...as high as 28%-50%. Septic shock: Is the presence of sepsis with hypotension despite fluid resuscitation along with the presence of inadequate tissue perfusion. Multiple organ dysfunction syndrome (MODS): Is the failure of two or more organ systems in an acutely ill patient such that homeostasis cannot be maintained without intervention. Identify the nursing priorities in the care of the patient with sepsis and septic shock: Oxygenation -Provide supplemental O2 Intubation/mechanical ventilation, if necessary Monitor SvO2 or ScvO2 Circulation- Aggressive fluid resuscitation End points of fluid resuscitation: CVP 15 mm Hg Pawp 10-12 mm Hg Drug Therapies- Antibiotics as ordered Vasopressors (dopamine) Inotropes (dobutamine) Anticoagulants (low molecular –weight heparin) Drotrecogin alfa (xigris) for patients with high risk death Supportive Therapies- Obtain cultures (blood, wound ) before beginning antibiotics Monitor temperature Control blood glucose Stress ulcer prophylaxis What class of bacteria is responsible for more than one half of the cases of septic shock? What are some common causes of this? The main organisms that cause sepsis are gram- negative and gram- positive bacteria. Parasites, fungi, and viruses can also lead to the development of sepsis and septic shock. Explain why myocardial depression is almost...
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...1. The hemodynamics indicate cardiogenic shock . Which hemodynamic values reflect this? What is status of preload and afterload? What medications can be given to manage the preload and afterload?: 1. Professors Response: The hemodynamics indicate cardiogenic shock, with decreased cardiac output increased preload and afterload. Management of all three parameters is needed. Preload can be decreased with venous vasodilators and diuretics. Afterload can be decreased with arterial vasodilators. Nitroprusside will vasodilate both venous and arterial beds. Nitroglycerine may be added as a venovasodilator. Contractility can be increased with dobutamine, dopamine or amrinone. Dopamine may increase afterload, whereas dobutamine and amrinone will increase contractility and may also cause vasodilation. 2. If medications are ineffective in managing preload and afterload, what mechanical device might be used and how would it improve cardiac output?: 2. Professors Response: If these measures are not effective, an intra-aortic balloon pump will decrease left ventricle workload by decreasing afterload and increase coronary artery blood flow. 3. Mr.G. improves and is discharged from the hospital; however, he returns to the hospital ED within 10 days with a diagnosis of heart failure. He states that I can t catch my breath and my legs are as big as tree trunks and I have pain on my right side . On assessment you find that he is strictly following the fluid and salt restriction ordered since recent...
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...for a 110-lb patient. The literature states that the usual dose is 2 to 5 mcg/kg/min. Available: Dopamine 200 mg in 250 mL D5W. a. Patient's weight in kg: 110 ÷ 2.2 = 50 b. SDR/min: 100 − 250 mcg/min c. Is the order safe? Yes. 4 mcg × 50 = 200 mcg/min. 200 mcg/min is within the SDR d. Hourly drug order in mcg: 12,000 (200 mcg × 60 min) e. Hourly drug order in mg*: 12 (decimal moved 3 places to left) f. TD : TV reduced ratio: 4 : 5 (200 mg : 250 mL) g. Hourly flow rate to be set on infusion device: 200 mg = 12 mg = 15 ml/hr 250 ml X ml *Because the available drug (250 mg) is in mg, the hourly drug order must also be entered in mg. 2. Ordered: Dobutamine HCl (Dobutrex) 5 mcg/kg/min IV for a 132-lb patient. Available: Dobutamine 250 mg in 250 mL D5W. The flow rate is currently infusing at 36 mL/hr. a. Patient's weight in kg: 60 kg b. Hourly drug order in mcg: 5mcg X 60 kg X 60 min = 18,000 mcg/hr c. Hourly drug order in mg*: 18,000 mcg ÷ 1,000 mcg = 18 mg/hr d. TD : TV reduced ratio: 1:1 (250 mg : 250 ml) e. Hourly flow rate to be set on infusion device: 18 ml/hr f. Is current infusion correct? No. Should be 18 ml/hr, not 36 ml/hr g. Evaluation and decision: Unsafe. Assess patient's vital signs, report per hospital policy, and contact physician for orders. 3. Ordered: Lidocaine 4 mg/min. Available: 1 g of lidocaine in 500 mL of D5W. a. TD : TV reduced ratio (mg : mL): 2 mg/ml b. Hourly drug ordered:...
