...A recent conflict I observed was in the intensive care unit. The patient was transferred to the unit with the diagnosis of respiratory failure. After few days of stay, the patient started with frequent diarrhea and severe abdominal pain. The patient was receiving multiple antibiotic treatment. Therefore, she asked the physician to order lab test to screen the patient for C.diff. Additionally, she placed the patient on special contact precautions as per the hospital policy. The physician refused to order C.diff screening and he got upset that the nurse placed the patient on isolation without the physician’s order. The physician argued that the patient might need some antibiotic changes and diarrhea was not related to C.diff. Moreover,...
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...holistic patient care. However, with the constant changes in nursing practice; patient safety has been at risk due to nurse’s competence towards detecting impending patient deterioration that may lead to further complications or even death. It is said that the most important practical lesson that can be given to nurses, is to teach them what to observe (Nightingale 1969). Having the ability to observe and interpret critical situations are the essential key features applied in clinical practice. Effective observation of ward patients is the first step in identifying the deteriorating patient and effectively managing their care (Odell, Victor & Oliver 2009, p. 1993). Studies have shown that poor vital sign recording, lack of knowledge, failure to respond to abnormal signs, lack of knowledge, lack of supervision and failure to report deterioration or seek advice, have all contributed to the suboptimal care of ward patients (Odell, Victor & Oliver, cited in McGloin et al. 1999; McQuilla et al. 1998; Smith & Wood 1998; Hodgetts et al. 2002, p. 1993). With constant observation established, patient safety is implemented and surveillance is then incorporated to be able to identify and prevent possible medical errors and adverse events that may be encountered. The purpose of surveillance is the early identification of risk and the need for intervention and to alert nurses to both anticipated and unanticipated changes in patient’s condition (Henneman, Gawlinski & Giuliano 2012). With both...
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...Case Study 3 Unit 5 and Unit 6 AO is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. AO also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, (potassium chloride) and sublingual nitroglycerin. Discussion Questions 1. Which type of heart failure (left- or right-sided) is usually associated with dyspnea? What other clinical findings are likely to be present with left-sided heart failure? * The type of the heart failure that associated with dyspnea or difficult of breathing is the left-sided. The clinical findings that are more likely to be present in left-sided heart failure are pulmonary congestion, respiratory crackle (rale ), hypoxemia, high left atrial pressure, and acute cardiogenic pulmonary edema. 2. What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output? 3. What is the most likely cause of AO’s pedal edema? The most likely cause of AO’S pedal edema is heart failure specially the right side heart failure due left side heart failure which leads to much pressure to right side of heart. 4. What is the cause of AO’s exertional chest pain? What laboratory tests would...
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...In the case study this week the patient presented with signs and symptoms of respiratory distress making it difficult for her to carry on a conversation. This case studies purpose was to simulate what nursing assessment is needed and interventions need to be implemented. The patient was in her early 30’s with a diagnosis of asthma. On entering the room, the patient was pale and was showing signs of difficulty breathing. When carrying for a patient it is always important to introduce yourself, wash your hands and identify the patient. Before entering the room, you want to have looked at the medical record and review the medical history, diagnosis, and orders. Her medical revealed a medical diagnosis of asthma In theory we learned that asthma...
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... That concept is critical when looking at arterial blood gases. This can help guide the nurse to anticipate what the doctor will order and the education that she needs to give the patient and the family. This case study should help to illustrate the point. Case Study The case study that was given to us is a 22 year old woman who reports being “sick with the flu” She has been vomiting and having difficulty keeping food and drink down. In addition she has been taking antacids to calm down the nausea. After fainting at home she was driven to the local hospital where they have put in an IV. Her blood gas reveals the following: pH of 7.5, PaCO2 = 40 mm Hg, PaO2= 95 mm Hg, SaO2 = 97% and HCO3- = 32 meq/liter. Interpretation If you start with the basics on this case, the first thing to determine if it is an alkalosis or an acidosis. pH is 7.5 so the result is alkalosis. pH below the 7.35 is an acidosis and pH above the 7.45 is an alkalosis. There are two organ systems that primarily help with the acid base balance in the body and that is respiratory and renal. The renal system contributes to metabolic acidosis or alkalosis. When we look at the respiratory system we are looking at the PaCO2 which in this case is normal. So the respiratory system is not the problem in this patient. When we look at the renal system then we are looking at the bicarbonate or HCO3-. When we look at that system we discover the bicarbonate is high. When the bicarbonate...
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...(RCA) is a tool employed by healthcare facilities to analyze adverse events and the systems that lead to them. A. Root Cause Analysis “A central tenet of RCA is to identify underlying problems that increase the likelihood of errors while avoiding the trap of focusing on mistakes by individuals” (AHRQ, 2012). The emphasis of RCA is on error prevention. It is a structured process of gathering data regarding the event, analyzing the information, and finding solutions to the problems to prevent reoccurrences. A team consisting of the charge nurse, a physician, a respiratory therapist, a pharmacist, hospital administrators, and patients not involved in the case is assembled to work through the process. The team begins by interviewing patients and staff involved to gather as much vital information as possible. Once all necessary information is compiled, the team works together to get to the root(s) of the problem. In the case of Mr. B, there were multiple issues that led to the adverse event as opposed to one root problem. In the process of defining the problem, several causal factors were identified. The error was a result of both facility and human error. Mr. B, a 67-year-old patient, presented to the small, six-room, rural hospital ED due to severe pain in his left hip following a fall. In his quest for care, he came across some hurdles that eventually led to his death. Amongst one of the many issues that led to complications was the fact that the hospital was short staffed...
