NURS 6501 – Advanced Pathophysiology Essay
If available lab results, I would like to see the resulted complete blood count with differential and complete metabolic profile. Possibly supplying the patient with supplemental oxygen if deemed so by her oximetry and perfusion status review. As such the following would be the initial assessment and treatment:
Obtain vital signs: blood pressure, temperature, pulse, respiratory rate with auscultation, as well as pain scale rating Note her capillary refill time and skin color and turgor, especially around lips for color and for turgor Seeing if she has sunken eyes or dry mucous membranes indicative of dehydration. NURS 6501 – Advanced Pathophysiology Essay Paper
Place a pulse oximeter on her finger for oxygenation levels. Place EKG monitor for heart rate and rhythm analysis.
Place IV for obtaining blood works and order stat CBC, CMP, PT/INR/PTT, ABG, CXR, cardiac and liver enzyme profiles. Perform blood glucose monitoring
with glucometer for immediate assessment of her diabetic state, is she hypo or hyperglycemic. Review airway for any obstruction as she is dyspneic.
While conscious review pain level, duration and site of pain and medical history-hopeful to review current medications, with attention to evaluate current mental status such as orientation to person, time and place. Note that she is in acute distress with disorientation that is progressing to unresponsiveness (Gerontological nursing, 2010). NURS 6501 – Advanced Pathophysiology Essay Paper
If unresponsive at the time of arrival, the nurse needs to be vigil in looking for clues to how she is experiencing pain by looking for signs such as moaning, agitation, restlessness and facial grimacing. Assess skin is intact with no abscesses or open wounds or sores. Consider value of inserting a urinary catheter.
Tools that will be utilized in the assessment of Mrs. Baker may include: Stethoscope- will be used for listening to heart beat to ascertain dysrhythmia above 90 beats/minutes would be indicative of concern and comparing radial/peripheral pulses with baseline of heart apex rate to ascertain if variance exists , auscultation of lungs for clearness of lung fields and respiratory rate should be 16 per minute if she is over 20 breaths/ minute concern for hyperventilation and oxygen delivery and consumption would arise . Tachypnea and dyspnea are noted, oxygen would be applied. NURS 6501 – Advanced Pathophysiology Essay Paper
blood pressure cuff (sphygmomanometer)- The blood pressure cuff will determine if she is normotensive or hypo-hypertensive, expected range is 120/80 mmHg if below 90 mm hg systolic or 70mm hg diastolic is cause for concern. Glucometer-ascertain rapidly, serum blood glucose level range expected 70 – 130 (mg/dL) before meals, and less than 180 mg/dL after meals (as measured by a blood glucose monitor).
blood tubes with needle access for blood testing (vacutainers)-to conduct CBC- to monitor white blood cell, red blood cell and platelet counts, CMP- for fluid and electrolyte
imbalance, kidney and liver function, ABG-, analysis for acid/base imbalance liver and cardiac enzyme for indication of liver or cardiac impairment as well as blood coagulation profile such as PT/INR/PTT- for elevation in bleeding time . Blood cultures and antibiotic sensitivities for sepsis pulse oximeter-to rapidly measure the oxygenation of her hemoglobin saturation 95 to 99 percent expected. NURS 6501 – Advanced Pathophysiology Essay Paper
continuous cardiac monitoring via electrocardiogram(EKG)-to examine rhythm and rate-expect normal sinus rhythm and rate 80-100 beats per minute. Thermometer-measure the core temperature which should be 37 c if above 38 c or below 36 c if hypothermic
bladder catheterization kit
chest x-ray- cardio pulmonary function
The benefits of using these tools, as time is critical for an older patient who has multiple
organ dysfunction syndrome(MODS), is to have precise and state-of-the-art information to
effectively treat the patient. Maintaining and monitoring tissue perfusion would be key goals in
her care and I would utilize these tools to evaluate blood pressure and respirations,
monitoring pulse and assessing for any cardiac arrhythmias. To evaluate for any underlying
respiratory disease, pneumonia, PE, or pulmonary edema a chest x-ray would be advantageous. NURS 6501 – Advanced Pathophysiology Essay Paper
A bladder catheter would give accurate accounting of urinary output.
