...a tension pneumothorax involving the left lung. Patient also states that he gets cramping in his right calf when he walks. PMH: Had cholecystectomy 20 years ago. Total dental extraction 5 years ago. Patient describes intermittent claudication. Claims to be allergic to penicillin. Diagnosed with emphysema more than 10 years ago. Has been treated successfully with Combivent (metered dose inhaler )-2 inhalations qid (each inhalation delivers 18 mcg ipratropium bromide; 130 mcg albuterol sulfate). Diagnosed with Type 2 Diabetes three years ago, treated with Janumet daily. Home Meds: Combivent, Lasix, Janumet, O2 2 L/hr via nasal cannula at night Smoker: Yes, 2 PPD for 50 years Family Hx: What? Lung cancer Who? Father Physical exam: General appearance: Acutely...
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...20. Her weight was up five pounds from last visit that was one week ago. She was a well- dressed woman. Her skin was warm, dry and intact. The mucous membranes were moist, and hearing was intact. Rales were auscultated in her right lower lung field. Her cardiovascular system was negative for chest pain. There was not any jugular vein distension, audible gallop, or heart murmur noted. She had bilateral +1 pedal edema, and peripheral pulses were found to be +2 at the radial and pedal location. Abdomen was soft with normal bowel sounds. An electrocardiogram showed a sinus rhythm with a first-degree heart block. Pertinent labs from the previous visit were as follows: WBC was 10.3, Hgb was 9.7, potassium 5.2, creatinine 3.2, BUN 24, GFR 27 and thyroid function studies were normal. Chest x-ray did not show significant change from her previous exam. However, there was significant cardiomegaly present. The diagnosis was volume overload with end-stage renal disease. There were no changes made to her medications at this time. Plan of care was discussed with her, and contact was made with her nephrologist. She was sent to the center for...
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...viral infections while the immune system is still developing • Being overweight • Low birth weight A person living with Asthma can function normally; they do not experience symptoms on a daily basis. Although daily activities are not compromised in any way, people with Asthma must be aware of conditions that can cause the airways to narrow and swell (Mayo clinic, 2011). Some things that can trigger Asthma symptoms are: • Allergens from dust, mold, pollen, etc. • Irritants like cigarette smoke and chemicals such as cleaning products • Physical activity • Respiratory infections like colds Diagnosis Asthma is diagnosed by a primary care doctor and the diagnosis is based on family history, medical history, a physical exam, and test results (National Institutes of Health, 2011). The tests commonly used to diagnose Asthma are: • Spirometry which is a test to see how the lungs are functioning by how much air is being inhaled and exhaled. • An allergy test to see which allergens have a negative impact • Bronchoprovocation which is used to measure the sensitivity of the airways • A chest x-ray or an electrocardiogram may be administered to ensure no other conditions are causing the symptoms Treatment...
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...NURSES: PARTNERS IN ASTHMA CARE NIH P UBLICATION N O . 95-3308 OCTOBER 1995 N ATIONAL I NSTITUTES OF H EALTH National Heart, Lung, and Blood Institute i T ABLE OF C ONTENTS PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NURSES’ ASTHMA EDUCATION WORKING GROUP . . . . . . 1. PATHOPHYSIOLOGY OF ASTHMA . . . . . . . . . . . . . . . . . 2. PRACTICAL GUIDE TO ASTHMA MANAGEMENT . . . . . . GOALS OF ASTHMA MANAGEMENT . . . . . . . . . . . . . . . GENERAL PRINCIPLES OF ASTHMA MANAGEMENT . . . FOUR COMPONENTS OF ASTHMA MANAGEMENT . . . . Asthma Management Component 1: Objective Measures of Lung Function . . . . . . . . . . . . Spirometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Peak Flow Monitoring . . . . . . . . . . . . . . . . . . . . . . Actions/Implications for Nurses: Objective Measures . . . . . . . . . . . . . . . . . . . . . . . . . Asthma Management Component 2: Environmental Control Measures. . . . . . . . . . . . . . . . Allergens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Irritants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Actions/Implications for Nurses: Environmental Control . . . . . . . . . . . . . . . . . . . . . . Asthma Management Component 3: Pharmacologic Therapy . . . . . . . . . . . . . . . . . . . . . . . Two Major Groups of Asthma Medications: Anti-inflammatory and Bronchodilator . . . . . . . . Step-Care for Chronic Asthma...
