Michael Emory

MTCC PNE / 2014 / PM

1-27-2014

                                                                Diverticulitis

      Diverticulitis is an inflammation of a diverticulum or of diverticula (multiple) in theintestinal tract, especially the colon, and most often in the sigmoid colon. It can result when food and bacteria retained in a diverticulum produces infection and inflammation that can impede drainage and can lead to perforation or abscess formation.( Lippincott Williams & Wilkins, 2013. Print. ). A diverticulum is a small sac-like out-pouching of mucosal and sub-mucosal layers of the colonic wall. In most cases there are more than one diverticulum and although these diverticula can form anywhere, including in your esophagus, stomach and small intestine, most occur in your large intestine. The presence of multiple diverticulum (diverticula) in the colon with no symptoms or inflammation issues is referred to as diverticulosis, however only a small percentage of persons with diverticulosis develop diverticulitis. Because these pouches seldom cause any problems, you may never know you have them. However when they do become inflamed, it often spreads to the surrounding bowel wall. In an acute circumstance, an abscess may develop leading to peritonitis, erosion of blood vessels that may produce bleeding, and finally gangrene, accompanied by a perforation could possibly develop. If the condition becomes chronic, constipations worsens, with mucus in the stool, severe abdominal pain, and like intestinal obstruction.( F.A. Davis, 1993 Print).

     Diverticulitis is found in approximately 10% of the U.S. population, but is more common inpeople that are over 60 years old, rising to an occurrence of 60% in those over 80 years old. A congenital predisposition is likely when the disorder is present in those under 40 years old.( Lippincott Williams & Wilkins, 2013. Print. ). The exact cause of the formation of these sac-like out-pouches is unknown; however, a diet with a low intake of dietary fiber is considered a major cause of the disease.( Delmar, 2011. Print). Diverticular disease is common in developed or industrialized countries, particularly the United States, England, and Australia where low-fiber diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber vegetable diets. Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Both the soluble and insoluble forms of fiber help make stools soft and easy to pass. Fiber also prevents constipation. Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. The excess pressure causes the weak spots in the colon to bulge out and become diverticula. (Web. 28 Jan. 2014).

     Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early. To help the colon rest; bed rest and a liquid diet, along with a pain reliever is the common remedy. An acute attack with severe pain or severe infection may require a hospital stay. Most acute cases of diverticulitis are treated with antibiotics and a liquid diet. The antibiotics are given by injection into a vein. In some cases, however, surgery may be necessary and the affected portion of the bowel is removed. A colon resection is performed and a colostomy may be required, temporarily or possibly long term. ( Lippincott Williams & Wilkins, 2013. Print. ).  For most people with diverticulosis, the condition leading up to diverticulitis, eating a high-fiber diet is the only treatment required. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily.

     Nursing care for patients with diverticulitis covers a wide range of observations, planning, interventions, and evaluation. The focus evolves around the planning and implementation of the maintenance of normal bowel elimination, pain relief, and preventing complications. Patients need to be educated about the disease and its symptoms.

     During an acute episode, the nurse should adhere to the prescribed treatment with fluid and electrolyte replacement; and antibiotics, antispasmodics, analgesics, and stool softeners; and nasogastric suction, as prescribed by the health care provider.. The nurse should observe the patient for increasing or decreasing distress and for any adverse reactions to the therapy. Stools should be inspected for mucus, blood, and consistency; the frequency of bowel movements is noted. The patient is assessed for fever, increasing abdominal pain, blood in the stools, and leukocytosis, and for indications of perforation, such as rebound tenderness. The nurse should be aware of signs and symptoms of infection. Rest is prescribed, and the patient is instructed not to lift, strain, bend, cough, or perform other actions that increase intra-abdominal pressure. When the patient resumes a normal diet, stool softeners may be employed. ( F.A. Davis, 1993 Print).

     In the nursing in the maintenance of diverticulosis and prevention of diverticulitis, the nurse should encourage a fluid/electrolyte intake of 2 to 3 liters a day and foods that are soft but have increased fiber to promote defecation. An individual exercise program should be encouraged to improve abdominal muscle tone. The nurse should educate the patient to understand the nature of the condition and to recognize signs of on-coming problems. A patient diagnosed with diverticulitis related to diverticulosis should be aware that pain or rigidity in the lower left quadrant, anterior or posterior, may indicate perforation or peritonitis, and should be reported immediately to their health care provider. ( Lippincott Williams & Wilkins, 2013. Print. ).

