Capstone Simulation Experience Paper
During the capstone simulation experience, I believe I performed well in quickly reporting the
perforated bowel to the provider. This is an urgent issue that needs to be addressed quickly to
prevent many serious complications such as: peritonitis, sepsis, hypovolemia, and low H&H due to
excessive bleeding. The routine procedure of a colonoscopy is not without risks and this simulation
experience was a great example of how an adverse event can go undetected until after discharge or
when the physical symptoms appear and start ailing the patient.
Providing handoff report to the oncoming nurse, the operating room nurse, or the physician is
something I need more practice in. I either feel as if I give too much information or not enough. The
SBAR ... Show more content on Helpwriting.net ...
The patient will require surgery to repair the hole in the intestines, and subsequently will have a
drainage tube, NG tube, and feeding tube. All drains will need to monitored for
placement/movement, and drainage. Input and output will be closely monitored and recorded. The
patient will remain on NPO, or nothing by mouth, to rest the bowels along with frequent
assessments to monitor for infection and bleeding. The nurse will need to monitor for bowel sounds,
vital sign changes, temperature changes, pain, abdomen girth, and wound/incision inspections. The
following labs will require monitoring: CBC, H&H, albumin, BUN & creatinine, glucose, and
ABG's and lactic acid if sepsis is suspected. Careful and frequent monitoring of labs will alert the
nurse if the patient develops sepsis, or hypovolemia due to excessive bleeding (Belinhof, et al.,
2012). In addition to vital signs and labs, the nurse will also include patient assessment into
consideration before drawing conclusions by means of critical thinking. After the full assessment
has been made, the nurse will report any findings to the health care provider that require further
investigation or
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Assignment 2-Risk Assessment Methods
1. According to Kaufman and Kent (2015), occupational exposure to industrial chemicals from
workplaces such as coal mines and not taking medications as prescribed could lead to swelling in
the airways and likely to worsen asthma over a period of time.
2. Eisel and Kent (2015) state oxygenation deficit from:
– Tachypnoea – Caused when fluid enters the pulmonary interstitial space, causing problem with
breathing, thus increasing RR.
– Mild hypertension – Due to vasoconstriction of vessels and tachypnoea.
– Frequent cough – Due to cilia being destroyed from lower respiratory tract infections. Secretion is
impaired and build of bacteria occurs and impacts oxygenation. 3. Jamie is currently on 6 litre of
oxygen. Face mask is appropriate for ... Show more content on Helpwriting.net ...
11.
– Risk assessment tools e.g. Braden scale should be assessed daily to minimize the risk of pressure
sores (Comfort, 2008).
– Encourage use of appropriate equipment such as Repose devices to prevent heel pressure injuries
(Asimus, Li & Kendall, 2011).
– Inspect skin for deterioration or improvement daily and document findings (Pressure Injury
Prevention and Management Clinical Guideline, 2012).
12. "Hospital Falls Prevention Strategies", (2009) suggest:
– Provide patient with equipment and assist patient with mobility, transfer and self–care.
– Ensuring patient is wearing non–slip, well fitted footwear.
13.
– Truong, Fan, Brower & Needham (2009) supported that long duration of bed rest with critical
illness leads to a reduction in muscle protein synthesis and increase nitrogen in urine which
indicates muscle catabolism.
– Prolonged immobility prompts a pro–inflammatory state from increased systemic inflammation
through increases in pro–inflammatory cytokines (Truong, Fan, Brower & Needham,

Acute Real Failure
The diagnosis of acute renal failure (ARF), also referred to as acute kidney injury (AKI),
encompasses a wide–ranging continuum of acute renal pathologies that are characterized by sudden
deterioration of kidney function. This results in abrupt aberrations in fluid, electrolyte, and acid–
base balance, nitrogenous waste removal, creatinine clearance, and glomerular filtration rate. ARF
or AKI is subdivided into three general categories based on the etiology. Again, aging alone, without
the presence of any comorbidities, is associated with an increased susceptibility to ARF. This is due
to deterioration of renal blood flow with age and consequent decrease in glomerular filtration rate
(GFR). This is probably because, with these changes, there ... Show more content on
Helpwriting.net ...
intracellular potassium ion gradient is fundamental to the establishment of the resting membrane
potential in excitable cells (neurons and muscle cells) is necessary in order to appreciate how
hyperkalemia (excess extracellular K) disrupts this delicate balance. Because of the loss of this
potassium gradient, excitable cells become hypopolarized, and are therefore less responsive to
stimuli (action potentials). This results in muscle weakness and flaccid paralysis that progresses in
an ascending pattern. The main concern with hyperkalemia is its implication on the cardiac system
(Copstead & Banasik, 2013). Hyperkalemia that exceeds 6.0 mEq/L can be fatal because of its
depressant effects on myocardial activity. This is demonstrated on an ECG tracing with the
disappearance of the P wave, extended T wave and QRS segment, and depressed ST segment.
Should this happen, the client is an emergent situation and immediate measures must be taken to
reduce serum potassium to prevent cardiac arrest (Osborn, et al. 2014). This patient's serum
potassium was 6.1 mEq/L on arrival, which placed at an extremely high risk for cardiac dysfunction.
He was immediately given a combination of immediate and longer–acting medications to lower his
serum potassium (calcium, D50, insulin, bicarbonate, and

Pathophysiology Of Postoprative Hypovolaemia And The Body...
1. Pathophysiology of Postoprative Hypovolaemia and the body's compensation mechanisms:
Presented with the post–operative assessments of Mr. George Jensen who suffered from an open
fracture of his right tibia and fibula and underwent an Open Reduction and External Fixation
procedure, a nurse can tell that he is experiencing post–operative Hypovolaemia.
Hypovolaemia pertains to an abnormal loss of blood volume and body fluid. It is a life–threatening
condition brought on by low blood venous return to the heart that results to decreased Cardiac
Output (CO), leading to a lack of adequate circulatory filling, reduced organ blood flow and organ
damage (Brown & Edwards, 2013; Craft, Gordon, Huether, Tiziani, McCance, & Brashers, 2013;
Plenderleith, 2007).
There are numerous factors responsible for the onset of hypovolaemia. But among the most
common causes and relevant to Mr. Jensen are:
o Haemorrhage from trauma, or surgery. It is the common cause of body fluid loss, and it may be
internal or external. In the limbs, a considerable amount of blood can be lost to a fractured tibia
(Page & McKinney, 2012, p.157).
A patient who undergoes surgery such as an open reduction external fixation fracture under general
anaesthesia can futher have an estimated blood loss in volume of 200cc, as suggested by
Mendelson, Kates, Pacos, Clark, & Wu (2011, p. 3).
o Dehydration that can be a result not just of poor fluid intake but also of badly managed Type 2
Diabetes Mellitus. Blood

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
more content on Helpwriting.net ...
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

How An Abdominal Aortic Aneurysm?
Introduction
This essay will discuss how an abdominal aortic aneurysm occurs, who are at risk of developing
one, how the body responds as well as the clinical presentations of the signs and symptoms. It will
also give an explanation of how the clinical presentations relates to the pathogenesis of abdominal
aortic aneurysms as well as how it affects homeostatic mechanisms.
Before those subjects it is necessary to understand what an abdominal aortic aneurysm is. An
abdominal aortic aneurysm is an augmented area of the lower aorta, most commonly occurring in
the portion of the aorta below the renal artery origin and iliac bifurcation.
How the chosen condition has occurred
(pathogenesis)
The aorta is the main blood vessel that supplies blood to the pelvis, abdomen and the legs,
According to Rahimi, MD Facs's Abdmonial Aortic Aneurysm: Practice Essentials, Background,
anatomy [22] After the age of 50, the normal diameter of the aorta is between 1.5 a. This
information was a concurred in Schaub, G's document. Schaub, G states in the document 'abdominal
aortic aneurysm– american family physician' [25] "an aneurysm is a permanent focal dilation of an
artery 1.5 times the normal diameter in size."
According to Macsweeney et al the pathogenesis of abdominal aortic aneurysm includes numerous
factors acting over time. However, the destruction of elastin in the aortic wall is one of the key
events that shifts the load produced by blood pressure on to collagen. This is

