...valve insufficiency causes regurgitation of stroke volume back to the low pressure left atrium and remodeling of the heart walls. Remodeling of the heart walls leads to progressive left-sided cardiomegaly in an attempt to compensate for decreased stroke volume but becomes a cascade of continued dysfunctional changes with no return to normal stroke volume. Stretching of the mitral annulus from remodeling increases the regurgitant orifice and regurgitant volume. A vicious cycle ensues in an attempt to compensate for dysfunctional changes by further remodeling.3,11 The majority of remodeling occurs prior to the onset of clinical signs with the most rapid changes occurring in the six months prior to onset of CHF.3,7 Animal models for mitral...
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...HEART RHYTHMS * 0.4 sec is the PR wave (it is actually the P-Q wave but called the PR wave) and it should be ≤ 0.20 sec. If it’s ≥ than that it indicates 1° heart block. * NSR: normal sinus rhythm, contraction originates from SA node and beats at 60-100 bpm * Sinus (atrial) Bradycardia: SA node discharges at < 60 bpm. TREATMENT is atropine and pacemaker if they become symptomatic. Usually the contractions are irregular but the same distance apart so they are irregular-regular * Sinus Tachycardia (atrial dysrhythmias): SA node discharges at > 100 bpm. Regular but fast; they won’t have heart block because the SA node is firing too rapidly. TREATMENT is BB or CCB to ↓ HR and BP * PAC (Premature Atrial Contraction): impulse travels across atria via abnormal pathway, creating a disturbed P wave. Contraction originates from ectopic focus in atrium other than the SA node. Caffeine and diet pills predispose people to these but they don’t adversely affect health. TREATMENT is none. * Atrial Flutter: atrial tachycardia resulting in recurring, regular sawtooth flutter waves. The ratio of atrial to ventricle contractions is 3:1. TREATMENT is synchronized cardioversion (like defibrillation but the less Joules, 150-200 vs 300, and you must push the “sync” button to synchronize the energy so as to not direct it onto the T wave and send the patient in V-fib) and ablations. * Valve Replacement: patient must be put on blood thinner afterwards and must be anticoagulated...
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...Surviving A review of the latest guidelines By Julie Miller, BSN, RN, CCRN 2.0 ANCC CONTACT HOURS AFFECTING MILLIONS OF people worldwide, sepsis is a systemic response to an overwhelming inflammatory process caused by an infection. Approximately one in four people who develop sepsis will die.1 In January 2013, the international Surviving Sepsis Campaign Guidelines Committee published its 2012 surviving sepsis guidelines (SSG), an update to the 2008 guidelines for early identification and management of sepsis in adults.1 The guidelines highlight the importance of screening every potentially infected patient for sepsis and providing best-practice interventions for managing sepsis, severe sepsis, and septic shock. This article provides an overview of care for the adult patient with sepsis, focusing on sepsis identification and the first 6 hours of goal-directed treatment according to current guidelines. Defining sepsis Sepsis is the presence of infection along with systemic manifestations of infection. If sepsis isn’t recognized and treated early, it progresses rapidly to severe sepsis, defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion. Sepsis-induced tissue hypoperfusion is defined as infection-induced hypotension, elevated lactate level, or oliguria.1 24 l Nursing2014 l April Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. www.Nursing2014.com D VOUGAO/iSTOCK ...
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...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 and Hypercapnia Chapter 20 - Oximetry and Capnography Chapter 21 - Oxygen Inhalation Therapy Chapter 22 - Acute Respiratory Distress Syndrome Chapter 23 - Severe Airflow Obstruction Section VIII - Mechanical Ventilation Mechanical Ventilation Chapter 24 - Principles of Mechanical Ventilation Chapter 25 - Modes of Assisted Ventilation Chapter 26 - The Ventilator-Dependent Patient Chapter 27 -...
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...Bronchodilation * Endocrine Compensation (RAAS, ADH, glucocorticoid release) * Renal reabsorption of sodium, chloride, and water * Vasoconstriction * Glycogenolysis | * Increased HR (EXCEPT NEUROGENIC) * Narrowed pulse pressure * Rapid, deep respirations causing respiratory alkalosis * Thirst * Cool,moist skin * Oliguria * Diminished bowel sounds * Restlessness progressing to confsion * Hyperglycemia * Increased specific gravity and decreased creatinine clearance. | Progressive | * Progressive tissue hypoperfusion * Anaerobic metabolism wih lactic acidosis * Failure of sodium potassium pump * Cellular edema | * Dysrhythmias * Decreased BP with narrowed pulse pressure * Tachypnea * Cold, clammy skin * Anuria * Absent bowel sounds * Lethargy progressing to coma * Hyperglycemia * Increase BUN, CREATININE, AND POTASSIUM * Respiratory and metabolic acidosis. | Refractory | * Severe tissue hypoxia with ischemia and necrosis * Worsening acidosis * SIRS * MODS | * Lifethreatening dysrhythmias * Severe hypotension despite vasopressors * Respiratory and metabolic acidosis * Acute respiratory failure * Acute respiratory...
