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Stress determinants
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SUBJECTIVE I did see Ms. Demethrice Collins who is complaining of left knee pain. She was seen on sick call and stating that it has re-aggravated the knee to climb up and down a bunk and her knee was swollen at that time. She is trying to exercise and get ready for CIP; however, it was noted that she has not only resting high heart rate which is around 100, but also the heart rate of 180 after exercise. She was advised to postpone her CIP evaluation until March, which she is reporting makes her stressed out and depressed. OBJECTIVE Vital signs are stable. Noted weight loss of about eight pounds in the past three weeks. She appears to be in no distress. Heart rate at rest was 100. On exam, her lungs were clear bilaterally. Heart: Regular
only diagnosed in 2013, she was also diagnosed with epilepsy . As of today her
hank you fore referring Mary Szczepaniak, a 63 year old lady who required admission to ICU post-operatively due to hypertension that is presumed due to anaphylaxis.
Mrs. Jones, 78 years old, arrived in the emergency department (ED) via ambulance. She was alert and oriented, but was having episodes of lost consciousness. She was put on the cardiac monitor and her vital signs were obtained. Her cardiac rhythm was normal. Her vital signs were as follows: Temperature 97.3°F, Pulse 43, respirations 26, blood pressure 100/58 and O2 saturation of 94% on room air. Additionally, Mrs. Jones was vomiting and had 2 loose, incontinent stools. She was pale, cool to touch and diaphoretic. Auscultation of her lungs revealed expiratory wheezes.
Vitals signs: BP 90/60, HR(heart rate) 90-100, RR(respiratory rate) 22, Temp: 100.2 F, Oxygen Saturation: 98%
During my morning rounds I began my assessment of Mrs. M., and I noted that she had shortness of breath and she was making gurgling sounds. I immediately auscultated her lungs and noted bilateral wheezing throughout all fields, her heart was irregular and rapid and she had 2plus pitting pedal edema. I noticed she had an IV running at 125ml/hr, which I quickly stopped. The patient did not have orders for IV fluid there was only an order to KVO. I raised the head of the bed and paged respiratory to the floor.
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
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Since admission to the hospital he has had irregular heartbeats which have dropped down into the 40s and was asymptomatic. On 3/18, a telemetry was placed on him for monitoring, but it has since been removed.
Airway, trachea was in the middle, tip of the endotracheal tube ends at 2.2 cm above the carina in between the second and third thoracic vertebrae; Bones, there were no broken bones; Cardiac silhouette, normal; Diaphragm, right hemi-diaphragm was higher than the left with sharp costophrenic angles; Effusion, no pleural effusion or pneumothorax; Fields, subsegmental atelectasis noted in the left upper lobe, right upper lobe and right middle lobe; Endotracheal tube (ETT), and Nasogastric tube (NG) were seen on the
The Daniel Pelka serious case review is one of many that are conducted around the United Kingdom every year. A serious case review is a local enquiry into the death or serious injury of a child, where abuse or neglect are known or suspected. These are conducted by the Local Safeguarding Children Boards; with the main focus being on what lessons can be learnt locally to prevent this from happening again (Brandon, Bailey, Belderson, 2010). In this textual analysis we will be looking back at previous case reviews including Jasmine Beckford and Baby P. We will then look at what recommendations have been made and use the Peka case to see weather we have learned from our previous mistakes or are we still in the same position now as we where then.
Dr. Murray, the chief resident who arrived around 8:00pm, charted Lewis’ heart rate as normal and noteds a probable ileus; however, nursing documentation at the same time recorded a heart rate of 126 beats per minute (Monk, 2002). Subsequent heart rates at midnight and 4:00am arewere charted as 142 and 140 beats per minute respectively without documented intervention (Monk, 2002 ). On Monday morning Lewis noted that his pain suddenly stopped after being very constant and staff charted that they were unable to get a blood pressure recording in either arm or leg from 8:30-10:15am despite trying multiple machines (Monk, 2002; Solidline Media, 2010).
Vitals - T 97.8, HR 72, BP 108/60 supine, RR 18 unlabored, height 6 ft., weight 133 lbs., BMI 18.04,
A review of his medical records indicates that he had his first CVA later March of 2016 then one week later he had another CVA. His last CVA resulted in a stay in ICU with a tracheostomy and peg tube placement. He no longer has a tracheostomy and he recently loss his peg tube and refused to have it replaced. He was recently hospitalized at SLMC with complaints of fatigue and neck pain. He suffers from co-morbidities of DM which is stable with insulin, HTN which is stable and hyperlipidemia which is stable.
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
D. standing near her room, breathing sharply. While asked what has just happened, she answered, ‘I feel dizzy and can faint!’ Mrs. D. then explained that she rose up from her chair in the television room and felt lightheaded. I decided to bring her to the room hoping she would feel less dizziness if she could sit. After consultation with my mentor and third year unit nursing student, I decided to perform measurement of her vital signs. Since only electronic sphygmomanometer was available for me that time, I had to use it for my procedure. Gladly, I discovered that I have already used such equipment in my previous nursing practice. Using the standard sized calf, I found that her blood pressure was 135/85, respirations were 16, and her pulse was 96 beats per minute (bpm). However, I decided to recheck the pulse manually, founding that it was irregular (78 bpm). The patient stated that she felt better after rest. Immediately after the incident I made a decision to explore carefully the medical chart of Mrs. D., along with her nursing care plan. That helped me to discover multiple medical diagnoses influencing her