Featured

Story Time About the Dog and His Owner.

"You must give everything to make your life as beautiful as the dreams that dance in your imagination"-Roman Payne.
My handsome big dog dedicated to his owner.Runs errand for the owner.
The dog is asked to go into the house and bring kola nut(this could be anything for
entertainment)

It is a bedtime story about a dog and his owner.The owner surprisingly had visitors that they were not expecting .So the owner started a song like this.

My handsome big dog go into the house in the living room and get me some kola nut, so that we can give to these uninvited visitors.I did not invite them and I am sure that you did not invite them.So come on big boy go into the house and get me some kola nut so that we can give to these strangers.Hopefully the kola nut will force them to tell us why they are here.

So the dog went into the house and got the kola nut.The uninvited strangers ate the kola nut.After eating the Kola nut (coca cola) they confessed that they are interested in buying the piece of land in their backyard so that they could be their neighbor.Sometimes a kind gesture can lead to meeting pretty nice people.The dog owner told them that she owns the land but the land is not for sale.So they left back to where they came from.The big dog and his owner live happily there after .The End.

Featured

My Honor As A Nurse.

On my honor as a Registered Nurse.


I will provide compassionate excellent Nursing care.

I will do my best now and tomorrow.
Be a good leader,not a follower.
I must Move Nursing Agenda Forward.
I must do my Best all the time.
I promise to update and obtain required CE every two years.
Advance my knowledge,education,and experiences.
I will be Knowledgeable not Knowledge Deficit.
Team player,work effectively with my colleagues and other ancillary.
Clock or sign in on time.
Clock or Sign out on time. Have all my equipment such as Stethoscope,Pen and Pencils.
I must Reason,and be Reasonable.
Perform my assigned role effectively and efficiently. Follow Hospital policies and Regulations.
Comply with JCAHO Standards of Care and Regulations.
Carry out Doctors Orders on Time.
Troubleshoot and be Supportive of my Colleagues. Know and Understand Patient Bill of Rights.
Respect Patient and Families. “The very First Requirements in a Hospital is that, it should do the sick no harm “Florence Nightingale .
Give medications by mouth and intravenously as ordered. Advocate for my Patients.
And provide TLC.
Must not Abuse Patients Physically, Emotionally or Sexually.
Promote Health and Prevent Diseases.
“I attribute my Success to this -I never gave or took any excuse”- Florence Nightingale .
Nursing Assessment.

545 CASE SCENARIO. SEVERE SEPSIS/ HYPOTENSION.

Sepsis is the complications of life threatening infection.The most common causes of Sepsis is bacteria infection.It can lead to multiple organ failures. So treatment should be started upon arrival to emergency room immediately and Sepsis alert started and announced.

Symptoms are : fever,fast heart rate, some mental confusion, low blood pressure, and difficulty with breathing.

Treatment is usually Antibiotics and hydration.

Monitor temperature,and lactic acid level.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.

INTERDISCIPLINARY KARDEX.

On Sepsis Alert.

Came into Emergency room with fever of 102.7°F

Age/Sex :65years old man.

Account number : Q005634372.

MR # : Q00058867522.

Admission date: June 10th 2021@04am.

Status: Inpatient admit.

Location : MedTelemetry.

Room :42114.

Attending doctor : Tommy Holbib.

Patient name : Money,Talks.

Resuscitation Status : Full code.

Primary diagnosis : Severe Sepsis/Hypotension. Secondary diagnosis: SOB,Prostate Cancer.S/P Radiation.

Chemotherapy 4days ago.

On Chemo treatment

Weight: 185lbs.

Height : 5feet 8inches.

Alert and oriented x4.

Allergy: NKDA.

Isolation Status :Standard Precautions.

Risk for fall:No.

Bathroom privileges.

Skin intergrity impaired: No.

Do patient have advance Directive:No.

Copy of advance Directive on the chart.

Diet: NPO after midnight for Bronchoscopy at 4pm.

Informed consent signed and dated in patient chart.

Ambulates to the bathroom.

02 @ 2liter NC.

No edema noted.

Doctor orders:

Blood culture done,result pending result.

Abcess to old porter cath site biopsy done.

CXR revealed Bronchitis.

Vancomycin 1gm IV Q12hours.

Rocephin 1gm IV Q24hours .

