...Postpartum Hemorrhage Learning Objectives: * Performs a basic physical assessment of the postpartum patient (APPLYING) * Identifies the signs and symptoms of postpartum hemorrhage (REMEMBERING) * Determines the most likely cause of hemorrhage (ANALYZING) * Performs appropriate nursing management interventions for the patient experiencing postpartum hemorrhage (APPLYING) * Evaluates effectiveness of interventions and revises plan of care as indicated according to patient’s condition and assessment (EVALUATING) * Prioritizes the implementation and approach to the nursing care of a patient with post partum hemorrhage when working with other health care team members (ANALYZING) Prep Questions 1. What is the normal location of the fundus two hours post-vaginal delivery? * Immediately after delivery, the uterus is about the size of a large grapefruit and can be palpated midway between the symphysis pubis and umbilicus and in the midline of the abdomen. Within 12 hours the fundus rises to about the level of the umbilicus 2. What assessments are vital for the nurse to perform on the postpartum patient? * Vital signs, skin color, location and firmness of fundus, amount and color of lochia, perineum (edema, episiotomy, lacerations, hematoma), presence degree and location of pain, IV infusion assessments, urinary output, status of abdominal incision and dressing, level of feeling and ability to move if regional anesthesia was used 3. What...
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...Review of article: “Statin Use and Risk of Cerebral Aneurysm Rupture: A Hospital-based Case-control Study in Japan,” Y. Yoshimura, Y. Murakami, et al. Design and Data Collection The presented study is a case-control study design, meaning it is based on measuring the associations between statin administration and the likely rupture of a cerebral aneurysm in purposefully selected indicator and control populations. The foundation of the study grew from theoretical components tied to animal models used in the past. The underlying conditions of interest are important but not commonly seen in humans, making it difficult to know the best medical measurements and, if possible, prescriptive interventions for unruptured neurological disorders, which generally now can be dealt with by way of surgical interventions. The written assessment of the study indicated limited evidence of human studies showing the effect of statin drugs in reducing the risk of aneurysmal ruptures. The study model used in this investigation (case-control) is readily suitable to study uncommon diseases with low overall prevalence rates. However, given the impact such a condition could have on a population segment thought to have many years of productivity – and because of promising animal studies – the study was deemed beneficial as an initial step toward learning more about the drug’s beneficial indicators. The primary endpoint of focus was the likelihood of the rupture of an aneurism and the protective effect...
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...Subarachnoid Hemorrhage Abstract Subarachnoid hemorrhages are more common than the public realizes. Asubarachnoid hemorrhageis a hemorrhage into the cerebrospinal fluid-filled space between the arachnoid and pia membranes on the surface of the brain.Trauma is the most common cause of subarachnoid hemorrhage. Some causes are vehicle accidents, aneurisms, sports, and falls. Some signs and symptoms of subarachnoid hemorrhage include headache, stiff neck, nausea, vomiting, slurred speech, impaired consciousness, loss of consciousness, and seizures. There are various ways of diagnosing subarachnoid hemorrhages among these are MRI, LP, and CT scans. Once discovered a subarachnoid hemorrhage needs to be treated right away. The most important part of treatment is time. The patient’s body must be allowed to attempt to heal on its own. If the hemorrhage does not stop on its own within 24 hours, surgery will be required. People who are conscious and demonstrate few neurologic symptoms when they reach medical help have the best outcome. There are many long term conditions that the individual will have to live with upon survival from fatigue to living in a vegetative state. Traumatic brain injury is the leading cause of subarachnoid hemorrhages, so it follows that efforts to prevent head injury would prevent these hemorrhages. A subarachnoid hemorrhage is a hemorrhage into the cerebrospinal fluid-filled space between the arachnoid and pia membranes on the surface of the brain....
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...Presenting Signs and Symptoms DS, a 55-year-old female, arrived by ambulance to the emergency room on Friday afternoon of October 7, 2011. Patient arrived to Sunrise Hospital complaining of a one-day history of headache with severe intensity that started the night before and became increasingly painful, prompting her to call 911. DS was experiencing difficulty breathing at rest, and altered mental status. In the emergency room, CT scan was done and revealed a large amount of subarachnoid hemorrhage (SAH) in the sylvian fissures and blood in the fourth and third ventricles. DS started suffering from rapid deterioration of mental state and emergency room physician elected to intubate. She was immediately evaluated by a neurosurgeon and he successfully placed a right frontal twist drill for external ventricular drain placement due to the subarachnoid hemorrhage. Pulmonologist was also consulted and aided on the ventilated patient after procedure. Her temperature had been as low as 94.8°F, and she was put on a bear hugger. She was given Propofol titrated to sedation and started on antibiotics. DS was transferred to Neuro ICU on mechanical ventilation and, so far, is currently stable. History and Physical DS has past medical history of emphysema, migraine headaches, and osteoporosis. Her past surgical history includes breast augmentation. DS drinks alcohol on occasion, but denies smoking and recreational drug use. Home medications include ProAir HFA Inhalation...
