...heart rate of 104, with an irregular gallop, crackles in left lower lobe, right side is dull, red sacral area, 3+ pitting edema to knees, and shortness of breath, difficulty sleeping. Lab/X-ray findings: Chest x-ray: left pleural effusion, CHF, Pneumonia. Course of Treatment: Course of treatment includes admission into the hospital, with the administration of diuretics and IV antibiotics; will also collect blood cultures and sputum if possible. Treatment will also include O2 and bedrest. Medications administered during treatment 25 mg Capoten po tid, 40 mg Furosemide po qd, 10 mg Nortriptyline HCL po qd, and 0.125 mg Digoxin po qod. The patient was also put on low sodium, low cholesterol, and lactose free diet. Condition on Discharge: Patient was discharged to a long term care facility closer to her family. Her strength and endurance improved during her treatment at the facility. Also new x-rays show a slight improvement in the left lower lung field infiltrate. Patient was still having problems with shortness breath at discharge, resulting in a dependency upon a wheelchair. Congestive heart failure (CHF) is most common among elderly patients, the heart is the most important muscle in the body, and without it doing...
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...1. What is an obstructive lung disorder? COPD- preventable and treatable disease state characterized by chronic airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. 2. What should the nurse consider when giving oxygen to the patient with an obstructive lung disorder and why? -02 has an irritating effect in mucous membranes and dries secretions, therefore it is important that a high liter of flow of 02 delivering 35-50% be humidified when administered. - Periodic reevaluations are necessary for the patient who using chronic supplemental O2 -Most patients with COPD can tolerate 2 L/min via cannula -Access patients nares and ears for skin breakdown and may need to pad cannula where its sits on the ears -Watch for complications -Periodically check o2 delivery device to ensure that the prescribed concentration is being delivered -Monitor the effectives of 02 therapy( pulse ox, ABG’s) to evaluate patient response to therapy -Observe for signs of o2-induced hypoventilation because this occurs with carbon dioxide nacrosis -Position to minimize respirator efforts ( HOB elevate and provide overbed table for patient to lean on) -The person with COPD who retains CO2 should be treated with low rates of 02 with careful monitoring of ABG’s to avoid hypercarbia. 3. What are nursing management issues...
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...When first thinking about changing the packaging of Tic-Tac breath mints one must ask why? The Tic-Tac package is an icon, recognizable by pretty much everyone across not only the United States but North America, South America, and Europe. Think of the classic Seinfeld episode where Elaine gives her co-worker a package of Tic-Tacs so she can hear when he is sneaking up on her. As a brand you know that you have a top position when one of the most successful television shows of all-time bases an entire episode around your product and packaging. With such strong brand recognition and being so well known across the globe it might seem foolish to change the packaging for Tic-Tac Chill mints. However, it is necessary that certain changes be made to the new package design in order to successfully compete and keep up with today’s breath mint market. Since 1969, when Tic-Tac first came out, the breath mint market has changed drastically. Mints are now typically larger and have much stronger flavors than breath mints from twenty and thirty years ago. Packaging now is also much more flashy and eye-catching than the classic Tic-Tac packaging that has been used since first being started. Since the Chill mints are going to be a more modern breath mint with a larger size than the original Tic-Tac and have a more intense flavor they are going to be competing against breath mints like Ice Breakers and Altoids who both have very distinct and noticeable packaging. To keep up with this...
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...A toddler with Down syndrome Jeffrey was 14 months when I met him. He was born with Down syndrome and a congenital heart defect and had an open heart surgery when he was 6 months old. Jeffrey often got ear infections and had recently had a set of pressure equalizing (pe) ear tubes placed. Jeffrey was not walking and was not yet crawling. Children with Down syndrome do learn to crawl and walk and talk; it takes longer. Recent research and clinical experience suggests that, with regard to talking, these children benefit from early oral stimulation, oral motor awareness and multiple experiences with oral sensory stimulation. As soon as I met Jeffery, we began working on ` mouth wakeup` activities , stimulating his teeth, lips, gums , hard and soft palate, inside cheeks, and outside jaw muscles with a variety of toys and tools, including vibrators. We taught his parents to do the same at home. Another part of getting ready to talk is stimulating receptive language (language comprehension). In speech therapy visits we begin using short descriptive sentences to describe toys Jeffrey picked up (he was in a high chair initially). We dropped direct questions during these periods of indirect language stimulation and encouraged the parents to do the same. After two to three weeks, Jeffrey’s mother became adept at these techniques and began describing his activities as he did them so that he could hear them and associate the object he had with the words he heard. Her continuing work in this...