0.9NS @ 50ml/hour IV right forearm 18guage clean / Patent/ Intact.

Normal Saline 500ml× 2.

Acyclovir 250mg po Q12hours.

Morphine sulfate 4mg IV Q4hours prn severe pain.

Zofran 4mg IV Q4hours prn nausea/vomiting.

Dilaudid 0.5mg IV Q3hours prn severe pain. Norco 10/325mg 1tablet po Q4hours prn moderate pain.

Infectious disease doctor: Green Wealth on board.

Continue with Antibiotics check lab values ESR,LDH,CRP.

Case manager consult for placement.

Laboratory results :

WBC 13.5.

H/ H 8.5/ 24.0.

K: 3.6.Replaced 20meqkcl .

Na: 135.

Ca+ 8.6.

Magnesium level 1.7 replacement order pending. Laboratory tests CBC with differential, Comprehensive Metabolic panel, magnesium, ESR,LDH, CRP in am.

Discharge home with wife when medically stable.

08amVital signs : Bp 132/76,Heart rate 89, Temperature 98.9°F,Respiration: 18,02 Saturation 94%.

At 12noon : Bp 122/78,Hr: 86,Temperature 98.4°f,Respiration 18,02 on room air 93°f.

At 1600: Bp 117/76,Hr. 78, Temperature 97.4.Respiration 19,02 sat 94RA,

544 CASE SCENARIO.ABDOMINAL CELLULITIS / PEG TUBE SITE.

Cellulitis is diffuse acute infection of the skin and subcutaneous tissue.

Characterized by localized heat pain,swelling, redness and occasionally by fever,malaise, Chills, headaches.

If antibiotics are not given Abcess and Tissue destruction will follow. Infection will quickly develop in damage skin,in diabetes Mellitus patients or patients with poor circulation. TREATMENT:

Antibiotics.

Warm soakes.

Keeping areas clean and dry.

Prevention of pressure on affected site.

If it is extremities,elevate the extremities.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX.

Age/ Sex: 72years.

Account number: Q001665897.

MR #:Q00049593429.

Admitted date : 06/12/2020 0450am.

Location : General Surgery.

Room : 62114.

Resuscitation status: Full Code.

Weight: 158.

Height: 5feet 8inches.

Alert and oriented x4.

Preferred language: English.

Support system: Family.

Primary diagnosis: Abdominal Cellulitis/Peg tube site.

Secondary diagnosis: Hypertension/ CVA,Left side weakness/ Flaccid.

Isolation Status: Contact Isolation.

Is patient at risk for fall : Yes.

Do patient have advance Directive: No.

Copy of advance Directive on the chart.

Diet: NPO.Strict.Hold tube feeding.

Glucerna 1.5 at 55ml/hour.

Flush with 10ml of water.

Plavix 75mg peg tube 09am scheduled.

02 @2liter NC.

Transportation method: Stretcher.Skin intergrity impaired: yes.

Allergy: NKDA.

Is patient at risk,for fall: Yes .

Fall prevention protocol in place( Yellow sign on the door, Yellow armband, yellow gown and yellow socks)

Do patient have advance Directive:No.

Copy of advance Directive on the chart.

Isolation Status: Contact Isolation.

Turn and reposition Q2hours for comfort and pressure redistribution.

Clean peg tube site and apply dressing as ordered by the doctor.

Discharge plans: Discharge th Skilled Nursing Facility when medically stable for transfer.

543 CASE SCENARIO. ELEVATED LFT,PANCREATITIS.

Follow doctor orders,your hospital policy and procedures.

An inflammation of the pancreas. It can be Acute pancreatitis or Chronic pancreatitis. Acute pancreatitis is generally due to Alcoholism, certain drugs, trauma or infection.Characterize by severe pain that radiates to the back,nausea and vomiting,fever and possible anorexia.

If the Common bile duct is obstructed Jaundice will develop. Complications such as Pseudocyst or Abcess in the pancreas may develop.

DIAGNOSTIC TESTS:

Physical Assessment.

Endoscopy.

Laboratory analysis to find out the level of Pancreatic enzymes in the blood.

TREATMENT.

Pain management.

NPO

Hydration intravenously.

Ngt placement.

Chronic Pancreatitis treatment is the same as acute pancreatitis.

