...eMedicine article/238798 MeSH D007676 Chronic kidney disease (CKD), also known as chronic renal disease (CRD), is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.[1] It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small...
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...Critical Pathway: Case Study of Chronic Renal Failure Advanced Pathophysiology NURS 5104 October 4, 2013 Critical Pathway: Case Study of Chronic Renal Failure I. Introduction Mr. P. J., a 38-year-old African American male, presented to the Emergency Department by the rescue squad team, with a six day old complaint of increased swelling of the bilateral lower extremities, unusual weight gain, and a feeling of ‘I can not breathe’ per patient. Patient was sent as a direct admit to the Intensive Care Unit (ICU) and placed on 2 liters NC with hydration and adult special care monitoring. Vital signs were taken by the paramedic enroute revealing the following: Ambulance Vitals: * BP 202/112 * Pulse 101 * Respirations 20 * O2 86% before O2 * Temp. 98.4 * Height 5’10 Patient stating * Weight 222 lbs. Patient stating (weighed the day before) The paramedic started a 20 gauge IV into Mr. J’s right antecubital and started him on 2 liters nasal cannula; due to the “presence of crackles no Procardia was administered” (J. Madden, personal communication, August 14, 2013). The paramedic monitored the vitals and reported to medical control the situation and estimated time of their arrival in five minutes. Mr. P. J. has been married to K for twenty years and they have one child, a twelve-year-old daughter. Mr. P. J. has worked in construction for twenty years; Mr. J stated working on his feet all day he noticed the swelling six days ago...
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...Collaborative Approach to End Stage Renal Disease Patient Care Chronic kidney disease (CKD) affected 15.1% of the U.S. population in 1999-2000. During the fifth stage of kidney disease, kidney failure occurs. This is known as end-stage renal disease (ESRD). As of 2006, 25% of the Medicare budget was being used for the treatments for CKD and ESRD patients. As the baby boomers age, these numbers are expected to rise as well. An innovative and collaborative approach, such as a patient-centered medical home (PCMH), to ESRD treatment will provide higher quality patient care while reducing cost (Odum &Whaley-Connell, 2012). A case study using the PCMH approach will be conducted. Case Description Natalie is a 53-year-old African American woman. She...
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...• . INTRODUCTION Fluid overload is a major clinical issue in patients with end stage renal failure. Oftentimes, unresolved and unaddressed fluid overload leads to congestive heart failure. Congestive heart failure is a progressive and systemic disease process that involves the interaction between the heart and kidneys. (Krishnan, 2007). Over time, worsening heart failure coupled with progressive kidney failure leads to diuretic resistance, consistent fluid volume overload and refractory heart failure. (Francis, 2006). Fluid balance is a goal for ESRD patients and should be one of the priorities for health promotion and prevention education. Fluid Overload and the Peritoneal Dialysis Client It is important to note that the client in this paper was diagnosed in 2007 for ESRD and hemodialysis treatment was initiated for this client right away. Initially, patient was getting three times a week dialysis treatments in-center. However, in the last three years, the client’s dialysis treatments were raised to four times per week to avoid fluid overload. Per client’s report, within the last year he would have 1-2 episodes of shortness of breath every three months ending in hospitalizations for congestive heart failure (CHF). In one of the client’s hospitalizations early this year, he was introduced to another treatment modality for ESRD patients. Client pursued peritoneal dialysis based on his nephrologist’s recommendation of said modality. The client’s perception of illness...
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...Dialysis case study A 66-year-old black male was seen by his primary provider for complaints of fatigue, anorexia, swelling of hands, face, and ankles, muscles cramps, and increased difficulty breathing. He has a 3-year history of poorly controlled hypertension related to non-adherence to the medical regimen. His B/P routinely runs in the range 155-165/92-102. His B/P today was 170/105. The client does not like to take pills and feels that they are not necessary. He also has been reluctant to modify his diet and likes to eat fried foods. He does not think his eating habits are causing any problems. Because of these symptoms, the client was admitted to the hospital for treatment and further evaluation. His lab values and renal studies confirmed the diagnosis of end stage kidney disease. Because of the severity of his problems, he was started on hemodialysis. What is the likely cause of his kidney failure? Explain your answers His kidney failure is caused by uncontrolled blood pressure and lack of treatment compliance. When you have uncontrolled high blood pressure it affects the kidneys because the blood vessels narrow and stiffen causing the nephrons in the kidney to work harder. Eventually if hypertension is left untreated it can lead to end stage renal disease because the nephrons in the kidney are no longer able to filter out the toxins such as nitrogen waste which builds up in the blood. They also are unable to maintain fluid or electrolyte balance. Eventually...
