ASSIGNMENT 1 For Medsurg

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

The primary nursing diagnosis for this patient is impaired gas exchange, related to abnormal ventilation and perfusion ratio, as evidenced by restlessness, irritability, anxiety, decreased level of consciousness, abnormal arterial blood gases, and abnormal skin color (Gulanick & Myers, 2014, p. 82). A.C. has an endotracheal tube (ETT), and there is a note for the next day to have surgery to put in a tracheostomy. She is currently a smoker, her C02 is 74.6mEq/L which is high, her pH is low at 7.19, and the bicarbonate is 28.6mEq/L which is high. Her oxygen saturation is maintaining at 90%. Her PA02 is 56mm Hg and FI02 is 0.60. The patient is very anxious and restless in the bed, despite sedation and pain medication, and her skin is pale in color and she is diaphoretic.

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

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.

Temperature is 97.2, pulse 84, respirations 14, blood pressure is 112/62, height 74 inches, weight 156 pounds, sating at 99% on room air. Generally, this is a thin man sitting comfortably in no acute distress. Skin is warm and dry. HEENT: Head: Normocephalic, atraumatic. Pupils equal, reactive to light and accommodation. Sclerae is anicteric. Oral mucosa is moist without lesions. No JVD. No thyromegaly. Lymphatics: No cervical, supraclavicular, axillary or inguinal adenopathy appreciated. Respiratory: Lungs are clear to auscultation bilaterally. Heart: Regular rate and rhythm. Abdomen: Soft, nontender. Positive bowel sounds. Liver and spleen not palpable. Strength is 5/5 throughout. Neurological exam is intact.

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.

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

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

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

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,

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).

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

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

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

Data was collected including Patients age, gender, diagnosis, BP, heart rate, CVP measurement (end of expiration), IVC diameter during expiration and inspiration and intra-abdominal pressures.