...created to improve the mortality rate of patients who had colonic adenocarcinomas but is now indicated for | |several pathologies including complicated and severe diverticulitis, rectosigmoid cancer, and in cases where a colon resection is needed but a primary anastomosis cannot be safely done. There are few | |contraindications to the procedure and is often the procedure of choice when other complicated procedures cannot be performed. Patients with hypotension, renal failure, diabetes, malnutrition, immune | |compromise, and ascites can have unfavorable performance to the procedure. | |The important labs for this patient are the CBC(WBC,H&H, and diff), CMP, ABG if intubated still, lactic acid if still septic/possibly septic, if still on TPN (glucose, calcium, magnesium, phosphate, | |LFT’s, albumin)...
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...exam and pap smear History of Present Illness: Last pap was 10 years ago and was abnormal. Patient has been having heavy but regular periods for the past year. Bleeding seems to be worsening monthly. Patient reports y days of bleeding with the first 2-3 so heavy that she is soaking through a super plus tampon and pad hourly day and night. She is fatigued all of the time but has increased fatigue the week of her cycle. She has large clots and very heavy cramping and back pain associated with cycles. She denies having a history of anemia aside from during pregnancy. She does feel occasionally dizzy or lightheaded with position changes the week of her cycle. Past Medical History Childhood illnesses: denies measles, mumps, rubella, varicella, rheumatic fever, and pertussis Major illnesses: none Hospitalizations and surgeries: History of Catheter Ablation Atrial Supraventricular Tachycardia 2012. Significant injuries: denies Health Maintenance General health screening: a. Frequency of dental exams/treatment: biannual exam & cleaning; most recent: 5/2015 b. Last eye exam: 4/2015 c. Colonoscopy and rectal exam: not performed d. Lab work: denies any lab work for the past 10 years e. Immunizations: Reports TDaP in 8/2013; received all routine childhood Immunizations. Substance use a. ETOH: denies b. Tobacco: denies c. Street drugs: denies Family History Family History of: a. HTN: mother ...
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...pain from any given cause to be worse. For example, a patient with fibromyalgia may find a massage painful instead of pleasant. In addition, back pain that someone without fibromyalgia experiences as moderate may be experienced as severe by someone with fibromyalgia, because the pain is amplified by abnormalities in pain processing by the central nervous system. Syndrome The defining feature of fibromyalgia is chronic widespread pain. This means pain in multiple areas of the body, most commonly in muscles, tendons, and joints. The pain is generally above and below the waist, on the left side of the body and on the right side of the body but can be localized, often in the neck and shoulders or low back, initially. The pain is chronic, which means it is present for more than three months. Patients commonly feel as if they "hurt all over" or as if they have the flu, or are about to develop a cold or the flu. It is common for some days to be worse than others, and many patients report...
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...Effect: Life Threatening: Thyroid storm, cardiac arrest. Common: Anxiety, insomnia, tremors, headache, excitability, tachycardia, palpitations, angina, dysrhythmias, hypertension, nausea, diarrhea, increased or decreased appetite, cramps, menstrual irregularities, weight loss, sweating, heat intolerance, fever, alopecia, decreased bone mineral density. Contraindication: Adrenal insufficiency, recent MI, thyrotoxicosis, hypersensitivity to beef, alcohol intolerance (injonly) Nursing Implications (lab value, V/S, ect.): • Determine if the patient is taking anticoagulants, antidiabetic agents; document on chart, • Take B/P, pulse before each dose; monitor I&O ratio and weight every day in same clothing, using same scale, at same time of day. Nursing diagnoses: • Knowledge, deficient (teaching) • Noncompliance (teaching) Patient Education: • Teaching patient that product is not a cure but controls symptoms and that treatment is long term. • Instruct patient to report excitability, irritability, anxiety, sweating, heat intolerance, chest pain, palpitations, which indicate overdose. Drug Brand Name: Metformin (Rx) Drug Generic Name: Glucophage Classification: Antidiabetic, oral Action: Inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin. Adult Dose: PO 500 mg bid or 80 mg q day initially, then 500 mg weekly or 850 mg q2wk up to 2000 mg/day in divided doses. Side Effect: Life Threatening: Heart failure, lactic...
