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A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid because of inflammation. What nursing interventions and patient and family teaching are warranted when caring for this patient Adequate drainage of the lung abscess may be achieved through postural drainage and chest physiotherapy. The patient is identified, and the planned surgical procedure and type of anesthesia are verified. Education is focused on rehabilitative therapies to promote independence in executing activities of daily living. Certain disorders of the nervous system, respiratory muscles, chest wall, and pulmonary arterial tree also may be responsible for cor pulmonale. The effects of hormones secreted by the endocrine system affect the nervous system and are, in turn, mediated by the nervous system. They must comply with a complex regimen of diet, medications, activity, follow-up laboratory studies, biopsies (to diagnose rejection), and clinic visits. In some cases, the nurse may need to prepare the patient for additional diagnostic studies (endoscopy) or surgery. For those who use tobacco, it is imperative to ask whether they are willing to quit. The infection is usually not via the umbilical vein, but from the mother at the time of birth and during close contact afterward. The nurse encourages patients to continue iron therapy as long as it is prescribed, although they may no longer feel fatigued. Management of acute embolic occlusion usually requires surgery because time is of the essence. Monitor closely to prevent inadvertent removal or displacement of tube, subsequent airway obstruction, and aspiration. Although the total leukocyte count can be low, normal, or high, the percentage of normal cells is usually vastly decreased. Exercises of the legs are necessary; the development of an individualized plan requires consultation with the patient and the health care team. Radionuclide evaluation of gastric emptying is now preferred over intubation methods because it gives more defined results (Phillips & Wingate, 1998). Several additional punctures or small incisions are made in the abdominal wall to introduce other surgical instruments into the operative field. Additionally, the nurse reminds the patient and family about the importance of health promotion activities and recommended health screening, including bone mineral density testing. After the patient is sedated, the endoscope is lubricated with a water-soluble lubricant and passed smoothly and slowly along the back of the mouth and down into the esophagus. The arms also have less muscle mass and are not subjected to the workload of the legs. Antiarrhythmic medications such as amiodarone (Cordarone, Pacerone), lidocaine (Xylocaine), magnesium, or procainamide (Pronestyl) are given if ventricular dysrhythmia persists (see Table 27-1). If the patient is hospitalized before the day of surgery, the staff enterostomal therapist is involved in the preoperative teaching. Stomal size and pouch size vary initially; the stoma should be rechecked 3 weeks after surgery, when the edema has subsided. Monitor medications to prevent administration of those that may precipitate hepatic encephalopathy (sedatives, hypnotics, analgesics). Complications of Pacemaker Use Complications associated with pacemakers relate to their presence within the body, and improper functioning. In addition, gentle oral suctioning, positioning to enhance drainage of secretions, and sublingual or transdermal administration of anticholinergic drugs (Table 17-3) to reduce the production of secretions will provide comfort to the patient and support to the family. The release of catecholamines early in the shock continuum causes glycogen stores to be depleted in about 8 to 10 hours.

