...Nurse Practitioner. Approved by the department Chief, Director of Nursing Practice, Physician-in-Chief or designees, and Medical Group Administrator. II. The Standardized procedure will be reviewed annually and revised if necessary. REVISION DATED ______________ REVIEWED DATED _______________ ______________ _______________ ______________ _______________ III. The Standardized Procedure was approved by the following. MEDICINE __________________________________________ DATE ______________ (Chief of Department) MEDICINE __________________________________________ DATE ______________ (PIC/Designee) NURSING ___________________________________________ DATE ______________ (Director of Nursing Practice) ADMINISTRATION ___________________________________ DATE ______________ (Medical Group Administrator) IV. PRACTITIONERS FUNCTION UNDER THIS STANDARDIZED PROCEDURE: Current list of authorized personnel are on file in the office of the Medical Group Administrator and department manager. PROTOCOLS: Childhood Asthma Acute Asthma Chronic Asthma References: Attached CHILDHOOD ASTHMA PROTOCOL I. RATIONALE This protocol will assist in the history, symptoms, physical exam, diagnostic tests, treatment, and follow-up visit for Childhood Asthma II. SYMPTOMS A. Acute 1. Dyspnea 2. Hypoxemia...
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...ASTHMA BRIEF BACKGROUND OF THE STUDY Asthma is a chronic disease of the respiratory system in which the airway occasionally constricts, becomes inflamed, and is lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an environmental stimulant (or allergen), cold air, warm air, moist air, exercise or exertion, or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold. This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing. The airway constriction responds to bronchodilators. Between episodes, most patients feel well but can have mild symptoms and they may remain short of breath after exercise for longer periods of time than the unaffected individual. Signs and symptoms In some individuals asthma is characterized by chronic respiratory impairment. In others it is an intermittent illness marked by episodic symptoms that may result from a number of triggering events, including upper respiratory infection, stress, airborne allergens, air pollutants (such as smoke or traffic fumes), or exercise. An acute exacerbation of asthma is referred to as an asthma attack. The clinical hallmarks of an attack are shortness of breath (dyspnea) and either wheezing or stridor. Although the former is "often regarded as the sine qua non of asthma," some patients present primarily with coughing...
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... Identify common concerns related to long-term use of opiod medications. 4. What are the top three nursing diagnosis priorities for a patient with an acute exacerbation of chronic pain? 5. Identify and explain at least two adjuncts, other than medications, that are used for chronic pain management. 6. Describe the possible impact of chronic pain on the psychosocial, spiritual, cultural, and developmental levels of a patient. Asthma 1. What are the risk factors for asthma? 2. Describe routine nursing care that would be appropriate for a homecare patient. 3. Describe education a patient requires to self-administer nebulizer treatments. 4. What are the top three nursing diagnosis priorities for the patient having an asthma attack in the home. 5. Identify three common complications for untreated asthma. Explain the nursing care designed to prevent each of these complications from occurring. 6. Describe the effects of common asthma medications. 7. Prepare for teaching a patient with limited English proficiency how to manage asthma at home. Tuberculosis 1. What are the risk factors for tuberculosis? 2. Describe three different types of tuberculosis and the common treatment recommendations for each. 3. Identify common concerns related to long-term administration of tuberculosis medications. 4. What are the top three nursing diagnosis priorities for a patient with tuberculosis? 5. Describe combination medications for tuberculosis...