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...9/20/12 HSC420 Lab Report 1-3 I. Introduction In lab 1, the heart rate and blood pressure were established. The principles that govern each of them are those of the heart. The heart rate (HR) is each full beat, or each pump, the heart does; this is recorded in beats per minute (bpm). The blood pressure (BP) is the amount of resistance the heart works against the arterial walls during each pump. My hypothesis for this lab was that my subject would have the same HR and BP for each of the locations and different methods used. I stated this because, at rest, the heart should be working at the same level no matter the position; although one position might slight lessen the heart’s workload. This is important in terms of my subject’s health and fitness because it means he has a normal, young strong heart. Per minute, it is important for the numbers to be lower because it means his heart is not working too hard but can supply his body with a sufficient amount of blood. In lab 2, the establishment of HR and BP were taken to another level and recorded during different exercises. The principles of this are that my subject’s HR and BP would gradually increase throughout exercise. Physiologically, this is because of the increased demand of oxygen in the working muscles. An increase of HR and BP is the heart’s response to these demands; a faster HR means that the heart is supplying the body with blood at a quicker rate; the higher BP is the high pressure the heart is working against...
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...HEART RHYTHMS * 0.4 sec is the PR wave (it is actually the P-Q wave but called the PR wave) and it should be ≤ 0.20 sec. If it’s ≥ than that it indicates 1° heart block. * NSR: normal sinus rhythm, contraction originates from SA node and beats at 60-100 bpm * Sinus (atrial) Bradycardia: SA node discharges at < 60 bpm. TREATMENT is atropine and pacemaker if they become symptomatic. Usually the contractions are irregular but the same distance apart so they are irregular-regular * Sinus Tachycardia (atrial dysrhythmias): SA node discharges at > 100 bpm. Regular but fast; they won’t have heart block because the SA node is firing too rapidly. TREATMENT is BB or CCB to ↓ HR and BP * PAC (Premature Atrial Contraction): impulse travels across atria via abnormal pathway, creating a disturbed P wave. Contraction originates from ectopic focus in atrium other than the SA node. Caffeine and diet pills predispose people to these but they don’t adversely affect health. TREATMENT is none. * Atrial Flutter: atrial tachycardia resulting in recurring, regular sawtooth flutter waves. The ratio of atrial to ventricle contractions is 3:1. TREATMENT is synchronized cardioversion (like defibrillation but the less Joules, 150-200 vs 300, and you must push the “sync” button to synchronize the energy so as to not direct it onto the T wave and send the patient in V-fib) and ablations. * Valve Replacement: patient must be put on blood thinner afterwards and must be anticoagulated...
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...benzodiazepines. They work by increasing the effect gamma-amino butyric acid (GABA), a chemical found in the brain, has on controlling the way the neurons in the brain react to each other, decreasing the activity, which then helps to decrease the feeling of anxiety (Manning & Rayfield, 2011). Clonazepam (Klonopin) is classified as a benzodiazepine, as well as an anticonvulsant. It works directly on GABA to suppress neurotransmitter activity. Some common side effects that occur when taking this medication are drowsiness, sedation, ataxia (the lack of coordination of the muscles), dry mouth, nausea, diarrhea, and constipation. If a patient were on this medication the nurse caring for them would want to monitor for signs of suicidal thoughts or ideas in depressed individuals. Patients on long-term therapy may experience physical and psychological dependence. Some signs and symptoms of overdose include confusion, irritability, muscle and abdominal cramps, and diminished reflexes (Shannon, Sheilds, & Wilson, 2012). Lorazepam (Ativan) is a drug that is considered the “most potent” of the benzodiazepines that also works directly on GABA’s efficiency as an inhibitory neurotransmitter (Manning & Rayfield, 2011). Some common side effects are drowsiness, sedation, disorientation, confusion, and possible blurred vision. A nurse caring for this patient would want to supervise any ambulation attempts made...
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...Medication Sheet Medication/Dose/RouteClassificationGeneric/Trade Name | Action | ContraindicationAdverse Effects | Nursing Considerations | Acetaminophen/500mg/ By MouthAntipyretic& Analgesic (nonopioid)Acetaminophen/TylenolCarvedilol/6.25mg/By MouthAlpha- and beta-adrenergic blocker & AntihypertensiveCarvedilol/CoregDocusate Sodium/100mg/By MouthLaxative stool softenersDocusate Sodium/ColaceFurosemide/40mg/By MouthLoop diureticsFurosemide/Lasix | Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat.Carvedilol causes vasodilation by blocking the activity of α-blockers, mainly at alpha-1 receptors. It exerts antihypertensive effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM.Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial...
