...common nosocomial infection in Critical Care units. VAP is linked with high mortality rates, increased hospital stays, longer mechanical ventilation and increased costs to hospitals and patients (Rosa, Hernandez, Carillo, Fernandez, & Valles, 2012). Patients who have an endotracheal tube (ETT) with mechanical ventilation are more likely to develop VAP. These patients have a poor cough reflex due to a decreased level of consciousness and diminished movement of the respiratory tract mucocila, leading to the inability to clear secretions. These contaminated secretions will then sit on top of the ETT cuff and eventually leak down and invade the lungs. Also aiding as a reservoir for microbes is a biofilm that can form on the ETT and enter the lungs causing infection (Mietto, Pinciroli, Patel, & Berra, 2013). Nurses are responsible for applying pharmacological and non-pharmacological measures to help prevent VAP which poses a very difficult challenge. Nurses must research and incorporate the use of evidence-based practice into their daily care of patients on mechanical ventilation (Sedwick, Lance-Smith, & Nardi, 2012). This paper will look closely at the evidence-based research and protocols implemented which best prevent ventilator-associated pneumonia. To help prevent further complications and improve outcomes in patients on mechanical ventilation, a standard of care was created by the Institute for Health Care Improvement (IHI) in 2004 called the Ventilator Bundle. These...
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...Case Study Three 1. What is the definition of ARDS? Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function. Acute Respiratory Distress Syndrome (ARDS) is also known as shock lung, wet lung, post perfusion lung and a variety of other names related to specific causes. What are the associated clinical indicators? The first signs and symptoms of ARDS are feeling like you can't get enough air into your lungs, rapid breathing, and a low blood oxygen level. Other signs and symptoms depend on the cause of the ARDS. They may occur before ARDS develops. Sometimes, people who have ARDS develop signs and symptoms such as low blood pressure, confusion, and extreme tiredness. This may mean that the body's organs, such as the kidneys and heart, aren't getting enough oxygen-rich blood. 2. What conditions did this patient experience that are common risk factors ssociated with ARDS? Brain present with near drowniess syndrome that lead to his diagnosis of ARDS. 3. Describe the major pathophysiological alterations in ARDS. Increased capillary permeability is the hallmark of ARDS. Damage of the capillary endothelium and alveolar epithelium in correlation to impaired fluid remove from the alveolar space result in accumulation of protein-rich fluid inside the...
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... Downloaded from jic.sagepub.com at UNIV OF THE INCARNATE WORD on April 15, 2013 Original Research The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Journal of Intensive Care Medicine Volume 24 Number 1 January/February 2009 54-62 # 2009 SAGE Publications 10.1177/0885066608326972 http://jicm.sagepub.com hosted at http://online.sagepub.com Carrie S. Sona, MSN, Jeanne E. Zack, PhD, Marilyn E. Schallom, MSN, Maryellen McSweeney, PhD, Kathleen McMullen, James Thomas, RN, BSN, Craig M. Coopersmith, MD, FCCM, Walter A. Boyle, MD, Timothy G. Buchman, MD, PhD, FCCM, John E. Mazuski, MD, PhD, and Douglas J. E. Schuerer, MD Objective: The purpose of this study was to determine the effects of...
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..........................................................…...8 Data collection ……………………………………..………….……………………………8 Statistics and data analysis …………………………………………………………….…...9 Expected results …………………………………………………………………………………..9 References cited………………………………………………………………………………….10 Appendix A………………………………………………………………………………………13 Appendix B………………………………………………………………………………………14 Appendix C………………………………………………………………………………………15 Appendix D………………………………………………………………………………………16 Ventilator associated pneumonia and chlorhexidine use in the traumatic brain injured patient Ventilator associated pneumonia (VAP), is defined as, a nosocomial pneumonia that develops more than 48 hours following endotrachial intubation and mechanical ventilation, and is a common and serious intensive care unit (ICU) complication. VAP causes noteworthy morbidity, mortality, amplified hospital costs, and increased utilization of healthcare resources, prolonged time for ventilator support, as well as lengthened ICU and hospital stay (Caruso, 2009). Antibiotics (ATBs) have traditionally been used to treat VAP, but the occurrence of resistance...
