...Obtain exact weight. Document the amplitude of femoral and distal arterial pulses in both legs. Check patient name and medical record number on the patient identification band (ID). Obtain a complete history of allergies before the procedure for administration of fluids, sedation, and emergency medication. Obtain a concise and targeted medical, surgical, catheterization, PCI history, and current medication. Oral and intravenous prophylaxis should be administered as soon as possible before the procedure. Insert a patent intravenous (IV) access, hydration should be established as soon as possible, the amount of hydration depends on renal status and cardiac function. Record a baseline set of vital signs, including oxygen saturation by pulse oximetry. (Moser, & Riegel,...
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...the rationale for holding/discontinuing this medication at that time? (5 points) Ibuprofen can increase the risk of bleeding during surgery because it prevents platelets from aggregating and decrease clotting. It is recommended to stop NSAID a week prior to surgery due to the life spam of platelets. 3. The patient also reports that he took hydrochlorothiazide and Tylenol last night (October 31) and that the doctor’s office told him not to take his hydrochlorothiazide this morning. What is the rationale for holding this medication at this time? (5 points) Hydrochlorothiazide is a diuretic for the treatment of hypertension. The mechanism of action impact electrolytes like potassium. According to the pre-op work up serum potassium level is below normal range which indicate a risk for developing hypokalemia. 4. Identify the potential cause(s) of the serum potassium laboratory result. (3 points) The serum potassium level is slightly below the normal range, this result can be attribute to the use of diuretics like hydrochlorothiazide which mechanic of action is to inhibit the absorption of potassium, sodium and chloride. 5. The nurse calls the surgeon with this lab value. What does the nurse expect the physician to order? (3 points) What does the nurse need to consider with this order? (3 points) Due to the potassium low level, it is mostly expected to receive an order of potassium via IV. A nurse consideration at the time of administrating potassium IV is to give it slowly to prevent...
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...(Drug Information Online, 2011). Pathophysiology: “Leukocytosis can be a reaction to various infectious, inflammatory, and, in certain instances, physiologic processes (eg, stress, exercise). This reaction is mediated by several molecules, which are released or regulated in response to stimulatory events that include growth or survival factors (eg, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, c-kit ligand), adhesion molecules (eg, CD11b/CD18), and various cytokines (eg, interleukin-1, interleukin-3, interleukin-6, interleukin-8, tumor necrosis factor)” (Medscape, 2010). Common signs/symptoms: Fever, bleeding, bruising, lethargic, dizziness, trouble breathing, weight loss, and sweating. Potential...
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...performance. As this focus on performance has increased, the area of recovery has received relatively limited focus. Recovery is a multi-faceted paradigm focusing on recovery from training—session to session, day to day and week to week. Recovery is also vitally important during training as well as in competition between matches and between days during multi-day tournaments. As more information is needed in the area of tennis specific recovery, the Sport Science Committee of the United States Tennis Association (USTA) sponsored an extensive evidence-based review of the available literature related to eight distinct areas of tennis-specific recovery. These eight areas are: • • • • • • • • Nutritional Aspects of Tennis Recovery Heat and Hydration Aspects of Tennis Recovery Psychological Aspects of Tennis Recovery Recovery Aspects of Young Tennis Players Physiological Aspects of Tennis Recovery Musculoskeletal Injuries/ Orthopedics...
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...NURS: 4450 Professional Nursing Leadership and Management H.B. is a sixty-four year old white male who was admitted to Memorial Hospital Ortho/Trauma Unit on January 31, 2015. His admitting diagnosis was left femoral acetabular fracture. Upon arrival, he complained of left hip pain after a truck that he was working on fell on him. His left lower extremity was shortened and internally rotated when compared to the contralateral side. The skin of the affected extremity was intact. A 2+ dorsalis pedis pulse was present on the left foot. In addition, the patient did not complain of pain upon palpation of the left thigh, knee, ankle, and foot. However, the patient complained of excruciating pain of the left hip upon attempted ROM. The findings of the pelvis CT scan showed a dislocation of the left femoral head superiorly and posteriorly with a comminuted fracture of the medial left femoral head and superior left acetabulum. The emergency department physician performed a reduction of the left hip with placement of skeletal traction pins before the patient arrived at the Ortho/Trauma Unit. Finally, a total hip arthroplasty (THA) was recommended and the patient is currently awaiting surgery that is scheduled on February 03, 2015. H.B.’s surgical history includes a colon resection for pre-cancerous polyp in 2013, a right wrist surgery in 2009, and a laminectomy in 1996. His medical history is composed of hypertension (HTN) and asthma. H.B. takes amlodipine and losartan for hypertension...
