NUR 634 Topic 4 DQ 2

Discussion: Practice the physical exam techniques outlined in the topics assigned Bates Physical Examination Videos and write a reflection on the following:

NUR 634 Topic 4 DQ 2 Assessment Description

Practice the physical exam techniques outlined in the topic’s assigned Bates’ Physical Examination Videos and write a reflection on the following:

Identify three techniques that you learned from the videos.

What aspects of the assigned physical examination are you doing well?

What are you going to focus on for improvement as you practice for the skills check off?

Scholarly resources are not required.

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Resources

Bates’ Guide to Physical Examination and History Taking

Required

Read Chapter 15 in Bates’ Guide to Physical Examination and History Taking.

View Resource

Bates’ Visual Guide: 12-Month Access Card to BatesVisualGuide. NUR 634 Topic 4 DQ 2 com With OSCE Clinical Skills Videos

Optional

View and complete video segments 9.1–9.5 in “Volume 9: Thorax and Lungs,” in Bates’ Visual Guide: 12-

https://batesvisualguide.com/

CareOnPoint

Optional

Read “Pulmonary Disorders,” located in the CareOnPoint? application.

http://app.careonpoint.com

NUR 634 Topic 4 DQ 2 Sample

A physical exam is crucial in patient evaluation and formulating a clinical diagnosis. Chest examination is used to assess the respiratory and cardiovascular systems. One important skill that I have learned is chest percussion. I have noted the importance of hyperextending the distal interphalangeal joint of the middle finger and striking the middle phalange using the opposite-hand middle finger in producing good percussion sounds. I have also learned how to differentiate resonant, hyper-resonant, dull, and stony dull percussion sounds and their relevance (Morgan, 2022). In addition, I have learned the importance of inspecting chest movements and palpating for chest excursion and expansion in identifying any pathology that may cause diminished airflow to one or both lungs. NUR 634 Topic 4 DQ 2 I have also learned the importance of palpating for tracheal deviation and cardiac impulse displacement in identifying conditions such as pneumothorax, pleural effusion, and lung collapse. 

During this experience, I have noted that I can confidently inspect and palpate the chest during a routine physical examination. On inspection, I can confidently identify chest wall deformities such as kyphosis, scoliosis, and barrel chest (Squires, 2022). In addition, I can also identify some signs of respiratory distress, such as the use of respiratory muscles of respiration, such as abdominal and sternocleidomastoid muscles, and tachypnea on inspection. I can identify the side to which the trachea is deviated or cardiac impulse displaced and proceed to perform percussion to identify the underlying pathology. NUR 634 Topic 4 DQ 2

However, I need to improve my auscultation skills. I have noted I have been experiencing challenges differentiating between fine and course crackles in certain lung pathologies (Arts et al., 2020). As a result, I am making it a routine to listen to lung sounds in different patients and on online videos. I have also noted I sometimes confuse dull and stony percussion notes, resulting in clinical misdiagnosis.

NUR 634 Topic 4 DQ 2 References

Arts, L., Lim, E. H., Marinus, P., Heunks, L., & Tuinman, P. R. (2020). The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: A meta-analysis. Scientific Reports, 10(1), 1-11. https://doi.org/10.1038/s41598-020-64405-6

Morgan, S. (2022). Respiratory assessment: undertaking a physical examination of the chest in adults. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 37(3), 75–82. https://doi.org/10.7748/ns.2021.e11602

Squires, E. (2022). Practice Nursing – Assessment and examination of the respiratory system. Practice Nursing. https://www.practicenursing.com/content/clinical/assessment-and-examination-of-the-respiratory-system/ NUR 634 Topic 4 DQ 2