A 76-year-old man was admitted to the hospital emergency room experiencing loss of consciousness, fever, fatigue, dilated pupils, facial paralysis, shortness of breath, and rapid breathing due to a second cerebrovascular accident (CVA or stroke). He had a history of diabetes, hypertension, amputations due to diabetic foot complications, and a previous CVA. A CT scan showed multiple cerebral infarctions and brain atrophy. The man was treated with IV fluids and medications. Nursing care focused on preventing vomiting, reducing anxiety, and promoting nutrition.
SubjectiveChief complaint headaches and blurriness of visi.docxpicklesvalery
Subjective:
Chief complaint: headaches and blurriness of vision on the right side
History of present illness: the patient is 67 years old Caucasian female, she complains of having had headaches for 2 weeks now. The pain is located in the right temporal area. She describes the pain as 8-10/10, sharp, constant, interferes with her sleep, she states that nothing aggravates it, not even the bright lights or high sounds, but she gets a little relief by taking Ibuprofen 800 mg. She stated that she has been having some blurriness in the right eye, while her left eye is fine. She also complains of pain in her jaw and tongue while chewing food. Her appetite has been low, and lost about 5 pounds in the last 2 weeks. She noticed low grade fever as well. She also reported ringing sounds in the right ear. She denies any nausea or vomiting. She denied having similar headaches in the past. The patient denies complaining of nasal or postnasal drainage.
PMH: past medical history is significant for Hypertension, type II diabetes mellitus, asthma, and degenerative arthritis of the knees.
PSH: hysterectomy
Medications: Lisinopril 10 mg PO QD
Metformin 500 mg PO BID.
Proair HFA 2 puffs PRN.
Ibuprofen 800 mg TID
Multivitamins
By comparing the medications that the patient is taking with Beers criteria, they all looked appropriate to be used in elderly patients.
Family Hx:
Father: HTN, diabetes, and stroke.
Mother: HTN, Diabetes, and breast cancer at the age of 72.
Social Hx: the patient never smoked tobacco products.
ETOH: social drinker
Illicit substances: denies ever using illicit drugs.
Allergies: penicillin.
Review of systems:
Constitutional: the patient complains of fever, fatigue, anorexia, and weight loss.
Head: the patient denies complaining dizziness or lightheadedness.
Eyes: blurriness in the right eye.
Ears: the patient reports tinnitus- right ear, but denies complaining of ear pain or ear discharge
Nose: the patient denies any nasal bleeding, discharge or obstruction
Mouth: the patient reports painful chewing, she denies gingival bleeding, having mouth sores, or having dental difficulties
Throat: no sore throat
Cardiovascular: the patient denies complaining of Chest pain, palpitations, or swelling in the legs.
Respiratory: the patient denies any wheezing, shortness of breath or coughing.
Gastrointestinal: the patient denies any nausea, vomiting, GERD, epigastric pain, diarrhea, constipation, having black stools, or blood in stool.
Genitourinary: the patient denies any dysuria, polyuria, or visible hematuria
Musculoskeletal: bilateral knee pain.
Integumentary (Skin): the patient denies having any skin rash or skin discolorations.
Neurological: the patient denies complaining of tingling or numbness in any extremity; there is no history of seizures, stroke, syncope, or memory changes.
Psychiatric: the patient denies complaining of depression, or anxiety, denies complaining of hallucinations.
Endocrine: the pat ...
Comprehensive SOAP ExemplarPurpose To demonstrate what each sLynellBull52
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last three days. She reported that the “cold feels like it is descending into her chest”. The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4, last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over the counter Ibuprofen 200mg -2 PO as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and an hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstrating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62. She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood.
Lifestyle:
She is a retired; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. She college graduate, owns her home and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center and she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness starte ...
Comment by Morgan, Dorothy Tali Do not forget to include a runniLynellBull52
Comment by Morgan, Dorothy Tali: Do not forget to include a running head to follow APA guidelines
Health History
Yensi Aguilar
Benjamin Leon School of nursing
NUR1060C: Adult Health Assessment
Professor Dorothy Morgan
April 7, 2021
Health History
Identifying data
Date of history: 28/02/2021
Examiner: Yensi Aguilar
Name: L.P.