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...Pre-Clinical Assignment Anita Mall Delaware Technical Community College Diagnosis Pneumonia: * Definition- Inflammation of the respiratory bronchioles and alveoli * Signs & Symptoms- Cough (productive or nonproductive), increased sputum (rust colored, discolored, purulent, bloody, or mucoid) production, fever, pleuritic chest pain, dyspnea, chills, headache, myalgia, and confusion in older adults * Assessment/Interventions- * Provide patient teaching and education on exercises (breathing and physical) that help prevent infection or pneumonia. * Have patient in Semi-Fowler’s or High-Fowlers position, especially during meals and drinking * Turn patient every 2 hours * Assess patient’respiratory status and vital signs every 4 hours * Provide adequate fluid intake * Administer prescribed meds (including oxygen) and monitor effects Diabetes: * Definition- (Mellitus) a group of chronic metabolic disorders characterized by inappropriate hyperglycemia * Signs & Symptoms- severe dehydration, hypovolemic shock (hypotension, weak and rapid pulse), severe hyperglycemia, shallow respirations, altered mental health status, abd pain * Assessment/Interventions- * Assess patient’s blood glucose before meals and before sleeping at night * Assess patient’s vital signs (especially BP) every 4 hours * Assess patient’s feet everyday * Provide patient teaching and education on the importance...
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...electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Contraindications Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Adverse effects Bradycardia, AV...
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... Recreational use became a problem in the early 20th century and became illegal is the United States in 1914. The chemical name for cocaine is benzoylmethyl ecgonine; it is a bitter, white, odorless crystalline drug. Cocaine has multiple methods of ingestion; it can be insufflated, taken orally or intravenously. It can be smoked to some degree, but tends to burn rather than vaporize because of the high temperature required. Freebase cocaine vaporizes at smoking temperatures and creates a more intense high whilst using less product. Street terminology consists of coke, snow, nose candy, white, blow and soft, among others. Freebase is known as crack, rock and hard, among others. Cocaine interferes with the reabsorption of dopamine, norepinephrine and serotonin. The buildup of these neurotransmitters in the brain create the high the user seeks. The general effects of using the drug are feelings of well-being/euphoria, stimulation, sexual arousal, increased focus, alertness, wakefulness, talkativeness, athletic performance, energy, decreased fatigue and...
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...1 NUR 201 DRUG CARD Student: ________________________ Generic Name: Bupropion hydrobromide________ Trade Name(s): Wellbutrin, Aplenzin, Zyban_ Classification: Antidepressant – atypical (heterocyclic), Aminoketone_____________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Mechanism of action is not known; the drug does not inhibit MAO, and it only weakly blocks neuronal uptake of epinephrine, serotonin, and dopamine. However, its action is believed to be mediated by noradrenergic and/or dopaminergic mechanisms. Exerts moderate anticholinergic and sedative effects, but only slight orthostatic hypotension. Indications: (1) Treatment of major depressive disorder (immediate-release and extended-release). (2) Major depressive episodes in those with a history of seasonal affective disorder (Wellbutrin XL only). (3) Aid to stop smoking (Zyban only); may be combined with a nicotine transdermal system. Contraindications: Hypersensitivity to bupropion or any ingredients. Seizure disorders; presence or history of bulimia or anorexia nervosa due to the higher incidence of seizures in such clients. Concomitant use of an MAOI. Use in clients undergoing abrupt discontinuation of alcohol and sedatives, including benzodiazepines. Use in clients who have shown an allergic response to bupropion or other components of the various products. Wellbutrin, Wellbutrin SR, Wellbutrin XL, and Zyban all contain bupropion; do not use together. Lactation...