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...June 25, 2012 was the day that changed my life forever. I was awakened around 1:00am by the most horrific noise coming from my husband, Jeff. He was having the most violent seizure I had ever witnessed. I started shaking him and screaming his name in hopes that he would snap out of it, but he remained unresponsive. My hands were shaking so much that I could barely dial 911 for help. It seemed like it took forever for the EMTs to arrive. They immediately began to try and stabilize him but all of their efforts fell short so their focus shifted to getting him to a hospital. It took about forty-five minutes to get him loaded onto a gurney for transport to Trident Regional Medical Center, the closest hospital. Jeff was still seizing when they left in the ambulance. I arrived at the hospital around 2:30am and was informed that the doctor(s) were trying to stabilize Jeff so they could run some tests and scans to try and figure out what was wrong. I decided to call Jeff’s brother, Greg, and let him know what was going on. Greg left work immediately and came to the hospital along with Malinda, their sister. We were summoned to a small, private room where we were greeted not by a doctor, but the hospital chaplain. As he began to talk, my heart sank. Why was he there and not a doctor? He was asking me question after question, but I could not answer him. I finally looked up at him and all I could say was that I wanted to talk to a doctor and that he could leave right then. By this point...
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...Case note on Carmel Collins v Mid-western health Board and O’ Connor This case concerns the death of a man in his early 40’s from a subarachnoid haemorrhage. In the HC the learned trial judge found there to be no action in negligence. The case was appealed to the Supreme Court. The deceased first fell ill on the 20th February 1991 while at work on a building site. He visited the second named defendant in his surgery later that day, after his wife had made an appointment over the phone. She told Dr. O’Connor: “Jim has a very bad headache. He does not usually go to doctors. He must be very bad.” Dr. O’Connor diagnosed the deceased with an upper respiratory tract infection or, in other words, a head cold. On Saturday the 23rd Feb the pf rang Dr. O’Connor to confirm his diagnosis. She told him that she was concerned about her husband who would usually never stay in bed. She asked him to prescribe something for her husband. Dr. O’Connor said the viral flu would just have to take its course. On the 25th February the pf rang the def at 8 am saying ‘Jim is very bad’. The def came around almost immediately and took the view that his headaches were due to sinus congestion. On 5th March, during a conversation regarding another matter, the def was informed the deceased was no better. On 17th March the deceased, still no better, went to see Dr. O’Brien because Dr. O’Connor was not working. Dr O’Brien immediately made an arrangement with the hospital to admit the deceased for a CT scan...
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...Abstract— Brain hemorrhage is a type of stroke, which occurs due to artery bursting in the brain, causing bleeding in the surrounded tissues. Diagnosing brain hemorrhage, which is mainly through the examination of a CT scan enables the accurate prediction of disease and the extraction of reliable and robust measurement for patients in order to describe the morphological changes in the brain as the recovery progresses. The aim of this project is to help radiologist as well as medical students in diagnosis of brain hemorrhage in more refined manner by feeding CT images & identify the type of brain hemorrhage using watershed algorithm along with artificial neural network. Keywords - Computed tomography (CT), Artificial Neural Networks (ANN), Back Propagation Network (BPN), Gray Level Co-occurrence Matrix (GLCM). I. INTRODUCTION This Brain hemorrhage is a type of stroke, which occurs due to artery bursting in the brain, causing bleeding in the surrounded tissues. The symptoms of brain hemorrhage are a sudden severe headache, Weakness in an arm or leg, nausea or vomiting, changes in vision, difficulty in speaking or understanding speech, difficulty in...