Address: 3403 SW 6h Street
Phone Number: 786-597-3071
Age:46
Sex: Female
Race: White
Place of Birth: Honduras
Marital Status: Married
Significant Other: Husband
Occupation: Teacher
Religion: Christian
Primary Language: Spanish
Secondary Language: English
Source of referral: The patient found the hospital’s address on the internet
Source of history: Documents with the patient’s health history gave information concerning the patient. The patient also talked concerning her health status.
Reliability: Currently, the patient seems to have a stable mental and physical state.
Chief Complaints/Reasons for Visit: According to the patient, she started experiencing high fever, blood-stained sputum, night sweats, coughing, and weight loss.
Present Illness
Time of onset: according to the patient, she started experiencing symptoms two weeks ago.
Type of onset: The patient says that she started by occasionally sweating, mild cough, headache, and pain in the abdomen area. Over time, these conditions became severe.
Original Source: The patient complains of pain in her chest and respiratory tract.
Severity: During the day, the patient does not feel many discomforts, but it becomes worse at night due to lower temperatures. Hence, the condition does not deter the patient from executing tasks during the day. The severity of her state is at 5 out of 10 on a 0-to-10-point scale.
Radiation: At night, the patient feels severe pain throughout her chest region
Time Relationship: At first, this condition was still developing and was easy to handle. However, it has evolved and has gotten worse.
Duration: It has been two weeks since the patient started experiencing the symptoms.
Association: The symptoms experienced by the patient are similar to those of flu.
Source of Relief: According to the patient, she feels better when resting after doing some light physical exercise.
Source of Aggravation: The symptoms become worse during the night. Again, exposure to allergens such as dust or cold increases the symptom’s severity.
Past History
General State of Health: The patient’s general condition is fair, considering she is suffering from a chronic illness.
Childhood Illnesses: She suffered from smallpox and measles as a child
Adult Illnesses: Hypertension, Anemia, and asthma
Psychiatric Illnesses: She has experienced mild depression in the past
Accidents and Injuries: Never had an accident or injuries
Operations: The patient denies any surgical operations
Hospitalizations: After visiting the hospital, the patient got an admission to the Jackson Hospital for one week to undergo treatment for asthma and hyper ...
Comprehensive SOAP ExemplarPurpose To demonstrate what each sec.docxmaxinesmith73660
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue .
SubjectiveChief complaint headaches and blurriness of visi.docxpicklesvalery
Subjective:
Chief complaint: headaches and blurriness of vision on the right side
History of present illness: the patient is 67 years old Caucasian female, she complains of having had headaches for 2 weeks now. The pain is located in the right temporal area. She describes the pain as 8-10/10, sharp, constant, interferes with her sleep, she states that nothing aggravates it, not even the bright lights or high sounds, but she gets a little relief by taking Ibuprofen 800 mg. She stated that she has been having some blurriness in the right eye, while her left eye is fine. She also complains of pain in her jaw and tongue while chewing food. Her appetite has been low, and lost about 5 pounds in the last 2 weeks. She noticed low grade fever as well. She also reported ringing sounds in the right ear. She denies any nausea or vomiting. She denied having similar headaches in the past. The patient denies complaining of nasal or postnasal drainage.
PMH: past medical history is significant for Hypertension, type II diabetes mellitus, asthma, and degenerative arthritis of the knees.
PSH: hysterectomy
Medications: Lisinopril 10 mg PO QD
Metformin 500 mg PO BID.
Proair HFA 2 puffs PRN.
Ibuprofen 800 mg TID
Multivitamins
By comparing the medications that the patient is taking with Beers criteria, they all looked appropriate to be used in elderly patients.
Family Hx:
Father: HTN, diabetes, and stroke.
Mother: HTN, Diabetes, and breast cancer at the age of 72.
Social Hx: the patient never smoked tobacco products.
ETOH: social drinker
Illicit substances: denies ever using illicit drugs.
Allergies: penicillin.
Review of systems:
Constitutional: the patient complains of fever, fatigue, anorexia, and weight loss.
Head: the patient denies complaining dizziness or lightheadedness.
Eyes: blurriness in the right eye.
Ears: the patient reports tinnitus- right ear, but denies complaining of ear pain or ear discharge
Nose: the patient denies any nasal bleeding, discharge or obstruction
Mouth: the patient reports painful chewing, she denies gingival bleeding, having mouth sores, or having dental difficulties
Throat: no sore throat
Cardiovascular: the patient denies complaining of Chest pain, palpitations, or swelling in the legs.
Respiratory: the patient denies any wheezing, shortness of breath or coughing.