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...Ackowledgement First of all, I would like to praise ALLAH THE ALL MIGHTHY. His will, I will not be able to complete the assignment. I would like to express my gratitute to all who gave me the possibility to complete this assignment. I want to thank the Dean of Nursing Faculty, I for giving the support, encouragement towards compliting the assignment. I deeply indebted to my tutor who gave an idea and suggestion and encouragement, helped me at the time of writing the assignment. My colleagues from Nursing Faculty who supported me in my assignment work. I thank them for all their support, help, interest and valuable hints. Last but not least, I would like to thank my family especially my husband whose patient love enable me to complete this work. Table of Content | | |Page No. | |1. |Introduction |1 – 2 | |2. |Clinical Assessment |3 – 6 | |3. |Management Related To Head Injury |7 - 8 | |4. |Immediate Care And Management Of Patient ...
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...this severe case of Community Acquired Pneumonia. My objectives in this case study will basically be to determine whether hospital admission for intravenous antibiotics are necessary. This will be done by using clinical scores and other in-hospital diagnostic criteria to determine prognosis and severity. The relevance to this case study with be treatment regime and a ventilator strategy you may not have heard of. Case study: 67 year old female of colored ethnicity from wellington, transferred from Paarl hospital intubated, ventilated will host of problems including Chronic Obstructive Pulmonary Disease grade ii , Community Acquired Pneumonia (CAP) , Gastro Intestinal Tract bleed which occurred just before transferring from Paarl, also history of smoking, one packet year, and ethanol (ETOH) abuser. Conclusion: Diagnostic criteria, is clinical presentation and chest x-ray. The simplest of all clinical scoring system is CURB-65 using 5 prognostic variables to determine the severity of Pneumonia, instead of 20. Much easier and practical can be applied at patient bedside. Inverse ratio ventilation to aid and improve filling of non-compliant...
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...I. OBJECTIVES The University of Pangasinan, College of Nursing aims to produce nurses who are competent in the care of people in participation with other care providers in the prevention of disease, promotion and maintenance of health, restoration of well being and alleviation of suffering. With these in mind, we form the following objectives. General objectives: * This case study is designed for student nurses like us to become practiced, well informed and mannered in delivering holistic care for patients diagnosed with tetanus, as well as to gain knowledge and overview about the disease. Specific objectives: * To imply appropriate nursing management for tetanus. * To be able to discuss the anatomy and physiology of the nervous system. * To be able to define tetanus and identify its clinical manifestations and risk factors. * To be acquainted with the different drugs for tetanus and their actions. * Plan for a suitable nursing care. * To know the purposes and specific nursing responsibilities before, during, and after some procedure done with the client. * To institute bond between the student nurse and the patient. II. INTRODUCTION Tetanus comes from the Greek word “teiteim” which means to stretch. It is also called lockjaw. It is a serious infectious disease of the nervous system in which toxin causes severe muscle spasm. It is a medical condition characterized by a prolonged contraction of skeletal muscle fibers...
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...Case Study for Final Exam Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. The name myasthenia gravis, which is Latin and Greek in origin, literally means "grave muscle weakness." With current therapies, however, most cases of myasthenia gravis are not as "grave" as the name implies. In fact, for the majority of individuals with myasthenia gravis, life expectancy is not lessened by the disorder. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Certain muscles such as those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder. The muscles that control breathing and neck and limb movements may also be affected. Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction - the place where nerve cells connect with the muscles they control. Normally when impulses travel down the nerve, the nerve endings release a neurotransmitter substance called acetylcholine. Acetylcholine travels through the neuromuscular junction and binds to acetylcholine receptors which are activated and generate a muscle contraction. ...
