Nephrotic Syndrome Research Paper

Nephrotic Syndrome Research Paper
Nephrotic syndrome (NS) is a disease process marked by excessive loss of protein through the urine,
proteinuria, which leads to decreased serum albumin, resulting in decreased capillary colloid oncotic
pressure (COP) and then edema. Physiologically, the capillary COP drives fluid from the capillaries
into the interstitial fluid, only in amounts that can be drained by the lymphatic system. In nephrotic
syndrome, the plasma COP is so severely decreased, unmatched with interstitial COP, that fluid
flows from plasma to interstitial fluid in quantities that are too high to be removed by the lymphatic
system, culminating in the formation of edema. When the plasma COP begins to drop, edema can
also be caused by water and sodium retention, since the ... Show more content on Helpwriting.net ...
Successful treatment with diuretics that do not significantly affect the COP would also negate this
theory. Another theory posits that the capillary walls are pathologically changed to allow for more
movement of albumin into the interstitial fluid, so that a combination of sodium retention by the
kidneys and capillary permeability together result in edema (Doucet, Favre, & Deschenes, 2007). In
favor of the underfilling theory, sustained hypovolemic status incurred by the flow of fluid into the
interstitium can lead to acute tubular necrosis, which may be the cause of decreased GFR. The
overfilling theory is explained by decreased ANP that leads to an increase of cyclic guanosine 3',5'–
monophosphate phosphodiesterase (cGMP) (Cadnapaphornchai, Tkachenko, Shchekochikhin, &
Schrier, 2014). Increased levels of cGMP work in opposition to ANP and cause sodium retention as
well as increased plasma volume, which explains both the edema and why NS patients remain
normotensive in spite of functional hypovolemia (Ni, Safai, Rishi, Baylis, & Humphreys,
... Get more on HelpWriting.net ...

Chronic Kidney Disease
Pathophysiology
Chronic Kidney Disease: Chronic kidney disease (CKD) is an irreversible condition that progresses
causing kidney dysfunction and then to kidney failure. It is classified by a GFR of <60mL/min for
longer than 3 months. There are five stages of CKD: Stage 1 has kidney damage but has a GFR ≥
90. Stage 2 has mild damage and a GFR of 60–89. Stage 3 has moderate damage and a GFR of 30–
59. Stage 4 has severe damage and a GFR of 15–29. Stage 5 is also known as end stage renal disease
(ESRD), this is kidney failure with a GFR of ≤ 15 and theses patients are typically on dialysis or in
need of an immediate transplant. The leading cause of CKD is diabetes. Hypertension is also a
major cause. Since most DM patients have HTN, ... Show more content on Helpwriting.net ...
Drug therapy consists of; Lasix, antihypertensives, antiemetics, H–2 blockers, erythropoietin,
vitamins and electrolyte balancing agents (phosphate, calcium, V–D, Vit–B, and amino acids.
Dialysis is mostly the patient's only way of survival. Nutritional therapy is encouraging patients to
avoid ↑Ca and ↑ protein foods. Fluid restriction is important since the kidneys have a difficult time
excreting. If left untreated the patient would essentially die. The fluid overload combined with the
toxicity of the left over wastes would shut down the body's organs and death would occur.
Discharge needs: This patient needs an interpreter for Spanish to assist with discharge instructions.
He needs to be informed of the medications the MD discontinued, new meds that are ready to pick
up at his pharmacy, the co–pay involved for those medications, proper administration of the
medications, side effects and when to call the doctor if there are any adverse effects. He also needs
to be taught the importance of fluid restriction to 1500mL/day. This includes water, ice, gravy, soup,
ice cream, dairy, soda or other fluids. He needs to be shown an example of how much 1500mL of
fluid looks like and taught the importance of daily weights. This patient did not have a scale at
home, so he needs to be informed that there are scales available for low cost at a local store. Dietary
restrictions of potassium, calcium, phosphorus and protein should also be addressed. He

Cirrhosis Essay
Cirrhosis is the eighth leading cause of death in the United States and the thirteenth leading cause of
death worldwide.1 Cirrhosis is the irreversible fibrosis of the liver characterized by hepatic
architectural distortion secondary to fibrous tissue and the formation of regenerative nodules.2
These anatomical changes cause hepatic vascular resistance and an increase in blood flow leading to
portal hypertension. Porto–systemic collaterals develop in order to overcome the increased portal
pressure gradient.3 Nitric oxide, an endogenous vasodilator is also released in effort to overcome
portal pressure with the expense of causing systemic vasodilation and a decrease in blood pressure.
As a result, a marked activation of neurohumoral vasoactive factors occurs in an effort to maintain
an effective arterial blood pressure. Hypervolemia, increased cardiac index, decreased systemic
vascular resistance, and systemic hypotension are manifestations of portal hypertension.3 Chronic
hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholism, nonalcoholic steatohepatitis (NASH),
and non–alcoholic fatty liver disease (NAFLD) are all major causes of cirrhosis. ... Show more
content on Helpwriting.net ...
Decompensated cirrhosis is characterized by the development of a cirrhosis–related complication,
including variceal hemorrhage, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome,
and/or coagulopathies. For patients with compensated and decompensated cirrhosis, the risk of death
is 4.7 and 9.7 times higher than the general population, respectively.4 Survival in patients with
decompensated cirrhosis is considerably lower than that of patients with compensated cirrhosis. The
median survival times are as low as 2 years in decompensated patients and greater than 12 years in
compensated

Chronic Bronchitis Case Study
1. What clinical findings correlate with M.K.'s chronic bronchitis? What type of treatment and
recommendations would be appropriate for M.K.'s chronic bronchitis? Prior to discussing MK's
clinical findings and its correlations with chronic bronchitis, we must first have an understanding of
what this disease involves. Chronic bronchitis is defined as a chronic obstructive pulmonary
disorder (COPD) and is identified by "a hypersecretion of bronchial mucus and chronic or recurrent
productive cough of more than three months and occurring each year for two or more successive
years in a patient" (Copstead & Banasik, 2013). Furthermore, if you break down the words "Chronic
Bronchitis" the word "Chronic" stands for a condition lasting over a long period ... Show more
Putting the words back together, chronic bronchitis is the chronic inflammation and swelling of the
bronchial mucosa, which can lead to scarring and a variety of other clinical manifestations. This is
where we can correlate the clinical findings from MK's case study to the chronic bronchitis. Here we
find clinical manifestations such as chronic coughing with more severe fits in the morning with
sputum, excessive peripheral edema, light–headedness, distended neck veins, and increased night
urination. The most predominant symptom in chronic bronchitis is the chronic cough, which can last
over the course of three months successively for at least two years. This is a result of inflammation
of the bronchial mucosa which leads to hypertrophy and causes scarring to occur. The hypertrophy
then cause the over production of mucus which results in the chronic coughing as the body tries to
get rid of the excess mucus. MK states that she has been smoking for the past 22 years which points
to her experiencing smokers cough with more severe fits in the morning. This is explained due to
M.K. laying down overnight that can cause the mucus to build up and can

