468 CASE SCENARIO. ACUTE KIDNEY INJURY/DEHYDRATION.

KINGDOM OF GOD HOSPITAL LOS ANGELES, CA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 65years old man.

Account number Q00099694.

MR#Q77000065487.

Admission Date:01/26/210340am .

Admission status: Inpatient.

Location MedTelemetry.

Room 43006.

Attending doctor: Tumtum,Worry .

Patient name:Luckyman,Features. Resuscitation Status: Full Code.

Allergy: NKDA.

Weight:170Ibs.

Height:5ft 9inches.

Primary diagnosis: AKI,DEHYDRATION. Secondary diagnosis dm,htn,hypothyroidism, amputation of right foot.

Isolation Status: Standard Precautions.

Is patient a high risk for falls: No.

Transportation: Wheelchair.

Skin integrity impaired: No.

Diet: Carb controlled diet.

Laboratory tests:

WBC:7.3.

H/H:9.8/30% .

K: 4.4.

NA:140.

Medications:Norco 5/325mg po Q4hours prn pain.

Zofran 4mg IV Q4hours prn nausea/Vomiting. Zosyn 3.375gm IV Q8hrs.

Morphine sulfate 2mg IV Q3hours prn pain.

0.9NS @ 125ml/hour IV right ac 20guage,patent/clean/dry.

Vital signs Q4hours.

Strict intake and output measurements.

CBC with differential, Chem 7 in am.

RECCOMENDED THERAPEUTIC RANGES FOR ORAL ANTICOAGULANTS.

Follow your facility policy and procedures.Every patient is different.Prophylaxis of venous Thromboembolism. (High risk surgery)

Treatment of pulmonary embolism ( P E). Target INR VALUE should be 2.0 to 3.0.

Bileaflet mechanical valve in aortic position. Prevention of systemic embolism.

Tissue heart valves.

Target INR VALUE .2.0 to 3.0.

Acute Myocardial infarction. To prevent systemic embolism.Valvular heart disease.

Atrial fibrillation 2.0 to 3.0.

Mechanical prosthetic valves (high risk)

To prevent recurrent Myocardial infarction (MI).TARGET INR VALUE 2.5 to 3.5.

467 CASE SCENARIO. LEFT FACIAL CELLULITIS DUE TO TOOTH EXTRACTION.

KINGDOM OF GOD HOSPITAL LOS ANGELES,CA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 59years male .

Account number: Q009996645.

MR# : Q88009765233.

Location: General Surgery department. Room/bed 32116.

Admitted: 01/12/21.@1640.

Status: Inpatient.

Attending doctor: Tumtum,Worry. Resuscitation status: Full code.

Weight:240lbs.

Height:6ft 2inches.

Chief Complain: left shoulder weakness, left neck redness and swelling.

Primary diagnosis: Left facial Cellulitis due to tooth extraction. (tooth removal)Incision and drainage with JP done today by doctor Smiley,Jacoboy ,DDS.

Secondary diagnosis:H Pyloric chronic renal failure, hip surgery, Hypertension, HLD/DM.

Isolation status: Standard Precautions.

Is patient at risk for fall: Yes. ( Language barriers)Interpreter at the bedside. Fall precautions protocol in place.

Medication reconciliation done.

Do patient have advance Directive:No.

Copy of advance Directive on the chart.

Suicidal risk: No.

Family Support: Daughter at his bedside:Mrs Elizabeth Successful.

Transportation: Bed.

02 @ 2liters NC.Saturation 93%.

Transferred from Coconut Hospital, Fresno California.

Tooth extraction was done 01/02/21 by doctor Draining, Peter.

Intraoral debridement by doctor: Badboy,James. DDS.Allergy: NKDA.

Diet: Carb controlled diet.Thin liquid. Consistency Regular. Glucerna 1can tid.( Chocolate or Vanilla.

Medications:

Zosyn 3.375gm IV Q8hrs.

LR @ 75ml/hour. Right Forearm clean/Dry/ Intact.

Clean mouth with hydrogen peroxide mouth swab after eating. No straws.

Discourage the use of straws.

