Essays on Hypotension

1. COPD: COPD exacerbation (in-patient): Administer Duoneb (albuterol/ipratropium) q6H once the patient is stable to prn, prednisone 40mg qd x 5days, abx (IV levo). Similarly, once the stable switch to po. Closely monitor the patient for any side effects of fever. Follow up the patient in 7-10days to assess infection. Discharge: when discharging the patient, give her Tiotropium / Olodaterol 2.5 – 2.5 mcg to be taken once daily while at home. Also give the patient to carry home 90 mcg albuterol rescue inhaler, to take 1-2 puffs every 4-6 hours prn 2. Chronic COPD: Continue giving the patient ...

Essay

Needs Assessment and Rationale Falls are a serious public health issue in the United States because it is the main cause of trauma-related incidents and injury-related emergency cases, and the leading cause of unexpected deaths among the elderly. People aged 65 and above comprise the majority of casualties from falls (Al-Faisal, 2006). The prevalence of falls rises continuously with age irrespective of gender and racial/ethnic affiliation. As reported by Stevens and colleagues (2010), “each year, about one-third of all older adults fall. In 2007, an estimated 1.9 million fall injuries among persons aged 65 years and older were treated ...

Parkinson’s disease lacks a cure but certain medicines can help manage the symptoms. These medications function to offer a substitute for dopamine, the signaling neurotransmitter in the brain. Carbidopa-levodopa is hitherto the most effective medicine to manage Parkinson’s disease. This chemical moves to the brain and is converted to dopamine. The chemical levodopa is mixed with carbidopa preventing it from being converted to dopamine prematurely out of the brain hence potential side effects such as nausea are lessened. Potential side effects with this medication however include orthostatic hypotension or feeling light headed and nausea. With continued use ...

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Question 1: Pathophysiology of Mr. Jensen’s post-operative hypovolemia

Hypovolemia is a surgical condition that indicates the rapid fluid loss that may result in organ failures. The outcomes of the hypovolemia are mostly due to insufficient circulating volume or scarce perfusion. Often hypovolemia is secondary to hemorrhage the reason of which includes severe internal or external blood loss and GI, thoracic and abdominal bleeding maladies (Devitt, 2001). Hypovolemia involves significant fluid loss other than blood that can be further accompanied by refractory gastroenteritis and widespread burns. Hypovolemia may develop in post-surgical incidence, bone fracture, due to ...

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Health History and Physical Examination

A 50 years old American Male comes to the hospital with angina-like symptoms. Subjective Data Demographic data: There exists a risk of cardiovascular ailments or malfunctioning. The patient is an IT professional with long sitting schedules.

Reason for care: The patient was admitted to the emergency ward due to the severity of the pain 6 days back.

Present illness: Currently facing chest congestion with breath shortness and exertion, with heavy perspiration, recommended cardiac catheterization. Perception of health: Patient is an educated, independent and sincere individual who thinks that he is healthy and with several precautions he will overcome the current situation. He is little worried about his excessive ...

Abstract

Heart failure (2.6% prevalent worldwide) is a complex clinical syndrome, resulting from a structural or functional cardiac disorder and impairing ventricular filling or ejection capability. The current case of a 59-year-old male patient admitted on August 18, 2016 due to worsening shortness of breath and bilateral left extremity edema (one week) involved an existing diabetes mellitus type 2 (DM2). Physical and clinical profiles indicate a comorbidity between heart failure (HF) and DM2. Laboratory and imaging findings were not indicated, while diagnosis was based on the NYHA Classification guidelines. A review of literature revealed three crucial weaknesses in the diagnosis. ...

Multiple choice questions

Multiple Choice Questions

Increased erythropoietin production Increased heart rate Increased cardiac output Enhancement in oxygen extraction The answer for this question is b. increased heart rate. A reduction in tissue oxygenation as happens in anemia stimulates increased production of erythropoietin through a complex feedback mechanism. Increased production of erythropoietin enhances erythropoiesis in anemia. Increased extraction of oxygen in anemia is a compensatory mechanism that is mediated by an increase in 2, 3-diphosphoglycerate concentrations. Increased cardiac output is the main hemodynamic compensatory mechanism in anemia that aims to increase blood flow to the body organs. An increase in heart rate ...

Introduction

Endometrial cancer refers to a type of cancer that affects the endometrium, which is the inner lining of the womb or uterus. Endometrial cancer is one type of cancer that is somewhat different when compared to other types of cancer, as it affects others parts of the body depending on its severity. That means that poor management of this type of cancer may have significant impacts to other parts of the body attributed to the spread of this cancer to different organs. The cancer arises from an abnormal growth of cells within the womb thereby resulting in a situation ...