V02max Exercise
They found that a high ambient temperature caused significant decreases in cardiac output. This
failure to adequately increase cardiac output constitutes an important contributory factor limiting
sedentary, unacclimated men's capacity to exercise in the heat. Gonzalez–Alonso and colleagues
(Gonzalez–Alonso &Calbet, 2003) extended this knowledge and looked at the primary factors that
limit V02max in trained men in thermoneutral and hot conditions. They found a decrease in V02max
and time to fatigue in the hot condition compared to a thermoneutral environment.
In addition, cardiac output decreased before fatigue, whileheart rate was still rising. The authors
measured a decrease in the oxygen delivery and leg blood flow in the hot condition and ... Show
more content on Helpwriting.net ...
2010).
The size of the pitch will be 15 m wide and 25 m in length for the three–a–side game situation and
30 m wide and 40 m in length for the six–a–side game situation (Rampinini et al., 2007). Warm up
and cool down parts will be normally performed as parts of the general training session. The three–
a–side and six–a–side games will be conducted with two goalkeepers and free touches. A necessary
requirement for scoring goals will be that all players should be in the opponent's half. Coach
encouragement using standardized instructions is also allowed (Rampinini et al., 2007). Water
ingestion will also be allowed during the recovery periods of the game protocol.
The protocol is about to be performed during the mid–season, in a footsal field. The training
sessions will take place one to two times per week, during conditioning training, seperatelly from
tactics and tecnique

Fluid Management Journal Article
Angela Trejo
Med Surg 1329 – 202
July 27, 2015
Journal Article : Fluid Management
Nearly 60% of the human body is water. The daily fluid intake required for an adult to consume
should be about 2600ml. A healthy person's average daily fluid output is anywhere between 2600 –
2900ml, balancing out the daily fluid intake. Our bodily fluids are consistently moving to help carry
nutrients to the cells as well as it carries wastes away from the cells. Not everyone is able to balance
the fluids in their body making them either retain more or lose more than the fluid required. When
suspecting any fluid imbalance or seeing any changes, the client should seek for any medical help to
their primary health care provider to evaluate the patient and begin any treatment initiation if
needed. When trying to manage fluid balance in patients that are hypovolemic, Intravenous therapy
(I.V) may be used to administer solutions and/or medications to help maintain fluid balance if
needed. ... Show more content on Helpwriting.net ...
But the first symptom a patient will show when dehydrated is thirst. The patient is then encouraged
to increase their fluid intake. As fluid volume increases, the body then begins to lose fluid, primarily
through urination. Other components that contribute loss of fluid include bowel movement
elimination, exudation, and breathing. Fluid losses from sweat and the vapor from exhaled air are
referred to as insensible losses because they are unnoticeable and unmeasurable. (Timby, pg. 204)
However in certain situations if a patient is on a fluid restriction, or if the patient is NPO, meaning
they can't take anything my mouth, the patient may be put in an IV therapy called Total parental
nutrition (TPN), in which it allows them to meet their nutritional needs and replenish

Case Study on a Patient with Acute Renal Failure
Acute Renal Failure Patients who are diagnosed with acute renal failure go through difficult times
dealing with the disease. Their families too experience psychological difficulties, not knowing the
degree of suffering their loved ones are going through. Therefore, in order to provide the best of care
for the patient, nurses need to be knowledgeable about the problem, and find the best professional
way to educate the patient and family so that the patient does not end up into the hospital for re–
admission. Family members can best relate to the situation and understand what their loved ones are
going through if they are included into the care of the patients. You get a better outcome when you
treat patients as a whole. It is critical for nurses and other health care workers to provide patients
and their family members with the necessary information in order for them to make informed
decisions. Patient Description For the purpose of confidentiality, the patient will be identified by the
initials A. S. A.S was a 52– year old African American woman who was admitted to the hospital
when she started to experience severe urinary retention and shortness of breath. She has three adult
children and eight grandchildren, but recently lost her husband of 25 years to diabetes. The patient
appears to be very independent because she lives alone in her home and is aware of the disease
process. She has a past medical history of acute renal

Tenapor and Sodium Intake
The average American consumes more than double the daily recommendation of sodium. These
levels are above the upper limit that is considered to have no adverse effects on our bodies. The
CDC lists heart disease as the most common cause of death for Americans, as well as kidney disease
at number nine on the top ten causes of death. These are conditions that can be exacerbated by high
sodium levels. Not only that, but high blood pressure affects nearly 1/3 of Americans and chronic
kidney disease effects about 10% of the population. These are conditions in which reduced sodium
in take could be very therapeutic. Especially considering that these very common medical conditions
cost many billions of dollars a year to treat. Tenapanor has been developed to help meet the needs of
those who need to reduce their sodium intake.
Tenapanor acts on the twelve transmembrane protein channel known as the sodium hydrogen
exchanger 3 (NHE3) which work how the name would suggest. By binding to this channel
tenapanor blocks the sodium from being absorbed at the intestinal level which leads to it traveling
straight through the body instead of being filtered by the kidneys (Zachos et al., 2005). NHE3
channels are highly expressed on the apical regions of enterocytes, whereas related the related
sodium hydrogen exchanger 2 (NHE2) channels are more heavily expressed on the apical side
(Barbry and Hofman, 1997). This gives tenapanor a unique ability to regulate sodium levels at the
point where we

Pleural Effusion Research Paper
What is pleural effusion
Pleural effusion is known as a build–up of fluid between the layers of tissue that line the lungs and
chest cavity.
Below is a picture of what the lungs will look like with the excess pleural effusion present:
http://www.medicinenet.com/pleural_effusion_fluid_in_the_chest_or_on_lung/article.htm
There is usually the presence of 10–20ml of pleural fluid, this is lower in protein ( 15% above the
cutoff levels for Light's criteria.
ULN = upper limit of normal.
Data modified from Light RW: Pleural effusion. New England Journal of Medicine 346:1971–1977,
2002.
Whether a transudative pleural effusion is unilateral or bilateral it can be treated without extensive
evaluation, however exudative requires much investigation.
Other causes:
Cause Comments
Transudate
Heart failure ... Show more content on Helpwriting.net ...
Symptomatic effusions can be treated for reaccumulating or repeated effusions, by the process of
thoracentesis. The amount of fluid to be removed has no set limits, and the removal of fluid can
continue until the effusion is drained or the patient then develops chest tightness, chest pain, or
severe coughing.
For pleuritic pain NSAIDs can be given or other analgesics, on some occasions a short course of
oral opioids is given.
However effusions that are considered chronic, recurrent and causing symptoms is teated with
pleurodesis or intermittent drainage with an indwelling catheter. The effusions caused by cancer and
pneumonia however may require additional specific measures.
The actual prognosis however is mainly dependant upon the underlying disease. Complications may
present, these may be:
After thoracentesis there may be presence of air in the chest cavity (pneumothorax)
Lung