Acute Renal Failure
Acute renal failure is described as an abrupt reduction in renal function with elevation of both BUN
and plasma creatinine levels. Acute renal failure can be classified as; pre–renal, intra–renal or post–
renal. Moreover, it is often linked to oliguria. However, urine output could still be normal or
increased. When most types of acute renal failure are diagnosed early, it is reversible.
The pathophysiology of pre–renal acute renal failure is due to impaired renal blood flow and is the
most common cause of acute renal failure. Moreover, the GFR decreases due to lowered filtration
pressure. As a result of the poor perfusion, renal vasoconstriction, hypotension, hypovolemia,
hemorrhage, or inadequate cardiac output can occur. Acute pre–renal ... Show more content on
Helpwriting.net ...
The three phases include; oliguria, diuresis, and recovery. Oliguria starts within one day after a
hypotensive even and can last between one and three weeks. Moreover, it can regress in several
hours or extend for several weeks. The stent of oliguria depends on the duration of ischemia or the
severity of the toxic injury. Specifically, there is approximately between ten and twenty percent of
cases that have non–oliguric failure. The BUN and plasma creatinine concentrations increase,
however the urine output may vary in volume. Also, other various manifestations are dependent on
the underlying cause of the renal failure. When the renal function improve, the urine volume
increases and is progressive. However, during the beginning of the diuretic phase the tubules are
still impaired. So, both the fluid and electrolyte balance need to be closely monitored due to
excessive urinary losses needing to be replaced. An index of renal function during the recovery
phase is provided my serial measurements of plasma creatinine. In order normal status to return is
may take anywhere from three to twelve months. Furthermore, about thirty percent of individuals do
not have a full recovery of a normal GFR or tubular

Hypovolemia Case Studies
Question 1:
Hypovolemia can be due to many predisposing factors such as fracture and surgery. The patient
experienced a type of open fracture which is categorize by a wound in combination with the fracture
(Whiteing, N., 2008, p. 50). Open Reduction Internal Fixation (ORIF) is the most common surgical
technique for patients with open fracture which also includes tibia and fibula (William, L & Hopper,
P., 2011, p. 1071). Since it was a major surgery massive blood loss or hypovolemia can be
experience by a patient who will undergo this procedure. Craft, J., Gordon C., & Tiziani, A. (2011,
p. 895) states that hypovolemia is a decrease in extracellular fluid volume and decrease in blood
volume. In addition, Buttaro, T., (2013, p. 982) implies that there is approximately two (2) ... Show
55). According to Wen–Chih et al. (2010, p.11), ageing patients are susceptible to blood loss since
they have limited physiological replacement. Thus, considering the age and the surgical procedure
the patient is at high risk of hypovolemia. If the loss of blood progresses and the body is unable to
compensate, the patient will be at risk for hypovolemic shock (D'Angelo, M., Dutton, R., 2009, p.
279). Hypovolemic shock means deficit in flowing blood causing to ineffectively filing the
intravascular space. Mamaril, M., Child, S., & Sortman, S., 2007, p. 191. Kolecki, P., & Menckhoff,
C. (2014) emphasizes that there are four (4) classification of hypovolemic shock. Class 1 is when
there is 0–15% of blood loss with only slight change in heart rate. If the patient heart rate becomes
more than 100 beats per minute and they experience tachypnoea and has cool clammy skin, the
patient is in the class 2 of hypovolemic shock. Class 3 and 4 is when the patient will manifest the
severe sympathetic response of the body due to the inability of compensate with the blood loss.
Thus, considering the age and the surgical procedure the patient is at high risk of hypovolemia or
even the more severe

Nursing Fluid Balance Report
The learning objective to be addressed in this essay is to be more adept at filling out a fluid balance
chart and understand its importance. I intend to use the Driscoll (2007) reflective cycle as I find the
root process of interrogating and assessing events the most helpful at being reflective. The fluid and
electrolyte balance monitoring and management are essential and highly significant to nursing care
as highlighted by Jevon and Ewens (2007). Patients suffering from a negative fluid balance is
understood as suffering in dehydration according to the definition of dehydration by Jevon (2010)
Some symptoms of dehydration, as described by Goertz (2006) include thirst, headaches, dry skin,
weight loss, fatigue and pyrexia. From this point onward ... Show more content on Helpwriting.net
...
Luckily enough, my mentor remembered and wrote down the urine output for that hour. I was
criticised by my mentor for forgetting to do so and she reminded me of the importance of keeping
rigorously accurate fluid balance chart as post–operative patients are at a higher risk of
hypovolaemia and oliguriaThey are at risk of hypovolaemia due to fluid loss during the procedure
Hypovolaemia, the decrease in the volume of blood circulating in the body, can lead to tachycardia.
A tachycardic heart rate is not efficient in oxygen delivery to the organs. The increase of work
demand and decrease of oxygen delivered on the heart can cause rate related ischaemia (Hutchins,
2013). A study conducted by Vaughn et. al (2014) showed that oliguria, which left untreated can
lead to tubular necrosis and acute kidney injury (AKI)..She reminded me of its importance in
delivering excellent care and ensuring the patient's good health. The chastisement that I received
from my mentor made me feel somewhat disappointed as I felt that such a simple mistake could
have been easily avoided. Her reminder of the importance of giving the highest quality of care also
made me realise the importance of little thing in the care of the patient. Little things, when put
together, make something big and significant. Although I was disappointed with myself for making
such a trivial mistake, I soon realised that my mentor gave me an important job which I should have
been more careful with. I understood that I am accountable for my actions and partly accountable
for whatever outcome may befall to the patient. Moments afterwards, I accepted my mistake and
was soon eager to prove myself and be worthy of such a

Proof Of The Resurrection
Proof of the Resurrection Before one can prove the resurrection, one must demonstrate that Christ
died on the cross. Many people in the world think that the claim to resurrection was an elaborate
hoax. The Qur'an contends that Jesus went to India and died there. The night before his crucifixion
was scheduled, Jesus was under so much stress that he sweat blood, a condition called hematidrosis.
This disorder would also make the skin very fragile, so when the Roman soldier flogged Jesus the
next day, his skin would be oversensitive. As the scourging continues, his back would become
shredded from his shoulders to his legs. He would have bled so much that he would have gone into
hypovolemic shock. Hypovolemia makes the heart beat faster, the blood pressure drops, the kidneys
shut down, and he would be very thirsty. Jesus would be in severe to critical condition just from the
beating. At the site of the crucifixion, Jesus would have been laid down, and his wrists would have
been nailed to the cross beam with five to seven–inch–long spikes. Then crossbeam was hoisted up
and attached to the vertical stake; then his feet were nailed to the cross. Jesus arms would have
stretched enough to dislocate both shoulders. This upright suspension caused his diaphragm to be
locked in the inhale position. He would have to push up with his feet to exhale, then relax and
inhale. As breathing slows down the carbonic acid would increase, causing an irregular heartbeat,
which along with the rapid heartbeat caused by low blood volume, would cause heart failure. Heart
failure would cause fluid to build up around the heart
Anthony 5 and the lungs. When the soldiers put the spear in his side, it would have released the
edema around the lungs and heart, and blood would have come from the hole they made in his heart.
At this point, Jesus was dead. Next to be proven is that the body of Jesus was buried and three days
later the tomb was empty.
A prominent member of the Sanhedrin, Joseph of Arimathea, requested that he be given the body of
Jesus to bury. When Pilate granted his request, he took Jesus' body down from the cross, wrapped it
in burial clothes, and laid him in a new tomb. The Christians would not have

