Oral hypoglycemic agents were omitted on day of surgery and started after surgery day or at time of discharge or replaced by insulin. In few cases, oral hypoglycemic agents were continued on the day of surgery deviating from literature. In majority of cases insulin was given on the day of surgery (STAT dose was given based o the GRBS). Certain target blood glucose levels were set by the physician which was patient specific and insulin dose was adjusted based on those levels. If blood glucose levels were within the target range insulin was omitted and if not, STAT dose with short acting insulin was given based on GRBS values through intravenous route.
Do not smoke. If you smoke, ask your doctor to help you quit, for example with psychological help, drugs and nicotine replacement products. 4. Keep an eye on other health problems. If you suffer from high blood pressure , high cholesterol, diabetes or other diseases that predispose to atherosclerosis, try to keep them in check with your doctor.
• Tingling, numbness, and pain in the distal extremities due to peripheral nerve damage. • Weight loss. How is diabetes mellitus diagnosed? If you are experiencing these symptoms, it is important that you visit your primary care physician immediately. Some of the tests that will be ordered include glycated hemoglobin A1c test which measures the Hemoglobin A1c in your body (normal level is below 5.7) as well as fasting blood sugar test which measures the glucose level in the blood after fasting overnight (normal level is 100 mg/dL or 5.6 mmol/L).
Before Bill was given medication, food, or fluids he was assessed for ineffective swallow by the nurse. If the screening shows swallow impairment the patient must be referred to SALT within 24hours (NICE,2008). The screen used in this hospital was the “Stroke dysphagia screen” (Lepine,2009 cited in Barnard,2011). This involves giving an alert patient (absent of facial droop and with a gag reflux) a sip of water, if they can swallow without coughing/choking they are allowed more and observed for coughing/choking (Barnard, 2011). If facial droop present, as in this case, the test is not done and the protocol requires immediate referral to SALT.A nursing diagnosis of “ineffective swallowing” was
For example, infusion therapy requires nurses to make sure the patient’s extremities out from swaddling for easy access the cannula site hourly, record the volume prescribes and the volume infused hourly, observe hourly for any leakage, redness, swelling, or warmth and to report if any abnormalities. -According to Beall, Hall, T.Mulholland and Gephart (2013), the recommendation for practice to avoid vascular injury includes: Use of small bored catheter to avoid restriction blood flow. Prevent repetitive use of same vein. Use the transparent dressing to allow direct visualization. Place the secure ape loosely over bony prominence to prevent restriction blood circulation to extremities.
Next, involve participation of family to learn on maintaining and checking for patency of tube by administering room-temperature water before and after feeding where it can establish patency before feeding and clear the tube after feeding. Remind clients and family that all feedings are given at room temperature or near body temperature. When giving feeding, nurses also should explain the correct technique which is by keeping the bed elevated for at least one hour after feeding to facilitates digestion and to decrease risk of aspiration. It is also important to monitor the tube’s length and notify physician or home care nurse if the segment of the tube outside the body becomes shorter or longer. Flushing the tube with 30mL of water after bolus feeding or medication administration is vital to ensure patency of the tube.
Abdominal CT scan was performed but revealed nothing except cholelithiasis. A descion of removing the previously inserted plastic stent in CBD was made. The patient underwent ERCP under general anesthesia to remove the stent. The fever started to decline 24 hours after ERCP and was completely gone after 48 hours. The patient was kept on antibiotics for 4 more days and was discharged with instructions of eating only boiled food and weekly
ICG requires additional preparation and precautions: (1) mixing the dye and (2) if combination ICG/FA, two consents forms that patients must agree and sign. The ICG product is a set of a powdered vial and and sterile aqueous solution. Using a 5ml syringe and large needle (18g, pink), draw 5ml from sterile water vial. Insert syringe into ICG powered vial making sure 5ml water contents are carefully distributed in. Take this step slow as the pressure may expel contents out from the rubber topper puncture site.
Main side effects Respiratory depression, light headedness, sedation, dizziness, nausea and vomiting, constipation, abdominal pain. Patient education To take Morphine with meals to avoid abdominal cramps and nausea. To avoid driving and carry heavy machines. To take it before sleep. Nursing intervention Monitor vital sings especially respiratory rate and have the antidote (naloxone) on hand, maximize the therapeutic effects by assessing the pain before and after medication administration, minimize side effects by assist the patient while walking and keep side rails up, provide patient and family education about side effects and how to avoid and minimize
Care had to be individualized with each patient and it included providing respect with his or her decisions in their care. An example includes respecting the decision when a patient refused to take lactulose because it made him have frequent bowel movements. In EPIC, we would chart patient refused the medicine resulting in providing patient-centered care. For quality improvement, the unit has data on how many infections have occurred with central lines and utilize benchmarks and evidence-based practice guidelines to prevent infections. For instance, I had to perform proper hand washing and scrub the hub for at least 30 seconds with alcohol pads to prevent infections in patients who have intravenous lines.
7. Which of the findings from the nursing assessment demonstrate possible adverse effects from amphotericin B? If respiratory distress occurs, discontinue infusion immediately; anaphylaxis may occur. Monitor patient closely during test dose and the first 1–2 hr of each dose for fever, chills, headache, anorexia, nausea, or vomiting. Renal function should be monitored frequently during Amphotericin B therapy.
An initial dose of 300-600 mg clopidogrel should to be given along with the aspirin (NSW Health 2012). Nursing consideration: monitor for internal and external bleeding and allergies. Heparin: heparin prevents conversion of fibrinogen to fibrin and prothrombin to thrombin. IV bolus of unfractionated Heparin or Subcutaneous injection of low molecular weight heparin (LMWH) may be used to prevent the formation of new blood clots. Nursing consideration: Require regular monitoring of activated partial thromboplasitn time (aPTT) and needed frequent heparin dose changes (Brunner and Suddarth’s, et al, 2010: 765).
3) Compensated alkalosis, which occurs when the body returns the acid-base balance but the carbon dioxide and bicarbonate levels, remain abnormal. Symptoms can be, hand tremors, muscle twitching, light-headedness, and confusion and numbness. Treatments have included medications to correct the chemical loss; breathing into a paper bag will allow more carbon dioxide into the body and having your vitals signs monitored by a healthcare
Blood tests are done daily as per routine. Clopidogrel, Aspirin and Daltaparin are collectively use routinely post-op to prevent blood clot formation. Derangements of clotting factors may result in bleeding and deficient fluid balance. Keep tabs on blood results such as WBC. An increase reading may elicit post-op infection.
Impressions are post concussion syndrome, memory loss or impairment, vestibular hypofunction and right tinnitus. Treatment plan includes scheduling impact and sway to assess fully balance disruption as well as screening and neurocognitive testing, referral to vestibular therapy for initial evaluation, referral to ear, nose and throat (ENT) specialist and to start PT. Baclofen will be changed from ½ tablet 3 times daily to 1 tablet at night. On the statement of medical necessity on the C-4 form dated 03/10/16, the patient requires vestibular/vision therapy services due to pronounced vestibular hypofunction symptoms and/or abnormal optokinetic integration symptoms as a result of mild traumatic brain injury/concussion. These are common findings after a concussion and while mild version will resolves spontaneously, a certain percentage of patients will require therapy.