ASSIGNMENT 1 For Medsurg

2. The medical director makes rounds and writes orders to start an IV of D51/2 NS at 75 m/hr

His Pulse ox of 94% reading is on the lower side, but still in normal range which indicated that there is less oxygen perfusion.

The patient is 66 year-old male who is brought to St. Joe's ER by BLS after being found with altered mental status at home. The patient reports he used heroin 2 days prior to admission. The patient was found by his brother hallucinatin with bladder or bowel incontinence the morning of presentation. The patient has not eating in approximately 4 days. The patient himself denies having any complaints, but he is a very poor historian. His medical history is significant for prior heroin and cocaine abuse, alcohol abuse of unknown duration, hypertension, cirrhotic liver, he has had an anterior cervical discectomy of C5-C7 with anterior compression in May of 2012 and a closed reduction of C6-C7 billateral dislocation , cholecystectomy in the

Urosepsis is sepsis with a source localized to the urinary tract. It is a severe infection, distinguishing it from other urinary tract infections including mild pyelonephritis accounts for 5% of severe sepsis, whereas UTIs account for 40% of nosocomial infections. Usually this infection stems from the nurses not using proper sterile technique when changing foley catheters, obtaining urine specimens from the port or having the adequate time to do proper foley management on these patients. Foley catheters are a flexible tube that passes through the urethra and into the bladder to drain urine which is used in certain cases such as urinary retention. The thin flexible tubes are known to harvest multiple bacteria especially if the foley catheter is left in place over a long period of time. Usually if a patient is in need of a foley catheter it is inserted by the nurse using aseptic technique to decrease the risk of infections. In some cases you may notice some nurses who do use the proper technique but as the nurse to patient ratio has increased there are more and more nurses that are breaking the sterile field while inserting foley catheters and they still continue to insert the tube

This week I took care of a 40-year-old man who came into the hospital after having multiple seizures at his assisted living facility. The patient had a history of cerebral palsy, intellectual disability, diabetes type two, and chronic hypothermia. The patient has both a foley catheter and stoma. He has been placed on contact precautions due to Klebsiella Pneumoniae in his urine. Safety precautions, such as, wrist restraints, gloves, and side rails upright are in place.

On January, 31st, Patient F.F. arrived to the emergency room in the hospital with her brother due to an increased temperature for ‘the past 3 days,’ fatigue, and was ‘unable to catch [her] breath.’ A focused assessment revealed crackles and wheezes in the lower lobes of the lungs. The patient was leaning over in a tripod position and breathing heavily between words. The patient’s heart sounds were normal with a regular S1 and S2. The patient denied having chest pain and edema was not present. The patient reported having a productive cough with green sputum for the past 3 days. Vital signs were taken and the patient’s oxygen saturation was 88%. The doctor ordered 2 liters of oxygen by nasal cannula for the patient with a continuous

During my time at cardiopulmonary I didn’t do much patient interaction and treatment.There was a code (blue meaning that the patient wasn’t breathing) that was called and the therapist that I was a part of the code team. I wasn’t there for the code but I got the after math. The cardiopulmonary therapist performed an atrial blood gas test. The atrial blood gas is used to determine what gas that’s in the body that us causing the partient to have difficulty with breathing. Gases include gases such as pH (part hydrogens), levels of oxygen, carbon dioxide, and bicardinate ion. The patients blood Ph was 7.689 which is supposed to be from 7.35-7.45.

Vitals: Temperature 97.1. Pulse 89. Blood pressure 136/70. O2 sat 93 % on room air.

Something sour or acidic in the mouth would cause the parotid duct to open and release secretions.

Blood pressure 122/80. Pulse 76. Respiratory 14. Weight 210 pounds, which is stable for patient.

On physical examination, he appears in no distress. Vital signs: blood pressure of 160/105 mmHg, heart rate of 90 beats/min, respiratory rate of 24 breaths/min,

Examination has revealed an oxygen saturation of 92% and chest auscultation is notable for reduced breath sounds with scant basal crackles.

1. The patient is instructed to keep a guide to symptoms which are observed by him after capsule

However none of these methods are perfect and all of them have both benefits and risks. In emergency departments, measurements of CVP are most commonly used. However the procedure can cause some early and late complications. Thus a non-invasive, cost efficient diagnostic approach to assess fluid status in emergency departments is desired.

The ABG testing above shows that this patient is experiencing respiratory acidosis. Respiratory acidosis is a respiratory dysfunction in which there is a retention of carbon dioxide (CO2) and a decrease in the blood pH leading thereby, in increased hydrogen. This dysfunction in the respiratory function decreases oxygen (O2) and CO2 exchange which leads to a sudden breakdown in the body ventilation causing hypoventilation (Ignatavicius & Workman, 2013). A PCO2 greater than 45mmhg with a pH less than 7.35 is considered an acute respiratory acidosis whereas chronic respiratory acidosis is a PCO2 greater than 45mmhg with normal or close to normal pH and an HCO3 greater than 30mmhg due to renal compensation (Byrd & Roy, 2015).