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...Cardiovascular Case Study Mr. Smith is a 56-year-old Caucasian man who is being evaluated in the emergency room with progressively worsening chest pain that began 2 hours ago. The patient describes the pain as pressure in the center of his chest. He rates his pain 7/10. He reports the pain is now radiating down his left arm and through to his back, he is diaphoretic, and complaining of shortness of breath. He denies nausea or vomiting. Mr. Smith reports no previous history of chest pain or pressure. He smoked one pack of cigarettes daily for 13 years but quit smoking last year. He denies a family history of heart disease. Upon initial examination he did not have jugular venous distension, no carotid bruits, normal S1 and S2 with an S3 present. No S4 or murmurs auscultated. Lung sounds clear to auscultation bilaterally, bowel sounds normal, all pulses palpable 2+/4, no edema present. Diagnostic data: BP: 165/98 mmHG HR: 96 bpm RR: 30 breaths/min Temp: 37 C SaO2: 96% with 2L/min O2 per nasal cannula Wt:100 kg A 12-lead ECG was performed in the emergency room showed: Normal Sinus Rhythm (NSR) with frequent premature ventricular contractions. ST segment elevation in Leads 1, aVL, and V2 through V6 (3mm). ST segment depression in Leads III and aVF. Q waves in V2 through V4. The chest X-ray revealed slight cardiomegaly with mild congestive heart failure. An echocardiogram reveals an ejection fraction of 30% and mild mitral valve regurgitation. Mr. Smith’s...
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...Major clinical procedures and treatments provided in the CIU include: implementation and documentation of the nursing process through assessment; establishment of nursing diagnoses, development of the plan of care and evaluation based on established standards of care, policies, procedures , and protocols; interdisciplinary treatment and discharge planning; invasive and non-invasive monitoring ( arterial blood pressure, 12 lead ECG, dysrhythmia interpretation, oxygen saturation, blood pressure, weight), transvenous and transcutaneous temporary pacing; peripheral and central line IV therapy; administration and titration of IV medications including lidocaine, procainamide, dopamine, dobutamine, cardiazem, heparin, GPIIb3a agents, IV sedation and blood and blood products. Other treatments include post PTCA monitoring and removal of sheaths, performance of activated clotting time(ACT) and capillary blood glucose testing (CBG), venous and arterial blood sampling, other specimen collection and oral, subcutaneous and intramuscular medication administration. Close observation of post procedure patients is performed. The nurses and physicians on the unit provide education related to cardiac procedures such as cardiac catheterization, balloon angioplasty, stent placement and cardioversion. Medication teaching including rationale, dosage scheduling, side effects, dietary precautions/interactions is also provided. Information regarding...
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...Accord Healthcare Limited | | Sage House, 319 Pinner Road, North Harrow, Middlesex, HA1 4HF, UK Telephone: +44 (0)208 8631 427 Fax: +44 (0)208 863 1426 WWW: http://www.accord-healthcare.eu Medical Information Direct Line: +44 (0)208 901 3370 Medical Information e-mail: uk@accord-healthcare.com Customer Care direct line: +44 (0)208 863 1427 Medical Information Fax: +44 (0)208 863 1426 Before you contact this company: often several companies will market medicines with the same active ingredient. Please check that this is the correct company before contacting them. Why? | | Summary of Product Characteristics last updated on the eMC: 01/08/2013 SPC | Atenolol 100 mg Tablets | Table of Contents * 1. Name of the medicinal product * 2. Qualitative and quantitative composition * 3. Pharmaceutical form * 4. Clinical particulars * 4.1 Therapeutic indications * 4.2 Posology and method of administration * 4.3 Contraindications * 4.4 Special warnings and precautions for use * 4.5 Interaction with other medicinal products and other forms of interaction * 4.6 Pregnancy and lactation * 4.7 Effects on ability to drive and use machines * 4.8 Undesirable effects * 4.9 Overdose * 5. Pharmacological properties * 5.1 Pharmacodynamic properties * 5.2 Pharmacokinetic properties * 5.3 Preclinical safety data * 6. Pharmaceutical particulars * 6.1 List of excipients * 6.2 Incompatibilities * 6.3 Shelf life * 6.4 Special precautions...
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...Angelicia Wingo 224 n Quincy ave Bradley, Il 60915 815-600-6076 braliy0025@gmail.com Education: * PCC Technical Institute Certification in Diagnostic Ultrasound/Vascular Graduated August 2006-July 2007 * University of Phoenix Online Pursuing Bachelor’s Degree Behavioral Science Present- December 2012 Work Experience Healthfair Cardiovascular Technician November 2011- Present * Performing cardiac screenings of 2-D echocardiograms, Carotid arteries, and abdominal aorta * Color flow, echo Doppler diastolic function, and measurements for echocardiogram * Color flow, Doppler, and measurement of CCA, ICA and ECA * Measurements of abdominal aorta Mid Distal and Prox. Sagittal and Transverse views | | Dr. Alaa Abdel-Meguid Echocardiography Trainee May 2007Dec2007/Present * Performing echocardiograms 2-D echocardiography, color flow, echo Doppler, Diastolic Function, M mode and Stress Echo exams for diagnostic purpose alongside lead echo tech Lisa Quick (13 Year experienced technician) * Orientate and prepare patients on procedures, complete all paperwork pertaining to scans performed Med 3000, Tinley Park, Il Collection Specialist/AR Team Lead June 2010-Present * Constantly adapt to changes in a fast-paced work environment while supervising a staff of 16 in Accounts Receivable and Collections ...