Your Kidneys during Acute Renal Failure
What happens when your kidneys fail? Acute renal failure is a disorder of the kidneys when it's
ceased to perform its functions. For example, the kidneys lose its ability to excrete wastes. When
your kidneys fail because of a disease or injury, wastes and extra fluid can build up in the blood and
make you sick. Kidneys will not be able to maintain homeostasis of electrolytes. A high level of
plasma potassium, sodium concentration, and elevated pH will be evident as well.
ARF can be arranged depending upon the underlying cause. Pre–renal is the disruption of flow to
the glomerulus. Decrease flow to the afferent arterioles can severely affect the nephrons ability to
perform its functions. This is due to an abrupt drop in blood flow because of massive
vasoconstriction in relation to decrease in volume. Intra–renal failure, however, is an actual damage
to the kidneys. Damage to the nephrons may be short–term that injury to the cells and nephrons are
not able to work. It could also be permanent where the damage to the nephrons is so severe that it
becomes completely dysfunctional. Despite the injuries, the nephrons are capable to restore itself
and recover once blood flow is brought back to normal. Post–renal is an obstruction beyond the
nephron. Blockage in the ureters, bladder, and urethra can cause buildup of waste products. An
example of this is BPH or benign prostate hypertrophy where the prostate gland gets so enlarged
that it causes disruption of urine flow.
History

Sodium Diet Benefits
A diet with two grams of sodium and 1000mls of fluid a day is a diet with limited sodium and fluid
intake. Sodium is a mineral found naturally in foods and is also added to foods. Sodium plays an
important role in maintaining normal fluid balance in the body. A two–gram sodium diet limits high
sodium foods. No table salt is allowed at meals or for cooking while you are on this diet. Even the
amount of milk is limited due to the amount of sodium it contains. A high sodium diet can cause
elevated blood pressure and worsen other health conditions such as poor liver function, heart
disease, kidney disease and weight gain from water retention. The goal of a two–gram sodium diet is
to prevent or lower high blood pressure, decrease water retention, and prevent kidney or liver
damage. To ensure the correct amount is consumed, it is important to read food labels. Reading food
labels is a good way to ... Show more content on Helpwriting.net ...
The purpose of this diet is to increase or decrease levels of electrolytes in the body due to a
malfunction in the body system. This type of diet may also be suggested in other diseases that cause
fluid retention or where excess fluids can complicate the disease such as edema, hypertension,
hypervolemia, hyponatremia, or hyperkalemia. A fluid restricted diet is commonly prescribed to
those with various diseases that involve retention or the body is unable to secret excess levels of
fluids and electrolytes. Excess fluid on the body can cause edema, which may restrict blood flow
and damage surrounding tissues. It may also build up in lungs which reduce the efficiency of the
lungs to oxygenate blood. Lastly, excess fluids increase blood volume which puts stress on both the
heart to circulate effectively along with the blood vessels by stretching them out and causing loss of
elasticity. Both scenarios can cause damage and

Massive Splenomegaly
Splenomegaly is a common finding in a wide spectrum of diseases. Massive splenomegaly,
however, always indicates underlying pathology. Massive splenomegaly is usually defined as a
spleen extending well into the left lower quadrant or pelvis orwhich has crossed the midline of the
abdomen. Massive spleens weigh at least 500 to 1000 g. the most common disorders associated with
splenomegaly were hematologic, infectious, hepatic, congestive, and inflammatory.1,2 Among
patients with massive splenomegaly, 31% had a hematologic disorder, 17% had hepatic disease, and
8% had infectious disease. Chronic leukemias were associated most frequently with massive
splenomegaly. The hallmark of CML isthe presence of a balanced translocation between thelong
arms

Symptoms And Treatment Of Infectious Diseases Essay
Mr. Brown, a 73 year old male with a medical history of a total hip replacement, was diagnosed with
a urinary tract infection (UTI). Experiencing a urinary retention immediately after the surgery he
was catheterised. The catheter was removed 24 hours later; however, the patient showed increasing
signs of confusion, urine appeared cloudy and had a strong smell (Ministry of Health, 2013).
Infectious Diseases Society of America (2015) states that UTI is a common risk factor associated
with a health–associated infection following a hip replacement surgery. In this case study firstly,
normal and pathological conditions will be summarized. Secondly, microbiology and infection
control will be outlined. Thirdly, the mode of action of the medication will be discussed and by
identifying the predisposing factors acquiring (UTI) disease case study will be finalised.
From the anatomical aspect, there are four systems in the human body performing excretory
functions by removing waste products; however, only the urinary system has a significant effect on
an individual's health and quality of life by finally not only adjusting water and ions balance to
required standards of homeostasis but also, performing work assemble by all parts of urinary tract in
order for normal maturation to occur. The urinary system or renal system consists of following
structures such as two kidneys left is higher by 1.5–2 cm then the right and perform filtering the
blood (Watt, 2014). Microscopic units of

Hypotension: A Case Study
7. Describe complications that can occur as a result of dialysis and identify nursing measures that
are designed to prevent these complications.
Hypotension
Hypotension that occurs during hemodialysis primarily results from rapid removal of vascular
volume (hypovolemia), decreased cardiac output, and decreased systemic vascular resistance
(Lewis, 2014, pp. 1122–1123). The patient may experience a drop in blood pressure during dialysis
process. As a result of cardiac ischemia the patient may also exhibit symptoms of light– headedness,
nausea, vomiting, seizures, vision changes, and chest pain. To combat these complications of
hypotension the volume of fluid being removed is decreased and administering 0.9% saline solution
through IV therapy (Lewis, 2014, pp. 1122–1123).
Muscle Cramps Muscle cramps are a complication associated with hemodialysis but, the
pathogenesis is not quite understood. The causes that evoke the development ... Show more content
on Helpwriting.net ...
This will help them plan according to manage times around ADLs and get them more involved with
proper medication management. Next, explain the risk of misuse of over–the–counter analgesics,
such as NSAIDS, and how they may further reduce kidney function and increase risk for chronic
kidney disease. Also, caution the patient about angiotensin–converting enzyme (ACE) inhibitors.
ACE inhibitors are commonly prescribed to prevent high levels of protein in urine (proteinuria) and
progression of kidney disease, especially in diabetic patients. (Lewis, 2014, pp. 1106–1107)
However, Ace inhibitors also have an adverse effect of decreasing perfusion pressure and causes
electrolyte imbalance of excessive potassium (hyperkalemia). As a caution, if diet modification,
diuretics, and sodium bicarbonate cannot control the hyperkalemia, ACE inhibitors may need to be
reduced or

Chronic Obstructive Pulmonary Disease ( Copd )
As a result of R.S.'s chronic obstructive pulmonary disease (COPD), he's going to be experiencing
the many consequences of his type B COPD, otherwise known as chronic bronchitis. Copstead &
Banasik (2013) states that the pathogenesis for chronic bronchitis has changes in the airways that
include swelling and chronic inflammation of the bronchial mucosa which can lead to scarring. In
addition, there is hypertrophy of mucosal glands and goblet cells, which leads to increased mucosal
production. In chronic bronchitis, there's also a hypersecretion of bronchial mucous (Copstead &
Banasik, 2013, p. 483). In normal conditions, the mucus produced by the mucus glands aids in the
protection of the lungs by capturing the foreign particles that enter into the lungs. Bellamy &
Booker (2004) report that when long–term smokers such as R.S., who are already developing
chronic airflow obstruction, the excess of hypersecretion of mucus contributes to the decline of lung
function. Long–term production of mucus may cause the patient to suffer lower respiratory tract
infection (p. 19). Chronic bronchitis' occurs in a period of more than three months that continues in
a period of two years (Copstead & Banasik, 2013, p. 483). The destruction of bronchial walls will
result in dilation of airway sacs. The dilated sacs contain infected secretion from streptococcal and
staphylococcal pneumonia, which can spread to nearby areas of the lungs such as other areas of the
body and even to the brain.