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...NRSG240 Final Test note CARDIAC NURSING 4 AMI 4 Definition (3marks)- very detailed needed. 4 Clinical manifestations of AMI. (5marks) 4 Nursing Interventions and Rationale for Managing a patient with Acute Chest pain(6marks) 4 and Ineffective Tissue perfusion (6marks) 5 Acute chest Pain 오류! 책갈피가 정의되어 있지 않습니다. 1. PQRST questions to evaluate MI- intensity, location, radiation, duration, precipitation & alleviating factors, in order to accurately evaluate, treat and prevent further ischaemia. 오류! 책갈피가 정의되어 있지 않습니다. 2. Semi-Fowler’s position & O2 therapy 2L via Hudson Mask in order to increase oxygenation of myocardial tissue & prevent further ischaemia. 오류! 책갈피가 정의되어 있지 않습니다. 3. Administer medications- Morphin (normally 2.5-5mg) & anginine 600mcg (given every five minutes; maximum 3 tablets in order to relieve/prevent pain & ischemia to decrease anxiety & cardiac workload. 오류! 책갈피가 정의되어 있지 않습니다. 4. 12-lead ECG & monitor in order to check hypotension & bradycardia, which may lead to hypoperfusion. 오류! 책갈피가 정의되어 있지 않습니다. Ineffective tissue perfusion 오류! 책갈피가 정의되어 있지 않습니다. 1. Monitor vital signs (Hourly) and saturation oxygen to determine baseline and ongoing change. 오류! 책갈피가 정의되어 있지 않습니다. 2. Administer oxygen by Hudson’s mask (6-10L/min) and monitor the effectiveness to increase oxygenation of myocardial tissue and prevent further ischaemia. 오류! 책갈피가 정의되어 있지 않습니다. 3. Monitor respiratory status for sysptoms of heart failure to maintain appropriate levels of oxygenation...
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...Nursing Care Plan The patient is , a 72 year old man who has been admitted for dyspnea or shortness of breath. reported that he has been coughing for the past week and his coughing has accompanied sputum discharge. His past medical history includes emphysema and chronic bronchitis. He used to smoke but has stopped since a year ago for economical reasons as well as it is also bad for his asthma. His bowel movements have also been irregular since his admission. He also reported that he is feeling depressed and fearful about the future. Further examination revealed that he has crackles in his left lower lobe with diffuse expiratory wheezing throughout his chest. Chest percussion also revealed his left lower lobe to be dull. Needs / Problems Goals Interventions Evaluation Dyspnea or shortness of breath Use the visual analog scale (VAS) to make an objective assessment of dyspnea. The VAS is a 100-mm vertical line with end points of 0 and 10. zero is equated with no dyspnea and 10 is equated with the worst brethlessness the client has experienced ( & , 2004) Dyspnea is difficult to quantify and to treat (Potter & Perry, 2004). Interventions need to be individualized for each patient, and more than one therapy is usually implemented. The underlying process that causes or worsens dyspnea must be treated and stabilized initially. Three additional therapies have to be implemented: pharmacological measures, physical techniques,...
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... With a previous diagnosis of asthma, her medications include an albuterol inhaler which she uses 3 to 5 times a day for the past 3 months. Her 14 point system review was unremarkable except for the chest which revealed wheezing on inspiration and expiration. It was noted that she was well-developed in mild distress. The differential diagnosis for this patient bronchitis, allergic rhinitis, chronic obstruction pulmonary disease (COPD), and asthma exacerbation. Bronchitis is a respiratory condition that is characterized by inflammation of the lung mucus membrane. Typical symptoms are a persistent coughing, shortness of breath (SOB), chest discomfort, and...
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...1. Discuss the pathophysiology of asthma. The pathophysiology of Asthma includes inflammation of the airway. The way in which this works is from an irritant which can include dust, pollen, cedar, or cat hair. When a reaction occurs, the airways become inflamed and narrow. The narrowing occurs because once the inflammatory response is triggered by an irritant, histamines, immunoglobulin E antibodies, and leukotrienes are released. Because of this, mucous production occurs. Since the bronchioles are inflamed and narrow, breathing becomes difficult. Wheezing sounds can be heard due to the lack of air being able to easily move in and out of the narrowed bronchioles. 2. Discuss the educational points that should be included when implementing standard education for the asthma patient. The standard education points when taking care of an asthmatic patient would be the important of recognizing the symptoms of an asthma attack. This is important so the patient would know when to use their inhaler before the situation becomes too severe. The patient should be aware that tightness of the chest, feelings of difficulty breathing, and the sound of wheezes are all indicators of an attack and the need for an inhaler. Another education point would be what can trigger asthma attacks. The patient should be educated on how changes in elevation, weather, cigarette smoke, animals, and exertion of the body can all trigger an asthma attack. The patient should be told to always carry their inhaler...