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...Nursing Care Plan The patient is , a 72 year old man who has been admitted for dyspnea or shortness of breath. reported that he has been coughing for the past week and his coughing has accompanied sputum discharge. His past medical history includes emphysema and chronic bronchitis. He used to smoke but has stopped since a year ago for economical reasons as well as it is also bad for his asthma. His bowel movements have also been irregular since his admission. He also reported that he is feeling depressed and fearful about the future. Further examination revealed that he has crackles in his left lower lobe with diffuse expiratory wheezing throughout his chest. Chest percussion also revealed his left lower lobe to be dull. Needs / Problems Goals Interventions Evaluation Dyspnea or shortness of breath Use the visual analog scale (VAS) to make an objective assessment of dyspnea. The VAS is a 100-mm vertical line with end points of 0 and 10. zero is equated with no dyspnea and 10 is equated with the worst brethlessness the client has experienced ( & , 2004) Dyspnea is difficult to quantify and to treat (Potter & Perry, 2004). Interventions need to be individualized for each patient, and more than one therapy is usually implemented. The underlying process that causes or worsens dyspnea must be treated and stabilized initially. Three additional therapies have to be implemented: pharmacological measures, physical techniques,...
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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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...and Plan Health Assessment Lab General Patient Information Client: 81-year-old Caucasian/Italian female Source: Client, seems reliable Marital status: Widower Religion: Catholic Occupation: House wife Formal education: High school Primary language: English, written and spoken Secondary: None Reason for Seeking Care: Shortness of breath and productive cough. History of Present Illness: Recurrent episodes of shortness of breathe and productive cough since 2008. First episode occurred when she was in her early 80’s. She was awakened in the middle of the night with a very painful right-sided chest pain and cough. There was no warning of a problem. She reports the pain was “tight and pounding”. The pain was a 10 on a numeric scale 0-10 lasting about 25 minutes. Patient states her cough worsens when walking long distances, especially without using her walker and her breathing becomes labored. She states her cough usually lasts about three days but has noticed it becoming more persistent and feels the need to cough up phlegm. She saw a physician for that episode. Diagnostic test confirmed a diagnosis of Chronic Obstructive Pulmonary Disease when she had her first episode of these symptoms. Her lung sounds presented with some wheezing on the upper lungs bilaterally, she had rapid shallow breathing with a respiration of 24. Upon walking long distances she becomes emotionally anxious; rest does not relieve the client’s pain immediately. She was treated...
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... MOHAVE COMMUNITY COLLEGE NURSING DEPARTMENT NURSING CARE PLAN NUR 122 ASSESSMENT A. ADMISSION DATA Date of admission 10/07/11 Client initials CW Medical diagnosis COPD/Leukocytosis Age 65 Sex Female Marital Status Divorced Ethnicity Caucasian Religion Catholic Vital signs upon admission: B/P 107/61 P 98 R 20 T 97.6 Ht 5’4 Wt 99.9lbs Allergies C.W. is allergic to ASA, it causes her to have an upset stomach. B. HEALTH-ILLNESS TRANSITION History of present illness C.W. is a 65 year old female with a history of COPD. She has been admitted to the hospital on several different occasions for a COPD exacerbation. C.W. was admitted through the ER on October 7, 2011 for an increased cough, shortness of breath, which got progressively worse with chest tightness. C.W.’s most recent hospitalization was on September 13, 2011 for a pneumothorax. She was also admitted sometime in August for a COPD exacerbation. Significant client health history (include family history) C.W. is a 65 year old female who lives with her ex-husband. She has a history of leukocytosis, anemia, hyponatremia, COPD, valley fever, chronic pain syndrome, back pain, osteoporosis, small-bowel obstruction, peripheral neuropathy, constipation, and pneumothorax. C.W. also admits to being a current smoker. She smokes approximately 1½ packs per day. C.W. has a family history of hypertension, diabetes, and peripheral neuropathy. C.W. stated that she recently lost her sister who...