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...the emergency department critically unwell. Consider the presenting symptoms as outlined in the social history, video clips and medical records and address the following; a) Provide and interpretation of Derek’s ABGs. Derek’s blood gases are as follows PaO2 80mm/Hg PaCO2 52mm/Hg PH 7.25 HCO3 30 The results show that Derek has respiratory acidosis. According to Porth and Matfin, (2009) respiratory acidosis is a condition was an acid imbalance occurs in the body. During gas exchange, the exchange of gas is impaired and results in excess carbon dioxide (CO2) being absorbed into the blood stream, initiating the formation of an acid, making the blood more acidic (Porth & Matfin, 2009). The PH drops as there is little ventilation of the alveolar, and compensation results in the production of hydro carbon dioxide (HCO2) (Farrell & Dempsey 2005). Respiratory acidosis may be caused by injury to the respiratory centres, diseases of the lungs, blockage of the airway and respiratory disorders (Porth & Matfin, 2009). b.) Provide two possible reasons for the ABG’s based on Derek’s history and presentation. The cause for Respiratory acidosis in Derek could have been caused by a respiratory disorder such as COPD which he has been diagnosed with since 1997, and was asked to cease smoking but up to date he has continued to smoke 20-30 cigarettes per day. Porth and Matfin, (2009) explain that conditions of the respiratory system may cause impairment of gas exchange...
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...oxygen delivery and control of FiO2. Nasal cannula may be used later in the treatment to improve patient comfort and convenience (Stoller, 2015). Arterial blood gases should be checked 30 to 60 minutes after starting oxygen therapy to ensure appropriate oxygenation without increased hypercapnia or acidosis (GOLD, 2014). Ventilatory support may be necessary during an exacerbation and can be provided by non-invasive or invasive ventilation. Bauman and Hyzy (2014) explain that non-invasive positive pressure ventilation (NPPV) is the preferred method of support for COPD exacerbation patient and has shown success in improving respiratory acidosis and decreasing respiratory rate and work of breathing. Additionally, NPPV reduces the risk of ventilator-associated pneumonia, hospital length of stay, mortality, and intubation rates. According to Allen (2014), invasive ventilation is normally avoided in the COPD population, but in situations such as respiratory distress and failure of oxygenation and ventilation it may be necessary. The decision of using invasive ventilation depends on clinical signs and symptoms, the patient’s preference for life support, and the availability of intensive care facilities (GOLD,...
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...Nursing Management of a Patient with Raised Intracranial Pressure after Traumatic Brain Injury and Dealing with Family Anxiety. Introduction The aim of this assignment is to explore, analyse and evaluate the nursing management of raised intracranial pressure (ICP) and family anxiety after head injury. In order to obtain a wider knowledge of the care of patients with raised ICP, a literature review was carried out. From this information I hope to improve the standard of care and ultimately patient outcome. The anxiety felt by family members are large and therefore I have decided to discuss this in my assignment. Consent has been sought from the next of kin. Confidentiality will be maintained in accordance with Nursing and Midwifery Council (NMC 2008). Patient’s Presentation Aldi is a 42 year old male who was found by police lying in the street, with loss of consciousness and believed to be assaulted. His eyes, lips and face was swollen. He was brought to the nearest hospital via ambulance as he had a seizure episode. In A&E it was noted that Aldi has sustained a head injury associated with a decrease level of consciousness and seizure activity. His pupils are both 2mm and reacting to light. His Glasgow Coma Scale (GCS) was 9-10. Opening eyes on pain, incomprehensible sound and moving all limbs. GCS is a worldwide recognized scale for documenting neurological assessment (Mavin,2008). After the initial presentation in A&E his neurological condition was rapidly...
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...Chapter 1 Nursing Images throughout History 1) The angle of mercy 2) The handmaiden 3) The battle-ax 4) The naughty nurse 5) The military image A. Nurses on the battlefield * Hospitalers – specialized soldiers who at the end of battle returned to the outposts to care for the sick and injured * Army nursing service – organize nurses and hospitals and coordinate supplies for the soldiers during the Civil War * Clara Barton a. Provided care in tents set up close to the fighting b. Did not discriminate c. Establishment of the American Red Cross * Harriet Tubman – helped slaves escape to freedom on the underground railroad * Walt Whitman – a poet * Louisa May Alcott – an author * Dorothea Dix – union’s superintendent of female nurses during the Civil War B. Nurses fighting diseases * Florence Nightingale d. Epidemiology – the study of the distribution and origins of disease e. Air, light, nutrition, and adequate ventilation and space assist the patient to recuperate * Lillian Wald & Mary Brewster f. Founded the Henry Street Settlement in NY to improve the health and social conditions of poor immigrants g. Improve health and prevent illness by promoting safe drinking water, adequate sewage facilities, and proper sanitation Florence Nightingale (1820-1910) ...
