Sim Prep-Nursing Essay

Sim Prep-Nursing Essay
1. What is an obstructive lung disorder?
COPD– preventable and treatable disease state characterized by chronic airflow limitation that is not
fully reversible. The airflow limitation is usually progressive and associated with an abnormal
inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette
smoking.
2. What should the nurse consider when giving oxygen to the patient with an obstructive lung
disorder and why?
–02 has an irritating effect in mucous membranes and dries secretions, therefore it is important that a
high liter of flow of 02 delivering 35–50% be humidified when administered.
– Periodic reevaluations are necessary for the patient who using chronic supplemental O2
–Most patients ... Show more content on Helpwriting.net ...
prevention of disease progression. 2. ability to perform ADLs and improved exercise tolerance. 3.
relief of symptoms. 4. no complications related to COPD. 5. knowledge and ability to implement a
long–term treatment regimen, and 6. overall improved quality of life.
Teaching– Overall guide, what is COPD, breathing and airway clearance exercises, energy
conservation techniques, medications, correct use of medications, psychosocial/emotional issues,
management plan, health nutrition.
4. How does a nurse know when a person is experiencing respiratory failure?
Fever, increased cough and dyspnea, or other symptoms suggestive of exacerbation
–Use of B–adrenergic blocker may also exacerbate respiratory failure
–Use of indiscriminate sedatives, benzos, and opioid's, especially in post–op patient who retains
Co2, may suppress the ventilator drive and lead to respiratory failure
5. What does it mean to be in acute respiratory failure?
It results when one or both of these gas–exchanging functions are inadequate . It is not a disease but
a symptom of an underlying pathology affecting lung tissue function, 02 delivery, cardiac output, or
the baseline metabolic state. It is a condition that occurs because of one or more diseases involving
the lungs or other body systems. Symptoms of this is hypoexia and hypercapnia.
6. What are the
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Explain The Basic Process Of The Respiratory System
Explain the basic process of the respiratory system from initial respiration through gas exchange.
➢ Inhaled air enters the nasal cavity, where it is cleaned, warmed and humidified on its way through
the pharynx.
➢ After leaving the pharynx, air enters the ;larynx, where two pairs of ligaments, together with the
mucosa covering them, forms the vestibular and vocal folds. These folds help prevent foreign
particles, including food, from entering the lower respiratory system.
➢ Air next enters the trachea, which divides into two primary bronchi. As the bronchi enter the
lungs they continue to divide into smaller bronchi, and ultimately into terminal bronchioles.
➢ Each terminal bronchiole divides repetitively to form respiratory bronchioles, alveolar

Describe The Difference Between Right Atrium And Right...
The heart is made up of four chambers, two atriums and two ventricles. The right side of the heart
receives deoxygenated blood and pumps the blood to the lungs, whereas the left side of the heart
receives the oxygenated blood from the lungs and pumps it to the rest of the body.
The right side of the heart consists of the right atrium and right ventricle. The right atrium receives
the deoxygenated blood via the vena cava (both the inferior and superior) from the rest of the body.
The blood then travels through the tricuspid valve into the right ventricle where it then gets pumped
to the lungs, where gas exchange can occur. The chambers on the left side of the heart are the left
ventricle and atrium. The left atrium receives the oxygenated blood from the lungs via the
pulmonary vein. It is then pumped through the atrioventricular valve into the left ventricle, where it
is pumped through the aorta and to the rest of the body. One adaptation of the heart is the thickness
of the walls. The ventricles have thicker walls than the atria as blood gets pumped out with higher
pressures. The left ventricle is even thicker as it must withstand the ... Show more content on
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The contraction, known as systole, pumps blood out of the heart. The relaxion phase, diastole, is
when the heart muscles relax, and fill will blood. These cause the stereotypical heart sounds, 'lub'
and 'dub'. The 'lub' occurs when the atrioventricular valves close, and the 'dub' when the semilunar
valves close.
An athletes heart has some slight adaptations that make it more efficient. In response to endurance
training, both the right and left ventricles expanded. For strength athletes, the muscle of the heart
thickened, but only for the left ventricle. These adaptations cause the heart to pump blood more
effectively as the myocardial contractions are more forceful, and the filling and ejection of blood
from the heart chambers is

What Is Deoxygenated Blood?
The heart is a muscular organ in charge of pumping blood to all parts of the body. As the heart
contracts, the blood is forced out through blood vessels and begins to follow a specific pathway. The
blood makes it way through pulmonary circulation (to the lungs) and then through systemic
circulation (the rest of the body).
Deoxygenated blood enters the right atrium through the superior and inferior vena cava. It then is
transported to the right ventricle through the right atrioventricular valve (tricuspid valve). The
ventricles contract and the valve closes so that blood does not flow back into the atrium. As the right
ventricle contracts, it forces the deoxygenated blood through the pulmonary semilunar valve and
into the pulmonary artery.

Pulmonary Arterial Hypertension ( Ph )
Pulmonary Arterial Hypertension (PAH) belong to group 1 in the classification of Pulmonary
Hypertension (PH). It is a chronic progressive disease caused by narrowing of the minor pulmonary
arteries due to vascular proliferation and remodeling.
Figure 1: Changes occur in blood vessels in PAH.
The estimated prevalence for PAH is 15–50 cases per million although it is a rare disease. The
female to male ratio is 1.7:1 with higher prevalence between 30–40 years old. To date there are 52
cases per million population of Scotland diagnosed with PAH. (1)
The current treatments available for PAH are prostaglandin (PG), calcium channel blocker (CCB),
Endothelin Receptor Antagonist (ERA), and Phosphodiesterase–5–inhibitors (PDE–5–I). The need
for new drug therapy is due to the drawbacks of the current treatment as shown in the tables below.
(3) This has led to the development of Opsumit (Macitentan), a new drug therapy for PAH.
Table 1: Drawbacks of using Calcium Channel Blocker (CCB) in PAH
Calcium Channel Blocker (Nifedipine, Diltiazem) The proportion of patient benefited from this drug
is too little.(2)
Table 2: Drawbacks of using Prostaglandins (PGs) in PAH
Epoprostenol I.V Iloprost nebulized Treprostinil S.C
– Inconvenience administration through IV route which requires hospitalization
– Unpresentable body image
– Administration of the drug might be associated with high risk of infection (need to be given
through continuous I.V infusion due to short half–life)

Enoxoparin Sodium Injection ( Low Molecular Weight Heparin )
Lovenox (Enoxoparin Sodium Injection) Classification: Anticogaulant (Low Molecular Weight
Heparin)
MW: 1134.899 g/mol pKa1 –2.4 pKa2 –4.4
Chemical Formula: C26H42N2O37S5 IUPAC name 6–[6–[6–[5–acetamido–4,6–dihydroxy–2–
(sulfooxymethyl)oxan–3–yl]oxy–2–carboxy–4–hydroxy–5–sulfooxyoxan–3–yl]oxy–2–
(hydroxymethyl)–5–(sulfoamino)–4–sulfooxyoxan–3–yl]oxy–3,4–dihydroxy–5–sulfooxyoxane–2–
carboxylic acid Description
Enoxaparin is a highly acidic mucopolysaccharide. It is an anticoagulant drug that is used primarily
for prophylaxis of deep vein thrombosis (DVT) or for patients that exhibit pulmonary embolism
(PE) that have underwent specific surgery. Enoxaparin functions as a serine–type endopeptidase
inhibitor and targets antithrombin–III. It binds to it and creates a vertex that irreversibly inactivates
clotting factor Xa. Enoxaparin binding to antithrombin–III also accelerates the activity of
antithrombin–III which is a serine protease inhibitor that modulates the activation of blood
coagulation. Enoxaparin inhibits the production of prothrombin to thrombin. Antithrombin–III
inhibits thrombin, factors Xa, IXa, and XIa, as well as matripatase–3/TMPRSS7. With the presence
of enoxaparin its inhibitory activity is increased greatly. With the Xa being catalyzed by the
attachment of enoxaparin, the translation of prothrombin to thrombin is decreased.

