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Write a one-page Peer Review of the Case Study below:
Prior to entering Mr. A’s room, I would like to initiate airborne and droplet precautions in order to contain exposure relative to his symptoms. Although it may not be the only infections mechanism that I am immediately considering, a presence of a cough for over a week, bloody sputum production, employment at a school, and presence of fever are suspicious enough to complete screening and to instate controls in an effort to prevent further disease spread. Tuberculosis airborne precaution guidelines from the Center of Disease Control (CDC) include environmental controls such as a room with proper ventilation and HEPA filtration as well as personal protective equipment (a surgical mask for the patient along with a fitted mask for healthcare providers) when possible (2023). Conducting a thorough and appropriate designated tuberculosis screening as well as a general infectious disease screening (similar to what we do in a regular triage) may yield helpful information, but until we know more information we should keep the patient, staff, and patients safe from potential transmission to the best of our ability.
Based upon Mr. A’s history of present illness (HPI), my priority and more focused assessments relative to his complaint and recent history would be the general survey, vital signs, skin, thorax and lungs, and cardiovascular elements. Upon initial contact with Mr. A, I would like to size up his level of consciousness, overall state of health, facial expression, motor activity, speech, skin color, and personal hygiene while simultaneously assessing for signs of apparent distress or pain (Hogan-Quigley & Palm, 2022). Although adult assessment does vary in several ways from pediatric assessment, I triaged a child today and drove my entire process based upon spotting his pallor before he approached the desk (as it turned out, he was hypoxic, lethargic, and needed an immediate sepsis workup). As such, gauging color and interaction upon entering the room can sometimes indicate a serious issue. Sooner rather than later, I would like to see if Mr. A’s vital signs indicate any clinical signs of hypoxia, respiratory distress, and sepsis warnings. As mentioned, a part of this initial contact could also include a screening for potential tuberculosis exposure as well as other infectious disease exposure (COVID, etc.). Assessing his respiratory rate and work of breathing can help greatly to determine if he is in respiratory distress.
Mr. A’s blood pressure readings can help to determine if his lisinopril course is current and effective (in conjunction with verbal questioning regarding his medication regimen) as well as helpful to determine if he may be dehydrated and benefit from fluid resuscitation if hypotensive. Auscultation, appreciation by palpation, measurement, and monitoring of Mr. A’s heart rate and rhythm can help ascertain if there are any irregularities; depending upon other findings as well as symptoms reported by the patient, cardiac monitoring and an EKG can be considered as well. It would also be important to feel for pulse strength and quality in a peripheral location (such as a radial pulse) after auscultating the patient’s apical pulse. The patient’s temperature should also be measured in order to ascertain if the patient may be febrile or hypothermic. Mr. A reported a previous fever with the onset of his illness but may be experiencing either end of the spectrum or normothermia at this time. Mr. A’s oxygen saturation levels (at rest and while ambulating) can also provide very helpful information to help determine if there is an immediate need for interventions (breathing treatments, oxygen, etc.). At that time, I would also want to assess Mr. A’s pain and gauge if he is having chest pain, currently having a headache as previously reported, or any other pain and discomfort. This can help set goals for the patient to make him more comfortable as well as to reveal important clinical findings based upon the location, severity, and quality of pain.
I would also like to appreciate Mr. A’s lung sounds after visually observing his work of breathing and positioning. With his cough history and extensive history of smoking, I would listen for presence of adventitious lung sounds if applicable; I would also like to take note of the sound and quality of his cough as well as visualize and culture any sputum specimens that may present themselves. I can also quickly assess Mr. A’s skin by looking for traits such as cyanosis, other discoloration, edema, and moisture level while also feeling the skin temperature (Hogan-Quigley & Palm, 2022). I would also take note of any papules or lesions evident. Any findings of peripheral or central cyanosis or even mottling or paleness could indicate a higher severity of respiratory illness. From a peripheral vascular perspective, I would also like to appreciate his capillary refill centrally and peripherally; this could be particularly helpful to identify shock if present.
Due to Mr. A’s ongoing headache, I would also like to perform a neurological assessment and ensure to take note of any deficiencies or abnormalities. Although the red flag seems to be his respiratory symptoms, this certainly does not preclude him from having a neurological issue concurrently or as a part of the overall illness. The other aforementioned domains can provide helpful data and context whether in an outpatient or emergency care setting and should not be forgotten following the primary and focused assessment pieces. For example, the patient denied having a sore throat. However, once the priority assessment components are addressed and any immediate interventions are carried out, conducting and ENT assessment may result in provision of helpful data, or can at least serve to potentially rule out certain issues.
References
Centers for Disease Control and Prevention. (2023, December 19). About tuberculosis. Centers
for Disease Control and Prevention. https://www.cdc.gov/tb/about/index.html#cdc_disease_basics_causes_risk_spread-how-it-spreads
Hogan-Quigley, B., & Palm, M. L. (2022). Bates’ Nursing Guide to Physical Examination and
history taking (3rd ed.). Wolters Kluwer.
Direction for Peer Responses:
Peer responses must be specific and not simply restate what your peer has said. You do not need to assess the quality of your peer’s work (e.g., good job with your post). Give your peer authentic feedback to engage in a scholarly discussion. Expand on Ideas: Instead of simply rephrasing what your peer said, aim to expand on their ideas. Add depth to the discussion by providing additional information, perspectives, or examples related to the topic. For instance, “Building on your point about [topic], I would like to add…” Offer a Counter Argument: If you have any critiques or suggestions for improvement, provide them in a constructive manner. Be specific about what aspects of their argument or reasoning could be enhanced. For example, “While I agree with your analysis of [topic], I believe considering [alternative perspective or evidence] could strengthen your argument.” Share Personal Experiences or Examples: Draw from your own experiences or clinical practice to illustrate or support your points. This adds authenticity and relevance to your response. For instance, “In my clinical experience, I encountered a similar situation where [describe situation]. This relates to your point about [topic] because…” Pose Thoughtful Questions: Encourage further discussion by posing thoughtful questions to your peer. These questions can help deepen their understanding of the topic or prompt them to consider alternative viewpoints. For example, “I’m curious about your thoughts on [related aspect of the topic]. How do you think [specific factor] influences [topic] in the context of [setting]?” Provide Evidence or References: If applicable, support your points with evidence from scholarly sources or relevant literature. This demonstrates academic rigor and enhances the credibility of your response. For example, “Research by [author] suggests that [fact or finding], which aligns with your argument about [topic].” Encourage Dialogue and Collaboration: Conclude your response by inviting your peer to continue the discussion or collaborate on future projects. This fosters a sense of community and engagement within the academic environment. For instance, “I look forward to hearing your thoughts on [related topic]. Peer reviewed scholarly resources should be used and a minimum of 2 references are required.
Correct APA format, including references and citations, writing mechanics, grammar, spelling, and punctuation are used.
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