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...Heart Failure Western Governors University Pathopharmacological Foundations for Advanced Nursing Practice Heart Failure It is estimated that about five million people in the United States are living with heart failure with an overwhelming number of 550,000 newly diagnosed cases each year, costing the nation roughly $32 billion dollars per year (Centers for Disease Control and Prevention, 2016). Heart failure is a complex, pathophysiological condition in which the ventricles of the heart is weakened and unable to pump effectively to meet the body’s needs for nutrients or has lost adequate filling capacity. Clinical presentations of heart failure depends on which ventricles have failed to pump blood adequately; left ventricular failure, also known as congestive heart failure (CHF) is more common than right ventricular failure (McCance & Huether, 2014). The most common symptoms of heart failure are shortness of breath, fatigue, and peripheral edema. HF is not a disease, but rather a manifestation of a diseased heart. Large number of disorders can lead to heart failure, and with the aging population and many surviving primary cardiac events, it is no surprise that the most common reason for hospitalization in patients older than 65 years old is heart failure (McClintock, Mose, & Smith, 2014). Heart failure has become a major public health problem because it is the only cardiac condition that continues to increase in prevalence (McClintock, Mose, & Smith, 2014)...
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...014CRNA Interview Preparation Q: Tell me about a time when you had to manage a difficult clinical situation. Q: Tell me about a time when you were working with someone who wasn't pulling their weight, and they had a different value system than yours. How did you deal with this person? Q: Tell me about a time when you failed. What happened, and how did you recover? Q: Tell me about a time when you had an ethical dilemma at work. What did you do? Q: Tell me about a time when you felt it was you against everyone else. You thought you were right and that everyone else was wrong. What did you do? Q: Why do you want to be a CRNA?** Q: What would make you a successful CRNA?** Q: How do you handle stress? Q: What kind of patients do you take care of? Your favorite and why?** Q: Tell us about your work experience.** Q: How do you describe success? Q: Do you foresee any barriers to your education? (finances, time commitments) Q: What does a CRNA do? How do you think your role as a CVICU nurse relates to the role and responsibilities of a CRNA?** Q: Where do you want to be in 5 years?**. Q: Why our program? Q: What questions do you have for us?** A: What do you look for in potential students? How does your program facilitate student research? I am very interested in teaching and education, how does your program prepare me to be an educator? What do you see as your school's strong points? On avg. how many intubations, art lines...
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...Accord Healthcare Limited | | Sage House, 319 Pinner Road, North Harrow, Middlesex, HA1 4HF, UK Telephone: +44 (0)208 8631 427 Fax: +44 (0)208 863 1426 WWW: http://www.accord-healthcare.eu Medical Information Direct Line: +44 (0)208 901 3370 Medical Information e-mail: uk@accord-healthcare.com Customer Care direct line: +44 (0)208 863 1427 Medical Information Fax: +44 (0)208 863 1426 Before you contact this company: often several companies will market medicines with the same active ingredient. Please check that this is the correct company before contacting them. Why? | | Summary of Product Characteristics last updated on the eMC: 01/08/2013 SPC | Atenolol 100 mg Tablets | Table of Contents * 1. Name of the medicinal product * 2. Qualitative and quantitative composition * 3. Pharmaceutical form * 4. Clinical particulars * 4.1 Therapeutic indications * 4.2 Posology and method of administration * 4.3 Contraindications * 4.4 Special warnings and precautions for use * 4.5 Interaction with other medicinal products and other forms of interaction * 4.6 Pregnancy and lactation * 4.7 Effects on ability to drive and use machines * 4.8 Undesirable effects * 4.9 Overdose * 5. Pharmacological properties * 5.1 Pharmacodynamic properties * 5.2 Pharmacokinetic properties * 5.3 Preclinical safety data * 6. Pharmaceutical particulars * 6.1 List of excipients * 6.2 Incompatibilities * 6.3 Shelf life * 6.4 Special precautions...