The patient became unresponsive; her respirations became more labored, so breathing became the main priority while reading the scenario. The patient is unable to verbalize how she is feeling and with her dyspnea it is clear she is in respiratory distress. Evaluating the electrocardiogram would be done to ascertain if there are any dysrhythmias that could be causing the symptoms. I would review the vital signs, is the patient having hypo- hypertension?
Review the patient’s pain assessment, is the patient experiencing any pain? I would then review lab results, focusing on abnormal results. The prioritization was done with basis for basic needs first, that of breathing effectively to promote oxygenation then focus of vital sign monitoring that is compatible with sustaining life.
I would assess pain in a geriatric patient who is alert by questioning the patient directly, do they have any pain, asking them where the pain is, what is the duration of the pain and when was onset.
On a numeric pain scale 0 to 10 what is their level of pain. Are they taking any pain medication at home? In a geriatric patient who is not alert, I would need to assess the patient based on signs such as moaning, agitation, restlessness and facial grimacing. I would manage the pain in a geriatric patient experiencing multisystem failure and showing signs of pain but not alert with caution. NURS 6501 – Advanced Pathophysiology Essay Paper
The elderly are susceptible to polypharmacy and often have impaired renal function that increases risk or potentiates the medication such as barbiturates. Knowing I have a standing order for acetaminophen and by judgment of the pain with a lot of moaning, restlessness and grimacing, I would elect to give the morphine 0.1mg/kg IM. She cannot take the acetaminophen by mouth as she not responsive, the 0.05 mg/kg Morphine IV will likely obtund the patient with the rapid absorption and likely decrease her blood pressure severely as she is dehydrated.
The patient’s pain level would need to be reevaluated approximately 20 minutes after administration for effectiveness and then again in one hour. It is likely with her being unconscious , I would assess by a presence or lack of grimacing, moaning or agitation. I found her to have been relieved of pain when reassessing her I have learned it is very important to recognize the fragility of the elderly related to polypharmacy, agedness of vital organs, key focus on concern of
cognitive ability and its role in assessment by nursing. NURS 6501 – Advanced Pathophysiology Essay Paper
It is likely that the metformin (Glucophage) can have decreased effects when combined with Hydrochlorothiazide (diabetes forum, 2012). The patient recently added lisinopril to her regimen and this in the form of Zestoric has hctz in it as well. It is possible she has had too much hctz and the prescribing physician needs to be alerted. The recommendation for this possible interaction is to monitor blood sugar levels when taking all three of these medications.
This is especially important when starting, stopping or changing the dosage of your lisinopril/HCTZ. The collaborative team members pertinent to her care are the emergency room physician for immediate assessment, diagnosis and treatment recommendation, the medical physician involved in her current care, possibly an endocrinologist who is managing her diabetes, a pulmonologist or intensivist who is caring for her current state as a consultant and the radiologist and cardiologist who will review her lab, radiology and EKG results. NURS 6501 – Advanced Pathophysiology Essay Paper
In the event where her status became unconscious the respiratory therapist and emergency room physician and ER code team responded to facilitate returning her to stable vital signs. It is likely she will need social work involvement and discharge care planning as she will be admitted until the current situation is diagnosed, treated and stabilized.
Gerontological Nursing: Competencies for Care, Second Edition, 2010. http://www.diabetesforums.com/forum/type-2-diabetes/48316-lisinopril-hctz-20-12-a.html accessed November 24, 2012.