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...or anemia. Patient does report dyspnea with exertion and having had three cardiac catherizations for cardiac arrhythmia and CAD in the past. Abdomen: Patient denies any jaundice or nausea. Patient denies dysphasia, heartburn, abdominal pain, or changes in bowel habits. Patient denies any hematochezia, melena, hemorrhoids, or constipation. Patient does report a decreased appetite in relation to the death of his daughter. GU: Caliber of urinary stream is strong; no hesitancy; no dribbling; no hernia. Reports he is heterosexual in no relationship at this time; no discharge or sores on the penis; no HIV or STD exposure; no testicular pain/masses; does not routinely perform testicular exams. Musculoskeletal: Patient denies edema in lower extremities. Patient denies any claudicating symptoms of pain with activity, no coldness, tingling, leg cramps or numbness; no varicose veins; no history of blood clots; no discoloration of the extremities; no ulcers; or decrease in range of motion. III. Objective Data Vital Signs: Blood Pressure- 130/80 Pulse- 74 Respirations: 16 Temperature: 97.0 Oxygen saturation- 94% Height: 68” Weight: 108 pounds BMI: 16.42 General Appearance: This patient is a 70-year-old, white male in no apparent distress. His speech is clear and is able to articulate his needs. He is developed well, extremely thin, and...
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...00_078973706x_fm.qxd 1/14/08 2:42 PM Page i NCLEX-PN ® SECOND EDITION Wilda Rinehart Diann Sloan Clara Hurd 00_078973706x_fm.qxd 1/14/08 2:42 PM Page ii NCLEX-PN® Exam Cram, Second Edition Copyright © 2008 by Pearson Education All rights reserved. No part of this book shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. No patent liability is assumed with respect to the use of the information contained herein. Although every precaution has been taken in the preparation of this book, the publisher and author assume no responsibility for errors or omissions. Nor is any liability assumed for damages resulting from the use of the information contained herein. ISBN-13:978-0-7897-2706-9 ISBN-10: 0-7897-3706-x Library of Congress Cataloging-in-Publication Data Rinehart, Wilda. NCLEX-PN exam cram / Wilda Rinehart, Diann Sloan, Clara Hurd. -- 2nd ed. p. cm. ISBN 978-0-7897-3706-9 (pbk. w/cd) 1. Practical nursing--Examinations, questions, etc. 2. Nursing--Examinations, questions, etc. 3. National Council Licensure Examination for Practical/Vocational Nurses--Study guides. I. Sloan, Diann. II. Hurd, Clara. III. Title. RT62.R55 2008 610.73'076--dc22 2008000133 Printed in the United States of America First Printing: February 2008 Trademarks All terms mentioned in this book that are known to be trademarks or service marks have been appropriately...
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...LEAN HOSPITALS “Mark Graban’s book has documented what is now happening in hospitals all across America as we learn to apply the Toyota Production System methodology to healthcare. This book lays out the nuts and bolts of the lean methodology and also describes the more difficult challenges, which have to do with managing change. Graban’s book is full of wins—these are the same type of wins that are happening at ThedaCare every day. I wish I could have read this book six years ago, as it might have prevented some of the mistakes we made in our lean transformation journey.” — John S. Toussaint, MD, President/CEO ThedaCare Center for Healthcare Value “Coupled with a foundation of alignment and accountability, the ideas in this book provide a powerful tool to help hospitals get closer to the goal we want – perfect care.” — Quint Studer, CEO, The Studer Group, author of Results that Last “Mark Graban is the consummate translator of the vernacular of the Toyota Production System into the everyday parlance of healthcare. With each concept and its application, the reader is challenged to consider what is truly possible in the delivery of healthcare if standardized systems borrowed from reliable industries were implemented. Graban provides those trade secrets in an understandable and transparent fashion.” — Richard P. Shannon, MD, Frank Wister Thomas Professor of Medicine, Chairman, Department of Medicine, University of Pennsylvania School of Medicine “There is an...