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These include increasing the humidity level, encouraging adequate fluid intake, getting adequate rest, using warm water gargles or irrigations and topical anesthetic agents to relieve sore throat, and applying hot packs to relieve congestion. When hope is viewed this way, it is not limited to cure of the disease, and instead focuses on what is achievable in the time remaining. Use appropriate tubing per institution policy (platelets often require different tubing from that used for other blood products). As the work of breathing increases over time, the accessory muscles are recruited in an effort to breathe. The history of the condition is important in determining venous or arterial insufficiency. In addition to the chloride level, sodium and potassium levels are also evaluated because these electrolytes are lost along with chloride. A thorough description of these processes is beyond the scope of this textbook; however, some mechanisms against which a specific treatment is targeted are briefly described in the relevant disease-specific sections of this chapter. Inadequate dietary intake is rare but can develop in strict vegetarians who consume no meat or dairy products. Check clinical responses, as noted in laboratory findings (blood urea nitrogen, serum protein, prealbumin, electrolytes, renal function, hemoglobin, hematocrit). These joint deformities result from the abnormal weight distribution on joints due to lack of proprioception. Table 38-5 and Figure 38-6 list mechanical causes of obstruction and describe how they occur. To prevent recurrence of pernicious anemia, vitamin B12 therapy must be continued for life. The amount of activity recommended at discharge depends on the age of the patient, his or her condition before the cardiac event, the extent of the disease, the course of the hospital stay, and the development of any complications. Warmed, humidified oxygen should always be introduced through the tube, whether the patient is breathing spontaneously or is receiving ventilatory support. Assessment and Diagnostic Findings On laboratory analysis, the serum magnesium level is less than 1. After the first few hours, half-normal saline solution is the fluid of choice for continued rehydration, if the blood pressure is stable and the sodium level is not low. Basal insulin is necessary to maintain blood glucose levels irrespective of meals. The nurse assesses the patient frequently for signs of hypoxemia and monitors the pulse oximetry values to evaluate the effectiveness of the oxygen therapy. Human inheritable genetic modifications: Assessing scientific, ethical, religious and policy issues. Time should be provided for the patient to ask questions and for thinking through all that has been discussed. It is important for the patient with a respiratory disorder to understand the condition and to be familiar with necessary self-care interventions. Small, frequent meals decrease the amount of energy needed for digestion while providing adequate nutrition. Assessment and Diagnostic Evaluation the presence and extent of ascites are assessed by percussion of the abdomen. Carbohydrates should be derived predominately from foods rich in complex carbohydrates, including grains, especially whole grains, fruits, and vegetables. Likewise, the person can carry cleaning supplies around in a basket or backpack rather than walk back and forth to obtain the items. Levin Tube the Levin tube has a single lumen (the hollow part of the tube), ranges from 14 to 18 Fr in size, and is made of plastic or rubber with openings near its tip. The rapid rise of pressure inside the right and left ventricles forces the pulmonic and aortic valves to open, and blood is ejected into the pulmonary artery and aorta, respectively. Assessment and Diagnostic Findings A barium swallow may be performed to determine the exact nature and location of a diverticulum.

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The procedure can be painful; therefore, moderate sedation in the form of an analgesic or tranquilizer, or both, is administered for the treatment. Later, there is a rapid elevation of blood glucose, followed by increased insulin secretion. Positron emission tomographic imaging with fluorodeoxyglucose is efficacious in evaluating malignant pulmonary disease. Whereas proponents of physician-assisted suicide argue that terminally ill individuals should have a legally sanctioned right to make independent decisions about the value of their lives and the Chapter 17 timing and circumstances of their deaths, its opponents argue for greater access to symptom management and psychosocial support for individuals approaching the end of life. Postural drainage is usually performed two to four times daily, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. Instructions on the early signs of a sinus infection are provided and preventive measures are reviewed. Metabolism of medications by the liver appears to decrease in the elderly, but such changes are usually accompanied by changes in intestinal absorption, renal excretion, and altered body distribution of some medications secondary to changes in fat deposition. Diverticulosis exists when multiple diverticula are present without inflammation or symptoms. Intravenous crystalloid solutions are administered, with careful monitoring of pulmonary status. The patient needs to understand that any pain unrelieved within 15 minutes by the usual methods (see Chart 28-4) should be treated at the closest emergency center; the patient should