Check for calcification and scarring of the smaller Pancreatic ducts,Abdominal pain, nausea, vomiting,

Steatorrhea,and creatorhea due to decreased output of Pancreatic enzymes.

Some patients will develop diabetes Mellitus due diminished insulin production by the pancreas.

TREATMENT.

Pain control.

Subtotal Pancreatectomy if pain is intractable. Pancreatic extract given.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX. Age/ Sex 65years old female.

Account number : Q005234372.

MR# Q00069593424.

Admitted date : 05/22/2021 @04 am.

Status : Inpatient admission.

Location: MedTelemetry.

Room: 42114.

Attending doctor: Green,Gode.

Resuscitation Status: Full Code.

Weight 152.

Height 5feet 6inches.

Allergy NKDA.

Primary diagnosis:

Elevated LFT,Pancreatitis. Abdominal pain.

Secondary diagnosis: Diabetes,Hypertension, high cholesterol. Bile duct dilation.

Isolation Status :Contact Isolation( MRSA of nare).

Risk for fall:Yes.

Do patient have advance Directive: No.

Copy of advance Directive on the chart.

Diet NPO after midnight .

ERCP.Consent signed and in the chart.

Alert and oriented x4.

Room air.

Voiding well.

Skin intact.

0.9NS @ 50ml/hour IV right forearm 18guage clean/ dry/Patent.

Flagyl 500mg IV Q8hours.

Zosyn 3.375mg IV Q8hours.

Carvedilo 6.25mg po Bid scheduled.

Accucheck Qac and Qhs.Sliding scales:

Bs sugar 50 to 200 = zero insulin.

201 to 250= 2units of insulin.

251 to 300= 4units of insulin.

301 to 350= 6units.

351 to 400 =8 units and notify the doctor.

Norco 5/325mg 2tablets po Q4hours prn severe pain.

Morphine sulfate 4mg IV Q4hours prn severe pain.

Colace 100mg po Bid.

Dilaudid 0.5mg IV Q3hours prn severe pain.

Metroprolol 10mg po Qday.

Tylenol 650mg po Q4hours prn temperature.

Zofran 4mg IV Q4hours prn nausea/ vomiting.

Laboratory results:

WBC: 8.5.0.

H/H 12.0,37.2.

K= 3.4 replaced with 40.0mEqkcl×1.

magnesium: 1.8.

Ca+8.9.

Nacl 135.

ALT,AST are high.( Elevated liver function test)

Discharge plans:

Discharge home when medically stable.

542 CASE SCENARIO. PNEUMONIA R/O TB.

Pneumonia can be life threatening especially with children and older adults above 65years old. Pneumonia is the infection that will inflame the air sacs in one of your lung or both lungs.The infected 🫁lung may be filled with air or pus. It is caused by the species of streptococcus pneumoniae.The alveoli and bronchioles will become plugged with lots of fluid exudate.

It can be caused by other kinds of bacteria and viruses. There are various kinds of Pneumonia such as :

Aspiration Pneumonia.

Mycoplasma Pneumonia.

Viral Pneumonia Bronchopneumonia,eosinophilic Pneumonia, lobar Pneumonia.

Interstitial Pneumonia.

Symptoms of Pneumonia are:

severe fever,chill,headache and chest pain.

The treatment of Pneumonia are as follows hydration,bedrest,antibiotics, pain medications and controlling the temperature. The doctor will place patient on antibiotics that is specific for that particular type of Pneumonia.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX. Age/Sex 65years old man.

Account number :Q005634472.

MR # Q00039593424.

Admitted date 06/12/2020 @0450am.

Location: MedTelemetry.

Room : 42119.

Attending doctor: Tomtom Worry.

Patient name: Banana Ripened.

Resuscitation Status : Full code.

Primary diagnosis: Pneumonia r/o TB. Persistent infiltrate in right upper lobe.

Secondary diagnosis:Smoker for 20years/ Etoh,COPD, Kidney Stones,Homeless.

Allergy : NKDA.

Weight : 135lbs.

Height : 5feet 3inches.

Alert and oriented x4.

Afb ×3 negative.

+ Rhonchi.

Fall risks: No.

Do patient have advance Directive: No.

Copy of advance Directive on the chart.

Diet : Cardiac heart health diet.