Shock, Hemorrhagic And Non Hemorrhagic
Shock is described as a state of hypoperfusion of the organs and tissues, which results in cellular
dysfunction and cell death. There are many varieties of shock, but for the purpose of this essay I will
focus on hypovolemic shock. The term hypovolemic means low volume; this term in and of itself
tells us what the root cause of this form of shock is, low blood volume. There are two different types
of hypovolemic shock, hemorrhagic and non hemorrhagic. I will be discussing the possible causes,
signs, symptoms, and treatment options for the hemorrhagic type. I will also explain what health
care providers in the field should be looking for to determine whether the patient is in a state of
compensated or decompensating shock. Compensated shock is when the body is using all of it's
resources to maintain perfusion but in the later stages of shock the patient will decompensate, this is
when the body's attempts at maintaining perfusion are beginning to fail. Recognizing the signs and
symptoms of hypovolemic shock early is vitally important! The first thing that emergency medical
providers should remember is that just because you can 't see bleeding does not mean it is not there.
Hemorrhagic shock can be missed if the care provider is hyperfocused on symptoms like low blood
pressure, which only becomes evident after the patient has already started de–compensating. A
symptom that can be seen earlier on, while the patient is still in a compensated state is decreased

Physiology Test 3 : Hemorrhagic Shock
Majriha Naorin
Physiology Test 3: Hemorrhagic Shock
Introduction
Hypovolemic shock "is an emergency condition in which severe blood and fluid loss make the heart
unable to pump enough blood to the body" ( Heller). Hypovolemic shock can be a result of
numerous things such as dehydration, excessive diarrhea or bleeding (Nall). Excessive bleeding,
both externally and internally, due to injuries is known as Hemorrhagic shock. Hemorrhagic shock
is a type of hypovolemic shock that is "associated with the sudden and rapid loss of significant
amounts of blood" (Dictionary).
Mechanisms of Hemorrhagic Shock
An average person has about five liters of blood in their body. However, if a person starts to lose a
massive amount of blood due to severe ... Show more content on Helpwriting.net ...
When there is insufficient amount of blood due to blood loss, organs do not obtain the amount of
blood that is needed. As a result, the organs do not receive enough nutrients and oxygen; hypoxia. A
decrease of blood pressure also decreases in perfusion of the carotid and aortic bodies, "several
clusters of chemoreceptors" (Boron).This decline in perfusion, increases the rate of the
chemoreceptors which increases the firing of the sympathetic vasoconstriction (Boron).
This activation of the sympathetic nerves causes the release of norepinephrine (neurotransmitters)
and epinephrine (hormones) from the adrenal medulla (located on top of the kidney), which then
binds with α1–adrenoceptors (Klabunde). As a result, the smooth muscle activates and
vasoconstrict. This causes the heart rate to increase along with the stroke volume and total
peripheral resistance which prevents blood from escaping. Due to the increase of heart rate, the
hemorrhagic patients will experience tachycardia (Boron).
Though turning on the sympathetic nervous system is body's response to the blood loss so that it can
go back to homeostasis, it can also detrimental to the body. Since there is a severe amount of blood
that is exiting the body, by increasing the heart rate, it will be supplying more blood to the wound,
releasing even more blood out of the body. Although the body does not redistribute blood to organs
due

Hypovolemic Shock Case Study
Hypovolemic shock is an emergency condition caused by loss of whole blood (hemorrhage), plasma
(burns), or interstitial fluid (diaphoresis, diabetes mellitus, diabetes insipidus, emesis, diuresis, and
diarrhea) in large amounts. This makes the heart unable to pump enough blood to the body (Heller,
2014). The severe compromise in blood flow and therefore systemic perfusion contributes to
cerebral, renal, or hepatic ischemia and possible organ failure. It is the most common type of shock
in children with dehydration and trauma being the most common factors (McCance, 2010. pp 1703).
Pathophysiology
Hypovolemic shock begins to develop after losing about a fifth or more of the normal amount of
blood in the body resulting in compensatory vasoconstriction, increased SVR (systemic vascular
resistance) and increased afterload in order to improve blood pressure and perfusion to core organs
of the body (Heller, 2014) (McCance, 2010. pp 1672). Compensatory mechanisms have limited use
and benefit.
Hypovolemic compensations:
Systemic vasoconstriction – increases left ventricular afterload and myocardial oxygen consumption
and may produce tissue ischemia.
Prolonged tachycardia – may impair subendocardial blood flow and increase myocardial oxygen
consumption; both may ultimately contribute ... Show more content on Helpwriting.net ...
After the onset of hypovolemic shock, the primary goals are to replace blood and fluid volume via
IV infusion; maximization of oxygen delivery, and minimization of oxygen demand. Patient is
positioned in a manner that supports maximal circulation and airway patency (oxygenation,
ventilation, and perfusion). Diligent treatment of fever, fear and pain are necessary to reduce oxygen
demand. Humidified supplementary oxygen is given as needed at up to 10 to 15 L/min by non–
rebreathing mask or bag–mask ventilation and is monitored continuously through pulse oximetry
(McCance, 2010. pp

Orthostatic Hypotension Case Study Essay
Case Study
Julia Atungsiri
Purdue University Global
Case study
1. What is the significance of the orthostatic hypotension, tachycardia, abdominal tenderness,
hematuria, joint pain, and petechiae? What is splinter hemorrhages and what is their significance?
Orthostatic hypotension is the reduction of the systolic pressure of at least 20mmHG or the dropping
of diastolic pressure of at least 10mmHg within three minutes of standing as compared to baseline
as such, the body is often unable compensate for the changes in the blood pressure values (Fournier
et al., 2016). The fall in the blood pressure is attributes to the fact that a small amount of blood
collects in the leg veins when a person stands as a result of gravity hence reducing ... Show more
content on Helpwriting.net ...
What are the major causes of infections?
References
Baddour, L. M., Wilson, W. R., Bayer, A. S., Fowler, V. G., Tleyjeh, I. M., Rybak, M. J., ... &
Bolger, A. F. (2015). Infective endocarditis in adults: diagnosis, antimicrobial therapy, and
management of complications: a scientific statement for healthcare professionals from the American
Heart Association. Circulation, 132(15), 1435–1486.
Fournier, P. E., Watt, G., Newton, P. N., Lamas, C. C., Tattevin, P., & Raoult, D. (2016). Blood
culture–negative endocarditis. In Infective Endocarditis (pp. 245–258). Springer, Cham.
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic
approach (p. 1056). Lippincott Williams & Wilkins.
Pettersson, G. B., Coselli, J. S., Hussain, S. T., Griffin, B., Blackstone, E. H., Gordon, S. M., ... &
Woc–Colburn, L. E. (2017). 2016 The American Association for Thoracic Surgery (AATS)
consensus guidelines: surgical treatment of infective endocarditis: executive summary. The Journal
of Thoracic and Cardiovascular Surgery, 153(6), 1241–1258.
Thuny, F. (2016). Diagnostic Criteria for Infective Endocarditis. In Infective Endocarditis (pp. 81–
86). Springer,