Laboratory tests:

WBC:10.6.

H/H10.0/32.4%.

NA:140.

K:4.4.

Plans Discharge tomorrow to follow up with appointment in 4days.

Discharge teaching ongoing process.

466 CASE SCENARIO. RIGHT FOOT DIABETIC ULCERS/INFECTED WOUND.

KINGDOM OF GOD HOSPITAL LOS ANGELES,CALIFORNIA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 69years female.

Account number : Q00009944868.

MR# :Q00888866467.

Date of admission: 01/20/21.@ 1900.

Attending doctor: Don’thate,Big.

Location: General surgery.

Room :30017.

Patient name: Watermelon, Micheline.

Code Status: Full Code.

Chief complaint: Right foot Diabetic wound that needs amputation.

Height: 5ft 2inches.

Weight:180lbs.

Primary diagnosis:Right foot diabetic ulcer/ infected wound.

Secondary diagnosis: HLD/DM/CVA/HTN.

Is patient at risk for falls:Yes.

Do you have advance: No.Copy of advance Directive on the chart.

Risk for suicide: No.

02 @ 4liter NC.

Allergy: NKDA.

Diet: Carb controlled diet. Consistency: Regular. Orthopedic consult: Doctor Saveme,Jonathan.

PT/ OT Consultation for evaluation and treatment.

Dressing with splint to right leg.

Alert and oriented x4. Right lower Extremity swollen. Elevated on pillows .

SCD to left lower Extremity.

Wound culture (+)Staphylococcus.

Laboratory tests.

WBC :13.2.

H/H=11.1/32%

Bun =22.

Creatinine =1.4.

Vancomycin through 18.7.

Blood sugar:176.

Medications: Norco 10/325mg po Q4hours prn pain.

Zofran 4mg IV Q4hours prn nausea/Vomiting. Purwick placed at 8pm.

Saline lock right AC 20guage,patent/clean/dry.

MAKING UNHEALTHY RELATIONSHIP HEALTHY.

I never realized how the body systems work together as a team until I could not bend down or sit down on the chair .

It was one faithful morning on May 22nd 2020.I remembered it as if it was yesterday. After I have recovered from all the symptoms of COVID19 that I had.I walked from my bedroom upstairs to downstairs. As I arrived at the kitchen area,I wanted to sit down but my back will not let me.All efforts for me to sit down was abortive. What is going on I asked myself?. I walked from upstairs to downstairs. If you know that you wouldn’t let me sit down why did you allow me to to walk downstairs?.I was talking to nobody but my back.There was no response. So I started to cry,I cried like a baby. Finally my daughter heard me crying so she came downstairs and asked me why I was crying. I told her. And she looked at me but couldn’t believe it.

She commended me to sit down but I couldn’t. She trying to force me to sit down, she could not force me. I stood there like a manikin with tears on her face.I requested for motrin. She gave me 600mg of motrin, I took it still standing. Fifteen to twenty minutes later, she helped me to sit down on a high stool. After forty minutes later I was able to transfer to a lower chair. But that is the beginning of my long journey.

As I looked down, I noticed that my right is two and half times my left leg. My body are not working together as a team. So moving around became a serious problem because my back and my right are on my way.I know that every part of my body has to be in agreement for me to function efficiently. I could not wash myself up .I could not wear my underwear simply because my lower back and my right leg will not let me.It took months and several doctors visits, Emergency room physician, primary care physician, Rheumatologist, Orthopaedic doctors.I finally got relieved when a bucket of yellow fluid was drained from my right knee and steroid therapy given. One week later I was able to use my legs.

So I was grounded for six months without serious movement and the ability to perform ADL (which is activity of daily living)Body parts have to be healthy for us to have a normal life. Can you imagine if you have a bad partner it will be difficult to be happy. So you got to find a solution to make unhealthy relationship healthy. Fixation of my right knee allow me to be whole again. I can move around, do my dishes,take shower,and walk around in my backyard. If relationship is unhealthy, it is not good just like my right knee was misbehaving so I fixed it for it to be in agreement with the other part of my body. But should I remove it and get a new leg?.That will be too expensive and highly inconvenient. Some divorce can be highly expensive and inconvenient.