     In summary, patient should be made aware of the advantages of a high fiber diet, appropriate fluid intake and exercise. The patient should be made aware of ways to control internal pressure of the intestines and lower bowels. Because of the potential for developing complex problems, prevention of diverticulosis, which can lead to diverticulitis should be emphasized.

                                                                   References

White, Lois, Gena Duncan, Wendy Baumle, and Shawn White. Procedures Checklist to Accompany Foundations of Basic Nursing Third Edition Lois White, Gena Duncan, Wendy Baumle. United States: Delmar, 2011. Print.

Thomas, Clayton L., M.D., M.P.H. (1993). Taber's Cyclopedic Medical Dictionary, Edition 18. F.A. Davis, 1993 Print. ISBN 0-8036-0194-8.

Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12th Ed. Fundamentals of Nursing, 7th Ed. Clinical Nursing Skills Video Guide, 2nd Ed. Taylor's Clinical Nursing Skills, 3rd Ed. LWW DocuCare One Year Access North American Edition. N.p.: Lippincott Williams & Wilkins, 2013. Print.

"CRS | Colon Rectal Specialists | Diverticulitis." CRS | Colon Rectal Specialists | Diverticulitis. N.p., n.d. Web. 28 Jan. 2014. . 

Michael Emory NUR 101 / MTCC PNE 2014                                                     Pneumonia       Pneumonia is a very serious infection or inflammation that can manifest one or both of your of your lungs. Many small germs, such as bacteria, viruses, and fungi, can cause pneumonia, however as I understand it, there are two main types Pneumonia; bacterial pneumonia and viral pneumonia. ("Understanding Pneumonia  N.p., n.d. Web. 12 Dec. 2013.)       Bacterial pneumonia can attack anyone from infants to the very old. People who are alcoholics, smokers, debilitated, post-operative patients, people with respiratory diseases or viral infections and people who have weakened immune systems are at greater risk. Pneumonia bacteria are present in some healthy throats. When body defenses are weakened in some way, by illness, old age, malnutrition, general debility or impaired immunity, the bacteria can multiply and cause serious damage. Usually, when a person’s resistance is lowered, bacteria work their way into the lungs and inflame the air sacs and a person’s temperature may rise to as high as 105 degrees Fahrenheit. ("Understanding Pneumonia  N.p., n.d. Web. 12 Dec. 2013.)      Another of the more common types is viral pneumonia. Half of all pneumonias are believed to be caused by viruses. More and more viruses are being identified as the cause of respiratory infection, and though most attack the upper respiratory tract, some of the organisms settle in small air sacs called alveoli and continue multiplying. As the body sends white blood cells to attack the infection, the sacs become filed with fluid and pus - causing pneumonia, especially in children. Most of these pneumonias are not serious and last a short time. Pneumonia coupled with the influenza virus may be severe and occasionally fatal. The virus invades the lungs and multiplies, but there are almost no physical signs of lung tissue becoming filled with fluid. It finds many of its victims among those who have pre-existing heart or lung disease or are pregnant. (Dasaraju, Purushothama - Web. 12 Dec. 2013.)       A pneumonia diagnosis usually begins with a physical exam and a discussion about your symptoms and medical history. A doctor may suspect pneumonia if they hear coarse breathing, wheezing, crackling sounds, or rumblings when listening to the chest through a stethoscope. Chest x-rays and blood tests may be ordered to confirm a pneumonia diagnosis. A chest x-ray can confirm pneumonia and determine its location and extent in the lungs. Blood tests measure white blood cell count to determine the severity of pneumonia and can be used to determine whether the infection is bacterial, viral, fungal, etc. An analysis of sputum also can be used to determine the organism that is causing the pneumonia. Under some circumstances a more invasive diagnostic tool is the bronchoscopy - a procedure whereby the patient is under anesthesia and a thin, flexible, and lighted tube is inserted into the nose or mouth to directly examine the infected parts of the lung. ( Medical News Today -Web. 11 Dec. 2013.)      