Increasing Septic Screening Compliance

Increasing Septic Screening Compliance

Abstract

There is a growing medical challenge within the confines of medical service facilities that if not addressed may lead to unnecessary loss of life. There has been a growing rate of sepsis infections, especially those who are admitted in the hospital. It is a baffling problem as one would image that the hospital is the last place where one’s sickness gets worse. Delving further into the probable causes of the increase of septic infection cases, once would discover that the methodologies that are being used to detect and address these infections are undependable. As ...

Article Summary:

The article entitled The Biology of Vibrio vulnificus provides a short discussion about the more important aspects of this pathogen. This pathogenic bacteria are known as one among the most deadly foodborne pathogen in the US, contributing to about 95 percent of deaths related to seafood acquired microbes in the country. Reports revealed that a larger number of cases occur during the more temperate months of May and October. The period of incubation is quite rapid, with an average of about 26 hours after ingestion, and the patient showing symptoms such as fever, chills, nausea, pain in the abdomen, ...

Monomorphic Ventricular Tachycardia

Cardiac arrhythmias often require immediate medical care that may include resuscitation (Ray, 2004). The diagnosis of cardiac arrhythmias can be challenging particularly in situations whereby the patient is asymptomatic and ECG findings are normal between symptomatic episodes (Cruickshank, 2008). Distinguishing between supraventricular and ventricular tachycardia is also a challenge (Australian Resuscitation Council, 2008). Cardiac arrhythmia should be suspected in patients with a history of syncope, near syncope, palpitations, and/or chest pain (Cruickshank, 2008). This paper will justify why monomophic ventricular tachycardia is the most likely diagnosis of a male patient who collapsed abruptly and has hypotension (BP 63/38), tachycardia ( ...

Acute coronary syndrome is an umbrella term for a group of clinical symptoms indicative of acute myocardial ischemia. These conditions include non-ST-segment elevation myocardial ischemia (NSTEMI), unstable angina, and ST-segment elevation myocardial infarction (STEMI). These conditions are high-risk manifestations of atherosclerosis in the coronary artery and significant causes of utilization of emergency services and hospitalization (Kumar and Cannon, 2009). STEMI causes 30% of all acute coronary syndromes in Australia (Harper and Lefkovits, 2010). This paper will describe the expected presentation, pathophysiology, ECG findings, pre-hospital management, and initial 24-hour management of STEMI in hospitals settings. These aspects will be described ...

Abstract

Ventilator-associated pneumonia (VAP) is an infection which often develops as a result of poor handling of mechanical ventilation. Such as, poor nursing practice in caring for patients with difficulty in breathing can lead to microorganisms entering patient’s body through a tube inserted especially via mouth and nose of the patient. When these microorganisms get into the respiratory system they cause lung infection which is referred to as ventilator-associated pneumonia (VAP). In preventing this infection, it is important that nurses adopt best practices to reduce the incidence of VAP and provide quality care that is aimed at improving the ...

Abstract

Ventilation Associate pneumonia is a nosocomial infection that affects immobile patients, especially those admitted in the Intensive Care Unit. The management of these patients has been challenged and it triggered numerous studies on the most efficient ways of managing such patients. In the ward care of a patient that is ambulant and can describe changes in their condition it is easy not to pay attention to the positions of the patients. However, in the acute wards, the positioning of such patients is significant in prevention of complications. One of the main challenges is pneumonia. The positioning of the head ...

Introduction

The body is on an ongoing and continuous quest to maintain an environment characterized with equilibrium. Scientifically, this state is called homeostasis. It is the body’s internal mechanism that is meant to make the person survive, despite the numerous internal and external changes it may encounter. The body of a person who was acutely exposed to a colder than usual environment would, for example, react by preserving the heat that is currently stored in and generated by the body—something which can be done in a lot of ways such as, but may not be limited to vasoconstriction, ...

Abstract

Nursing shock patients in the Intensive Care Unit entails medication accuracy and critical judgment to save the lives of the patients. As such it is important to know the nature, pathophysiology and types of shock, which are named as hypovolemic, cardiogenic, neurogenic, and distributive tasks. Also it is important to know the roles of ICU nurses in the health care service for the shock patients, from the time the patient is sent to the ICU up to the monitoring and communication with the relatives of the patients. This paper is intended for a qualitative literature review which follows ethical ...