Gastrointestinal: the patient denies any nausea, vomiting, GERD, epigastric pain, diarrhea, constipation, having black stools, or blood in stool.
Genitourinary: the patient denies any dysuria, polyuria, or visible hematuria
Musculoskeletal: bilateral knee pain.
Integumentary (Skin): the patient denies having any skin rash or skin discolorations.
Neurological: the patient denies complaining of tingling or numbness in any extremity; there is no history of seizures, stroke, syncope, or memory changes.
Psychiatric: the patient denies complaining of depression, or anxiety, denies complaining of hallucinations.
Endocrine: the pat ...
Comprehensive SOAP ExemplarPurpose To demonstrate what each sLynellBull52
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last three days. She reported that the “cold feels like it is descending into her chest”. The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4, last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over the counter Ibuprofen 200mg -2 PO as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and an hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstrating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62. She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood.
Lifestyle:
She is a retired; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. She college graduate, owns her home and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center and she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness starte ...
Comment by Morgan, Dorothy Tali Do not forget to include a runniLynellBull52
Comment by Morgan, Dorothy Tali: Do not forget to include a running head to follow APA guidelines
Health History
Yensi Aguilar
Benjamin Leon School of nursing
NUR1060C: Adult Health Assessment
Professor Dorothy Morgan
April 7, 2021
Health History
Identifying data
Date of history: 28/02/2021
Examiner: Yensi Aguilar
Name: L.P.
Address: 3403 SW 6h Street
Phone Number: 786-597-3071
Age:46
Sex: Female
Race: White
Place of Birth: Honduras
Marital Status: Married
Significant Other: Husband
Occupation: Teacher
Religion: Christian
Primary Language: Spanish
Secondary Language: English
Source of referral: The patient found the hospital’s address on the internet
Source of history: Documents with the patient’s health history gave information concerning the patient. The patient also talked concerning her health status.
Reliability: Currently, the patient seems to have a stable mental and physical state.
Chief Complaints/Reasons for Visit: According to the patient, she started experiencing high fever, blood-stained sputum, night sweats, coughing, and weight loss.
Present Illness
Time of onset: according to the patient, she started experiencing symptoms two weeks ago.
Type of onset: The patient says that she started by occasionally sweating, mild cough, headache, and pain in the abdomen area. Over time, these conditions became severe.
Original Source: The patient complains of pain in her chest and respiratory tract.
Severity: During the day, the patient does not feel many discomforts, but it becomes worse at night due to lower temperatures. Hence, the condition does not deter the patient from executing tasks during the day. The severity of her state is at 5 out of 10 on a 0-to-10-point scale.
Radiation: At night, the patient feels severe pain throughout her chest region
Time Relationship: At first, this condition was still developing and was easy to handle. However, it has evolved and has gotten worse.
Duration: It has been two weeks since the patient started experiencing the symptoms.
Association: The symptoms experienced by the patient are similar to those of flu.
Source of Relief: According to the patient, she feels better when resting after doing some light physical exercise.
Source of Aggravation: The symptoms become worse during the night. Again, exposure to allergens such as dust or cold increases the symptom’s severity.
Past History
General State of Health: The patient’s general condition is fair, considering she is suffering from a chronic illness.
Childhood Illnesses: She suffered from smallpox and measles as a child
Adult Illnesses: Hypertension, Anemia, and asthma
Psychiatric Illnesses: She has experienced mild depression in the past
Accidents and Injuries: Never had an accident or injuries
Operations: The patient denies any surgical operations
Hospitalizations: After visiting the hospital, the patient got an admission to the Jackson Hospital for one week to undergo treatment for asthma and hyper ...
Comprehensive SOAP ExemplarPurpose To demonstrate what each sec.docxmaxinesmith73660
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue .
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
1. Case Study
Introduction:
A.H. is a male Pt., 76 years old, living in DAIR AMMAR; his house
is composed of4 rooms. He is Muslim and he was married with two wifes
and he is sitting at home without working. He admitted to the
RAMALLAH hospital in 27/04/2004 at 6pm with his sons as emergency
situation because of signs & symptoms:
(loss of consciousness, hyperthermia {39˚c axillary}, drowsy, fatigue,
dilated pupils, facial paresis, dyspnea, shortness of breath, tachypnoea {38
breath/minute}) due to second CVA; because the pt was suffer from old
CVA in the right side of the brain that mean abasia in the left side of the
body. The medical team took lab tests and x-rays examination to his chest
and his head, and ct-scan for his head, and they found that there was
Brain ct-Multiple cerebral infarction & Brain Atrophy
Health History:
1- Chief Complain/s:
The Pt. was suffering from loss of consciousness hyperthermia {39˚c
axillary}, drowsy, fatigue, dilated pupils, facial paresis, sweating,
dyspnea, shortness of breath, tachypnoea {38 breath/minute} due to
CVA.