In the United States, more than 3 million people develop pneumonia each year. Most people with pneumonia recover, but about 5% will succumb to the condition. The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within 12 to 36 hours, there is increasing breathlessness; the cough becomes worse and produces a small amount of mucus. There is a high fever and there may be blueness of the lips. It can have over 30 different causes this means it is affected in different parts of the body. The main parts are lungs, stomach, and the temperature of the body. If you have pneumonia then you may suffer from fever, chills, cough, rapid breathing, breathing with grunting or wheezing sounds. Some other signs may include: Labored breathing that makes a child’s rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath), vomiting, chest pain, abdominal pain, loss of appetite. In extreme cases, bluish or grey color of the lips and fingernails.( Medical News Today -Web. 11 Dec. 2013.)      Increased awareness of pneumonia and vigilance in observations and basic nursing care will help nurses to identify possible cases of pneumonia, and facilitate early intervention and better quality of care for patients. Nursing treatment for pneumonia should include oxygen therapy as an essential component of treatment for all patients with pneumonia. Its aim is to maintain their saturations above 93%. Physiotherapy is often beneficial to help teach patients how to breathe properly, control their breathing and good posture to promote good lung expansion. Deep breathing helps to open the air passages in your lungs. Coughing helps to bring up sputum (mucus) from your lungs. You can deep breathe and cough on your own, or with the help of an incentive spirometer. Any signs of dehydration and hypotension should be addressed immediately as good hydration makes it easier for patients to expectorate secretions. Nutrition should also be considered. Many patients with severe pneumonia will experience nausea and therefore have a poor appetite however; their calorific requirement is raised due to the presence of infection. An adequate calorie intake should be sought to enable the body to fight the infection. (“Pneumonia 2: Nursing Practice  Web. 13 Dec. 2013.)      If you develop pneumonia, your chances of a fast recovery are greatest under certain conditions: if you’re young, if your pneumonia is caught early, if your defenses against disease are working well, if the infection hasn’t spread, and if you’re not suffering from other illnesses. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. After a patient’s temperature returns to normal, medication must be continued according to the doctor’s instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack. Besides antibiotics, patients are given supportive treatment: proper diet and oxygen to increase oxygen in the blood when needed. In some patients, medication to ease chest pain and to provide relief from violent cough may be necessary. The most common place where it occurs is the lungs or the stomach. In 1996 (latest data available), there were an estimated 4.8 million cases of pneumonia resulting in 54.6 million restricted-activity days and 31.5 million bed days. In 2000, there were approximately 1.3 million hospitalizations, 1.3 million emergency room visits, and 63,548 deaths recorded in the United States. ( Foundations of Nursing, White & Duncan, 3rd Edition. 2011.)

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"Understanding Pneumonia - American Lung Association." American Lung Association. N.p., n.d. Web. 12 Dec. 2013. .

Dasaraju, Purushothama V. Infections of the Respiratory System. U.S. National Library of Medicine, 17 Jan. 0096. Web. 12 Dec. 2013. .

Medical News Today. MediLexicon International, n.d. Web. 11 Dec. 2013. .

"Pneumonia." (Inpatient Care). N.p., n.d. Web. 13 Dec. 2013. .

 "Pneumonia 2: Effective Nursing Assessment and Management." Nursing Practice and Peer-reviewed Clinical Research for All Nurses. N.p., n.d. Web. 13 Dec. 2013. .

Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12th Ed. Fundamentals of Nursing, 7th Ed. Clinical Nursing Skills Video Guide, 2nd Ed. Taylor's Clinical Nursing Skills, 3rd Ed. LWW DocuCare One Year Access North American Edition. N.p.: Lippincott Williams & Wilkins, 2013. Print.

Foundations of Nursing, White & Duncan, 3rd Edition. 2011.

