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Nursing assessment

Nursing assessment

Nursing requires that the practitioner should be able to recognize various features of the human body and their functionality. The life of their clients is on their hands, and for them to remain effective, they must assess the patients’ problems with competence and care. That is a compulsory requirement all round (Weber & Kelley, 2009).

Scenario 1

For effective examination to take place there is a need to consider important guidelines and principles, especially when using the four methods of examination, i.e. inspection, auscultation, percussion and palpation. Principles that should be considered while examining the Sarah’s conditions are as follows:

a. The examination should end up with the parts that the patient considers irritation causing. This aids in avoidance of making early conclusion and avoiding other problems that exist but unnoticeable.

b. It is always important to conduct the examination in this order: start with inspecting, then auscultation, then percussion and end with palpation. This ensures that the patient undergoes least discomfort.

c. Organs that move during respiration should be allowed to palpate the waiting fingers.

Percussion is done well by shifting dullness away from broadened or inflamed intra-abdominal organs (Giger & Davidhizar, 2008).


In most cases, the patients of appendicitis lie still to avoid the pain caused by the peritoneal irritation caused by movements. With the signs given, Sarah is most likely suffering from acute appendicitis. Therefore, further examination of the abdomen is required. Patients of this disease are most likely to feel tenderness at the right lower quadrant of the abdomen. This is because of the localized muscles rigidity and inflammation. It is also associated with rebound, quivering, or tenderness on taping (Cleary, 2010).

Right lower quadrant tenderness is the most reliable among all symptoms of acute appendicitis. Its occurrence should be considered as a notification of appendicitis, whether other symptoms are present or not.

However, a professional should not jump into conclusion without joining all the observations and decide on what should be done. Other multiple symptoms are usually observed, and they should be used to come up with a reliable conclusion. They include:

1. Rovsing’s sign: this is where the patient experience pain in the right lower quadrant on palpation of the left lower quadrant.

2. Psoas sign: this is pain when the leg at the right hip is flexed.

3. Obdurator sign: this is pain when the right the flexed right thigh is rotated.

This signs also indicate peritoneal inflammation (Klingensmith, 2008).

After these signs are noted, essential diagnosis is a just away from being concluded. A collection of all the symptoms puts deep emphasis on the fact that Sarah if suffering from appendicitis.

Diagnostic investigation

Sarah should undergo an abdominal computerized tomography to verify that she is really suffering from appendicitis, or it is just gastroenteritis. X-ray shows the level of damage. The ultra-sound can be used to measure the diameter of the appendiceal. If it is more than 6mm, then the patient may be suffering from the acute appendix. However, it is hard to diagnose perforated appendicitis with ultra-sound (Klingensmith, 2008). It helps in assessing the level of damage and the method best for appendectomy. Usually, gastroenteritis has the same symptoms as the appendicitis. This is even more essential in case the only symptoms are pain and tenderness at the right lower quadrant, and the other symptoms are not there, or the patient is not sure where she is exactly feeling pain. The white blood cell count is also essential. This is usually associated with the perforation for the case of progression to perforation. The leucocytes increase in number at the point of perforation in order to protect the place from more harmful organs (Klingensmith, 2008).

Treatment and care

Due to dehydration, intravenous fluids should be begun. The urine flow should be closely monitored. Dehydration causes reduction in the flow of urine. It should be made sure that her flow is normal and of enough quantity. This is called preoperative preparation of appendicitis. When Sarah will be diagnosed with appendicitis, she will be taken to operating room without delay so as to reduce the chances of more infection to perforation (Fleisher & Ludwig, 2010). The first problem to solve for Sarah is the treatment of the disease. Treatment can be of two ways: either open appendectomy or laparoscopic appendectomy. Sarah is a mother and therefore, she need to get well fast for her child, also to ensure that all the other conditions are also diagnosed. Therefore, laparoscopic appendectomy is the most appropriate for her. This is because, laparoscopic appendectomy heals fast- one month. It causes a few wounds, and fewer healing problems (Marshall Cavendish Corporation, 2007). However, the problem with this operation is that other organs are affected when the insertions are made. In addition, this type of appendectomy is very expensive (Denny, Costello & Cochran, 2004).

Open appendectomy would be rational if the family did not have enough money for the laparoscopic appendectomy, and to ensure efficiency of the operation. Unaffected organs can be protected. It causes more wounds, and takes time to heal (Klingensmith, 2008). The husband will be put under counselling. This will help him to take care of them without a lot of distress for the time of diagnosis.

