Glycemic Control in Critically Ill Patients
The patient is a 56-year-old male admitted for altered mental status, scalp laceration, and right pneumothorax after a fall off his porch onto concrete. This patient has been in the hospital for 9 days with these problems and now has developed pneumonia and showing signs of possible sepsis. One of the abnormal assessment findings were his respiratory assessment. Currently the patient has a trach tube and is on mechanical ventilation of 50%. He has diminished breath sounds on the right side especially in the base of the lung and clear on the left side. The patient has regular labored breathing with the use of accessory muscles. Another abnormal finding is that his heart rate is tachy and heart rhythm
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He was really working on breathing even with the assistance of the breathing machine. Some interventions that I used to help keep an eye on was to continue monitoring his O2 levels because this would tell me that he was not getting enough oxygen in the body and he was having buildup of excess carbon dioxide in the body. I also watch to see if there were any changes in breath sounds and in respiratory rate because this could tell me if is work of breathing was getting worse or improving. Another problem that I addressed was his heart. All I did for that was to watch out for any development of life threating rhythms and continue to monitor his heart rate. Another problem that I addressed was his blood sugars. I watch out for his high blood sugars because high blood sugars can be very damaging to the body. It is also hard to control blood sugars sometimes because the body is under extreme stress and the body is just going to keep releasing. So to help this problem we put him on an insulin drip and two hours blood glucose checks to help keep a tighter control on this problem. The last problem that I addressed was the fact he is at high risk for sepsis. With his high repository rates, temperatures, blood sugars and a fast heart rate all point to the possibility of him developing sepsis. So what I did to help monitor this was kept looking at his CBC numbers, put him on vancomycin along with the other …show more content…
It has been known that hyperglycemia is a risk factor for infectious complications and even death in patients especially in critically ill patients according to Addison (2006). So this policy looks at how they can help identify patients who are at risk for uncontrolled blood sugars when they enter the ICU setting. According to Addison (2006), “Tight glucose control resulted in a significant reduction in mortality” What they do for every patient that comes in is that their blood sugar is checked to see where they are at. After that they are put in certain category’s based on their blood sugar. Based on their number they are given certain treatments like if you have a blood sugar below 60 you are given some kind of therapy and put on 15 min accu- checks. If the patient has a blood sugar above 111 they are further put into category’s based on if they are mechanically ventilated. At that point they are either started on a continuous insulin iv therapy or subcutaneous insulin therapy and put on either a 2 hour or 4 hour accu check. The purpose of this policy again is to help identify patients who are at risk for additional complications due to uncontrolled blood sugars and to help reduce mortality based on their high blood
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
Without question the cost of medical care in this country has skyrocketed over the last few decades. Walk into an emergency room with an earache or the need for a few stitches and you’re apt to walk out with a bill that is nothing short of shocking.
Pritesh has a previous medical history of asthma and has experienced right-sided haemothorax as he got hit by a hockey ball during a competition. Currently, the nurse suspects that Prithesh may be developing tension pneumothorax which is a life-threatening medical emergency (Brown & Edwards, 2012). Tension pneumothorax develops when a hole in the airway structures or the chest wall allows air to enter but not leave the thoracic cavity (Rodgers, 2008). The pressure in the intrathoracic space will continue increase until the lung collapses, place tension on the heart and the opposite lung leading to respiratory and cardiac function impairment, and eventually shock may result (Professional guide to pathophysiology, 2011; Rodgers, 2008). Tension pneumothorax usually results from a penetrating injury to the chest, blunt trauma to the chest, or during use of a mechanical ventilator (Brown & Edwards, 2012; Rodgers, 2008).