Diabetes Mellitus

Michael Emory
NUR 101 / 2014
MTCC PNE
                                                     Diabetes Mellitus
     Diabetes Mellitus is caused by insufficient insulin production or lack of responsiveness to insulin, resulting in hyperglycemia, causing the glucose in the blood not to be absorbed into the cells of the body (high blood glucose levels). There are 2 primary types of diabetes mellitus, Type I (insulin-dependent or juvenile-onset), which may be caused by an autoimmune response, and type II (non-insulin-dependent or adult-onset). Diabetes insipidus is typically due to hormonal dysregulation. (Web. 02 Dec. 2013)
     The muscle cells and other tissues of the body require certain specific levels of glucose and carbohydrates to maintain their normal functions. The levels of glucose absorbed into the bloodstream by the intestines, and the method by which glucose enters the body’s cells, is controlled by the hormone, insulin. The insulin is produced in the pancreas, a gland about the size of a person’s hand that is located behind the lower part of the stomach. ( Web. 01 Dec.2013)
     Diabetes is a disease characterized by excessive urination. An interesting fact, according to The American Heritage College Dictionary; Diabetes is named for one of its symptoms. The disease was known to the Greeks as Diabetes, which was derived from the verb “diabainien”, made up of the prefix “dia” meaning across or apart and the word “bainen” which means to walkor stand. The verb “diabainien” meant “to stride, walk, or stand with legs apart. Its derivation diabetes meant one that “straddles”, which gave rise to it being used to describe a disease involving the discharge of excessive urine.
     Diabetes mellitus (DM) is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone. Insulin is produced in the pancrea sby the beta cells of the islets of Langerhans. Absence, destruction, or loss of these cells causes an absolute deficiency of insulin, leading to Type I Diabetes (insulin-dependent diabetes mellitus [IDDM]). Type I Diabetics must have daily injections of insulin to survive. There is currently no cure for Diabetes. This condition can however be managed so that patients cans live relatively normal lives. Treatment of Diabetes focuses on two goals; keeping blood glucose levels within normal range and preventing the development of long-term complications. Careful monitoring of diet, exercise, and blood glucose levels are as important as the use of insulin or oral medication in preventing complications of Diabetes. Most children with diabetes have IDDM, often referred to as juvenile diabetes, which begins most commonly in childhood and requires a lifetime dependence on exogenous insulin.( William H Lamb)
     Type II diabetes, the most common form of the disease (non–insulin-dependent diabetes Mellitus [NIDDM]), is a heterogeneous disorder, in which the pancreas still has the ability to produce insulin, but the amount is not enough for the body’s needs. Patients with NIDDM have insulin resistance and their beta cells lack the ability to overcome this resistance. The symptoms for Type II Diabetes develop gradually and include; feeling tired or ill, frequent night urination, thirst, blurred vision, possible weight loss, frequent infections, and sores that heal slowly or not at all. Although this form of diabetes previously was uncommon in children, 20% or more of new patients with diabetes in childhood and adolescence now have NIDDM, a change associated with increased rates of obesity. (Mayo Clinic Research, 3-14, 2013. Web. 12-1, 2013)
     Insulin is essential to process carbohydrate, fat, and protein. Insulin reduces blood glucose levels by allowing glucose to enter muscle cells and fat cells and by stimulating the conversion of glucose to glycogen as a carbohydrate store. Insulin also inhibits the release of stored glucose from liver glycogen and slows the breakdown of fat to triglycerides, free fatty acids, and ketones. Additionally, insulin slows the breakdown of protein for glucose production.(Martin,Terry R., 2010. Print)
     Hyperglycemia results when insulin deficiency leads to uninhibited gluconeogenesis and prevents the use and storage of circulating glucose. The kidneys cannot reabsorb the excess glucose load, causing glycosuria, osmotic diuresis, thirst, and dehydration. Increased fat and protein breakdown leads to ketone production and weight loss. Without insulin, a child with IDDM wastes away and eventually dies from diabetic ketoacidosis. Information on mortality rates is difficult to ascertain without complete national registers of childhood diabetes, although age-specific mortality probably is double that of the general population. Particularly at risk are children aged 1-4 years who may die with DKA at the time of diagnosis. Adolescents also are a high-risk group. Most deaths result from delayed diagnosis or neglected treatment and subsequent cerebral edema during treatment for DKA, although untreated hypoglycemia also causes some deaths.(Molitch, Mark E., U.S. National Library of Medicine, 17 Jan. 0090. Web.02 Dec. 2013)
     IDDM complications are comprised of 3 major categories: acute complications, long-term complications, and complications caused by associated autoimmune diseases. Acute complications reflect the difficulties of maintaining a balance between insulin therapies, dietary intake, and exercise. Acute complications include hypoglycemia, hyperglycemia, and DKA. Long-term complications arise from the damaging effects of prolonged hyperglycemia and other metabolic consequences of insulin deficiency on various tissues. While long-term complications are rare in childhood, maintaining good control of diabetes is important to prevent complications from developing in later life. The likelihood of developing complications appears to depend on the interaction of factors such as metabolic control, genetic susceptibility, lifestyle, pubertal status, and gender. Most cases of IDDM are the result of environmental factors interacting with a genetically susceptible person. This interaction leads to the development of autoimmune disease directed at the insulin-producing cells of the pancreatic islets of Langerhans. These cells are progressively destroyed, with insulin deficiency usually developing after the destruction of 90% of islet cells. (Mayo Clinic Research, 3-14, 2013. Web. 12-1, 2013)