Types And Classifications Of Pulmonary Hypertension
Abstract Pulmonary hypertension is a disease that without treatment becomes progressively worse
until a patient dies. It is characteristically a disease of young adults, but may occur all across the
lifespan making this disease even more devastating.1 Pulmonary hypertension is characterized by
elevated intrapulmonary pressures which cause dynamic changes to the cardiovascular system of the
affected individual. The adequate functioning of the cardiovascular system is vital to the survival of
the patient so while treatment is rarely curative, with the exception of organ transplant which will be
discussed later, the main goal of medical therapy is to optimize cardiovascular functioning and stop
disease progression allowing people living with this disease the best possible quality of life and
level of functioning. There are several types and classifications of pulmonary hypertension with
multiple pathogenesis. Different treatment modalities have been proven effective to treat this disease
process; the mainstay of treatment relies heavily on pharmacologic therapies. Pharmacologic
treatments include drugs in the following pharmacological classes: calcium channel blockers,
prostacyclins including synthetic prostacyclins and prostacyclin analogues, endothelin receptor
antagonists, and phosphodiesterase inhibitors. While pharmacologic therapies are the mainstay of
treatment, heart and, or lung transplant maybe available for a specific subtype of PH, primary PH.
Organ transplant is

First Blue Baby Surgery Analysis
that Thomas trains him throughout the first Blue Baby surgery over the protests of Hopkins
management. The movie is relevant to what we did in Biology 2060 class on the Heart, the center of
the Cardiovascular System. The mainly common reason of blue baby syndrome is congenital heart
defect that is present at birth. The heart is composed of two sides, the right side and the left side.
Each side of the heart has two chambers, a superior chamber for receiving blood also known as the
atrium and inferior chamber for pumping blood away from the heart also known as the ventricle.
This makes up the four chambers of the heart. The left ventricle must produce a force adequate to
push blood through the systemic circulation. Therefore, the

SCD Compliance
Change is a hard concept for most, but change in the hospital setting can be beneficial for both staff
and patients. According to Mclean (2011), "Every change begins with an ending" (p.79). How
people respond to change can make the process easy or hard depending on how the change is
presented.
Sequential Compression Devices (SCD's) mechanically replace normal muscle motion in the leg via
a cuff that inflates and deflates uniformly. This mechanical inflation and deflation keeps blood
flowing in the veins and prevents the formation of clots that can result in deep vein thrombosis
(DVT) or pulmonary embolism. SCD's are used as prophylaxis in patient groups with low to
moderate risk of DVT (Brady et al., 2007, p. 256). Patient compliance ... Show more content on
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Studies to show which type of leg compression device is optimal for DVT prevention are not
available. Knee–length SCD's are more comfortable to patients, encourages higher levels of
compliance and also provide beneficial prophylaxis against DVT.
An informal survey of perioperative nurses, physicians and patients was performed regarding the
use of thigh–length versus knee–length SCD's. The surgical services management team, clinical
nurse educator, surgeons, and materials management were also involved in the process of using only
knee–length SCD's on all surgical patients. The surgeons, staff, and patients were perceptive and
willing to use only knee–length SCD's. The perioperative nurses were hesitant at times to call the
physician for an order to place knee–length SCD's on the surgical patient. This was a barrier to the
suggested change project.
Havelock's model of change will be used for this project. Perception of need, diagnosis of the
problem, identification of the problem, devising a plan of action, gaining acceptance of the plan,
stabilization, and self–renewal are all steps included in Havelock's model of change (Kearney–
Nunnery, 2012). Leadership is also an important part of the change process. In order to have a
positive outcome, the leader must incorporate the staff in the change process.
Providing clarity about the change can improve the transition process. According to Mclean (2011),
leaders

Acute Respiratory Stress Syndrome Essay
Acute Respiratory Distress Syndrome (ARDS) is a medical condition that is capable of affecting a
person of any age, which is usually characterized by the development of a serious condition of
health. Accordingly many of the affected persons are usually admitted to medical facilities when
such conditions develop. For a long time, many believed that the disease is caused by sepsis and
shocks. However, ARDS is defined by an acute onset of hypoxemia, bilateral pulmonary edema of
non–cardiogenic origin, and reduction in respiratory system compliance.1–3 Therefore, ARDS has
the characteristics of non–cardiogenic pulmonary edema and severe hypoxemia.1 This disorder is a
rapidly progressive form of acute respiratory failure.1 During World Wars, many doctors noticed
that patients had a condition, which hosted symptoms such as severe pancreatitis, non–thoracic
injuries, massive transfusion, sepsis, and other conditions that develop respiratory distress, diffuse
lung infiltrates.1–3 These symptoms lead to respiratory failure.1,2 In 1967, Ashbaugh et al. studied
many patients who showed the features of ... Show more content on Helpwriting.net ...
According to the AECC, this disease is characterized by severe features of acute lung injury, in a
form of diffuse alveolar injury, bilateral pulmonary infiltrate, and severe hypoxemia with no
evidence of cardiogenic pulmonary edema.1 However, the severity of the hypoxemia conditions is
crucial diagnosing of ARDS. This is because this disorder was defined by the ratio of the partial
pressure of oxygen in the patients' arterial blood (PaO2) to the fraction of oxygen in the inspired air
(FIO2).1–6 ARDS is believed to be the most severe form of acute lung injury (ALI) based on the
form of diffuse alveolar injury. Though, ARDS described based on the PaO2/FIO2 ratio less than
200 while ALI is defined by the ratio of PaO2/FIO2 less than