Neurogenic Caused Myocardium Case Study
Introduction
Neurogenic stunned myocardium (NSM) is a condition that neurogenic insults lead to transit cardiac
dysfunctions, which mimics the clinical presentations of acute coronary syndrome. It commonly
occurs in subarachnoid haemorrhage (SAH) (Nguyen & Zaroff 2009). Various names, such as
'broken heart syndrome', 'takotsubo', 'neurogenic stress cardiomyopathy' appear in literature to
describe identical mechanisms of NSM and indicate the same medical entity (Dande & Pandit 2013;
Guglin & Novotorova 2011). The detailed pathophysiology of NSM remains unclear. However, a
proposed theory of a catecholamine surge resulting from brain injuries, leading to overstimulation of
the sympathetic nervous system and ultimate cardiomyocytes death, has ... Show more content on
Helpwriting.net ...
More recent cases and retrospective reviews suggested that the ST segment elevation or depression,
T wave inversion and prolonged QT interval were commonly identified (Chin, Branch & Becker
2005; Malik et al. 2015; Shoukat et al. 2013; Waller et al. 2013). In addition, case studies claimed
that these observed abnormalities predominantly occurred in the anterior and lateral leads (Franco et
al. 2010; Waller et al. 2013), suggesting impaired ventricular repolarisation in a cardiac cycle. These
ECG patterns are commonly seen in patients with acute myocardial infarctions. However, in the
setting of SAH, the changes of ECG pattern were not associated with coronary obstruction (Banki et
al. 2006), but rather the reflection of autonomic dysfunctions that are induced by the neurological
insults.
Left ventricular dysfunction that leads to reduced ejection fraction (< 2.8 ng/mL that was associated
with NSM. In contrast, a couple of recent large studies suggested that the peak serum troponin I >
0.1 ng/mL within 72 hours of patients with SAH were associated with NSM (Kilbourn et al. 2015;
Malik et al. 2015). A high–sensitive troponin T may assist for early detection of cardiac leakage.
This is due to that cardiac enzymes might be released early after SAH, and thus have key values for
early identification for developing NSM (Oras et al. 2015). Although, creatine kinase –MB level
cannot distinguish the NSM and acute myocardial infarction

Hyponatremia Case Study
Administration inappropriate hypotonic intravenous fluid after surgery.
Sever malnutrition, in diet that depend on high water intake and low protein. This will limit the
ability of the kidney to handle the free water when there is decrease intake of solutes.
The compulsive intake of large amount of water will exceed the dilute capacity of the kidney which
is >20 L/d even if its with normal solute intake which is 600–900 mOsm/d.
NSAID may increase the risk of developing hyponatremia by inhibiting prostaglandin formation.
Prostaglandin reduction will increase NaCl reabsorption in the thick ascending Henle and ADH
action in the collecting duct which lead to impairment in free water excretion. [1]
Excessive fluid losses for example vomiting ... Show more content on Helpwriting.net ...
sodium is the most abundant electrolyte on the extra cellular fluid, and is a good indicator of water
body balance. Water always follow sodium.
2. The kidneys are responsible for execrating sodium from the body.
Hyponatremia occur when there is drop on serum level which is calculated as 2(Na) mEq/L + serum
glucose (mg/dL)/18 + BUN (mg/dL)/2.8. although its occur only when there is impairment on free
water excretion. [3]
Hypoosmolality (serum osmolality < 280 mOsm/kg) indicate excess in total body water relative to
the solute in the ECF as the water moves freely between Intracellular compartment and extracellular
compartment. This will cause imbalance which can due to solute depletion and solute dilution.
solute depletion: sodium loss corresponding to fluid loss. We see it in case of hypovolemia and it
will cause decrease blood pressure, weight loss, tachy pulse, dry skin, and low urine specific gravity.
solute dilution: low sodium level due to excessive water. We see it in case of hypervolemia and it
will cause high blood pressure, weight gain, rapid pulse and high urine specific gravity. [4]
When there is acute drop in serum osmolality, neuronal cell will swell because of water shifting
from extracellular compartment to intracellular compartment.

Enrolled Patient Study
Nursing interventions the Enrolled Nurse could do for a patient with fluid overload may include
reporting to the doctor, decreasing the IV rate or ceasing the IV depending on the Doctors orders,
regular monitoring of the patient's vital signs including listening to the patients lungs (Farrell &
Dempsey, 2014, p 153). Obtaining a daily weight of the patient, a weight measurement is a good
indicator of how much fluid is in the body when comparing the readings from day to day that may
be recorded in the progress notes as well as the observation chart. As well as placing the patient on a
fluid balance chart that monitors the amounts of fluids going in and out of the body over a period of
time. As the patient may have difficulty breathing position

Case Study : Congestive Heart Failure And Cardiomyopathy
Case Study 2 involves a geriatric patient, Mr. P., who is having difficulty managing his congestive
heart failure (CHF) and cardiomyopathy (GCU, 2013). For one to find the best way to help him, one
must have an understanding of his disease processes. This paper will briefly describe congestive
heart failure and cardiomyopathy. It will look at the nurse's approach to care and define a treatment
plan. The treatment plan will include methods for educating Mr. P. and his wife. Furthermore, a
teaching plan will be included with language the patient and the wife will understand.
Congestive Heart Failure and Cardiomyopathy
Understanding CHF is complex, but can be briefly stated as the "impaired structure and/or function
of the heart, leading to dyspnea and fatigue at rest or with exertion" (Francis & Tang, 2003, p. S14).
CHF is not a stand–alone disease, as there is always a cause. Francis and Tang (2003) list etiologies
such as coronary heart disease, hypertension that is not well–controlled, valvular heart disease, and
cardiomyopathies. Cardiomyopathy is a disease of the heart muscle (National Institute of Health
[NIH], 2015). Cardiomyopathies may be primary idiopathic, genetic, lymphocytic inflammatory
myocarditis, or stem from toxic chemicals such as amphetamines, cocaine, ephedrine, or
chemotherapy. Although we do not know the etiology, we can surmise his Mr. P's CHF is likely
related to his cardiomyopathy.
Approach to Care
With cardiomyopathy and CHF, caring for Mr. P. is

