Question

Part 2

P.A. is a 72-year-old female who presents to the family practice with her 40-year-old daughter. The daughter states that her mother has been confused lately, complaining of a headache, shortness of breath, and coughing. The cough has been persistent for 6 days, and a fever developed 2 days ago. The patient states that she is bringing up yellow-green mucus and has a cough, which gets worse at night. Vital signs are T 100.5, P 88, R 16, and BP 110/55. Lungs are positive bilaterally for wheezing, positive egophony. A chest x-ray reveals consolidation indicative of bacterial pneumonia. Labs and culture are pending for specific antigen. The nurse proceeds with the physical exam of the head, face, neck, and associated lymphatic system.

1. When performing a review of systems, the nurse obtains subjective data concerning the patient’s headache. What specific questions will assist the nurse in determining the cause of the headache?

The nurse proceeds to palpate the lymph nodes.

2. Which lymph nodes are located in the neck?

3. When performing the physical examination, what objective data should the nurse inspect and palpate for the head and neck?

4. How might the physical examination vary given the patient’s age?

Answer 1

1. The specific question which assists the nurse while examination is the possibility of meningitis as well as sinusitis. In the case of bacterial pneumonia there are equal chances of appearance of meningitis as well as sinusitis. The nurse should palpate the cervical lymph nodes to check lymphadenopathy in the patient.

2. Cervical lymph nodes are most common lymph nodes found in the neck.

3. While performing the physical examination, the nurse should follow the kerning's sign guidelines. In this condition, the stiffness appears and the patient is unable to straighten the legs when their hips are flexed to ninety degree.

4. Concerning the patient's age (as the patient is very old) while kerning's sign her neck should not be extended, due to old age she must be suffering from osteoporosis.