...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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...symptoms like fatigue and palpitation may present. Dyspnea and tachycardia are the most common complaints. Around a half of cases achieve spontaneous and complete recovery of left ventricular function after gestation. However，the remaining present with a much more progressive disease which may require intensive treatments and even heart transplantation [3]. Here we report a fatal case of PPCM, which was successfully managed...
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...Critical Care Case Study Crystal Meyer Mohave Community College Nursing 222 Mrs. Michelle Christensen April 1, 2014 Critical Care Case Study ADMISSION TC is a 61-year-old English speaking Caucasian female born on April 29, 1952. She weighs 99.7 Kg and is 5 feet, 5 inches in height with a BMI of 35.84. On March 5, 2014, TC was brought into the emergency department after her daughter-in-law called 911 when she found TC unresponsive at home in her bathroom. When paramedics arrived, she was found to be cool, pale, and diaphoretic with oxygen saturations in the high 70’s. Emergency responders placed a non-rebreather high flow oxygen mask and her oxygenation began to improve with saturations in the low 90’s. Upon arrival to the emergency department, TC’s vital signs were as follows: T 97.4; P 97; BP 120/95 mm Hg; RR 15 per minute; and O2 sats of 98% via NRB oxygen mask on 8L. A chest x-ray (CXR) revealed no abnormality and lungs were determined to be grossly clear. However, TC was checked for a pulmonary embolism via a pulmonary artery angiogram with IV contrast and found to have a large clot burden with a small saddle embolism. TC also complained of right ankle pain. An X-ray of her right ankle revealed a distal tib/fib fracture, which was presumed to be related to her fall during her hypoxic episode. With these findings, TC was admitted to the Intensive Care Unit of Kingman Regional Medical Center and placed on an NPO diet in preparation for placement of an inferior vena...
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...the reaction of the person’s tissue to its presence. After several weeks the host develops an immune response to the bacilli, cells attack the bacilli and permit the initial damage to heal and prevent future disease permanently. Being infected with the bacteria does not mean that the person is contagious or ill. They might have symptoms of the disease. The chest x-ray will remain negative. However they can become ill after many years. Symptoms The symptoms of Tuberculosis disease are weight loss, fever, night sweats, coughing, chest pain, coughing greenish-yellowish sputum, coughing up of blood, loss of appetite, weakness and weight loss. Complications Pneumothorax and pleural effusion can develop as a result of the infection causing difficulty to breathe. A chest tube...
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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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...He was found to have am occluded left popliteal aneurysm with occlusion of all tibial vessels. The patient was taken to the OR with vascular service for initiation of thrombolysis therapy. He is currently hospitalized for left lower extremity ischemia, angiogram, thrombolysis, bypass femoral popliteal thrombectomy, irrigation and debridement of wound, and a fasciotomy. Then, he was taken back to the OR for debridement of left anterolateral muscular compartment necrosis. This morning, he was noted to be “confused”. The patient was stable and oriented until at least yesterday evening. Per the primary team, he did not appear confused when seen at 6am. He was also noted to have a temperature of 37.4. He did not have any labs checked for 2 days, but this morning his labs were notable for leukocytosis of 13 from 9, hemoglobin on 6.2 from 7.6, and Na of 131 from 136. The patient denies any specific complaints, but does not appear to focus on questions. Pathophysiology: Popliteal aneurysms are defined as localized dilatations of the popliteal artery greater than 2 cm in diameter or an increase of 1.5 times the normal arterial size (Galland, 2007)....
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...Symptoms The list of symptoms attributable to SLE is extensive and astonishing. Among symptoms most frequently observed are painful joints, usually of the hands and feet, which may also include the larger joints. Of all SLE patients, 92% endure significant joint pain. Similarly, 84% of all SLE patients suffer from fevers. Skin eruptions, including round or discoid lesions, as well as a butterfly rash presenting on the cheeks below the eyes and bridging the nose, will afflict 72%. Inflammatory kidney dysfunctions, including bloody urine, loss of proteins through urine, high blood pressure, edema, and nephrotic syndrome are seen in 60%. 50% of all SLE patients will experience inflammation of the pleural sack around the lungs and the collection of effusion fluids in the pleural cavity. 50% will suffer from the symptoms of inflammation of the pericardial membrane, including chest pains, dry...