2- History of present illness:
The pt was suffering before admission to the hospital from
hyperthermia for 3 days {38˚c axillary} and in the fourth day the
temperature raised to {39˚c axillary}, and the pt felt of drowsy, fatigue
then he felled down and he lost his consciousness, so the family called
the Dr, when the Dr came the pt was suffering from dyspnea, shortness
of breath and tachypnoea {38 breath/minute}, when the Dr examined
the pt, he found all the signs and symptoms above and he examined his
pupils and they were dilated. Then the Dr talled the family that the pt
must go to the hospital as quickly as possible. And so the pt admitted to
the hospital as emergency condition with his sons in 27/04/2004 at
6pm, and he admitted to the emergency room which the medical teem
2. there apply IV solution and did suction for the respiratory tract and took
x-ray for his chest.
In the second day in the hospital the Dr wrote order to examine his head
by ct-scan, and the ct-scanwas taken and the Dr found that there was a
clot close completely the major artery feed the left side of the brain and
there was brain atrophy in the right side of the brain related to old CVA
in the right side of the brain.
3- Other current health problems:
The Pt. suffered from diabetes {300mg/dL} for 40 years, but after the
pt admitted to the hospital the level of glucose in the blood decreased
gradually to {130mg/dL}, diabetic foot since 1999, hypertension for 30
years {150-180/70-90mmHg}, but when the pt admitted to the hospital
the blood pressure decreased to {100/60mmHg}.
4- Operation and present admission / date performed:
There was no operation for the pt but there were lab tests like CBC,
electrolytes tests and chest x-ray and brain ct-scan.
5- Past medical history & operations:
1) Influenza every two years.
2) Amputation for the left leg before 1 year related to diabetic foot.
3) Amputation for the big toe in the right leg before 5 months related to
diabetic foot.
4) He took all vaccines when he was child.
6- Family History:
The family was composed ofthe father and two wives and 6 sons and 5
daughters.
Three of his sons were smoking, and all of his sons and daughters were
married.
The pt. mother's and father's were suffering from hypertension and
hyperglycemia, so the pt. and 4 of his children were suffering from
hypertension and hyperglycemia.
His house was composedof4 rooms, the electricity was good and it
wasn't been cut off, the water was good too and it wasn't been cut off,
there wasn't a telephone in the house, the ventilation was good because
there were two windows in each room.d
3. Physical Assessment:
1- General Appearance:
The hair was white and short and there was a **** in the partial part of
his head, he was thin, there were wrinkles in his skin, the color of the
skin was frumentaceouse ()حنطي, his face was pale related to the facial
paralysis and the poorcirculation in the face, and there was bad smell
from the pt. because he didn't get bathing since 2 days.
2- Skin:
There were wrinkles in the hands and the legs and on his face, the skin
was dry , the color of the skin was frumentaceouse ()حنطي, there were
no masses, there were bedsores at the lower back ,there were no rash or
scares, there was no redness, there was bad smell from the pt. because
he didn't get bathing, the nails was been cuted.
3- Head & Neck:
-Head:
The pt couldn't move his head, there were no trauma in his head, the
pt. didn't suffer from hydrocephaly, there were no wounds in his
head, there was a **** in the partial part of his head, the skin of the
head was moist and clean.
-Hair:
The pt's hair was white and short, there was a **** in the partial part
of his head, there were no dandruff, and there wasn't alopecia.
-Neck:
The pt couldn't move his neck, there were no masses or node
enlargement, and there was neither swelling nor tenderness.
-Eyes:
There was no responsefor vision, the pupils were dilated, the two
eyes were symmetric, there was no excessive tearing, there was no
glaucoma nor discharge, the pt. wasn't use glasses before his
disease, his eyes didn't have any allergies from any thing, his eyes
color was black, he didn't use lens, his eyebrows and eyelashes were
thin.
4. -Ears:
There was no responsefor hearing, there were no discharge from his
ears, there were no waxes nor bleeding in his ears, he didn't use
hearing aids, the two ears were symmetric.
