Critical Care Experience Report ( Micu )

A (assessment): Ms. O’Reilly’s vital signs are temperature of 37.5 C, pulse of 112, blood pressure of 102/52, and respirations of 24. Her respirations are still deep but have a regular rhythm. She has a CBS of 8.1 and regular insulin running as per orders. The lab work shows uncompensated metabolic acidosis with no hypoxia. Ms. O’Reilly’s neurological status has improved with a GSC of 13. Her dehydration is being treated with NS containing 40mEQ KCL/L running at 200ml/hr and potassium levels maintained at 4.

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

Her drug screen showed positive benzodiazepines and blood alcohol was negative. Troponins were negative. Also, her initial work up showed acute kidney injury with a creatinine of 1.84, and potassium of 5.8. Her chest x-ray showed small amount of infiltrate in the right lower lobe. The CT scan of the head did not show any acute changes. The abdominal CT scan showed constipation and 6 mm opacity in her bladder. She had an electroencephalogram (EEG) which revealed diffuse generalized nonspecific encephalopathy. In addition, there was slowing of the left hemisphere consistent with left intracerebral lesion. The assessment diagnoses were acute respiratory failure (ABG of 87.287, pCO2 of 45.2, pO2 of 380 and biacarbonate of 20 on vent settings), altered mental status, attempted suicide, infectious process, medication use, hyperglycemic nonketotic, and less likely cerebrovascular accident given that her CT scan of the head was normal. She was admitted to the Intensive Care Unit under the care of Dr. Modupe Kehinde. She was intubated for airway protection and remained intubated until 5/23/2016 (7 days). She was on ventilator and was given nutritional support

2/10/2016, 1600, Vital Signs: BP 140/85 P132 RR32 Temp 102.2 SpO2 85% on 2 liter by nasal cannula. Jacquline Catanzaro is 45 years old female on disability admitted to Medical Unit Hospital. Sister with patient. Reason to admit is can’t breathe. Diagnosis is 30 year of asthma exacerbation, psychiatric schizophrenia, obesity, pneumonia and herniated disc. Smokes 40 packs year. Drinks 2 pots of coffee a day. Drinks 3 beers each day. Frequency ED visits and hospitalization dependence on rescue inhaler. Patient refuses wear nasal cannula because of worry that it contains poison. Patient has a long history of stopping taking psychiatric medication and asthma medications. Patient has isolated herself from others. Sister is only caregiver. Neuro

There have been many studies documented in the literature regarding the reduction of CLABSIs. The majority of the studies have reported statistically significant decreases in CLABSI rates post-implementation of a quality improvement initiative (O‟Grady et al., 2011). Some studies used approaches in which multiple strategies have been implemented together to improve compliance with the use of evidence-based guidelines. A seminal study conducted by Pronovost et al. (2006), known as the Keystone ICU project, included a collaborative cohort of 108 ICUs within the state of Michigan. The strategies in this study included the use of five evidence-based bloodstream infection prevention practices for CVC insertions, use of a checklist to ensure adherence

Negligence 1 Negligence: Wrongful Death Suit September 26, 2010 Negligence 2 Negligence: Wrongful Death Suit The healthcare industry is booming and people will always need to be cared for at hospitals, doctor’s offices, and etc. Healthcare professionals must be careful and focused on everything they are doing with their patients. They must keep track

The patient is a 53-year-old African American female who was recently hospitalized from 1/19 -1/22, had a complete workup for seizure disorder, was discharged home and she represented to the ED several times on the 23rd complaining of seizures. She present after having a single isolated seizure which lasted 20 minutes witnessed by her family. She also presented earlier in the evening of the previous evening because she continued to have seizures. She is a history of CVA, hypertension, bipolar disorder. The patient has required intubation in the past. Her laboratory work is essentially unremarkable, phosphatase of 26, AST of 72 and ALT of 75. Dilantin levels are not reported at this point. The case was discussed with Dr. Amr Kahf. I