Although the flow chart is straight forward and easy to follow, nurses often use nursing wisdom, which is based on their knowledge and experience (McGonigle & Mastrian, 2012). For example, rather than giving orange juice or one tube of glucose gel and rechecking a patient’s blood glucose in 15 minutes, nurses may wait for a breakfast tray to arrive and recheck a patient’s blood glucose after breakfast. Possible risks include a patient not eating his or her breakfast and their blood sugar continuing to drop. Possible benefits are a patient eats his or her breakfast and his or her blood sugar returns to normal. However, there are applications in the computer where a diabetic educator is able to view when a patient had a low blood sugar and it was not rechecked in a timely manner to ensure that the blood glucose returned to normal. Managers are often being talked to by diabetic educators, because nursing staff at times decide to use their own judgment when treating low blood sugars rather than following the hospital protocol and then nurses are forced to explain their decisions. Thus, the importance of documenting and ensuring a patient’s blood glucose has returned to normal, even though the flow chart was not implemented is often emphasized.
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
Consulting for the Caring Angel Hospital Working in the health care industry takes a lot of courage and patience in order to deal with different individual’s personalities and to be equipped to handle stressful situations according to the issues at hand. As a senior consultant at the Practical Health Care Consulting firm, my supervisor has instructed me to spend three months at the Caring Angel Hospital. While at the hospital there are a few tasks for improving the quality of care, adding value to the organization, improving employee morale, etc. Although these obstacles will be a challenge, there is an opportunity for improvement. This will allow the Caring Angel Hospital to increase revenue and accomplish the goals that are established.
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
The care plan is composed of the right food, exercise and medication (Mayo Clinic Staff, 2014). The person needs to know what type of foods affects their blood sugar levels and most of the time the patient is sent to a nutritionist to follow a diabetic diet. The patient needs to keep track of a food log to discuss later with the doctor or nurse on the next appointment (Mayo Clinic Staff, 2014). An exercise regimen also helps to keep the sugar levels balanced. It is important to keep an exercise schedule that will help the person to keep an exercise routine in accord with the medications and meals. It is very important to stay dehydrated and to keep track of the blood sugar levels (Mayo Clinic Staff, 2014). The medications are to lower the blood sugar levels. It is very important to store the insulin properly, check the expiration date and double check the dose before administration. The person will need to report to the doctor if the blood sugar gets too low or still high, because the doctor might need to adjust the dosage or timing. Also, it is important for the doctor to know if the person is taking medications for other conditions, because that will help the doctor to prescribe the correct medication for the person (Mayo Clinic Staff,
The cost of Medical equipment plays a significant role in the delivery of health care. The clinical engineering at Victoria Hospital is an important branch of the hospital team management that are working to strategies ways to improve quality of service and lower cost repairs of equipments. The team members from Biomedical and maintenance engineering’s roles are to ensure utilization of quality equipments such as endoscope and minimize length of repair time. All these issues are a major influence in the hospital’s project cost. For example, Victory hospital, which is located in Canada, is in the process of evaluating different options to decrease cost of its endoscope repair. This equipment is use in the endoscopy department for gastroenterological and surgical procedures. In 1993, 2,500 cases where approximately performed and extensive maintenance of the equipment where needed before and after each of those cases. Despite the appropriate care of the scope, repair requirement where still needed. The total cost of repair that year was $60,000 and the repair services where done by an original equipment manufacturers in Ontario.
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
That is to say that “People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia” (“Diagnosis”). In order to seek the proper care for diabetes, patients must undergo: distinguishing its symptoms, classifying if it is pre-diabetes or type 2 diabetes, and the proper treatment.
...ey may require aggressive treatment, such as continuous fluid drainage and use of mechanical ventilation to help the patient to breathe. Whatever the severity of it, it is important to get medical care as quickly as possible to have the best chance of full recovery.
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.
In conclusion, early diagnosis followed by an appropriate airway intervention is essential to prevent cardiac arrest or irreversible brain damage that occurs within minutes of complete airway obstruction. Although the conventional techniques remains standard option, every physician has to be familiar with the process of evaluating a difficult airway and, in the event of the unanticipated difficult airway and be able to use a wide variety of techniques to avoid complications and fatality. Airway management of the patient requires a coordinated effort from other consultants or colleagues, if available, can be the key to success in some circumstances.