Blunt Force Trauma, Flail Chest, Heamoneumothorax,...
Blunt force trauma, Flail chest, Heamoneumothorax, Pulmonary contusion, Pericardial Tamponarde,
Shock, Respiratory shock, Hemoragic shock, and brake or fracture.
Steve is complaining of 8/10 pain on his left leg, it is clearly deformed, is a potential fracture or
dislocation. This is not a life threatening injury but a major distracting injury.
One of the patient's main injuries is the 12 cm contusion on his left axial/anterior chest with 8/10
pain.
When excessive blunt force trauma is applied to the chest wall above the body's tolerance the
musculoskeletal system protecting the vital organs will fail. "This blunt trauma can lead to fail chest
syndrome"...(Aaron MR at el 2001), pulmonary contusion, heamothorax or pneumothorax and ...
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This leads to oedema, coagulation in alveolar spaces causing deficit of anatomical structure &
function. This injury can take up to 24 hours to develop eventually leading to poor perfusion,
increased pulmonary vascular resistance and decreased lung compliance. "50–60% of patients with
significant pulmonary contusions will develop bilateral Acute Respiratory Distress Syndrome
(ARDS)...(trauma.org 2004)"
Pulmonary contusions is hard to diagnose and can only be evaluated by the mechanism of injury
(MOI) , such as obvious signs of chest wall trauma such as contusion, fractures or flail chest.
"Crackles may be heard on auscultation but are rarely heard in the emergency room and are non–
specific."
This contusion involves injury to alveolar capillaries, resulting in accumulation of blood and fluids
within the lung tissue. This causes a V≉Q mismatch, increased intrapulmonary shunting, fluid shift
and segmental lung damage. Causing hypoxemia, hypercarbia and increases laboured breathing.
Blood loss of 150ml is usual for a single uncomplicated rib fracture. This amount of blood loss is
not life threatening on its own. If this blood enters the plural space it becomes a heamothorax.
Heamothorax can occur when bleeding penetrates into the pleural space. This can cause
hemodynamic and respiratory changes depending on the amount of blood loss. The pleural space
can hold 4 or more litters of blood causing shock. Due to the

Pulmonary Hypertension Research Paper
Pulmonary Hypertension Pulmonary Hypertension is high blood pressure that occurs in the arteries
in the lungs.
Classifications of Pulmonary Hypertension
There used to be two types of Pulmonary Hypertension. Primary Pulmonary Hypertension is when
there is no other disease or illness accompanying it. Secondary Pulmonary Hypertension is when
there is a pre–existing disease that triggers the Pulmonary Hypertension.
Etiology
"Why the blood vessels in the lungs thicken in Pulmonary Hypertension has a complex answer–
numerous factors can be involved."(medicalnewstoday.com) The most common causes of
Pulmonary Hypertension are left heart failure, parenchymal lung disease with hypoxia,
miscellaneous conditions such as sleep apnea, connective tissue ... Show more content on
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The first thing to look for when trying to determine if a person has pulmonary hypertension is a
family history of the disease and all of the details of their symptoms. A physical exam looks for
swollen ankles or legs, bluish color to the skin or lips, and looks for signs of pulmonary
hypertension in a person's heart and lungs. There are quite a number of tests that are done to confirm
a diagnosis of pulmonary hypertension. A blood test will check oxygen levels, liver and kidney
function, and certain blood tests can assess the strain on the heart. Chest x–rays can reveal an
enlarged right ventricle or pulmonary arteries. An electrocardiogram will check the electrical
impulses of the heart. An echocardiogram estimates the pressures in the right heart and will tell how
well the heart is functioning. Pulmonary function tests how much air your lungs can hold and how
much air moves in and out of them. The test also tests a person's lungs ability to exchange oxygen. A
patient will likely be asked to perform a six minute walk test which identifies the patient's exercise
tolerance level. Nuclear scans will test for blood clots in the lungs. Once these tests have been done
and they point to a diagnosis of pulmonary hypertension a right heart catheterization will likely be
performed. "Right–heart catheterization is one of the most accurate and

Care Of The Patient With Multi System Organ Failure
Saint Anselm College
Manchester, NH
NU 450: Senior Synthesis
Name: Christina Delaney Preceptorship Faculty: Welch
Critical Care Case Study: Care of the patient with multi–system organ failure
Allen Hale, 27 years old, was admitted to the ED of a community hospital after running a red light
in his car and colliding with another car. The patient was intubated in the field. A left pleural chest
tube was placed in the ED. He also has a visibly fractured left femur. A total body CT scan reveals a
left parietal subdural hematoma and a flail chest with L pneumothorax and pulmonary contusions.
He has no intra–abdominal issues.
Since Allen arrived in the ED, he has been responding to noxious stimuli only. His blood alcohol
level was 200 mg/dl (0.2% weight/volume) and there was indication of marijuana on his toxicology
screen. The health care team was unable to determine if he had a durable power of attorney or any
family who could make a decision for him. He needs to go emergently to the OR. How should the
healthcare team proceed prior to surgery?
1. List 3 rationales for proceeding with surgical intervention with an individual who may be unable
to give fully informed consent.
a. The patient is unconscious and the probability of harm with out the procedure is greater than the
risk of harm from the procedure itself
b. Irreversible harm or death can occur if the procedure is delayed in emergent situations
c. When there is no family of the patient around to act for

The Treatment Of Pulmonary Hypertension
Treatments in Pulmonary Hypertension
Brooke Throckmorton
Kettering College
Abstract This paper discusses some of the different medications used in the treatment of pulmonary
hypertension. There are six different articles being used for each the medications, and other basic
information pertaining to pulmonary hypertension. The articles discuss studies performed on the
drugs to demonstrate their effectiveness on pulmonary hypertension. The articles exhibit important
information about how the therapeutic effects of the drugs have different levels of success in varying
patients. A few of the most common medications used in the treatment of pulmonary hypertension
being discussed in this review are: Vasodilators, High–Dose ... Show more content on
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Therefore, the pressure of the blood in the vessels is higher, causing pulmonary hypertension. If
blood cannot filter through the lungs properly, it does not get completely oxygenated. Poorly
oxygenated blood can cause many other issues to the body, so it is important to properly treat
pulmonary hypertension. Many different medications are used in treatment of pulmonary
hypertension including: Vasodilators, Endothelin Receptor Antagonists, Sildenafil, Tadalafil,
Prostacyclins, Calcium Channel Blockers, Anticoagulants, Diuretics, and Oxygen. Due to the fact
that the underlying cause of pulmonary hypertension is unknown, there are many studies on the
disease and the drugs used to treat it (Voelkel, Bogaard, Gomez–Arroyo, 2015). This review will
discuss the different types of medications used to treat pulmonary hypertension. Some of the
medications are found to be more effective than others based on the results of many studies that
have been performed on animals and humans. The goal of this review is to successfully compare and
contrast these different drugs based off of the studies performed on them.
Method
For this review, the Kettering College library online database was used to find peer reviewed articles
as references. Beginning on February 22, 2015, the search "treatment of pulmonary hypertension"
was used to narrow the results for the study. To shorten the results further, the year limit was set
from 2005

Case Study On Acute Pulmonary Oedema Secondary
Case study The case study relates to Mr Brown, who diagnosed with acute pulmonary oedema
secondary to acute renal failure, due to excessive use of opioids. The assignment will address Mr
Brown's initial presentation and assessment, relevant past history, medications as well as the current
assessment finding that had him admitted to intensive care unit. Briefly discussing the patients'
pathology results scans and as well as drug treatments to correct electrolyte imbalances.
Furthermore discuss the effects of age related physiological effects on respiratory, cardiovascular
and renal system and lastly the pathophysiology and treatment on opioid toxicity, acute renal failure
and acute pulmonary oedema. Mr Brown is a 76 year old male, which presented to the emergency
department via ambulance with thoracic back pain, which commenced two days prior to the
presentation. The triage assessment stated the patient is alert, orientated, distressed, chest clear and
equal, neurovascular intact with equal strength in all extremities and good strong regular pulses. The
nil injury stated patient said he 'just woke up with it'. The patient's observation displayed a
temperature of 36.9°C, blood pressure of 169/105, pulse rate of 99 beats per minute, respiratory rate
of 20 breaths per minute, Glasgow coma score of 15, and a blood glucose level of 5.4. Mr Brown's
has a past medical history of atrial fibrillation, asthma, emphysema, hypertension, chronic back
pain, lumbar fusion (L1), total

