...eMedicine article/238798 MeSH D007676 Chronic kidney disease (CKD), also known as chronic renal disease (CRD), is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.[1] It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small...
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...An Overview of Renal Failure and Its Treatment Option Renal failure can affect any population in society with no discrimination to age or race. There are several different types of renal failure and a multitude of treatment options depending on the severity or complexity of the disease process. With a change in healthcare on the horizon an examination into the area and the current school of thought is a must. While renal failure is just one small area of the healthcare sector, it is rapidly growing and affecting more and more every day. According to the data from the CDC more than 4.4 million Americans are diagnosed with some form of kidney disease (CDC). Renal Failure is best defined when the kidneys no longer work properly. Now one might ask, what do the kidneys do? The kidney’s simply remove metabolic waste and water from the human body and maintain homeostasis. Without the kidneys functioning properly the body will no longer make urine and dangerous electrolyte abnormalities can occur. One must realize there are several categories of renal failure. The two main classifications are Acute and Chronic Renal Failure. Acute Renal Failure is best defined as rapid and new onset renal failure sometimes reversible when treated appropriately while Chronic Renal Failure long term and irreversible unless treated via transplant. Now that a basic foundation definition of Renal Failure has been established, one must gain knowledge of what causes Renal Failure. Now that there...
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...ineffective and unnecessary treatment. One of the latest developments by the Government and Department of health is the concept of Advance Care Planning. I have looked at this from various perspectives and would like to be involved in introducing the process to Sheffield Kidney Institute. In 2004, the number of patients receiving renal replacement therapy in England, Scotland and Wales was 33,511, this figure is sourced from data which has been made available to them from participating renal units throughout the country, the number of patients receiving dialysis since 2000 has risen by 7% (Ansell et al 2005) with it projected to rise by a further 10 percent over the next 5 years (Ansell et al 2005). About 15-29 percent of deaths of patients with end stage renal disease results from a decision to discontinue dialysis (Davison 2006). Importantly we need to explore which patients especially those reaching the end of their lives are choosing to discontinue receiving aggressive renal replacement therapy and what knowledge and skills would be required to facilitate a change in practice and help them towards a ‘peaceful death’. End Stage Renal Disease presents many challenges to the patient who experience and suffer from it and the health care professionals who care for them. Its chronicity and...
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...system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be substantially lowered over minutes to hours with an antihypertensive agent. Contents [hide] * 1 Treatment * 2 Incidence * 3 Definition * 3.1 Hypertensive emergency as a generic term * 4 Pathophysiology * 5 Mortality * 6 Clinical history * 7 References * 8 See also | ------------------------------------------------- [edit]Treatment Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient's usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensiveeffect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used. It is also important that the blood pressure is lowered not too abruptly, but smoothly. The initial goal in hypertensive emergencies is to reduce the pressure by no more than 25% (within minutes to 1 or 2 hours) and then toward a level of 160/100 mm Hg within 2–6 hours. Excessive reductions in pressure may precipitate coronary, cerebral, or renal ischemia...
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...the NMB of NSW. ▪ Frequency of documentation relies on: - physical/ mental status of the pt. - the type of care provided (self care v. intensive care) - requirements of health care agency - any legal or other obligations that the health record must meet ▪ Content of documentation needs to be: - relevant - appropriate - accurate - requirements will vary according to pt acuity - content may be guided by framework (assessment, intervention, response) ▪ Documentation framework: - assessment: conclusions reached utilising subjective and objective data - intervention: reflects the action taken - response: reflects the pt’s response to the intervention ▪ Example of using framework to case: Mrs Pat Martin, a 28y/o lady has been admitted overnight via Casualty accompanied by husband. She is 16 wks pregnant and has been diagnosed with appendicitis by Dr Chan. At the moment she is only experiencing mild pain and has a low grade fever of 37.7. IMI Pethidine 50mgs was given at 2am, and may be repeated PRN. Shes been added to the theatre list at 9.30am. She remains NMB and has IV normal saline running over 10hrs. IV Keflin QID commenced, is next due 12md. Her husband remains at bedside. It is now 630am and Mrs Martin is resting, however she has not had much sleep overnight. Her 6am vital signs are: BP: 120/80 Respirations: 16, Ward urinalysis shows no abnormalities Temp: 37.7. Pulse: 80 (reg). ASSESSMENT: - Mrs Martin aged 28 ...
