...Steven A Flores, MD. August 2, 2013 RE: Mr. Tim Molton Willard R. Beets 7895 West Sherman Street San Diego, California 92111 Dear Dr. Beets I saw Mr. Tim Molton, your patient, in my office yesterday afternoon. As you will recall, Mr. Molton is a 49- year old professional gardener who came to see you with a chronic cough and a history of expectoration of witish material . 1 He brought the x-rays from your office with him, and I noted a fossa on the superficial surface of his lung. He was afebrile today and stated that he had been so since the onset of his symptoms. He did not complain of pain but did experience some dyspnea on exertion and shortness of breath.2 I did not carry out a physical examination, but I did skin test him for both tuberculosis and coccidioidomycosis. I did not give him a prescription for any medication and will wait until we get the results of his skin test. 3 It seems to me that your diagnosis of his problem is correct, so we will proceed with that in mind. As you probally know, valley fever is endemic to San Diego; and since Mr. Molton was born and raised in New York State, he could be very susceptible. 4 You may tell his employer that if he does have valley fever, he will have convalesce for a month to six weeks, after which time he should be fully able to return to his normal duties.I will keep you posted on the results of his test. 5 Thank you very much for letting me help you with Mr. Molton problem. 6 Sincerely Steven A. Flores...
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...Case Study Pleural effusion NSG/340 Sandra Gilderson, MSN/Ed, RN Case Study Diagnosis and admission A.B. admitting diagnosis pleural effusion, pulmonary infiltrates possible pneumonia based on the result of chest x-ray. Also the presenting signs and symptom provided information that can link to pleural effusion evidenced of his signs and symptoms Pleural effusion Is an abnormal collection of fluid in the pleural space, it is not a disease but an indication of a disease (Lavie et al, 2014). Difference between transudate and exudate “A transudate effusion occurs primarily in noninflammatory conditions and is an accumulation of protein-poor, cell-poor fluid” (Lavie et al, 2014, p. 549). The fluid is leaking into the pleural space, the hydrostatic pressure is increased in the blood vessels, and the protein is low. “An exudate effusion results from increased capillary permeability characteristic of inflammatory reaction. It is most commonly associated with infections and malignancies” (Lavie et al., 2014, p. 549). The blood vessel is blocked or the inflammation result from fluid escaping into the tissues and cavities. Three common causes of pleural effusion “Pleural effusions can arise from a variety of disease states or medications including heart failure, bacterial pneumonia, and pulmonary embolism” (Saguil et al., 2014 p. 2). The reduction in lung volume, depression of the diaphragm and reduced chest wall compliance cause dyspnea, and occasionally pain or cough (Myatt...
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...ABTRACT Pulmonary embolism (PE) caused by blockage of one of the arteries of lungs. Usually caused by deep vein thrombosis (DVT) from upper or lower extremities. The classical clinical presentation of PE is sudden onset of pleuritic chest pain, hypoxemia, and shortness of breath. Most often patient does not display any classic symptoms. PE is one of the major concerns of short-term mortality and long-term morbidity after aesthetic surgery. The present case report describes a 42-year-old female who survived after an episode of bilateral PE after undergoing an elective abdominoplasty. A literature review was conducted to explore the prevalence, pathophysiological presentation and use of prophylactic practice among plastic surgery patient to prevent thromboembolic events. INTRODUCTION Venous thromboembolism is major health concern after any surgical procedure. Unlike general surgical sector, plastic surgery practice underestimates the risk of venous thromboembolism and PE. According to American Society of Plastic Surgeons, abdominoplasty is the fifth most commonly performed plastic surgery procedure in the United States (US).1 Compared to 2014, an estimated nine percent increase in the number of abdominoplasty procedures carried out in the US during to 2015.2 According to Murphy and colleagues3 more than 900,000 people develop DVT in U.S. each year, 500,000 of them experience PE and resulting in nearly 300,000 deaths. Even though all plastic surgery poses a risk for thromboembolic...
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...in a rally car accident and has sustained injuries (School of Nursing & Midwifery 2014). This paper scopes the pathophysiology of the lungs as well as a pneumothorax and how this injury can affect the normal functions of the cardiac and respiratory systems. It also looks into how kinetic energy from a car accident aided these injuries. Secondly, the paper looked into the use of an under water sealed drain (UWSD) and how it can prevent the development of a tension pneumothorax. Furthermore, it also discusses two medications Leigh has been prescribed and are linked to his injuries with a rationale and pharmacology explained. Lastly, the paper will explore one sign and symptom and why they manifest in conjunction with his pneumothorax. The human lungs are two paired...