-Nose:
There was no responsefor smelling, there were no discharge from
the nose, his nosewas clean, his nose was symmetric with his face,
and there was NG tube within his nose for feeding and given orally
medications through it.
-Mouth:
There was no responsefor tasting, pt. wasn't use dentures, his teeth
were clean, there were no infections in the gums, no food's remains
between his teeth, his mouth was dry, his lips were pink and dry,
and he could distinguish between different tastes.
4- Breast & Axillary:
Because the pt. was female, he refused to let me to examine his chest,
but he tolled me that there were no masses in his chest, there were no
infections in his chest, his breasts were symmetric, he examined his
breasts in the home, and there were no infections in his axilla.
5- Respiratory:
The rate of respiration was 30/minute, the respiration wasn't deep, the
pt. suffered from unproductive coughing, the respiration was irregular,
the pt. feel difficulty in breathing, there was fluid in the plural cavity as
I saw in the results of the examinations, so the pt. suffer from dyspnea.
6- Circulatory:
The pulse was 84b/m, the pulse was regular, the BP was 180/ 70
mmHg, the pt. suffered from hypertension, the pt. suffered from
hyperglycemia (diabetes), there was little cyanosis, there were no
infiltration at the site of the IV solution.
7- Abdomen:
5. The pt. suffered from abdominal pain when he entered the hospital, but
after he got his medications he didn't suffer from abdominal pain, he
could eat softfood like milk, butter milk, bake, thyme, olive oil, but he
couldn't eat heavy food like banana, apple, egg … etc, there were no
masses in the abdomen, the pt. suffered from vomiting.
8- Diet & Nutrition:
The pt. ate from the hospital food just the soft food like milk, bake,
cheese with little little amount because he was suffering from vomiting,
at normal situation (without vomiting) the pt. couldn't eat heavy food
like banana, apple, egg … etc, because it caused anxiety for the pt., the
pt. didn't have allergy from any kind of food.
9- Elimination:
- Urinary:
The pt. went to the bathroom 7 times a day for urination, and
once every two days or discharge stool, the color of the urine
was straw, the odorwas aromatic, there were no blood cells or
fibers in the urine, the urine was acidic, so the two kidneys
worked good, there were no infections in the pt's urinary
system, there were no masses or enlarge organs in the urinary
system.
- Bowel:
The pt. hadn't pain in the bowel, the pt. didn't suffer from
constipation, were no masses or enlarge organs in the bowel,
there were sounds in the bowel, no rectal bleeding.
10- Reproductive System:
There were no infections in the genital area, the menstruation
was on it's time every month, he didn't suffer when he was
birthing, the deliveries were easy and full term birth, all
deliveries were out of the hospital.
11- Muscles:
The pt suffered from fatigue in all parts of his bodywhen he
admitted to the hospital, but after one day the pt felt better
that he could stand, he could walk, he could change his
6. position in the bed, there were no masses in the muscles, the
joints worked free without limitation.
12- Neurological:
The pt couldn't hear very well, he could hear the personwho
was near his, the pt couldn't see very well that he could see
the person who was near his, the pt suffered from glaucoma in
his left eye, the pt didn't use glasses, the pt can smell and taste
very well that he could distinguish between different things,
the pt was full conscious, he could orient to person& place &
time, the pt was suffering from anxiety related to the vomiting
and dyspnea, his memory was good that he could remember
clearly.
13- Psychosocial:
The pt was sad because he couldn't stay at the hospital in the
bed for a long time, his family came to see his in the hospital,
the family was composedofthe mother and the father and 4
men and 4 women, but the father was died and one of his sons
died when he was child, and other son died before 2 years
because of Israeli soldiers, his house was composed of3
rooms, the electricity was good and it wasn't been cut off, the
water was good too and it wasn't been cut off, there wasn't a
telephone in the house, the ventilation was good becausethere
were two windows in each room.
14- Social Problems:
The pt didn't have social problems, all of his relationships
were good, his family came to the hospital to see his, and
some of his neighbors came to see his too.
Pathophysiology of Inflammatory Pleuritis – Pleurisy
7. Common causes of inflammatory Pleuritis are pneumonia, tuberculosis,
lung abscess, bronchiectasis, rheumatic fever and systemic lupus
erythematosis.