Scenario 2

Mr. Johnson will be assesses as follows: there will observation on Symmetry of Chest Expansion, Signs of Increased Respiratory Effort, Changes in Skin Color; Air Movement at Mouth & Nose, Air Movement in Peripheral Lung Fields will be listened to; Air Movement at Mouth & Nose, and Symmetry of Chest Expansion will be felt. The movement of the chest wall and the depth of breathing will also be observed so as to assess the effort used in breathing. The respiratory rate should be observed for one complete minute.

Most people suffering from respiratory diseases have irregular breathing patterns; therefore, regularity should be determined so as to ensure that the survival rate of the Mr. Johnson is high. The Chyne stokes breathing pattern shows the breathing patterns just before death, which are usually irregular. The accessory muscles will be observed, because they usually strain hard in case the muscles in the thoracic area are struggling. The kind of breathing should also be note, either slow, fast or shallow breathing. Observation on the increase in temperature will be made (Orient, 2009).

Percussion will be used, where the chest is tapped lightly. If the lung is inelastic, i.e. consolidation, because of pneumonia, a dull thud will be heard instead of a hollow drum-like sound. The sound can also be caused by pleural effusion, which is the filling up of space between the two lungs (Ferguson, 2009). Among the tools important in the examination is the stethoscope. It aids in observing the through listening to the sounds made in the chest of a pneumonia victim (Williams, 2009). These sounds include:

1. Rales, or crackling sound. They can be heard on one side of the chest or another when the patient is lying on the ground. This suggests that there is a high probability of pneumonia presence.

2. Mostly, there is abnormal rumbling that point out that there is a lot of sputum blocking the airways. In most cases, the thermometer is important in measuring the temperature of the patient. Usually, a pneumonia patient has high fever. The pulse oximeter measures the pulse rate. In most cases, pneumonia victims have a very slow heartbeat (Tuvesson, Wann-Hansson & Eklund, 2011).


All of these symptoms aids in the conclusion of which diagnostic investigation should be carried out and prioritizing of the treatment procedures. Diagnosing pneumonia is difficult because many hospitalized patients show the same symptoms:

  1. Most of the hospitalized patients have same symptoms, e.g. fever or signs of lung permeation on x-rays.

For these patients, sputum or blood tests often indicate the invasion of bacteria or other organisms, and these agents do not necessarily mean that there is pneumonia (Joshi, 2010). However, this common conditions coming in the investigation are ruled out by the following diagnosis:

a. Chest x-ray: this shows the position of the infection and the extent of the infection. Pneumonia has a distinct positioning in the lungs.

b. Lung fluid sample: the colour of the sputum that has been coughed up by Mr. Johnson will reveal the extent of the disease, and the organisms in it will be tested so as to verify that they are bacteria caused by the disease. He will be asked to cough as deep as possible in order to bring the sputum from the lungs. For Mr. Johnson, it may be hard to give a hard cough. To make him produce enough sputum, I will give him saline spray. For another alternative, a tube should be put through the nose to the lower tract to ignite a deeper cough. If the sputum contains blood, or it is brown, green or yellow then there is an infection (Gina, 2011).

c. Two sets of blood cultures. This is done to determine which organ is causing pneumonia. White blood cell count may be very high thus indicating the presence of harmful bacteria.

d. Urine analysis for legionella pneumophila. It is usually conducted when the condition is very severing like one of Mr. Johnson.

e. Invasive tests: in critically ill patients who maybe undergoing ventilator associated pneumonia, sampling of the fluid from the lings or the trachea. It is very specific and aids in identifying the pneumonia-causing bacteria. This aids in administration of the right antibiotic (Gina, 2011).


If Mr. Johnson will be diagnosed for pneumonia, he will be given the appropriate antibiotics i.e. different antibiotics serve as different cures for different types of pneumonia or their causes. Alongside that, Mr. Johnson will be advised to have bed rest, to take plenty of fluids, therapy coughing, breathing work outs, appropriate diet, pain killers and fever reducers e.g. aspirin for adults. Oxygen therapy and artificial ventilation will be administered in severe cases (Ferguson, 2009).

The son should be advised on the essentials of being near him, and supporting him during the illness and after illness. Healing is said to come from within. Therefore, the son and the family member will be advised to encourage him, and show him love. Due the fact that he is recovering from another operation, less intense medical treatment should be administered. This will enable him to tackle both treatments (Vadivelu, 2011).


Health assessment of a patient is as important as the treatment itself. As mentioned earlier, effective examination can only take place if the practitioner knows the features of the body and their functionality very well (Ferguson, 2009).


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