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...Diagnostic Procedure Thoracentesis Ariah Dunbar Diagnostic Procedure Thoracentesis Before the procedure it is important for the nurse to prepare the patient for the procedure to ensure cooperation and prevent complications (Ignatavicius & Workman, 2010). If the patient is taking any medicines that thin the blood or prevent clots the physician should be talked to about stopping, changing, or adjusting the dose of those medications before the procedure. The nurse must gather base line vital signs. The nurse should also tell the patient they may experience a sting sensation when the local anesthetic is given and pressure when the needle is inserted. Instruct the patient not to move suddenly and to avoid deep breathing or coughing during the procedure. After making sure the consent for the procedure is signed and the patient has been asked about allergies to medications and local anesthetic agents the nurse may administer any ordered analgesics. During the procedure if the nurse should make sure the patient is physically supported and stand in front of them to keep them from falling. Since this is a sterile procedure the nurse must make sure surgical asepsis is maintained (Taylor, Lillis, LeMone, & Lynn, 2011). They will also monitor pulse and respiratory rate and observe for diaphoresis, cyanosis nausea, shock, pain, pallor, and any other adverse reactions and immediately report them to the physician. Fainting, nausea and vomiting may occur in patients who are receiving...
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...------------------------------------------------- MARFAN SYNDROME ------------------------------------------------- BY MELISSA STEVENS May 22, 2014 southeastern college Abstract Marfan syndrome is a genetic disorder that affects the body’s connective tissue. Connective tissue holds all the body’s cells, organs and tissue together. It also plays an important role in helping the body grow and develop properly. About 1 in 5,000 people have Marfan syndrome, including men and women of all races and ethnic groups. There is no cure for Marfan syndrome. To develop one, scientists may have to identify and change the specific gene responsible for the disorder before birth and medical research has not yet evolved to the point of cure. People with Marfan tend to be unusually tall, with long limbs and long, thin fingers. Marfan syndrome has various expressions ranging from mild to severe: the most serious complications are defects of the heart valves and aorta. Additionally, it may affect the lungs, eyes, dural sac surrounding the spinal cord, the skeleton, and the hard palate. This makes it very important for people with Marfan syndrome and related disorders to receive accurate, early diagnosis and treatment. Without it, they can be at risk for potentially life-threatening complications. The earlier some treatments are started, the better the outcomes are likely to be. The appropriate specialists will develop an individualized treatment program; the approach the doctor’s use depends...
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...striking abnormality of the eyes. The weakening of ciliary zonules causes partial lens dislocation. In other words, the stretching of abnormal elastic fibers moves the lens of the eyeball out of its proper position behind the iris, often causing moderate visual issues like nearsightedness and blurred vision. Technically, the lens can slip far enough off course to cause glaucoma, but, thankfully, this isn’t too common. Another generally non-lethal side effect of Marfan Syndrome is an intimidating-sounding condition known as spontaneous pneumothorax (8). Commonly known as “collapsed lung,” pneumothorax involves the collection of air in the pleural space between the lung and chest wall that detaches the two and releases the pressure difference between the inter-organ space and the lung that is so vital to breathing. There is sparse research on this particular aspect of Marfan Syndrome, but it is reasonable to postulate that, in this case, pneumothorax occurs because of weak connective tissue between the lung and the chest wall. Finally, the afflicted also have to contend with dural ectasia, or the destruction of connective tissue within the dural sac which protects the spinal cord. It affects a...
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...intubation, ventilation, and chest tube insertion. The diagnosis of blunt injuries may present as more challenging and time consuming endeavor, requiring additional investigations such as computed tomography (CT) scanning (Trauma, 2004). Blunt trauma needs the additional time for diagnosis because the extent of damage to the thoracic organs cannot be determined at first glance when it is presented as bruising or superficial injuries. The diagnosing procedure has to be thorough and confirm whether it is only blunt trauma or if there is an underlying penetration trauma that is not visible externally. A patient can destabilize and inevitably expire if they are not treated as soon as possible when certain findings are present. Like a tension pneumothorax, immediate care is preferred over a complete diagnosis once the key signs are recognized. If the results of the computed tomography scan present a more severe situation, like blunt damage to the diaphragm without external bleeding, there is a possibility that the damage is due to internal structures penetrating the organs; elevating the severity to the levels of a penetrating injury; immediate surgery is then mandatory. Blunt trauma initially has least invasive technique for management; in the sense that surgery is more invasive than intubation, because it is not always necessary to open the thoracic cavity when there is nothing that surgery can do to for the current situation. That can promote for a higher risk of infection with no benefits...
