Beat of Another Drum
Mr. Rembert is a 65- year old African American male that was transported by ambulance to this Las Vegas, Nevada long term acute care facility. The patient has a substantial history of cardiopulmonary difficulties with a chronic cough and has been diagnosed with COPD (a grouping of both chronic bronchitis and emphysema); Emphysema is injury to the alveoli which are the tiny sacs in the lungs that permit oxygen and carbon dioxide to interchange between the blood stream. This produces huge air spaces that are distributed throughout both of the lungs. This occurs without fibrosis (scarring) and causes the lungs to be hyper inflated (over distended). Chronic bronchitis is chronic inflammation of the bronchial walls; this irritation will cause the size of the mucous glands to increase in magnitude and production. A chronic cough that is insistent for three successive months in a consecutive two-year period can be classified as chronic bronchitis; this disease process is caused chiefly by smoking.
At this time Mr. Rembert presents with a hemoglobin level of 6.5 (normal 13.5- 17.5 for males) and appears to be severely anemic (severe iron deficiency) which is believed to have brought on his dyspnea (difficulty breathing) and caused an exacerbation of COPD. (T. Similowski, 2006) There is a PEG tube introduced in the patient’s abdomen with approximately 8 to 12 inches extending outside of the patient’s body and enclosed in a freshly changed bandage keeping it in place. (percutaneous endoscopy gastrostomy that is positioned within the patient’s stomach and protein- calorie nutrition is given to the patient; typically used for patients who have a tough time swallowing foods). (Gaurav Arora & Chief Editor: Danny A Sherwinter, 2015) Mr. Rembert similarly has a history of Diabetes type II in which the body cannot use insulin properly so the pancreas begins to over produce insulin to make up for the insulin that the body is not properly using causing insulin resistance (American Diabetes Association, 2015), Hypertension in which the pressure of the blood in the blood vessels are higher than what it should be and is forceful against the artery walls. (J.A. Barberà, 2003) This pressure is causing the heart to work and pump harder to move blood through the rest of the heart and body (National Stroke Association, 2007) , History of stroke in which the cells in the patient’s brain die due to inadequate blood flow to the brain; there are two types of stroke; ischemic which merely means lack of blood flow and hemorrhagic in which bleeding starts to form on the brain. This is the root for the patient’s brain not performing appropriately. (National Stroke Association, 2007) The patient furthermore has an extensive …show more content…
O: Patient is not in respiratory distress. Vital signs: RR 14 bpm, HR: 62, Increased AP diameter, mild productive cough, moderate amount of frothy sputum, no accessory muscle use, so excessive diaphragmatic breathing, skin temperature is warm and dry to the touch (afebrile), skin color is pale in color as well as his eyes. breathing pattern is eupneic, no pursed lip breathing, no nasal flaring, unable to access for JVD, no edema, no digital clubbing, AUS: diminished breath sounds in bases with rhonchi in upper lobes of lungs. A: Moderate airway secretions (COPD Hx, rhonchi, moderate amounts of frothy sputum), severe anemia (pale skin and eye color, Hb value of 6.3, pt. is weary), Air trapping (increased AP
Mr. Rembert is a 65- year old African American male that was transported by ambulance to this Las Vegas, Nevada long term acute care facility. The patient has a substantial history of cardiopulmonary difficulties with a chronic cough and has been diagnosed with COPD (a grouping of both chronic bronchitis and emphysema); Emphysema is injury to the alveoli which are the tiny sacs in the lungs that permit oxygen and carbon dioxide to interchange between the blood stream. This produces huge air spaces that are distributed throughout both of the lungs. This occurs without fibrosis (scarring) and causes the lungs to be hyper inflated (over distended). Chronic bronchitis is chronic inflammation of the bronchial walls; this irritation will cause the size of the mucous glands to increase in magnitude and production. A chronic cough that is insistent for three successive months in a consecutive two-year period can be classified as chronic bronchitis; this disease process is caused chiefly by smoking.
At this time Mr. Rembert presents with a hemoglobin level of 6.5 (normal 13.5- 17.5 for males) and appears to be severely anemic (severe iron deficiency) which is believed to have brought on his dyspnea (difficulty breathing) and caused an exacerbation of COPD. (T. Similowski, 2006) There is a PEG tube introduced in the patient’s abdomen with approximately 8 to 12 inches extending outside of the patient’s body and enclosed in a freshly changed bandage keeping it in place. (percutaneous endoscopy gastrostomy that is positioned within the patient’s stomach and protein- calorie nutrition is given to the patient; typically used for patients who have a tough time swallowing foods). (Gaurav Arora & Chief Editor: Danny A Sherwinter, 2015) Mr. Rembert similarly has a history of Diabetes type II in which the body cannot use insulin properly so the pancreas begins to over produce insulin to make up for the insulin that the body is not properly using causing insulin resistance (American Diabetes Association, 2015), Hypertension in which the pressure of the blood in the blood vessels are higher than what it should be and is forceful against the artery walls. (J.A. Barberà, 2003) This pressure is causing the heart to work and pump harder to move blood through the rest of the heart and body (National Stroke Association, 2007) , History of stroke in which the cells in the patient’s brain die due to inadequate blood flow to the brain; there are two types of stroke; ischemic which merely means lack of blood flow and hemorrhagic in which bleeding starts to form on the brain. This is the root for the patient’s brain not performing appropriately. (National Stroke Association, 2007) The patient furthermore has an extensive …show more content…
O: Patient is not in respiratory distress. Vital signs: RR 14 bpm, HR: 62, Increased AP diameter, mild productive cough, moderate amount of frothy sputum, no accessory muscle use, so excessive diaphragmatic breathing, skin temperature is warm and dry to the touch (afebrile), skin color is pale in color as well as his eyes. breathing pattern is eupneic, no pursed lip breathing, no nasal flaring, unable to access for JVD, no edema, no digital clubbing, AUS: diminished breath sounds in bases with rhonchi in upper lobes of lungs. A: Moderate airway secretions (COPD Hx, rhonchi, moderate amounts of frothy sputum), severe anemia (pale skin and eye color, Hb value of 6.3, pt. is weary), Air trapping (increased AP