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...Hypertension Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. Hypertension is the consistent elevation of systemic arterial blood pressure. It is also the most common primary diagnosis in the United States (Brashers, 2010). It is one of the most common worldwide diseases afflicting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. Over the past several decades, extensive research, widespread patient education, and a concerted effort on the part of health care professionals have led to decreased mortality and morbidity rates from the multiple organ damage arising from years of untreated hypertension. I. Prevalence of disease (in US) and risk factors Hypertension is a major U.S. health problem affecting some 50 million individuals. Approximately 65% of Americans older than age 60 have hypertension. Of those diagnosed with hypertension, over 30% do not have their hypertension adequately treated and controlled. Ninety to ninety-five percent of hypertension is idiopathic and called primary hypertension. Five to ten percent of hypertension is the result of an identifiable etiologic cause and is called secondary hypertension. According to Center of Disease Control (CDC) the prevalence of hypertension, 45.3% had been treated...
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...ACUTE GLOMERULONEPHRITIS DISCLOSED _________________________ A Case Study Presented to The Clinical Instructors AUP College of Nursing Adventist University of the Philippines __________________________ In Partial Fulfillment of the Requirements for the Course NMCN 244, Care of Mother, Child, Family and Population at Risk ___________________________ TABLE OF CONTENTS I. Introduction Significance of the Study II. Patient DataBase A. Demographic Data B. Nursing History 1. Developmental Tasks 2. Health History 3. Medical Diagnosis & Chief Complaints III. The Disease Entity A. Review of Normal Physiology B. Theoretical Background C. Statistical Report D. Risk/Aggravating Factors E. Pathophysiology Narrative w/ Documentation F. Pathophysiology Diagram G. Prognosis of Disease IV. Assessment A. Gordon’s or Head to Toe Assessment B. Book Picture vs Patient’s Manifestations V. The Management A. Diagnostic Test Result and Significant B. Therapeutic/Medical Interventions 1. Surgeries/Treatment 2. Drugs C. Nursing Initiated Interventions 1. Nursing Care Plan 2. Discharge Plan VI. General Evaluation of the Study A. Summary B. Recommendation VII. Bibliography I. Introduction Acute glomerulonephritis is a disease that affects glomerular capillaries. Etiologic factors are many and varied; they include immunologic reactions, vascular injury, metabolic...
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...The research counterbalanced one another, as ED visits are usually one-time visits where patient are given temporary relief until patients follow-up with their primary care physician or a pain specialist. While other settings, there is more of an established relationship with patients and physicians can monitor pain and prescriptions more carefully. Also, emergency department visits tend to be for acute pain while other clinical settings usually deal with chronic pain. Thus, this leads to non-ED clinical settings to exceed CDC guidelines. Also, research shows that disabled Medicare users are more likely to fill their opioid prescription again. This makes sense as those are patients who have long-term illnesses or renal failure, need pain medication more often than those with acute pain. For instance, a wisdom tooth removal does not require repetitive refills for painkillers as the pain will go away after a few weeks, while those with chronic back pain may need repetitive opioid...