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...Stage Renal Disease 20 to Diabetic Nephropathy Presented by: Balgos, Rachelle Ann Dayto, April Feranil, Daniel Fulinara, Janice Fuentes, Maila Joy Garrido, John Paolo Mendoza, Kenneth Robert Nazareno, Jhon Ryan Olfindo, Kristine Joy Sombilon, Jorgette Kim *** In Partial Fulfilment of the Requirement in NURS 60 for the Degree Bachelor of Science in Nursing TABLE OF CONTENTS I. Demographic Data 4 II. Chief Complaints 4 III. History of Present Illness 4 IV. Past Medical History 5 V. Developmental History 6 VI. Heredo-familial History 15 VII. Gordon’s Functional Health Patterns 16 VIII. Physical Examination 22 IX. Diagnostic Test 43 X. Anatomy and Physiology 75 XI. Pathophysiology 81 XII. Case Management 82 XIII. Nursing Care Plan 107 ABSTRACT “"The divine is not something high above us. It is in heaven, it is in earth, it is inside us..." - Morihei Ueshiba We, group 2 of Level III section 2, have chosen this case to gain more knowledge about the mechanism of End Stage Renal Disease and its process. Our patient C.C is a 51 -year old male who was diagnosed to have diabetes mellitus seventeen years ago and now has End Stage Renal Disease due to Diabetic Nephropathy. His disease leads to fluid accumulation to his lungs and edema on his extremities. Our group chose the case because it is also our first time to handle a case related...
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...sequencing of the genes that encode transporters and channels (as well as their subunits) is not a trivial matter and must be complemented by experiments determining expression patterns. The Xenopus oocytes that have been used for such studies are transfected cells rather than “real” polarized cells of the thick ascending limb of the loop of Henle surrounded by the sophisticated hypertonic environment of the renal medulla. The complex polyuria–polydipsia syndrome described by Schlingmann et al. is attributable to the concomitant loss-of-function mutations in both CLCNKA and CLCNKB; the syndrome results in ion selectivity, demonstrating the means whereby a renal tubular cell lets one type of ion (chloride) through the lipid membrane to the exclusion of others. It thus provides yet another example of the molecular basis of Bartter’s syndrome (see Figure). The contributions of Roderick McKinnon and Peter Agre to solving these two complementary problems of the resorption of renal solute and renal solvent earned them the 2003 Nobel Prize in chemistry.5 We live in a fascinating time in which clinical syndromes can be deciphered at the molecular and even the atomic level. From the Department of Medicine and the Membrane Protein Study Group, University of Montreal (D.G.B.); and the Department of Human Genetics and Medicine, McGill University (T.M.F.) — both in Montreal. 1. Peters M, Jeck N, Reinalter S, et al. Clinical presentation of genetically defined patients...
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...THE DISTRICT OF COLUMBIA: CASE SCENARIO THE AFFORDABLE CARE ACT BACKGROUND The argument that every American citizen should have a guaranteed healthcare cover takes two dimensions (Grover, 2007). Is it that all citizens should have access to the same level of healthcare? Or should they have a right to some minimum healthcare cover? The U.S government has selected the second option in relation to the policies it creates directed to healthcare. There are quite a number of policies that have been put in place to realize this goal since there is no single healthcare policy that can cater for all of this demands. The government has made a move to provide access to medical services. In the past, particular groups of people have been selected based on their economic status or their distinctive social circumstances. The policies include Medicaid (for poor children), Medicare (for the elderly), Veterans’ Administration (for veterans), Indian Health Services (for Native Americans) and renal failure security (for transplants and kidney dialysis). The purpose of this study The research’s main focus is to investigate the how government and nurses are involved in the development and implementation of healthcare related policies. The District of Columbia will be the highlight of this paper. Accordingly, the paper will put more emphasis on one of the most recent health care policies in the Obama governance i.e. The Affordable Care Act. Significance of this study The research will try...
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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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...have to share, if we wish to see a better and a healthy future ahead. There is an immense need to develop skilled manpower in the area of healthcare and modern as well as traditional medicines. I am glad that this Summit on Emerging trends in Healthcare will bring forth the journey from research desk to the bedside of patient, as we will look at healthcare at the frontline to identify some common challenges that may help explain the complex nature of healthcare and the scale of the “change” challenge. I wish to thank KPMG for unanimously contributing towards this Knowledge Paper, which gives a rich and comprehensive insight of the trend in healthcare. I would also take the opportunity to thank QCI for supporting this event. The case studies contributed providing the best of their services and support towards improving the healthcare scenario of India, I wish them great success ahead. Last but not the least, I wish to extend a token of appreciation for the Healthcare/ BioPharma team for their effort and interaction with the Healthcare/Bio Pharma industry at different levels. (D.S. Rawat) Secretary General ASSOCHAM © 2011 KPMG, an Indian Partnership and a...
