Mr. Fenske, 58 years old, is brought to the emergency department by his wife wit

Question

Mr. Fenske, 58 years old, is brought to the emergency department by his wife with complaints of difficulty breathing. Mr. Fenske's vital signs are recorded as: blood pressure 145/88, pulse rate 105, respiratory rate 30, pulse oximetry (SpO2) 90%. His immediate admitting diagnosis is acute respiratory distress. His nurse Karen introduces herself to Mr. Fenske and begins to obtain a nursing history regarding his respiratory function.

Karen knows that she must obtain Mr. Fenske's history pertaining to which of the following areas? (Select all that apply)   

Smoking

Bowel sounds

Allergies

Complete blood count

Cardiac risk factors

Smoking

Bowel sounds

Allergies

Complete blood count

Cardiac risk factors

Explanation / Answer

Ans. All areas apply

Smoking

A pulse oximeter measures the percentage of circulating hemoglobin to which oxygen is bound. By standard pulse oximetry, carboxy-hemoglobin is indistinguishable from oxyhemoglobin. Also, carbon monoxide causes a left-shift of the oxyhemoglobin dissociation curve. This means the hemoglobin is holding onto the oxygen more tightly, resulting in a higher saturation of hemoglobin. It is for both of these reasons that students are often taught about the “cherry red” appearance of skin and mucous membranes in carbon monoxide poisoning.** In contrast to hypoxemia (low SpO2) when mucous membranes tend to turn blue due to low oxygen saturation, the hemoglobin saturation in carbon monoxide poisoning will be seen (both by our eyes and by pulse oximetry) as high. Pulse oximetry may be spuriously high in smokers due to the presence of carboxyhemoglobin.

Bowel Sounds

Auscultation is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (heart and breath sounds), as well as the gastrointestinal system (bowel sounds).

Health professionals (doctors, nurses, etc.) listen to three main organs and organ systems during auscultation: the heart, the lungs, and the gastrointestinal system.

When auscultating the heart, doctors listen for abnormal sounds, including heart murmurs, gallops, and other extra sounds coinciding with heartbeats. Heart rate is also noted.

When listening to lungs, breath sounds such as wheezes, crepitations and crackles are identified.

The gastrointestinal system is auscultated to note the presence of bowel sounds.

Allergy

Insect stings, food, antibiotics, and certain medicines may produce a systemic allergic response that is also called anaphylaxis; multiple organ systems can be affected, including the digestive system, the respiratory system, and the circulatory system. Depending on the rate of severity, it can cause a skin reactions, bronchoconstriction, swelling, low blood pressure, coma, and death.

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