1. Inadequate bone, muscle, or nerve function to move air into the lungs, such as rib fracture that reduces inhalation due to pain, muscle weakness that prevents full thoracic expansion, or cervical spinal cord injury that limits movement of the diaphragm
2. Narrowed airways from bronchoconstriction (e.g., in asthma) or from obstruction (e.g., in chronic bronchitis or cystic fibrosis)
3. Poor gas diffusion in the alveoli, such as in pulmonary edema, acute respiratory distress syndrome, or pneumonia
1. Nutritional therapy has the most impact when started at the onset of the diagnosis of the disease.
2. It can be the most challenging and it is essential that the patient understand the importance of making healthy diet choices.
3. A coordinated team effort takes into consideration the patient's behavioral, cognitive, socioeconomic, cultural, and religious aspects of the patient.
4. Healthy dietary choices are the same for the diabetic patient as for the general population.
5. The goal of nutritional therapy for the diabetic patient is to assist the patient in making healthy nutritional choices, eat a varied diet, and maintain a regular and consistent exercise regimen that will promote metabolic control of their blood glucose levels.
6. This over-arching goal includes maintaining BG levels to near normal levels as safely as possible, achieving lower lipid profiles and blood pressure levels to reduce cardiovascular risk, preventing or slowing the development of chronic complications seen with diabetes, addressing individual nutritional needs of the patient, and providing a variety of food choices to maintain the pleasure of eating.
1. Foot ulcers,
4. Loss of protective sensation,
6. Renal disease,
7. Heart disease,
9. Eye disorders, and
10. Psychiatric disorders,
1. Somnolence, coma, seizures, hemiparesis, and aphasia.
2. These symptoms resemble CVA.
3. It is extremely important then to determine what the BGL is so as to differentiate between HHS and a CVA. 4. What blood tests do you think you'd want to see before making a determination as to the patient's condition? =
(Serum glucose or CBG, CBC, pH, electrolytes, BUN, arterial or venous blood gases, urine dipstick for glucose and ketones.)
1. Anxiety, hunger, diaphoresis, confusion, blurred or double vision, shakiness, irritableness, and cool, clammy skin, appearing drunk.
2. Decreased mental functioning occurs as well as a result of a lack of glucose to the brain tissues.
3. This is seen in difficulty speaking, visual disturbances, stupor, confusion and coma.
4. If left untreated, hypoglycemia can result in loss of consciousness, seizures, coma and even death.
1. Integument (edema, jaundice, non-healing lesions, changes in appearance of hair/skin)
2. Head/neck (visual changes, exophthalmos, myxedema, goiter, acromegaly)
3. Cardiovascular (chest pain, dysrhythmias, hypertension, bruising, ascites, hemorrhoids, changes in VS)
4. GI (nausea/vomiting, weight loss or gain, heartburn, changes in bowel habits)
5. Musculoskeletal (weakness, fatigue)
6. Mental status/sensory changes (mood or mental status, neurological changes, body image issues)
7. GU/Reproductive changes (urine color changes, frequency, menstrual irregularities, decreased libido, decreased fertility)
8. Excessive thirst, excessive hunger, cold sensitivity, heat intolerance
9. Evaluate body composition: weight, BMI, waist circumference
1. Iodine deficiency was corrected by adding iodine to table salt and most multivitamins, as well as eating foods high in iodine, such as dairy products, seafood, meat, some breads, and eggs.
2. Pregnant women especially need higher amounts of iodine and are given a prenatal vitamin that has the recommended daily allowance which is 150mcg/day.
3. Iodine is necessary not only for proper thyroid function but is also a factor in damage to brain tissues, delayed growth, hearing and speech.
4. Severe iodine deficiency can result in mental retardation, deaf mutism, spasticity, and short stature.
5. More in women then in men
6. Levothryoxine to only treat hypo
7. Want to take it in the morning before type eaten with a full glass of water and wait to take other 2 hrs later
1. After cell injury, arterioles in area briefly undergo transient vasoconstriction.
2. After release of histamine and other chemicals by the injured cells, vessels dilate, resulting in hyperemia.
3. Chemical mediators cause increased capillary permeability and facilitate fluid movement from capillaries into tissue spaces.
4. Initially composed of serous fluid, this inflammatory exudate later contains plasma proteins, primarily albumin, and these proteins exert oncotic pressure that further draws fluid from blood vessels. Both vasodilation and increased capillary permeability are responsible for redness, heat, and swelling at the site of injury.
5. Vasodilation chemical mediators cause increased capillary permeability and facilitate movement of fluid from capillaries into tissue spaces.
6. As plasma protein fibrinogen leaves blood, it is activated to fibrin by products of the injured cells.
7. Fibrin strengthens a blood clot formed by platelets.
8. In tissue, clots trap bacteria to prevent spread of infection and also serve as a framework for the healing process.
1. Blast injuries resulting from an explosive incident, such as seen in IED explosions, car bombings, gas furnace explosions, propane tank explosions, etc) are particularly damaging as they can encompass several types of inflammatory injuries: mechanical, thermal (burns), and, depending on what exploded and what it contained, you might also see chemical, radiation, or even biological injuries.
2. Blast injuries are particularly common among military veterans who have suffered injuries from IED explosions in the combat arena.
3. Other inflammatory injuries that might be seen with veteran populations is chemical injuries (Agent Orange, toxic burn pits, oil fires and toxic smoke), potential exposure to radiation or even biological agents while in combat.
4. Many of the injuries sustained from blast injuries become chronic inflammatory responses that persist for months or years.
5. When working with patients in a hospital it is a good idea to ask if they ever served in the military or a combat area (even civilian contractors can sustain blast injuries), and if yes, then exploring in more detail what types of exposures they might have encountered will help greatly in determining the appropriate interventions that need to be implemented.
1. Implementation during the acute phase is focused on hemodynamic stability, pain control, fluid and electrolyte balance, and nutritional support.
2. Accurate I&O's are required, monitoring of stools for number, amount, and appearance; teaching the patient how to manage stress; encourage smokers to quit because smoking stimulates the GI tract and exacerbates Crohn's disease.
3. Because of the frequency and character of the stools, the person may experience frustration, anxiety, discouragement and depression.
4. Often psychotherapy is beneficial for these patients. 5. Rest is important as these patients suffer severe fatigue, which limits energy needed for physical activity.
6. Sleep is interrupted due to the frequency of diarrhea and abdominal cramping.
7. Malnutrition and anemia may leave the patient feeling weak and listless.
8. Teach patients to pace themselves, take frequent rest breaks and schedule activities around rest breaks.
9. Due to the frequency of diarrhea, these patients may experience embarrassment from odor, periods of incontinence and skin breakdown.
10. Keeping the skin clean, dry and odor free is essential to the well-being of the patient.