case study

Mr. Yu, a 55-year-old female retired worker with a college degree, Who was married, and smoking for 40 years.

History of present health concern: the client had a cough with expectoration after having a cold 2 years ago. After having expectorant cough medicine, his cough relieved, and occasional attacked, sometimes with blood in phlegm, whichcould be alleviated by the same treatment, thus he ignored this. For nearly three weeks, his cough and expectoration got worse then earlier, mostly with adry cough, with blood in phlegm occasionally, since no obvious improvementwith  taking cough expectorant medicine, hepresents to the hospital for help.

Physical examination:

General condition was good, a date pitssized lymph node on the right supraclavicular notch was palpated, with qualitative hard, poor activity, no tenderness. Bilateral thorax was symmetry,rhythmicity breath, fremitus was bilateral symmetric, no obvious increase ordecrease, the percussion note of two lungs was resonance, bilateral breathing sounds was clear, without rhonchi, moist rales or pleural rub. Other examination (-).

Questions:

a. What is the most possible diagnosis of this client? In order to make a accurate diagnosis, what kinds of accessory examination should be done?

b. Please give the nursing diagnoses,collaborative problems, and/or referrals of this client.

作业：

1.叙述正常呼吸音的类型及听诊部位。

2.叙述啰音产生的机理、听诊特点及临床意义。

3.比较大叶性肺炎、阻塞性肺气肿、胸腔积液、气胸的体征。