Clostridium Difficile
| | | | | Clostridium Difficile |
Clostridium Difficile The healthcare professional can expect to encounter various conditions within
their scope of experience. Clostridium difficile represents one of the most common and challenging
nosocomial infections that can cause life–threatening complications such as hypervolemia, sepsis,
pain, and peritonitis (Grossman and Mager 155). The recognition, diagnosis, treatment and
inhibition of transmission of this bacterium are imperative in order to limit infection and prevent
death. "Clostridium difficile is a gram positive, spore forming anaerobic bacillus, which may or may
not carry the genes for toxin A–B production" (Patel 102). In the 1930's, Hall and O'Toole ... Show
Contact precautions include: the patients being placed in private rooms, performing proper hand
hygiene with antimicrobial soap and water, using friction for 15 seconds, and using gloves and
gowns during patient care (Keske and Letizia 332). "One should also ensure adequate cleaning and
disinfection of environmental surfaces and reusable devices. The uses of both buffered and buffered
phosphate hypochlite solutions (bleach) have been shown to decrease the rate of C. difficile
contamination and helps in reducing Clostridium Difficile associated disease (CDAD) rates" (Patel
104). A patient diagnosed with CDAD, must discontinue the use of the prior antibiotics. "Excessive
antibiotic use and the lack of available treatment options remain major challenges in the prevention
and treatment of CDAD. Antibiotic use is both a risk factor for CDAD and the mainstay of
treatment" (Crawford, Huesgen and Danziger 934). The primary antibiotic treatment is determined
by the patient's white blood cell count (WBC). Metronidazole and Vancomycin are the most
common choices (Keske and Letizia 331). Current research has suggested that Fidaxomicin is well
tolerated and has been effective in patients who have presented with a recurrent CDAD.
Fidaxomicin is still in the clinical trial phase of

Essay on Mechanically Ventilated Patients, An Annotated...
Review of literature
Monnet et al(1) published a review article on assessment of volume responsiveness in mechanically
ventilated patients using heart and lung interactions. He explained that mechanical ventilation
produces cyclic changes left ventricular stroke volume due to inspiration and expiration induced
changes in LV preload. It denotes preload dependency of left ventricle indirectly right ventricle. He
also describes various limitations of respiration variations in SV for predicting fluid responsiveness.
Guidet et al(2) conducted a study in sepsis patients to find haemodynamic efficacy and safety
between 6%HES 130/0.4 vs 0.9% NaCl. He found that volume requirement was less with HES than
NaCl in inial phase of fluid ... Show more content on Helpwriting.net ...
He found that there was less colloid consumption, less hypotension episodes and lower lactate level
at end of surgery in vigileo group. He concluded that haemodynamic stability was better when SVV
was used a guide for fluid optimization.
Fiessel M et al(5) related fluid responsiveness and respiratory variation in inferior vena cava
diameter in mechanically ventilated patients with septic shock. He induced volume change by
loading patients with 8ml/kg of colloid solution. Changes in IVC diameter and cardiac output were
measured using echography before and after volume loading. 15% increase in Cardiac output post
volume loading were called as responders. 16 out of 39 pt responded to fluids and he has given 12%
delta IVC cut off for detection those volume responders.
Stawicki SP et al(6) studied the correlation between inferior vena cava collapsibility index(IVC–CI)
and central venous pressure(CVP). They used intensivist–performed bedside
ultrasonography(INBU) for assessing IVC–CI. They divided the patients into three groups based on
IVC–CI (<0.20,0.20–0.60 and >0.60). They concluded that IVC–CI correlate well with CVP in
low(<0.20) and high(>0.60) collapsibility ranges.
Nagdev et al(7) conducted a study to find that greater than or equal to 50% increase in caval index is
associated with CVP < 8 mmHg. The study was done among adult patients undergoing central

Congestive Heart Failure: A Case Study
1. Introduction: In this case study, there is a patient named Mr. Wilson who is a 70 years old man.
He stated that he had difficulty in breathing and caught a 'flu' a week ago. Currently, he has been
observed pitting oedema on his lower legs. In addition, the patient had history of heart attacks,
which has been diagnosed with congestive heart failure. The case study will provide a complete care
plan for the patient. Its aim is to provide a better quality of care for the patient as well as promoting
holistic treatment of the patient. The report will firstly assess the patient's condition by two nursing
assessment tools while offering rationale for choosing these assessment tools. The client's health
problems will then be identified and ... Show more content on Helpwriting.net ...
In addition, the client has already been observed oedema in lower legs. Therefore, fluid balance
chart, which can record intake and output of fluid, can help to integrate patient's health status. 3.
Client Health Problems: This section is to identify three client health problems the patient has and
sort by prioritization. 3.1 Impaired gas exchange. The most serious health problem that the client has
is impaired gas exchange. According to Sue Galanes (2007), impaired gas exchange is result from
the balance between ventilation and perfusion is offset by a certain condition which affects the
efficiency of the gas exchange. On account of client has congestive heart failure that can contribute
to dyspnea, which means the efficiency of gas exchange is decreased. One of the significant defining
characteristics of impaired gas exchange is dyspnea (Sabtu, 03 Agustus 2013). In addition, it was
hard for the patient to talk in long sentence due to difficulty in breathing. Hence, impaired gas
exchange is one of the health problems that the client suffered from. In regards of O2 is the basic
element that all of cells and organs need, it can be considered as a fuel of human body. Therefore,
impaired gas exchange is the most severe health problem the patient has currently. 3.2 Excess Fluid
Volume. The second health problem that the client has is excess fluid volume. Fluid volume excess
occurs from an increase in total body sodium content and an increase in total body water

Organic Compound
Inorganic and organic compounds are both necessary for the human body. The definition of an
inorganic compound is a compound that does not contain hydrocarbon groups. An inorganic
compound is composed of several other elements, such as salts, metals, and other elemental
compounds, but can contain hydrogen or carbon. If they have both, carbon and hydrogen molecules,
they are organic. Organic compounds are defined as compounds containing hydrocarbon groups.
Organic compounds will include things like the nucleic acids, found in DNA, lipids and fatty acids
found in the cells of living organisms, proteins and enzymes that are necessary for cellular processes
to take place, and more. There are numerous effects to the body if there are disturbances ... Show
Hypervolemia, hypovolemia, overhydration, and dehydration are four examples of disturbances in
water balance. Hypervolemia is an upsurge of too much blood plasma, causing an elevated volume
of blood. Hypovolemia is a decrease in the volume of blood in your body, which can be due to blood
loss or loss of body fluids. Overhydration is an excess of water in the body, while dehydration is a
deficiency of water in the body. Electrolytes are important minerals stored in very small amounts in
the body, which include: sodium, calcium, magnesium, and potassium. An electrolyte disturbance
can be caused by severe fluid loss through sweating and by certain health conditions, such as kidney
problems, diabetes, malnutrition, hormone disorders, and heart disease. Some consequences of an
electrolyte disturbance are dizziness, nausea, fatigue, or muscle twitching or spasms that continue.
The carbohydrates in foods are long chains of simple sugar molecules and must be broken down. If
an enzyme needed to process a certain sugar is missing, the sugar can accumulate in the body,
causing glycogen storage diseases. Glycogen storage diseases are caused by lack of an enzyme
needed to change glucose into glycogen and break down glycogen into

Describe The Maximisation Of Anticoagulation Of...
(Karmiova, 2001) and is predictive of subsequent multiple organ failure, infection and than
eventually death in these patients. These conditions have many features common with sepsis. Blood
concentrations of various cytokines, soluble receptors and endotoxins increase within as early as 3
hours after cardiac arrest, the magnitude of these changes is associated with the outcome. Activation
of blood coagulation without adequate activation of endogenous fibrinolysis is an important
pathophysiological mechanism that may contribute to microcirculatory reperfusion disorders
(Böttiger, 1995). For patients that undergo CPR and achieve ROSC, their
coagulation/anticoagulation and fibrinolysis/antifibrinolsis systems are activated. Anticoagulant
factors such as antithrombin, protein S and protein C are decreased and this decrease is associated
with transient increases in endogenous activated protein C after resuscitation (Adrie,2005). The
stress of total–body oxygen debt also affects adrenal production and function. Although patients
have increased plasma cortisol levels they have a relative adrenal insufficiency defined as failure to
respond to corticotrophin. This failure to respond causes the adrenal cortex to not be stimulated to
secrete the hormones necessary to respond to stress.