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...Care Plan: Sample Care Plan: Heart failure |Nr. | Diagnosis |Date | Intervention |Sign | | |Decreased cardiac output | |Cardiac Care (4040) | | | | | |• Evaluate chest pain (e.g., intensity, location, radiation, duration, and | | | |Related factors: | |precipitating) | | | |Altered Stroke Volume | |• Document cardiac dysrhythmias | | | |Altered contractility | | | | | |Altered heart rate/rhythm | |Fluid Monitoring (4130) | | | |Symptoms: | |• Obs fluid balance __________________ 24 hour | | | |Chest pain | | ...
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...having an episode of spontaneous pneumothorax. Spontaneous pneumothorax could affect a respiratory illness in a patient that is suffering from bronchitis or asthma. This condition usually targets athletic young males who often have good health. Basically, spontaneous pneumothorax is a small tear that causes air to leak out of the lung. Usually if the tear is small the patients lung will collapse a little, however, if it is a significant tear then the entire lung may collapse. For a small tear there is really no treatment involved because the tear should heal over a couple of days. The doctor may prescribe medicine for pain and order an x-ray in a week or two to see if tear has closed. However, a significant tear could cause air to be trapped inside the chest wall. Unfortunately, this air would have to be removed using large syringe, three-way stopcock, and a thin tube that is inserted through the chest wall. The syringe sucks out some air through the tube and the three-way stopcock is turned closing off the tube. The air inside the syringe is then released outside of the body. The doctor may have to perform this a few times to get rid of all the air. Sometimes a larger tube is inserted through the chest wall and is left place for a few days to allow the torn lung tissue to heal. Thankfully, this scary acute lung condition can be quickly treated using these techniques and providing effective results Reference: Kenny, D. T., & Tidy, D. C. Pneumothorax. www.patient.co.uk. Retrieved...
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...lung. 2)What can be a major cause of an airway emergency? Tongue 3)How should an unresponsive casualty be positioned? Back 4)What technique should be used to open the airway of a casualty with a suspected neck injury? Jaw thrust 5)What type of lubricant do you want to use for the NPA? Water based 6)If the casualty has a broken jaw, mouth wound or his jaw is slightly closed by spasms, use the_mouth_____to__nose____method. 7.How many lobes are in the right lung? 3 8.A moist sucking or bubbling sound as air moves in and out of a hole in the chest is a sign/symptom of? Sucking chest wound 9.Which is the appropriate treatment for a sucking chest wound? Occlusive dressing 10.Which is the treatment for a tension pneumothorax? Perform needle thoracentesis 11.Which type of hemorrhage is characterized by a steady, even flow, and the blood will be dark red in color? Venous 12.The small battle dressing holds__300_____ml of blood. 13.What is the purpose of a tourniquet? Controls life-threatening extremity hemorrhage 14.What is used to treat a non-life threatening extremity hemorrhage when a pressure dressing is not effective? Quickclot 15.Which organ is the pump of the cardiovascular system? Heart 16.In which class of shock is a patient with a systolic pressure of 80/P? II 17.What is the most important step in treating shock? Treat Life threatening hemorrhage 18.What is the recommended size of a catheter used on a trauma patient? 18 ...
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...Define the following terms in the proper context for the chart of Jane Dare. Jane Dare Health Record Term | Definition | 1. CONGESTIVE HEART FAILURE | Congestive heart failure is when you heart muscles doesn’t pump blood as well as it should. | 2. LEFT PLEURAL EFFUSION | Left Pleural Effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. | 3. NONCONTRIBUTORY | Noncontributory is a form of insurance wherein the employer pays the full premium and the employee is not required to contribute at all. | 4. FUNDOSCOPIC | Fundoscopic is the act of examining the fundus of the eye, as with an ophthalmoscope or with a biomicroscope and slit-lamp. | 5. SUPPLE | Supple is when you can Move and bend with ease. | 6. CRACKLES | A crackle is a small, sharp sound heard on auscultation. It is caused by dry, bristly hair and insufficient pressure on the stethoscopehead. | 7. BENIGN | Benign refers to a condition, tumor, or growth that is not cancerous. | 8. VOIDED | Voiding is another word for emptying the bladder or urinating. | 9. SELF-CARES | Self-cares are care performed for oneself. For example, after the nurse shows a patient how to put on ted stockings and the patient do it for themselves. | 10.COGNITIVE | Cognitive is a generic term embracing the mental activities associated with thinking, learning, and memory. | 11.CARDIOMYOPATHY | Cardiomyopathy is a chronic disease of the heart muscle (myocardium), in which the muscle is abnormally enlarged...