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...Ulcerative Colitis A. Description Ulcerative colitis is an autoimmune disorder that, along with Crohn’s disease, is referred to as inflammatory bowel disease (IBD). IBD is characterized by diarrhea (up to 20 stools during acute exacerbation), crampy abdominal pain, and exacerbations (“flare-ups”)/remissions. B. Pathophysiology Ulcerative colitis usually starts in the rectum and moves in a continual fashion toward the cecum. Although there is sometimes mild inflammation in the terminal ileum, ulcerative colitis is a disease of the colon and the rectum. The inflammation and ulcerations occur in the mucosal layer, the inner-most layer of the bowel wall. Since it does not extend through all bowel wall layers, fistulas and abscesses are rare. Water and electrolytes cannot be absorbed through inflamed mucosa. Diarrhea with large fluid and electrolyte losses is a characteristic feature of damage to the colonic mucosa epithelium. Breakdown of cells results in protein loss through stool. Areas of inflamed mucosa form pseudo-polyps, tongue-like projections into the bowel lumen. C. Common signs & symptoms or clinical manifestations The common signs of ulcerative colitis include diarrhea, bloody stools, weight loss, abdominal pain, fever and fatigue. It is considered a chronic disorder a chronic disorder with mild to severe acute exacerbations that occur at unpredictable intervals over many years. The primary manifestations...
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...Delegation Exercise in a Health Care Setting Ana Bergeron University of Phoenix Assignment After rounding on patients the RN made the following assignments. See appendix for a full description of each patient: Assignments | | Macy LPN #1 | Pod 1 | | Mr. Black (UTI) | | Ms. Johnson (Crohn’s) | | Mr. Raynor (diabetic foot ulcer) | | Mrs. Tolento (CHF) Mr. Smith (pneumonia) | | Ms. Swanson (S/P hysterectomy day 2, in pod 2) | Ana RN | Pod 2 | | Mr. Smith (GI Bleed) | | Mr. Moretz (Night sweats, neg pressure room) | | Mrs. Flanco (S/P Colectomy day 2)Mr. Reddington (GSW) | Mike LPN #2 | Pod 3 | | Mr. Smith (Atrial Fib) | | Ms. Harper (s/p breast mastectomy) | | Ms. Levin (s/p attempted suicide) | | Mrs. Walnut (aspiration pneumonia)Mrs. Stewart (Diabetic Ketoacidosis) | | | Gilda CNA | Pods 1-3 | | | Explanation The following is a detailed explanation of the assignments made for this shift: Macy LPN: Macy was given her patients based of her skill and scope. She always volunteers to take on the Spanish speaking patients since she is more comfortable speaking in Spanish. The RN, after moving patients to different pods, she gave Macy one possible discharge today and what would be consider by some a difficult patient that can be abusive and refuses to be take care of be the other LPN on shift today. Macy also had to take on a total of 6 patients instead of six, the RN will cosign her notes at of shift. The patients...
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...the U.S. alone for this population is approximately $245 Billion annually. (American Diabetes Association, 2012) Proper wound care is an essential step in the wound healing process, however,wound care alone is not sufficient. Nutritional status is extremely important in wound healing. Diabetic patients need to be educated and assessed for protein-energy malnutrition (PEM) as the body’s nutritional needs significantly increase during the wound healing process (Demling, 2009). Supplementation (especially protein) and the importance of it for wound healing need to be discussed with the patient. Without all the necessary interventions applied the process of wound healing can be lengthy and may lead to infection, excessive hospitalization and potential amputations. Understanding the body’s nutritional needs and how the body uses protein in the repair process is imperative. The recommendation for the amount of protein supplementation is between 0.8grams/kilogram to 1.2 grams/kilogram and is based on patient nutritional status and severity of the wound (Collins 2014) (Goodridge 2006) (Lansdown 2004). Maintaining recommended amounts of protein intake has shown dramatic decrease in days-to-heal and better patient outcomes overall (Demling, 2009). Purpose The primary purpose of this integrated review is to summarize the findings from studies that evaluated the use of protein...
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...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 it, certain risk factors...
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...Chapter 6: Cancer Care *The following is a sample care plan meant for adaptation. Always revise to meet your facility’s protocols and the latest research and nursing diagnoses. |PLAN OF NURSING CARE | |The Patient With Cancer | |nursing diagnosis: Risk for infection related to inadequate defenses related to myelosuppression secondary to radiation or antineoplastic | |agents | |goal: Prevention of infection | |Nursing Interventions |Rationale |Expected Outcomes | |1. Assess patient for evidence of infection: |1. Signs and symptoms of infection may be |● Demonstrates normal temperature and vital | |a. Check vital signs every 4 hours. |diminished in the immunocompromised host. |signs. | |b. Monitor white blood cell (WBC) count and |Prompt recognition of infection and subsequent |● Exhibits absence of signs of inflammation: | |differential...