A 45-year-old grocery sales clerk has been suffering from bouts of severe pain in his left flank region. He blamed it on prolonged standing for 8 hours straight while working. He was taking over-the-counter pain medications for his pain. One day, he found fresh blood in his urine. He went to a doctor who performed urine tests, CT scans, and x-rays. He was diagnosed with urinary calculi. •Discuss possible factors that may have been responsible for the development of the stone and use this case to show how the patient’s diet and water intake can help analyze the composition of the calculi. NURS 6501 – Advanced Pathophysiology Essay Paper
Factors responsible for the development can include his family or personal history, being over 40, his gender, his diet, weight, over the counter medications, and possible dehydration. He will need to drink plenty of water, avoid excess caffeine, black tea, grapefruit and apple juices. He should also avoid foods high in oxalates, limit his sodium Intake, limit his animal protein and avoid mega-doses of vitamin
C. By following this dietary and water intake method it should help analyze if the calculi composition is Calcium oxalate, Calcium phosphate, Cystine, Magnesium ammonium phosphate, or Uric acid. •What would be the test results of his white blood cells, blood calcium levels, CT scan, and x-ray? Urinalysis will be positive for nitrite, leukocyte esterase, and blood. The white blood cell (WBC) count will be elevated, with a left shift. Creatinine level will also be elevated in outlet obstruction. CT scan will demonstrate bladder calculi if the test is performed without IV contrast material. The unenhanced spiral CT is sensitive but yet specific in diagnosing calculi along the urinary tract and even pure urate calculi can be detected this way. KUB detects radiopaque stones because pure uric acid and ammonium urate stones are radiolucent and can be coated with a layer of opaque calcium sediment. NURS 6501 – Advanced Pathophysiology Essay Paper
The sonogram will show a classic hyperechoic object with posterior shadowing, and it is effective in identifying both radiolucent and radiopaque stones. (Basler, 2014) •Suggest the best treatment for the patient and a plan to prevent recurrence post-treatment. Treatment is with analgesics, antibiotics for infection, medical expulsive therapy, and, sometimes, shock wave lithotripsy or endoscopic procedures. •Facilitate calculus passage with α-receptor blockers such as tamsulosin. •For persistent or infection-causing calculi, complete removal using primarily endoscopic techniques. (Preminger, 2014). NURS 6501 – Advanced Pathophysiology Essay Paper
Drink plenty of water, get the proper amount of calcium according to your age, reduce sodium , limit animal protein such as red meat, poultry, eggs, and seafood , and avoid stone-forming foods such as beets, chocolate, spinach, rhubarb, tea, most nuts rich in oxalate, and colas rich in phosphate.
As defined by Phipp’s (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) congestive heart failure occurs when, the myocardium of the heart is unable to uphold a sufficient cardiac output to meet the body’s metabolic needs. Heart failure can result from either systolic or diastolic dysfunction (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007). Assessment tools that will be used in the assessment of Mr. Toscana include, head to toe, physical, and systems assessments. A risk assessment will also be done on Mr. Toscana to insure that he is safe in hospital (Berman, A, Kozier, B, Erb, G.L, 2008,). As Mr. Toscana suffers from congestive heart failure a wide range of education and psychosocial support is available to help with his condition (Heart Foundation, 2010). A nursing care plan has been made to show four nursing diagnoses and interventions to reduce the impact of the diagnosis. These nursing diagnoses’s can be solved through a variety of diagnostic tests to make sure that every possible outcome is looked at (Berman, A, Kozier, B, Erb, G.L, 2008). Mr. Toscana is taking a few medications at the present time to manage his cardiac issues along with other medical conditions he suffers from, these medications are, Lasix, digoxin, aspirin, warfarin and perindopril. (Tiziani, A, 2010), (Better Health Channel, 2010). NURS 6501 – Advanced Pathophysiology Essay Paper
PATHOPHYSIOLOGY OF CONGESTIVE CARDIAC FAILURE Both systolic and diastolic heart failure are second to myocardial injury. Progression of heart failure is highly dependent on the level of ventricular remodelling, this occurs after myocardial injury (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007). The changes in ventricle shape and dimension will cause a decrease in its effectiveness as a pump. An increase on diastolic pressure possibly will further change the shape of the left ventricle, thus resulting in papillary muscle rearrangement and mitral insufficiency. It is more common for congestive heart failure to begin in the left ventricular systolic dysfunction. Some of the common causes for decreased left ventricular stenosis include that of, CAD, systemic hypertension, and aortic stenosis. CAD by diminishing the oxygen supply to the myofibrils decreases contractility. Hypertension causes the left ventricle to contract more with more force to eject blood into the aorta. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) Over a period of time hypertrophy of the muscle fibres happens and an increase in myocardial oxygen consumption occurs. Aortic stenosis, the left ventricle must increase its pumping force to deliver blood through the tight valve. Heart failure will be the result when the hearts need of oxygen cannot be met and blood remains at the end of systole. (Mccance, K, Huether, S.E, Brashers, V.L, Rote, N.S, 2010,). NURS 6501 – Advanced Pathophysiology Essay Paper
