...to medical ward with an exacerbation of chronic obstructive pulmonary disease (COPD; emphysema). Past medical history (PMH) indicates hypertension (HTN), well managed with enalapril (Vasotec) past six years, diagnosis (Dx) of pneumonia yearly for the past three years. D.Z. appears cachectic with difficulty breathing at rest. Patient reports productive cough with thick yellow-green sputum. He seems anxious and irritable during subjective data collection. He states, he has been a 2-pack-a-day smoker for 38 years. He complains of (c/o) insomnia and tiredness. His vital signs (VS) are 162/84, 124, 36, 102° F, SaO2 88%. Admitting diagnosis is chronic emphysema with acute exacerbation. Admitting orders includes: diet as tolerated; out of bed with assistance; oxygen (O2) to maintain SaO2 of 90%; maintenance IV of D5W at 50 ml/hr.; intake and output (I&O); arterial blood gases (ABGs) in AM; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q24h; prednisone 60 mg/day PO; doxycycline 100 mg PO q12h x10 days, azithromycin 500 mg IV piggyback (IVPB) q24h x2 days then 500 mg PO x 7 days; theophylline 300 mg PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 ml) in 3 ml normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q AM. In this case, I will discuss the definition of COPD/emphysema, causes, S/S, risk factors, contributing factors, normal lab values, current lab values, diagnostic tests...
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...Airway/Breathing (Oxygenation) Pneumonia/Chronic Obstructive Pulmonary Disease Clinical Reasoning Case Study STUDENT Worksheet JoAnn Walker, 84 years old Overview This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Principles of spiritual care are also naturally situated in this scenario to provide rich discussion of “how to” practically incorporate this into the nurse’s practice. Concepts (in order of emphasis) I. Gas Exchange II. Infection III. Acid-Base Balance IV. Thermoregulation V. Clinical Judgment VI. Pain VII. Patient Education VIII. Communication IX. Collaboration I. Data Collection History of Present Problem: Pneumonia-COPD JoAnn Walker is an 84-year-old female who has had a productive cough of green phlegm 4 days ago that continues to persist. She was started 3 days ago on prednisone 60 mg po daily and azithromycin (Zithromax) 250 mg po x5 days by her clinic physician. Though she has had intermittent chills, she first noticed a fever last night of 102.0. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement. Therefore she called 9-1-1 and arrives at the emergency department (ED) by emergency medical services (EMS) where you are the nurse who will be responsible for her care. Personal/Social History: JoAnn was widowed...
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...Pulmonary Problems Chapter 10 Pneumonia is inflammation of the lungs resulting in consolidation Obstruction in gas exchange on the alveolar level Aspiration most common cause 2nd most frequent cause is droplet inhalation Least likely cause is blood borne Protein rich fluid move into the alveoli- complicated by production of the organism- result is decreased alveolar surface area-resulting in elevation of pco2 and a decrease in po2 Inspection-tachypnea and central cyanosis Percussion-dullness Palpitation-tactile fremitus Auscultation-crackles, rhonchi, wheezing, or egophony Diagnosis-labs, chest xray Ct not recommended unless anthrax is suspected Bronch-immunocompromised individuals and patients who have not responded to treatment Xrays Focal- bacteria Interstitual-viral Rapid progression/ multifocal- legionella, pneumococci, staphylococci Medialstinal widening without infiltrates- inhalation anthrax Tamiflu within 48 hours to be effective HAP-received care in a health care institution for at least 2 days in the last 90 days prior to infection VAP- pneumonia within 48 hours of intubation HAP more difficult to treat compared to CAP COPD- include emphysema, chronic bronchitis, and small airway disease Emphysema-structural change via destruction and enlargement of alveoli Chronic bronchitis- chronic cough and mucous production Small airway disease-generalized narrowing of bronchioles, may include asthma COPD-4th leading cause of death in United States ...
