NSG 3012 Week 1 Discussion – Introduction to Physical Assessment

NSG 3012 Week 1 Discussion – Introduction to Physical Assessment

The thyroid gland is complex and initiates multiple body reactions. Understanding the function and causes of the thyroid gland in depth can help a nurse greatly when assessing a patient with multiple symptoms that usually wouldn’t lead to a definite diagnosis. The tympanic membrane is small but is intertwined with such a vital part of the human body. One of the areas of the body that is less known by people, not in the medical field, this little part of the body causes a huge change within a person with a tympanic membrane issue. A detailed assessment of both can positively affect patient care when the proper diagnosis is made.

Tympanic Membrane Assessment

To assess the tympanic membrane, you will perform an otoscopic exam. To begin the exam, especially with a child, a trusting relationship needs to be established. This is a very simple exam but can be frightening when looking at the equipment and the touching inside the ear. To start, you will gently pull the top of the ear upward and back in an adult. If this was a child, you would gently pull downward and back. Hold the otoscope like a pen/pencil and use the little finger area as a fulcrum. This prevents injury should the patient turn suddenly [ACh97]. During the examination, you should be aware of the color of the membrane. It can range from white, yellow, and red. A normal color to be present is pinkish and translucent in a neutral position. The Malleus lies in an oblique position behind the upper part of the drum. The tympanic membrane in a normal, healthy patient should be intact and movable.

Thyroid Assessment Methods

When assessing a thyroid, you can approach this in two different ways. The most common is the posterior method, which is usually taught in nursing school. To assess the thyroid in a posterior approach, you will begin behind the patient with the patient sitting down. You will then, using both hands, place the middle and index finger in the middle of the neck. Usually, this is 2cm above the suprasternal notch on the patient. The thyroid gland should not be enlarged. If enlarged, you should always record the size, consistency, and shape. The second way to assess a thyroid is an anterior approach. In this case, the examiner will be in front of the patient. The examiner will place his hand around the sternocleidomastoid muscle. The patient will then be asked to swallow. The examiner is looking for a non-palpable thyroid gland.

NSG 3012 Week 1 Discussion – Introduction to Physical Assessment

1^st Assessment

S- 32-year-old female complaining of increased restlessness, sweating, inability to concentrate, unexplained weight loss, tiredness, and emotional instability.

O- Family history obtained, and no major disease noted in the immediate family. Pt listed current medications are taken on a regular basis as a multivitamin and Tums for heartburn. Questioned the patient about any recent lifestyle changes, including increased stress, change of diet, or moods, and Pt denied any major changes. He denies any alcohol and drug use.

A- Pt vital signs obtained. The patient’s respirations were elevated at 22 bpm, and the pulse rate was elevated to 120 at rest. Patient unable to remain still during assessment and small amount of sweat noted to forehead. The patient eyes were noted to be slightly protruding. The assessment was noted to be normal in all other areas. During this time, I placed the patient in a quiet, dimmed room to decrease stimulation.

P- Labs were drawn, and TSH levels were observed. Normal ranges for TSH are 0.5-5.0. The patient’s current TSH level is 0.1, which is being suppressed. Followed by this lab will include an Iodine uptake test to determine how much Iodine the thyroid is using. An assessment has been made that this patient exhibits the signs and symptoms of Graves’ disease or Hyperthyroidism. This disease is present when the thyroid gland is producing too much TSH. At this stage, your T3 and T4 levels will be high. Options for treating hyperthyroidism can range from surgery to medication treatment such as PTU, which cannot be stopped abruptly once begun. Patients with hyperthyroidism require vigilant care to prevent acute exacerbations and complications [Mat13]. Some home treatments to help alleviate some of the eye discomfort are to use lubricating eye drops, wear sunglasses, and elevate the head of the bed.

NSG 3012 Week 1 Discussion – Introduction to Physical Assessment

2^nd Assessment

S- A 5-year-old child was brought in, and the mother states that the child is constantly tugging on his ear and has had symptoms of a cold, such as a runny nose and itchy eyes, for a little over a week. Pt has run a low-grade fever of 100.1 for three days.

O-Mother states the child hasn’t had any recent lifestyle changes and plays outside for around an hour a day. The child isn’t on any current medication and has no allergies. The mother of the child did mention at the end of the conversation that her son has been swimming every day this week at his grandparents’ house. She also stated as a baby, he would have ear infections at least every 2 months.

A- Pt’s vital signs are stable with the exception of the low-grade fever. The patient eyes are slightly red, and a small amount of yellow discharge is noted on the nose and ears. A very mild nonproductive cough was noted as well.

P- Throat swab and culture from ear drainage obtained. Diagnosis of Otis Externa. Due to child’s increased swimming activity and previous cold this could have been a contributor to the diagnosis. In cases like this with children, an examiner will provide a prescription of ear drops to be used daily. Several interventions can help reduce the risk of recurrent infections. These include avoidance of tobacco smoke, breastfeeding, continuous low-dose antibiotics, and/or surgical placement of tubes in the ears[Jer13]. I would encourage the mother to refrain the child from swimming until the condition has cleared and all medications have been taken.

Conclusion

While many of the symptoms noted in thyroid cases and tympanic cases can be vague, if you perfect your assessment skills and take time to really notice the details and complaints of your patient, you can provide important information and findings to the patient’s doctor and become one step close to providing treatment. Key tests and exams will guide you in making the correct nursing diagnoses for your patient.

References

Chandrasekhar, M. (1997). Otoscopic Examination. Retrieved from Loyola University Medical Education Network: http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pd/pstep18.htm

Klein, J. O. (2013, August). Patient information: Ear infections (otitis media) in children (Beyond the Basics). Retrieved from Up to Date: http://www.uptodate.com/contents/ear- infections-otitis-media-in-children-beyond-the-basics

Vera, M. (2013). Seven Hyperthyroidism Care Plans. Retrieved from Nurse Labs: http://nurseslabs.com/7-hyperthyroidism-nursing-care-plan-ncp/

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