Pleurisy can be classified as wet or dry. Dry pleurisy is extremely
painful and is associated with an audible pleural rub. It is not associated
with an effusion. Wet pleurisy is associated with development of an
effusion due to the often copious serous exudation that accompanies the
inflammation.
In general, in uncomplicated cases, the effusion consists of a relatively
clear, straw colored fluid, but some particularly those associated, with
carcinoma of the lung, can be mildly to heavily blood stained. If the
effusion is relatively small it may be re-absorbed with complete
resolution. However, these effusions can comprise several liters and
can therefore encroach considerably on lung spacewith accompanying
respiratory distress. Pleural effusions can also be a focal site of
infection due to both the static nature of the condition, and the potential
culture medium for bacterial growth.
- Clinical manifestations:
The severity of these will depend largely on the size of the effusion.
Most are insidious and often asymptomatic. Breathlessness, dyspnea,
and chest pains usually accompany only large effusions.
- Diagnosis ofdisorders of the pleura:
All pleural effusions are diagnosed by chest X-ray. Differential
diagnosis is by aspiration and analysis of pleural fluid.
- Medicaland nursing management:
Inflammatory effusions and hydrothoracies are dealt with by thoracic
aspiration, that is, an aspiration needle is inserted into the pleural cavity
and the fluid is aspirated via a syringe.
Preparation of the pt for thoracic aspiration:
An explanation is given to the pt as his cooperation throughout the
procedureis important. The pt is asked not to sneeze or cough or take a
sudden deep breath without indicating that suchan occurrenceis
imminent. The pt is sat in an upright position with his arms resting on
an overbed table in order to expand the thoracic cavity. An anxiolytic
drug may have been given to help him relax. A local anesthetic is
8. injected and the aspiration needle is passed between the ribs, through
the intercostals muscles, untie fluid can be withdrawn.
At this stage an artery forcep is clamped onto the needle, at the point of
entry, in order to prevent deeper penetration of the needle. The fluid is
then withdrawn the needle removed, and a small dressing placed over
the puncture site.
Samples of the fluid may be sent for bacteriological, cytological and
biochemical analysis. Following the procedure, the pt's respiratory
symptoms should abate, and often the pt is free to return home.
Thoracic aspiration may be required by some pts on a regular basis.
Pneumothorax caused by needle puncture of the lung is the main
complication of this procedure. Infection is always a possibility whise
an invasive procedure is performed.
Nursing Care Plan
Problem Nursing action Rational Evaluation
Vomiting RT
inflammation in
the chest.
-Assist the color
and the amount
of what did he
vomit.
-relieve all
things that
stimulate the
vomiting.
-let the pt to eat
small amount of
meals and soft
food like milk,
better milk and
more meals,
especially fluids.
-To determine
the cause of the
vomiting.
-to prevent any
thing that
stimulate the
vomiting.
-The vomiting
been stopped.
-The pt felt
better.
Short
Term
Goal
To stop
vomiting during
hospitalization
period.
Long
To stop the
vomiting after
9. Term
Goal
discharge the pt
and promote his
health.
Problem Nursing
action
Rational Evaluation
Anxiety R/T
the length
period of
hospitalization,
vomiting,
anorexia.
-assist the
causes of the
anxiety
reasons.
-keep privacy.
-encourage his
family to talk
with his.
-stop vomiting.
-decrease the
level of
coughing.
-treat the
anorexia.
-let his to see
his family
sitting around
his talking
with his.
-to
determine
the points of
anxiety
reasons.
-to decrease
the level of
anxiety and
make pt feel
comfortable.
-to form
trust with
the pt.
-to
encourage
the pt to talk
about his
problems.
All actions
were done,
and the
level of
anxiety
decreased,
and the pt
felt
comfort.
Short
Term
Goal
To decrease
the anxiety
during
hospitalization,
and prevent it.
Long
Term
Goal
To prevent
anxiety to
happen after
discharge of
the pt.
10. Problem Nursing action Rational Evaluation
Anorexia R/T
length period of
hospitalization,
and a result of
vomiting.
-Assist his
situation about
his diet, about
his weight.
-give the pt
some of his
likely meals.
-give the pt
vitamins as Dr
order.
-give the pt
information
about the
benefits of the
food.
-let the pt to see
his family sitting
around his
talking with his.
-give the pt soft
food as he like.
-determine the
unlike food to
the pt.
-to encourage
the pt to eat
properly.
-to give the pt all
nutrients that he
need.
-to protect the pt
to loose his
weight.