Disease management constitutes an important area in the clinical research where drugs possess a significant position. The effect of drugs on various organ systems has been the area of much research interest which gradually made feasible the development of several classes of drugs. Drugs may have dual role of promoting and inhibiting the vital biochemical and molecular pathways that play influential role in the disease outcome.

Angiotensin converting enzyme (ACE) inhibitors are considered as anticongestive heart failure and antihypertensive agents. They have gained wide spread physician and patient satisfaction. The ACE inhibitors prevent the ...

However, it is possible that hypertension is an incorrect diagnosis. Normal blood pressure should be bellow 120/80, but it is also considered that the blood pressure can deviate up to 140 mmHg systolic pressure and 90 mmHg diastolic reading. Because Mrs. Chang’s blood pressure reading is lower than 140/90, her case can be considered pre-hypertension at most (Cunha, 2010). Another possibility is that Mrs. Chang’s condition has changed since her last examination, but she could not have known that because she cannot remember her last examination. She currently appears to suffer from orthostatic hypotension rather than hypertension. ...

Antipsychotic drugs are used for managing psychosis and other mental and emotional disorders. The primary indication of antipsychotic drugs is schizophrenia. It is also used to patients with bipolar affective behaviors and Tourette’s syndrome. Antipsychotics also have indicative components that manage depression. For the elders, it is most commonly used to manage agitated behaviours caused by dementia and Alzheimer’s disease. These two are the most common disease associated to growing old. For the elderly, these are said to have adverse effects. However, these drugs are still being used to them. Because of their age, it is ...

Sepsis is a clinical condition that evokes an inflammatory response of the host immune system in response to clinically-suspected infections. It usually occurs in an individual with a weak immune system such as a post-surgery patient, organ transplant patient, cancer patients or an AIDS patient. It spreads throughout the body via the bloodstream. There are several degrees of sepsis such as severe sepsis, septic shock and refractory septic shock (Morrell, Micek & Kollef, 2009) that together make up the systemic inflammatory response syndrome (SIRS) (Mayr, Yende & Angus, 2014). Sepsis and septic shock are some of the leading causes of death in the world, ...

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Abstract

Unplanned extubation can be defined as the premature removal of ETT. It can be deliberate or accidental. Usually, it is caused by mechanical ventilation, which is the common process in neonatal intensive care unit (NICU). Unplanned extubations represents fourth most common adverse event in NICUs in North America. Unplanned extubation can result in several complications such as acute cardiorespiratory deterioration, bronchospasm, hypotension, ventilator-associated pneumonia, and subglottic stenosis. Duration of intubation, short length of ETT, less common use of sedatives and muscle relaxants, and time spent out of bed in the hand of parents, i.e. movements, are some of ...

Blood Pressure, Hypertension and the Nervous System

Cardiovascular activities within the human body are generally facilitated by the regulation of the sympathetic and parasympathetic afferent and efferent nerve fibers. Blood pressure is the relationship between the vascular resistance and the amount of blood that the heart pumps per minute (i.e. cardiac output). Cardiac output is affected by the following factors: end-diastolic volume, cardiac muscle contraction, and heart rate. While the sympathetic nervous system controls the blood volume and the tone of venous smooth muscle (determinants of end-diastolic volume) alone, the myocardial contraction and heart rate is controlled by both sympathetic and parasympathetic regions of the autonomic ...

Abstract

The acute respiratory distress syndrome is a form of injury to the lungs that impedes the supply and uptake of oxygen from the alveoli resulting in a state of severe hypoxemia, dyspnea, anxiety, and tachypnea. This review has established that genetics may be playing a role in increasing one’s susceptibility to acute respiratory distress syndrome (ARDS. Moreover, biomarkers would also play a significant role in the diagnosis and treatment of the disease. However, it still remains unclear on the type of genes and biomarkers that play a role in causing ARDS. It has also been established that young children (less than 2 years ...

Management of the Postsurgical CABG Patient

Management of the Postsurgical CABG Patient Coronary artery bypass graft (CABG) surgery is a recommended treatment for coronary heart disease (CHD). In the United Kingdom, around 2.7 million people have been diagnosed with this condition (NHS, 2012). The aim of surgery is to relieve angina and shortness of breath by improving the flow of blood to the heart (Parry et al., 2010). These symptoms cause severe discomfort and distress as well as limit the amount and type of physical activity a patient may engage in. Surgery helps patients attain a higher quality of life referred to as satisfaction with life ...