A Brief Note On Diabetic Ketoacidosis : A Potentially Life...
Reflection Paper: DKA Simulation
Pathophysiology
Diabetic ketoacidosis is a potentially life threatening complication found patient who have diabetes
mellitus.. Most often DKA, is the first presenting symptom in undiagnosed diabetics, illness in
diabetics, and/or poor compliance with insulin therapy. Diabetic Ketoacidosis Is an event marked by
shortage of insulin production, thus the body breaks down fat into ketone bodies to compensate for
needed energy production. The lack of insulin is compensated with increased glucagon levels from
the liver, osmotic diuresis occurs in which high glucose levels are excreted thought the kidneys
leading to polyuria, dehydration, and polydipsia. The ketone bodies cause the body to become
acidotic, the bicarbonate buffering system become overworked and hyperventilation (Kussmaul
respirations), this allows carbon dioxide to be released. This is when symptoms become apparent,
most often the patient will have vomiting, confusion, polyphagia, polydipsia, polyuria,
hyperventilation, abdominal pain, fruity breath and occasionally coma. DKA is diagnosed by blood
and urine test. The blood test will show an elevated Hemoglobin A1c; metabolic acidosis: plasma
pH under 7.35, plasma bicarbonate under 15 mEq/L, elevated blood sugar above 250 mg/dL,
abnormal sodium, chloride levels, hyperkalemia. Urine test will show elevated ketones, and glucose.
Diagnosis/Interventions
ϖ Deficient fluid volume related to osmotic diuresis due to hyperglycemia
¬

Nursing Reflection
Reflection of Performance Reflecting upon my performance during the CAPSTONE simulation, I
feel I did really well. After reading about the history of the patient, recent procedures, complaints,
and lab work I quickly determined he most likely had suffered a perforated bowel. However, I did
not limit my thinking to that specific ailment. Maintaining an open mind as a nurse is the only way
you can prevent overlooking something because you are not open to considering it. Keeping this
data in mind during the assessment however, other objective data started to cement my suspicions.
Symptoms such as elevated temperature, elevated heart rate, increased respirations, ridged board
like abdomen, and decreased blood pressure suggested hypervolemia or internal hemorrhaging,
symptoms that also happen to be consistent with a perforated bowel. After notifying the physician of
the history, labs, and assessment data further testing was ordered as well as a surgery consult, with
the expected perforated bowel and sepsis prevention being the focus. After the subsequent testing
confirmed perforated bowel, sepsis treatment was began and the patient ... Show more content on
Helpwriting.net ...
Is the benefit of routine colonoscopies worth the risk of a bowel perforation? According to Mueller,
et al., colorectal cancer (CRC) is the second–leading cause of cancer deaths in the United States.
Furthermore, due to CRC being asymptomatic until end–stage, routine screening is absolutely
paramount to detection if you want to have any hope in treating it.
So why use colonoscopies? Surely there are other ways of detection. There are indeed other less
evasive procedures such as a barium enema and computed tomography colonography (CTC).
However, the main advantage of colonoscopy verses other detection methods is the ability to
immediately remove early cancer during the procedure, in real time, as opposed to having a follow–
up appointment to do so. So how often is removal of these masses

A Brief Note On The Role Of Intervention
VASOSPASM IN SUBARACHNOID HAEMMORHAGE The Role of Intervention
INTRODUCTION Subarachnoid haemorrhage (SAH), is a significant healthcare problem. It is
associated with significant mortality and morbidity even after adequate treatment has been
delivered. One of the major causes for this poor outcome is the development of vasospasm from the
pathophysiological process itself. For those patients who have survived the initial bleed, it remains a
challenge to ward off the effects of vasospasm. Various interventional and medical strategies have
been advanced to alleviate or minimise the effect of vasospasm, but are they really effective? An
attempt at answering this question will be made in this review of this terrible and life threatening
illness. CASE A 40 yo female presented to the emergency department of our institution with a two
hour history of a sudden onset of severe global headaches. This was associated with two episodes of
vomiting and photophobia. She had no complaints of loss of consciousness or lateralising weakness.
On examination she had a Glasgow Coma Score (GCS) of 15 with no neurological deficits. A non
contrast Computed Tomography (CT) Brain (Fig1) showed extensive subarachnoid blood in the
Sylvian fissure and basal cisterns. A CT angiogram showed a left posterior communicating (PCOM)
artery aneurysm. The patient was commenced on Nimodipine , intravenous crystalloids, blood
pressure control by titration with hydrallazine. A digital subtraction

Patient C. Z Case Study Nursing
Patient C.Z. was a 64 year old female who presented to the Emergency Department (ED) with acute
chronic heart failure (CHF). Prior to her arrival, the patient had been seen by her primary care
provider (PCP) for a routine visit. Due to the patient's poor status, the PCP sent her to the emergency
department (ED) of Christiana Hospital. Upon arrival to the ED, the patient's chief complaint was
difficulty breathing; this was evidenced by the patient stating she could not breathe. As part of her
treatment plan for CHF, patient C.Z. explained she had been prescribed 40 milligrams (mg) of
furosemide (lasix) to relieve symptoms related to hypervolemia which often accompanies CHF; her
presenting condition corroborated that the prescribed lasix had

Environmental Factors Affecting The Disease Essay
have the second and consequent attacks after exposure to infection. Environmental factor–The
disease is seen throughout the year, but higher incidence is reported during rainy season and
increased fly breeding in June–September, because the disease is spread mainly due to flies. Social
factor–Drinking water or milk and food contaminated by intestinal contents of the patients or
carriers or by flies which often transmit the disease. Eating unwashed and uncooked vegetables are
good source of infection. Symptoms and signs The disease is characterized by a continued, high
inflammation of the intestine, formation of intestinal ulcers, haemorrhage and enlargement of spleen
can occur, Payer's patches or fiat patches of lymphatic tissues situated in the small intestine but
mainly in the ileum are the seat of infection in typhoid fever. The patient may complain of diarrhoea
or constipation and severe stomach ache. Abdominal absorption of nutrients is decreased and the
patient may feel headache and anorexia. Sources of infection : The main source of infection is the
faeces and urine of the case and the carrier and indirect cause may be food, fly, finger, fomite, fluids.
Mode of trajismjssioa : The typhoid is spread through faeco–oral or urine oral route. The disease
spreads through contaminated hands, by urine or stool of case or carrier or indirectly by ingestion of
contaminated food, water, milk through flies or any other means. Treatment Chloramphenicol is the
drug of choice