-to balance the
fluid and
electrolytes.
-to prevent the
pt from
hypoglycemia.
-the pt can eat
anything as he
like.
-the pt felt
comfort.
Short
Term
Goal
-To let the pt to
eat properly in
the hospital.
-To keep the
nutrition of the
pt good in the
hospital.
Long
Term
Goal
To keep the pt's
health good
without any
problems or
diseases related
to anorexia after
discharge.
11. Problem Nursing action Rational Evaluation
Difficulty in
breathing R/T
fluids in the
pleural cavity.
-let the pt to sit
in semi sitting
position.
- let the pt to eat
small amount of
meals and soft
food like milk,
better milk and
more meals.
-to sit the pt in
comfortable
position for
breathing that
the airways are
open.
- to prevent the
stomach to press
on the
diaphragm.
The pt can
breath well
without any
efforts.
Short
Term
Goal
To let the pt
breath better and
decrease the
difficulty in
breathing in the
hospital.
Long
Term
Goal
To let the pt
breath properly
without any
effort and
promote his
respiratory
system after
discharge from
the hospital.
Lab Tests
31/12/2003
Test Result Normal Values
WBC 11.6 k/µl (H) 4.1 – 10.9 k/µl
LYM 2.9 0.6 – 4.1
MID 1 0.0 – 1.8
GRAN 7.7 2 – 7.8
13. Amylase 29 U/L <90 U/L
Glucose p.p 187 mg/dl (H) 70-140 mg/dl
Bun 23 mg/dl (H) 8-21 mg/dl
Creatinine 1 0.5-1.2
SGOT 376 U/L <42 U/L
SGPT 227 U/L <41 U/L
Alk Phosph 249 U/L 98-279 U/L
Chloride 111 mEq/L 98-107 mEq/L
Na 145 mEq/L 136-145 mEq/L
K 4.3 mEq/L 3.5-5.1 mEq/L
HBAIC 5.1 mEq/L 4.5-7 mEq/L
Pleural Fluid
30/12/2003:
Test Result
Total cells 250/mm
WBC Zero
RBC 250/mm
Protein 2.5g/dL
LDH 357U/L
Glucose 108 mg/dL
Urine Analysis
14. 29/12/2003:
Test Result
Color Straw
PH Acidic 5
Transparency Hazy
Specific Gravity 1.015
Albumen Trance
Sugar Pos +1
Kenton Negative
Bilirubin Negative
Urobilinoyen Normal
Blood Negative
Nitrate Negative
Ultra Sound Report
30/12/2003:
- Liver presents heterogeneous hyperechoic solid lesion of
6.5x5cm of diameter in ITS 8-TH segment.
- GB bed is free.
- Biliary tree is not dilated.
- Pancreas is intact.
- Spleen contains small calcification.
- Renal small cysts, with no definite stones or hydronephrosis.
- Small amount of RT. pleural effusion.
- No pelvic masses or fluid collection.
- CT.SCANmay be helpful.
15. Medications
Name of Drug Route Dose Action Side effects
Trufen P.O 400mg Trufen is used for the
relief of mild to
moderate pain in
conditions such as
rheumatoid arthritis,
osteoarthritis,
dysmenorrhoea,
migraine, postoperative
pain, headache,
toothache, muscular
pain and for the
reduction of fever.
Gastrointestinal
disturbances may
occur(diarrhea,
heartburn, nausea,
abdominal pain).
Rarely: dizziness,
nervousness, skin rash,
pruritis, and
hypersensitivity
reactions.
Cordil P.O 40mg Vasodilators which
prevent angina pectoris
attacks, treatment of
congestive heart failure
(CHF).
Nausea, headache,
dizziness especially
after standing up from
a lying position,
tachycardia, vomiting,
restlessness.
Ratidine I.V 50mg For the treatment of
duodenal and gastric
ulcer, in reflux
oesophagitis and
Zollinger-Ellison
syndrome.
Allergic reactions such
as skin rahes, urticaria,
and angioedema.
Rocephin I.V 1gm Inhibit the cell wall
synthesis of the
bacteria.
Diarrhea, nausea,
vomiting, stomatitis,
glossitis, eosinophilia,
leucopenia, edema,
headache, increase in
liver enzyme, oliguria.
Klaricare P.O 250mg Macrolide Antibiotic. Gastrointestinal
disturbances may
occur(diarrhea,
heartburn, nausea,
abdominal pain)
headache, and skin