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...The signs of shock are caused due to the circulation being compromised. The patient is being deprived of Oxygen and must be treated immediately. The patient may have a very rapid but weakened pulse; the pulse can be felt by palpating the femoral artery. Their breathing will likely be rapid as the body attempts to compensate for the decreased circulation which lowers the amount of hemoglobin being sent to the lungs. They may become very nervous, especially in their attempts to breathe. Many patients will have pale mucous membranes and their extremities may feel cool to the touch due to poor circulation or poor perfusion. Some patients in shock may have dilated pupils and be staring straight ahead. It is also possible for a patient in shock to vomit and experience seizure activity. The signs of respiratory distress may include changes in the effort, rate or rhythm in breathing. Clinical signs of respiratory distress include: difficulty or not wanting to exercise, wheezing or rattling when breathing, the patient may be open-mouth breathing, the breathing may be shallow or rapid, they may be panting and extending their neck out to breathe. Their tongue or gums may be bluish in color due to a lack of oxygen. Signs of poisoning can be numerous dependent on the poison exposed to and what system it affects. Many poisons will cause lethargy and a depressed state. A loss of appetite may be noted as well as emesis (vomiting) or a pu/pd (urinating/drinking more than usual)...
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...Teaching Plan When a patient has surgery it is important for them to keep their lungs healthy and to take slow deep breaths. After surgery it can hurt too much or they may feel too weak to take the deep breaths, which can cause lung illnesses. A device that can be used is an incentive spirometer. Its important for someone to learn who to use the incentive spirometer as they will not benefit from using it if not used correctly. A nursing diagnosis for a patient after surgery is ineffective breathing pattern related to surgery as evidenced by patient being short of breath. A short-term goal for this is the patient will use the incentive spirometer for 5 sets 10 times a day. To teach the patient how to use the incentive spirometer I would take the time and sit with them and explain how to use it and also demonstrate how to use it. Then I would have the patient show it back to me and I would give them feedback. Also when I go in the room again I would ask them to show me how it’s done to make sure they are doing it correctly. The step-by-step outline that will be used to teach the patient includes: 1. I would have the patient to sit in semi-fowler position if they can as this will increase lung expansion. 2. Since they are post op I would place a pillow or folded blanket over chest or abdominal incision for splinting. 3. Show the patient how to steady device with one hand and hold mouthpiece with the other. 4. Instruct the patient to exhale normally and then place lips securely...
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...Chapter 2 Restrictive Resp. Disorders * Resulting from basically a collapsed lung - Alterations in lung parenchyma, pleura, chest wall, or neuromuscular function * Decrease in vital capacity (VC), lung capacity (TLC), functional residual capacity (FRC), residual volume (RV) * The greater the decrease in lung volume, greater the severity of disease Fibrotic Interstitial Lung Disease * Immune reaction * Begins with injury to alveolar epithelial or capillary endothelial cells * Interstitial and alveolar wall thickening * Increased collagen bundles in interstitium * lung tissue becomes infiltrated * Persistent alveolitis leads to obliteration of alveolar capillaries, reorganization of lung parenchyma, irreversible fibrosis * Lead to large air-filled sacs (cysts) with dilated terminal and respiratory bronchioles * Occurs early, reversible * Triggering event leads to inflammatory response and increased inflammatory cells * Injury leads to increased membrane permeability and movement of fluid/debris into alveoli * Fibroblastic proliferation and deposition of large amount of collagen * Caused by increased mesenchymal cells and fibroblasts in interstitium * Alveolar walls become thickened with increased amounts of fibrous tissue * Progressive dyspnea with exercise with desaturation * Rapid-shallow breathing * Irritating, nonproductive cough * Clubbing of nail beds (40%-80%) * Bibasilar end-expiratory...
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