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...Pneumonia Case Study August 27th, 2014 Mrs. Yolanda Bone South University Pneumonia Case Study A major cause of morbidity and mortality is Pneumonia. Pneumonia is a lung infection caused by bacteria, fungi or viruses (Center for Disease Control, 2014).The infection is classified into two categories; community-acquired pneumonia (CAP) or health care-associated pneumonia (HCAP). The classification is determined by the environment in which the infection develops (CDC, 2014). HCAP develops during or following a stay in a healthcare facility. In contrast, patients who are diagnosed with CAP have had no contact within a health care setting prior to presenting with the infection (Driver, 2012). Pneumonia may be present as a mild illness but has the potential to be life-threatening. Despite advances in research, pneumonia remains a common illness contributing to the death of young children in developing countries and the elderly population of developed countries throughout the world (Ruuskanen, et al., 2011). In 2010, approximately 50,000 people in the U.S. died after developing the infection (CDC, 2014). From a global perspective, 450 million cases of pneumonia are recorded annually and roughly 4 million of those diagnosed will die from this illness (Ruuskanen, et al., 2011). CAP is the eighth-leading cause of death within the U.S. and is the leading cause of death from infection in the developed world (Brown, et al., 2012). While anyone is susceptible to contracting...
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...Coccioidiodal Mycosis Coccioidiodal Mycosis According to Fauci et al., fungal infections are classified into categories based on anatomic location and epidemiology. The most frequent anatomic categories are mucocutaneous and deep organ infections. The most common epidemiologic categories are endemic and opportunistic. The endemic mycoses, such as coccidioidomycosis, are infections caused by fungal organisms that are not found in normal human flora and are instead acquired from environmental sources. In contrast, organisms found in normal human microbial flora cause opportunistic infections. Endemic fungal infections are acquired almost exclusively by inhalation of molds in the environment. Soil, dust, and dirt are the natural reservoirs for most of these infections, demonstrated by an increase in cases following dust storms, seismic events, archeological digging, or recreational activities (Fauci et al., 2008). The incidence of endemic fungal infections has risen substantially over the past several decades, especially in geographic locations in which there has been substantial population growth (Fauci et al., 2008). Healthcare providers may be required to recognize and treat an increasing number of severe coccidioidal infections as growth and urbanization to these areas increases. Additionally, a recent study of community-acquired pneumonia (CAP) in Arizona suggested coccidioidomycosis might be a...
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...NUR160 Ca Name: Jodi Wiak | Section: 160 | Instructor: Ms. Higgins | Dates of care: 4/1/14 | Week: 1st clinical | Name: Jodi Wiak | Section: 160 | Instructor: Ms. Higgins | Dates of care: 4/1/14 | Week: 1st clinical | General Survey | Age: 85 | Sex: F | Ethnicity: Caucasion | # of days since admission: 7d | Allergies: Latex PCN | Code Status: FULL CODE | Diet: TPN | Rationale: Small bowel obstruction and resection benefit TPN over tube feedings is that all the nutrition is delivered at a cellular level making it immediately available for the body to utilize rather than making the body breakdown and absorb nutrients in the GI tract. It makes it easier on the digestive tract by giving the GI a chance to rest and heal without causing more harm. The patient also has to expend energy to breakdown foods/nutrition through the GI tract. Getting it TPN conserves the much needed energy the patient needs to heal their tissues and gain strength. | Activity: bedridden w/slight mobility with a walker | Rationale: Post surgical abdominal surgery, pt age, weakness, and recent foot surgery limiting her mobility. | Behavior/Affect: My pt was anxious when I first arrived due to her elevated B/P, N&V, and pain intolerance. By the end of shift my patient was very calm and communicative. | Isolation: | Yes | No | Culture: ⦵ | Source: ⦵ | Type of Isolation: ⦰ ⦵ | Height: 5’ 7.5” | Weight: 133 | BMI: 20.5 (BSA 1.71) | General Survey | Age: 85 | Sex:...