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...Assessment Case Study Introduction The focus of this case study is to examine further focused assessments that should be undertaken after Mr S's initial presentation of acute exacerbation of asthma. Reasoning for recommended focused assessments will be discussed with consideration of Mr S's presentation of symptoms, history, pathophysiology and risk factors for asthma exacerbation. Research on current asthma assessment protocols will guide recommendations, and assessment parameters will be described. Follow up care and self-management options for Mr S will also be explored. Asthma Asthma is a chronic inflammatory disease of the lungs. It is characterised by airflow obstruction and lung inflammation (Johnson, 2010). Asthma symptoms include wheezing, chest tightness, shortness of breath and cough (Johnson, 2010). Potential triggers for asthma include allergens, viral respiratory infections, irritants, stimuli such as cold air or exercise and gastro-oesophageal reflux (Estes et al, 2013). Airway obstruction in asthmatics is variable and reversible. However poorly managed asthma can leave lasting structural changes in the cells and tissues of the lower respiratory tract, resulting in airway remodelling and permanent fibrotic damage (Kaufman, 2011). There is currently no cure for asthma, therefore the disease needs to be managed (NACA, 2014). Pathophysiology and assessment parameters It is important to understand the underlying pathophysiology of Mr Saunders’ presentation to...
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...Epidemiology of Asthma: Asthma is a chronic inflammatory disease of the airways which causes episodic wheezing, shortness of breath ,chest tightness, and coughing. Asthma effects people of all ages, backgrounds , religion and gender. According to one article no one risk factor is responsible for asthma morbidity; rather asthma risk factors include living in poverty, in the inner city being uninsured or Medicaid enrolled and being African American. (Kimberly P Toole, 2013) Asthma is a significant health problem in the United States and Massachusetts. Asthma is one of the most common chronic childhood illnesses in the United States where prevalence nearly tripled from 3.6% in 1980 to 9.1% in 2007. Asthma impacts both society and the individual causing millions of lost school days. (Woodin, Tin, Moy, Palella, & Brugge, 2010) Nationally the total cost of asthma in 2007 was 19.7 billion dollars, in Massachusetts the total charges for acute care hospital utilization for asthma was over 136 million dollars in 2006. (Zotter & huisingh, 2009). According to the CDC 1:11 children have asthma in the U.S., that amounts to seven million children in 2010 and the prevalence of asthma is increasing in the United States and in Massachusetts. Studies done by the CDC indicate that in children more boys than girls have asthma. The surveys also indicated that socioeconomic status plays apart in asthma prevalence. Families with an annual household income of 75,000 dollars or...
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...Danielle Wilkinson Alternate Clinical Assignment 01/27/2014 Case Study #1 Episode I 1. List five common environmental triggers for asthma and give at least one specific example for each. Five common environmental triggers for asthma are exercise, allergens, odors, weather, and food. Exercise induced asthma is common in young children and adolescents. The airways in the lungs become narrowed during strenuous exercise. There are many different types of allergens that induce asthma like dust mites, pollen from tress, mold, and pet dander. Odors that can trigger asthma are cigarette smoke, some kinds of perfume, cleaning products, and smoke from burning wood. Weather can trigger asthma by a sudden change in temperature, extreme hot or cold temperatures, and humidity. Foods may also trigger asthma in some by eggs, milk, peanuts, wheat, and soy. 2. Describe the impact of asthma (e.g., morbidity, mortality, economic impact, groups disproportionately affected) on the U.S. population. Asthma affects approximately 16 million Americans, with 2million emergency department visits, and 4,000 deaths a year. Low socioeconomic status impacts Americans with asthma because they may not be able to afford the medication that is prescribed. The more persistent asthma is to an individual, the more damaging occurs in the lungs. The airways begin to undergo remodeling which includes persistent changes in airway structure. The airways begin to become narrower because the epithelial...
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...ASTHMA in Adolescents and Adults ASTHMA in Adolescents and Adults Susan Corbridge and Thomas C. Corbridge ASTHMA in Adolescents and Adults Many individuals suffer from a respiratory condition known as asthma and experience the acute and sometimes chronic effects of this disorder. This disorder often presents itself in an individual exhibiting the hallmark signs and symptoms of breathlessness, wheezing and coughing, due to the airway wall being inflamed and smooth muscle bronchospams. At this time it is imperative to assess the situation and take the appropriate action. Research shows that there is various causes to why inflammation and bronchospasm obstruct the airway, making it difficult to pin point any one cause. This article states that atopy has been identified as a risk factor, as well as exposure to allergens can increase or induce an asthma attack (GINA: the Global Initiative for Asthma, Global strategy for asthma management and prevention). There are many factors that can affect any one person with this condition, such as heredity, obesity, smoke, exercise, upper respiratory tract infections, perfumes and certain occupations can trigger respiratory distress with an asthmatic episode. There are other treatment considerations that evaluate and treating other conditions...
