Ms. Lieberman Case Paper

and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of

Table 3: Lung Capacities and Minute Ventilation Breathing Rate 2.6 2.9 3 2.8 TV(L) 2.9 3 2.9 2.9 Resting Values ERV(L) IRV(L) 3.9 4.3 4.3 4.2 5.5 5.9 5.9 5.8 RV(L) 3.4 3.6 3.7 3.6 Breathing Rate 2.2 2.3 2.3 2.3 TV(L) 4 4.3 4.4 4.2 Exercising Values ERV(L) IRV(L) 5.6 5.9 6 5.8 6.2 5.3 6.7 6.1 RV(L) 42.2 50.2 49.5 47.3

Scenario T.C. is a 30-year-old woman who 3 weeks ago underwent a vaginal hysterectomy and right salpingooophorectomy for abdominal pain and endometriosis. Postoperatively she experienced an intraabdominal hemorrhage, and her hematocrit (Hct) dropped from 40.5% to 21%. She was transfused with 3 units of packed RBCs (PRBCs). After discharge she continued to have abdominal pain, chills, and fever and was subsequently readmitted twice: once for treatment of postoperative infection and the second time for evacuation of a pelvic hematoma. Despite treatment, T.C. continued to have abdominal pain, chills, fever, and nausea and vomiting (N/V).

An evaluation of Mrs Smith circulation was the next step carried out by the nurse, as in the breathing assessment Mrs Smith pallor was noted as being flushed and the patient appeared confused this could be associated with poor cardiac output. The nurse recorded the patient’s blood pressure using a dinamap it was measured at 88/50, it was then rechecked manually to ensure accuracy. The pulse was checked manually for rate and rhythm it was recorded as 98 beats per minute. Capillary refill was checked, was found to be normal.

Pulse oximeter used to check his oxygen saturation level, which was 98% on air with no central or peripheral cyanosis. Since Mr Devi, does not seem to have any sign of abnormal respiration. The next assessment is circulation, where there are many physical signs to look for. The colour of the hand and digits, are they blue, pink, pale or mottled. Also need to measure for capillary refill time (CRT) by applying cutaneous pressure for 5 Sec on a fingertip held at heart level of Mr. Devi. The normal value of CRT is usually less than 2 second prolonged CRT suggests poor peripheral perfusion. Measure his Blood Pressure (B/P), count pulse rate by listening to the heart with a stethoscope or palpate peripheral and central pulses, assessing for the presence, rate, quality, regularity and equality. All of this assessment indicates the cardiovascular system in the patient is within the normal range or is there any emergency measures should take (Resus.org.uk 2016). However, Mr Devi’s circulation is a concern because his HR was 110bpm which is higher than normal range, the normal heart beat for adults ranges from 60-100bpm. Also his BP was 190/99mmhg with mean arterial pressure (MAP) of

3. At this point, you are ready to begin the lab exercise. Click on the “Information” button on the blood

increasing problems. CPT Code: ____________________ ICD-9-CM Code: ____________________ 14. CPT Code: 99281/ICD-9-CM Code: 918.1 15. Provide the CPT code(s) for the following hospital scenario. PROGRESS NOTE: The patient is seen today. She has been transferred from the ICU to the floor. She has essentially stabilized. Again, she is having some type of

I have gained full consent to use this lady as my patient in my care study. Consent is important as you must always gain permission from the patient in regards to their care plan and keep them fully informed. ‘It is vital that the person consents before any treatment, care, examination or assessment’ (Brooker et al., 2007, p.157). ‘Confidentiality is a fundamental part of professional practice that protects human rights’ (NMC, 2008). To maintain my patient’s confidentiality throughout my care study I am going to call her Annie. Annie is a 72 year old lady whose care I have been involved with on placement. Annie’s medical history included; previous left hip replacement, osteoporosis, high blood pressure, high cholesterol and

Chapter 18 The Circulatory System: Blood True / False Questions 1. Hemostasis is the production of formed elements of blood. Difficulty Level: Remember/Understand Section: 18.1 Introduction Topic: Cardiovascular System 2. Blood viscosity stems mainly from electrolytes and monomers dissolved in plasma. Difficulty Level: Remember/Understand Section: 18.1 Introduction Topic: Cardiovascular System 3. Lymphoid hemopoiesis occurs mainly in the bone marrow. Difficulty Level: Remember/Understand Section: 18.1 Introduction Topic: Cardiovascular System 4. Oxygen and carbon dioxide bind to different parts of hemoglobin. Difficulty Level: Remember/Understand Section: 18.2 The viscosity of blood is due more to _____________ than to any other factor. A. fibrin B. albumin C. sodium D. erythrocytes E. nitrogenous wastes Difficulty Level: Remember/Understand Section: 18.1 Introduction Topic: Cardiovascular System 27. Erythrocytes transport oxygen and serve to A. defend the body against pathogens. B. initiate blood clotting. C. regulate erythropoiesis. D. transport nutrients. E. transport carbon dioxide. Difficulty Level: Remember/Understand Section: 18.2 Erythrocytes Topic: Cardiovascular System 28. Most oxygen is transported bound to A. the plasma membrane of erythrocytes. B. alpha chains in hemoglobin. C. beta chains in hemoglobin. D. delta chains in hemoglobin E. heme groups in hemoglobin. Difficulty Level: Remember/Understand Section: 18.2 Erythrocytes Topic: Cardiovascular System 29. If all the 280 million molecules of hemoglobin contained in RBCs were free in the plasma,

Proprietorships Advantages a) It is easy to create. b) The individual owner has full control. c) The individual owner keeps all the money. Disadvantages a) The individual owner is responsible for all losses. b) The individual owner is limited to personal money and loans when it comes to funding the business.

Para 3: pulse and respirations Ensuring that the patient was relaxed and comfortable I began to take her pulse, using my three middle finger tips to locate the pulse. I did so for 15 second and timed by fore for the next 15 seconds I measured her respiration rate and timed by 4. I did not explain to my patient that I was taking her respirations as looking at her chest may have made her feel uncomfortable and increase her respirations. Her pulse rate ending up being 85 beats per minute and respirations were 15 breaths per minute. These results were within normal range, as her pulse rate was between 80 and 120 bpm and respirations were between 12 and 20 (Tollefson, 2010). The change in pulse and respiration rate can increase during excercise. If a pulse is recorded below 50 bpm the patient can be at risk of a heart attach. A fast pulse exceeding 100 bpm can be a sign of infection or dehydration. This can be detected quickly and appropriate action taken to prevent negative affects on the patient’s well being.

Mr. Douglas Murrow Based on the information presented in the case of 39 year-old Douglas Murrow, he has been charged with criminal infractions consisting of breaking and entering his parent’s home in the middle of the night, as well as physically assaulting them. Murrow constantly theorizes about a conspiracy plot against him and has consistently displayed episodes of paranoid, delusional behavior. Murrow’s erratic behavior is marked by the belief that “his parents” are “conspiring with his doctor” to force him to take psychopharmaceuticals. The delusional ideation is amplified by Murrow’s insistence that his parents are entering into “his apartment at night” to torture “him” while he is asleep (Laureate Education, Inc., 2017).

110/62, a pulse oximetry reading (Pox) of 92%. At this time Mr. B should have been placed on

Lisa Sherman Case Analysis: October 2010 Summary: Lisa Sherman worked for Verizon for many years. While there she never revealed her sexual orientation .Then one fated day, there was a diversification workshop with her fellow managers. The outcome of this was that her coworkers were bigoted towards homosexuality. Lisa Sherman had a tough decision to make, whether to stay or to leave. The following analysis shows a suggested solution.