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...Exp’t 112 Isolation of Casein, Lactose, and Albumin from Milk Adapted by R. Minard (Penn State Univ.) from Introduction to Organic Laboratory Techniques: A Microscale Approach, Pavia, Lampman, Kriz & Engel, Saunders, 1990. Revised 3/20/2000 PreLab Exercise: Draw a mechanism for the acid-catalyzed hydrolysis of the acetal bond in lactose; see reaction below. Hint: your textbook may be of some help; first identify the functional group that is undergoing a reaction and consider the catalyzed used. H HO OH CH2OH O O H OH H2C OH O HO HO OH OH H2C OH O HO HO + HO OH H2O OH CH2OH O HO H + D -Galactose D -Glucose OH α-Lactose: D -Galactose+ D -Glucose Introduction: The Chemistry of Milk Milk is a food of exceptional interest. Not only is milk an excellent food for the very young, but humans have also adapted milk, specifically cow’s milk, as a food substance for persons of all ages. Many specialized milk products like cheese, yogurt, butter, and ice cream are staples of our diet. Milk is probably the most nutritionally-complete food that can be found in nature. This property is important for milk, since it is the only food young mammals consume in the nutritionally significant weeks following birth. Whole milk contains vitamins (principally thiamine, riboflavin, pantothenic acid, and vitamins A, D, and K), minerals (calcium, potassium, sodium, phosphorus, and trace metals), proteins (which include all the essential amino acids), carbohydrates (chiefly lactose), and lipids...
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...Overview Hypercalcemia is the most common life-threatening metabolic disorder associated with neoplastic diseases, occurring in an estimated 10% to 20% of all adults with cancer. It also occurs in children with cancer, but with much less frequency (approximately 0.5%–1%).[1-3] Solid tumors (such as lung or breast cancer tumors) as well as certain hematologic malignancies (particularly multiple myeloma) are most frequently associated with hypercalcemia.[4] Although early diagnosis followed by hydration and treatment with agents that decrease serum calcium concentrations (hypocalcemic drugs) can produce symptomatic improvements within a few days, diagnosis may be complicated because symptoms may be insidious at onset and can be confused with those of many malignant and nonmalignant diseases. However, diagnosis and timely interventions not only are lifesaving in the short term but also may enhance the patient’s compliance with primary and supportive treatments and may improve quality of life.[5] When a patient has a refractory, widely disseminated malignancy for which specific therapy is no longer being pursued, the patient may want to consider withholding therapy for hypercalcemia. For patients or families who have expressed their wishes regarding end-of-life issues, this may represent a preferred timing and/or mode of death (as compared with a more prolonged death from advancing metastatic disease). This option is best considered long before the onset of severe hypercalcemia or...
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...science and technology of SPM. AFM and SFM have been also newsworthy items in Science and Nature in the past year [14••,15•–17•,18••,19]. An introduction to AFM is covered well in a recent issue of Current Opinion in Chemical Biology, which describes and illustrates the design and mode of operation of AFM [4••]. The AFM images sample surfaces by raster-scanning a sharp tip back and forth over the surface. The tip is on a cantilever that responds to height changes on the sample surface in a way that generates a topographical map of the surface. We build on this excellent introduction by presenting some of the many advances in SPM that have occurred since that review was written. (The accompanying images are from AFM research in the authors’ lab). Atomic force microscopy imaging Proteins Entropic brush...
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...Wearable Computers EEE 439 What is a Wearable Computer? As we continue to integrate computers into our everyday lives at an ever faster rate, the idea that a static desktop, or even a portable laptop can fulfill all of our computing needs is becoming increasingly more ridiculous. The integration of technology constantly creates situations in which we pause and think, “If only I had a computer,” The wearable computer does this. It goes where you go, it does what you do. Its there when you want to use it, unobtrusive when you don’t. So what is a wearable computer? Why don’t we just put our laptops on a sling? In 1998, Steve Mann gave a keynote address at the International Conference on Wearable Computing in which he explained the operational modes of wearable computers and six defining traits of a true wearable computer. According to Mr. Mann, the wearable computer creates three new modes of interaction between human and computer which have not existed before. These three new modes of operation are Constancy, Augmentation, and Mediation (Mann, 1998). Constancy means that the computer is always on and available for use by the user; traditional devices are turned off and closed when not in use. Augmentation is the idea that wearable computers will augment the user’s abilities instead of merely providing computing power on demand. Mann splits Mediation into two different areas; Solitude – the ability to cut oneself off from material, and Privacy – the ability to block or modify...
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...NCLEX-RN® DETAILED TEST PLAN 2010 NCLEX-RN Detailed Test Plan ® Effective | April 2010 Item Writer/Item Reviewer/Nurse Educator Version Mission Statement The National Council of State Boards of Nursing, composed of member boards, provides leadership to advance regulatory excellence for public protection. Purpose and Functions The purpose of the National Council of State Boards of Nursing (NCSBN ) is to provide an organization through which boards of nursing act and counsel together on matters of common interest and concern affecting the public health, safety and welfare, including the development of licensing examinations in nursing. ® The major functions of NCSBN include developing the NCLEX-RN and NCLEX-PN examinations, performing policy analysis and promoting uniformity in relationship to the regulation of nursing practice, disseminating data related to NCSBN’s purpose and serving as a forum for information exchange for NCSBN members. ® ® Copyright© 2010 National Council of State Boards of Nursing, Inc. (NCSBN) All rights reserved. NCSBN , NCLEX , NCLEX-RN and NCLEX-PN are registered trademarks of NCSBN and this document may not be used, reproduced or disseminated to any third party without written permission from NCSBN. ® ® ® ® Permission is granted to boards of nursing to use or reproduce all or parts of this document for licensure related purposes only. Nonprofit education programs have permission to use or reproduce all or parts of this document...
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