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...Critical Thinking Paper Aubrey Lewis Grand Canyon University 11/11/11 SYSTEMATIC ASSESSMENT Biographical Data Patient, C.L, is a 52-year-old Caucasian female that was admitted to Banner Thunderbird on 09/29/11 for difficulty breathing and shortness of breath (SOB). The patient has no known drug or food allergies and is registered as a “do not resuscitate” and “do not intubate” (DNR/DNI). History of Present Illness Patient stated that she had woken up through out the night drenched in sweat and the inability to catch her breath. This is what brought her to the emergency department where she presented with difficulty breathing (dyspnea), and shortness of breath. Based upon how the patient presented and the results of the diagnostic tests that were conducted the patient was admitted to the progressive care unit of Banner Thunderbird. Diagnostic tests that were conducted was a chest X-ray, magnetic resonance imaging (MRI), and ultra sound to determine if there is a build up or either fluid and/or air in the pleural spaces of the lungs or a tumor that is causing the patient to have difficulty breathing. Non-imaging tests that are conducted would be a blood studies and arterial blood gas test. The blood studies would be able to dictate if the patient has a bacterial or viral infection, pneumonia, rheumatic fever, a pulmonary embolus, or lupus, and the arterial blood gas test will be able to show how well the lungs are taking in oxygen...
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...A kid with Hepatitis A can return to school 1 week within the onset of jaundice. 2. After a patient has dialysis they may have a slight fever...this is normal due to the fact that the dialysis solution is warmed by the machine. 3. Hyperkalemia presents on an EKG as tall peaked T-waves 4. The antidote for Mag Sulfate toxicity is ---Calcium Gluconate 5. Impetigo is a CONTAGEOUS skin disorder and the person needs to wash ALL linens and dishes seperate from the family. They also need to wash their hands frequently and avoid contact. positive sweat test. indicative of cystic fibrosis 1. Herbs: Black Cohosh is used to treat menopausal symptoms. When taken with an antihypertensive, it may cause hypotension. Licorice can increase potassium loss and may cause dig toxicity. 2. With acute appendicitis, expect to see pain first then nausea and vomiting. With gastroenitis, you will see nausea and vomiting first then pain. 3. If a patient is allergic to latex, they should avoid apricots, cherries, grapes, kiwi, passion fruit, bananas, avocados, chestnuts, tomatoes and peaches. 4. Do not elevate the stump after an AKA after the first 24 hours, as this may cause flexion contracture. 5. Beta Blockers and ACEI are less effective in African Americans than Caucasians. 1. for the myelogram postop positions. water based dye (lighter) bed elevated. oil based dye heavier bed flat. 2.autonomic dysreflexia- elevated bed first....then check foley...
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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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...INTRODUCTION Review of Related Literature Pneumonitis Pneumonitis is a general term that refers to inflammation of lung tissue. It occurs when some irritating substance – solid particles, liquids, gases, radiation or bacteria – cause the tiny air sacs to become inflamed. This can hamper the exchange of oxygen and carbon dioxide in the air sacs. Pneumonia is one type of pneumonitis caused by an infection. There are several types of pneumonitis. They include: • Aspiration pneumonitis- occurs when you inhale (aspirate) foreign matter into your lungs. Stomach contents, such as ingested food or liquid, are a frequent cause of aspiration pneuomonitis. Accidental inhalation of small particles, such as tiny pieces of peanuts or vegetables, while swallowing is common in young children. • Chemical pneumonitis- is a type of aspiration pneumonitis that develops when you inhale chemicals that are toxic to your lungs. Industrial and household chemicals, such as chlorine gas, ammonia, solvents and pesticides can all cause chemical pneumonitis. • Hypersensitivity pneumonitis- is nicknamed “farmer’s lung,” “mushroom picker’s disease” and other colorful names with good reason. Dust from animal dander, molds and plants, all potential allergens, can provoke an inflammatory reaction in your lungs. Symptoms usually develop within six hours of exposure to the allergen. Some people are more susceptible to developing hypersensitivity pneumonitis than are others, although it’s...
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...Courtesy of L E K A R SPECIAL EDITION Authors: Marino, Paul L. Title: ICU Book, The, 3rd Edition Copyright ©2007 Lippincott Williams & Wilkins ISBN: 0-7817-4802-X Authors Dedication Quote Preface to Third Edition Preface to First Edition Acknowledgments Table of Contents Section I - Basic Science Review Basic Science Review Chapter 1 - Circulatory Blood Flow Chapter 2 - Oxygen and Carbon Dioxide Transport Section II - Preventive Practices in the Critically Ill Preventive Practices in the Critically Ill Chapter 3 - Infection Control in the ICU Chapter 4 - 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...
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