Natalie Wood Research Paper
The Mysterious Death of Natalie Wood Natalie Wood was an American actress in many movies
including West Side Story, Brainstorm, and The Searchers. She was loved and adored by many, until
her untimely death off the coast of the island of Santa Catalina. Natalie Wood drowned on a trip to
Santa Catalina island, on her yacht. There are many theories on how Wood died: one being that it
was Christopher Walken, who was with them on the trip, or that it was an accident. However, her
husband killed her. Christopher Walken was Wood's close friend that went her and her husband on
their yacht to Santa Catalina island. According to the captain the night Wood was killed she and
Robert Wagner, her husband, were fighting although Walken was not involved in that fight. For a
long period of time Wagner did not comment on the events of that night, but Walken did and stated
that Wagner was in a drunken rage(Staff, Radar). Although Walken did eventually come forward and
has now written a book on his late wife's life. Wood and Walken had been friends for a long while
when they went on this trip, Walken was a guest with only Wood and her husband which is very
unusual, proving that Wood and Walken were close friends. Therefore, due to Wood and Walken's
close friendship and Walken's willingness to speak on the events of that night Walken did not kill ...
Wood expressed her fear of deep water openly, those who knew Natalie knew of this fear. Natalie's
sister Lana Wood said in an interview "Natalie hated the water, she had a great fear of it. She didn't
go into her own swimming pool at home(Sherwell, Philip)." Wood's sister, Lana Wood, understands
that the possibility of Wood accidentally slipping and falling overboard is almost impossible and
spoke out. Someone with a fear of deep ocean would not put themselves in a compromising
situation including deep

Essay on Case Study 8 DVT
Case Study 8
1. List 6 risk factors for DVT.
Inheriting a blood clot disorder
Prolonged bed rest, such as long hospital stay
Injury or surgery
Pregnancy
Birth control pills or hormone replacement
Being overweight or obese
2. Identify at least 5 problems from L.J.'s history that represent his personal risk factors.
Smoking history
Personal history of DVT
Prolonged bed rest
Age of above 60 years old
Sitting for long period of times (Bus Driving)
3. Something is missing from the scenario. Based on his history, L.J. should have been taking an
important medication. What is it, and why should he be taking it?
He should have been taking a blood thinner. This will decrease the blood's ability to clot. This keeps
the existing clots from getting ... Show more content on Helpwriting.net ...
"Your physician prefers the injections over the pills."
d. "The enoxaparin will work to dissolve the blood clot in your leg."
8. The order for the enoxaparin reads: Enoxaparin 70mg every 12 hours subcutaneous. L.J. is 5ft,
6in. and weighs 156lb. Is this dose appropriate? The dose is appropriate because enoxaparin may be
given at rate of 1mg/kg every 12 hours for acute impatient DVT treatment. Pt is 156lb which is
approx. 70kg making this his appropriate dose.
9. What special techniques do you use when giving the subcutaneous injection of enoxaparin?
a. Rotate injection sites
b. Give the injection near the umbilicus
c. Expel the bubble from the prefilled syringe before giving the injection
d. After inserting the needle, do not aspirate before giving the injection.
e. Massage the injection site gently after the injection is given.
10. True or False: Enoxaparin dosage is directed by monitoring activated partial thromboplastin time
(aPTT) levels. Explain your answer.

While aPTT may be monitored in obese or patients with renal insufficiency, it is not typically
necessary for deciding dosages. Instead patient weight typically is used to decide appropriate drug
dosing for Enoxaparin.
11. What instructions will you give L.J. about his activity?
He is to be on bed rest with low mobility due to need for elevation of extremities to prevent
thrombus from developing into an embolus. Tell him to change positions periodically to

Case Study Ards Essay example
Case Study Three
1. What is the definition of ARDS? Acute respiratory distress syndrome (ARDS) occurs when fluid
builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less
oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function.
Acute Respiratory Distress Syndrome (ARDS) is also known as shock lung, wet lung, post perfusion
lung and a variety of other names related to specific causes.
What are the associated clinical indicators?
The first signs and symptoms of ARDS are feeling like you can't get enough air into your lungs,
rapid breathing, and a low blood oxygen level. Other signs and symptoms depend on the cause of
the ARDS. They may occur ... Show more content on Helpwriting.net ...
Pulmonary capillary blood flow is lowest in the apices where alveolar pressure is greater than
capillary pressure. So ventilation is greater than perfusion. Blood flow is greatest at the bases of the
lungs where the pressure in the vessels is greater than alveolar pressure so perfusion is greater than
ventilation. Blood flow and alveolar ventilation are never perfectly matched. Perfusion (Q) is
usually greater than ventilation (V). A normal V/Q ratio is 0.8. If the V/Q ratio is low this means
there is not enough ventilation to oxygenate the blood. If the V/Q ratio is high this means blood flow
is less than ventilation so ventilation is being wasted.
What is the cause of hypoxemia in ARDS and how is it treated?
Hypoxaemia can result when there is inequality in alveolar ventilation and pulmonary perfusion
(V/Q mismatch). V/Q mismatch is the most common cause of hypoxia in critically ill patients. It is
caused by intrapulmonary shunting of blood resulting from airspace filling or collapse. Findings
include dyspnea and tachypnea. Diagnosis is by ABGs and chest x–ray. Treatment usually requires
mechanical ventilation.
What is the clinical significance of static compliance?
Lung compliance is a measurement of the relationship between changes in lung

Increased Altitude : Adverse Effects On The...
Increased Altitude: Adverse Effects on the Cardiopulmonary System
With regards to elevation, high altitude is defined as a height of 1,500–3,500 meters (4,900–11,500
ft.) but can differ by a 1,000 ft., depending on the defining source. The definition of elevation
continues with very high altitude, which is 3,500–5,500 meters (11,500–18,000 ft.) then continues to
extreme altitude of which is above 5,500 meters (18,000 ft.). Within healthy individuals, substantial
clinical changes are difficult to exhibit at elevations lower than 1,500 meters. But once the human
body reaches altitudes at or above high altitude, the adverse effects on the human body become
increasing pronounced and considerable. As altitude increases, the barometric pressure falls and the
environmental partial pressure of inspired oxygen declines. The reduction of inspired oxygen, in
combination with other environmental factors such as a decline in temperature, humidity, paired
with physical activity, the human body must be able to compensate for the adverse effects opposed
primarily on the cardiovascular and respiratory systems. (Auerbach) (Donegani)
Physical alterations within the cardiopulmonary system begin to be substantial over an altitude of
2500 meters. However, the human body can use both short–term and long–term means to adapt to
high altitude, and even beyond, that will allow the body to partially compensate or even fully
compensate for the lack of inspired oxygen. But, there is also a limit to the

