Tag: chest

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Chest physiotherapy for pneumonia in children

Read the following articles: Lisy, K. (2014). Chest physiotherapy for pneumonia in children. The American Journal of Nursing, 114(5), 16. doi:10.1097/01.NAJ.0000446761.33589.70
Makic, M., Rauen, C., Jones, K. and Fisk, A.  (2015) Continuing to challenge practice to be evidence-based.  Critical Care Nurse, 35(2), 39-50. doi:10.4037/ccn2015693

Certain practice habits continue to be used despite the availability of research and other forms of evidence that should be implemented to guide practice interventions. CPT is often prescribed for children with pneumonia, asthma, bronchiolitis, and atelectasis following surgery or mechanical ventilation.

I would like to know if you guys can follow the directions,  giving to me below.. I also need  three  to five years old reference

Initial Discussion Post::

(1)What is the expected outcome when implementing CPT?

(2)What are the risks of performing CPT?  Do the risks outweigh the benefits?
(3)Is the practice of CPT supported by evidence?
(4) Are there safe, alternative interventions that the RN can implement to achieve the same outcome as performing CPT?

(5)If so, identify at least one.

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Chest physiotherapy is described as a process of bronchial hygiene which include specialized cough technique, vibration, chest percussion, postural drainage and turning. Chest physiotherapy helps the children to remove excess mucus from the lungs. Most often, chest physiotherapy for the children is required when they suffer from lung illness. However, the treatment can be prolonged when the child suffers from chronic lung diseases. Normally, chest physiotherapy consists of two procedures, percussion and positioning or postural drainage. Percussion involves the process of clapping the child on the chest(Levy, 2015). The expected outcome is that when the child is clapped, the chest is shaken and the mucus becomes loose, thus making it easier to be coughed outside. Also, when the position of the baby is changed, mucus which is watery moves from the high position to low position, hence helping to move the mucus from the bottom of the airways to the larger airways which is located in the middle of the lungs.

            Studies have shown that it is advisable to carry………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

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…………………………………………………………………………………………………………………………………………………………………………………………Chest physiotherapy for pneumonia in children……………………………………….

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The chest pain “comes and goes”

A 55 year old female walks in to the clinic with the chief complaint of chest pain. The chest pain “comes and goes”.
1.Describe the work up that will take place in the office today.
2.What are the differential diagnoses?
3.Choose one of the likely diagnosis and outline the treatment plan for her, include medications and lifestyle changes as needed.

Be sure to appropriately cite any sources you use to support your responses with standard APA citations. Answer the prompt question(s) thoroughly using a minimum of 150-200 words


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Diagnosis of Chest Pain Complaint

(Name of Student)

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Diagnosis of Chest Pain Complaint

            A 55 year old female who walks into the office with chief complaint of chest pain that “comes and goes” could signify possible myocardial infarction. According to Souza (2014) there is a large variation in the presentation of chest pain and this necessitates proper evaluation. Once the patient presents herself in the clinical office, patient evaluation will be done. The evaluation includes requesting from the patient for their medical history, the patient physical activities, and other areas of the body such as hands, arms, and shoulder where the pain may have been felt.

            The possibility of myocardial infarction is often the first consideration in adults when they report to the emergency room with complaints of chest pain. However, there is need for further diagnosis to rule out other possible conditions such as pneumonia and pulmonary embolism. Differential diagnosis provides a way in which further diagnosis can be done to determine presence of other conditions (Dennison & Farrell, 2015). The differential diagnoses for myocardial infarction are swallowing of lidocaine to relieve esophagitis, and inserting nitroglycerin under the tongue to diagnose coronary insufficiency. In addition, chest x-rays, lung scan, and arterial blood gases may be conducted to eliminate other possibilities.             The first treatment line for the female patient is the use of nitroglycerin to increase vasodilation and blood flow to the myocardium (Souza, 2014). The drug should be provided through continuous IV infusion using non-absorptive tubing at 5 mcg/min. This should be increased at intervals of 3-5 minutes at rates of 5 mcg/min up to 20 mcg/min. The lifestyle changes that the patient may need to adopt include increasing………………………………………………………………………………………………

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Chest Pain 1. How do you evaluate a patient with a history of chest discomfort and risk factors for heart disease?

