs for a suspected pulmonary embolus in the lungs (Jong, 2018). Positive for pulmonary embolus in right lower lung. 

Ultrasound: most common test for diagnosing deep vein blood clots. It uses sound waves to create pictures of blood flowing through the arteries and veins (Medline Plus, 2011). Positive for DVT in the right calf. 

Chest X-Ray: clear. R/O TB. Secondary to hemoptysis.    

A.

Differential Diagnoses:1. Pulmonary embolus. One of the first signs of a pulmonary embolus is sharp, stabbing chest pains that get worse when breathing (Crosta, 2018). The patient stated in his chief complaint that his chest pain is sharp and gets worse with breathing. Long periods of bed rest or inactivity increase the risk of DVT (Crosta, 2018). The patient stated that he was on a flight for eight hours. 

2.Deep vein thrombus(DVT). Maybe related to pulmonary embolus. Sign and symptoms of a DVT are swelling in the leg, redness, warmth, and tenderness (Medline Plus, 2011). The patient had pain in right calf, edema, redness, and was tender to touch. 

Bacterial Pneumonia. The most common sign and symptom is a cough with thick blood tinged mucus and stabbing chest pain that worsens when coughing or breathing (Chase, Leonard, & Gotter, 2017). The patient had a cough with blood in the morning. 

4.Tuberculosis. The most common form of tuberculosis. S/S is coughing of blood and chest pain (Carey, Higuera, & Nall, 2018).  

Panic disorder. Pt was anxious and was HR was 112. Pt stated that his heart felt like it was racing.  S/S includes rapid breathing, chest pain, and sweating (Medline Plus, 2018).

P.   

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. 

References 

Carey, E., Higuera, V., & Nall, R. (2018, March 28). Pulmonary Tuberculosis. Retrieved from Healthline: https://www.healthline.com/health/pulmonary-tuberculosis. 

Chase, C., Leonard, M., & Gotter, A. (2017, March 17). Bacterial Pneumonia: Symptoms, Treatment, and Prevention. Retrieved from Healthline: https://www.healthline.com/health/bacterial-pneumonia. 

Crosta, P. (2018, January 22). What’s to know about pulmonary embolism? Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/153796.php. 

Jong, I. (2018, August 24). VQ Scan. Retrieved from Inside Radiology: https://www.insideradiology.com.au/vq-scan-hp/. 

Medline Plus. (2011). Deep Vein Thrombosis: Symptoms, Diagnosis, Treatment and Latest NIH Research. Retrieved from National Institutes of Health: https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg20-21.html. 

Medline Plus. (2018, July 19). Panic Disorder. Retrieved from National Library of Medicine: https://medlineplus.gov/panicdisorder.html. 

A Sample Answer 4 For the Assignment: NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 
Title: NURS 6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System 

Patient Information: 

H, 54, Male, Caucasian

CC: “shortness of breath” 

HPI: James Hendrix is a 54- year-old Caucasian male presents today with shortness of breath that began a few days ago and feeling fatigued all the time. He reports having difficulty breathing at rest that began a few days ago. This shortness of breath is characterized as occurring all the time. Associated signs and symptoms include a productive cough that lasts all night long, abdominal and leg swelling, and a 5 lbs. weight gain. Exacerbating factors include walking and the shortness of breath is worse at night, he is unable to lie in bed and sleeps in a recliner. Nothing relieves the shortness of breath.  

Current Medications: Furosemide 20mg daily (not taken in the last 3 weeks) for edema, Lisinopril 20mg daily for hypertension, and Tamsulosin 0.4mg daily for BPH.  

Allergies: No Known Drug Allergies 

PMHx: Last tetanus shot was 8 years ago, all immunizations are current, received influenza vaccine 2 months ago. Hypertension, BPH, and total right knee arthroplasty (2015). 

 
Soc Hx: Employed as a CPA, married for 30 years, 2 children in high school. Current smoker, 3 cigarettes a day, current alcohol use of 4 beers a week. Patient states always wears a seatbelt while in the car and does not text/ use