NURS6531 Week 5 Discussion: Examining Chest X-Rays

NURS6531 Week 5 Discussion: Examining Chest X-Rays

NURS6531 Week 5 Discussion: Examining Chest X-Rays

Chest x-rays are an invaluable diagnostic tool as they can help identify common respiratory disorders such as pneumonia, pleural effusion, and tumors, as well as cardiovascular disorders such as an enlarged heart and heart failure. As an advanced practice nurse, it is important that you are able to differentiate a normal x-ray from an abnormal x-ray in order to identify these disorders. The ability to articulate the results of a chest x-ray with the physician, radiologist, and patient is an essential skill when facilitating care in a clinical setting. In this Discussion, you practice your interprofessional collaboration skills as you interpret chest x-rays and exchange feedback with your colleagues.

Consider the four patient x-rays (Note: By Day 1 of this week, your Instructor will assign you to post on one of these x-rays):

X-ray 1

Note: Please view the Week 5 Discussion area to view the image for X-ray 1.

X-ray 2:

Note: Please view the Week 5 Discussion area to view the image for X-ray 2.

X-ray 3:

Note: Please view the Week 5 Discussion area to view the image for X-ray 3.

X-ray 4:

Note: Please view the Week 5 Discussion area to view the image for X-ray 4.

To prepare:

Review Part 10 of the Buttaro et al. text in this week’s Learning Resources, as well as the provided x-rays.

Reflect on what you see in the x-ray assigned to you by the Course Instructor.Consider whether the patient in your assigned x-ray has an enlarged heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs.


Week 6 Discussion: Diagnosing Gastrointestinal Disorders

In primary care settings, patients often present with abdominal pain. Although this is frequently a sign of a gastrointestinal (GI) disorder, abdominal pain could also be the result of other systemic disorders, making this type of pain difficult to assess. While abdominal pain is most common, many other GI symptoms also overlap multiple disorders, further increasing the difficulty in diagnosing and treating patients. This makes provider-patient communication essential. You must be able to formulate questions that will prompt the patient to provide the necessary information, as this will guide your assessment and diagnosis. For this Discussion, consider potential diagnoses for the patients in the following case studies.

Case Study 1:

A 49-year-old man presents to the office complaining of vague abdominal discomfort over the past few days. He states he does not feel like eating and has not moved his bowels for the last 2 days. His patient medical history includes an appendectomy at age 22 and borderline hypertension, which he is trying to control with diet and exercise. He takes no medications and has no known allergies. Positive physical exam findings include a temperature of 99.9 degrees Fahrenheit, heart rate of 98, respiratory rate of 24, and blood pressure of 150/72. The abdominal exam reveals abdominal distention, diminished bowel sounds, and lower left quadrant tenderness without rebound.

Case Study 2:

A 40 year-old female presents to the office with the chief complaint of diarrhea. She has been having recurrent episodes of abdominal pain, diarrhea, and rectal bleeding. She has lost 9 pounds in the last month. She takes no medications, but is allergic to penicillin. She describes her life as stressful, but manageable. The physical exam reveals a pale middle- aged female in no acute distress. Her weight is 140 pounds (down from 154 at her last visit over a year ago), blood pressure of 94/60 sitting and 86/50 standing, heart rate of 96 and regular without postural changes, respiratory rate of 18, and O2 saturation 99%. Further physical examination reveals:

Skin: w/d, no acute lesions or rashes

Eyes: sclera clear, conj pale

Ears: no acute changes

Nose: no erythema or sinus tenderness

Mouth: membranes pale, some slight painful ulcerations, right buccal mucosa, tongue beefy red, teeth good repair

Neck: supple, no thyroid enlargement or tenderness, no lymphadenopathy

Cardio: S1 S2 regular, no S3 S4 or murmur

Lungs: CTA w/o rales, wheezes, or rhonchi

Abdomen: scaphoid, BS hyperactive, generalized tenderness, rectal +occult bloo

Case Study 3:

A 52-year-old male presents to the office for a routine physical. The review of symptoms reveals anorexia, heartburn, and weight loss over the past 6 months. The heartburn is long standing, occurring most days during the week. He takes TUMS or Rolaids to relieve the discomfort. The patient describes occasional use of ibuprofen for back pain, but denies other medications including herbals. He has no known allergies. He was adopted so does not know his family history. Social history reveals that, although he stopped smoking ten years ago, he smoked for 20 years. He occasionally consumes alcohol on the weekends only. The only positive physical exam finding for this patient was slight epigastric tenderness. The remainder of his exam was negative and the rectal exam was negative for blood.

To prepare:

Review this week’s media presentations and Part 12 of the Buttaro et al. text in the Learning Resources.

Select one of the three case studies listed above. Reflect on the provided patient information including history and physical exams.

Think about a differential diagnosis. Consider the role the patient history and physical exam played in diagnosis.

Reflect on potential treatment options based on your diagnosis.