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

Case 10 Nicholas Mysterious Suntan 1 Essay
Student's Name: Marylene Mosburg Date: 11/31/2014
BIO169 Case_10: Nicholas's Mysterious Suntan
This case study presents a clinical situation related to the endocrine system. The questions at the
each segment of the case will test your understanding of the endocrine system.
Nicholas T., age 32, is a busy systems analyst for a computer manufacturer. Working his way up the
corporate ladder, he travels extensively, putting in many hours without much sleep. Nicholas has a
tendency to be overweight but continues to eat fatty foods and does not have an exercise program.
He craves salty pretzels and potato chips. ? In recent months, however, he has often felt weak, and
occasionally experiences dizziness when moving from a lying down to a ... Show more content on
Helpwriting.net ...
He experiences severe pains in his abdomen, back, and legs. ? Feeling extremely weak, he catches a
flight home, and contacts his family physician, Dr. Ortega. Dr. Ortega measures his blood pressure
at 70/50 and then orders a series of laboratory tests. ? He asks Nicholas how long he has had the
"tan" and the other symptoms he describes. Nicholas indicates he only noticed them within the last
year.
Q. What might cause the pain in the abdomen, back and legs? Electrocytes imbalances and/or
dehydration.
Q. The viral infection poses a kind of stress. Why might Nicholas have such a severe reaction? He is
already in a compromised state; people who are not "healthy" have bodies that are not equipped to
handle additional stressors.
Results of the lab tests on Nicholas are summarized below: low serum Na (<130 mEq/l) high serum
K (>5 mEq/l) ? ratio of serum Na:K (<30:1) elevated hematocrit ? low WBC count decreased
plasma cortisol and aldosterone urine ? shows increased excretion of Na and decreased excretion of
K low levels of hydroxycorticosteroids in the urine
Q. How do the abnormal Na and K levels relate to adrenal function?
The mineralocorticoid (aldosterone) is normally released by the adrenal cortex in response to
decreased sodium and increased pottasium levels; the hormonally acts to promote the retention of
Na and the excretion of K. It isn't working; hence the abnormal serum levels.
Q. What does the high hematocrit means?
The ratio of the percentage of

Advanced Key Terms Of Central Line- Iv Line
Advanced Key Terms central line– IV line inserted into a large vein typically in the neck or near the
heart hypertonic– fluid on the outside of the cell membrane has a greater tonicity and osmotic pull
than on the inside of the cell membrane hypotonic– fluid on the outside of the cell membrane has a
lesser tonicity and osmotic pull than the fluid on the inside of the cell membrane osmolarity–
concentration of solute in the solution osmosis– a process by which molecules of a solvent tend to
pass through a semipermeable membrane from a less concentrated solution into a more concentrated
one, thus equalizing the concentrations on each side of the membrane peripheral line– IV line
inserted into a vein in the arm, leg, or scalp in an infant PICC line– thin, soft, long catheter that is
inserted into a vein in a child 's arm, leg or neck solute– minor component in a solution, dissolved in
the solvent solution– a liquid mixture in which the minor component is uniformly disturbed within
the major component solvent– able to dissolve other substances, the liquid in which a solute is
dissolved to form a solution Advanced Questions 1. The fluid that surrounds the cell membrane has
the same tonicity and osmotic pull as inside the cell. 2. A hypertonic solution will cause the cell to
shrink because more particles are in the solution and not in the cell. 3. Continuous irrigation is fluid
instilled into the body at a steady rate. Intermittent infusions are for medication administration and

Hypernatremia Case Summary
The main concern with HHNC is the client diuresing . This is a concern because of the loss of fluid,
which in early stages results in hyponatremia . Later in the disease process, the patient will display
elevated serum sodium levels, due to excessive fluid loss. This is a late sign that will be seen in a
comatose patient suffering from HHNC . When a patient is constantly losing fluid , as such the case
with HHNC, the patient's serum level are increasingly elevated due to less fluid in the vascular
space. This a main reason for elevate osmolality levels. Therefore , the patient will display signs of
hypernatremia . Such signs, would include increased thirst or impaired thirst due to fluid loss and
elevated serum sodium levels. Muscle weakness,

Toxic Shock Syndrome Analysis
Toxic Shock Syndrome is a rare, potentially life–threatening, syndrome that was initially discovered
and diagnosed in the 1970s. "It is characterized by high fever, rash, hypotension, multi organ failure
(involving at least 3 or more organ systems), and desquamation of the skin, typically of the palms of
the hands and soles of the feet, 1–2 weeks after the onset of acute illness. The clinical syndrome can
also include severe myalgia, vomiting, diarrhea, headache, and nonfocal neurologic abnormalities.
(Venkataraman, 2014) " Toxic Shock syndrome can also lead to surgical debridement and
amputation (Willey, 2014)." At time of discovery, toxic shock syndrome was more prevalent
amongst women, particularly those who used tampons or intrauterine ... Show more content on
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Generally, a reaction from the immune system in response to a foreign organism or a foreign antigen
is considered to be a positive event, however, in the case of Toxic Shock Syndrome, there is an over
response to the foreign antigen. When the foreign antigen or superantigen is present the immune
system will have a more intense response than usual. Once in contact with the hosts' cells the
superantigen causes many reactions to take place within the body. Some examples of these reactions
include "activation of blood vessel muscle cells leading to vasodilation and fall in blood pressure,
activation of skin lymphocytes causing a non–purpuric red rash, activation of gut lymphocytes
leading to diarrhea, and activation of muscle cells leading to pain and cramps." (EMERGENCY
NURSE) In response while attacking the superantigen to destroy it, other healthy tissues in the body
of the host will ne negatively impacted or destroyed. The strength of this response can lead to many
of the characteristic signs of TSS including fever, rash, desquamation of the skin, and organ failure;
which may culminate in septic shock or death of the

Nursing Case Study Hypovolemic Shock
School of Nursing
ASSESSMENT COVER SHEET
Student Name(s): JAYA SHREE BHURTEL Student No.(s): N9580689
Note: If this is a group assessment submission, please list the student name and numbers of all group
members in the above box.
Unit Name: Integrated Nursing Practice 3 on Campus
Unit Code: NSB 236 Due Date: 22nd September 2017 By 8:45 PM
Lecturer's/Tutor's Name: Dr. Naomi Tutticci
Tutorial Day/Time: Monday 11am–13pm
Assessment No. 1 Assessment Title: The Deteriorating Patient: Case Studies (Hypovolemic Shock)
Hypovolemic shock is an urgent condition of rapid reduction of circulatory volume in the body,
which can be created due to blood or plasma or body fluids loss (Kettley & Marsh, 2016, p. 31;
Perner & Backer, 2014, p. 613). Blood loss can be induced by internal or external injuries, excessive
perspiration or diuretics (Craft & et al, 2015, p. 852). Maureen Hardy's hypovolemia has been
precipitated by hematemesis.
Maureen shows clinical manifestations such as hypotension (BP 80 mmHg systolic), tachycardia
(HR 120 bpm and irregular), tachypnea (Resps 28 bpm), SaO2 unreadable, capillary refill time
>4secs, temp 36.5°C (core) indicating the signs of hypovolaemia (Perner & Backer, 2014, p. 614).
With the reference of Mrs. Hardy's medical condition, such as arthritic knees and atrial fibrillation
(INR 2.7), she is under diclofenac Acid 50mgs PO BD and warfarin 2mgs PO mane respectively
(Jordan, 2010, p. 567; Zacher, et al., 2008, p. 930). Diclofenac is a

