N.T., a 72 year old female with a past medical history of hypertension, COPD hyperlipidemia, and hip surgery was diagnosed with rhabdomyolysis after the patient made a visit to the ER several days following a severe fall. A CMP was ordered which revealed elevated glucose, creatinine, BUN, CO2, and AST values. Also noted were decreased potassium and ALB values as well as severely elevated creatinine kinase levels.
CIWA-Ar is a 10-item scale which numerically scores the severity of a patient’s nausea, sweating, agitation, headache, anxiety, tremor, sensory disturbances (visual, tactile, and auditory), and orientation23 to determine appropriate benzodiazepine dose. It is usually administered by a nurse and takes only a minute or two to complete. There is a maximum of 67 points and a score >18 indicates a patient is at severe risk for major alcohol withdrawal complications.5 Patients with scores <8 may be reevaluated every 8 hours, however patients with higher CIWA scores will need to be reevaluated more frequently depending on worsening or improving symptoms, sometimes requiring hourly assessments.. Hourly assessments may be quite burdensome for a floor
A root cause analysis is mandated by The Joint Commission (TJC) to be completed for every sentinel even. By doing this it allows healthcare providers to review contributing factors, establish a baseline and how to prevent future events from occurring. Root causes are identified factors within a process that can be restructured to decrease the risk of harm being repeated. (The Joint Commission, 2013) A sentinel event is defined by The Joint Commission as “unexpected occurrences involving death, or serious physical or psychological injury”. (The Joint Commission, 2013)
Mr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning.
The problem that was identified in my module 1 is Oxygen desaturation in the pacu patient or post-op surgical patient, patient that is still on opiate analgesics after surgery. The clinical problem that was presented in module 1 reflects on the bodies decrease respiratory capacity after receiving opioid analgesics, or IV anesthesia during the operative setting. Patience are at higher risk 4 retaining carbon dioxide CO2, and they 're also a greater risk for experiencing respiratory depression that can lead to respiratory distress
In this method of execution the prisoner is restrained and sealed in an airtight chamber and dropped hydrochloric acid potassium cyanide or sodium cyanide crystals which producing hydrocyanic gas. This gas destroys the body's ability to process blood hemoglobin, and unconsciousness can occur within a few seconds if the prisoner takes a deep breath. Death usually occurs within six to 18 minutes. After the pronouncement of death the chamber is evacuated through carbon and neutralizing filters. Crews wearing gas masks decontaminate the body with bleach solution, and it is out gassed before being released. If this process was not done, the undertaker or anyone handling the body would be killed.
Opioids are a category of pain medications that reduce the stimulus of pain signals sent from the brain. Within this category are medications such as hydrocodone, oxycodone, morphine, codeine, and other similar drugs. These medications are used to treat mild to severe pain depending on dosages and type of opioid given. With the reduced perception of pain also comes a plethora of unpleasant symptoms such as drowsiness, mental confusion, nausea, constipation, and, depending upon the amount of drug taken, can depress respiration. However, many experience a euphoric experience after administration that drives them to abuse opioids. This abuse leads to addiction or overdose which
The capillary nail refill test is a quick test done on the nail bed. It is used to monitor dehydration and the amount of blood flow to tissue. If there is good blood flow to the nail bed, a pink color should return in less than 2 seconds after pressure is removed.
According to the HPC Code of Conduct (2015), all registrants and students must respect service user’s right of confidentiality. Therefore, the author will fictionally refer the patient as Sibert. Before Sibert came to theatre for surgery, a pre-assessment is conducted in the pre-assessment clinic. During this assessment, medical history, general health and family history are checked and assessed. Aikenhead et al., (2007) stated that full medical must be compiled before surgery as this will in some way affect the anaesthetic process. Sibert had no history of medication or drugs taken. Having this information was important because drugs may cause resistant to induction agents or sedative drugs as mentioned by Davis and Cashman,
Synchronized Intermittent Mandatory Ventilation (SIMV) mode: SIMV is considered a weaning mode, and the patient is placed on this mode when he or she shows evidence of improvement. In SIMV, the machine delivers a set rate, and the patient is allowed to breathe spontaneously. The patient has more freedom, which means that when he takes a breath, the machine allows him/her to take a breath of his/her own tidal volume. Even though the tidal volume is set in the control panel, it does not kick in the tidal volume because the ventilator senses an inspiratory effort by the patient. Conversely, if the machine does not sense an inspiratory effort by the patient, it will deliver the tidal volume set in the machine’s control panel. Therefore, you will
A malleolus fracture is a break (fracture) of the tibia, the large bone in your lower leg. The medial malleolus is the lower part of the tibia that you feel as the bump on the inside of your ankle. The posterior malleolus is the lower-rear part of the tibia that is closest to your heel.
Electroconvulsive Therapy (ECT) is a long-standing treatment option for depression in patients who have not responded to medications. Emergence agitation occurs in approximately 1 in 10 patients post-ECT.1 The agitation is often mild, and can be settled through non-pharmacological means such as verbal reassurance, however, in some patients agitation can be severe and require pharmacological interventions. We describe a case of severe post-ECT agitation which failed treatment with propofol, esmolol and midazolam, but responded well to dexmedetomidine.
Over-sedation in mechanically ventilated patients is common issues in a critical care setting. According to findings by Wøien, Vaerøy, Aamodt, and Bjørk (2012), as much as "30-60% of intensive care patients receive periods of prolonged sedation" (p. 1552). Also, deep sedation was associated with an "increase in mortality, prolonged mechanical ventilation, and increased intensive care unit length of stay" (DAS-Taskforce, 2015). Current literature generates a level of personal interest and clinical significance to nursing practice. When there are care rendering practices nurses can do to improve outcomes for patients, a deeper understanding of the related processes needs to be explored.
Nebulized epinephrine has been a recognized therapy for the treatment of moderate to severe croup for some time1-8. It is believed that the alpha adrenergic action may constrict the small vessels in the larynx and relieve the symptoms9 9. Whether or not the beta adrenergic effect is beneficial is open to debate in infants10 While the onset of action is rapid, the administration system is cumbersome and almost always intermittent. This results in an immediate effect that lasts an indefinite but often very short time. The Vapotherm system (Stevensville, MD)11;12 uses a cartridge of tubules that are permeable to water vapour to humidify hospital air (or oxygen). It is designed to provide high levels of humidity to the airway continuously for long periods. The water, cartridge and air are heated to body temperature or slightly above and a triple lumen tube that goes to the
This is a summary of the article “A Systematic Review of the Impact of Sedation Practice in the ICU on Resource Use, Costs and Patient Safety” by Jackson et al. in the Critical Care journal. The article begins by addressing Intensive Care Unit (ICU)’s patients’ tendency to be put under sedation for prolonged durations. The focus of the article is to evaluate the impact of altered or diverse practices for sedation management on economical implications and patient safety consequences.