Isolation Status: MRSA/Airborne.

O edema.

02 @ 2liter NC.Productive cough.

Vancomycin 1gm IV Q12hours. 20guage left forearm.

Pneumococcal vaccine PCV13(Prevnar 13) and Flu vaccine ordered ■given @ 1700pm

Rocephin 1gm IV Q24hours.Given @09am

Phenergan 12.5mg IM Q6hours prn nausea/vomiting.Given @1300.

Norco 5/325mg 2tablets po Q4hours prn moderate pain.

Discharge plans. Discharge tomorrow after the last antibiotics to homeless Shelter.

Case manager/ Social worker consult.

541 CASE SCENARIO: PNEUMONIA. CHIEF COMPLAINT DIFFICULTY WITH RESPIRATION.

Patient had fever and productive cough with greenish Sputum for 1week.Coughing ×1 week,Shortness of breath x2days,labored breathing.Symptom worsen so he went to primary care physician.He advised patient to go to emergency room immediately.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX. Age/Sex 25years old man.

Account number Q005634372.

MR #Q00058867544.

Admission date 09/21/2021@08am.

Admission status: Inpatient admit.

Location MedTelemetry.

Room 42114.

Attending doctor Tommy Holbib.

Patient name: Redpot Michaelsin.

Resuscitation Status :Full code.

Primary diagnosis Pneumonia. Chief complaint: Difficulty with respiration. Secondary diagnosis: None.

No known home medication.

Isolation Status : Standard Precautions.

Fall risk: No.

Suicidal risk: No.

Skin intergrity impaired: No.

02 at 2liter NC.

Allergy:NKDA.

Weight 185lbs.

Height: 5feet 6inches.

Do patient have advance Directive: No.

Copy of advance Directive on the chart.

Diet Cardiac heart health diet.

Medications:

Zofran 4mg IV Q4hours prn Nausea/Vomiting .0.9NS @ 100ml/hour,left forearm 20guage clean/ dry/ intact.

Albuterol sulfate 3ml Amp.per respiratory therapist.

Toradol 30mg IV Q6hour prn severe pain. Tylenol 500mg po Q4hours prn temperature. Cefazolin 1gm IV Q8hours.

Rocephin 1gm IV Q24hours.

Azithromax 250mg po Q12hours.

Benadryl 25mg po Q4hours prn itching. Laboratory results:

WBC 13.6.

H/H 12.0,37.2.

Magnesium: 1.8.

MCV: 88.5.

MCH: 29.0

MCHC: 33.0.

Platelet 378.

Na 135.

K: 3.4.

Cl: 98

.Ca+= 8.8.

Glucose:99.

Cloudy yellow urine.

Leukocytes in urine.

Discharge plans: Discharge home to family in two if there is no temperature for 24hours.

LUNG CANCER BRIEF REVIEW.

Lung malignant is a Pulmonary cancer (Malignant)most often associated to Cigarette smoking is over 50% of lung cancer patients. Lung cancers have been associated with repeated exposure to substances that cause tissue irritation or inflammation.

Lung cancer develops most often from chronically diseased lung or scarred.

Before cancer is detected it has metastasized in most cases. So metastasis comes before the primary lesions in the lung are detected.

RISK FACTORS ASSOCIATED WITH LUNG CANCER.

History of Cigarette Smoking:

  1. Cigarette smoking is described as the number of packs smoked for how many years.You will multiple the number of packs smoked in a day by the number of years smoked.

2. Obtain information on frequency of smoking, intensity of Cigarette smoking and the duration.

3. Exposure to certain industrial substances such as arsenic, acronitile, asbestos and certain organic chemicals, Chromium, beryllium, Chloromethyl ether, Mustard gas,vinyl chloride,ionizing radiation, uranium petroleum, nickle.

WHAT ARE THE WARNING SIGNS ASSOCIATED WITH LUNG CANCER ?.

●Hoarseness.

●Persistent coughing or change in cough pattern.

●Change in respiratory pattern.

● Dyspnea.

● Clubbing.

● Blood streaked Sputum.

●Purulent Sputum or rust colored.

● Hemoptysis.

●Chest pain or tightness.

● Recurring episodes of pleural effusion.

●Or repeated Pneumonia or bronchitis.

● Wheezing.