Symptoms And Symptoms Of Acute Pancreatitis
Mr. P.M. is a forty–seven–year–old African Canadian who came to emergency with complains of
vomiting and severe abdominal pain. He stated that he finished a heavy meal accompanied with 3–4
glasses of wine when his pain began. He usually consumes 2–3 cans of beer per day. Based on
clinical findings and tests, he was diagnosed with acute pancreatitis and admitted to the medical–
surgical unit. I was assigned to care for Mr. P. M. during the day shift following his admission.
Acute pancreatitis is a rapid inflammatory process when the tissue of pancreas "digests" itself due to
enzymatic activity. The main reason for that is alcohol abuse and gallstones (Pfrimmer, 2008). Upon
physical assessment of this patient, my findings were severe ... Show more content on
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He expressed concerns about his nutrition regimen as he was NPO, the possibility of chronic disease
after this acute episode, and diminished ability of moving in bed and ambulating due to severe pain.
My nursing priorities for this patient should be preserving normal pancreatic function and
preventing complications that may lead to organ failure and death. My major goals are providing
supportive care and limiting systemic complications (Susan, 2007). Another nursing goal is to
provide family–centered care (Pfrimmer, 2008). Supportive care includes intravenous fluids, bowel
rest, pain management, and monitoring (Susan, 2007). My top priority in care of Mr.P.M. is to
assess his ABCs and vital signs meticulously. Since his oxygen saturation is slightly diminished, I
should administer supplemental oxygen. Pain management is a high priority as well. Since the pain
is severe (8/10) and interrupts the patient's activity, I have to manage it with IV narcotics (Morphine,
Meperidine, etc). Usage of PCA with Fentanyl (Patient Controlled Analgesia) is also effective. It is
crucial that pain is managed successfully since it may have a valuable influence on Mr. P.M.'s
physical and psychological condition. I should advise him to stay in bed because it may diminish the
severity of pain. Promoting relaxation or distractive techniques may refocus his attention. Sedative
medications such as

Hypothermia And Hyperthermia
Hypothermia and hyperthermia are very different disorders. The definition of hypothermia is the
condition of having an abnormally low body temperature, typically one that is dangerously low. The
definition of hyperthermia is the condition of having a body temperature greatly above normal.
Extreme temperatures and exposure to different surroundings causes both. Hypothermia is caused
by cold temperatures, diabetes, and thyroid conditions. A few other causes are severe trauma drugs
and some medications. Not only does alcohol cause hypothermia, it can also cause hyperthermia.
Not enough water consumption, lack of air, and environmental heat conditions all contribute to
causing hyperthermia. People who are outdoors get these disorders. The elderly, infants, and
children without heat, clothing, or food are at a higher risk of getting hypothermia. The mentally ill
are also at a great risk. Young children with seizure have a high chance of suffering from
hyperthermia. ... Show more content on Helpwriting.net ...
Hypothermia cause physical effects such as shivering, incapable to walk, and have a difficult time
trying to speak and be understood. The mental effects of hypothermia are feeling apathy and
confused. Hyperthermia physical effects are high heart rate, reddened skin organ failure,
unconsciousness, heat stroke, pale in face, seizures, and death. The mental effects of hyperthermia is
confusion and mental changes such as decision making. Their symptoms range from shivering to
heat strokes. The main symptoms of hypothermia are shivering, weakened pulse, gray and cold skin,
and hallucinations. The top symptoms of hyperthermia are heat strokes, muscle cramps, fatigue,
dizziness, seizures, tachycardia and

Acute Pain Case Study
Acute pain · Extreme pain is due to the hypoxic environment that results from the occlusion of
capillary beds within tissues by sickled RBCs. This sickling is due to the polymerization of HbS in
low–oxygen environments occluding tissues and causing local hypoxic environments. Inflammation
is indicated as the trigger for this process in many cases. Experimental studies in transgenic HbS
homozygote mice using hypoxia and inflammatory drugs showed occlusion of the postcapillary
venules due to increased interactions between leukocytes, RBCs, and the vascular endothelium. In
addition, precapillary obstruction is observed in sickled RBCs with especially high [HbS] and
increased interactions between the vascular endothelium and RBCs. The tissue damage that results
from the hypoxic environment leads to an increase in inflammation in the area once the tissue is
repurfused with ... Show more content on Helpwriting.net ...
Nitric oxide acts as a vasodilator and regulator of the adhesion of leukocytes and platelets to the
endothelium. Its inhibition leads to the accumulation of inflammatory cells and further oxidative
damage to the tissue and endothelium. Additionally, the anemia due to hemolysis of sickled RBCs
can lead to mental deficiencies in addition to mental deficiencies due to silent infarcts. Those
suffering from silent infarcts are also more likely to suffer a major stroke later on. Acute chest
syndrome · Infection, occlusion of bone–marrow vasculature leading to formation of a fat embolus,
and agglutination of sickled RBCs in the pulmonary vasculature leading to occlusion of the
pulmonary vasculature in at least one lung segment all contribute to the incidence of acute chest
syndrome. Pulmonary

Hypovolemic Shock Case Studies
1.Mr. P presents abdominal pain in the left lower quadrant, which extended to the middle of the
abdomen. I would say that Mr. P has hypovolemic shock. Hypovolemic shock occurs when the
circulating blood volume is inadequate to fill the vascular network. Intravascular volume deficits
can be triggered by eternal or internal losses of either blood or fluids. This can result to lack of
oxygen transport and nutrients to tissue. The severity of hypovolemic shock depends on the volume
deficit, the acuity of volume loss, type of fluid lost, age, and preinjury health status of the patient.
The most common cause of hypovolemic shock is hemorrhage. However, if ASA is given in high,
prolonged dosages, it may precipitate GI bleeding. Warfarin can also cause ... Show more content on
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Priority Nursing diagnosis
Altered tissue perfusion related to decreased blood volume (hypovolemic shock) as evidenced by
low hemoglobin–7.9g/dl, hematocrit–23.7%, BP–65/40, HR–150, hypoxemia, decreased urine
output.
4. Nursing and Medical interventions are
Maintain patent airway
Monitor oxygenation: pulse oximetry, ABGs, SvO2 at least 90%
Suction as needed
Replace blood components as indicated; obtain laboratory specimen for type and crossmatch
Administer fluids as ordered
Evaluate patient's response to fluid challenges and blood product administration: improved vital
signs, level of consciousness, urinary output, hemodynamic values, and serum and urine lab values.
Monitor cardiopulmonary status: HR, RR, BP, MAP, skin color, temperature, and moisture, capillary
refill, hemodynamic values, cardiac rhythm, neck veins, lung sounds
Monitor level of consciousness
Monitor gastrointestinal status: abdominal distention, bowel sounds, gastric PH, vomiting
Monitor fluid balance: I & O, daily

Cardiogenic Shock Research Paper
Shock is a collapse of Circulatory function caused by severe injury, blood loss, or disease, and
characterized by pallor sweating, weak pulse, and very low blood pressure .There are three basic
types of shock. Cardiogenic Shock [includes tension pneumothorax, cardiac tamponede and
pulmonary embolism] which is caused by the heart failing to pump as designed. Distributive shock
[includes septic shock, neurogenic shock, anaphylactic shock and psychogenic shock] which is
caused by poor vessel function. Lastly we have hypovolemic shock [includes hemorrhagic shock
and non hemorrhagic shock]. Cardiogenic shock is basically shock that is cardiac in nature. It is also
the end off of the road for all other causes of shock. Cardiogenic shock ... Show more content on
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Now lets look a tension pneumothorax. A tension pneumothorax is when airs builds up in the pleural
space [from a chest injury allowing air to enter but not get out] and cause the lungs to compress and
decrease return blood flow to the heart causing shock. Tension pneumothorax is a serious and
potential deadly condition that can sometimes be controlled by placing a coated trama pad over the
hole to control air going in. Another procedure called needle decompression can be done by ALS
providers. Next we have Cardiac tamponade [which is caused by blunt or penetrating trauma or a
few medical conditions such as cancer or autoimmune dieses] which is a serious condition where
the blood accumulates in the pericardial sac [the sack around the heart]. While there is no definitive
treatment on a basic level and ALS provider can relieve fluid with a needle in a risky but necessary
procedure the last form of cardiogenic shock is a pulmonary embolism. A pulmonary embolism is
when there is a blood clot blocking the flow of the pulmonary veins leading to obstructive shock
and causing heart failure. Interesting enough to mention is the fact that one of the more common
causes to cardiogenic shock is damage to the heart muscle however just because you have a heart
attack does not necessarily mean you have had caridogenic