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...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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...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 for pneumonia and influenza (for high and low risk, P .002; for intermediate risk, P = .11). Effectiveness was 19%, 39%, and 33% (for each, P .008), respectively, for reducing hospitalizations for all respiratory conditions and 49%, 64%, and 55% for...
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...patient outcomes as specific situations occur by forming a team of experts that were involved in the situation. Cases are reviewed and processes are implemented to correct the errors that took place. Four key questions are asked, what happened, why did it happen, what can be changed to prevent it from happening again and how are we going to evaluate the change. This process takes place soon after the event so details are not forgotten. The professionals involved in the root cause analysis would take on roles. The team leader would be a representative from risk management. The nursing supervisor that was working on the day of the event would be the recorder. The team members would include the manager of the emergency department, the RN, LPN, and physician involved with the patient from the emergency department. The advisor would be the chief nursing officer or another member of the executive staff. The first thing is to review the many causative factors that were in place on this particular day. There was inadequate staffing for the emergency department for the number and high acuity of patients that were being treated. There was a hospital protocol for conscious sedation that was not followed. The nurse was ACLS and CPR certified. The patient was not fully monitored for the procedure. This would require Mr. B’s level of consciousness, blood pressure and respiratory status to be continuously monitored. There was no supplemental oxygen provided for the patient nor was his...
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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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...Case study This paper will use a case study approach to explore the registered adult nurse’s role in the holistic care, in the first 24 hours, given to patient presenting with chest pain, caused by a myocardial infarction (MI). Using clinical guidance and evidence based research. The case study will use the ABCDE assessment framework. The resuscitation council (2006) recommends that nurses should follow the ABCDE method when assessing acutely and critically ill patients as it ensures nurses quickly and accurately identify acute illness and promptly begin management of the condition/ illness (Jevon, 2010). The aim of the assessment is to determine the cause of the chest pain efficiently and prioritise care needed. The main priorities were; pain control, informing appropriate medical staff and the nurse in charge, reperfusion of myocardial tissue, managing anxiety and monitoring for complications of MI and the effects of the treatment given. A MI occurs when a coronary artery becomes occluded, most commonly by a thrombus due to the rupture of an atherosclerotic artery which results in the necrosis of myocardial tissue because of the ischemia the thrombus causes (O’Neil, 1996). For the purpose of this case study and in order to protect confidentiality and anonymity the patient used will be fictitious and given a pseudonym. However the events the case study follows are very much a reality (Edwards, 2002). Case scenario Brian, a 64 year old male, was recovering...
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...This paper will analyze the cause of the sentinel event which occurred to Mr. B, a sixty seven year old patient which presented to the emergency room with left leg pain. A root cause analysis will be necessary in this case to investigate the causative factors which led to Mr. B’s sentinel event. The factors in this unfortunate case weather they were errors in his care, or hazards in the system will be identified. The Change theory will be used to develop an improvement plan that will be used to decrease the chances of a reoccurrence of the sentinel event that happened to Mr. B. in the scenario. Root Cause Analysis A root cause analysis, is a system that is used to develop a plan that will identifying the causative factors of an adverse event and formulate a plan to decrease the occurrence or chances of a sentinel event. A team consisting of , a member of the hospital administration, a pharmacist, a respiratory therapist, a charge nurse or nurse manager, a physician, and a member of the family board should be brought together to perform a root cause analysis in this case. These team members would have a meeting to discuss the factors that led to Mr. B’s sentinel event. The first step would be for the team to begin interviewing the staff involved with the case to gather as much data as possible. The data that would be needed include, Mr. B’s vital signs, laboratory results, pain scores, a history of medication that he was given during his time in the emergency room in addition...
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...life-threatening lung disease. Chronic bronchitis and emphysema are earlier terms used for different types of COPD. The main symptoms include shortness of breath and cough with sputum production. COPD centers on the common feature of altered lung function but recognizes both the systemic nature and the heterogeneity of COPD. Its pulmonary component is characterized by airflow limitation that is not absolutely reversible. The adverse of COPD can aftereffect from several etiologies; a lot of frequently cigarette smoking that affects the mucociliary barrier and phagocyte activity, triggering an abnormal inflammatory response in the lungs.7 Besides smoking, added accident factors includes ageing, infections, toxic air pollutants, childhood respiratory infections...
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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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...124, 36, 102° F, SaO2 88%. Admitting diagnosis is chronic emphysema with acute exacerbation. Admitting orders includes: diet as tolerated; out of bed with assistance; oxygen (O2) to maintain SaO2 of 90%; maintenance IV of D5W at 50 ml/hr.; intake and output (I&O); arterial blood gases (ABGs) in AM; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q24h; prednisone 60 mg/day PO; doxycycline 100 mg PO q12h x10 days, azithromycin 500 mg IV piggyback (IVPB) q24h x2 days then 500 mg PO x 7 days; theophylline 300 mg PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 ml) in 3 ml normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q AM. In this case, I will discuss the definition of COPD/emphysema, causes, S/S, risk factors, contributing factors, normal lab values, current lab values, diagnostic tests, prevention, treatment, patient care, education, and discharge instructions. Chronic Obstructive Pulmonary Disease (COPD); Emphysema Patient D.Z.is a 65-year-old male admitted to medical floor for...
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