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...lumina, or airway destruction. The term COPD includes chronic bronchitis and emphysema. Although asthma also involves airway inflammation and periodic narrowing of the airway lumina (hyperreactivity), the condition is the result of individual response to a wide variety of stimuli/triggers and is therefore episodic in nature with fluctuations/exacerbations of symptoms. Asthma: Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and constriction of bronchial smooth muscle, hypersecretion of mucus, and edema. Precipitating factors include allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections. Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum, and marked cyanosis. Emphysema: Most severe form of COPD, characterized by recurrent inflammation that damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-trapping). ------------------------------------------------- Diagnostic Studies * Chest x-ray: May reveal hyperinflation of lungs, flattened diaphragm, increased retrosternal air space, decreased vascular markings/bullae (emphysema), increased bronchovascular markings (bronchitis), normal findings during periods of remission (asthma). * Pulmonary function tests: Done to determine cause...
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...antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. It’s best to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full recovery. A case with a diagnosis of Pneumonia may catch one’s attention, though the disease is just like an ordinary cough and fever, it can lead to death especially when no intervention or care is done. Since the case is a toddler, an appropriate care has to be done to make the patient’s recovery faster. Treating patients with pneumonia is necessary to prevent its spread to others and make them as another victim of this illness. NURSING PROFILE a. Patient’s Profile Name: R.C.S.B. Age: 1 yr,1 mo. Weight:10 kgs Religion: Roman Catholic Mother: C.B. Address: Valenzuela City b. Chief Complaint: Fever Date of Admission: 1st admission Hospital Number: 060000086199 c. History of Present Illness 2 days PTA –...
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...an exacerbation of asthma. My client’s mother brought her to the Emergency Room January 14th at 9:30 am due to respiratory distress. My client was running a fever of 101.8 and had been coughing and wheezing for two days and was not showing any signs of improvement. According to Moby’s Pediatric Reference, asthma is a lung disease where there is an obstruction, or inflammation in the airway, airway hyperresponsiveness, or spasm of the bronchial smooth muscle. A flare up, or exacerbation of asthma can be precipitated by allergens, such as mold, animal dander, or dust. Asthma can also be brought on by stress, changes in the season or exercise. When interviewing my client’s mother, she stated G.G. had been trying to acclimate herself to a new living situation in her fathers home and this was causing her a significant amount of stress. My client’s father introduced a newborn baby and a new girlfriend to G.G. My client also does not have a bed at her father’s residence and as a result sleeps on the floor, near dust and dander. These are clearly the reasons why my client had an exacerbation of asthma. The prognosis stated by G.G. physician is “very optimistic” as long as there is a significant decrease in emotional stress and an improved sleeping condition at her father’s house. When assessing G.G. I noticed she was very irritable, and did not want to be bothered. She was congested and seemed restless as a result of this. As far as the pathophysiology of asthma, my client demonstrated...
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...look for the device that had often relieved your symptoms of asthma, knowing if you do not find your inhaler you could be flopping on the floor until consciousness is lost. Some asthmatics say it feels like your trying to breathe through a straw. This feeling is due to the inflammation caused by a trigger that causes the narrowing of the airway leading to the chest tightness, shortness of breath, wheezing and coughing. Asthma is the most common chronic disease affecting people today. Asthma is described as an epidemic rather than and endemic because it is not restricted by age, sex, racial group or region. Asthma is widespread throughout the world but higher rates of prevalence are seen in African Americans. Asthma can affect anyone, despite the development of new treatment options; asthma remains a major health problem in the United States. According to the National Heart, Lung, and Blood Institute (NHLBI), about 15 million Americans have or carry a diagnosis of asthma and it is the third leading cause of preventable hospitalizations in the United States. About 500,000 hospitalizations and 5,000 deaths occur annually from asthma, and the mortality rate continues to rise. This rise is especially dramatic in the African-American community, despite the absence of a known racial preference for asthma. It is now well established that under treatment and inappropriate treatments are the leading contributors to asthma morbidity and mortality in the United States. The African-American...
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