CLINICAL MANIFESTATIONS OF CONGESTIVE HEART FAILURE As stated in Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007, Page 814, ‘the clinical manifestations of heart failure occur secondary to elevated filing pressure and tissue hyperfusion’ Clinical manifestations of congestive heart failure can be broken down into the systems in which they affect the respiratory, cardiovascular, gastrointestinal systems and show effects in both cerebral and psychosocial. Clinical manifestations in respiratory are, dyspnoea, orthopnea, a persistent cough, crackles in the lungs. The cardiovascular system is affected by, the onset of angina, tachycardia, increase of systolic blood pressure and an increase in systolic blood pressure. Gastrointestinal clinical manifestations include that of, enlargement of the right upper quadrant of the abdomen, nausea and vomiting, pain in the epigastric region, anorexia and bloating. Confusion and restlessness can be seen as manifestations of cerebral, and anxiety is associated with manifestations to psychosocial. Generalised manifestations include oedema; either pitting or peripheral, weight gain and fatigue. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), (Mccance, K, Huether, S.E, Brashers, V.L, Rote, N.S, 2010,), (Better Health Channel, 2010) NURS 6501 – Advanced Pathophysiology Essay Paper
NURSING ASSESSMENT OF MR. TOSCANA For Mr. Toscana a variety of nursing assessments will be done upon admission. As well as the usual monitoring of vital signs, assessments such as, head to toe, physical and systems assessments, need to be completed. A head to toe assessment will be performed to give a detail initial assessment studying the whole body to see if there is any other factors that may cause harm or pain, in a head to toe assessment circulatory problems, pressure areas, existing wounds, can all be seen as well as gaining an in depth assessment of the skin. A physical assessment will be done on Mr. Toscana will also be performed, a physical assessment includes, inspection; which is the visual inspection of a person, palpation; the examination done by touch, auscultation; a form of examination by listening to the sounds made by the body (heart, lung and bowel), percussion; the examination done by tapping, percussion is done to listen for abnormal sounds and detect issue (Berman, A, Kozier, B, Erb, G.L, 2008,). A systems assessment of Mr. Toscana will be beneficial because, along with the other forms of assessment a systems will be able to give a base mark of where he is, a systems assessment covers, central nervous (CNS), cardiovascular (CVS) assesses, respiratory (RESP), gastrointestinal (GIT), renal (RENAL), skin integrity (SKIN), and psychosocial (PSYCH). Together these forms assessment will provide a detailed amount of information to create a nursing care plan for Mr. Toscana, including interventions that need to be made, and things to implement to further his recovery and aid in his discharge. (Berman, A, Kozier, B, Erb, G.L, 2008,). NURS 6501 – Advanced Pathophysiology Essay Paper
NURSING CARE PLAN Please refer to appendices one for full nursing care plan. (Berman, A, Kozier, B, Erb, G.L, 2008,). (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), (Heart Foundation, 2010), (Holmesglen, 2009), (Better Health Channel, 2010)
DIAGNOSTIC TESTS For Mr. Toscana there are a number of diagnostic tests that will help with the assessment, management and detection of underlying issues. Tests that can be performed on Mr. Toscana are as follows, a chest X-ray to see if there are any problems with his lungs, or vascular congestion, or congestion of the liver (this can suggest right sided failure) (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007), a full blood test including electrolytes, an ECG to check the rhythm of the heart, and determine the causes for Mr. Toscana’s symptoms. The use of urine analysis to see if infection is present, function of kidneys, traces of blood in relation to fluid build up. The combination of these tests will provide a baseline for assessment, guide the nursing care, and rule out all other possible causes of the symptoms that Mr. Toscana has presented with. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007). NURS 6501 – Advanced Pathophysiology Essay Paper
RISK ASSESMENT From the history of Mr. Toscana a risk assessment can be done. Assessments such as falls, and pressure care. A falls risk assessment will be done on Mr. Toscana to determine the risk he is of falling, and if further measures need to be implemented to insure that he is safe while in hospital, a suitable framework for a falls risk is the FRAT tool, (Falls Risk Assessment Tool), (Department Of Human Services Victoria, 2005) a FRAT tool will show the level of risk that Mr. Toscana is, and risk factors. A pressure area risk check can be done by using the Braden risk assessment tool (Berman, A, Kozier, B, Erb, G.L, 2008,), (South Australia Health, Date Unknown). this will help minimise the risk of Mr. Toscana developing pressure areas where possible. Things at home can also be deemed a risk, things such as; not being compliant with his medications can lead to poor health, and stress can all affect his general wellbeing and lead to further the progression of medical conditions. NURS 6501 – Advanced Pathophysiology Essay Paper