Anaphylactic Shock Research Paper
Meagan Moss
Shock is defined as a state of collapse and failure or the cardiovascular system. The medical term of
shock is hypoperfusion. While in the beginning of shock, the body tries to maintain homeostasis. As
the stages of shock progress, the blood circulation slows and may eventually cease. Shock generally
is most commonly associated with traumatic events but may also occur due to a medical event as
well. If the symptoms of shock are not immediately taken care of, the patient will soon be lifeless.
(Pollak, 2010 slide 4)
There are numerous causes of shock. It may be a result of bleeding, respiratory failure, allergic
reaction, or infection. Pump failure may cause one's body to do into a state of shock. This may be
due to Heart attack, ... Show more content on Helpwriting.net ...
Neurogenic shock is typically a result of an injury to the part of the nervous system that controls the
size and muscle ton of the blood vessels. Causes of Neurogenic shock include damage to the spinal
cord, brain conditions, tumors, pressure on the spinal cord and spina bifida. Muscles in the blood
vessel walls are cut off from nerve impulses that cause them to contract. (Pollak, 2010 slide 27)
The progression of shock has three stages. First, compensated shock is a very early stage when the
body is still capable of compensating for blood loss. Next is decompensated shock, which is a late
stage of shock when blood pressure falls. Last is irreversible shock, this is the terminal stage when
transfusion is not enough to save the patient. (Pollak, 2010 slide 38–40)
In conclusion, there are many different forms of shock that all have a variety of treatments. It is
important for medical responders to have a basic understanding of shock so if they respond to a call
or have a patient that exhibits these signs, the EMS working knows that if needs to contact medical
control and using the knowledge of shock may advise what they are seeing and then may be given
farther direction depending on the form of

What Are The Negative Effects Of Chemotherapy Related...
The Negative Effects of Chemotherapy Related Diarrhoea on Systems Homeostasis
Important information for new physiologists working with CRD affected patients
Patients suffering from chemotherapy related diarrhoea (CRD) will face a multitude of social and
physiological challenges, and it's important to understand that the chronic nature of CRD is the basis
for most of them. Within hours of the onset of symptoms, isotonic dehydration will rapidly lead to
hypovolemia and consequently; tachycardia, hypertension, delayed capillary refill and slightly
reduced blood flow to the brain. In these early stages of dehydration and mild hypovolemic shock –
the body, while not performing optimally, is within its homeostatic limits and is not susceptible ...
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The chronic increased stress on the cardiovascular system imparted by the action of these
homeostatic regulators, drastically increases risk of ischaemic heart disease later in life and forms
some of the basis for the pathophysiology of other major systems. If fluid losses become too severe
and electrolytic imbalance cannot be remedied by the release of aldosterone, cerebral oedema and
death can result. In less severe but chronic dehydration, the large water content of the brain is tapped
into for use in more vital physiological processes, and as a consequence the hydrolysis of ATP that
is so important for maintaining brain activity is not as efficient. Over time grey matter in the brain
shrinks and the decreased efficiency adds to the symptoms of memory impairment and lethargy.
Even slightly impaired cognition and memory, headaches, lethargy and light headedness will take a
significant toll on everyday life if the patient is considering returning to work or study.
Especially in Australia where summer temperatures regularly rise above 38°C and a significant
proportion of the working population is made up of manual labourers, it's important to note that the
bodies main cooling system can shut down in very severe dehydration. This presents as inactivity of
eccrine sweat glands and in serious heat–waves the reduced fluid volume and inability to reduce
core temperature causes a huge number of homeostatic problems. Notably, as hyperthermia

Dehydration Lab Report
Hydration plays a fundamental role in body function. As such, fluid intake and excretion are tightly
regulated by various heterogeneous body mechanisms that work together to maintain a homeostatic
fluid balance. Fluid and solute balance affects every organ system in the body, especially, the
cardiovascular system, the nervous system, the genitourinary system, and the various fluid
compartments such as the interstitial and intracellular spaces. Dehydration occurs when there is an
extracellular fluid volume deficit and can originate from a variety of diverse causes. It can be the
result of insufficient fluid intake, excess fluid loss, or a combination of the two. Common causes of
excessive fluid loss that lead to dehydration include unmonitored ... Show more content on
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These mechanisms include activation of the sympathetic nervous system (SNS), which elicits
systemic vasoconstriction (via catecholamine binding of α1 receptors) in an attempt to increase
peripheral vascular resistance (PVR), and increases heart rate (via catecholamines binding to β1
receptors) in an attempt to increase CO, both of which are fundamental components of the blood
pressure equation. This is done to maintain an adequate perfusion pressure in order to oxygenate the
tissues and prevent hypoxic cell injury. If hypovolemia is present, the body will first shunt the blood
away from less critical organs such as the GI tract in order to maintain perfusion of critical organs
such as the brain, the heart system, and the kidneys. If hypovolemia and tissue hypoperfusion are
severe enough, major organ damage will occur as a result of hypoxia (Copstead & Banasik, 2013).
This patient experienced clear signs of systemic tissue hypoperfusion secondary to severe
hypovolemia as evidenced by his syncopal episode (cerebral hypoperfusion), his persistent
pressure–like chest pain (myocardial ischemia), and his acute renal failure (renal hypoperfusion).
The fact that these critical organs were affected indicates just how severe his state of hypovolemia,
hypotension, and hypoperfusion

Small Bowel Obstruction Case Study Essay
Sally Checketts
Small bowel obstruction
Student Case Study
Please review the information available in DocuCare patient chart, including demographics, notes,
diagnostics, assessments and flow sheet. Included in the "notes" section is a history and physical (H
& P) which includes a review of systems (ROS), past history and family history as well as the
physical exam (PE).
Please utilize the DocuCare information, your text and other resources to assist in answering the
following questions and to prepare for simulation. Complete your answers with a maximum of 5
sentences. Cut and pasted responses are not acceptable and will result in a low grade. If references
are cited, please use APA format. Submit to canvas prior to the Friday simulation and bring a copy
the day of simulation for in–class review. We will review the case in class and develop a priority
based care plan for this patient.
1. State in your own words what you would say to this patient to explain why she is unable to eat or
drink (relate to diagnosis).
You are unable to eat and drink before surgery because we don't want to make the bowel obstruction
worse because ... Show more content on Helpwriting.net ...
Checketts for adequate hydration by checking many things, but six assessments that are important
are: (1) amount of urinary output or yellow urine, (2) normal blood pressure, (3) elastic skin turgor
with no tenting (Kalia, 2008), (4) basic metabolic panel (BMP) to assess BUN, creatine, and
electrolytes including sodium, potassium, chloride, and bicarbonate (Dehydration, 2016), (5) her
level of consciousness (LOC) including confusion and lethargy, and lastly (6) seizures. Other
assessments include checking if capillary refill is less than three seconds and if pulse and
respirations are normal. I'm also checking to make sure mucus membranes are moist (Kalia, 2008)
and if her eyes normal and not sunken in. I'd perform a urinalysis, a CBC to check hematocrit, and
finally a blood/urine osmolality (Dehydration,

