He is nonverbal, and aphasic. Room 370 has a PEG-Tube and he cannot swallow safely. He is non-ambulatory and cannot move his right arm. Room 370’s close family members have had meetings with palliative care. At the last palliative care meeting, Room 370 indicated that he would want CPR, but his brother said he would not want to be kept on a machine for more than two weeks. Room 370’s past medical histories include: multiple strokes, vertigo, HTN, benign prostate hypertrophy (BPH), diabetes mellitus type 2, which Room 370 is currently taking insulin for, vitamin D deficiency, diabetic neuropathy, chronic kidney disease stage 3, and…
A nurse is caring for an 80-year-old patient who was admitted to the hospital with a diagnosis of dehydration. The patient stated he had been vomiting for 2 days and had been unable to take food or fluids. He has been healthy and currently takes only a diuretic for his blood pressure. On physical examination, the nurse notes the patient’s skin is dry with decreased turgor, oral mucous membranes are dry, heart rate is 100, and blood pressure is 90/60. The patient’s urine is dark amber with a specific gravity of 1.028. His urine output was 30 cc/hour for the past 4 hours since admission.…
1. It seems the patient has respiratory acidosis. Production of carbon dioxide occurs fast and the failure of proper ventilated increases the CO2 in the blood.…
The time is 1900 hours. You are working in a small, rural hospital. It has been snowing heavily all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in good weather), have been grounded by the weather until morning. The roads are barely passable. WR., a 48 year old construction worker with a 36 pack year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male pattern obesity (beer belly, large waist circumference) and a barrel chest, and he reports a dietary history of high fat food. His wife brought him to the ED after he complained of unrelieved indigestion. His admission VS were 202/124, 96, 18, and 98.2°F. WR. Was put on O2 by nasal cannula titrated to maintain SaO2 over 90%, and an IV of nitroglycerin was started in the ED. He was also given aspirin 325 mg and was admitted to Dr. A’s service. There are plans to transfer him by helicopter to the regional medical center for a cardiac catheterization in the morning when the weather clears. Meanwhile you have to deal with limited laboratory and pharmacy resources. The minute WR. Comes through the door of your unit, he announces he’s just fine in a loud and angry voice and demands a cigarette.…
The patient was then transferred to a different hospital and this time was not provided the appropriate gastric suction machine, even after being promised as part of the treatment; this led to another incident of aspiration and the prolongation of the pneumonia. A different hospital received this patient and replaced the damaged gastric tub, but the staff did not know how to use it properly and was introducing food through the wrong port. Once again the patient was transferred to one of the prior hospitals without the right gastric suction machine; this time the patient's wife offered to provide the device herself, but the hospital refused, consequently inadequate suctions complicated the pneumonia and the patient developed sepsis. The same situation continued to occur in other hospitals as the staff cared for this patient, due to the inability to provide the appropriate gastric equipment, or the staff inappropriately using the gastric tube or damaging the tube. Patient condition only kept deteriorating until the wife finally decided to transfer the patient to Florida, but the hospital rejected the transfer claiming that the patient was not stable; the patient died two days…
Admitted to the medical-surgical unit with a chief complaint of “breathing problems”. She speaks broken English & requests that her daughter be allowed to stay with her. She is on nasal cannula oxygen & sitting up in bed. At this time, she seems slightly short of breath, but is not in acute distress. You note that she is pale & has a petite frame. Her ankles are swollen. Her daughter tells you that she has been complaining of feeling more tired in the evenings & “unable to catch her breath”. While at home, she has been sitting up either in an easy chair or in bed with three pillows. Her daughter states that Mrs. Lee has not had to urinate as much in the last 2 days, but she gets up twice each night to use the bathroom.…
Nosocomial pneumonia is acquired during a hospital stay. It happens when a patient is admitted into the hospital with a medical diagnosis that they are hoping to be treated for and contract the infection of pneumonia through the spread of germs. “Nosocomial pneumonia (NP) clinically presents more than seven days after hospitalization with new fever, pulmonary infiltrates, and leukocytosis. Nosocomial pneumonia is a common nosocomial bacterial infection and is most prevalent in medical and surgical intensive care units. The most common pathogens associated with NP are: P aeruginosa, Klebsiella pneumoniae, Escherichia coli, and S marcescens (Medscape, 2015). Whereas community acquired pneumonia is contracted in the community. “Community-acquired pneumonia (CAP) is one of the most common infectious diseases and is an important cause of mortality and morbidity worldwide. CAP is usually acquired via inhalation or aspiration of pulmonary pathogenic organisms into a lung segment or lobe” (Medscape, 2015). The most common organisms involved in causing CAP are: Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis.…
