Nurse Gary stated that client was extubated at about 1125; he indicated that she is no on any drips, but only receiving fluids NS 9% @ 75 ml/hr and home medications. I gave him the eye drops Carteolol as requested. Lina was lying in bed, with head of bed elevated at about 50 degrees. Awake and alert, making noises and yelling when BP is being taken. She is receiving oxygen via nasal cannula at 3 lpm; none apparent respiratory or any other type of distress. Her skin is intact; however I noticed right hand swelling, possible IV infiltration, she has an IV in the affected hand that I did not see during my previous visit since she was wearing meetings. Hypoactive bowel sound, abdomen soft-non-tender. She continues with a Central line to right
I am now reporting to you from the patient’s femoral vein. I am headed north to her right lung. The femoral vein is one of the largest veins in the body. The ride has been smooth so far. I have been seeing many different types of cells go by my submarine window. I just saw an army of white blood cells headed the same way that I am. They most likely are headed towards the bacteria infestation in the right lung. I am also hearing the heart beat; it is making a LUB- DUB sound. I can also hear the blood flow; it is making sort of a swooshing noise. That noise is reminding me of the ocean! The right femoral vein is now turning into the external iliac vein; I am now by the urinary system and reproductive system. This is also known has the pelvic region. As we continue north the eternal iliac vein is now called the common iliac vein. As we continue on, the common iliac vein is now called the inferior vena cava. We are getting closer to the heart! We are in the abdomen of the body. There are diff...
A 73-year old female presented to St Vincents Emergency Department, with a 3 week history of progressive dyspnoea, cough, and lethargy, on a background of a 6-year history of Multiple Myeloma. Just prior to presentation, she had also developed a fever.
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
Urine output is a time-honored measure of the patient’s effective blood volume (EBV) and a surrogate for tissue perfusion. Urine output is typically measured at one-hour intervals and expressed in milliliters per hour (ml/h). Because small volumes are difficult to measure, initial information becomes available only 20-30 minutes after catheter insertion by extrapolating to one full hour. This extrapolation can result in considerable over- or underestimation.
Luna C., a 28-year-old Spanish female, came into the E.R., due to fatigue, and a fever of 102.3°F, a sore throat and abdominal pains. Her symptoms have been ongoing for the past two days. Luna C., is a nurse who has recently traveled to Liberia in West Africa to aid in the healthcare facilities they had available. She came home 5 days before coming into the E.R. without any signs or symptoms of illness. When she initially came to the hospital, she didn’t inform the doctors or nurses that she had traveled out of the country. She was sent home after receiving fluids intravenously. On day 10, she arrived back to the emergency room complaining of fatigue, a fever of 106.7°F, severe headache and abdominal pain along with profuse diarrhea,
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
Osmara is a 22yo, primigravida, who is currently 34 weeks 5 days. She has been followed for an elevated inhibin. On her visit 2 weeks ago she was noted to be LGA that was symmetric and growth > 90%ile. Amniotic fluid was normal but generous at 19 cm. In the last week, she has gained a fairly significant amount of weight and has noted edema. She does tend to wake-up with the edema but it can be relieved with elevation. She has an occasional headache and has not really taken Tylenol but otherwise has no visual changes or nausea/vomiting.
The most important elements of the guidelines are organized into two “bundles” of care (Angus, 2013). The first “bundle” is for within the first 3 hours sepsis is suspected. The first thing you would do is measure the lactate level. The second thing is obtaining blood cultures prior to administration of prescribed antibiotics. You administer broad spectrum antibiotics in patients with septic shock. The risk of dying increases by approximately 10% for every hour of delay in receiving antibiotics. The last thing you would do for the 3 hr “bundle” is fluid resuscitation: administer 30 mL/kg crystalloid for hypotension or lactate ≥ 4mmol/L (Subtle Signs of Sepsis, 2017). The second “bundle” is for within the first 6 hours sepsis is suspected. The nurse would do the same protocol for suspected sepsis within 3 hours and continue for more advanced treatment. The next thing you would do is administer vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a MAP ≥ 65 mmHg. For persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥ 4 mmol/L (36 mg/dL), reassess volume status and tissue perfusion and document findings. After initial fluid resuscitation, repeat focused exam, including pulse, capillary refills, vital signs, cardiopulmonary assessment, and skin (Subtle Signs of Sepsis,
5/14/2016 PO day 4 Scr 2.62 H/H 6.5/18.7 transfused 2 units PRBC. Ventilator weaning held due to blood
Due to the risk to for noncompliance from multiple medications, uncontrolled chronic health conditions and impaired vision of the patient, the family’s reasons for referral to a home health care coincided with the physician’s as well. Three major safety concerns validated this decision: several medications throughout the day, multiple co-morbidities, and advance age. Her ability to properly manage her medications was questioned when the healthcare team suspected she was uncompliant with her Carvedilol prescription, which consequently resulted in a hypertensive crisis. The progression of her chronic conditions, especially her kidney failure and recurrent dialysis treatment, affects her quality of life and increases her risk for complications.
Patient: is a 55-year-old male, came into the hospital confused and incontinent, stated he had pain in his abdomen but could not state where exactly, pointed to the whole abdomen. Patient lives at home with a friend in an apartment that had beer bottles all over his apartment. Patient drinks 24 beers a day and smokes a pack a day. Blood tests were done when patient was admitted into the hospital: ammonia levels were high (79), Hemoglobin was low (105), Platelet count low (113), Magnesium normal (0.60), Potassium normal (4.9), Sodium normal (141), urea normal (4.0), ALT high (76), leukocytes high (8.1)
Mrs. A is a 71-year-old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother 's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:
Dr. Tagge, the lead surgeon, finally updated the family over two and a half hours later stating that Lewis did well even though he had to reposition the metal bar four times for correct placement (Kumar, 2008; Monk, 2002). Helen reported wondering if Dr. Tagge had realized how much Lewis’ chest depression had deepened since he last saw him a year ago in the office, especially considering he did not lay eyes on Lewis until he was under anesthesia the day of surgery (Kumar, 2008). In the recovery room, Lewis was conscious and alert with good vital signs, listing his pain as a three out of ten (Monk, 2002). Nurses and doctors in the recovery area charted that he had not produced any urine in his catheter despite intravenous hydration (Kumar, 2008; Monk, 2002). Epidural opioid analgesia was administered post-operatively for pain control, but was supplemented every six hours by intravenous Toradol (Ketorolac) (Kumar, 2008; Solidline Media,
According to doctor’s order, repeat CBC at 1600hr and if the HB is less than 80 transfuse two units of PRBC and lasix 40 mg in between the transfusion. I visited each patients room and around 4PM I entered Mr.Govanni’s room and I noticed that he was doing something with his mobile and I greeted him but he replied without looking at me by shaking his head and said, oh!.. yes, and he continued what he was doing....
The patient is a 30 year old male with an active bacterial infection on his right leg attacking his Integumentary system. The patient is from Tanzania, Africa but came back to work in a factory that produces plastic. If he has Cellulitis, it can get bad enough to travel to other organs like the Liver and Kidney and cause failure. If this happens, Edema can form, usually on one half of the body; this is the Urinary system being attacked. The main system being attacked is the Lymphatic system because Cellulitis attacks the lymphatic draining system. For Cellulitis to travel to organs, it had to go through the blood, so the cardiovascular system is also in effect.