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...always cause an obstruction of the LVOT. In this review study, to get a better understanding of patients with HCM, they now stress the patients to evaluate LVOT obstruction, mitral regurgitation, left ventricle asynergy and diastolic function. An exercise stress test will be ordered when a patient with HCM is complaining of dyspnea, syncope and chest pain during exertion. Although these complaints are subjective, preforming a stress test can give physician’s objective finding towards the extent of the patients HCM. These objective findings can include systolic anterior motion of the mitral valve (SAM), LVOTO and EKG abnormalities. Based on the literature, exercise stress test work best as opposed to pharmacological stress test such has dobutamine (DOB). Physicians prefer to have HCM patients stress test customized to the daily activities that causes the onset of their complaints. Most hospitals stress their patients on treadmills or a stationary bike. Prior to stressing, there will be a resting EKG taken and baseline echo picture of the PLAX, SAX, 4ch and 2ch. While exercising, the patient will need to reach target heart rate before post exercising evaluations can begin. Target heart is 85% of the patient’s maximum heart rate. Max. HR of the patient equals 220- their age, take that answer and multiply it by .85 to calculate the target HR. Once the patient has reach their target heart rate, the sonographer needs to start the post exercise pictures and Doppler samples as quick...
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...depression. * ↑ risk of bradycardia when used with digoxin, verapamil, diltiazem, or clonidine . * ↑ hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates . * Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia). * Concurrent administration of thyroid administration may ↓ effectiveness. * May alter the effectiveness of insulins or oral hypoglycemic agents (dose adjustments may be necessary). * May ↓ the effectiveness of theophylline . * May ↓ the beneficial beta1-cardiovascular effects of dopamine or dobutamine . Use cautiously within 14 days of MAO...
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...(9.6%), wrong administration timing (1.9%).). The studied sample of the present study didn't follow and comply with the evidence based guidelines while administering positive inotropics recommended by Ann Williams, (2001), Andrew, (2012) , Oshikoya, et al (2008) and Wolf (2006); that dosage calculation must be calculated and verified by two registered nurses and Obtain pre-infusion assessment; Heart rate (apical & radial), edema, assess peripheral pulses, B/P, respirations, temperature, lung sounds, pulse oximeter reading, skin color, abdominal girth (if applicable) and capillary refill. and document the baseline findings in the clinical note. The researchers added that when patient is receiving continuous infusion of Dopamine, Dobutamine or Milrinone, B/P, heart rate will be monitored by caregiver every AM .When dosage is changed, B/P and heart rate will be taken 15 minutes. In the present study, The researchers examined the relationship between knowledge sub items and practice sub items scores regarding the selected positive inotropic medications. It revealed that no correlation were exist between participants' knowledge and practice regarding selected positive inotropics except Dopamine. This finding could be interpreted that lack of knowledge about Dopamine administration may have relevance to decreased practice scores .This finding is partially consistent with Hajebi, et al,(2010) who performed a study to determine the knowledge , attitude and practice of nurses...
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...Patient Data | Patient Name | Age | Gender | DOB | Medical Record # | Lenny Xigris | 49 | M | 8/13/1964 | 1819 | Chief Complaint | History of Present Illness | slipped in BR and shattered R patella and associated ligament tear | S/P (Status/Post) Right total knee replacement | Past Medical History | appendectomy at age 13, HTN | Current Medications | 1. lisinopril 10mg QD 2. HCTZ 12.5mg QD | Allergies | Height | Weight | Levels of End of Life Care | NKDA | 5”3” | 64kg (141 lbs) | Full Code | Admission Date | Admission Diagnosis | Admitting Physicians | Today | S/P (Status/Post) R total knee replacement | McNasty Ortho surgeon | Scenario Data | Learning Objectives | Note: This simulation is part of a Microbiology course (MICRO 290). The main learning objective is to use a simulation of sepsis to facilitate student visualization and understanding of the mechanisms of key chemical and biochemical events in the human body during a human pathological scenarioBy the end of this scenario, the participant will be able to: 1. Observes and discusses the use of patient history and assessment data in the early identification and management of patients at risk for or with sepsis, septic shock and multi-system organ dysfunction (ANALYSIS). 2. Observes and discusses the possible diagnostic orders and therapies including medications for the management of patients with sepsis, septic shock and multi-system organ dysfunction. Uses factor analysis to calculate...