●Weight loss.

DIAGNOSTIC TESTS.

Bronchoscopy is done to confirm that there is a lung cancer.

Fiberoptic Bronchoscope is inserted through the trachea that goes into the bronchus.Tissue samples from visible tumors or to perform brushing and washing of peripheral lesions.

Sputum collection in 3 consecutive days sample.

Transbronchial needle biopsy with a bronchoscope will be used to collect node tissue when hilar or mediastinal lymph nodes are involved Percutaneous transthoracic needle biopsy is used to biopsy the lesions that are on fluoroscopy usually when they are closed on the lung 🫁surface.

Excision of lesion is done through small incisions. Lasers or mechanical staplers are usually used with this procedure.

Also video assisted Thoracoscopy or Thoracotomy will be useful when small diagnostic wedge excisions is performed. STAGING TECHNIQUES OF LUNG CANCER.

This include Lateral Chest Xray to show tumors especially on the edge of the lung.

CT Scan with contrast will enhance findings, and MRI will be able to differentiate the underlying mass from inflammation or atelectasis.

In case there is invasion of the Chest wall MRI will be used to find out the connection of visceral pleura and Parietal pleura.

CT scanning can also be used to show malignant pleural effusion which means it cannot be treated or remedied by surgical intervention.

But before decisions are made about inoperable, malignant cells should be identified in the pleural fluid.

Thoracentesis : If there is evidence of pleural effusion thoracentesis is performed upto 1000ml will be removed.

If patient has lung cancer the pleural effusion will be occurring constantly.

Thoracotomy and Mediastinoscopy are also useful tools for evaluation and examination of lung cancer.Follow doctor orders, ask questions when in doubt.

WHAT ARE SOME CLINICAL MANIFESTATIONS?.

●10% of patients are asymptotic and are identified on routine Xray.

●75% have persistent cough.

●Shortness of breath and unilateral wheezing.

● 50% have hemoptysis.

There is Lung Cancer Tumor Node Metastasis.( TNM) Classifications.Review textbook for more detail information and explanations.

Stage Grouping of Cancer.

Stage 0.

Stage 1.

Stage 11.

Stage 111A.

Stage 111B.

Stage IV.

Your doctor will explain to you how you are doing and what needs to be done .Do not hesitate to ask questions.

Nursesyoumoveme.com/Philomena N Okeke RN BSN, MSN.

POST PNEUMONECTOMY NURSING INTERVENTION.

What nurses need to do after pneumonectomy are as follows:

1. Make sure that patient lies on their back or the operated side but should not lie with operative side UPPERMOST because of fear that the suture of the bronchial stump may open making it possible for fluid to drain into unoperated side and then drown the patient.

2.Monitor for signs of mediastinal shift such as :Distended neck veins.

Trachea displaced to one side.

Dyspnea.

Pulse and respiration are increased.

Monitor patient check the trachea to make sure that it remains in the midline.

3.Supervise and encourage deep breathing and coughing exercises to expand the lung.

4. Monitor adequate intake and output.

Properly record amounts of intravenous fluids and blood given.

This is to prevent fluid overload. Also it is important to monitor Central venous pressure.

5.Support and encourage exercise and activity that patients can perform without leading to dyspnea.

Encourage early ambulation of patient with assistance.

6.Instruct patients to report to the doctor at once if the patient has :

Dyspnea.

Hoarseness.

Pain with swallowing or localized chest pain develops because these are signs and Symptoms of complications.

After Pneumonectomy there is no need for chest tube insertion because there is “No” lung left to re- expand on the Operated Side.Serious drainage will be collected in the operative space and over time will solidify to the consistency of axle grease. This is very important to keep the mediastinum from shifting towards the operative side.

WHAT ARE THE COMPLICATIONS OF CHEST SURGERY.

1.Hypotension which is due to blood loss.This can lead to low bood pleasure which leads to dizziness or fainting because the brain is not getting enough oxygen.

2.Cardiac dysrhythmia which is irregular beating of the heart either beating too slow or too fast.That is the electrical impulse are not working well.

3.Pulmonary edema this is a build up of fluid in the alveolar in the lungs preventing oxygen from getting into the blood.

4.Subcutaneous emphysema that is air will be trapped in the tissue beneath the skin.This is a very rare occasion. Doctors will refer to them as Crepitus,Subcutaneous air or as tissue emphysema etc.

