American Surgeon, 70, 198-201. Postoperative Care of the Septic Pediatric Patient Secondary to a Ruptured Appendix, 3. Describe at least 3 pain scales which can be used in pediatric pain assessment. Of the
Adult myocyte hyperplasia: divided they fail? J Am Coll Cardiol. 1994;24:150–151. Kang PM, Izumo S. Apoptosis and heart failure: a critical review of the literature. Circ Res.
1. Discuss the nursing management of the postoperative patient who has undergone a total abdominal hysterectomy with bilateral salpingo-oophorectomy. * Determines patient’s immediate response to surgical intervention. * Monitor patient’s physiologic status. * Assess patient’s pain level and administers appropriate pain relief measures.
Cardiac case study Case Study #2 Professor: Methavichit Sandra Martin 10/01/2013 Case Study Questions: Myocardial Infarction 1. What is the significance of an elevated ST segment inversion on an EKG and the PVCs the nurse sees on the monitor? It is Hypoxic Injury. Rapid discharges that record on the monitor as back-to-back PVCs tells us that his heart is getting ischemia. Usually requires more aggressive treatment such as reperfusion therapy.
Clinical Manifestations Clinical Clinical Presentation of Sepsis Classic Hemodynamic Alterations: – HR – CVP/PAOP – BP – CO/CI – SVR – Scv02 Effects: – Edema – Hypoperfusion/ Hypotension – Tachycardia – Tissue & cellular hypoxia – Altered organ function (renal, liver, CNS, coagulation, cardiovascular) Patient’s Clinical Presentation Hemodynamic Alterations: –HR –CVP/PCWP –BP –CO/CI –SVR –Scv02 128 10/14 90/50 (60) 8.9/5.4 614 (PVR 139) 77% on vasopressors ICU day #1 PAC via Right IJ inserted Deadspace ratio performed (Vd/Vt) – Vd/Vt = 67% – AC 28, Vt 480 mLs, .70/14 – 7.32/40/64/20/-5/92% Activated Protein C (Xigris) started Calcium repleted (chloride & gluconate) Vasopressin @ 0.04 units/min started Fentanyl @ 25 mcg/hr & Versed at 3 mg/hr infusions started 6 Atypical Hemodynamic Presentation –HIGH –HIGH –LOW –LOW –LOW –LOW HR CVP/PAOP BP CO/CI SVR Scv02 Clinical Manifestations Coagulopathy – Increased clotting stimulatedmicrothrombi (PAF) – Decreased fibrinolysis –↓ –↑ –↓ –↑ Platelets PT (INR) & PTT Fibrinogen D-dimers or FDPs/FSPs 75 K 24.5 (2.2)/>100 120 mg/dL 10,000 ng/mL (Plasminogen activator inhibitor) Clinical Manifestations Clinical
Patricia Worster Drainage of Renal Abscess Index: Incision and Drainage Abscess Kidney ….. 50020 Page: 715 Code: 50020 Page: 223 4. Stephan English Percutaneous core needle biopsy Complete thyroidectomy Index: I found this one under Surgery/Endocrine System Code: 60100 ….. Page: 257 Index: Thyroidectomy Total
Case 679 ________________________________________ CLINICAL HISTORY The patient is a 10 year old female, who underwent liver transplantation at the age of 2 for Alagille syndrome-related end-stage liver disease. Prior to transplantation, she received 36 mg of thymoglobulin followed by 24 mg post transplant, and tacrolimus 2 mg twice daily. Her immediate post transplant course was complicated by a pulmonary thromboembolism and acute cellular rejection which were treated with corticosteroids and antibiotics. Approximately one year after transplant, the patient presented with flu-like symptoms that included fever, rhinorrhea, body aches and an EBV titer of 30 million copies/ml. She was admitted for ganciclovir and CytoGam administration with EBV surveillance.
Inpatient Meds: * amiodarone (Cordarone) 200 mg 1 T PO Daily * Digoxin 250 mcg 1 T PO Daily * enoxaparin (Lovenox) 90 mg Subcut every 12 hour * pantoprazole (Protonix) 40 mg 1 T PO Daily before breakfast * NaCl flush IV Push every 8 hours * warfarin (Coumadin) 5 mg 1 T PO Daily PRN meds: Active meds * acetaminophen (Tylenol) 325 mg 1 tablet every 4 hours as needed (received 2/6/12 and 2/7/12) * MOA: inhibits COX-2 and release PG by inhibiting pyrogens in the hypothalamus * AE: nausea and pruritis * diphenhydramine (Benadryl) 25 mg 1 capsule PO QID PRN itching (received 2 doses on 2/7/12, 2/6/12) * antagonizes histamine at the H1 receptor * Fentanyl 25mcg/0.5ml IV push PRN pain (Cath lab) (Received 2/6/12, 3 doses on 2/7/12) * acts with the opioid mu-receptor in the CNS * depresses cough, may lead to N/V * hydromorphone (Dilaudid) 0.5mg/0.25ml IV push PRN pain (received 2/7/12) * opioid agonist * constipation, N/V * metoclopramide (Reglan) 10 mg 2ml Injection IV push every 4 hours PRN N/V (received 2/7/12) * promotes motility in the upper GI tract by sensitizing tissues to the action of
3. Insert your dissecting scissors or scalpel into the left auricle at the base of the aorta and make an incision down through the wall of the left atrium and ventricle, as shown by the dotted line in the external heart picture. Locate the mitral valve (or bicuspid valve) between the left atrium and ventricle. This will have two flaps of membrane connected to papillary muscles by tendons. Make observations and measurements of as many structures as you can, filling in your results table.
What causes ascites? The most common cause of ascites is advanced liver disease or cirrhosis. Approximately 80% of the ascites cases are thought to be due to cirrhosis. Most theories suggest portal hypertension (increased pressure in the liver blood flow) as the main contributor. The basic principle is similar to the formation of edema elsewhere in the body due to an imbalance