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...PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE Nursing Assessment 1. Part of Nursing Process 2. Nurses use physical assessment skills to: a) Obtain baseline data and expand the data base from which subsequent phases of the nursing process can evolve b) To identify and manage a variety of patient problems (actual and potential) c) Evaluate the effectiveness of nursing care d) Enhance the nurse-patient relationship e) Make clinical judgments Gathering Data Subjective data - Said by the client (S) Objective data - Observed by the nurse (O) Document: SOAPIER Assessment Techniques: The order of techniques is as follows (Inspect – Palpation – Percussion - Auscultation) except for the abdomen which is Inspect – Auscultation – Percuss – Palpate. A. Inspection – critical observation *always first* 1. Take time to “observe” with eyes, ears, nose (all senses) 2. Use good lighting 3. Look at color, shape, symmetry, position 4. Observe for odors from skin, breath, wound 5. Develop and use nursing instincts 6. Inspection is done alone and in combination with other assessment techniques B. Palpation – light and deep touch 1. Back of hand (dorsal aspect) to assess skin temperature 2. Fingers to assess texture, moisture, areas of tenderness 3. Assess size, shape, and consistency of lesions and organs 4. Deep = 5-8 cm (2-3”) deep; Light = 1 cm deep C. Percussion – sounds produced by striking body surface 1. Produces different notes depending on underlying mass (dull...
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...Overview of Bioterrorism This course has been awarded two (2.0) contact hours. This course expires on November 12, 2014. Copyright © 2008 by RN.com. All Rights Reserved. Reproduction and distribution of these materials are prohibited without the express written authorization of RN.com. First Published: Updated: November 12, 2008 Nov 12, 2011 IMPORTANT INFORMATION RN.com strives to keeps its content fair and unbiased. The author has no conflicts of interest to disclose. The planners of the educational activity have no conflicts of interest to disclose. (Conflict of Interest Definition: Circumstances create a conflict of interest when an individual has an opportunity to affect Education content about products or services of a commercial interest with which he/she has a financial relationship.) There is no commercial support being used for this course. Participants are advised that the accredited status of RN.com does not imply endorsement by the provider or ANCC of any products/therapeutics mentioned in this course. The information in the course is for educational purposes only. There is no “off label” usage of drugs or products discussed in this course. Acknowledgements RN.com acknowledges the valuable contributions of… Material protected by Copyright …The Centers for Disease Control (CDC) (www.cdc.gov), the key government agency responsible for disseminating knowledge about various biological agents. …U.S. Medical Research Institute of Infectious Diseases...
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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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...Running Head: CASE STUDY IN INEFFECTIVE PHARMACOLOGICAL MANAGEMENT Case Study in Ineffective Pharmacological Management Southern University A&M College Graduate Nursing 652 Dr. Blair April 23rd, 2015 Introduction In the case study of Mr. J; he has been exhibiting dyspnea upon exertion and fatigue. His blood pressure was 170/95 mmHg. After reviewing his labs; his LDL level was 200 mg/dl. Upon physical examination, he was found to have peripheral edema and jugular vein distention. A chest X-ray revealed cardiomegaly and pleural effusion. An echogram has also been scheduled. Based on his signs and symptoms, the physician suspects Mr. J has new onset Stage C heart failure. Mr. J has multiple prescribed drugs for Hypertension, Hyperlipidemia, Parkinson’s, Gout and Depression. After careful reviewing Mr. J’s medications there is concerns ineffective pharmacological management. Ineffective pharmacological management refers to medication therapy prescribed that does not take into account the patient’s age, diagnoses and comorbidities; therefore leading to complications of existing health problems. Side effects, adverse reactions and drug to drug interactions have to also be considered when reviewing a patient’s medication regimen. The drug categories most commonly involved in adverse reaction are cardiovascular agents, antibiotic, diuretics, anticoagulants, hypoglycemic, steroids, opioids, anticholinergic...
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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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