Aneurysm Case Studies
In the case of this patient, the patient has been admitted after an abdominal aortic aneurysm (Jim &
Thompson, 2015). An abdominal aortic aneurysm can happen because of the wall surrounding the
aorta is compromised and becomes weak (Jim & Thompson, 2015). When the wall is compromised,
the blood can seep out and create issues, therefore the aneurysm is seen (Jim & Thompson, 2015).
There are many risk factors that may increase the chances of having an abdominal aortic aneurysm
such as smoking, hypertension, other aneurysms and being male (Collins, 2013). In order to assess
the aneurysm, there are 2 lab tests that need to be performed to get an accurate understanding and
those are the pulmonary artery pressure, or PAP, and the pulmonary artery wedge pressure, or PAWP
(Silvestry, 2015).
In order to perform the tests accurately the test must be zeroed, or setting it back to where nothing
else can intervene with the testing (Silvestry, 2015). The test must also use referencing, or the ability
to have a starting line when the test is concluded. The reference is something to compare to,
therefore, creating a value that can be used as a comparison (Silvestry, 2015). It is also important
when performing these tests that the placement is ... Show more content on Helpwriting.net ...
These values are important to have to understand the severity of disease process that is causing the
problem. For the PAP value, the result should be between 10 and 22 (Silvestry, 2015). This range is
important because any value outside of this range can signify a more serious disease process such as
a myocardial infarction, and possibly a form of stenosis (Silvestry, 2015). When looking at the
PAWP value the result should be between 6 and 15 (Silvestry, 2015). This value is also important
because this test can show a disease process such as hypervolemia (Silvestry, 2015). Both values
should be decreased with the patient having hypovolemia (Silvestry,

Ap Case Study Psychology
What clinical findings are likely in R.S. as a consequence of his COPD? There are many clinical
findings the R.S is likely to be faced with as a result of his COPD. Due to the inflammation and
swelling of the bronchial mucosa as a result of the COPD the R.S. will have an irreversible
productive cough. His cough will be accompanied by dyspnea, wheezing, and large amounts of
mucus collecting in the bronchioles. This is caused because the lining in the bronchioles are
constantly irritated and become inflamed. Mucus forms in the airways which make it harder to
breath. The R.S. will wheeze when breathing. The R.S. is likely to have chills, muscle aches, and
fatigue associated with the pneumonia. These are just the outward signs and symptoms. ... Show
Interpret R.S.'s laboratory results. How would his acid–base disorder be classified? What is the most
likely cause of his polycythemia? The R.S. laboratory results show the patient is suffering from
respiratory acidosis with a metabolic compensation. The PH is decreased from the normal 7.4, his
PaCO2 is elevated from the normal range of 34–45 mm Hg, and his O2 is elevated from the normal
range of 24–30 mm Hg. his elevated PaO2 indicates that he has a metabolic compensation. The
body does not like to be in acidosis therefore it will start to correct the problem through
compensating by promoting the kidneys to produce more metabolic acid to help restore the balance.
His hematocrit is 52% which is elevated from the normal 45% in men. The polycythemia occurs due
to the presence of hypoxemia due to his COPD. The body will produce more red blood cells to
attempt to increase the amount of O2 being delivered to the body tissue. 4. What is the rationale for
treating R.S. with Theophylline and a ß2 agonist? According to an journal publication on the
benefits of Theophylline "It is now apparent that patients taking theophylline may enjoy clinically
important benefits in terms of functional status and quality of life, beyond simple bronchodiolation,
as a result of theophylline's impact

COPD Case Study Essay
What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ
from those of emphysematous COPD? Patients that do have chronic bronchitis ( B COPD) typically
exhibit shortness of breath on exertion, excessive amounts of sputum, chronic cough, and evidence
of excess bodily fluids (edema, hypervolemia). Chronic cough tends to be most severe in the
mornings, is productive, and occurs for more than 3 months and occurring each year for at least 2
consecutive years. In addition, patients tend to complain about chills, malaise, muscle aches, fatigue,
loss of libido, and insomnia. Smoking is also a typical clinical manifestation and is the leading cause
of B COPD (accounting for 90% of cases). Late signs include right–sided heart ... Show more
is stated to have a history of prolonged smoking, a leading cause of B COPD. R.S. has a PaO2 of 50
mm Hg and PaCO2 of 60 mm Hg, showing elevated PaCO2, and decreased levels of PaO2 that are
consistent with that of B COPD. Patient is taking inhaled β2 agonists and theophylline which are
treatments of COPD. Since R.S.'s PaO2 is less than 50 mm Hg, it is recommended that R.S. be
treated with low–dose oxygen therapy. Since PaO2 is decreased in R.S., excess strain on the heart
would occur in order to move oxygen throughout the body which could go along with coronary
artery disease and peripheral arterial vascular disease as these are diseases of the arteries and arteries
pump oxygenated blood away from the heart. Smoking is also a possible involvement of coronary
artery disease and peripheral arterial vascular disease. Coronary artery disease and peripheral
arterial vascular disease are usually caused by atherosclerosis of coronary arteries unrelated to
COPD. Additionally, patients with B COPD often exhibit bacterial colonization that causes
pneumonia. Since R.S. has an area of consolidation in his right lower lobe that is thought to be
consistent with pneumonia, patient is as risk of

emazariegos case study 04 030115 Essay
Module 08 Case Study: Urinary System and Electrolyte/Acid–Base/pH Balance
Each question is worth 1 point, unless otherwise noted.
I Got To Micturate: Part I–"Mini Case Studies" Questions
Case 1: Frank Johnson
1. How does the urinary system relate to sexual function in males? How does the prostate relate to
the bladder infections in males?
The reproductive system in the male is closely intertwined with the urinary system, both
functionally and anatomically. The male reproductive system is so closely linked with the urinary
tract, that urinary health is important for optimum sexual health in the male. When the prostrate is
enlarged it can cause a urinary bladder infection in males.
2. On Frank's follow up examination, what are some ... Show more content on Helpwriting.net ...
If so, how?
The initial symptoms are urine incontinence, difficult urination, and a strong urge to pee but very
little being released. Yes these symptoms can be caused from pregnancy because hormonal changes
can cause blood to flow more quickly through the kidneys causing the bladder to fill much quicker.
13. What does Debbie's test results indicate?
Because of the positive nitrite and small amount of leukocytes I would say that could indicate a
urinary tract infection.
14. What symptoms were concerning that Debbie developed after her initial doctor's visit?
Debbie's fever, the chills and the nausea are all very concerning symptoms. |
15. What do these new symptoms possible indicate with Debbie?
The lower back pain could indicate a possible kidney infection, which is why I believe the doctor,
told her to rush to the hospital.
16. Why could this be a possible medical emergency for Debbie?
A kidney infection if not treated quickly and properly can permanently damage your kidneys or the
bacteria can spread to your bloodstream and cause a life–threatening infection.
17. How is this condition treated during pregnancy?