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...Heart Failure Christy Harding Western Governors University C155- Pathopharmacological Foundations for Advance Nursing Practice Heart failure affects nearly 6 million Americans. It is the leading cause of hospitalization in people older than 65. Roughly 550,000 people are diagnosed with heart failure each year (Emory Healthcare, 2014). Heart failure is a pathologic state where the heart cannot pump enough blood to meet the demand of the body’s metabolic needs or when the ventricle’s ability to fill is impaired. It is not a disease, but rather a complex clinical syndrome. The symptoms of heart failure come from pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Individuals experience orthopnea, fatigue, dyspnea, cough with frothy sputum, peripheral edema, and decreased urinary output. Heart failure is caused by many conditions that damage the heart’s muscle. Any form of heart disease can lead to heart failure. A1. Pathophysiology Heart failure arises as a consequence of an abnormality in cardiac structure, conduction, rhythm, or function (Figueroa & Peters, 2006). Heart failure always begins with an index event. This event could be silent, as with the expression of a genetic mutation, or obvious, such as a myocardial infarction (Francis & Tang, 2003). Heart failure can be categorized into systolic ventricular dysfunction also known as systolic heart failure or diastolic ventricular dysfunction also known as diastolic heart failure...
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...Geriatric History and Physical with Problem List and Plan Health Assessment Lab General Patient Information Client: 81-year-old Caucasian/Italian female Source: Client, seems reliable Marital status: Widower Religion: Catholic Occupation: House wife Formal education: High school Primary language: English, written and spoken Secondary: None Reason for Seeking Care: Shortness of breath and productive cough. History of Present Illness: Recurrent episodes of shortness of breathe and productive cough since 2008. First episode occurred when she was in her early 80’s. She was awakened in the middle of the night with a very painful right-sided chest pain and cough. There was no warning of a problem. She reports the pain was “tight and pounding”. The pain was a 10 on a numeric scale 0-10 lasting about 25 minutes. Patient states her cough worsens when walking long distances, especially without using her walker and her breathing becomes labored. She states her cough usually lasts about three days but has noticed it becoming more persistent and feels the need to cough up phlegm. She saw a physician for that episode. Diagnostic test confirmed a diagnosis of Chronic Obstructive Pulmonary Disease when she had her first episode of these symptoms. Her lung sounds presented with some wheezing on the upper lungs bilaterally, she had rapid shallow breathing with a respiration of 24. Upon walking long distances she becomes emotionally anxious; rest does not...
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...ADN VS BSN: Differences in Competencies Juline DiSilvestro Grand Canyon University Professional Dynamics NRS-430 V Monica Kidder RN, MSN May 11, 2013 ADN VS BSN: Differences in Competencies The complexity of modern healthcare and the patients of today mandate a higher level of academic preparation than in the past. Advanced critical thinking skills are a must. Nurses need to function independently, making clinical decisions, providing bedside care, case management, education to patient and family in regards to disease process, treatment, and how to adapt to a healthier lifestyle. As healthcare continues to evolve and become more complex, it is necessary to assure proper education has been achieved. Controversy among the nursing profession has existed for many years regarding what is the acceptable minimum education for nursing practice. The ADN program takes 2-3 years to complete. The ADN programs started due to a need for nurses during a nursing shortage brought on by WWII. The ADN program provided a shorter period of time to acquire the necessary minimal skill to obtain licensure, and practice safe entry level nursing without the emphasis on leadership, nursing theory and critical thinking. The focus of ADN programs has been to prepare the nurse with considerable clinical experience and technical nursing tools needed to provide patient care at the bedside (Cresia & Friberg, 2011). They do not have the education to perform research activities which becomes the basis...
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...All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it. Scenario D.Z., a 65 year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD, emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years, has had pneumonia yearly for the past 3 years, and has been a 2 pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124 HR, 36 RR, 102 degrees F, Sao2 88%. His admitting diagnosis is an acute exacerbation of chronic emphysema. Chart View Physician’s OrdersDiet as toleratedOut of bed with assistanceOxygen (O2) to maintain Sao2 of 90%IV of D5W at 50 ml/hrECG monitoringArterial blood gases (ABGs) in AMCBC with differential nowBasic metabolic panel (BMP) nowChest x-ray (CXR) q 24 hrs. Sputum cultureAlbuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT | 1. Explain the pathophysiology of emphysema...