Resources:
1) Pediatric Type 1 Diabetes Mellitus Clinical Presentation
Author: William H Lamb, MBBS, MD, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Stephen Kemp, MD, PhD
2) Martin, Terry R. Hole's Human Anatomy & Physiology: Laboratory Manual, Twelfth Edition [by] David Shier, Jackie Butler, [and] Ricki Lewis. New York: McGraw-Hill Higher Education, 2010. Print.
Websites:
3) Molitch, Mark E. Diabetes Mellitus. U.S. National Library of Medicine, 17 Jan. 0090. Web. 02 Dec. 2013. .

4) Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 14 Mar. 2013. Web. 01 Dec. 2013. .

5) "Diabets.org." Diabets.org. N.p., n.d. Web. 02 Dec. 2013. .

6) "Diabetes." Diabetes. N.p., n.d. Web. 01 Dec. 2013. .

Michael Emory

            MTCC PNE / NUR 101

                                                 Chronic Kidney Disease (CKD)                    

Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of months or years. The early symptoms of worsening kidney function vary and often go un-noticed. Chronic kidney disease (CKD) causes destruction of the kidneys. It is progressive and irreversible. (Brunner).

Your kidneys are an essential part of your body’s ability to function. They have a number of functions: they help maintain the balance of minerals and electrolytes such as calcium, sodium, and potassium, they play an essential role in the production of red blood cells, they maintain the delicate acid-base balance of the blood, and they excrete water soluble wastes from the body. Each kidney contains about one million tiny filtering units called nephrons. (Shier, 12th Edition) Any disease that injures or scars these filtering units can cause kidney disease. (White etal., 2011)

Diabetes and high blood pressure can both damage the nephrons. (Brunner) High blood pressure can also damage the blood vessels of the kidneys, heart, and brain. This is key, because, in general, blood vessel diseases are dangerous to the kidneys. The kidneys are vascular—meaning they contain lots of blood vessels. (Brunner) The risk of CKD increases over the age of 65 and chances seem to increase if there is a family history of renal disease. It is more likely to occur in African-Americans, American Indians, and Asian Americans. Other risk factors for CKD include: cigarette smoking, obesity, high cholesterol, diabetes, and autoimmune disease. (White etal., 2011)

CKD does not cause noticeable symptoms until about 90 percent of the kidney has been destroyed. Once the kidney is severely damaged, symptoms of CKD could include: swelling around the eyes (per orbital edema), swelling of the legs (pedal edema], fatigue, shortness of breath, nausea vomiting, especially in the morning and after eating. (Brunner). BUN can be elevated when the kidney starts to fail. Normally, the kidney clears products of protein breakdown from the blood. However, after kidney damage,

byproducts build up. Urea is one byproduct of protein breakdown. Urea is what gives urine its odor. (Brunner).

The diagnosis of CKD begins with a medical history. A family history of kidney failure can raise suspicions. So can a history of high blood pressure or diabetes. However, other tests are needed to confirm a CKD diagnosis.  A complete blood count (CBC) can show anemia. Kidneys produce erythropoietin. This is the hormone that stimulates the bone marrow to produce red blood cells. When the kidney is severely damaged, the ability to produce erythropoietin decreases. This causes the decline in red blood cells known as anemia. (Brunner).

