Patient With SCD

Management of the acutely ill adult is a complex and perplexed procedure. It requires underpinning knowledge of the pathophysiology of the disease currently affecting the patient, as well as ensuring that professionals are equipped to deal with the development of a rapid deterioration. The National Institute for Clinical Excellence (2007) explain that patients are sometimes inadequately treated due to staff not acting in a sufficient time manner, and so a systematic assessment of the patient recommended by the Resuscitation Council (2006) should initially be followed (Jevon, 2009).

The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another

541). Interventions should be rendered continuously, promptly and appropriately as it can cause life-threatening complications (Holt 2009, p. 26). Apparently, the patient is stable, but continuous assessment and management should be done to avoid recurrences of untoward signs andsymptoms and prevent potential complications. Firstly, continuous assessment and vital signs should be done and these include blood pressure, cardiac rate, respiration, venous distention and skin turgor to assess possible occurrence of fluid overload as a result of rapid administration of large fluid that is often needed to treat the patient with DKA (Smeltzer & Bare 2004 p. 1185). Aside from this, documentation of fluid intake and output should be monitored and documented to assess for circulatory overload and renal function (Holt 2009, p. 61). Significantly, it is integral in the provision of continuous care that nurses reassess the factors that may have contribute or led to DKA, and educate the patient and his family about strategies to prevent its recurrences (Smeltzer & Bare 2004 p. 1186; Lemone, Burke & Bauldoff 2011, p. 551).

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

Early identification of these patients helps to identify individual patient needs and problems so that coordinated efforts can be utilized to meet the patient’s needs. Failure to coordinate care, gaps in inpatient treatment and therapy along with lack of proper patient care follow up post discharge increases the chance of readmission for these patients (Chamberlain, Lau, Siracuse,

Sepsis is the body’s response to infection. The onset of sepsis is often undetected until the condition has become critical. Sepsis progresses into severe sepsis, septic shock, and eventually death; typically from organ failure. The condition affects over 500,000 individuals annually, has a mortality rate of over 25%, and presents a risk to patients in every inpatient setting regardless of acuity level (Whelchel et al., 2011). My first experience with sepsis was enlightening because it affected a patient under my care. I was surprised at the insidious onset of the symptoms, the rapid decline in the patient’s condition, and the missed opportunities that the healthcare team had to implement the recommended care bundle protocols.

This information was reviewed with Dr. Snyder and Kellie Moran, LCSW. The both share the disposition that the patient should be discharged pending his agreeing to follow up with outpatient services. Patient has agreed to follow up with his outpatient services as recommended in the morning. The patient's family member has been contacted and made aware of plans concerning the patient. Patient contracted for safety, was given outpatient referral information,and completed a crisis

Somatic symptom disorder (SSD) has had many different names Somatization disorder; Somatiform disorders; Briquet syndrome; and Illness anxiety disorder. It was first diagnosed in 1982. It was added to the DSM on july 4 2013 Since being discovered, how has it evolved?

Hence, all patient are admitted from the emergency with a status of observation. Some of the most common symptoms and conditions for patients placed in these units include chest pain, atrial fibrillation, congestive heart failure, asthma, back pain, dehydration, gastroenteritis and trauma. There are additional patients who are in transition, for example, awaiting surgery or other invasive procedures. Generally, patients are satisfied with this unit because of the timely completion of their diagnostic exams, interventions, and discharge.

Without dialysis, patients with ESRD will accumulate toxins in a matter of days which will ultimately lead to death. Dialysis is a safe procedure with few complications. However, for the frail elderly patients with impaired cognition, dialysis can do more harm than good. Dialysis can potentially expose patients to acute delirium which can be brought on by a combination of dialysis disequilibrium, fluctuation in blood pressure, changes in fluid balance, electrolyte imbalances, and/or blood stream infection (MacPhail et al., 2015). Moreover, patients with severe cognitive impairment are unable to report symptoms such as chest pain, shortness of breath, fatigue, cramping, and/or dizziness that occur with dialysis. More importantly, patients with a declining mental status can easily become agitated with their situation, which can develop into disruptive behaviors such as yelling, using profanity, waving their arms or fists, pulling on their bloodlines, and attempting to pull out their needles. In light of that, the need to avoid harm to the patient outweighs the overall benefits of continuing dialysis. Specifically, when it comes to elderly patients with multiple comorbidities in addition to a declining cognitive function, the quality of life dialysis provide is less beneficial than being treated with conservative (nondialytic) management (Ying et al.,

SCD patients can take preventive measures to reduce the frequency of pain crisis, but it is often difficult to predict when it will occur and how long the episode will last. As a result, patient could miss school or work for a prolonged period time until the symptoms improve, causing disruption in studies, work, and other plans. Patients are encouraged to avoid activities or situation that could trigger crisis. For students, this may mean refraining from any contact sports with high injury risk or swimming which causes rapid change in body temperature. SCD patients need accommodation for work or school that gives permission to refrain from high risk activities, and social worker is involved in obtaining needed paperwork as well as advocating to meet patients’ other needs.

You mentioned medical errors in your post. As a nurse working in the ICU a few years back, I have seen my share of medical errors as it happened. Sad to say, most of them were highly preventable. According to Garrouste (2012), medical errors and adverse events are very common in ICUs, and among them the most prevalent involve medications (Garrouste-Orgeas, et al., 2012) . It is interesting to note that diagnostic errors are also a frequent cause of medical errors in the U.S.( Singh, et al., 2008). The authors cite some examples of diagnostic errors (Singh, et al., 2008): failure to use an indicated diagnostic test, misinterpretation of test results, and failure to act on abnormal results. The authors also added that although diagnostic errors

Despite the fact that the studies previously mentioned were not carried out in an emergency care setting, the results are translatable as emergency departments care for similar patients, in many cases more acutely ill and on a shorter-term basis. Furthermore, often the groups studied are “frequent” emergency care area patients. One such study,

SCD begins with a mutation of the genetic makeup of the hemoglobin, a protein contained by red blood cells (RBCs) that deliver oxygen throughout the body. Hemoglobin is made up of two alpha and two beta polypeptide chains made up of amino acids. Normal hemoglobin allows RBCs to take on a biconcave or doughnut like shape and is able to squeeze or alter its shape in order to travel through different sized blood vessels. Hemoglobin has a high affinity for oxygen, is oxygenated in the lungs and delivers the oxygen to the body’s tissues. Once deoxygenated, hemoglobin returns to the lungs to return carbon dioxide and become re-oxygenated.

There are currently no special dietary recommendations for SCD patients, even with data suggesting that the life of the disease is to increase the food requirement, much like in pregnancy or growth. (Hibbert, Gee, & Hyacinth, 2010) SCD patients should have a diet that is high in calories and that is full of nutrients. They must also have adequate fluid consumption to decrease the risk of dehydration. Dehydration can bring on a sickle cell crisis (pain episode). Vitamin and mineral supplementation may also benefit a SCD patient. Blood levels of several vitamins and minerals including: vitamin A and carotenoids, vitamin B6, vitamin C, vitamin E, magnesium, and zinc are often low in these patients.