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...Definition Organ transplantation is the moving of an organ from one body to another or from a donor site to another location on the person's own body, to replace the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be re-grown from the person's own cells (stem cells, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person's body are called auto grafts. Transplants that are recently performed between two subjects of the same species are called allograft. Allograft can either be from a living or cadaveric source. Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, nerves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed by the liver and then the heart. Cornea and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold. Organ donors may be living, brain dead, or dead via circulatory death. Tissue may be recovered from donors who die of circulatory death, as well as of brain death – up to 24 hours past the cessation of heartbeat. Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked". Transplantation...
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...Nichol, MD, MPH; J. Wuorenma, RN, BSN; T. von Sternberg, MD Background: Vaccination rates for healthy senior citizens are lower than those for senior citizens with underlying medical conditions such as chronic heart or lung disease. Uncertainty about the benefits of influenza vaccination for healthy senior citizens may contribute to lower rates of utilization in this group. Objective: To clarify the benefits of influenza vaccina- tion among low-risk senior citizens while concurrently assessing the benefits for intermediate- and high-risk senior citizens. Methods: All elderly members of a large health maintenance organization were included in each of 6 consecutive study cohorts. Subjects were grouped according to risk status: high risk (having heart or lung disease), intermediate risk (having diabetes, renal disease, stroke and/or dementia, or rheumatologic disease), and low risk. Outcomes were compared between vaccinated and unvaccinated subjects after controlling for baseline demographic and health characteristics. Results: There were more than 20 000 subjects in each pitalizations (P .001), a 32% decrease in hospitalizations for all respiratory conditions (P .001), and a 27% decrease in hospitalizations for congestive heart failure (P .001). Immunization was also associated with a 50% reduction in all-cause mortality (P .001). Within the risk subgroups, vaccine effectiveness was 29%, 32%, and 49% for high-, intermediate-, and low-risk senior citizens for reducing hospitalizations...
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...Hindawi Publishing Corporation International Journal of Hepatology Volume 2012, Article ID 487480, 6 pages doi:10.1155/2012/487480 Review Article Acute Liver Failure Caused by Amanita phalloides Poisoning Luca Santi,1 Caterina Maggioli,1 Marianna Mastroroberto,2 Manuel Tufoni,1 Lucia Napoli,1 and Paolo Caraceni1 1 U.O. Semeiotica Medica, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy 2 S.S.D. Liver Transplant, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy Correspondence should be addressed to Paolo Caraceni, paolo.caraceni@unibo.it Received 4 May 2012; Accepted 11 May 2012 Academic Editor: Bruno Nardo Copyright © 2012 Luca Santi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell...
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...HBSP Product Number TCG239 THE CRIMSON PRESS CURRICULUM CENTER THE CRIMSON GROUP, INC. Boulder Public Schools Edward Caton, a teacher in a midsize elementary school in Boulder, Colorado, hoped someday to rise through the administrative ranks to serve as a principal of his own school, but he felt that to do so, he should understand more about the position to which he aspired. This was especially important to him in terms of the control he might have over the budget, which he knew was central to real power in many organizations. In an effort to learn more about the operations of the Boulder Public Schools, he set up some informational interviews with the principals of an elementary school, a middle school, and a high school. Before making those rounds, he visited the headquarters of the Boulder School Committee to obtain background information for his interviews. BACKGROUND Mr. Caton learned that the Department of Implementation (DI) was central to the school system. It’s manager reported directly to the Superintendent of Schools. The DI was responsible for making school enrollment projections each December for the coming fiscal year (which ran from July to June). These projections were important since annual staffing needs for each school were determined by a rather complex formula that used the DI's projections as the starting point. Moreover, since personnel formed the bulk of the budget, these projections effectively determined a school's budget. Each school...
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...Volume 3, number 2 What is critical appraisal? Sponsored by an educational grant from AVENTIS Pharma Alison Hill BSC FFPHM FRCP Director, and Claire Spittlehouse BSc Business Manager, Critical Appraisal Skills Programme, Institute of Health Sciences, Oxford q Critical appraisal is the process of systematically examining research evidence to assess its validity, results and relevance before using it to inform a decision. q Critical appraisal is an essential part of evidence-based clinical practice that includes the process of systematically finding, appraising and acting on evidence of effectiveness. q Critical appraisal allows us to make sense of research evidence and thus begins to close the gap between research and practice. q Randomised controlled trials can minimise bias and use the most appropriate design for studying the effectiveness of a specific intervention or treatment. q Systematic reviews are particularly useful because they usually contain an explicit statement of the objectives, materials and methods, and should be conducted according to explicit and reproducible methodology. q Randomised controlled trials and systematic reviews are not automatically of good quality and should be appraised critically. www.evidence-based-medicine.co.uk Prescribing information is on page 8 1 What is critical appraisal What is critical appraisal? Critical appraisal is one step in the process of evidence-based clinical practice. Evidencebased clinical practice...
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