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DEHYDRATION AND A LONG FLIGHT

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Most people who anticipate taking a long plane flight may hardly stop to think about dehydration and its consequences. Making sure appropriate clothing is packed, arriving at the airport on time, and making sure pets or children are cared for are just a few of the concerns a traveler might have. Skipping a meal as a result of anxiety may very readily happen. To further complicate matters, there are significant changes in time zones on a long flight across the globe.
Someone who has been on a long flight and sitting for a considerable length of time, coupled with inadequate fluid intake, may be at risk for DVT (Deep Vein Thrombosis).
It is worth noting that taking the time to drink extra fluids before and during a long flight will help prevent dehydration.
To learn more about Dehydration, you can watch a video here or  here.

ASPIRATION PNEUMONIA AND PREVENTION

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Scenario: Tim was involved in a car accident about a week ago. He is responsive but lethargic. The doctor ordered enteral feeding as Tim has difficulty swallowing.

Why is enteral feeding ordered?
Enteral feeding may be ordered by the doctor for a patient who is unable to swallow. The patient with a brain injury, stroke, or on mechanical ventilation may require tube feeding.

How can aspiration pneumonia be avoided?
Aspiration pneumonia can be avoided by the nurse being vigilant. The head of the bed is generally kept at 30 degrees while tube feeding is running unless otherwise ordered.

Helpful Hints:
- Follow MD orders
- Check lung/bowel sounds
- Check for residuals
- Check abdominal distention
- Follow MD orders for high residual volume

Notes for Nurses:
- The potential for aspiration of tube feeding should be reflected in the plan of care.
- Documentation of the quantity of stomach contents should be done.
Enjoy watching the video:
Enteral and Parenteral tube feeding

AN OVERVIEW OF PACEMAKERS

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Why is a pacemaker implanted?
Pacemaker implantation may be done for different reasons. Any damage to the heart muscle or the electrical conduction which will interfere with the ability of the heart to function normally may be indications for a pacemaker. Sick sinus syndrome (though rare) or myocardial infarction are examples.

What are some symptoms of a dysfunctionl natural pacemaker?
Patients who have dysfunction of their own natural pacemaker may experience dizziness, syncopal episodes (temporary loss of consciousness), chest pain, shortness of breath, fatigue, and a decrease in blood pressure (hypotension).

Why do these symptoms occur?
These symptoms are due to a lack of blood flow to the body's organs.

Notes for Nurses:
- See the sample of an EKG above showing a pacemaker lead (wire) in the ventricle. There is normally a spike in front of the QRS. The spike may not appear if the pacemaker malfunctions.
- Spikes in front of P and QRS means both chambers are paced.

ISCHEMIA VS. INFARCTION

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What is the difference between ischemia and infarction?
When an area of the heart muscle is ischemic or infarcted, that area is deprived of blood and oxygen. Infarction results in the complete death of muscle, whereas ischemia results from a shortage of blood and oxygen and there is a chance of recovery for the muscle.

What are some causes of ischemia and infarction?
Causes include :
- A blood clot obstructing a blood vessel
- Fatty deposits in blood vessel

PANCREATITIS AND TURNER'S SIGN

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Scenario:
Sara is describing the symptoms she had over the last few days. These include abdominal pain, nausea, and vomiting. The nurse notes Sara's complaints and also does an assessment. She noted that there was tenderness over the abdomen. CT scan and lab values are ordered by the doctor. Lab values such as lipase and electrolytes may be ordered for the patient with pancreatitis.

What is Turner's Sign?
Turner's sign is an indication of acute pancreatitis. It shows as a bruising around the flank. Documentation should be done.

What is pancreatitis?
Pancreatitis is defined as inflammation of the pancreas. This condition may be acute or chronic. The Islets of Langerhans, which produce insulin, are in the pancreas. Insulin controls blood glucose.

How does pancreatitis develop?
Pancreatitis may be caused by:
- Alcohol ingestion in excess
- Trauma
- Tumors
- Certain medications, and more
- Gallstones: blockage of the common bile duct with gallstones from the gallbladder can c…

DIABETIC ASSESSMENT

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What is HNKS? HNKS stands for Hyperglycemic Hyperosmolar Nonketotic Syndrome.
Who is affected by HNKS? Patients who exhibit this condition are usually older and have type 2 diabetes.
What are some symptoms of HNKS? Severe dehydration (due to high blood glucose), mental confusion, hypotension, and seizures may result. 
How is HNKS treated? Medical management is necessary. Fluid replacement therapy to combat dehydration and correction of electrolyte imbalances are ordered by the doctor.
What is the difference between Hyperglycemia and Hypoglycemia? Hyperglycemia is high blood sugar and may complicated diabetes. Hypoglycemia is low blood sugar and may result from insulin being given and mealtime being skipped.
Note for Nurses: Monitoring blood glucose is an essential part of managing the diabetic patient. Hypoglycemic agents or insulin or both will be ordered by the doctor to meet the patient's needs.


Scenario: Tom is a 35 year old male who had open heart surgery two weeks ago. Wou…

ADRENAL GLANDS

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What are the adrenal glands, and what is their function? The adrenal glands are small endocrine glands which are situated one on top of each kidney. The hormone adrenaline (epinephrine) is produced by the adrenal glands. This hormone is commonly known as the one of "fight, flight, and right".
Scenario 1: Tina is a patient in the ICU. She is on the surgery schedule in the morning. Her family members are at the bedside to comfort her. The nurse did an assessment and vital signs. She noticed that Tina's blood pressure was elevated and heart rate was rapid. Tina is obviously scared. his is just one of a number of ways that adrenaline (epinephrine) goes to work in times of stress. The blood pressure or heart rate may increase due to stimulation of the hormone adrenaline.
Scenario 2: Tim is being admitted to the hospital for a workup. Over the last few weeks, he noticed unusual symptoms that caused concern. They include: feeling depressed, nausea, poor appetite, fatigue,…