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...Cerebrovascular Disease Introduction Stroke is a part of a cardiovascular disease that occurs when the supply of blood or oxygen to the brain is disrupted by a blockage in the artery or when there is usually a trauma that causes spontaneous bleeding in the brain (Duncan, Zorowitz & Lambert, 2005). Bleeding in the brain, is referred to as a haemorrhagic stroke which results from either ruptured blood vessels or due to an abnormal vascular structure such as arterio-venous malformation. Although stroke can be classified into two different categories (ischemic and haemorrhagic), one should note the indispensable relationship between the two. This would be later explained at a greater detail into the case study. The following would be a brief introduction of my chosen case study. Emergency Department A 22 year old gentleman was brought to the Emergency Department at 1235hrs on 28th October 2012 via ambulance. Patient was unresponsive upon arrival, GCS= 3, E1V1M1, bilateral pupils non-reactive to light and slight epistaxis noted. History obtained from eye-witnesses stated that patient just finished boxing practice and complained of severe giddiness before fainting shortly after and never regained consciousness. On arrival at Emergency Department, patient was sent for a CT (computed tomography) Brain with chest and cervical spine X-ray followed by a swift intubation at 1315hrs. Patient, as per trauma protocol, was nursed on cervical collar although no cervical fracture was...
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...(2013). Gastrointestinal Alterations. In Pediatric Nursing: Caring for Children and Their Families (3rd ed., pp. 669-673). Clifton Park, New York: Thomas Delmar Learning. CLARK, D. (n.d.). Esophageal Atresia and Tracheoesophageal Fistula. Retrieved November 1, 2015. Data & Statistics. (2015, October 27). Retrieved November 1, 2015. Leifer, G. (2015). The Child with Gastrointestinal Condition. In Introduction to maternity and pediatric nursing (7th ed., pp. 643-644). St. Louis, Missouria: Elsevier. Scott, D. (2014, June 12). Retrieved November 1, 2015. Tracheoesophageal Fistula and Esophageal Atresia Symptoms and Diagnosis. (n.d.). Retrieved November 1, 2015. Silvestri, L. (2013). Metabolic, Endocrine, and Gastrointestinal Disorders. In Saunders comprehensive review for the NCLEX-PN examination (5th ed., pp. 409-410). St. Louis, Missouri: Elsevier/Saunders. Glossary Fig 1. There are five types of EA/TEF: 1) EA with distal TEF 2) isolated or pure esophageal atresia 3) pure tracheoesophageal...
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...and Management G u i d e l i n e f o r Marlene Walden, PhD RNC NNP CCNS Sharyn Gibbins, PhD RN NNP P r a c t i c e , 2 n d E d i t i o n Pain Assessment and Management Guideline for Practice, 2nd Edition This guideline is an outline of the pain assessment and management practices that currently are accepted and documented by experts in the field of neonatal care. In addition, it summarizes and recommends pain assessment and management practices based on the best evidence for the nursing care of infants. This guideline does not preclude the use of manufacturers’ recommendations or other acceptable methods of assessing and managing pain in infants. The use of other practices known to improve the quality of neonatal care is encouraged and not restricted by this document. The National Association of Neonatal Nurses (NANN) developed this guideline in response to members’ requests. Broad in scope, it can provide a foundation for specific nursing protocols, policies, and procedures developed by individual institutions. Authors Marlene Walden, PhD RNC NNP CCNS Sharyn Gibbins, PhD RN NNP Reviewers Daniel Batton, MD, American Academy of Pediatrics Sandra Sundquist Beauman, MSN RNC Jim Couto, MA, American Academy of Pediatrics Mary Ann Gibbons, BSN RN Melinda Porter, RNC CNS NNP Ann Stark, MD FAAP, Chair of AAP Committee on Fetus and Newborn Carol Wallman, RNC NNP MS, NANN/AWHONN Liaison to AAP Committee on Fetus and Newborn Development...
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