Assignment:Identifying Normal and Abnormal Findings in Patient Presentation.

Assignment:Identifying Normal and Abnormal Findings in Patient Presentation.

Assignment:Identifying Normal and Abnormal Findings in Patient Presentation.

Identifying Normal and Abnormal Findings in Patient Presentation.

Discussion 1

A patient is said to be unconscious or having an altered level of consciousness if their alertness levels is reduced or they cannot be easily aroused. Reduced level of unconsciousness is usually due to an injury to the cerebral hemispheres or disruption of the ascending reticular activating system following a neurological disorder, metabolic disturbances, drugs or alcohol intoxication and psychiatric disorders (Cooksley et al., 2018).

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 When assessing an unconsciouspatient, the initial assessment should followthe ABCD algorithm where a healthcare practitioner checks if the patient’s airways are patent and if they are breathing with any difficulties. Care should be taken to rule out Cheyne stroke ventilation, kusmall breathing and central hyperventilation. The pulse rate, blood pressure and the temperature of the patient’s peripheries will reveal their circulation status. Patient should also be assessed to locate any disabilities or injuries on their bodies that could have resulted to their condition.

The patients level of consciousness should then be assessed using the Glasgow Coma Scale (GCS) which has three components, that is, eye opening, verbal response and motor response with low scores indicating that the patient is critical(Li et al., 2021).The central nervous system should be assessed and this entails the assessment of the cranial nerves and the motor functions where one checks for muscle power, tone and bulk. When assessing the cranial nerves, the pupil should be carefully assessed for the size, symmetry and its reaction to light. A gag reflex, cough reflex and corneal reflex will also be helpful in this patient. A fundoscopy to rule out papilledema and increased intercranial pressure is also crucial.

References.

Cooksley, T., Rose, S., & Holland, M. (2018). A systematic approach to the unconscious patient. Clinical Medicine, 18(1), 88–92. https://doi.org/10.7861/clinmedicine.18-1-88

Li, A., Atem, F. D., Venkatachalam, A. M., Barnes, A., Stutzman, S. E., & Olson, D. M. (2021). Admission Glasgow Coma Scale Score as a Predictor of Outcome in Patients Without Traumatic Brain Injury. American Journal of Critical Care, 30(5), 350–355. https://doi.org/10.4037/ajcc2021163

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Discussion 2

Potassium levels above the normal above 5.5 mEq/L, is considered hyperkalemia. Mild hyperkalemia is usually asymptomatic but severe cases of hyperkalemia i.e. potassium levels > 6.5mEq/L usually gives rise to life threatening complications such as arrhythmias and paralysis(Palmer et al., 2021).

When conducting a head to examination the practitioner should be keen to pick up the signs of these complications. Checking the face of the patient to determine if they are alert or not as severe electrolyte abnormalities cause altered levels of consciousness. In the head and neck region one should check for any signs of hypoperfusion such as central and peripheral cyanosis and features of respiratory distress. This is because hyperkalemia can paralyze muscles that aid in respiration. Asses the the jugular and carotid pulses as hyperkalemia is known to cause cardiac toxicity which presents with palpitations, arrhythmias, tachycardia and cardia conduction abnormalities(Saad et al., 2021). Palpate for other pulses and compare with the rest noting the rhythm and rate. Inspect the chest for any signs of a hyperactive precordium which can be indicative of palpitations. Palpate and auscultate for any added heart sounds.

Inspect the chest for any movements to rule out paralysis. Auscultate the lungs  to check for air entry. In the limbs, inspect for the color to rule out cyanosis of the peripheries, inspect for edema to rule out heart failure and kidney failure complications. Feel for the local temperature and take blood pressure to rule out heart failure. Check for muscle power, muscle tone and bulk to rule out muscle paralysis. Deep tendon reflexes should also be checked in all the limbs as they might be diminished or reduced in cases of hyperkalemia.

References

Palmer, B. F., Carrero, J. J., Clegg, D. J., Colbert, G. B., Emmett, M., Fishbane, S., Hain, D. J., Lerma, E., Onuigbo, M., Rastogi, A., Roger, S. D., Spinowitz, B. S., & Weir, M. R. (2021). Clinical Management of Hyperkalemia. Mayo Clinic Proceedings, 96(3), 744–762. https://doi.org/10.1016/j.mayocp.2020.06.014

Saad, S. M., Yasin, S., Jain, N., & LeLorier, P. (2021). Cardiac Manifestations in a Case of Severe Hyperkalemia. Cureus. https://doi.org/10.7759/cureus.13641

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Each discussion board requires a minimum of 250 words and at least 1 peer reviewed article within the last 5 years. APA format required.

Discussion 1: You walk into a patient’s room and find him unconscious; he does not greet you when you walk in. What are some initial assessment techniques that need to be employed and why?

Discussion 2: You just reviewed the morning laboratory report for a patient in critical care. You noted that the potassium level is 6.5 mEq/L. What areas of the patient would you need to assess to monitor for complications from hyperkalemia? Explain your approach in a head to toe assessment.