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...Final exam study guide: Cancer: Know the difference between Benign and Malignant tumors. Classification of tumors Benign neoplasm Well differentiated Usually encapsulated Kidneys have their own capsule so is easier to catch Expansive mode of growth Characteristics similar to parent cell Metastasis is absent. Rarely recur Classification of tumors Malignant neoplasm May range from well differentiated to undifferentiated Able to metastasize Infiltrative and expansive growth Frequent recurrence Moderate to marked vascularity Rarely encapsulated Becomes less like parent cell Check Moles and Freckles Shows differentiation Hair growing = blood supply = no differentiation = CANCER * Know the warning signs/clinical manifestations of cancer. * CAUTION: * Change in bowel or bladder habits * A sore that does not heal * Unusual bleeding or discharge from any body orifice * Thickening or a lump in the breast or elsewhere * Indigestion or difficulty in swallowing * Obvious change in a wart or mole * Nagging cough or hoarseness Know the different staging, grading and classifications of cancer. Clinical staging classifications * 0: Cancer in situ * 1: Tumor limited to tissue of origin; localized tumor growth * 2: Limited local spread * 3: Extensive local and regional spread * 4: Metastasis * 0 – enclosed extremely localzed * 1 – only in tissue...
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...International Classification of Diseases Coding II Chapter 17 – 27 Chapter 17: 1. Which of the following anemias is caused by a failure of the bone marrow to produce red blood cells and may be congenital or acquired? A. Bone marrow deficiency anemia B. Sickle-cell anemia C. Aplastic anemia D. Thalassemia 2. Which of the following terms refers to either a reduction in the quantity of hemoglobin or a reduction in the volume of red blood cells? E. Anemia F. Coagulation defect G. Thrombocytopenia H. Leukocytosis 3. When a diagnostic statement of anemia is not qualified in any way, what should the coder do? I. Review the record for a surgical procedure; and if the patient had surgery, code as anemia due to acute blood loss. J. Review the medical record before assigning an unspecified type of anemia. K. Review the medical record to determine if the patient has been prescribed iron tablets, and code as iron-deficiency anemia. L. Review the medical record to determine if the patient has received chemotherapy, and assign the code for anemia due to antineoplastic chemotherapy. 4. Which of the following statements is true regarding a patient with documented sickle-cell trait? M. The patient has sickle-cell disease. N. Both of the patient’s parents carried the sickle-cell gene. O. The code for sickle-cell disease should be assigned. P. The patient received...
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...Heart Failure Western Governors University Pathopharmacological Foundations for Advanced Nursing Practice Heart Failure It is estimated that about five million people in the United States are living with heart failure with an overwhelming number of 550,000 newly diagnosed cases each year, costing the nation roughly $32 billion dollars per year (Centers for Disease Control and Prevention, 2016). Heart failure is a complex, pathophysiological condition in which the ventricles of the heart is weakened and unable to pump effectively to meet the body’s needs for nutrients or has lost adequate filling capacity. Clinical presentations of heart failure depends on which ventricles have failed to pump blood adequately; left ventricular failure, also known as congestive heart failure (CHF) is more common than right ventricular failure (McCance & Huether, 2014). The most common symptoms of heart failure are shortness of breath, fatigue, and peripheral edema. HF is not a disease, but rather a manifestation of a diseased heart. Large number of disorders can lead to heart failure, and with the aging population and many surviving primary cardiac events, it is no surprise that the most common reason for hospitalization in patients older than 65 years old is heart failure (McClintock, Mose, & Smith, 2014). Heart failure has become a major public health problem because it is the only cardiac condition that continues to increase in prevalence (McClintock, Mose, & Smith, 2014)...
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...Prevention of Hospital Readmissions Related to Symptoms of Congestive Heart Failure NRS 441V Professional Capstone March 1, 2014 Abstract Providing patients diagnosed with Congestive Heart Failure effective teaching can eliminate reoccurring hospitalizations. Patients are discharged with CHF and readmitted within 30 days. The information provided will examine the process of enhancing patient knowledge and provide additional resources essential for effective health care management. Research evidence provides data that proves patients who are diagnosed with CHF needs a variety of health care needs during admission and after discharge. The proposal will display an evaluation plan, implementation plan and a dissemination of the evidence. Provide at least 1 evidence based literature; for at least 1 evidence based solution. Keywords: congestive heart failure, therapy, education, patient outcomes Description of the Problem Prevention of Hospital Readmissions Related to Symptoms of Congestive Heart Failure Health care providers must ensure skills, knowledge and teaching is effective when providing care to their patients and families about symptoms of CHF. The length of stay for an average hospital visit can be two days however, for more chronic issues warrant an even longer stay. To avoid readmission of the disease processes of CHF warrants additional care and resources during and after discharge. . Some patients cannot follow up with their primary care physician because...