TYPES OF THORACIC SURGERY AND IT’S SPECIFIC USES.

1.Exploratory Thoracotomy: It is a surgical intervention to find the cause of a disorder by opening a thoracic cavity.This is use to confirm suspected diagnosis of lung 🫁or chest disease especially for carcinoma for biopsy.

2.Pneumonectomy: This is Surgical removal of all or part of a lung, bronchogenic carcinoma when lobectomy will not remove all of lesion, tuberculosis when when other surgery will not remove all of diseased lung.

3.Lobectomy: Removal of one of the lung.Bronchogenic Carcinoma is confined to a lobe,bronchchiectasis,emphysematous blebs or bullae,lung abcess,tuberculosis,fungal infections,benign tumors.

4.Thoracoplasty:Removal of ribs,residual air space after surgery; chronic empyema space.

5.Wedge Resection: Removal of pie-shaped section from surface of lung; localized inflammatory disease such as TB,well- circumscribed benign tumors,metastatic tumors.

6.Decortication: Removal of fibrinous peel from visceral pleura; chronic empyema.

7.Bilobectomy:Removal of two lobes from the right lung; bronchogenic carcinoma when lobectomy will not be able to remove all the disease.

8.Sleeve Lobectomy:This is the Resection of main bronchus or the distal trachea with reanastomosis to a distal uninvolved bronchus: bronchogenic carcinoma to preserve functional parenchyma.

9.Segmental Resection:Segmentectomy: This is removal of one or more lung. Segments; bronchchiectasis; lung abcess or the cyst; metastatic carcinoma.

WHAT IS A BRIEF SUMMARY OF PULMONARY EMBOLISM?.

The Etiology of pulmonary Embolism is due to blood clot from a deep venous thrombosis (DVT )breaks loose from one of the veins in the lower extremities or from the Pelvis to the pulmonary artery. That is blood clot that travel from the legs or other parts of the body.

Examples of these are:

foreign objects like:

broken intravenous catheters.

Infected fibrin clots or pus.

Fat.

Air.

Amniotic fluid.

Tumor cells.

Injected particles.

The thrombus will detach itself travels through the vena cava and right side of the heart and then lodges into the bifurcation or in a Capillary of the pulmonary artery – Platelets will then accumulate the embolus which leads to Vasoconstriction.

Pulmonary constriction will develop due to high pressure in the lung,resulting in Hypertension, impaired ventilation and perfusion.

ASSESSMENT OF PATIENT.

Assess patient for risk of DVT.

Gathering background information.

Previous history of thromboembolism.

Surgery.

Obesity.

Major trauma.

Advanced age.

Prolonged immobilization.

Smoking.

Estrogen therapy.

Hypercoagulability.

WHAT ARE THE CLINICAL MANIFESTATIONS?.

Dyspnea.

Diaphoresis.

Pleuritic chest pain.

Substernal chest pain.

Crackles in some patients with Pulmonary Embolism and decreased breath sounds. Tachycardia.

Tachypnea.

Hemoptysis.

Dry cough.

Apprehension.

Low grade fever.

DIAGNOSTIC TESTS:

ABG :

That is Arterial Blood Gas.

ABG will show respiratory alkalosis > respiratory acidosis-> Metabolic acidosis.

Lung Scan if inconclusive then Pulmonary Angiography .

Electrocardiogram.

Nursing Responsibilities.

Provide patient with pain medication as ordered.

Educate patient and family members on the disease because patient and family lack knowledge regarding conditions due to lack of exposure.

There will be alteration in tissue perfusion related to vascular Obstruction due to emboli.

DISCHARGE GOALS.

Coagulation studies within normal range.( Prothrombin time ,Partial Prothrombin time)

Prothrombin time(International normalized ratio,PT,PTT ) test for rapid blood clotting.INR: Medical and Surgical thromboembolic states =2.0 to 3.0 is effective therapeutic range.

Artificial heart valves and recurrent embolism =3.0 to 4.5.

IV site is intact no redness.

PAO2 is within normal range : 80 to 100mmHg.

PaCO2 is : 35 to 45mmHg.

PH : 7.35 to 7.45.

Patient verbalized and demonsticated signs and Symptoms of pulmonary embolism.