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...Preventing Heart Failure Readmissions Henry D. Santos Purdue University Calumet I. Introduction High morbidity, mortality, and healthcare spending have been connected with heart failure management. As per Gheorghiade et al., every year, there are almost a million cases of hospitalization for heart failure, responsible for 6.5 million hospital days, and estimated expenditures of $37.2 billion here in the United States alone (2013). The incident of heart failure readmissions has increased over the last decades, distinctly related to the aging population and surpassed recovery after a myocardial infarction. Based on the Centers for Medicare and Medicaid Services (CMS) 2005 data, heart failure is the most frequent diagnosis among Medicare beneficiaries and the third highest reimbursement for hospitals (AHRQ, 2013). In 2009, CMS started the public reporting of readmission rates after being discharge for heart failure, and, the year after, the Patient Protection and Affordable Act inaugurated financial penalties for healthcare establishments with most rates of readmission within the 30 days after discharge. The elevated concern relating the want to decrease readmissions has been the biggest focused of national researchers and hospitals with the efforts of identifying and predicting which patients with heart failure are likely to be readmitted. Formulated designs and preventive strategies have been established, in order to avoid unnecessary readmissions. Heart failures risk factors...
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...Alimentary Prophylaxis Chapter 5 - Venous Thromboembolism Section III - Vascular Access Vascular Access Chapter 6 - Establishing Venous Access Chapter 7 - The Indwelling Vascular Catheter Section IV - Hemodynamic Monitoring Hemodynamic Monitoring Chapter 8 - Arterial Blood Pressure Chapter 9 - The Pulmonary Artery Catheter Chapter 10 - Central Venous Pressure and Wedge Pressure Chapter 11 - Tissue Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia and Hypercapnia Chapter 20 - Oximetry and Capnography Chapter 21 - Oxygen Inhalation Therapy Chapter 22 - Acute Respiratory Distress Syndrome Chapter 23 - Severe Airflow Obstruction Section VIII - Mechanical Ventilation Mechanical Ventilation Chapter 24 - Principles of Mechanical Ventilation Chapter 25 - Modes of Assisted Ventilation Chapter 26 - The Ventilator-Dependent Patient Chapter 27 -...
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...Stage Renal Disease 20 to Diabetic Nephropathy Presented by: Balgos, Rachelle Ann Dayto, April Feranil, Daniel Fulinara, Janice Fuentes, Maila Joy Garrido, John Paolo Mendoza, Kenneth Robert Nazareno, Jhon Ryan Olfindo, Kristine Joy Sombilon, Jorgette Kim *** In Partial Fulfilment of the Requirement in NURS 60 for the Degree Bachelor of Science in Nursing TABLE OF CONTENTS I. Demographic Data 4 II. Chief Complaints 4 III. History of Present Illness 4 IV. Past Medical History 5 V. Developmental History 6 VI. Heredo-familial History 15 VII. Gordon’s Functional Health Patterns 16 VIII. Physical Examination 22 IX. Diagnostic Test 43 X. Anatomy and Physiology 75 XI. Pathophysiology 81 XII. Case Management 82 XIII. Nursing Care Plan 107 ABSTRACT “"The divine is not something high above us. It is in heaven, it is in earth, it is inside us..." - Morihei Ueshiba We, group 2 of Level III section 2, have chosen this case to gain more knowledge about the mechanism of End Stage Renal Disease and its process. Our patient C.C is a 51 -year old male who was diagnosed to have diabetes mellitus seventeen years ago and now has End Stage Renal Disease due to Diabetic Nephropathy. His disease leads to fluid accumulation to his lungs and edema on his extremities. Our group chose the case because it is also our first time to handle a case related...