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...GI and Diabetes Exam Study Guide Tube Feeding – (enteral nutrition) refers to the administration of a nutritional balanced liquefied food or formula through a tube inserted into the stomach, duodenum, jejunum. It is used to provide nutrients via the GI tract either alone or as a supplement to oral or parenteral nutrition. - Nasogastric (NG) Tube – is most commonly used for short-term feeding problems. Other means of feeding are; esophagostomy, gastrostomy or jejunostomy. Transpyloric tube placement or placement into the jejunum is used when physiologic condition warrant feeding the pt below the pyloric sphincter. Special Indications – anorexia, orofacial fractures, head and neck cancer, neurologic or psychiatric conditions that prevent oral intake, extensive burns and those who are receiving chemotherapy or radiation therapy. Procedure for tube feeding 1. Patient position – 30-45 degrees position. Head remain elevated for 30-60 mins 2. Patency of tube – Tube should be irrigated with water before and after each feeing to ensure patency. 3. Tube Position – Placement of tube is checked before each feeing or every 8 hours with continuous feeings. Checking methods; aspiration and pH. 4. Formula 5. Administration of feeding – feeing are given either by gravity drip method or by feeding pump. 6. General Nursing Considerations – daily weight, accurate I’s and O’s. Blood glucose check. Complication Related To tube and feeding - Vomiting and or Aspiration -...
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...American Thoracic Society ATS Statement: Guidelines for the Six-Minute Walk Test THIS OFFICIAL STATEMENT OF THE AMERICAN THORACIC SOCIETY WAS APPROVED BY THE ATS BOARD OF DIRECTORS MARCH 2002 CONTENTS Purpose and Scope Background Indications and Limitations Contraindications Safety Issues Technical Aspects of the 6-Minute Walk Test Required Equipment Patient Preparation Measurements Quality Assurance Interpretation References PURPOSE AND SCOPE This statement provides practical guidelines for the 6-minute walk test (6MWT). Specifically, it reviews indications, details factors that influence results, presents a brief step-by-step protocol, outlines safety measures, describes proper patient preparation and procedures, and offers guidelines for clinical interpretation of results. These recommendations are not intended to limit the use of alternative protocols for research studies. We do not discuss the general topic of clinical exercise testing. As with other American Thoracic Society statements on pulmonary function testing, these guidelines come out of a consensus conference. Drafts were prepared by two members (P.L.E. and R.J.Z.) and were based on a comprehensive Medline literature search from 1970 through 2001, augmented by suggestions from other committee members. Each draft responded to comments from the working committee. The guidelines follow previously published methods as closely as possible and provide a rationale for each specific recommendation. The final recommendations...
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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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...teach the client? A) B) C) D) Clean the meatus, begin voiding, then catch urine stream Void a little, clean the meatus, then collect specimen Clean the meatus, then urinate into container Void continuously and catch some of the urine A: Clean the meatus, begin voiding, then catch urine stream. A clean catch urine is difficult to obtain and requires clear directions. Instructing the client to carefully clean the meatus, then void naturally with a steady stream prevents surface bacteria from contaminating the urine specimen. As starting and stopping flow can be difficult, once the client begins voiding it’s best to just slip the container into the stream. Other responses do not reflect correct technique 3. Following change-of-shift report on an orthopedic unit, which client should the nurse see first? A) B) C) D) 16 year-old who had an open reduction of a fractured wrist 10 hours ago 20 year-old in skeletal traction for 2 weeks since a motor cycle accident 72 year-old recovering from surgery after a hip replacement 2 hours ago 75 year-old who is in skin traction prior to planned hip pinning surgery. C: Look for the client who has the most imminent risks and acute vulnerability. The client who returned from surgery 2 hours ago is at risk for life threatening hemorrhage and...
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