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bucknell supplement essay help 32 patient encounter part 3 the patient’s bp responds to the antihypertensive agent within 40 minutes and his current bp is 178/100 mm hg. He is still experiencing weakness in the left arm and leg and difficulty speaking at times. The neurologist decides to administer iv alteplase because it is now almost 4 hours after the onset of symptoms, and the patient is being managed in the stroke unit. What recommendations would you make regarding the administration of iv alteplase in this patient?. What treatments would you recommend at this time to reduce risk of another stroke?. »» other recommendations management of diabetes and lipids based on treatment guidelines, cessation of smoking, increased physical activity, and reducing alcohol use in heavy drinkers are additional recommendations for management of patients with previous stroke or tia. 32 statin therapy is recommended in patients with previous stroke or tia, regardless of history of coronary heart disease. Table 11–5 provides drug and dosing recommendations for treatment of ischemic stroke. Treatment of acute hemorrhagic stroke supportive measures acute hemorrhagic stroke is considered to be a medical emergency due to intracerebral hemorrhage (ich), subarachnoid hemorrhage (sah), or subdural hematoma. Initially, patients experiencing a hemorrhagic stroke should be transported to a neurointensive care unit.

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https://graduate.uofk.edu/user/diploma.php?sep=good-customer-essay good customer essay Swelling should be noted and identified, distinguishing between cialis tab use caput succedaneum, cephalobematomas, and subgaleal hemorrhage. Caput succedaneum, often boggy in texture, is simply soft tissue swelling from the birth process. Caput is most commonly located occipitally, although may also have a "sausage" shape in the parietal area, may cross suture lines, and most often resolves within a day or two. Cephalohematomas, more common in the setting of an instrumented vaginal birth and most often involving one of the parietal bones, are the result of subperiosteal bleeding and, thus, do not cross suture lines. Cephalohematomas may initially be obscured by overlying caput and become increasingly apparent over the first 3 to 4 days of life. They are typically more tense to palpation than caput and may take weeks to even months to fully resolve. Cephalohematomas are a source of excess bilirubin production, which may contribute to neonatal jaundice. Subgaleal hemorrhages, also associated with vacuum extractions but much rarer in incidence, result from bleeding underneath the aponeurosis of the occipitofrontalis muscle and, classically, result in very loose, soft swelling that may flow freely from the nape of the neck to the forehead. It may even be possible to generate a fluid wave across the swelling from a subgaleal hemorrhage. If a subgaleal hemorrhage is suspected, the newborn should be carefully monitored for possible hemodynamically significant bleeding within the hemorrhage. C. Skull bones. The skull bones (occipital, parietal, and frontal) should be examined and suture lines {sagittal, coronal, lambdoidal, and metopic) should be palpated. Mobility of the sutures will rule out craniosynostosis. Mobility can be appreciated by placing one's thumbs on opposite sides of the suture and then pushing in alternately while feeling for motion.

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http://www.cs.odu.edu/~iat/papers/?autumn=vikings-homework-help-bbc vikings homework help bbc Risk o poor outcome in patients with neurologic injury and fever ou ome r ela ive r i k mortality 1.5 neurological de cit 1.3 dependence 1.9 lower unction 2.2 greater stroke severity 1.4 longer icu stay 2.8 longer hospitalization 3.2 table 2 7. Rationale for use o urinary catheters app op ia e urinary retention or bladder outlet obstruction ports be ore accessing the catheter. Remove all nonessential cvc.41 inapp op ia e obtain urine or diagnostic testing i patient can void spontaneously in ection control bundles xt in ection control bundles include evidence-based interventions and best practices such as sta education, hand hygiene promotion, proper use o contact and isolation precautions, in ection-speci c environmental cleaning, and targeted surveillance. Aspiration xt aspiration can lead to pneumonitis rom chemical injury or pneumonia rom bacterial colonized secretions.42 aspiration pneumonia is the leading cause o death in patients with dysphagia due to neurologic disorders. Aspiration risk increases with decreasing consciousness. Dysphagia is present in 40–70% o stroke patients with need or accurate urinary output measurement prolonged postoperatively without indication perioperative (genitourinary surgery, prolonged operation, large-volume in usions) convenience open sacral/perineal wound prolonged immobilization end-o -li e care alternatives including external catheters in cooperative male patients without retention or obstruction, intermittent catheterization in patients with spinal cord injury or neurogenic bladder, and diapers should be considered. Aseptic catheter insertion technique includes sterile gloves, drape, sponges, and single-use lubricant. Maintenance includes periurethral cleaning by trained providers. Sp and hand hygiene must be perormed be ore and a er insertion or manipulation.41 a closed drainage system should be maintained. T e catheter system should be replaced i there is a break in aseptic technique, disconnection, or leakage. T e collection unit must be below bladder level without tubing impingement to prevent obstruction and retrograde ow.41 urinary catheters should not be routinely changed without indication. Irrigation is unnecessary unless obstruction is suspected.41 central venous catheters (cvc) maximum sterile barrier techniques must be employed. Avoid the emoral vein or access in obese adults.41 con irmed aspiration. Pneumonia occurs 7 times more o en in those with aspiration.42 assess risk with comprehensive swallowing evaluation.

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essay on aging process 2. The parents need to feel supported regardless of the decision that is made. 3. The quality of the relationship and the communication style of the team members can influence the ability of the parents to understand the information presented and to reach consensus with the heath care team. General newborn condition i 227 4. Shared decision making involves the support and participation of the entire team. 5. Meet with the family in a private, quiet area and allow ample time for the family to understand the information presented and the recommendations of the team. A.

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