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...Organ Dysfunction Syndrome (MODS) 2. Identify the nursing priorities in the care of the patient with sepsis and septic shock. 3. What class of bacteria is responsible for more than one half of the cases of septic shock? What are some common causes of this? 4. Explain why myocardial depression is almost always present in a patient with septic shock despite an initial rise in cardiac output. 5. Discuss the cascade of host infl ammatory responses that produce the major detrimental effects seen in sepsis due to gram-negative bacteria. 6. What is early goal directed therapy in the management of sepsis? 7. Identify the treatment guidelines currently recommended for the management of sepsis and septic shock. 8. Discuss how the drug dobutamine affects cardiac output. Identify the nursing implications with the administration of this drug. 9. Discuss how norepinephrine works and its indications for use. Identify the nursing implications with the administration of this drug. 10. Discuss how drotrecogin alfa works and its indications for use. Identify the nursing implications with the administration of this drug. 11. Describe the concept of ScvO2 monitoring. Identify the signifi cance of abnormally high and low ScvO2 readings. 12. Describe the nursing responsibilities in assisting with central line insertion. 13. Discuss the importance/rationale for central line placement...
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...According to Urden, Stacy, and Lough (2006), shock is a life-threatening condition that can lead to ineffective tissue perfusion or may further progress to multiple organ dysfunction and death. The different types of shock include hypovolemic shock, cardiogenic shock, anaphylactic shock, neurogenic shock, and septic shock (Urden, Stacy, & Lough, 2006). This essay will analyze septic shock based on the analysis of a presented case study. To further understand this concept, a review of treatment and management of septic shock as used in the writer’s practice setting will be discussed. The writer chooses the “case study one” as an issue of septic shock because Karen’s vital signs, physiological and behavioral symptoms are clear indicators of septic shock. Septic shock is described as the body’s inflammatory response to overwhelming infection (Urden, Stacy & Lough 2006). It is also classified as existence of an infection with hypotension despite fluid replacement along with the presence of tissue perfusion abnormalities (Urden, Stacy & Lough 2006). According to Bench (2004), the diagnostic criteria for septic shock include a heart rate greater than 90 beats per minute, a respiratory rate greater than 20 beats per minutes, an increased white cell count, hypotension, and temperature greater than 38 degrees or less than 36 degrees. Karen met these criteria with an increased temperature of 41 degrees which is usually an indicator of infection, increased heart rate and respiratory...
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...Pulmonary Problems Chapter 10 Pneumonia is inflammation of the lungs resulting in consolidation Obstruction in gas exchange on the alveolar level Aspiration most common cause 2nd most frequent cause is droplet inhalation Least likely cause is blood borne Protein rich fluid move into the alveoli- complicated by production of the organism- result is decreased alveolar surface area-resulting in elevation of pco2 and a decrease in po2 Inspection-tachypnea and central cyanosis Percussion-dullness Palpitation-tactile fremitus Auscultation-crackles, rhonchi, wheezing, or egophony Diagnosis-labs, chest xray Ct not recommended unless anthrax is suspected Bronch-immunocompromised individuals and patients who have not responded to treatment Xrays Focal- bacteria Interstitual-viral Rapid progression/ multifocal- legionella, pneumococci, staphylococci Medialstinal widening without infiltrates- inhalation anthrax Tamiflu within 48 hours to be effective HAP-received care in a health care institution for at least 2 days in the last 90 days prior to infection VAP- pneumonia within 48 hours of intubation HAP more difficult to treat compared to CAP COPD- include emphysema, chronic bronchitis, and small airway disease Emphysema-structural change via destruction and enlargement of alveoli Chronic bronchitis- chronic cough and mucous production Small airway disease-generalized narrowing of bronchioles, may include asthma COPD-4th leading cause of death in United States ...
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...this means there is a blockage which is not allowing the blood to perfuse that part of the organ. Myocardial perfusion imaging: Myocardial perfusion imaging (MPI) is a form of functional cardiac imaging, used for the diagnosis of ischemic heart disease. The underlying principle is that under conditions of stress, diseased myocardium receives less blood flow than normal myocardium. MPI is one of several types of cardiac stress test. A cardiac specific radiopharmaceutical is administered. E.g. 99mTc-tetrofosmin (Myoview, GE healthcare), 99mTc-sestamibi (Cardiolite, Bristol-Myers Squibb now Lantheus Medical Imaging). Following this, the heart rate is raised to induce myocardial stress, either by exercise or pharmacologically with adenosine, dobutamine or dipyridamole (aminophylline can be used to reverse the effects of...
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