My focused respiratory assessment included full vital signs, and an inspection of the patient’s breathing patterns, skin color, and respiratory status, also I did palpate to see if there were any abnormalities and listened to her lung sounds using a stethoscope. My patient’s vitals were normal, the only thing her oxygen was dropping to 93% but went back up to 95%, her blood pressure was also elevated at 161/85 but she has a history of Hypertension and is on BP meds and she has been running a little high.

A patient was seen in the ED one week ago due to suffering a traumatic fracture of the body mandible, on the left side.  He is being seen today by a maxillofacial surgeon for a pre-op visit. NOTE: Assign only the injury code. This is not the patient’s first medical encounter with this injury. Guidelines direct us to code the place of occurrence and activity codes only on the initial visit.

You are called to the delivery room at 2:00 a.m. for a laboring gravida 1 para 0 mother at 28 weeks gestation. The mother had good an-
prenatal care and had a normal integrated prenatal screening (IPS), normal 20-week ultrasound, and protective serology, including rubella immune, human immunodeficiency virus (HIV) negative, venereal disease research laboratory (VDRL) negative, and hepatitis negative. Group B Streptococcus (GBS) status is unknown as the woman had not yet had swabs done. Social history was negative for tobacco, alcohol, or recreational drug use during the pregnancy. She has gestational diabetes mellitus, which was reasonably controlled by diet and exercise
alone.

You arrive at the delivery room moments before the baby is born and prepare equipment for a potential resuscitation, which includes oxygen, a bag and mask, suction, towels to dry, and intubation equipment. At birth, the newborn cries spontaneously. She is placed on the warmer to be dried and stimulated; her heart rate is 120 beats per minute and her respiratory rate is 60 breaths per minute. The infant grunts intermittently. At 4 minutes of age, the newborn has both subcostal and intercostal retractions, nasal flaring, and continuous grunting. Her respiratory rate is now 82 breaths per minute and her heart rate is 190 beats per minute. Oxygen saturation by pulse oximetry is 84% with blow-by oxygen. You begin providing CPAP at 6 cm H2O by mask with a t-piece resuscitator. A systolic murmur gr 2/6 is auscultated loudest at the left upper sternal border (LUSB). The infant is transferred to the NICU where she continues to receive nasal CPAP at 6 cm H2O and a FiO2 of 0.45. The chest X-ray shows a diffuse ground-glass appearance with air bronchograms. An arterial umbilical catheter (UAC) is inserted. Arterial blood gas reveals the following: pH 7.23, CO2 60, PaO2 40, HCO3 27, BE +1, and lactate 4.8.
Blood work shows white blood cell count 20.3, neutrophils 12.3, no left shift, hemoglobin 16.5, platelets 260.

1. What is the first line of therapy for this premature infant considering her presentation?
2. What are the chemical components that make up surfactants?
3. How does surfactant work in the lung?

Create a plan of care for a client diagnosed with the bacterial pneumonia-must list at least two priority diagnoses (one of them physiological and one health promotion).

The care plan must include the following: For each diagnosis provide at least 3 interventions; at least three goals/plans; at least 3 evaluation criteria; at least three interventions for each.

Complete patient education must address the prevention of adverse/side effects of treatment and health promotion; there should be a minimum of 4 teaching points. The patient education section should be completed in full.

Below is the patient information

Male, 01/31/1960 (62 years old), 173 cm, 63 kg

MRN: 26236

Attending: John Mack, MD

Allergies:

Demerol

Code Status: Full

Comments: none

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Patient Summary

Primary Concern: Pneumonia

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Labs

list the six types of sensory receptors classified based on the type of stimulus they detect and describe the types of stimuli that each type can detect. Classify the three types of sensory receptors categorized based on their location; identify the origin of stimuli that activate them; and describe the nature of the stimuli that cause their excitation.