There are nearly 5 million cases of epilepsy in the United States every year. The most common and serious form of status epilepticus occurs to people with no prior history of epilepsy. About 5% of adults and 10% to 25% of children will develop this disorder every year. Infants and elderly people are at more great risk of developing Status epilepticus yearly than others1. About 1.4% of white and 1.1% of black people will develop this disorder every year compared to 0.6% of Hispanic who will have a lower rate of such incidence. About 1.23% of women will develop ...

The adrenal glands sit on top of the kidneys; anatomically it is composed of an outer cortex and an inner medulla. The cortex produces the three major steroids 1. Corticosteroids, 2. Mineralocorticoids, and 3. Adrenal androgens. An excess amount of cortisol in the body is known as Cushing’s syndrome; deficiency of cortisol is known as Addison’s disease. Symptoms of Cushing’s include fat redistribution, skin striae, osteoporosis, hypertension, menstrual changes in women, erectile dysfunction in men, and cognitive disturbances. Whatever the cause of Cushing’s syndrome the end result is an increase in cortisol secreted by ...

The importance of effective management of pain in the post-operative patient cannot be overemphasized. Its inadequate management can have profound adverse effects on patients such as sleep disturbances, mobilization difficulties, aggression, high levels of anxiety, and increased distress and suffering (Carr et al., 2005). Post-operative pain can also have unwanted physiological effects on patients and cause complications such as nausea, vomiting, paralytic ileus, and increases in blood pressure (Mackintosh, 2007). This paper will critic the pharmacologic and non-pharmacologic interventions that were used in the management of post-operative pain (rated at 6/10 on the numeric scale) in a patient who is ...

Introduction

The body is made up of various organ systems which perform various functions. One of this is the urinary system which is responsible for excretion of various metabolic wastes. An important organ in the urinary system is the kidney. In the kidney, blood undergoes ultra filtration; nutrients such as glucose are reabsorbed back while waste products such as urea and excess water form urine which is excreted. The kidney maintains electrolyte and water balance in the body. During sustained physical activity, the body looses a lot of water through sweating. This disrupts the electrolyte balance in the body and leads ...

1. Which of the following is an antidote for benzodiazepine overdose or toxicity?a. Buspirone (BuSpar)b. Hydroxyzine (Visteril)c. Flumazenil (Romazicon)d. Naloxone (Narcan)There is one other drug overdose antidote in the above list. Name the drug and its mechanism of action. Flumazenil (Romazicon®) is another drug given to reverse the depressant effects of benzodiazepine and thus useful for overdose treatment. It acts as a competitive antagonist of benzodiazepines, having high affinity to GABAA receptors, which is the BZD binding site. This allows it to specifically target benzodiazepine and drugs with similar MOA such as zolpidem, but not other ...

Myocardial infarction is a term that is used in the clinical setting in reference to the necrosis of a section of the myocardium which occurs as a result of the interruption of the supply of blood to the heart. This often takes place as a result of the occlusion of the coronary artery. From a pathological point of view, myocardial infarction is myocardial infarction refers to the death of the myocardial cells as a result of prolonged ischemia. It may the result of chronic heart disease or as the onset of coronary heart disease. The prolonged ischemia which triggers the death of myocardial cells ...

M.P. is an 83-year-old white female who began taking furosemide 20 mg PO twice daily approximately 2 weeks ago for peripheral edema. She is being admitted to a medical surgical floor following complaints of being exhausted and a physician diagnosis of dehydration. She has been getting up several times each night to use the bathroom. The swelling in her ankles has markedly improved; however, her laboratory values and assessment indicate the need for an admission for hydration and electrolyte balance. The physician has ordered furosemide 20 mg IV daily upon admission.

Keywords: furosemide, edema, diuretic, hypotension

Furosemide Management Plan

Furosemide is a “water pill used to reduce ...

Abstract

Dexmedetomidine is a centrally acting α-2 receptor agonist that is used as anaesthesia during surgical procedures. It has several properties that make it suitable for use during monitored anaesthesia care (MAC). DEX has analgesic properties thus there is considerably reduced opioids requirements both before and after surgery (Candiotti, et al., 2010). Tachychardia and hypertension are mitigated by the symphatholytic effect of DEX. It has also been known to be friendly to respiratory system as it does not depress the respiratory system during its use. These properties make it suitable for MAC during orthopedic, ophthalmic, plastic surgery, dental and diagnostic procedures. ...