Drug Abuse ( Polysubstance ) Essay
On the 10/05/2016, I took care of a 29 year old female who has been on admission since
09/24/2016. EMS found her in a ditch intubated her (ETT), mechanical ventilated, and brought her
to the hospital. The patient informed me that police tried to stop her and her boyfriend but her
boyfriend refused to stop, so she decided to jump out of a moving vehicle. Later she informed me
that her boyfriend is in jail. However, her story about her incident is unclear. Her admission record
shows that she started drugs at the age of 12. In addition, she is homeless, and her mom died when
she was very young. Furthermore, her past medical and surgical histories are type 1 diabetes,
ADHD, depression, anxiety, history of MRSA, TB ( latent TB per history from patient's mother),
history of drug abuse( polysubstance abuse) and hysterectomy. She has no known allergies. The
following list of her home medications are Seroquel, Neurontin, Celexa, Remeron, Ativan, Klonipin,
and Xanax. Patient was placed on contact isolation because of MRSA & TB.
The admitting diagnosis is rib fracture, lung contusion, sternum fracture, femur fracture, right
occipital condyle fracture, spine fractures, pelvic fractures, and right hand fractures. Due to her
multiple orthopedic injuries, she was placed on morphine & Dilaudid for pain relief because she
rated her pain 7–10 during my shift. She was extubated on 10/04/2016 but still on 3liters of Oxygen
via nasal cannula. In addition, she has a lot of stitches due to her

Normal Heart Rate Chart
Normal Heart Rate Chart
The heart is an organ located just behind and slightly to the left of the breastbone, and pumps blood
through a network of veins and arteries known as the circulatory system. The right atrium is sent
blood from the veins, and delivers it to the right ventricle. It is then pumped to the lungs where it is
oxygenated. The left atrium collects the oxygen enriched blood from the lungs and delivers it to the
left ventricle, where it is pumped throughout the body, and the ventricle contractions create blood
pressure.
A pulse is the beating of the heart as it is felt through the walls of an artery, such as the radial artery
at the wrist. Pulse rates can also be felt and measured at the carotid artery located on the side of ...
Heart Rate During Exercise
Your maximum heart rate is the highest heart rate that is achieved during strenuous exercise. One
method to calculate your approximate maximum heart rate is the formula: 220 – (your age) =
approximate maximum heart rate. For example, a 30 year old's approximate maximum heart rate is
220 – 30 = 190 beats/min.
You can maximize the benefits and reduce the risks when you are exercising within your target heart
rate zone. Your target heart rate when exercising is normally 60 to 80 percent of your maximum
heart rate. This may be increased or decreased depending on your health factors, and your health
care provider may want you to limit the target heart rate zone to 50 percent. However, it is not
recommended to exceed 85 percent of your maximum heart rate. Anything above 85 percent
increase risks to the orthopedic and cardiovascular system, with minimal added benefits from the
exercise.
Normal Maximum and Target Heart Rate Chart
The following table shows the approximate target heart rates for various age groups. Find the age
group closest to your age and find your target heart rate. The guidelines for moderately intense
activities is about 50–69% of your maximum heart rate, and hard physical activity is about 70% to
less than 90% of the maximum heart

Embolism In Hospital Setting
It is not uncommon for death to occur in an unusual way in a hospital setting. One such occurrence
is frequently identified as a pulmonary embolism. The patient comes in with an initial diagnosis of
lung cancer with metastasis to the liver. She is expected to live for a few more days. To show
compassion, the nurse decides to give her a bath, change her linens, and help her become more
comfortable. After providing her with care, the patient has one more request, to get a leg massage.
Oblivious to any complications, the nurse proceeds to give the patient a good leg rub. Minutes later,
the patient is found unresponsive on the floor. The patient suffers from a venous thromboembolism
in one of her legs, that when massaged, travels all the way up ... Show more content on
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Anti–embolic stockings work by exerting graded circumferential pressure from distal to proximal
regions of the leg conforming to a Sigel pressure profile. These increase blood velocity, promote
venous return, and have shown to be effective (Barker, 2011). Intermittent pneumatic compression
periodically compresses the calf and thigh muscles, mimicking the muscle pump created by
walking, promoting fibrinolysis, and have shown to also be effective (Barker, 2011). Foot impulse
devices increase venous outflow and reduce stasis in immobilized patients. They also mimic
walking by compressing the plantar venous plexus, and they are effective after orthopedic surgery in
reducing asymptomatic DVT (Baker, 2011). Mechanical methods will most likely be used in
patients at high risk for bleeding. Physiotherapy and nursing has also been a method used by staff in
increasing the prevention of VTE. Risks can potentially be mediated by mechanical calf and foot
venous compression, bed exercise, active or passive, and early mobilization, and by hydration
(Barker,

High Altitude Is Defined As An Elevation Of 1500-3500 Metres
With regards to elevation, high altitude is defined as an elevation of 1,500–3,500 meters (4,900–
11,500 ft.) but can differ by a 1,000 ft., depending on the defining source. The definition of elevation
continues with very high altitude, which is 3,500–5,500 meters (11,500–18,000 ft.) then continues to
extreme altitude of which is above 5,500 meters (18,000 ft.). Within healthy individuals, substantial
clinical changes are difficult to exhibit at elevations lower than 1,500 meters. But once the human
body reaches altitudes at or above high altitude, the adverse effects on the human body become
increasing pronounced and considerable. As altitude increases, the barometric pressure falls and the
environmental partial pressure of inspired oxygen decreases. The reduction of inspired oxygen, in
combination with other environmental factors such as a decline in temperature, humidity, paired
with physical activity, the human body must be able to compensate for the adverse effects opposed
primarily on the cardiovascular and respiratory systems.
Physical alterations within the cardiopulmonary system begin to be substantial over an altitude of
2500 meters. However, the human body can use both short–term and long–term means to adapt to
high altitude, and even beyond that will allow the body to partially compensate or even fully
compensate for the lack of oxygen. But, there is also a limit to the level of adaptation and
compensation that can take place. Once an altitude of or above 8,000

Essay On Pulmonary Contusion
Pulmonary Contusion
A pulmonary contusion is a deep bruise to the tissues of the lung. The lungs bring oxygen into the
bloodstream and remove carbon dioxide that the body cannot use. A pulmonary contusion causes the
lung tissue to swell and bleed into the surrounding area. This interferes with the ability of the lungs
to function. You may feel short of breath because you are not getting enough oxygen.
CAUSES
This condition is usually caused by a chest injury, such as an injury from:
A car crash.
A severe fall, especially from a high height.
Being near an explosion.
A sports injury.
A crush injury, such as from industrial or farming machinery.
A physical assault, especially if struck in the chest with a blunt object.
... Show more content on Helpwriting.net ...
This may be needed if you have difficulty breathing and have low blood oxygen. In severe cases,
you may need to have a tube placed in your throat and a machine (ventilator) to help with breathing.
Surgery if a blood vessel continues to bleed uncontrollably or if the lung has been punctured.
Initial treatment for this condition is often given in an emergency department.
HOME CARE INSTRUCTIONS
Take medicines only as told by your health care provider. Do not take aspirin for the first few days,
because this may increase bruising.
Continue to do deep breathing exercises. Use an incentive spirometer for deep breathing exercises as
told by your health care provider.
Return to your normal activities only as told by your health care provider. Talk to your health care
provider about:
○ What activities are safe for you.
○ When you can return to driving, work, school, and sports.
Keep all follow–up visits as told by your health care provider. This is important.
SEEK MEDICAL CARE IF:
You have shaking chills.
You cough up mucus.