Procedures that can be done to help with the diagnosis include a Renal Flow and Scan.  This is an imaging study of kidney function A Renal Ultrasound This noninvasive test measures the kidneys and prostate. It gives information about whether an obstruction is present.  Additional tests for CKD include: biopsy of the kidney, bone density test, abdominal computed tomography (CT) scan abdominal magnetic resonance imaging (MRI).  (Brunner).

CKD is chronic and irreversible. Treatment focuses on improving the underlying disease.

Treatment can also prevent and manage complications of CKD, such as: fluid overload, congestive heart failure, anemia, and weight loss and electrolyte imbalance. Control of underlying problems, such as hypertension and diabetes, can slow the rate of kidney damage. Chronic kidney disease frequently progresses to complete kidney failure. When this happens either dialysis or a kidney transplant is necessary for continued survival.  There are steps a person can take to properly manage chronic kidney disease and prevent the process from progressing.   One very important issue is controlling blood sugar. And keeping your blood pressure well controlled is probably two of the single best ways to manage chronic kidney disease So, Making exercise and healthy eating will help to regulate blood pressure and blood sugar which in turn helps to manage chronic kidney disease. (Brunner) (White etal., 2011) (Shier, 12th Edition)

                                                            

References

Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). Brunner & Suddarth's textbook of medical-surgical nursing (7th ed.). Philadelphia, New York: Lippincott Williams & Wilkins.

 "Hole's Human Anatomy & Physiology (Shier), 12th Edition." Your Page Title. N.p., n.d. Web. 14 Nov. 2013. .

White, Lois, Gena Duncan, and Wendy Baumle. Foundations of Nursing. Clifton Park, NY: Delmar/ Cengage Learning, 2

Atrial Fibrillation (Afib)

Michael Emory

MTCC PNE

                                                 Atrial Fibrillation (Afib)  

Atrial Fibrillation (Afib)   is an irregular and often rapid heart rhythm.  The irregular rhythm, or arrhythmia, results from abnormal electrical impulses in the upper chambers (atria/atrium) of the heart that causes the heartbeat (ventricle contraction) to be irregular and usually fast.  The irregularity can be continuous, or it can come and go.  Some individuals, especially patients on medication, may have atrial fibrillation constantly but not have rapid (> 100 heartbeats per minute) at rest.  Normal heart contractions begin as an electrical impulse in the right atrium.  The impulse comes from an area of the atrium called sinoatrial (SA) or sinus node, the “natural pacemaker” that causes the normal range of regular heartbeats.  In an adult person with a normal heart rate and rhythm the heart beats 50-100 times per minute at rest.  If more than 100 time per minute, the heart rate is considered fast (tachycardia).  If the heart beats less than 50 times per minute, the heart is considered slow (bradycardia).

In atrial fibrillation, multiple sources of impulses other than only from the SA node travel through the atria at the same time.  Instead of coordinated contraction, the atrial contractions are irregular, disorganized, chaotic, and very rapid.  The atria may contract at a rate of 400-500 beats per minute.  The blood flow from the atria to the ventricles is often disrupted.  These irregular impulses reach the AV node in rapid succession, but not all of them make it past the AV node.  Therefore, the ventricles beat more slowly than the atria, often at fairly fast rated of 150-180 beats per minute in an irregular rhythm.  The resulting rapid, irregular heartbeat causes an irregular pulse and sometimes a sensation of fluttering in the chest.

Atrial fibrillation can occur in several different patterns:

Intermittent - The heart develops atrial fibrillation and typically converts back again spontaneously to normal (sinus) rhythm.  The episodes may last anywhere from seconds to days.

Persistent - Atrial Fibrillation occurs in episodes, but the arrhythmia does not convert back to sinus rhythm spontaneously.  Medical treatment or cardioversion (electrical treatment) is required to end an episode.

Permanent - The heart is always in atrial fibrillation.  Conversion back to sinus rhythm either is not possible or is deemed not appropriate for medical reasons.  In most cases, the rate is reduced by medications and the patients are placed on anticlotting medications for their lifetime.