EDUCATION AND PSYCHOSOCIAL SUPPORT For Mr. Toscana education is a must, education about the maintenance of his congestive heart failure, about the importance of taking medication on a regular basis. How to manage the affects of his congestive cardiac failure, and avoid the effects, support for Mr. Toscana is also imperative to aid in his recovery things such as providing strategies to minimise the health problems, referral to a social worker to help with issues that are affecting him at home. Support groups set up by the heart foundation of Victoria will help with the emotional issues related to having this condition. (Heart Foundation, 2010) The importance of education and psychosocial support will be seen through less medical admissions or problems, increased quality of life and will give Mr. Toscana the ability to be able to deal with small problems before they grow into something much bigger. (Monahan, F, Sands, J, Neighbours, M, Marek, J.F, 2007) , (Berman, A, Kozier, B, Erb, G.L, 2008,) (Better Health Channel, 2010). NURS 6501 – Advanced Pathophysiology Essay Paper
MEDICATIONS Mr. Toscana is taking a number of medications including, warfarin and digoxin. The action of Digoxin is, it increase the myocardial contraction force in the failing heart, decreases conductivity of the heart in particular the A-V node, increase on vagal activity this results in the slowing of the sinoatrial nodal rate, increases myocardial excitability this can result in ectopic beats this happens mostly through high doses of digoxin, oral digoxin effective in an approximate time frame of 1 hour, maximal effect is reached between four and six hours. The use of digoxin for Mr. Toscana is, to treat his congestive heart failure. Digoxin may produce a false ST-T wave change on an ECG if tested during exercise. Digoxin can cause the following adverse effects, gastrointestinal issues including, anorexia, nausea, vomiting, diarrhoea, and pain in the abdomen. Cardiovascular effects, ectopic beats, bradycardia, heart block. Tachycardia (ventricular). The adverse effect of toxicity is a decrease on appetite, nausea, vomiting, diarrhoea, severe stomach pains, weakness and tiredness, a slow and irregular heartbeat, blurred vision, drowsiness, mental depression or confusion, fainting and headaches. Nursing points/precautions which should be followed are that the tablet should never be halved; neither IM nor SC routes are recommended due to unpredictable absorption, because prolonged or intense pain and necrosis of the muscle to the client (Intramuscular), severe irritation may occur when given via a subcutaneous injection. A rapid IV administration should be avoided as it may cause hypertension and vasoconstriction. The action of warfarin is a suppressant of vitamin-K dependant synthesis of prothrombin in the liver, this prevents the extension of a clot that is already established of the formation of a new one, warfarin has an anticoagulant effect that is produced after 36-72 hours and can persist for between 4 and 5 days after the discontinuation of therapy. The use of warfarin is, as a prevention and management of the following, deep vein thrombosis (DVT) or pulmonary embolism, thromboembolism in atrial fibrillation, and can be used as an adjunct to therapy for coronary occlusion. For Mr. Toscana there is no relevant interaction with this drug. The adverse effects of warfarin are fatal or non fatal bleeding, nausea, vomiting, diarrhoea, alopecia, fever, hypersensitivity reaction, an overdose is seen by bleeding from the gums and haematuria, in rare cases skin necrosis is also seen. Some of the nursing points and precautions with warfarin are, that all intramuscular injections be avoided, and subcutaneous injection sites should be closely monitored for haematoma, make sure that the does is given the same time daily to Mr. Toscana, observation for the early signs of overdose things such bleeding especially important from the gums.( Tiziani, A, 2010). NURS 6501 – Advanced Pathophysiology Essay Paper
CONCLUSION Through a range of assessments, diagnostic testing, education and the development of a nursing care plan Mr. Toscana’s condition should improve as well as his general wellbeing. Goals set out in the care plan will be achieved by interventions put in place insuring a quicker recovery for Mr. Toscana. Education is particularly important for Mr. Toscana’s medication regime, support strategies will help with the improvement of overall health and wellbeing.
Patient Case Question 1: For which condition is this patient likely taking nifedipine?
Nifedipine is a calcium channel blocker used to treat high blood pressure and chest pain. Patient’s past medical history indicates that he has had hypertension “for years,” the patient is most likely taking Nifedipine to manage this condition. May also be taking nifedipine so as to prevent chest pain from his past condition of Coronary Artery Disease (CAD). NURS 6501 – Advanced Pathophysiology Essay Paper
Patient Case Question 2: For which condition is this patient likely taking lisinopril?
