1.What is the significance of each of D.W.'s laboratory findings?
• With the ANA titer, most people with SLE test positive for this antibody. While not every person does, it is common to see this result positive, and in this case, it helps prove the SLE.
• In nearly 85% of patients with untreated SLE test positive of dsDNA. This finding shows that it is probable SLE even though it is not always present in every case, but because it is not seen positive with other connective tissue problems, it is associated with Lupus.
• The positive anti-Sm is used as a diagnostic test meaning the patient most likely has Lupus.
• The elevated CRP and ESR are ways that can show how the disease progresses. The elevation of these can be common in those with
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http://www.lupus.org/answers/entry/lupus-tests http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8178 9th edition Medical-Surgical Nursing book
6. The physician orders cyclophosphamide (Cytoxan) 100 mg/m2/day orally in two divided doses. D.W. weighs 140 pounds and is 5 feet, 4 inches tall. How much will she receive with each dose?
• First you must find m2 which is the body surface area. 5 feet 4 inches must be converted into cm. There are 2.54 cm in 1 inch and 12 inches in 1 foot which equates to 64 inches multiplied by 2.54 equals 162.6 cm. Now the 140 pounds must be converted into kg. There are 2.2 pounds in 1 kg, so the 140 pounds equals 63.6 kg. I found a website that calculates the body surface area. The body surface area as a result is 1.69.
• 100 mg/1.69/day would result in 100 mg x 1.69 = 169 mg/day. Each dose would be 84.5 mg.
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Measuring D.W.'s blood pressure every 2 hours
b. Assisting D.W. with personal hygiene measures
c. Counseling D.W. on seizure safety precautions
d. Assessing D.W.'s neurologic status every 2 hours
e. Emptying the urine collection device and measuring the output
f. Monitoring D.W.'s BUN and creatinine levels
• 9th edition Medical-Surgical Nursing book
1. What is PJP?
• It is an opportunistic pneumonia fungal infection caused by Pneumocystis jiroveci. While technically a fungal infection, antifungals have shown to be ineffective against it, so the treatment requires antibiotics and short term steroid use in HIV/AIDS patients. The PJP was causing his shortness of breath and cough.
http://emedicine.medscape.com/article/225976-overview https://medlineplus.gov/ency/article/000671.htm 9th edition Medical-Surgical Nursing book
2. What is the significance of the purplish spots over K.D.'s neck and arms?
• It is significant because it could be a sign of Kaposi Sarcoma which is a cancer that many in the health care field believe to be related to HIV. It is a type of herpesvirus that can be spread through sexual contact and saliva. When patients reach a CD4 level of less than 200, a person infected with this virus may begin to show the symptoms of Kaposi Sarcoma which include the purplish spots. This means that his HIV is progressing, and his immune system is worsening because the virus is able to show symptoms of
The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
Hospital-acquired infections (HAI) are preventable and pose a threat to hospitals and patients; increasing the cost, nominally and physically, for both. Pneumonia makes up approximately 15% of all HAI and is the leading cause of nosocomial deaths. Pneumonia is most frequently caused by bacterial microorganisms reaching the lungs by way of aspiration, inhalation or the hematogenous spread of a primary infection. There are two categories of Hospital-Acquired Pneumonia (HAP); Health-Care Associated Pneumonia (HCAP) and Ventilator-associated pneumonia (VAP).
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.
The incidence of SLE is 7.6 cases per 100,000 with a prevalence of approximately 68 cases per 100,000 (Bernknopf, Rowley, & Bailey, 2011). It affects women more than men with a 9:1 ratio, and typically affects women of childbearing age (Patel, Fenves, & Colbert, 2012). The mean age of symptom onset was 29 years in the Euro Lupus Project that studied 1000 patients with SLE (“Systemic Lupus Erythematosus”, 2012). Children and older adults are also diagnosed with SLE but at a much lower rate, 8%-15% and 3%-18%, respectively (Arnaud, Mathian, Boddaert, & Amoura, 2010). Patients with ethnic backgrounds have a higher incidence rate with African Americans developing SLE 3-4 times more than Caucasians, unlike drug-induced lupus erythematosus (DILE) which has an equal male to female prevalence yet a higher disease severity in Caucasians (Bernknopf, Rowley, & Bailey, 2011).