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...them, and the options for treatment. (Transition: Let's start with the nature of panic attacks.) Body I. Panic attacks are a severe medical condition with a number of physical and mental symptoms. A. As defined by the National Institute of Mental Health, panic attacks involve “unexpected And repeated episodes of intense fear accompanied by physical symptoms." 1. The attacks usually come out of nowhere and strike when least expected. 2. Their length can vary from a few minutes to several hours. B. There are a number of symptoms common to most panic attacks. 1. Physical symptoms include a pounding heart, shortness of breath, bbbbbbbbbbbbbblightheadedness, and numbness or tingling sensations in the arms and legs. 2. Mental symptoms include acute fear, a sense of disaster or helplessness, and a hhhhhhhhhhhhhhfeeling of being detached from one's own body. (Transition: Now that you know something about the nature of panic attacks, let's look at how widespread they are.) II. Panic attacks affect millions of people. A. According to the American Psychiatric Association, six million Americans suffer from hhhhhhhhpanic attacks. B. Some groups have a higher...
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...Comprehensive Health Assessment LETTICA JOHNSON September 17, 2013 9/17/2013 15:30 PM S:Mrs. Easter is a pleasant, but very anxious, 32 year old married mother of 2 residing in Houston, TX and is an Executive Administrative Assistant and business owner. Referral: None Reliability: Self-referred; seems reliable. Chief Complaint:Patient complained of “shaky hands” Present Illness: For the past year Mrs. Easter has had a problem with unsteady hands and palpitations in her heart. She was seen in the emergency room one month ago due to what she felt was a possible heart attack at the time. The emergency room physician diagnosed a panic attack and possible Generalized Anxiety Disorder. She has also had recent episodes of blurred vision along with sharp headaches in the back of her head. The pain is usually moderate and lasts about 20-30 seconds. The patient reports being diagnosed with pre-hypertension at the age of 25 and was prescribed Metoprolol, which the patients has refused to take. The blood pressure recorded at that time was 142/89. Medications:Patient is prescribed Metoprolol 50mg, denies taking as perscribed Allergies: Patient reports Doxycycline and Celcor severe allergy causes rash, swelling, vomiting, and bleeding Tobacco:Denies tobacco usage. Alcohol:Patient reports wine on rare occasions. Past History: Childhood Illnesses. Patient reports history of Bilateral Glue Ear, Chicken Pox, and Asthma. Denies history Scarlet Fever or Rheumatic Fever...
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...was about to faint. I was crying calling out to my son to answer me. The paramedics were tring to claim ne down. I was unable to make out my words. I was trying to stop and think. They calm me down knowing he was alright and well. Throughout the night I felt my symptoms trying to come back. My fingers were numb with a tingling sensation. I had trouble sleeping that night. I found myself waking up in a panic to check to see if he was alright. Anxiety could generally be a onetime result but often it is seen the effects are ongoing process. As an individual who suffer from panic attacks regularly it affect my everyday living a healthy life. People often ask “what are anxiety attacks”. It is a frightening state, having shortness of breath, dizziness, hot flashes, and tingling sensation of the fingers and toes. Rapid heart beating and sweatiness. Nervousness worrying tension with emotional stress. There was a point in my life I felt like this disorder was taking over my everyday life. I suffered with having the attacks while driving, out in public and in my...