SEEK IMMEDIATE MEDICAL CARE IF:
You have difficulty breathing and it is getting worse.
Your chest pain gets worse.
You cough up

The Treatment Of A Nurse
As a nurse we are trained to take all the necessary steps to save lives. However, there are situations
that the people we are caring for tends to refuse treatment, and we have to respect their decision.
According to the HDC (Health and Disability Commissioner) Code of Health and Disability
Services Consumers' Rights Regulation 2004, every citizen has the right to make an informed choice
and give informed consent. Services like medication can only be provided if the consumer gives an
informed consent. In regards to the situation I have experienced in the facility, the patient has the
right to refuse to take the Warfarin. Even if this poses a risk to his health the members of the health
care team has to respect his decision. I truly respect the decision of the patient. I empathize with his
decision not to take the Warfarin because it needed for the INR to be monitored which causes
discomfort in him since it was difficult to extract blood from him. However, the Warfarin is a very
important medicine needed because of his medical condition.
Warfarin is used to prevent blood clots from forming or growing larger in your blood and blood
vessels. It is prescribed for people with certain types of irregular heartbeat, people with prosthetic
(replacement or mechanical) heart valves, and people who have suffered a heart attack. Warfarin is
also used to treat or prevent venous thrombosis and pulmonary embolism. Warfarin is in a class of
medications called anticoagulants. It works

Venous Tromboembolism: A Case Study
Venous thromboembolism (VTE) is the formation of a blood clot that causes some life–threatening
conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), and post–thrombotic
syndrome (Hillegass et al., 2016). The risk of developing DVT in patients after surgery ranges
between 20–30% and PE ranges between 0.2–0.9% (Soomro, Yousuf, Bhutto, Abro, & Mamon,
2014). Therefore, it is critical to identify the risk factors and initiate early thromboprophylactic
therapy to prevent VTE. While working in an orthopedic hospital I came across several cases with
clinically diagnosed DVT and PE.
Early mobility is the fundamental treatment to prevent VTE. After surgery such as knee
replacement, hip replacement or any other surgical treatment I used to get an approval from a
surgeon or skilled ... Show more content on Helpwriting.net ...
While taking regular physical assessment the therapist should be aware of the signs of DVT or PE
that include redness, warmth, or swelling. Additionally, DVT can be predicted from a few laboratory
tests such as International normalized ratio (INR), prothrombin time, and hemoglobin level. These
laboratory tests indicate blood clotting. Homan's sign is one of the tests to rule out DVT but it is not
reliable because of the low sensitivity and specificity, and the therapist should not be relied on it
(Goodman & Snyder, 2013). Doppler ultrasound is the most common noninvasive and painless test
for DVT. In the hospital where I was working, the treatment protocol to prevent DVT included
assisted walking and leg exercises as soon as possible after surgery. Leg exercises included static
quads and ankle, knee, and hip joint movements, not just to strengthen the lower extremity muscles
but also to improve blood circulation in the deep veins and avoid blood clotting. Continuous passive
movement

Ventricular Serptal Syndrome
A ventricular septal defect (VSD) is a defect due to an abnormal connection between the lower
chambers of the heart. A heart has four chambers. There are left and right upper chambers, which are
called an atrium, and left and right lower chambers, called a ventricle. The ventricular septal defect
is a hole that occurs between the left and right pumping chambers of the heart.
This ventricular defect occurs because of problems in the early development of the heart. There is no
clear cause of a ventricular septal defect but most doctors think that genetics play a role. It's a very
common defect and it's common for this defect to come with other congenital heart defects. It
happens during fetal development, when the muscular wall fails to form ... Show more content on
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Small defects usually cause none to few problems. Medium and large defects can cause more severe
problems. These range from mild to life threatening complications. Pulmonary hypertension can last
for years or a lifetime. It is a type of high blood pressure that affects arteries in the lungs and heart.
It increases the blood flow to the lungs, affecting the lung arteries, which can cause them to become
permanently damaged. This complication can cause the reversal of blood flow through the hole,
which is Eisenmenger syndrome. Endocarditis is another complication that could come about, but it
is less common and occurs more in adults. It is an infection of the heart's inner lining, causing
inflammation of the heart valve. This is only short–term, so it resolves within days or weeks. Lastly,
other heart problems include abnormal heart rhythms and valve

Epidemiological Studies On Erds
Epidemiological data
The annual incidence of ARDS is 13–23 people per 100,000 in the general population and it is
higher in the mechanically ventilated population in intensive care units which represents 16.1%
percent in ventilated. Pneumonia and sepsis are considered as leading trigger of ARDS as
pneumonia represent in up to 60% of patients and may be either causes or complications of ARDS
and according to literature approximately 30% of patients with severe sepsis may develop ARDS or
ALI. Other triggers include aspiration, circulatory shock, mechanical ventilation, smoke inhalation,
trauma especially pulmonary contusion major surgery, massive blood transfusions, drug reaction or
overdose, fat emboli and reperfusion pulmonary edema after lung transplantation or pulmonary
embolectomy. Alcohol excess appears to increase the risk of ARDS. Until the 1990s, majority of
studies reported a 40–70% mortality rate for ARDS. However, 2 reports in the 1990s, one from a
large county hospital in Seattle and one from the United Kingdom, suggested much lower mortality
rates, in the range of 30–40%. Possible explanations for the improved survival rates may be better
understanding and treatment of sepsis, recent changes in the mechanical ventilation, and better
overall supportive care of critically ill patients. (Koh et al, 2012)
We noticed that most deaths in ARDS are related to sepsis or multiorgan failure rather than to a
primary pulmonary cause, although the recent success of mechanical

Functions Of The Respiratory System
Functions of the Respiratory System
Introduction
The main purpose of the respiratory system is to exchange oxygen and carbon monoxide between
the body and the environment. Throughout the body are specific organs and structures that make the
respiratory system possible. In humans, respiration takes place in the lungs. In the article by Kim
Ann Zimmermann, "Respiratory System: Facts, Function, and Diseases" she explains how the series
of organs in a person 's body work together to exchange the gases we breathe and distribute it
throughout the rest of the body.
This information is useful for any person wanting to know more about their body, a medical student,
and people in the healthcare field. This report will go over the parts of the respiratory system
starting with the first step in the process to the last step.
Description of Each Part of the Respiratory System
Mouth/Nose– The nose and mouth are part of the facial area in humans. The main purpose for both
is to let in and out air. The nose is responsible for a human's sense of smell. The mouth is
responsible for the intake of fo od and water.
Trachea– The trachea is a broad membranous tube assisted by rings of cartilage. The main purpose
is to provide air flow to and from the lungs.
Lungs– The lungs are two organs located within the rib cage. They consist of elastic sacs with tubes
and airway passages which air is brought in so that carbon dioxide will be removed and the oxygen
will go into the blood.
Bronchial