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...When I was 10 years old, I was treated many times for severe headaches. I was examined by various doctors and was prescribed different medicine every time because none worked. Being prescribed many different medications and never getting a true answer to my chronic headaches, I was always in pain. It was roughly 5 years later during my freshman year in High School when I learned the reason for my headaches. The experience of having a brain tumor completely changed the way I saw life and taught me to not take my life for granted.. It all started when I was 10 years old going from doctor to doctor for my headaches, being told the same thing over and over, that I should take a certain medication for my migraines. However, every time I saw a different doctor I was prescribed a new medication, which had no effect on me and didn’t stop my headache problem. This went on for a few years, going back and forth getting no true answer for my headaches. I would tell my mom that I did not want to go to school because I could not focus at all and she would usually respond, “stop crying it is just a little headache. Take some Tylenol like the doctor said.” She was as clueless about my situation as the doctors were, so I had to suffer the unbearable pain in and out of school. It was not until 5 years later, when I started my freshman year in High School that I realized my motor skills were different and I was failing many classes from not being able to focus in class. One Monday morning when...
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...Epidural Hemorrhage An epidural hemorrhage is a type of traumatic brain injury (TBI). It is caused by bleeding between the skull and the outer membrane that covers the brain (dura mater). As the amount of bleeding increases, the blood pushes down on the brain. The amount of bleeding may increase pressure on the brain, possibly causing that part of the brain to stop working and may eventually cause death. An epidural hemorrhage is a medical emergency. CAUSES An epidural hemorrhage is caused by bleeding from a ruptured blood vessel. The bleeding usually results from trauma to the head. Head trauma can occur with: • Traffic accidents. • Falls. • Assaults. • Sport injuries. Less often, an epidural hemorrhage can occur without a head...
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...Derek and Meredith were getting Zola and Bailey ready for the hospital day care just like any other day, but today was different. They needed to get to the hospital early to start practicing. Meredith and Derek have a special surgery that they are scrubbing in on. This surgery is the first one to be done at Grey Slone Memorial Hospital and Seattle Grace. The head of Neuro at Grey Slone Memorial is Derek Shepherd and in three days he will perform a brain stem Glioma surgery on a six year old. Cancerous Brain Stem Gliomas are nearly impossible to cure with surgery, but the risk is even higher on a child. These type of brain stem surgeries are rarely performed because the brain stem controls your breathing, heart rate, sight, hearing, walking, talking, and eating, so one simple mistake in surgery can paralyze or even kill a person, so this is going to be the start to Derek’s new clinical trial. Derek and Meredith are not the only ones to be in on this surgery, Dr. Avery, Dr. Karev, and Arizona are also scrubbing in along with three interns. So the first two days the seven doctors are practicing on how to reach the tumor and what the best way to take it out is. While they are practicing Dr. Wilson, one of the interns scrubbing in, will be checking on the six year old cancer patient by checking his vitals every 30 minutes making sure the tumor does not erupt. On the second day of practicing, Dr. Wilson notices that the patient's vitals are not very good and goes to tell Dr. Shepherd...
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...Abortion The most common causes of maternal death in abortion are infection, hemorrhage and embolisms. (Calhoun, 2015) Abortion is the termination of a human pregnancy. Most abortions are performed during the first twenty-eight weeks of pregnancy. Abortions in the first trimester are considered minor surgeries. Advancing gestational age increases the risk of complications for the woman. The fifth leading cause of maternal death in the United States is induced abortion. (Calhoun, 2015) One reason that women choose abortion is because of their lack of financial stability. Also, because they are not in a stable relationship or are too young. Another reason is because the pregnancy was unplanned. Birth control is available even if women are on a limited income. Abortions should be made illegal because of the associated risk to women such as infection, hemorrhage and embolism. Abortion should be illegal because of the risk of infection. Deaths from infection are nine times higher in abortion than live births. (Calhoun, 2015) The most common type of post abortion infection reported is endometritis. (Shannon, 2004) Endometritis is an infection in the inner uterine wall and a major cause of maternal mortality. Risk of infection is a concern for providers because they are keen to avoid complications that may affect the health of young healthy women. Complications caused by abortion can cause future fertility problems. Genital tract infection is another main infection from abortion that...