call 911 for assistance. Most patients report a greatly improved sense of well-being after treatment of hyperthyroidism, and some fail to continue to take prescribed thyroid replacement therapy. Therefore, the number of affected cells in the circulation is typically lower than normal. These events activate the coagulation cascade, a complex series of interactions among phospholipids, calcium, and various clotting factors that converts prothrombin to thrombin. Patients and family members need to learn the early signs and symptoms of infection and other complications so that they seek appropriate health care promptly. If such is the case, a family member or friend should be taught to assist the patient to apply the stockings so that they do not cause undue pressure on any part of the feet or legs. The multidisciplinary team conducts an initial assessment of the patient and family. With the appearance of each new symptom, the patient may experience dread and fear that the disease is progressing. Enteritis involves more of the descending colon, and symptoms include watery, bloody diarrhea; abdominal pain; and weight loss. Postoperatively, a catheter extends from the stoma and is attached to a closed drainage suction system. Weight loss is a major problem in chronic pancreatitis: more than 75% of patients experience significant weight loss, usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. Regulation of Acid Excretion the catabolism, or breakdown, of proteins results in the production of acid compounds, in particular phosphoric and sulfuric acids. The goals of intraaortic balloon counterpulsation include the following: stances, nursing management includes working with other members of the health care team to prevent shock from progressing and to restore adequate cardiac function and tissue perfusion. There is, however, an increase in fibrous material and some fatty deposition in the normal pancreas in patients older than 70 years of age. Avoids ulcers caused by pressure and neuropathy Demonstrates/verbalizes diabetes survival skills and preventive care Understands treatment modalities. The patient is instructed to avoid stress, fatigue, sudden changes in temperature, and excessive alcohol intake, all of which lower resistance to pneumonia. They are often frightened by having to breathe on their own again and need reassurance that they are improving and are well enough to handle spontaneous breathing. Invasive procedures, particularly those involving mucosal surfaces, can cause a bacteremia. If the patient is awakened at night with an urge to void, catheterization may be performed after an attempt to void (Reilly, 2001).

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Chapter 23 Nursing Management Management of Patients With Chest and Lower Respiratory Tract Disorders 543 Nursing management of the patient with pulmonary edema includes assisting with administration of oxygen and intubation and mechanical ventilation if respiratory failure occurs. Obstructive sleep apnea may be associated with obesity and with other conditions that reduce pharyngeal muscle tone (eg, neuromuscular disease, sedative/ hypnotic medications, acute ingestion of alcohol). It is important to instruct the patient to restrict activity until the pain subsides. Therefore, nurses need to initiate this discussion with patients and not wait for them to bring it up in conversation. Lower extremity ulcers are observed in patients with arterial or venous insufficiency. In that spirit, nurses encourage patients to regain the highest level of function and independence possible. Patients taking antithyroid medications are instructed not to use decongestants for nasal stuffiness because they are poorly tolerated. After the body stores of vitamin B12 are depleted, patients may begin to show signs of the anemia. During surgery, intrathecal opioids are used almost exclusively after a spinal anesthetic agent is administered. Patients and family members need to make the decisions about the treatment plan, but they also need to understand the possible outcomes of those decisions. The tubing is irrigated hourly, and drainage will indicate whether bleeding has been controlled. Renovascular disease (renal artery stenosis and end-stage renal disease), including hypertension, is discussed in Chapter 45. If their use is necessary, the dose is one-half or one-third that ordinarily prescribed in patients of similar age and weight with normal thyroid function. The duration of the sound is the important distinction to make in identifying the sound as noncontinuous or continuous. Cells that play a key role in the inflammation of asthma are mast cells, neutrophils, eosinophils, and lymphocytes. Newer investigational agents are being studied for effectiveness in resistant tumor lines. Because there is isotonic retention of body substances, the serum sodium concentration remains essentially normal. Diagnostic Evaluation In identifying and diagnosing the various abnormalities affecting the vascular structures (arteries, veins, and lymphatics), various tests may be performed. Unfractionated heparin (heparin) is administered subcutaneously to prevent development of deep vein thrombosis, or by intermittent intravenous infusion or continuous infusion for 5 to 7 days to prevent the extension of a thrombus and the development of new thrombi. The Trendelenburg position usually is used for surgery on the lower abdomen and pelvis to obtain good exposure by displacing the intestines into the upper abdomen. Monitor patient for increasing severity of signs and symptoms