Which of the following assessment findings the nurse may expect during physical examination of a patient with… - RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Medical & Surgical Nursing

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Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

Emphysema involves the destruction of alveolar walls, which leads to a loss of lung elasticity and permanent enlargement of airspaces.
This pathology causes air to become trapped in the lungs (air trapping), leading to chronic hyperinflation.
The increased volume of trapped air in the chest acts as an insulator, muffling the sound of air moving through the airways.
As a result, a key finding during auscultation of a patient with emphysema is diminished, quiet, or distant breath sounds.

Option B: Purulent (pus-filled) sputum is a sign of a bacterial infection. While patients with COPD may have chronic sputum production (chronic bronchitis), purulent sputum specifically indicates an infection or an acute exacerbation, not a baseline finding of emphysema.
Option C: Generalized oedema (swelling) is a sign of systemic fluid retention, often due to right-sided heart failure (cor pulmonale). While cor pulmonale can be a late-stage complication of severe COPD, oedema is not a direct respiratory sign of emphysema itself.
Option D: Dull chest pain is not a characteristic symptom of emphysema. Patients may experience a feeling of chest tightness due to the increased effort of breathing, but dull, aching pain is more suggestive of musculoskeletal, cardiac, or other non-pulmonary issues.

Clinical Relevance

Nursing practice connection: Use the key finding related to Physical assessment findings in emphysema to guide bedside assessment, documentation, and the next nursing action.
Auscultation is a critical nursing skill for assessing patients with COPD. Recognizing diminished breath sounds helps confirm the diagnosis of emphysema and establish a baseline for the patient.
Any change from the patient's baseline breath sounds (e.g., the appearance of crackles or wheezes) can signal a complication like an infection or fluid overload, requiring prompt nursing intervention and reporting.
What if? If a patient with known emphysema and diminished breath sounds suddenly develops absent breath sounds on one side along with sharp pain and severe dyspnea, the nurse should suspect a pneumothorax (collapsed lung). This is a medical emergency requiring immediate escalation.

How to Approach the Question

First, identify the core pathophysiology of the disease mentioned in the question. Emphysema is defined by the destruction of alveoli and subsequent air trapping.
Next, think about how this core problem would manifest during a physical examination. Air trapping leads to lung hyperinflation.
Evaluate each option based on this pathophysiology. Consider how a hyperinflated lung would affect sound transmission. Increased air would muffle sounds.
This reasoning directly points to 'Diminished breath sounds' as the correct answer.
Rule out the other options by identifying them as signs of infection (purulent sputum), complications of advanced disease (oedema), or non-characteristic symptoms (dull chest pain).

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 595-597

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 32-34

E6 Medicine Macleod Clinical Examination 15e p. 106-108