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...Darren & Jenny’s Nursing Study Guide Darren & Jenny Nursing Study Guide Nursing Formulas and Conversions Drugs and Dosage Formulas and Conversions Volume 60 minims = 1 dram = 5cc = 1tsp 4 drams = 0.5 ounces = 1tbsp 8 drams = 1 ounce 16 ounces = 1pt. 32 ounces = 1qt. Weight 60 grains = 1dram 8 drams = 1 ounce 12 ounces = 1 lb. (apothecaries') Household 1tsp = 1tsp = 3tsp = 1tbsp = Household 1tsp=5cc 3tsp=1tbsp 1tbsp=0.5oz or 15cc 2tbsp=1oz or 30cc 1pt.=16oz or 480cc 1qt=32oz or 960cc 1/60 grain=1mg 15 grains=1g 2.2 lbs.=1kg Apothecary 1 dram 60 gtts (drops) 0.5 ounce 0.5 ounce Metric 5cc=1tsp 15cc=1tbsp 30cc=2tbsp(1oz) 1cc=16minims Apothecary 1fl.dram=4cc 4drams=0.5oz 8drams=2tbsp(1oz) 16minims=1cc 500cc=0.5L or 1pt. 1000cc=1L or 1qt. Temp. Conversion C= F-32/1.8 F= 1.8*C-32 2 Darren & Jenny Nursing Study Guide NOTES CARDIOVASCULAR Arterial Ulcer – Pale, deep base, surrounded by tissue that is cool with trophic changes such as dry, soluble skin and loss of hair. Cause by ischemia from inadequate arterial blood supply of oxygen and nutrients . Venous stasis Ulcer – Dark, red base, surrounded by skin that is brown in color with edema. Caused by the accumulation of waste products of metabolism that are not cleared due to venous congestion. Stage I Ulcer – Reddened area with intact skin surface. Management of DVT – Bed rest, limb elevation , relief of discomfort with warm, moist, heat and analgesics (Tylenol, not narcotics) prn. Ambulation is contraindicated...
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...Darren & Jenny’s Nursing Study Guide Darren & Jenny Nursing Study Guide Nursing Formulas and Conversions Drugs and Dosage Formulas and Conversions Volume 60 minims = 1 dram = 5cc = 1tsp 4 drams = 0.5 ounces = 1tbsp 8 drams = 1 ounce 16 ounces = 1pt. 32 ounces = 1qt. Weight 60 grains = 1dram 8 drams = 1 ounce 12 ounces = 1 lb. (apothecaries') Household 1tsp = 1tsp = 3tsp = 1tbsp = Household 1tsp=5cc 3tsp=1tbsp 1tbsp=0.5oz or 15cc 2tbsp=1oz or 30cc 1pt.=16oz or 480cc 1qt=32oz or 960cc 1/60 grain=1mg 15 grains=1g 2.2 lbs.=1kg Apothecary 1 dram 60 gtts (drops) 0.5 ounce 0.5 ounce Metric 5cc=1tsp 15cc=1tbsp 30cc=2tbsp(1oz) 1cc=16minims Apothecary 1fl.dram=4cc 4drams=0.5oz 8drams=2tbsp(1oz) 16minims=1cc 500cc=0.5L or 1pt. 1000cc=1L or 1qt. Temp. Conversion C= F-32/1.8 F= 1.8*C-32 2 Darren & Jenny Nursing Study Guide NOTES CARDIOVASCULAR Arterial Ulcer – Pale, deep base, surrounded by tissue that is cool with trophic changes such as dry, soluble skin and loss of hair. Cause by ischemia from inadequate arterial blood supply of oxygen and nutrients . Venous stasis Ulcer – Dark, red base, surrounded by skin that is brown in color with edema. Caused by the accumulation of waste products of metabolism that are not cleared due to venous congestion. Stage I Ulcer – Reddened area with intact skin surface. Management of DVT – Bed rest, limb elevation , relief of discomfort with warm, moist, heat and analgesics (Tylenol, not narcotics) prn. Ambulation is contraindicated...
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...Prevalence, outcome and prognostic factors of sepsis in Jimma Specialized Hospital. By Dr Tadiwos Hailu (M.D) A Proposal Submitted to the Department of Internal Medicine, Jimma University, in Partial Fulfillment of The Requirement for a Specialty Certificate in Internal Medicine. September, 2012 Jimma, Ethiopia Prevalence, outcome and prognostic factors of sepsis in Jimma specialized hospital. Dr Tadiwos Hailu By Advisors: 1-Dr.Daniel yilma [M.D] 2-Birtukan Tsehayneh [Bsc. Msc.] September, 2012 Jimma Ethiopia i Abstract summary Background: Sepsis is a final pathway of infectious disease in critically ill patients. It is highly fatal condition. Though many researches are undertake in pathophysiology, epidemiology and management of sepsis in developed nation ,very limited information is available in low incomes countries where infections are prevalent. Objective: The objective of the study was to determine the prevalence and outcome of sepsis and its prognostic factors in patients admitted to Jimma University Specialized Hospital. Method: Patients with systemic inflammatory response due to infections were studied using prospective cohort study design for four month period in Jimma University hospital. A structured questioner was used to collect data on socio demographic feature of the patient and clinical feature, outcome and prognostic factors . Data was cleaned, edited and entered to SPSS window for analysis. The survival analysis and determination...
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