Lisinopril is an ACE inhibitor that treats high blood pressure and heart failure.
Patient could be taking lisinopril in tandem with nifedipine to manage his hypertension and Coronary Artery Disease.
Patient Case Question 3: For which Condition is this patient likely taking paroxetine?
Paroxetine is used to treat various mood disorders. It is most likely that the patient is taking paroxetine to treat his generalized anxiety disorder, which he has been experiencing for the past 18 months (according to his past medical history). NURS 6501 – Advanced Pathophysiology Essay Paper
Patient Case Question 4: What is meant by “tenting of the skin” and what does this clinical sign suggest?
“Tenting of the skin” involves a skin turgor test. By pulling a fold of skin from the back of the hand, lower arm, or abdomen with two fingers one can assess the ability of the patient’s skin to change shape and return to normal (elasticity). “Tenting of the skin,” indicates that the skin is not returning to normal quickly, which means the person has severe dehydration, a fluid loss of 10% body weight. The result of his skin turgor test indicates late signs of dehydration (patient had skin with poor turgor), and the presence of tenting in the skin indicates the severity of his dehydration. Patient Case Question 5: Are the negative Grey Turner and Cullen signs evidence of a good or poor prognosis? NURS 6501 – Advanced Pathophysiology Essay Paper
A positive test for Cullen sign occurs when a patient has superficial bruising in the subcutaneous fat around the umbilicus. A positive Grey Turner test occurs when a patient has bruising of flanks (last rib to top of hip), which indicates a retroperitoneal hemorrhage. Both Cullen and Grey Turner signs are used to indicate/predict acute pancreatitis, when these signs are present one has a high rate of mortality (37%). The patient tested negative for both Grey Turner and Cullen signs, so his prognosis is good.
Patient Case Question 6: Identify THREE major risk factors for acute pancreatitis in this patient.
Patient has sinus tachycardia, paired with the patient’s severe dehydration the patient is showing signs of having acute pancreatitis. Patient also has a history of alcohol abuse and is regularly taking ACE inhibitors, which puts him at a high risk of developing acute pancreatitis. Patient also has diminished bowel sounds that indicate possible acute pancreatitis. NURS 6501 – Advanced Pathophysiology Essay Paper
Patient Case Question 7: Identify TWO abnormal laboratory tests that suggest that acute renal failure has developed in this patient.
Patient’s Blood Urea Nitrogren (BUN) level is 34 mg/dL; which indicates decreased kidney function. Patient has a potassium level of 3.5 meq/L which is below normal range (3.7- 5.2 meq/L), this indicates possible renal artery stenosis. Both of these lab results suggest that the patient has developed acute renal failure.
Patient Case Question 8: Why are hemoglobin and hematocrit abnormal? Patient’s hemoglobin level is 18.3 g/dL, normal hemoglobin levels for men are between 14 and 18 g/dL. Patient’s hematocrit level is 53%, normal hematocrit levels are 40-50%. This abnormally high lab results indicate early stages of kidney disease and anemia. Patient has developed acute renal failure, so these test results are as expected for a patient under such conditions. NURS 6501 – Advanced Pathophysiology Essay Paper
Patient Case Question 9: How many Ranson criteria does this patient have and what is the probability that the patient will die from this attack of acute pancreatitis?
Patient has seven points of Ranson criteria. Patient’s WBC count was over 16K, patient is over age 55, patient’s blood glucose level was higher than 200 mg/dL, patient’s LDH level was over 350, patient had high BUN level, and Patient had high fluid needs due to his dehydration. Patient’s predicted mortalitiy is 100% based upon the Ranson criteria, so it is very likely that the patient will die from this attack of acute pancreatitis.NURS 6501 – Advanced Pathophysiology Essay Paper
Patient Case Question 10: Does the patient have a significant electrolyte imbalance?
Patient has a sodium level that is 1 meq/L below normal range, and a potassium level 0.2 meq/L below normal range. This indicates that the patient is having renal complications that are interfering with electrolyte balance. Patient Case Question 11: Why was no blood drawn for an ABG determination?
No blood was drawn for an ABG determination because patient’s lungs were clear to no auscultation, so no test was needed to test patient’s blood PH. Also patient had urine with a PH within normal range, so an ABG test was not really needed.