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...Stroke Definition: A stroke is the sudden death of the cells in a specific area of the brain caused by inadequate blood flow. Another name for it is cerebral vascular accident (CVA). A stroke is also called a brain attack. Description: A stroke occurs when an artery bursts or becomes closed when a blood clot lodges in it and blood flow is interrupted to that part of the brain. Blood circulating to that area of the brain served by the artery stops at the point of rupture, and the brain tissue in that area dies or is damaged. The effects of a stroke are determined by which portion of the brain is affected and how much damage occurs. A stroke can cause memory loss, speech impairment, reasoning ability, loss of vision, paralysis, coma, and death, depending on what region of the brain is affected. Strokes are considered to be medical emergencies that require immediate treatment. About one third of strokes can be followed by transient ischemic attacks (mini-strokes). These strokes temporarily interrupt blood flow to the brain and cause similar symptoms like sudden vision loss or temporary weakness in a limb. Quick treatment can improve the chances of survival and increase the degree of recovery. A person who may have suffered a stroke should be seen in a hospital emergency room immediately. To be most effective, blood clot prevention treatment should begin within three hours of a stroke. More than half a million people in the United States experience a new or recurrent stroke...
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...INTRODUCTION Placenta previa is generally defined as the implantation of the placenta over or near the internal os of the cervix. There are four types of placenta previa; total, low-lying, partial, and marginal. The higher incidence of low-lying placenta and placenta previa is sonographically diagnosed in the second trimester and ranges from 6% to 46%. This rate, however, decreases to as low as 0.5 % at delivery (11). Despite advances in blood transfusion techniques and surgical procedures, abnormal placentation still remains a difficult challenge for obstetricians. Intrapartum maternal hemorrhage and the need for emergency cesarean section or hysterectomy related to abnormal placentation are main causes of maternal-fetal morbidity and mortality. The overall incidence of placenta previa at delivery is reported as 0.5 % in most studies (3, 5) and the risk factors for placenta previa include advanced maternal age (above 35 years), parity, smoking, and, most importantly, prior cesarean delivery. Placenta previa with prior cesarean delivery increases risk up to 1% - 4%. As the number of previous cesarean deliveries increases, the incidence of placenta previa and abnormal placentation shows a linear increase (3). Vaginal ultrasound is the most accurate method for localizing and diagnosing placenta previa, because it can provide a better resolution in the lower margin of the placenta (4, 6, 11). There is a little increase in congenital anomalies associated with placenta previa...
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...Keywords: trachea-innominate fistula, tracheostomy, complications, hemorrhage, sternotomy, airway protection. Tracheo-innominate artery fistula (TIF) is a rare but devastating complication following tracheostomy. This fatal complication has an incidence of 0.1-1% and most commonly occurs within 3 weeks after tracheostomy.1 TIF may result from pressure against the trachea facilitating erosion into the innominate artery by the tracheostomy tube, cuff, or balloon.1 Early bleeding is common after tracheostomy and attributed to surgical causes; however, delayed bleeding is less common and may be a sign of impending massive hemorrhage. 2 A high level of suspicion and prompt surgical intervention is imperative in the diagnosis and successful management of TIF. 3 Case Report A 49-year-old female with a history of cirrhosis was hospitalized for episodes of hepatic encephalopathy requiring intubation. Patient was extubated and re-intubated for hypercapnic respiratory failure after developing stridor treated with racemic epinephrine nebulizer treatments. Hospital course was complicated by acute respiratory distress syndrome (ARDS) versus hospital-acquired pneumonia (HAP), acute...
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...What are the causes of normochromic, normocytic anemia? How can chronic inflammation cause anemia? (4 pts) Normochromic, normocytic anemia is caused by a hemorrhage or hemolysis. The hemorrhage can be caused by the GI or GU tract secondary to diseases that are affecting these systems. Also congenital bleeding disorders such as hemophilia or von Willebrand disease. The underlying cause of the anemia must be treated and not just the anemia. Chronic inflammation can cause anemia because the inflammation interferes with bodies ability to use stored iron and absorb the iron from the body, thus causing anemia. Which kind of anemia is associated with a beefy red tongue? Why does the beefy red tongue develop? What approach should be taken in treating this type of anemia? (4 pts) Pernicious anemia is associated with a beefy red tongue. Vitamin B12 is deficient and this causes the beefy red tongue. The intrinsic factors in the stomach do not work to absorb the vitamin B12, it causes the papillae on the tongue to loose the smooth appearance. Pernicious anemia can be treated with Vitamin B12 pills or sometimes injections. Why is classification of leukemia important? How does knowing the specific type of leukemia or lymphoma a patient has affect the treatment plan? (3 pts) Classification of leukemia is important to know because it tells you how fast it progresses, when you know the classification. Acute leukemia is fast and can overrun the body in a few weeks to...
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