Verbalized and demonstrate the reasons for coagulation therapy, prescribed doses and time of administration of medication.

And also plan to follow up care including going for laboratory tests on coagulation therapy. Adminster Oxygen due to hypoxemia that occurs.

Prophylactic is used for high risk patients such as :heparin 5000units subQ Q12hours preoperatively.

And every 8to 12hours postoperatively until patient is ambulatory.

Coumadin 5 to 10mg daily x3days.

Then maintenance dose on the basis of Prothrombin time.

Must Check Laboratory for Coagulation. TREATMENT :

Heparin approximately 5000units to 15,000units IV bolus then continuous infusion approximately 1000units every hour or 2500 to 5000units every 4hours.

Long term treatment with 5mg to 10mg of Warfarin daily.

The administration of prescribed thrombolytic therapy can promote immediately dissolution of the embolus with prompt return of pulmonary function.

Example Streptokinase or Urokinase.

Thrombolytic therapy is delivered either systematically or directly into the pulmonary artery through the selective catheterization though systemic therapy is much better. Follow doctor orders.

Patient is prepared for pulmonary embolectomy.Follow doctor orders.

Provide your patient with antiembolism stockings.

Do not massage the legs.

Elevate lower extremities with pillows.

Assess lower extremities for adequate pulses.

Provide teaching regarding common signs and Symptoms of pulmonary embolism such as Coughing, dyspnea,substernal chest pain,hemoptysis,chest palpations and apprehension.

No smoking .

No constrictive clothing.

No sitting or standing for a prolonged period of time.

Follow your doctor orders and your facility policy and procedures.

540 Case Scenario.Multiple Rib Fractures/ Left Chest Tube.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX. Age/Sex 53years old Man.

Account number :Q005634572.

MR #: Q000495934293.

Admitted date :09/12/2020 @0450am.

Status: Inpatient.

Location: Med Telemetry.

Room:42111.

Attending doctor :Hussein Andersona.

Patient name: Banana Yorke.

Resuscitation Status: Full Code.

Weight :152.

Height :5feet 6inches.

Primary diagnosis Multiple Rib Fractures/ Left Chest Tube.(Closed head injury without intracranial Pressure) Clavicle and elbow dislocated, ribs fractures, hemopneumothorax,left rib plating. VATS,left Thoracotomy.

Open Thoracotomy is considered a major surgical intervention use for the treatment of pneumothorax. It requires general anesthesia and the application of endotracheal tube.

It could be single or double insertion and the patient will be under mechanical ventilation for the duration of the procedure. Management of pain is very very important and requires system or epidural analgesia.Patient will be properly positioned and secured in order to provide adequate exposure of the thoracic cavity.

Thoracotomies are performed are performed with patient in lateral Decubitus position.It is important that care should be taken to prevent injuries that might happen during positioning.

VATS: This is a Video assisted Thoracoscopic Surgery.It is a minimally invasive surgical technique used to diagnose and treat problems in your chest.

During the procedure a tiny Camera (thoracoscope)and surgical instruments are inserted into your chest through one or more small incisions in the chest wall.

SCD: Bilateral lowerExtremity,

Left Chest tube)

NWB.

PT/ OT NWB to bilateral lower extremities.

Consultation done.

02 at 3liter NC.

Transportation Method: Bed.

Skin intergrity impaired: Yes.

Suicidal risk: Yes.

Language barrier: No.

Doctor Orders: CBC with differential, Comprehensive Metabolic panel in am.

Norco 10mg/325mg 1tablet po prn moderate pain .

Norco 10/325mg 2tablets PO Q6hours prn severe pain.

Zofran 4mg IV Q4hours prn nausea Vomiting.

Morphine sulfate 2mg IV Q3hours prn moderate pain.

Morphine sulfate 4mg IV Q3hours prn severe pain.

Colace 100mg po Bid.

Zosyn 3.375gm IV Q8hours.

Secondary diagnosis:

Hypertension

Isolation Status: Standard Precautions.

Is patient at high risk for falls: No.

Language Barrier: No.

Do you have Advance Directive: No.

Copy of advance Directive on the chart.

Diet Cardiac heart health diet.

Discharge plans:

Discharge home to wife in 48hours with home health nurse if medically stable.