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Such changes are associated with disruption in family cohesion buy calan amex blood pressure range for men, loss of leisure pursuits order calan 240mg free shipping arrhythmia means, and loss of work capacity buy generic nicotinell 52.5 mg online, as well as social isolation of the caretaker. The family may experience marital disruptions, anger, grief, guilt, and denial in recurring cycles (Hsueh-Fen & Stuifbergen, 2004). To promote effective coping, the nurse can ask the family how the patient is different now, what has been lost, and what is most difficult about coping with this situation. Helpful interventions include providing family members with accurate and honest information and encouraging them to continue to set well-defined short-term goals. Support groups help the family members share problems, develop insight, gain information, network, and gain assistance in maintaining realistic expectations and hope. The Brain Injury Association (see Resources) serves as a clearinghouse for information and resources for patients with head injuries and their families, including specific information on coma, rehabilitation, behavioral consequences of head injury, and family issues. This organization can provide names of facilities and professionals who work with patients with head injuries and can assist families in organizing local support groups. Many patients with severe head injury die of their injuries, and many of those who survive experience long-term disabilities that prevent them from resuming their previous roles and functions. During the most acute phase of injury, family members need support and facts from the health care team. Many patients with severe head injuries that result in brain death are young and otherwise healthy and are therefore considered for organ donation. Family members of patients with such injuries need support during this extremely stressful time and assistance in making decisions to end life support and permit donation of organs. Bereavement counselors and members of the organ procurement team are often very helpful to family members in making decisions about organ donation and in helping them cope with stress. Any decrease in this pressure can impair cerebral perfusion and cause brain hypoxia and ischemia, leading to permanent damage. Impaired Oxygenation and Ventilation Impaired oxygen and ventilation may require mechanical ventilatory support. The patient must be monitored for a patent airway, altered breathing patterns, and hypoxemia and pneumonia. Interventions may include endotracheal intubation, mechanical ventilation, and positive end-expiratory pressure. Impaired Fluid, Electrolyte, and Nutritional Balance Fluid, electrolyte, and nutritional imbalances are common in the patient with a head injury. Undernutrition is also a common problem in response to the increased metabolic needs associated with severe head injury.


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Clinical Manifestations The clinical picture is one of sepsis with few or no localizing signs order calan 120 mg on line blood pressure chart american medical association. Fever with chills and diaphoresis purchase calan 120 mg with visa prehypertension what to do, malaise order line cefixime, anorexia, nausea, vomiting, and weight loss may occur. Assessment and Diagnostic Findings Blood cultures are obtained but may not identify the organism. Nursing Management Depends on the patient‘s physical status and the medical management that is indicated. Encourage rest when fatigued or Reports increased strength when abdominal pain or 3. Provide diet high in and protein for healing ample periods of rest carbohydrates with protein 6. Provides additional nutrients Takes vitamins as intake consistent with liver prescribed function. Nursing Diagnosis: Imbalanced nutrition: less than body requirements, related to abdominal distention and discomfort and anorexia Goal: Positive nitrogen balance, no further loss of muscle mass; meets nutritional requirements 1. Identifies deficits in nutritional Exhibits improved nutritional nutritional status through diet intake and adequacy of status by increased weight history and diary, daily weight nutritional state (without fluid retention) and measurements and laboratory improved laboratory data. Reduces edema and ascites carbohydrates with protein formation Identifies foods high in intake consistent with liver carbohydrates and within 57 function. Reduces discomfort from protein requirements abdominal distention and (moderate to high protein in 3. Assist patient in identifying decreases sense of fullness cirrhosis and hepatitis, low low-sodium foods. Elevate the head of the bed Reports improved appetite on the stomach during meals. Provide oral hygiene before measures and increased appetite; reduces meals and pleasant environment unpleasant taste for meals at meal time. Encourage patient to eat meals calorie diet; adheres to protein the patient with anorexia and and supplementary feedings. Promotes appetite and sense of aesthetically pleasing setting at that are nutritious and well-being meal time. May reduce incidence of Reports increased appetite prescribed for nausea, vomiting, nausea and well-being diarrhea, or constipation. Encourage increased fluid symptoms and discomforts that intake and exercise if the patient decrease the appetite and Takes medications for reports constipation.

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Their receptors lie in the walls of the peritoneal cavity just outside the parietal peritoneum buy generic calan 240mg blood pressure of 150/90. Somatic abdominal pain buy calan 80mg on-line pulse pressure of 65, there- fore cheap inderal 40 mg overnight delivery, is sometimes referred to as parietal pain, and the signs provoked are referred to as peritoneal signs. Pressure on or motion of the painful area accentuates the pain, and this tenderness provokes a pro- tective reflex spasm of the overlying abdominal wall muscles (invol- untary guarding). This is comparable to the somatic pain receptors in a finger touching a hot surface: the burn is recognized rapidly and localized precisely, the finger is withdrawn quickly and reflexively, and the patient avoids further contact with the tender site. Abdominal somatic receptors respond to irritation from inflammatory mediators and physical insults such as cutting, pinching, or burning. The pain usually is sharp, severe, and continuous and is aggravated by pressure, motion, and displacement. Patients suffering somatic pain lie very still, suppress urges to cough or sneeze, and resist being moved or touched in the painful area. Not infrequently, the acute abdomen begins with poorly localized visceral pain caused by swelling, distention, or ischemia of the abdominal viscus primarily involved. The pain initially is perceived in the topographic area of the abdomen corresponding to the level of 21. Subsequent irritation of the parietal peritoneum adjacent to this organ, as the inflammatory process progresses, pro- duces localized pain and tenderness at the exact location of the process. Diagnosing Abdominal Pain Diagnosis of the cause of abdominal pain begins with the collection of all relevant clinical information by history taking, physical examina- tion, and standard diagnostic tests. Integration of this information allows the physician to reach a preliminary or working diagnosis that may be sufficient for initiating a therapeutic plan or may require further refinement by way of special tests and examinations. The history of the present illness includes a careful characteriza- tion of the pain, significant associated symptoms, and a past history of medical and surgical events that may be pertinent to the current problem. Because pain syndromes often change over time, the tempo- ral pattern is important. What potentially significant events had occurred in the day or hours prior to the onset, and is there anything that makes the pain better or worse? Has the patient had pain like this before, and, if so, how long did it last and what was the final outcome? Dull, constant, pressure-like pain often is indicative of an overdistended viscus; colicky pain often is indicative of hyperperistaltic muscular activity; burning and lancinating pain often is neurogenic in origin; and aching or throbbing pain suggests an inflammatory process under pressure. The severity of the pain, described on a scale of 1 to 10, often reflects the seriousness of the underlying process. Pain that is getting better usually means an improvement in the underlying pathology; however, rupture of an abscess or viscus under tension may result in a transient improvement in pain followed by more severe somatic pain. The location of the pain, both at its onset and during the examina- tion, helps in determining the site of the pathology. Is the pain local- ized, with a point of maximum intensity, or is it diffuse and ill defined? Or, in the worst-case scenario, is the pain constant throughout the abdomen with attendant generalized muscular rigidity?

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