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...Aldosterone: Role in Edematous Disorders, Hypertension, Chronic Renal Failure, and Metabolic Syndrome. Schrier RW, Masoumi A, Elhassan E. University of Colorado Denver, Aurora, Colorado. Abstract The role of aldosterone has expanded from the hormone's genomic effects that involve renal sodium transport to nongenomic effects that are independent of the effect of aldosterone on sodium transport. The nongenomic effects of aldosterone to increase fibrosis, collagen deposition, inflammation, and remodeling of the heart and blood vessels, however, are markedly increased in the presence of high sodium intake. The genomic effect of aldosterone increases renal sodium transport, but the administration of large doses of aldosterone to normal individuals does not cause edema, relating to the phenomenon of "aldosterone escape"; however, in edematous disorders including cardiac failure, cirrhosis, and nephrotic syndrome, impaired aldosterone escape leads to renal sodium retention and edema formation. There is now considerable evidence for the nongenomic effects of aldosterone in several important diseases. Thus, low dosages of mineralocorticoid antagonists, with little or no effect on urinary sodium excretion, have been shown to afford a beneficial effect on morbidity and mortality in patients with advanced cardiac failure and after acute myocardial infarction. Three-drug-resistant hypertension has also been found to respond to spironolactone in modest dosages. The combination of an...
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...Hindawi Publishing Corporation International Journal of Hepatology Volume 2012, Article ID 487480, 6 pages doi:10.1155/2012/487480 Review Article Acute Liver Failure Caused by Amanita phalloides Poisoning Luca Santi,1 Caterina Maggioli,1 Marianna Mastroroberto,2 Manuel Tufoni,1 Lucia Napoli,1 and Paolo Caraceni1 1 U.O. Semeiotica Medica, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy 2 S.S.D. Liver Transplant, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy Correspondence should be addressed to Paolo Caraceni, paolo.caraceni@unibo.it Received 4 May 2012; Accepted 11 May 2012 Academic Editor: Bruno Nardo Copyright © 2012 Luca Santi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell...
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...CHAPTER I INTRODUCTION A. Background of the study According to Jordan, childbearing is universally treated as a life crisis event. In most societies birth and the immediate post partum period are considered a time of vulnerability for mother and child. It is a time of ritual danger for the entire family. Most societies tend to have certain sets of practices and beliefs in childbirth. Practices and beliefs of each society have common goals namely, the maintenance of well-being and preservation of life of a new mother and her newborn. Confinement is the period after the birth and is perceived as a critical condition for a mother. At this period, women are considered to be in a weakened state due to the loss of blood during the delivery of the baby. Because a woman is weak, she is susceptible to all sorts of all illnesses and diseases. Therefore, there are a number of cultural practices which must be observed in order to gain strength and to avoid illness.[i] The puerperium is a time of great change which spans a period of transition from the pinnacle of experience of birth to the assumption of the joys and responsibilities of family life. Well-integrated post-natal care has an important role to play in assisting this transition and launching the family in their new life together. The puerperium is a period of 6 weeks which begins as soon as the placenta has been expelled. During this time a number of physiological and psychological changes take place: ...
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...University Department of Therapeutics and Clinical Pharmacology, The Royal Infirmary, Edinburgh, EH3 9YW, Scotland INTRODUCTION Acetaminophen (paracetamol, N-acetyl-p-aminophenol, 4-hydroxyacetani lide) is a non-prescription antipyretic analgesic that was first introduced into clinical medicine towards the end of the last century (1). It attracted little interest until it was found to be the major metabolite of both acetani lide and phenacetin (2, 3) and in recent years it has become an increasingly popular substitute for aspirin. Acetaminophen seemed to be remarkably safe when taken in recommended doses and formal toxicity studies were never carried out. In 1964 Eder (4) first reported liver damage in cats given 25-50 mglKg of acetaminophen daily for 26 weeks, and two years later Boyd & Bereczky described extensive hepatic necrosis in acute toxicity studies in rats (5). At the same time liver damage was first reported in man following acetaminophen overdosage (6, 7). The use of acetaminophen for self-poisoning has since increased dramatically in many countries and acute hepatic necrosis, sometimes fatal, has attracted much attention as the major complication (8-16). CLINICAL MANIFESTATIONS AND COMPLICATIONS OF ACETAMINOPHEN POISONING Apart from nausea and vomiting there are no specific early signs of severe intoxication and consciousness is not impaired. However, 12 to 36 hours after ingestion biochemical...
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