Faries, D. E., Houston, J. P., Sulcs, E. N., & Swindle, R. W. (2012). A cross-validation of the provisional diagnostic instrument (PDI-4). BioMed Central, 13(1), 104. doi:10.1186/1471-2296-13-104
My disease is Streptococcal pneumonia or pneumonia is caused by the pathogen Streptococcus pneumoniae. Streptococcus pneumoniae is present in human’s normal flora, which normally doesn’t cause any problems or diseases. Sometimes though when the numbers get too low it can cause diseases or upper respiratory tract problems or infections (Todar, 2008-2012). Pneumonia caused by this pathogen has four stages. The first one is where the lungs fill with fluid. The second stage causes neutrophils and red blood cells to come to the area which are attracted by the pathogen. The third stage has the neutrophils stuffed into the alveoli in the lungs causing little bacteria to be left over. The fourth stage of this disease the remaining residue in the lungs are take out by the macrophages. Aside from these steps pneumonia follows, if the disease should persist further, it can get into the blood causing a systemic reaction resulting in the whole body being affected (Ballough). Some signs and symptoms of this disease are, “fever, malaise, cough, pleuritic chest pain, purulent or blood-tinged sputum” (Henry, 2013). Streptococcal pneumonia is spread through person-to-person contact through aerosol droplets affecting the respiratory tract causing it to get into the human body (Henry, 2013).
Lupus is more common in women than men, and although it can affect people of all ages, it is most commonly developed between 15 and 40. Lupus is also more common in African Americans, Hispanics and Asians.
When someone has lupus they have a different outlook on life. For patients with this disease, even the easiest task can be painful to the body or joints. Lupus is not contagious. “Lupus is a disease of the immune system. The immune system protects the body from inflection”(http://lupus.webmd.com). With lupus, the immune system attacks the tissue in many parts of the body. Lupus affects women more than men(www.womenshealth.gov). There are many different types of lupus, and each symptom affect different parts of the body. With treatment you can obtain and fulfill a healthy lifestyle.
Koplik’s spots – these are spots inside the mouth, throat and side’s of cheek, they are a greyish-white colour.
Relevance: You might ask why should I care? How does this affect me or what is it exactly? Well the truth is that most people don’t realize they have Lupus. It so difficult to diagnose it is know as the “great imitator” since it resembles a variety of other diseases.
This more severe form usually prevails in elderly, cigarette smokers, people with chronic lung disease, or those who are immunocompromised, such as cancer or AIDS patients. Virulence:.. Being a gram-negative bacterium, L. pneumophila has lipopolysaccharides (LPS) that act as endotoxin within a human host. The presence of a flagella is thought to mediate adherence to human lung cells, thereby causing infection, since flagella-less strains do not cause disease. Once attached to human cells, the organism is engulfed by a macrophage that utilizes the internal environment to multiply.
Magro, C., Cohen, D., Bollen, E. L., Buchem M. A., Huizinga, T.W., and Steup-Beekman, G. M. (2013). Demyelinating disease in SLE: is it multiple sclerosis or lupus? Best Practice Res Clinic Rheumatol. 27(3):405-24
Systemic lupus erythematosus, or simply lupus is a chronic autoimmune disease or immune system malfunction. A person's immune system normally protects the person from viruses, bacteria and other foreign materials. When a person has an autoimmune diseases like lupus, the immune system turns against itself and attacks itself.
m= 10km2 x 1000m x 1000m = 107m2 107m2 x 15= 1.5 x 1.8m3 = 1.5 x 1011kg
MEDICAL DIAGNOSIS: Empyema, Hemoptysis, Necrotizing pneumonia, Aspergillosis (Aspergillus fumigatus) cachexia secondary to malnutrition/infection, hypothyroidism, Diabetes Type II melitius , and...