What will the next package look like?.What about the kids?.Who takes the kids?.How do we split the wealth. What can I tolerate in this marriage?.He or she want too much sex?. Well I can live with that.She doesn’t make the bed.I can live with that.Rather than divorce and let her take away all my wealth. Let us hire house keepers to keep the house clean. Sometimes some marriages can be worse than hell fire so divorce becomes the best option because the bible say that if your hand hand can cause you stumble cut it off and throw it away from you.Mattew 5:30.

SBAR HAND OFF FORM.(NURSING STUDENTS)

LONDON SCHOOL OF PROFESSIONAL HEALTH SCIENCES, LOS ANGELES,CALIFORNIA 900000.

Student Nurse name:Lovesoda,Icecre.

SITUATION: Room 3124.

Date 03/13/21.

Age/Sex 46.

Chief complaint: SOB,Chest pain.

Primary Diagnosis: Atria Fibrillation. Surgery/ Procedures:Echocardiogram. BACKGROUND:

Secondary diagnosis:ESRD/HTN.

CODE STATUS: FULL CODE.

Intervention: 02@2liter NC.

Blood pressure medication given as ordered by the doctor. Assessment of pain,medicate as ordered with morphinesulfate 4mg IVQ3hours prn pain.Reasssessment in 30minutes.

Monitor blood pressure and notify the doctor for any critical value.

ASSESSMENT:

Neuro: Headache, dizziness.

Respiratory: dyspnea.

Cardiac: Chest pain.

GI/GU: Dialysis, Nocturia.

Musculoskeletal : Weakness LLE,Swelling.

Skin: Intact. No skin breakdown.

Psychological: Anxiety, depression.

Vital sign/pain: BP:,140/88,Hr:108,Temperature: 98.0,Resp:20.

Weight: 144lbs.

Height:5ft 4inches. Ambulates to the bathroom. No bowel movement today.

Blood sugar: N/A.

Laboratory:WBC 6.8.

H/H9.8/29.7%.

Creatinine:5.5.

Bun:28.

Xray: Chest Xray results: Pending.

IV lines/Fluids: Saline lock right ac 20guage,patent/clean/dry. RECCOMENDATION:

Vital signs within normal range.

Consultation: Cardiology consult.

Discharge Instruction:

Educate patient on medication and the side effects.

Risk of CHF.

Diet and Exercise.Balanced diet three times a day.Stop smoking.

Medication reconciliation done.

Pneumonia vaccine/flu vaccine given.

Is patient at risk for falls :No.

Suicidal risk: No.

Do patient have copy of advance Directive:No.

Copy of advance Directive on the chart.

The 12 cranial nerves.

1. Olfactory nerve = Sense of smell.

11. Optic nerve = vision.

111. Oculomotor nerve= Eyeball and eyelid movements.

V1 . Trochlear. = Eye movement.

V. Trigeminal = This is the largest cranial nerves and it is divided into three branches, which consist of the ophthalmic, maxillary and mandibular nerves.

The functions are to control facial sensations and chewing.

V1. Abducens nerve is also for eye movement.

V11 .Facial nerve is for facial expression and sense of taste.

V111 .Vestibulocochlear nerve is for Equilibrium and hearing.

1X .Glossopharyngeal nerve. Swallowing, sense of taste and saliva secretion.

X . Vagus nerve = Smooth muscle sensory and motor control in the throat, lung, heart and the digestive system.

X1 .Accessory nerve = Movements of the neck and shoulder.

X11. Hypoglossal nerve: This is the movement of tongue, swallowing and speech.

The cranial nerves consist of 12 nerves that arise from the brainstem.

The olfactory and optic nerve arise from the anterior portion of the brain called cerebrum.

The Glossopharyngeal, Vagus and hypoglossal nerves are attached to the medulla oblongata.

The Oculomotor, and trochlear cranial nerves stem from the midbrain.

Trigeminal,Abducens and Facial nerves arise in pons.

Vestibulocochlear nerve arise from the inner ear and travels to the pons.

pexels.com/pictures .