of hypothyroidism. Troponin I is measured in a laboratory test that has several advantages over traditional enzyme studies. As a rule, these reactions result from manipulation of various structures, particularly those within the abdominal cavity. Throughout the course of a serious illness, patients and their families will encounter complicated treatment decisions, bad news about disease progression, and recurring emotional responses. The nurse prepares the patient for surgery, which includes an intravenous infusion to replace fluid loss and promote adequate renal function and antibiotic therapy to prevent infection. Equally important, the patient and family must understand the role of nutritional supplements in the proper context, because many forms of anemia are not the result of a nutritional deficiency. Many factors can alter this blood flow and pressure, including hypotension, decreased oncotic pressure in the blood, and increased pressure in the renal tubules from an obstruction. Undoubtedly, a patient about to undergo surgery is faced with various fears, including fears of the unknown, of death, of anesthesia, pain, or cancer. Nursing Implications Patients receiving 131I therapy share many of the fears and concerns expressed by those receiving treatment for more prevalent forms of cancer. Provides close monitoring of new symptoms and minimizes trauma to the confused patient 8. Two-stage procedure decreases chance of thrusting needle through posterior wall of vein as skin is entered.

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Vitamin K is required by the liver for synthesis of prothrombin and some of the other clotting factors. The bronchial walls become thickened, the bronchial lumen is narrowed, and mucus may plug the airway. Assessment of Respiratory Function 467 Lung Volumes and Capacities Lung function, which reflects the mechanics of ventilation, is viewed in terms of lung volumes and lung capacities. The nerve supply to the anal sphincter is sometimes impaired, causing fecal incontinence (Luekenotte, 2000). A history and physical examination are performed by nursing and medical personnel. The deoxygenated blood returns to the right heart by way of the systemic veins and is pumped into the pulmonary circulation. Clinical Manifestations Vague epigastric or periumbilical pain progresses to right lower quadrant pain and is usually accompanied by a low-grade fever and nausea and sometimes by vomiting. When to observe for these effects and for how long depends on the onset, peak, and duration of the medication. The newer meters that do not require removal of blood from the strip generally are easier to use. Coumarin anticoagulants bind to albumin, are metabolized in the liver, and have an extremely long half-life. In aortic insufficiency, the aortic valve does not close completely, allowing blood to flow back or leak from the aorta into the left ventricle. Young adults are often forced to live with multiple, often severe, complications from their disease. It is easier to put up with pain than with the side effects that come from pain medicine. In the years between 1984 and 1996, which followed the creation of the Medicare Hospice Benefit, there was a 70-fold increase in the number of hospices participating in Medicare (Hospice Association of America, 2001). The nurse reinforces the importance of follow-up care for approximately 1 year, the need to report recurrence of symptoms, and the need for treating possible problems that occur after surgery, such as intolerance to dairy products and sweet foods. The goals of chest physiotherapy are to remove bronchial secretions, improve ventilation, and increase the efficiency of the respiratory muscles. In the meantime, the taste of unsalted foods can be improved by using salt substitutes such as lemon juice, oregano, and thyme. A definite sign is offered by the prolonged history of productive cough, with sputum consistently negative for tubercle bacilli. It occurs more frequently in patients who have had previous transfusions (exposure to multiple antigens from previous blood products) and in Rh-negative women who have borne Rh-positive children (exposure to an Rhpositive fetus raises antibody levels in the mother). Urinary sodium values, in contrast to serum values, reflect early, sensitive changes in sodium balance. Common problems associated with voiding include frequency, urgency, dysuria, hesitancy, incontinence, enuresis, polyuria, oliguria, and hematuria. The patient must be alert enough to follow instructions and to report symptoms such as chest pain. As long as the patient continues to receive opioids, a regimen to combat constipation must be implemented. If short of breath, the patient should concentrate on breathing slowly and rhythmically. Ventilation is further improved with chest physical therapy and bronchial hygiene maneuvers as indicated to remove accumulated secretions, and the administration of bronchodilators. Many organizations conduct cancer screening events that focus on cancers with the highest incidence rates or those that have improved survival rates if diagnosed early, such as breast or prostate cancers. Other contributing factors include straining the voice, chronic laryngitis, nutritional deficiencies (riboflavin), and family predisposition (Chart 22-5). Septicemia is treated with intravenous fluids and antibiotics; corticosteroids and vasopressors also may be necessary. Teaching the patient and family about the dangers of an inadequate fluid intake is an important role of the nurse caring for the elderly patient.