Although it is preferred that pregnant women do not take medications because of the affects it could
have on the baby, there are a number of antibiotics that are effective in treating kidney and urinary
tract infections that are known to be safe for both mother and baby. Such antibiotics are cephalexin,
ampicillin, and

Congestive Heart Failure Research Paper
Congestive Heart Failure Heart failure HF is a condition involving the heart muscle that is unable to
pump enough blood through the body to meet its oxygen needs. HF is associated with conditions
such coronary artery disease, myocardial infarction, anemia, infection, thyrotoxicosis,
hypothyroidism, dysrhythmias, bacterial endocarditis, pulmonary diseases, Paget's disease,
nutritional deficiencies and hypervolemia. HF main characteristic is ventricular dysfunction, usually
left–sided heart failure develops first causing intolerance to exercise, reduction of quality of life and
short life expectancy (Lewis, 2014).
In the States approximately 5 million people have HF. Also, The American Heart Association
(AHA) estimates that 550,000 new cases

Endocrinology
Endocrinology In the endocrinology department, you would see an endocrinologist. An
endocrinologist diagnose diseases related to the glands or certain types of cancers. In the department
of endocrinology, we see patient both males and females of all ages. Our most common cases
includes type 1 diabetes, type 2 diabetes, hypercalcemia, hyperkalemia, hypervolemia, glycosuria,
hyponatremia, obesity, pancreatic cancer and thyroid carcinoma.
To help us diagnose what is wrong with you, we do things such as a 24–hour urine collection test,
CRH Stimulation Test, and Five–Day Glucose Sensor Test (For Diabetes). Other common
procedures we use are thyroid scan a procedure to assist in diagnosing, hypothyroidism, thyroiditis,
thyroid nodules, and thyroid cancer. Last but not least a bone density test X–ray that can access your
bone. All in all endocrinologist ... Show more content on Helpwriting.net ...
The neurologist is a medical doctor who specializes in treating disorders of the nervous system. It
has two major divisions central nervous system the brain and spinal cord, peripheral nervous system,
and sensory receptors. In the department of neurology, our most common causes include
Alzheimer's disease, coma, spina bifida, closed head trauma, dementia, concussion, and intracranial
tumors.
To help us diagnose what is wrong with you, we do things such as angiography, biopsy, brain scans
diagnose tumors, echocardiogram, and what we all know computed tomography (CT scan) painless
loud machine that scans image of bones, cancer, and more. All in all neurologist treat disorders that
affect the brain, sclerosis, and most of all on a personal level strokes. I had two strokes last year and
I'm only 29 and my neurologist helped me and changed my life. We need more neurologist working
in the hospital and just around in general. They play an important role in the nervous system, brain,
and many more areas that we use in our everyday

Questions On Nursing And Discharge Planning
Name: J.L. Code Status: DNR Age: 67 Gender: Female Ethnicity: Caucasian Allergies: NKA
Occupation: Hygienist Current weight: 149.7 kg Chief complaint: "I began having shortness of
breath, I couldn't breath." Medical diagnoses: Pulmonary hypertension Patient Education &
Discharge Planning Patient will not be discharged anytime soon. But she is informed through the
nurse and doctors that an increase in her oxygenation might be prescribed if experience any
symptoms of shortness of breath will at home. Nutritional/ Diet: She is on a regular diet. At the
moment she is on fluid restrictions. But having a nutritionist speak to her about decreasing her
intake of sodium will help relieve some of the edema. Social worker: The social worker came to
speak to her about the possibility of being transferred to nursing home or have assess to home
health. Developmental Stage Integrity versus Despair J.L. is a 67 year–old Caucasian, female. Under
the Erikson's stages, she falls under the integrity versus despair stage, where many adults review
their lives with a sense of satisfaction, even with their inevitable mistakes (Perry, Stocker, Hall,
2013), she stated to being proud of having two professional children. She worked hard to raise them
good. Pathophysiology/Health history Diabetes Mellitus Type 2: is a chronic disorder where the
pancreas is unable to produce enough insulin, or the body does not have the ability to use up the
insulin it produces, or both, resulting in

Applying Standardized Terminology in Nursing Essay
Applying Standardized Terminologies in Practice
Chamberlain College of Nursing
NR 512: Nursing Informatics
Fall 2014
Introduction
As a result of the introduction of computer technology and the combination of evidence–based
practice in nursing; standardization of terminologies has become imperative in the classification of
nursing diagnosis, interventions and expected outcomes. The most popular and successful systems
are the North American Nursing Diagnosis Association International (NANDA–I), Nursing
Outcomes Classification (NOC), and Nursing Intervention Classification (NIC) (de Lima Lopes, de
Barros, & Marlene Michel, 2009). This paper aims to provide a brief outline of these standardized
terminologies (STs) as they relate to a ... Show more content on Helpwriting.net ...
Nurses should take care to select the proper outcomes to ensure optimum care is provided to patients
with CHF. The plan of care is dependent on the nursing diagnosis and the desired nurse–sensitive
outcomes. The priority NOC outcome for the diagnosis of CHF is Fluid Balance and Fluid Overload
Severity. Other related NOC outcomes are Knowledge: Cardiac Disease Management, Knowledge:
Energy conservation, Knowledge: Medication, Knowledge: Prescribed Activity, Knowledge:
Treatment, and Knowledge: Weight Management (Johnson et al., 2012). These are only a select few
of the multiple outcomes available; care should be modified as the disease progresses through the
problems which evolves over the lifetime of patients diagnoses with CHF. Once all these
determinants are established, the nurse will be prepared to determine which level of NOC is
essential to effectively manage the disease.
Nursing Intervention Classification
Nursing interventions are focused on nursing behaviors to guide the patient in the direction of the
most preferred outcome (Johnson et al., 2012). Fluid management, fluid/electrolyte management,
and hypervolemia management are the major interventions in effective management of CHF. Fluid
management is the most difficult intervention for all patients suffering from CHF. Evaluation of the
patient's ability to make the appropriate lifestyle changes required to

Oliguric Phase
b) Oliguric Phase: This stage is where our patient, Paul is in. Oliguria is usually present in most of
the patients with worse cases of acute kidney injury. In this stage, the patient produces less urine
than normal (less than 100 milliliters) and they become anuric. As the volume of urine excreted
reduces, the rate at which metabolic waste products are stored is increased and this causes
imbalances in electrolyte levels. This will cause hypervolemia, edema and high blood pressure.
During assessment, presence of distended jugular veins is seen, which indicates fluid overload. Also,
weight gain, crackles in the lungs can be heard and signs of heart failure can also be seen. White
blood cells, red blood cells and casts can also be seen in the

The Failure Of Heart Failure
ABSTRACT
Heart failure is one of the leading causes of mortality, both globally and in New Zealand. It is
defined as the inability of the heart to meet the bodies metabolic need for oxygen and is
characterised by a decrease in cardiac output. The body has many intrinsic mechanisms to attempt to
maintain cardiac output, including activating the renin–angiotensin–aldosterone system (RAAS).
The RAAS cascade acts to restore cardiac output by increasing fluid retention, thus increasing blood
volume and pressure. Unfortunately, in decompensated heart failure, this is not enough to re–
establish cardiac output, causing the action of this system to be upregulated and blood volume to
increase further. This is detrimental to the already failing heart. A new drug, aliskiren, affects the
pathophysiology of hypertension and heart failure by directly inhibiting renin, a mechanism that is
distinct from current therapeutic agents that also target the RAAS, such as ACE inhibitors and
Angiotensin II Receptor Blockers. This gives potential benefits by blocking the RAAS further
upstream. However, clinical trials have failed to demonstrate the predicted benefits of aliskiren.
Taking this into consideration, there is a strong possibility for development of further direct renin
inhibiting agents displaying a higher potential therapeutic index for the treatment of hypertension
and heart failure. In order to thoroughly discuss the potential benefits of aliskiren in relation to
hypertension and heart

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