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...Final exam study guide: Cancer: Know the difference between Benign and Malignant tumors. Classification of tumors Benign neoplasm Well differentiated Usually encapsulated Kidneys have their own capsule so is easier to catch Expansive mode of growth Characteristics similar to parent cell Metastasis is absent. Rarely recur Classification of tumors Malignant neoplasm May range from well differentiated to undifferentiated Able to metastasize Infiltrative and expansive growth Frequent recurrence Moderate to marked vascularity Rarely encapsulated Becomes less like parent cell Check Moles and Freckles Shows differentiation Hair growing = blood supply = no differentiation = CANCER * Know the warning signs/clinical manifestations of cancer. * CAUTION: * Change in bowel or bladder habits * A sore that does not heal * Unusual bleeding or discharge from any body orifice * Thickening or a lump in the breast or elsewhere * Indigestion or difficulty in swallowing * Obvious change in a wart or mole * Nagging cough or hoarseness Know the different staging, grading and classifications of cancer. Clinical staging classifications * 0: Cancer in situ * 1: Tumor limited to tissue of origin; localized tumor growth * 2: Limited local spread * 3: Extensive local and regional spread * 4: Metastasis * 0 – enclosed extremely localzed * 1 – only in tissue...
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...Fibromyalgia [pic] Exercise for Special Populations February 17, 2012 Fibromyalgia Syndrome (FMS) is a debilitating neurological disorder characterized by chronic widespread pain and fatigue. It affects approximately 2% of the population, and is more common in women than in men. Central nervous system sensitization affects the entire body, leading to many secondary symptoms. This paper will cover the history, symptoms, and causes of FMS as well as known treatments and exercise prescription for the syndrome. Fibromyalgia has been described as a full-body migraine. Another common explanation is to compare everyday life with FMS as being similar to the aches and pains associated with a severe case of the flu. FMS patients experience intermittent flares, which are episodes of increased symptoms. Flares usually occur in response to physical or emotional stress, a schedule change, an illness or injury, a new job, the birth of a child, etc. While fibromyalgia is not considered a degenerative disorder, its symptoms usually become more severe if the patient also has a degenerative disorder such as arthritis. First, a patient must have experienced continuous pain in all four quadrants of the body for at least three months (Wolfe et al., 1990). Doctors will usually order many tests in order to rule out other conditions that might be confused with fibromyalgia. The key diagnostic tool for FMS is the tender point exam. No more than...
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...Nursing Process Focus: Patients Receiving Phenelzine (Nardil) |Assessment |Potential Nursing Diagnoses | |Prior to administration: |Sorrow, Chronic related to | |Obtain complete medical history including allergies, neurological , |depressive state. | |cardiac, renal, biliary, and mental disorders including blood |Thought Processes, Disturbed related to | |studies: CBC, platelets and liver enzymes,. |effects of drug therapy | |Obtain patient’s drug history to determine possible drug interactions|Adjustment, Impaired related to inadequate | |and allergies |drug effectiveness. | |Obtain 24 hour dietary history to identify |Knowledge, Deficient, related to drug | |tyramine containing foods ingested |action and side effects. | |recently |Suicide, Risk for related to inadequate drug ...
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...Endocarditis * AVR * CABG x1 * Abscess of aortic root * Pacemaker * Hypertension * Complete Heart Block * Mitral Regurgitation * Coronary Artery Disease * Aortic Stenosis * Paroxysmal A-Fib * Metoprolol tartrate (lopressor) * Amlodipine (Norvasc) * Enalapril (Vasotec) * Furosemide (Lasix) * D: Decreased cardiac output related to inflammation of lining of the heart and valves. * I: Monitor for symptoms of heart failure and decreased cardiac output. Listen to heart sounds, lung sounds and note flowing symptoms: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, Cheyne-Stokes respirations, fatigue, weakness, third and fourth heart sounds, and crackles in lungs. * D: Risk for infection due to previous diagnosis of endocarditis and recent surgery. * I: Observe and report signs of infection such as redness, warmth, discharge, and increased body temperature and white blood cells. Pain: * Acetaminophen (Tylenol) 650 mg * Oxycodone-acetaminophen (Percocet) 5-325 mg * D: Acute pain related to inflammation and surgery. * I: Conduct pain assessment using scale of 0-10 and implement pain management interventions. Circulatory: * Heparin (Porcine) 5,000 units * D: At risk for blood clots due to artificial valve, cardiac disorders, and lack of mobility due to activity intolerance related to reduced cardiac reserve. * I: Apply compression stockings and have patient use incentive spirometer...