A Brief Note On The And Its Effects On The Body
Section 1– Justifications
1. According to LeMone et al. (2014), hypovolemia is the ' 'decreased circulating blood volume ' '.
the body will compensate by constricting blood vessels and raising heart rate, and if the volume is
low enough, shunting blood to vital areas (the brain, the heart) from less vital areas (skin, muscles,
digestive tract, even the kidneys.) according to Nolan, Pullinger, Bath, & Oxford ( 2014),
hypovolemia can lead to hypovolemic shock; where a person can lose up to 20 percent of their
blood or body fluid. Shock occurs when blood pressure is low to the point where blood does not
perfuse the organs and stays low long enough that cells start to malfunction and die. Hypovolemic
shock is a medical emergency.
2. ... Show more content on Helpwriting.net ...
A doctor may prescribe a drug–thinning medication, such as dabigatran also known as Pradaxa and
warfarin also known as Coumadin to help lower patients risk.
4. According to LeMone et al. (2014) hypertension is the excess pressure in the arterial area of the
systemic circulation. hypertension is a risk factor for cardiovascular disease. It is a nurses
responsibility to monitor and stabilise the patient 's Blood pressure as it is a major force for the
blood to travel around the body. Without a stable blood pressure blood cannot deliver fresh blood
with oxygen and nutrients systemically (high blood pressure research council of Australia, 2008).
Hypertension leads to an increased risk of morbidities such as cardiovascular disease which can
result to further complications such as heart attack, heart failure, stroke, kidney failure and blindness
(Rafey, 2000) . An ideal and common blood pressure for a an adult is 120 over 80.
5. According to LeMone et al. (2014), chronic right hip pain is prolonged pain, usually lasting
longer than 6 months affecting the right hip. According to Black (2014), Chronic right hip pain
caused by osteoporosis is a chronic condition. Osteoporosis can results in pain, stiffness, joint
deformity and fractures. Osteoarthritis can an individual 's ability to walk, work, and quality of life.
Mild arthritis pain can be managed with ice or heat, rest, changing activity of daily living ,
medications, or

Elderly Dehydration Essay example
Most people don't think about dehydration; let alone elderly dehydration. It is a common problem,
in the aging, and often recognition along with treatment may be delayed; contributing to a high
mortality rate. (Lavizzo–Mourey, 1987) By recognizing a potential problem early, you may save an
older adult from a debilitating complication. (Hamilton, 2001) The prevention of elderly
dehydration will deter illness and increases life expectancy, along with decreasing unnecessary
hospitalization and cost.
There are several causes to elderly dehydration, which can be broken down into four groups:
physiological factors, psychological factors, functional impairments, and mechanical impairments.
(Hamilton, 2001) The physiological factors are: natural ... Show more content on Helpwriting.net ...
(Hamilton, 2001)
If, these signs and symptoms go undetected, for a long period of time, they will result in chronic
dehydration and cause several other medical issues. (Vasey, 2002) One of the results of chronic
dehydration is fatigue or energy loss which resembles depression. (Vasey, 2002) Constipation is
another result chronic dehydration, by removing too much excess liquid from stool making it hard to
expel. (Vasey, 2002) Chronic dehydration also contributes to digestive disorders such as: poor
digestion, gas, bloating, pain, nausea, ingestion, and loss of appetite. (Vasey, 2002) The average
body produces 7 liters of digestive juices daily; but a dehydrated individual will secrete less, thereby
causing improper digestion. (Vasey, 2002) Chronic dehydration causes high blood pressure due to
low blood volume and the vessels sharply contracting. (Vasey, 2002) It can also cause low blood
pressure in individuals, with weak vasoconstriction, who again, have a low blood volume. (Vasey,
2002) Chronic dehydration is also the culprit of gastritis and

Cardiac Output Analysis
Decreased Cardiac output related to decreased contractility and altered heart rhythm
Monitor and document cardiovascular status: heart rate and rhythm, heart sounds, blood pressure,
pulse pressure and the presence or absence of peripheral pulses. Compare to the baseline
assessment. Report abnormalities to the physician, particularly tachycardia, a new S3 heart sound or
systolic murmur, hypotension, decreased pulse pressure or pulse loss or increased arrhythmias One
of the earliest signs of worsening HF is increased HR. A new S3 heart sound or systolic murmur
may reflect increased fluid volume, leading to increased cardiac congestion and failure.
Hypotension can reflect decreased cardiac output from impaired myocardial contractility or ... Show
These are the foundation of medical treatment for heart failure and relieve symptoms, improve
exercise capacity and reduce mortality.
Diuretics reduce circulating volume, enhance sodium and water excretion and improve symptoms
but can cause true hypovolemia from excessive fluid loss or hypokalaemia from potassium loss
Deficient knowledge related to lack of exposure to information
Explain the need to adhere to a low sodium (2 pound) weight change in 1 day or a trend over several
days. Patient to be weighed consistently (e.g. before breakfast, on the same scale, after voiding, in
the same amount of clothing, without shoes).
Body weight is a more sensitive indicator of fluid or sodium retention than intake and output. A 2 to
3 pound increase in weight in a day normally indicates retention of about 1L of fluid and a need to
adjust fluid or diuretic therapy.
Patient will display stable weight Monitor/calculate 24–hour intake and output (I&O) balance.
Diuretic therapy may result in sudden/excessive fluid loss (circulating hypovolemia), even though
oedema/ascites

Hypovolemic Shock Research Paper
Background:
According to the National Trauma Institute, hypovolemic shock is the second leading cause of death
in people with traumatic injuries. [1] This makes the initial identification and management of
Hypovolemia detrimental to the outcome and survival of many patients involved in traumatic
events. Hypovolemia refers to a medical condition in which rapid fluid loss results in multiple organ
failure due to inadequate circulating volume and consecutive inadequate perfusion. [1,2,3]
Method:
We searched Australian databases, including Australasian Journal of paramedics, Queensland
paramedics Clinical practice manuals and textbooks dated from 2007 to 2017. We included peer
reviewed journal articles, published books and Clinical practice

Example Of Nursing Physical Assessment
The patient is a 45 year old man who had GI surgery 4 days ago. He is NPO, has a nasogastric tube,
and IV fluids of D51/2saline at 100 mL/hr. The nursing physical assessment includes the following:
alert and oriented; fine crackles; capillary refill within normal limits; moving all extremities,
complaining of abdominal pain, muscle aches, and "cottony" mouth; dry mucous membranes, bowel
sounds hypoactive, last BM four days ago; skin turgor is poor; 200 mL of dark green substance has
drained from NG tube in last 3 hours. Voiding dark amber urine without difficulty. Intake for last 24
hours is 2500mL. Output is 2000mL including urine and NG drainage. Febrile and diaphoretic; BP
130/80; pulse 88; urine specific gravity 1.035; serum ... Show more content on Helpwriting.net ...
Pt.'s with NG tubes loose potassium through suctioning. Sodium of 140 is normal but on the higher
end which is indicative of dehydration. Chloride of 92 is a little low which is interesting because the
sodium is normal–high and usually chloride follows sodium. Mag of 1.4 is low maybe because of
low calcium.
4.) The physician is planning to place a percutaneous central line to infuse TPN. Which site is
recommend and why?
A percutaneous central line is entered into the patient's subclavian vein. Because TPN solution is
concentrated it is better to have CVC access in the subclavian vein so the solution has less distance
to travel to its destination. This reduces the risk of the line clotting or damaging the vein.
4b.) What are the nurse's responsibilities for placement of the central line?
The nurse is responsible for positioning the patient and should assess the patient throughout to see
how well he is tolerating it. If the patient is on a heart monitor, the nurse should monitor vital signs
and heart rate as the catheter is being put in for any fluctuations. Afterword's, the nurse should
assess for complications or adverse reactions like pneumothorax. Make the patient comfortable and
listen to bilateral breath sounds. Obtain a stat XRAY to verify correct placement.
The assessment includes: Date and time of procedure, name of provider, site of insertion, type of
fluid infusing in each lumen, blood