Blood doping has been one of the most publicized issues that hit the sporting industry over the years. Blood doping is a process whereby an athlete or competitor uses additional red blood cells to improve their performance. There are two methods of blood doping namely autologous and homologous transfusion. The deaths of several athletes in both the Olympics and other international sporting events have put into question the effectivity of blood doping practice. This paper will investigate the problem, background, and risks involved in blood doping. NURS 6501 – Advanced Pathophysiology Essay Paper
An Overview of Blood Doping Engaging in competitive sports can take a lot out of the body of an athlete. To be competitive, the athlete would require a lot of stamina. In order to maintain their endurance and drive for competition, red blood cells would have to be injected in the muscles of the athlete. By doing so, they would have a huge advantage over their rivals. This has paved the way for the birth of an illegal method called blood doping or blood packing. The Meaning and Rationale For Blood Doping Doping is usually conducted prior to the start of competition. NURS 6501 – Advanced Pathophysiology Essay Paper
The blood of the athlete will be collected and then processed so it will accumulate concentrated blood cells. Afterwards, the collected sample will be kept in a freezer so it will be re-injected into the athlete or matched with the sample of a donor before their scheduled event(Pollick, n. d). Blood doping is resorted to by athletes because they believe that getting additional red blood cells will provide more oxygen as well as other vital components to their muscle system which can pave the way for improved endurance and better stamina. NURS 6501 – Advanced Pathophysiology Essay Paper
For an athlete who is competing in events such as cycling or running, condition is more important than skills and strategies(Pollick, n. d). It is worth noting that another kind of practice known as “downstream” is a good method designed to maintain the physiological and biological balance of the body. This can be used to compensate for the undesirable effects of “upstream” doping(CNRS, 1998). Blood Doping Methods There are two ways of injecting blood into the body of an athlete.
Autologous doping involves the transfer of the sportman’s own blood which has been frozen until required. Homologous doping, on the other hand, is the transmission of blood from a donor which matches the blood type of the athelete(Pollick, n. d). The History of Blood Doping Ancient Greece was the sight of the first doping attempts by sportsmen. They were believed to have utilized special food and stimulated ingredients to provide them strength. During the 19th century, Greek cyclists used caffeine, strychnine, alcohol, and cocaine(WADA, n. NURS 6501 – Advanced Pathophysiology Essay Paper
d). In 1904, Thomas Hicks won the gold medal in Olympics by consuming brandy and raw egg, and injecting himself with strychnine shots. By the 1920s, prohibitions on drug use was being put in place(WADA, n. d). The International Amateur Athletic Federation (IAAF) in 1928 pioneered the bannig of performance-enhancing drugs among international sports federations. However, they proved futile due to the absence of testing methods. The problem becam worse with the introduction of synthetic hormones in the 1930s.
It was only during the 1960 Rome Olympic Games when Knud Enemark Jensen, a Dutch cyclist, died as a result of amphetamine, did sports authorities made attempts in testing drug use among athletes(WADA, n. d). Cycling and football were the first sports events that conducted drug testing among their athletes. In 1967, the IOC instructed its Medical Commission to come up with an initial listing of prohibited drugs(WADA, n. d. ). By the 1970s, majority of the international sports federations were engaged in drug testing among their athletes. NURS 6501 – Advanced Pathophysiology Essay Paper
By this time, anabolic steroids were becoming popular particularly among athletes competing in strength competitions. The substance was added to the IOC list in 1976 which resulted to several disqualifications in the latter part of the 1970s(WADA, n. d. ). Drug testing became mandatory in the Olympics beginning at the Winter Olympics and at the Olympics in 1968. Anti-doping measures became even more dire with the death of Tom Simpson at the Tour de France(WADA, n. d. ). Successful Drug Testing Efforts
The ten years covering the 1970s to the 1980s became even more complicated after suspicions of some countries engaging in blood doping were aroused. This was proven by the case of the German Democratic Republic. The most notable disqualification of the Olympic Games happened in 1988 when Ben Johnson, who was then the reigning world champion in the 100-meter event, was found positive for using anabolic steroids(WADA, n. d). In 1998, huge stacks of illegal medical drugs were discovered during a raid in the Tour de France. NURS 6501 – Advanced Pathophysiology Essay Paper