D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is an acute exacerbation of chronic emphysema.…
The case study presents the outcome of smoking that resulted to RS’ chronic bronchitis and chronic obstructive pulmonary disease. His ABGs’ show partially compensated respiratory acidosis as manifested by decreased pH, increased PaCO2, decreased PaO2 and increased HCO3. RS most likely has the following clinical findings caused by COPD: enlarged right heart along with the signs and symptoms of the right-sided failure, secondary polycythemia, hypoxemia and hypercarbia. The fact that he has chronic bronchitis, his cough is productive with thick mucus, breath sounds are coarse rales and chest is tight. Expected symptoms in emphysema…
More so, it was difficult to establish If Charlie was experiencing any pain due to the severity of his condition. Doctors did not have a positive reason to continue ventilation unless it served a greater purpose, that is to reverse his condition and quality of life. Merely being alive was not sufficient. Although it is a legal and moral duty of the parents to make informed decisions on the treatment pursued for their child’s best interests. If it appears, however, that the proposed course of action can endanger and are contrary to the child’s best interests, it is a moral responsibility of the medical team to intervene.…
Copd is at the apex of causes for mortality worldwide, with a greater incidence rate than ten years prior; systemic infections are the mainstay of the disease process. Periodontal disease has been vividly studied and the absolute foundation of the multifactorial process restrictive airways. The infection leads to inflammatory responses that perpetuates the diseased state via inflammatory mediators, and thus mediating copd. Counter arguments for obesity-related hypoxia and other namely although creditable factors are also taken into account when understanding the disease, this is because all mediating factors result in acute inflammatory response which contribute to increased inflammation and later increase stimulation in the systemic circulation, this stimulation leads to the perpetual increase in total peripheral resistance, and later comorbidities associated with cardiac functioning. The present conception in the physiology of copd and site of immense work is in regard to the understanding of the link between systemic infections. Periodontal disease has shown that there is an increase connection with the effect of this process and that of pulmonary functioning. This paper will summarize the primary epidemiological findings and compares them to clinical evidence, while setting the stage for the counter action from a public health stand point.…
A 55 year old patient admitted for chest pain and on telemetry monitoring. This patient requested for shower, a nurse removed his telemetry and was ask to assist the patient during shower, but the patient insisted to shower on his own. Then the nurse left the patient alone without instructing him to call for help if he felt any discomfort. After a while, the nurse went back to check, patient was…
Furthermore, failure to follow a systematic assessment in the treatment of an acutely ill patient is also another contributing factor (Resuscitation Council UK 2006). There is however, the risk of this kind of approach being subjective as each individual may observe, feel or hear symptoms differently. Due to the word constraint, this assignment will concentrate on the breathing assessment aspect of Dominic’s condition and also the pathophysiology of COPD and the use of oxygen (O2) as treatment to alleviate his symptoms.…
On arrival at the low caring nursing home, the patient was assessed and it was found that she was inadequately perfused (HR 122, BP 90/55mmHg, warm and flushed), had a normal respiratory status with GCS 13. Upon conducting the secondary survey, her temperature was 39.2, foul odors present and she has been incontinent of urine. The patient refuses to be transported to the suggested hospital as she has had bad experiences on previous admissions. Consent needs to be obtained from the patient in order for transportation to proceed as long they are competent of sound mind and they understand the information that was provided (2). The patient’s autonomy dictates that their requests should be honored and respected…
On arrival I was surprised to find the patient unattended and untreated in a room with no HCP present. I felt extremely concerned there had been no monitoring performed especially with his evident dyspnoea, I also felt a real sense of empathy towards the patient being alone and clearly very anxious. I was relieved that the paramedic with me took control of the situation providing the patient with compassion and reassurance.…