Atrial Fibrillation or A Fib is one of the most common heart rhythm disorders.  It affects about 4% of the population, mostly people older than 60 years.  This amounts to more than 2.6 million people in the U.S.  People older than 40 have about a 25% chance of developing Afib in their lifetime.  The risk of developing A fib increases as we get older.  About 10% of people older than 80 years have atrial fibrillation.  For many people, A fib may cause symptoms but does no harm.

  Complications like blood clot formation, strokes and heart failure can arise, but appropriate treatment reduces the chances that such complications will develop.

 Some of the signs and symptoms that may be seen are shortness of breath, wheezing, chest tightness and edema in lower extremities.  Due to the possibility of edema and fluid retention of the patient the Dr. may perform a thoracentesis to remove fluid from the pleural space within the

chest wall. Latter a chest X ray may be ordered to check for fluid within the lower lobes of the lungs.  An EKG will show there is a rapid atrial flutter, along with Para pneumonia effusion.

Following these tests patients can be started on several different drugs:

1.  Digoxin (Lonoxin):   This drug decreases the conductivity of electrical impulses through the AV node.  Digoxin is currently used primarily in patients with associated heart disease, such as poorly functioning left ventricle.  The health care provider, nurses, and AP staff should monitor patient for edema and wheezing.

2.  Coumadin (Warfarin):  A blood anticoagulant that inhibits the function of Vitamin K dependent coagulation.  Coumadin is used to inhibit the coagulation of blood to reduce or prevent the chance of developing heart attacks, strokes and venous and other blood clots; deep vein thrombosis, pulmonary embolisms and thrombi produced by atrial fibrillation.  The most common side effect of this drug is bruising and bleeding.

3.  Lasix (Furosemide):  This drug belongs to a group of medications called loop diuretics (water pills).  Lasix is given to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease and other medical conditions. Together with other medications it can be used to treat high blood pressure.  If this drug is used for a long time, the heart and arteries may not function properly.  This can damage many vital organs resulting in stroke, heart failure, or kidney failure.

Works Cited:

Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12th Ed. Fundamentals of Nursing, 7th Ed. Clinical Nursing Skills Video Guide, 2nd Ed. Taylor's Clinical Nursing Skills, 3rd Ed. LWW DocuCare One Year Access North American Edition. N.p.: Lippincott Williams & Wilkins, 2013. Print.

COPD

Michael Emory

NUR101/ MTCC PNE 2014

                                              COPD

     Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus, and Emphysema, which leads to the destruction of the lungs over time. Most people with COPD have a combination of both conditions.

     Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. (Hanania). Other risk factors for COPD are; Exposure to certain gases or fumes in the workplace, Exposure to heavy amounts of secondhand smoke, pollution, and frequent use of cooking fire without proper ventilation. (Hanania).

     The most common symptoms are cough, with or without mucus, fatigue, respiratory infection, shortness of breath that gets worse with mild activity, trouble catching one's breath and wheezing. Because the symptoms of COPD develop slowly, some people may not know that they are sick.

     The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away, and the test does not involve exercising, drawing blood, or exposure to radiation. (Hanania) Using a stethoscope to listen to the lungs can also be helpful. However, sometimes the lungs sound normal even when COPD is present. Pictures of the lungs (such as x-rays and CT scans) can be helpful, but they also sometimes look normal even when a person has COPD. Sometimes patients need to have a blood test to measure the amounts of oxygen and carbon dioxide in the blood to determine if there is adequate gas exchange. (Hanna).

     There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse. Persons with COPD must stop smoking. This is the best way to slow down the lung damage.

     Medications used to treat COPD include: Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol, Inhaled steroids to reduce lung inflammation, Anti-inflammatory medications such as montelukast (Singulair) and roflimulast are sometimes used. (Hanania) In severe cases or during flare-ups, you may need to receive: Steroids by mouth or through a vein (intravenously), Bronchodilators through a nebulizer, Oxygen therapy assistance during breathing from a machine, using a mask, BiPAP, or endotracheal tube. (Hanania) Antibiotics are prescribed during symptom flare-ups, because infections can make COPD worse.(Hanania) You may need oxygen therapy at home if you have a low level of oxygen in your blood. Pulmonary rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Exercise can help maintain muscle strength in the legs. Walk to build up strength and slowly increase how far you walk. Try not to talk when you walk if you get short of breath. Use pursed lip breathing when breathing out to empty your lungs before the next breath.