Critical Care Issue in Trauma
Trauma was the major cause of mortality and morbidity till last 2 decades but after that there have
been major improvements in management and resuscitation of trauma patients. This does not imply
only to emergency care but also ICU management.
It is well established that there is trimodal distribution of death in trauma patients. First peak is
within seconds to minutes because of head or cervical spine injury or to injury to major blood vessel
and much cannot be done about this. The second peak occurs in minutes to hours due to life
threatening injuries and prognosis depends on initial resuscitation of the patients both in the
emergency department and ICU.Then there is third peak which occurs several days to weeks and is
often due to sepsis and multiorgan dysfunction[1]. This third peak can be prevented by good ICU
management of these patients. Here comes the role of good intensivist who has experience in
managing trauma patients as trauma patients are different from other patients coming to ICU.
There are majorly two kinds of trauma patients coming to ICU; one who are still in the phase of
ongoing resuscitation coming directly from the ED or Operation Theatre [OT] after damage control
surgery. Secondly there are patients who were being treated in the ward, deteriorated and then
shifted to ICU. There are certain problems particularly seen in trauma patients. In this review we
will try to highlight certain these problems.
Resuscitation of trauma patients Resuscitataion

Left Axillary Vein Thrombosis Case Study
Demographics:
Name: LH
DOB: 1/6/1942
Age: 75 years old
Gender: Male
Height/Weight: 150lb, 5'6
Allergies: No Known Allergies
Code Status: Full Code
Admission Date: 3/25/2017
Reason for Admission:
Fever, nausea, vomiting, and swelling of the upper extremity
Past Medical History:
Hypertension, Hyperlipidemia, Anemia, Small bowel ischemia
Surgical History:
Cholecystectomy, General surgery, Colorectal surgery, thrombectomy
Social History:
Married with 2 children, Non–smoker, Social drinker–One or 2 drinks a week.
Admitting Diagnosis:
Left Axillary Vein Thrombosis
Assessment Findings:
Neuro: Patient appeared to be AAOx3, pupils equal reactive to light.
Head and Neck: Head of the patient round and symmetrical, no lesions or mass noted. Tracheal ...
Witnessing the communication among the: interdisciplinary team, HCP, Nurse Practitioners, Lab
technicians, and others was great. Every time the patient or family member requested to speak to the
HCP, my nurse would page the HCP through the computer and the HCP would be calling or
showing up to the patient's bedside. If my nurse questioned an order and began to be concerned, she
would contact the HCP, and await confirmation by the HCP to provide reassurance regarding any
concern. As a nurse, you provide comfort and answer any question the patient asks to relieve their
anxiety. My nurse did an exemplary job. Every question the patient or family member had, she
answered it with the correct information and eased their concerns. My communication style
impacted in my own way during my assessment. I was able to communicate with the patient and ask
the reason he was admitted into the hospital. At first, he was startled as to why I was doing my
assessment and the questions I asked towards him. He then began to be more outspoken as I gained
his trust. I believe that all the organized foundation the interdisciplinary team offers facilitates the

quality of care toward the patient. I believe there's always room for improvement. As for myself, and
my own professional self–development, I believe I can improve in being more confident when I ask
questions towards my patients. All in

My Best Friend
Aletha C. Middleton once stated, "God picks the perfect flowers and lets the others grow, He takes
the sweetest blossoms for they are ready to go." My best friend, Stephanie Elysse Inman, suddenly
and unexpectedly passed away on Friday, October 28th, at 11:48AM. Not a day goes by that
Stephanie is not on my mind. Her death has taught me many life lessons, but the most important
lesson was to live each day to the fullest. As I look back on my childhood, every vivid memory I
have involves Stephanie. We spent much time together during elementary school and were always
on the same youth league sports teams. Steph and I both played basketball and field hockey during
high school and we were constantly partnering up during practices. We had countless sleepovers and
endured important life milestones together. We both had the same persona and could have passed as
sisters. She was the definition of a true friend. Once college began, we constantly would Facetime,
text, and Snapchat each other to keep in touch. She was thriving at Penn State. Her bare face and
bags under her eyes always filled my phone during our Facetime calls. She was hustling in all of her
classes, striving for flawless grades so she would have a chance at dental school. She was headed
towards a 4.0 grade point average during her time at Penn State. Stephanie was constantly making
friends and joining new clubs. Her personality was a perfect fit for a career in the medical field.
Right as biology lab was ending, I

History and Physical Examination for Putul Barua Essay
CASE STUDY 3
HISTORY AND PHYSICAL EXAMINATION
Patient Name: Putul Barua
Patient ID: 135799
Room No.: CCU–4
Date of Admission: 01/07/2013
Admitting Physician: Simon Williams, MD
Admitting Diagnoses 1. Rule out myocardial infraction 2. History of tuberculosis. 3. Hemoptysis. 4.
Status post embolectomy.
CHIEF COMPLAINT: Tightness in the chest, shortness of breath, fast heart rate.
HISTORY OF PRESENT ILLNESS: Mr. Barua is a 42–year–old gentleman from Bangladesh who
presents with chest tightness, shortness of breath, and tachycardia. Dr. J.K. McClain of cardiology is
evaluating his heart condition. The patient has had the recent onset of hemoptysis. He was treated
for tuberculosis in Bangladesh 15 ... Show more content on Helpwriting.net ...
PHYSICAL EXAMINATION: Vital signs are WNL. Apparently he has had no chills, night sweats,
or favors. Generalized malaise and a lack of energy have been the main concerns. HEART: Regular
rate and rhythm with S1 and S2. No S3 or S4 is heard at this time. LUNGS: Bilateral rhonchi. No
significant amphoric sounds are noted. ABDOMON: Soft nontender. No hepatosplenomegaly or
masses are detected. RECTAL EXAM: Prostate smooth and firm. No stool is present for hemoccult
test.
DIAGNOSIS: Hemoptysis with history of tuberculosis.
PLAN: I have reviewed the chest x–rays available here and agree with the finding of bleb formation
in the right and left upper lobes. Despite the fact that the patient has had a high INR, because of his
history of tuberculosis and hemoptysis I believe obtaining sputum for TB is very, very important.

We should rule out any other endobronchial lesions as the cause for his bleeding. I have discussed
this matter with the patient and his wife. I have told them that there is the possibility of observing
the condition by x–rays and repeated tests of his sputum. They understand that this is an option;
however, they decided that because of concern regarding his repeated hemoptysis, they would
consent to bronchoscopy. We will arrange for the patient to have a bronchoscopy done. He is off
Coumadin.
(Continued)
HISTORY AND PHYSICAL EXAMINATION
Patient Name: Putul Barua
Patient ID: 135799
Date of Admission: 01/07/2013

Essay on Nclex Rn Questions Chapter 58
Chapter 58
Practice Questions page 755 (652–674)
(652) 1. An emergency department nurse is assessing a client who has sustained a blunt injury to the
chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? *
Diminished breath sounds
Rationale: This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed
pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea,
cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur
on the affected side. A sucking sound at the site of injury would be noted with an open chest injury.
(653) 2. A nurse is caring for a client hospitalized with acute ... Show more content on
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If side effects develop, especially cardiac irregularities, the procedure is stopped and the client is
reoxygenated. * * (659) 8. A nurse is assessing the respiratory status of a client who has suffered a
fractured rib. The nurse would expect to note which of the following? * Pain, especially with
inspiration * Rationale: Rib fractures are a common injury, especially in the older client, and result
from a blunt injury or a fall. Typical signs and symptoms include pain and tenderness localized at
the fracture site and exacerbated by inspiration and palpation, shallow respirations, splinting or
guarding the chest protectively to minimize chest movement, and possible bruising at the fracture
site. Paradoxical respirations are seen with flail chest. * * (660) 9. A client with a chest injury has
suffered flail chest. A nurse assesses the client for which most distinctive sign of flail chest? *
Paradoxical chest movement * Rationale: Flail chest results from multiple rib fractures. This results
in a "floating" section of the ribs. Because this section is unattached to the rest of the bony rib cage,
this segment results in paradoxical chest movement. This means that the force of inspiration pulls
the fractured segment inward, while the rest of the chest expands. Similarly, during exhalation, the
segment balloons outward while the rest of the chest moves inward. This is a