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...Associate Level Material Medical Report This assignment is for you to create a screening tool for potential hires in your health care facility. As the health care administrator, you would want to ensure that your future employees have a strong understanding of medical reports and medical terminology. You are writing these reports for the applicants to read, interpret, and answer a set of questions you have developed. Refer to the samples of medical records reports on pages (142-144, 196, & 261-263) of the textbook. Each medical record should be completed and contain two questions you would ask of the potential hires. The following suggestions will help you get started: • Sometimes it is easier to start at the end. Think of the diagnosis the patient will receive. If you know what the end diagnosis will be, it makes it easy to know what symptoms, signs, and diagnostic methods would be used to achieve that diagnosis. • For the History of Present Illness, consider what questions the physician might ask the patient about his or her chief complaint and symptoms and then chart that in this section. This section serves as an account of what the patient would report, based on their symptoms. Remember, symptoms are subjective, in that they are conditions experienced by the patient, and are therefore included in the patient history. • For Past Medical History, document anything the patient may indicate in terms of past medical conditions that would be relevant...
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...management/ preparedness needed in order to effectively treat this disease. Botulism is a rare, naturally occurring disease that may be caused by deliberate or accidental exposure to the toxins of Clostridium botulinum. The three types of naturally occurring disease are food-borne, wound and intestinal colonization botulism, dependent on the route of ingress of the toxins. It may also be a result of biological terrorism. It presents with an afebrile, descending, symmetrical, flaccid paralysis of motor and autonomic but not sensory nerves. Respiratory failure can occur rapidly with little prior ventilatory deterioration. Management includes respiratory support, specific antitoxin and if wound related, surgical debridement and antibiotics. I will report different cases of botulism and discuss the presenting features that should alert the emergency physician to the diagnosis and direction of further treatment. ASSESSMENT AND SYNTHESIS OF THE PROBLEM Pathology The rare toxin is a protein produced under anaerobic conditions by the bacterium Clostridium botulinum, and affects a wide range of animals, including mammals, birds and fish. Clostridium botulinum is a large anaerobic Gram-positive bacillus that forms sub-terminal endospores. There are seven serological varieties of the bacterium denoted by the letters A to G. The toxin from all of these acts in the same way and produces similar symptoms: the motor nerve endings are prevented from releasing acetylcholine, causing flaccid paralysis...
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...Lithium: Ther. class. mood stabilizers Indications Manic episodes of manic depressive illness (treatment, maintenance, prophylaxis) Therapeutic Effect(s): Prevents/decreases incidence of acute manic episodes S/E: CNS: SEIZURES, fatigue, headache,impaired memory, CV: ARRHYTHMIAS, ECG changes GI: abdominal pain, anorexia, bloating,diarrhea, nausea, GU: polyuria,Derm: acneiform eruption, folliculitis, Endo: hypothyroidism, Hemat: leukocytosis. MS: muscle weakness Neuro: tremors.S Lithium Toxicity: Assess patient for signs and symptoms oflithium toxicity (vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness, or twitching). If these occur, report before administering next dose.The therapeutic range for lithium has been established at 0.6 - 1.2 mmol/L." Shellys list Block1 lithium: • Tx of Manic (opposite of depression) Depression • Monitor lithium lab level PP 24 • Tx of bipolar disorder involves variety of drugs used to stabilize mood. Lithium, valproate, divalproex, carbmazepine, olanzapine, oxcarbazepin, lamotregine, quetiapine, and risperidone are examples of drugs used. Only lithium is approved by FDA for use in those 12-18 years. Early treatment is key to preventing chronic, serious mental illness. Nurses are instrumental in identifying children with this disorder, providing info to families and monitoring drugs and psychotherapy. Nurses should observe for side effects to specific drug regimen used and assist parents to find...
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