     Things you can do to make it easier for yourself around the home include: Avoiding very cold air, Making sure no one smokes in your home, Reducing air pollution by getting rid of fireplace smoke and other irritants. Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about eating foods with more calories. People often can help ease the stress of illness so perhaps joining a support group in which members share common experiences and problems might be helpful.

     Surgery may be used, but only a few patients benefit from these surgical treatments. Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with emphysema and lung transplant for severe cases.

     COPD is a long-term (chronic) illness. The disease will get worse more quickly if you do not stop smoking Patients with severe COPD will be short of breath with most activities and will be admitted to the hospital more often. These patients should talk with their doctor about breathing machines and end-of-life care.

References

Nicola A. Hanania, COPD (2011). Retrieved from http://Googleebook.com

Pulmonary Hypertension

                                                    Pulmonary Hypertension

Pulmonary hypertension (or PHT) is a type of heart disease that causes dangerously high blood pressure in your lungs, affecting the arteries of your lungs and part of your heart. It is a different measurement altogether from systemic blood pressure. It reflects the pressure the heart must exert to pump blood from the heart through the arteries of the lungs. Pulmonary blood pressure is normally a lot lower than systemic blood pressure. Normal pulmonary-artery pressure is about 14 mm Hg at rest. If the pressure in the pulmonary artery is greater than 25 mm Hg at rest and 30 mm Hg during exercise, it is abnormally high and is called pulmonary hypertension. (Web. O7 Nov. 2013). Symptoms of pulmonary hypertension may not develop until the disease has advanced, and if not treated, you may develop life-threatening diagnosis. Pulmonary hypertension can be diagnosed by a cardiologist or a pulmonologist with an echocardiogram, which uses sound waves to make a picture of your heart. (White & Duncan 2011).

Early on, you may think you're simply "out of shape" because general fatigue and tiredness are often the first symptoms. Symptoms are shortness of breath while exercising, and eventually, chest pain, fatigue, fainting, swelling in your feet, ankles and legs, and cyanosis of your lips, fingers and toes. (Web. O7 Nov. 2013)

Pulmonary hypertension is caused by the hardening or narrowing of the arteries in your lungs and the right side of your heart. Spending time at high altitudes (8,000 feet and higher) may cause you to develop pulmonary hypertension because of low blood oxygen or accumulation of fluid in your lungs. (Holes 2013)

Factors that increase your risk of pulmonary hypertension include older age, being female and having a family history of the condition. Medical conditions such as AIDS, chronic hepatitis, sickle cell anemia, sleep apnea, lupus and emphysema may cause you to develop secondary pulmonary hypertension. Complications of pulmonary hypertension may be fatal without treatment and include heart arrhythmia, bleeding into the lungs, blood clots and heart failure. (Web. O7 Nov. 2013)

The effects of Pulmonary Arterial Hypertension (PAH) are nonspecific; therefore persons with pulmonary heart disease may be required to undergo many different kinds’ lifestyle changes. If you smoke, stop. If you don't exercise, start. Excessive use of alcohol is not recommended, but some doctors may suggest a small glass of red wine every day, which may produce benefits from its high content of flavonoids and antioxidants. Flavonoids and antioxidants can also be found in foods from a well-balanced diet, including vitamin and mineral supplements. (Patient Survival Guide, Web. 07 Nov. 2013)

Exercise may help strengthen the heart muscle and help increase stamina and strength for some. Preventing further heart damage is the key to living with pulmonary heart disease. Controlling blood pressure and watching cholesterol levels are also important for anyone suffering from any form of heart disease. . (Patient Survival Guide, Web. 07 Nov. 2013)

Works Cited:

1) "Hole's Human Anatomy & Physiology (Shier), 12th Edition." Your Page Title. N.p., n.d. Web. 07 Nov. 2013. .

 2) "PULMONARY HYPERTENSION: A PATIENT’S SURVIVAL GUIDE." PH Patients Survival Guide. N.p., n.d. Web. 07 Nov. 2013. .

 3) "What Is Pulmonary Hypertension?" What Is Pulmonary Hypertension? N.p., n.d. Web. 07 Nov. 2013. .

4) Foundations of Nursing, White & Duncan, 3^rd Edition. 2011.