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Resultant venous hypertension can occur whenever there has been a prolonged increase in venous pressure, such as occurs with deep venous thrombosis. The nurse instructs and encourages the patient to perform oral care on a regular basis to prevent halitosis and infection. Transcatheter arterial embolization interrupts the arterial blood flow to small tumors by injecting small particulate embolic or chemotherapeutic agents into the artery supplying the tumor. For example, they may react to cefazolin sodium (Ancef) because it has a similar antimicrobial action of attaching to the penicillin-binding proteins found on the walls of infectious organisms. Some individuals who have coexisting medical diagnoses, such as heart failure or end-stage renal disease, need to discuss their daily fluid limit with their primary health care provider. When the catheter is in the large vein, the balloon is inflated to its recommended volume. Other manifestations include an increased appetite and dietary intake, progressive weight loss, abnormal muscular fatigability and weakness (difficulty in climbing stairs and rising from a chair), amenorrhea, and changes in bowel function. You are caring for a patient who is to have a gastrectomy to treat gastric cancer. Supplemental oxygen may be necessary, but it is rarely needed on a long-term basis unless there is underlying severe cardiac or pulmonary disease as well. The nurse may make referrals and coordinate available community resources (eg, local office of the American Cancer Society, home aides, church groups, parish nurses, and support groups) to assist patients and caregivers. Respiratory care may range from close monitoring of arterial blood gases to use of humidified oxygen to intubation and mechanical ventilation (see Chap. Anticoagulants such as warfarin (Coumadin) have been given to patients because of chronic pulmonary emboli. Knowing that the nurse is nearby and will respond immediately can help alleviate some of this anxiety. A characteristic feature is arterial hypoxemia that does not respond to supplemental oxygen. Evaluate temperature and color of the affected extremity and any patient complaints of pain, numbness, or tingling sensations to determine signs of arterial insufficiency. You are conducting your first home care visit to an 88-year-old woman who has been hospitalized three times in the last 4 months with heart failure. Repetitive apneic events result in hypoxia and hypercapnia, which triggers a sympathetic response. In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation is prevented. With these exceptions, the symptoms are nonspecific, and patients usually do not seek medical attention until late in the disease; 80% to 85% of patients have advanced, unresectable tumor when first detected. The patient may exhibit behavior that reflects denial or depression or may experience postcardiotomy psychosis. It also may occur in patients after acute systemic infections such as rheumatic fever, in those receiving immunosuppressive therapy, or in those with infective endocarditis. This whole process of gas exchange between the atmospheric air and the blood and between the blood and cells of the body is called respiration. For intermittent feedings with small-bore tubes, observation of aspirated contents and pH evaluation should be performed. In addition to assisting with the surgical procedures, perioperative nurses are responsible for the comfort and safety of the patient. The air is moistened, warmed to body temperature, and brought into contact with sensitive nerves. Most patients are discharged before that time, and more than half of wound infections are diagnosed after discharge, highlighting the importance of patient education regarding wound care. Once it is determined that switching from other routes of morphine administration to the patch is appropriate, the correct dosage for the patch must be calculated. However, although the patient is free of symptoms, certain permanent residual effects remain that often lead to progressive valvular deformities. Primary hyperparathyroidism occurs two to four times more often in women than in men and is most common in patients between 60 and 70 years of age.