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...a half day’s work as a carpenter. Dyspnea is said to occur only after long hours of work and persist for 2 hours. Paroxysmal nocturnal dyspnea sometimes occured. He had been unable to lay flat in bed at night; 3-pillow orthopnea. No wheezing but with nonproductive cough, no fever, no chest pain, no swelling of the feet or ankle. 4 mos, PTA, patient was brought to NOPH for the first time due to moderate to severe dyspnea which manifested after a very tiring work. He was found out to have cardiomegaly. He was prescribed with Losartan and Lanoxin as maintenance medication. Good compliance to medication; patient is responsive and has become asymptomatic. 1 month PTA, patient skipped maintenance meds. Patient noted onset of shortness of breath while unloading wooden slabs. 1 day PTA, patient presents with dyspnea after carpenting for 5 straight hours; described as intolerable and unrelieved by all other known measures. PAST HISTORY Childhood Illness. Chickenpox Adult Illness. Flu, Common Colds Allergies. Bulad, fish (paksiw) Hospitalization. 4 months ago (NOPH) – due to dyspnea Surgical. Transurethral Resection of the Prostate (TURP) – in his 50’s (Mr. P.D forgot the exact date or year) Medical. , +hypertension, BP ranges (160/120 -120/80) Current Medications: Lanoxin, Losartan, Aspirin FAMILY HISTORY Mr. P.D’s parents both had...
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...A Complete Patient Assessment Susan Eisen RN Ramapo College of New Jersey A 63 y/o African American female presents to the emergency room complaining of shortness of breath worsening over the past week. Patient states she becomes severely short of breath while preforming everyday activities and has noticed that her legs have been “getting bigger”. Patient had been sleeping with 3-4 pillows a night for comfort and occasionally sleeping in a recliner. Patient states this evening she got up to use the restroom and had a sudden onset of severe shortness of breath. Felt as though she wasn’t moving any air. Patient called 911. The paramedics on scene established IV access and medicated patient with 40 of furosemide and Nitroglycerin sublingual 0.4 mg times 3 doses. Patient was placed on CPAP and brought to the ER. Upon arrival CPAP was continued, a nitroglycerin infusion was started at 20mcg/min. Additional IV access was established and labs were obtained. Stat EKG and Chest Xray were completed. Additional dose of furosemide 80mg was administered IV push and patient was provided with an indwelling foley catheter which is draining clear yellow urine. Past Medical History is significant for Hypertension, Diabetes, Congestive Heart failure, and Atrial Fibrillation with two unsuccessful cardioversions. Medications: Patient currently taking Furosemide, Lisinopril, Digoxin, ...
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...M. H. is a 74-year-old Caucasian female who lives with her husband and two grandchildren in one story modest home in a rural area in northern Texas. A safety assessment was performed on a Friday afternoon on July 26, 2013. Marian was willing to participate in the safety assessment and these finding are the result of the safety assessment. M. H. uses a walker due to Rheumatoid arthritis and shortness of breath from COPD. She uses oxygen continuously and has enough tubing to allow her to ambulate to the restroom and kitchen without moving the concentrator. When entering her home there is a ramp, which is clutter free, and in need of repair due to soft areas in the wood, with a secure handrail on the left only. Marian H. flooring has areas of ripped vinyl around the kitchen table and the carpet in the living area and bedrooms have areas that are torn. No throw rugs are noted in the house. There are secure locks on the front and back door to keep intruders out. Her husband checks the locks each night before they go to bed. The windows are obscured by furniture in the living area of the home but are easily assessable in the other rooms with locks on the inside to keep intruders out. Marian H. reports she is aware of the trip hazards such as oxygen tubing and torn carpet and vinyl but she is careful using her walker when ambulating in the home and has never fallen inside or outside the home. M. H. does not have a landline phone at this time but has...
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...failure? * The type of the heart failure that associated with dyspnea or difficult of breathing is the left-sided. The clinical findings that are more likely to be present in left-sided heart failure are pulmonary congestion, respiratory crackle (rale ), hypoxemia, high left atrial pressure, and acute cardiogenic pulmonary edema. 2. What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output? 3. What is the most likely cause of AO’s pedal edema? The most likely cause of AO’S pedal edema is heart failure specially the right side heart failure due left side heart failure which leads to much pressure to right side of heart. 4. What is the cause of AO’s exertional chest pain? What laboratory tests would be useful to confirm this diagnosis? 5. What is the rationale for the use of each of AO’s medications in managing her heart disease? h TV is hospitalized with deep vein thrombosis (DVT) in her left leg as a complication of abdominal surgery. She is being treated with bedrest and anticoagulant therapy. On the third postoperative day, she suddenly experiences severe dyspnea and is...
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