Fluid Resuscitation Protocols And Interventions Have...
Fluid Resuscitation in Burn Patients
Fluid resuscitation protocols and interventions have established guidelines for nursing care of burn
patients in hospital settings. Although these protocols aid the nurse in making treatment decisions,
the nurse must first understand the fluid pathophysiology of burns, the different fluid alternatives,
the amount of fluid volume infusions allowed and their effects within the patient's body, as well as,
any complications related to fluid resuscitation for burn patients. In addition, fluid resuscitation
should be carefully and diligently monitored to ensure the main goal of therapy which is to attain
adequate tissue perfusion while minimizing patient's complications.
Understanding the fluid pathophysiology of burns
Local and systemic inflammatory response occurs within the body due to fluid shifts from
intravascular compartments into the interstitium caused by changes in capillary permeability. The
body's specific response to burns directly correlates with the total body surface (TBSA) percentage
affected. Patients with 25% TBSA burns experience an increase in generalized capillary
permeability, at 30% TBSA burns patients are affected by a disruption on the cellular ion gradient
lasting several days and requiring a longer hospitalization stay, and patients with 50% TBSA burns
end up losing half of their fluid resuscitation volume due to increased leaks into the non–thermally
injured tissue (Diver). Several studies coincide that the

Essay On Hypovolemic Shock
Rebecca Blackburn
Instructor: J. T. Cash
EMT–Basic
3 November 2015
Hypovolemic Shock
Shock is described as a state of hypoperfusion of the organs and tissues, which will result in cellular
dysfunction and cell death. There are many varieties of shock, but for the purpose of this essay I will
focus on hypovolemic shock. The term hypovolemic means low volume, this term in and of itself
tells us what the root cause of this form of shock is, low blood volume. There are two different types
of hypovolemic shock, hemorrhagic and non hemorrhagic, I will be discussing the possible causes,
signs, symptoms, and treatment options for the hemorrhagic type. I will also explain what health
care providers in the field should be looking for to determine whether their patient is in a state of
compensated shock, where their body is doing everything it can to maintain perfusion, or if the
patient is de–compensating and the body 's attempts at maintaining perfusion are failing.
1
Recognizing the signs and symptoms of hypovolemic shock early is vitally important! The first
thing that emergency personnel should remember is that just because you can 't see bleeding does
not mean it is not there. Hemorrhagic shock can be missed if the care provider is hyperfocused on
symptoms like low blood pressure, which only becomes evident after the patient has already started
de–compensating. A symptom that can be seen earlier on, while the patient is still in a compensated
state is

Symptoms And Symptoms Of Acute Pancreatitis
Mr. P.M. is a forty–seven–year–old African Canadian who came to emergency with complains of
vomiting and severe abdominal pain. He stated that he finished a heavy meal accompanied with 3–4
glasses of wine when his pain began. He usually consumes 2–3 cans of beer per day. Based on
clinical findings and tests, he was diagnosed with acute pancreatitis and admitted to the medical–
surgical unit. I was assigned to care for Mr. P. M. during day shift following his admission.
Acute pancreatitis is a rapid inflammatory process when the tissue of pancreas "digests" itself due to
enzymatic activity. The main reason for that is alcohol abuse and gallstones (Pfrimmer, 2008). Upon
physical assessment for this patient, my findings were severe epigastric pain 8/10 radiating into the
back, associated with nausea and vomiting. He had distended abdomen with bowel sounds
diminished in all 4 quadrants. Patient was sweating and febrile, and demonstrated signs of
hypovolemia due to fluid loss (Parker, 2004). His temperature was 37.8 C, heart rate 106 beats per
min., respiratory rate 26 breaths per min., oxygen saturation 95%, and blood pressure 105/64
mmHg. The reason for temperature increase could be acute inflammation; patient was tachycardic,
had diminished saturation, and dyspnea in attempt to compensate for decreased cardiac output and
tissue hypoxia. His BP was low due to hypovolemia. Upon psychological assessment, I found that
the patient demonstrated signs of anxiety,

Diabetic Ketoacidosis : An Acute Complication Of...
Diabetic Ketoacidosis
Background
Diabetic Ketoacidosis (DKA) is an acute complication of uncontrolled glucose levels characterized
by reduced levels of insulin and presence of ketones. It is a medical emergency and results can be
detrimental if left untreated. DKA is commonly seen in patients with type 1 diabetes mellitus (type 1
DM). However, critically ill patients with type 2 diabetes mellitus (type 2 DM) such as trauma,
surgery or infection, are also at risk for DKA (Ignatavicius & Workman, 2013). Patients with type 1
DM are predisposed to DKA if their underlying conditions are not diagnosed early and in some
cases, they may experience similar signs and symptoms without actually developing DKA.
Comorbidities involving parts of ... Show more content on Helpwriting.net ...
Likewise, patients with type 2 DM are resistant to/lack the insulin hormone (Sole et al. 2013). There
is also the free activity of lipase, an enzyme responsible for the breakdown of triglycerides into fatty
acids and glycerol. This enzyme is founding adipose cells due to clustering and increased production
of fatty acids leading to an output of ketone from the liver (Grossman & Porth, 2014). As ketone
levels rise, so does bicarbonate levels leading to metabolic acidosis which is characterized by rapid
breathing otherwise known as Kussmaul respirations, a fruity breath, and in some cases increase in
lactic acid (Sole et al. 2013).
In addition to the disorders in the metabolism, patients with DKA experience a condition known as
Hyperglycemia–Induced Osmotic Diuresis characterized by the intracellular and extracellular shift
of increased glucose levels in the blood, and leads to electrolyte imbalance, increased serum
osmolality, and dehydration. Affected electrolytes include sodium, potassium, magnesium, calcium,
and phosphorus. Hypokalemia occurs as a result of absorption of potassium from cell to skeletal
muscle (Gosmanov, Gosmanova, & Dillard–Cannon 2014). These changes may cause a false
elevation of serum potassium levels (Sole et al. 2013).
Furthermore, dehydration becomes worse as the body tries to compensate for fluid shifts from the
intracellular to the intravascular spaces leading to a decrease in glomerular filtration rate, decreased

Aphylactic Shock Case Studies
Anaphylactic Shock
Shock is a serious medical issue characterized by insufficient perfusion, which can lead to sepsis
and death. A patient going into shock is something that an EMT may face in the field, therefore an
EMT must be able to accurately identify and diagnose all types of shock. Although there are many
specific types of shock, the most widely accepted division of shock was established by authors of
"The Fundamental mechanisms of shock" Hinshaw and cox. Hinshaw and cox explain that shock
can be separated into four broad pieces: hypovolemic shock, cardiogenic shock, distributive shock,
and extracardiac obstructive shock (Sethi).
Hypovolemic shock occurs when there is an overall "loss in circulatory volume", which means not
enough blood is circulating through the body. Cardiogenic shock occurs when the heart cannot
provide enough blood to maintain the organs of the body. Distributive shock occurs when the
volume of blood is at a normal level, however the distribution of the blood is abnormal. Finally,
extracardiac ... Show more content on Helpwriting.net ...
General treatment could include making sure the individual is comfortable and warm, keeping his or
her legs elevated above their head, administering appropriate medications if given authorization, and
providing oxygen to the patient (Quick and Dirty Guide to Shock). Prevention is the best type of
treatment. This means keeping a healthy lifestyle, and obtaining as much self–knowledge as
possible.
Specific treatment of anaphylactic shock includes making sure the airways of the patient are open,
providing oxygen, and giving authorized medications. Specifically, medications such as albuterol,
epinephrine, and dopamine may be administered (Mayo Clinic). Just like in almost any emergency
case, keeping the airway open, and managing oxygen levels is extremely important during
anaphylaxis. Patients should be provided with aiding oxygen, and monitored (Quick and Dirty
Guide to

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