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Three major nasoenteric tubes used for aspiration and decompression are the Miller-Abbott tube, the Harris tube, and the Cantor tube. It is helpful in evaluating patients with chronic constipation or fecal incontinence and is useful in biofeedback for the treatment of fecal incontinence. It is also important to assess the patient for infection or emotional stress that may lead to elevated blood glucose levels despite adherence to the treatment regimen. Rapid/shallow breathing index: used to assess the breathing pattern and is calculated by dividing the respiratory rate by tidal volume. You are caring for a young adult patient who has had repeated hospitalizations for sickle cell crisis. Because large quantities of blood may be lost quickly, immediate correction of blood loss may be required to prevent hemorrhagic shock. Two types of contractions occur regularly in the small intestine: segmentation contractions and intestinal peristalsis. One of the most positive benefits of this procedure is that after visualization of a problem, excision (eg, removal of the gallbladder) can then be performed at the same time, if appropriate. The risk for cancer increases with long-term ingestion of carcinogens or co-carcinogens or chronic absence of proactive substances in the diet. In spite of the inverse correlation between pain intensity and satisfaction, the satisfaction ratings were high. Although serum bilirubin levels are increased, liver histology and liver function test results are normal, and there is no hemolysis. Figure 43-3 illustrates the three processes of urine formation and typical values of water and electrolytes associated with each process. Retrograde pyelography is used infrequently because of improved techniques in excretory urography. The result is sequential atrioventricular contraction, which provides for the most effective flow of blood, thereby optimizing cardiac output. Often it is combined with a local regional block by injecting the nerves immediately supplying the area. The very top of the pyramid comprises fats, oils, and sweets, foods that should be used sparingly by people with diabetes to obtain weight and blood glucose control and to reduce the risk for cardiovascular disease. Intense lower abdominal pain that radiates to the legs, hematuria, and signs of dehydration indicate that the urine should be strained. Assess for psychological dependence if the physiologic parameters indicate weaning is feasible and the patient still resists. Liver dysfunction may be acute or chronic; chronic dysfunction is far more common than acute. All of these medications have been shown to reduce major coronary events (Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001). The end-of-life content constituted 2% of text pages, while the pain content represented only 0. Once the patient is ready to start oral feedings, the nurse explains that thick liquids will be used first because they are easy to swallow. Results of large, randomized studies demonstrated dramatic reductions in myocardial infarction, stroke, and cardiovascular death when blood pressure was decreased to at least 140/90 mm Hg (Moser, 1999; McAlister et al. Drains are frequently inserted during the surgical procedure, and the nurse must observe and record the character of the drainage postoperatively. The older patient, particularly when malnourished, may have low plasma protein levels. The correct way to apply tape is to place the tape at the center of the dressing and then press the tape down on both sides, applying tension evenly away from the midline. Squamous cell carcinoma is more centrally located and arises more commonly in the segmental and subsegmental bronchi in response to repetitive carcinogenic exposures. This study was conducted to determine the effects of maintaining a tracheal cannula in spontaneously breathing patients following discharge. It briefly inhibits calcium reabsorption from bone and decreases the serum calcium concentration.

References:

• https://agrilife.org/gold/files/2012/05/Gold-et-al.-2011.pdf
• https://www.gapha.org/wp-content/uploads/2016/06/7-5.411-Human-papillomavirus-associated-cancers.pdf
• https://spautomotive.files.wordpress.com/2016/09/ashlee-vance-elon-musk-tesla-spacex-and-the-quest-for-a-fantastic-future.pdf
• https://www.mdanderson.org/content/dam/mdanderson/documents/for-physicians/algorithms/screening/screening-pancreatic-web-algorithm.pdf
• https://www.myofascialrelease.com/downloads/brochures/Myofascial-eVersion-Jan-2014.pdf