The Six Minute Walk Distance ( 6 Mwd )
Galie's et al. compared the six–minute walk distance (6–MWD) in patients twelve years or older
with symptomatic pulmonary arterial hypertension (PAH) who took placebo versus 4 doses of oral
tadalafil with or without bosentan. This multi–center, double–blind, placebo–controlled, randomized
controlled study lasted 16 weeks. The patients were placed into 5 different groups: tadalafil 2.5mg,
10mg, 20mg, 40mg, or placebo once daily, and stratification was based on walking distance of
325m, type of PAH, and bosentan use. Patients were not qualified to participate in this study if they
had a 6–mintue walk distance <150m or > 450m. Safety was determined by the level of adverse
events severity. It was shown that all doses, but 2.5mg, improved 6–MWD at week 16, although, the
tadalafil 40mg was the only one that was statistically significant (p<0.01). Compared with placebo,
tadalafil 40mg had statistical significance of 6–MWD without bosentan therapy at 44m, versus
patients with bosentan with a 6–MWD of 23m. The WHO functional class was not statistically
significant in comparison with placebo because patients with better WHO functional class showed
no difference in comparison to people with worse WHO functional class. After the 341 patients
completed the 16 week trial, 334 of them accepted participation in another 16 week trial. Their 6–
MWD slightly improved from 37m to 38m after 44 weeks, which was shown to be statistically
significant (95% CI, 29 to 47). In addition, WHO functional

Hip Replacement Case Study
Complications from a hip replacement surgery can occur Post–operatively. One of these
complications includes deep vein thrombosis. DVT is a cardiovascular disease, in which a blood clot
forms in a vein deep in the body, commonly occurs in the lower leg or thigh. The clot can break
loose and travel within the body and block any blood vessels in the deep vein, this blockage of
vessels can occur in places such as the lungs or the brain, subsequently leading to death if not
treated immediately. When a patient is resting in bed for prolonged period of time after surgery the
body is not efficient in helping the blood to flow back to the heart from the lower extremities due to
the fact that the muscles in the lower extremities are not active, hence

Major Cardiac Circuits
The two major cardiovascular circuits in the human body is the pulmonary circuit and the systemic
circuit. Both of these circuits work together in order to make the body function properly. The major
difference between these two circuits is where the blood travels and what areas of the body the
blood reaches. The pulmonary circuit carries blood to only the lungs which focuses more on gas
exchange. The systemic circuit carries blood to the tissues in the entire body which focuses more on
supplying the tissues with oxygen and nutrients. Another interesting fact that separates these two
circuits is the blood itself and the process that which it flows. At the beginning of the pulmonary
circuit, the blood is deoxygenated. The oxygen poor blood then

Respiratory Distress Syndrome Essay
Respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD), is a disease
that predominantly affects premature neonates. It is due to a deficiency in surfactant which is vital in
increasing lung compliance, preventing atelectasis at the end of expiration, and promoting the
recruitment of collapsed alveoli by reducing surface tension. Its other name, HMD, is derived from
the characteristic histological findings in early post mortems of premature babies, hyaline
membranes were observed, which did not occur in stillborns (Halliday, 2008). RDS is the most
common cause of respiratory distress in the neonate. Over 90% of RDS is seen with preterm births.
The incidence is much higher in males, at approximately 66%. It is ... Show more content on
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Although mice studies have demonstrated morbidities in SP–A and SP–D deficiency, no cases have
been reported in humans (Serrano et al., 2006). With insufficient surfactant, the lungs have an
increased critical pressure, causing atelectasis. Increased pressure and oxygen toxicity results in
damage to the endothelial and epithelial cells within the alveoli. This results in an exudate that forms
a fibrous hyaline matrix. SP–B deficiency (SFTPB gene) has been identified in full term infants who
demonstrate hyaline membrane–like disease on x–ray. It is usually fatal. Thirty–four mutations have
been described in this deficiency, with over two–thirds having the c.397delCinsGAA mutation
(121ins2) in exon 4. The result of this mutation causes a frameshift, leading to a premature
termination signal which ultimately leaves the individual completely SP–B deficient. SP–B
deficiency further causes a lack of lamellar bodies (Figure 3) in alveolar type II pneumocytes which
are responsible for the storage of surfactant proteins, thus reducing the amount of SP–C. SP–C
mutations have also been identified (SFTPC gene) in the cause of interstitial lung disease and
emphysema in the older patient (Kurath–Koller, 2015). Another genetic mutation identified is the
ABCA3 mutation. It has been demonstrated that this mutation is more common than SP–B
deficiency (Somaschini et al., 2007) This gene encodes the ATP–binding cassette protein A3. The
protein is highly

Phosphatidylcholine
I. Overall Lung Function and Organization The human lung is a series of blind end tubes, hollow
tubes that that allow for the conduction of air. The conduction of air starts from the nasal cavity or
oral cavity, continues to flow through the trachea and bronchus and finally reaches the bronchioles
that lead into the alveolus that allows for gas exchange to occur (Phalen et al. 1983). This system
can be broken down into two different region; a conducting region and a region of gas exchange.
The conduction portion of the respiratory system begins in the nasal cavity and the oral cavity and
continues to the bronchioles. The transition from the bronchioles to the alveolar duct results in the
transition from the conducting region of the respiratory ... Show more content on Helpwriting.net ...
De novo synthesis of surfactant phospholipids are dependent on the amount of fatty acids available
in circulation. During fetal development, the type II alveolar cells use intracellular stores of
glycerol–3–phosphate for lipid synthesis. Type II Alveolar cells in the postpartum lung need to
synthesize lipids and proteins to establish the reduction in surface tension needed to maintain a
proper liquid–air barrier(Ridsdale et al. 2004). Glycogen appears to be the main source of carbons
needed to develop the glycerol backbone within surfactant lipids. Ridsdale et al. (2004) states the
metabolic demands required of type II alveolar cells during close term requires a build up of
glycogen which could play the role of an energy source in surfactant lipid synthesis. Lamellar
bodies contain Golgi apparatus, Endoplasmic Reticulum(ER), and mitochondria that is necessary for
the production of the lipids and protein components of surfactant. The build up of glycogen changes
the orientation of the type II alveolar cell organelles. In the presence of the glycogen, the golgi
appartus, ER, and mitochondria are surround the glycogen. However glycogen region is where the
lamellar bodies are present. Risdale et al. illustrates with Figure 2– C,D and E labeled with arrows
pointing to the ER, the mitochondria labeled

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