Piilani Enos Clinical Journal #2 A memorable event that happened to me was giving an SVN treatment to my patient. This event stood out to me because it was the first time I gave a SVN treatment. I was to give a SVN treatment to a patient who is paraplegic from the

Knowing that Mrs. Baker was recently started on lisinopril while already taking metformin and hydrochlorothiazide, the immediate assessment would include possible adverse reactions to the medications. Therefore, edema could be a possible factor when examining a patent airway. If Mrs. Baker’s airway is compromised in any way due to edema or an obstruction, it will be necessary to intubate

On Monday, November 11, 2015, a 79-year-old female was brought to the emergency department (ED) of Fairview Southdale via ambulance for myocardial infarction (MI). A few hours prior to the ambulance arriving, the patient was experiencing chest discomfort, shortness of breath, and upper abdominal pain. At that time, she called her son who then went to her house to check on her. Her son made the decision to call 911. Minutes after the paramedics arrived, the patient went into cardiac arrest. The patient had previously expressed to her family that she wanted to be “do not resuscitate” (DNR) to her family, however, upon cardiac arrest her son told the paramedics that he wanted all measured taken to resuscitate her. Cardiopulmonary resuscitation (CPR) was initiated with a Lucas device and the patient was deemed rapid transport. In route to the ED, the patient was in ventricular tachycardia and ventricular fibrillation. An automated external defibrillators (AED) was used to shock her 3 times in route and 1 dose of epinephrine was given. She was intubated with a 7.0mm endotracheal tube (ETT) to protect her

• History of present illness: This patient has a history of hypoxic-ischemic encephalopathy due to non-accidental trauma (child abuse), cerebral palsy, scoliosis, obstructive sleep apnea on home CPAP, gastrostromy tube (GT) dependence, recent fundoplication, and was admitted for respiratory failure likely due to pneumonia vs. viral infection. Patient presented with fever and increased work of breathing for a week. Temperature at home was at 104 F and he desaturated into low 70s on home pulse oximeter. The emergency medical services put him on non-rebreather and escalated to BiPAP and still there was significant work of breathing despite increasing pressures, so he was intubated in the emergency room. He was started on vancomycin and ceftriaxone after blood cultures were obtained as well. Currently the patient is diagnosed with respiratory failure, neuromuscular disorder (neuromuscular scoliosis), and anoxic brain injury. Patient has been hospitalized in the past for pneumonias.

1. The patient was on hydromorphone for his abdominal pain due to liver disease, deferoxamine mesylate to treat secondary hemosiderosis, insulin due to diabetes mellitus, folates for sickle cell anemia, sertraline for possibly depression due to the hepatitis C, lansoprazole for stomach acid balance, promethazine for pain, and digoxin for cardiomyopathy.

Clinical case A 34-year-old previously healthy woman, transferred from another hospital presents for neck stiffness, lethargy and abnormal jerks of all four limbs. Three months ago, she had severe weight loss (around 20 kilos) and she complained of subacute headache, without cranial nerve involvement, associated to ow grade fever and vomiting on

Pre-operative Care for the Patient with Diabetes Nursing has provided me with a unique set of experiences that has altered the way in which I process a situation. Part of assessing an individual is not simply focusing on the admitting diagnosis or procedure but rather the whole picture. On Surgical Day

The research project will be conducted from four adult intensive care units (ICUs) at a level I trauma county hospital in Santa Clara County. The sample in this research will be registered nurses from four ICUs in the hospital. The researcher will be using a purposive sampling strategy to select the appropriate sample by recruiting ICU nurses who are qualified to provide the data needed for this study. Purposive sampling is sometimes called “judgmental sampling,” and it is based on the researcher's judgment to select the proper sample for the study (Murphy et al., 2018). The sample will consist of 8 to 10 registered nurses who are willing to share their experiences of a patient death in the ICU settings and are in the best position to provide