Please follow the soap note template provided:
Title page – including the identified case study name and number
 
1. Learning Issues – what do you need more information in order to develop a plan? If so, what information do you need or want? (Can be bullet points)
    1. Example – Chest Pain
        1. How do you evaluate a patient with a history of chest discomfort and risk factors for heart disease?
        2. What are the laboratory findings that are important to look for with someone with chest discomfort?
* How do you manage abnormal lipids?
1. What lifestyle changes are important to recommend to reduce cardiac risk
2. Interpretation of Cues, Patterns, and Information – symptoms analysis and identification of any missing data that would helpful in making a plan for care (Can be bullet points)
    1. Example – Chest pain
        1. Chest discomfort – musculoskeletal vs gastrointestinal vs cardiac vs respiratory?
        2. What labs are missing that would assist in the planning process for this patient?
* Family history that could increase risk of cardiovascular disease
1. Psychosocial issues – caffeine intake, smoking, ETOH use, or working history
2. Differential Diagnoses – include 3 differential diagnoses including ICD-10 codes (Can be bullet points)
    1. Example – Chest pain
        7. Precordial Pain – R07.2
        8. Acute Myocardial Infarction – I21.9
* Gastroesophageal Reflux Disease without esophagitis– K21.9
4. Diagnostic Options – what additional laboratory work, diagnostic testing, or possible referrals may be required? (Can be bullet points)
5. Final Diagnosis – what is the most probable cause of the patient problem?
6. Therapeutic Options – this is related to your final diagnosis (Paragraph Form or Bullet Points)
    1. Pharmacological
    2. Nonpharmacological
    3. Educational
    4. Social Determinants of Health
7. Follow up – when should this patient return to the office? What conditions would need earlier follow up? (Paragraph Form)
8. References page (APA Format)

Case 16

1:30 PM
Jerome Wilson
Age 47 years
Opening Scenario
Jerome Wilson is a 47-year-old man on your schedule for a follow-up visit. He had an annual examination six months ago with elevated lipid levels. At that time, you recommended that he start lipid-lowering medication. Rather than using medication, Mr. Wilson preferred to try to improve his lipids by working on lifestyle changes for six months. He was started on a heart-healthy diet and an exercise and stress management plan. The results of his lipid profile drawn six months ago, as well as other tests ordered, are shown in Table 16-1 and Table 16-2.
Notes of Jerome Wilson’s Visit Six Months Ago
Reason for Visit
Jerome Wilson is a 47-year-old man scheduled for a complete physical examination. It has been three years since his last physical with you.
History of Present Illness
“I am planning to increase my exercise level by joining a local fitness club. I thought it would be a good idea to schedule a physical before doing this. I feel fine and have not had any change in my health.”
Medical History
No hospitalizations or surgery. Seen twice in the past for bursitis of the left shoulder, which required steroid injections. No hypertension, coronary artery disease (CAD), or diabetes mellitus.
Family Medical History
Mother: 71 years old (hypercholesterolemia, surgery at age 65 for vascular occlusion in the leg)
61
Father: 71 years old (Alzheimer’s disease for three years)
Sister: 47 years old (current diagnosis of breast cancer)
Grandparents: All died many years ago; he does not know causes of death
Social History
Lives with wife and three children, ages 3, 8, and 12. Works as a certified public accountant in a large accounting firm. Nonsmoker for 15 years. Four drinks of alcohol per week. Three cups of coffee per day. Golfs two to three times a week in good weather.
Medications
None
Allergies
NKDA
Review of Systems
General: States energy level is good; sleeps well; feels healthy but stressed keeping up with family and work responsibilities
Integumentary: Dry, itchy areas on scalp
HEENT: Denies problems with hearing; recently began to use reading glasses; sees dentist regularly
Respiratory: Denies any chest pain, shortness of breath, cough, or dyspnea on exertion
Gastrointestinal: No heartburn, nausea, abdominal pain; occasional constipation with occasional painful hemorrhoid; no rectal bleeding
Genitourinary: No dysuria, frequency, hesitancy, nocturia
Musculoskeletal: No current joint pain, but occasionally (every few months) notes transient joint pain in knees, wrists, and fingers; uses aspirin or acetaminophen when needed with good relief of symptoms
Neurological: No headaches; denies depression, memory changes
Physical Examination
Vital signs: Temperature 98.0° F; pulse 72 bpm; respirations 16/min; BP 136/74 mm Hg
Height: 5 ft 8 in; weight: 160 lb; BMI: 24
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