Chronic Obstructive Pulmonary Disease (COPD) in the Elderly

Chronic Obstructive Pulmonary Disease (COPD) in the Elderly As a response of two main factors, which are ageing population and exposure to risk factors, the prevalence of chronic obstructive pulmonary disease (COPD) is rising worldwide. In fact, the disease is a challenge for public health and health care system because it demands high costs (Lisspers, Johansson, Jansson, Larsson, Stratelis, Hedegaard, Stallberg, 2014). Besides, the American Lung Association (2013) reinforces that the COPD is the third leading cause of death in the United States. Data from 2007 showed that nearly 125,000 deaths nationwide occurred in response this disease, so it represents one COPD death approximately every four minutes. In addition, underlined in these numbers, many clients are not diagnosed or managed correctly, so the process to educate the client and the client knowledge are fundamental to eliminate risk factors and promote better quality of life for whom has been diagnosed with this pulmonary disease (Lisspers, et al., 2014). Throughout the course of th is paper, some information will be described as the following: client’s information, description and clinical manifestation the client’s disease, the client’s prescription, and nursing diagnoses and intervention, which applies to this client. Client’s Information Firstly, fundamental information about the client is necessary to be investigated and understood to proceed the diagnose and manage. Client’s history must provide knowledge to link present manifestations to past situations, and these will conduct to better management and promotion for future interventions. Patient Mrs. S., 82 years old, married, retired, catholic, and level of education restricted (not concluded high school). She was hospitalized as a result of pneumonia after being diagnosed with productive cough, which was with yellow secretion; and her temperature was 38.5oC. In her health history, she related that she was diagnosed with chronic obstructive pulmonary disease (COPD) although Mrs. S. could not specify the time when these diagnoses occurred. Mrs. S. was not alcoholic and smoking. She has related that at home, she uses medication (not specified) to relieve pain when it is necessary. In addition, she has related that she was not allergic and was responding well front the hospitalization. During her physical examination, she presented as following information: patient was LOC and verbalizing with difficulty because of gas exchange. She was using oxygen therapy by the spectacle-type nasal catheter with 2L/min; RR 32 and tachypnea; HR 81 bpm and normocardic; BP 130/70 mmHg and normotensive; temperature 38,5oC and febrile; and saturation SpO2 90%. Skin: dehydrated, normal colored, turgor characteristic of her age, hematoma in member superior left because of the catheter for serotherapy. In the moment, the catheter was salinized. The nervous reflex was preserved, full and firm pulse, rhythmic. Cranium: it was not present alterations and was hygienic. Pupils were isochoric and photo reactive. Thorax: plan, symmetric, thoracic expansion kept, symmetrical breasts characteristic of senescence. Lung: vesicular murmur and stridor presented in bilateral basis; pulmonary auscultation: normal sounds, regular rhythm in regular rhythm of two. Abdomen: it was plan, palpable in ascend ing loop, Blumberg/Cystic/McBurney negatives. Genito- urinary: paravaginal and perianal presented dermatitis. Eliminations: faeces twice by day with pasty aspect. Urine in grand quantity in diaper, dark yellow and characteristic smell, not related pain to urinate. Alimentation: hyposodic diet, oral, preserved appetite. Water ingest around one liter by day. Activity and sleeping: restrict movements and perambulation with family help difficulty to sleep. Security and protection: Braden’s scale with 16 points – low risk. Comfort: related pain – number six in the right shoulder. Client’s Physiopathology Secondly, understanding the Mrs. S’s history and results of the physical examination can provide an overview about the physiopathology because it must define connections among disease route. These connections are linked to the quality of life to know better about pneumonia and COPD. Pneumonia is an inflammation of the lung parenchyma caused by different microorganism agents (Hinkle Cheever, 2010). In relation to Mrs. S. the according to the drugs prescribed the hypothesis is that the pneumonia is caused by a type of bacteria, which is inhaled by ambient air, where an upper airway bronchoaspiration occurred with colonization this bacteria, so this type of bacteria did a migration to lower airway and colonization in the bilateral inferior lobule region. For instance, some risk factors can be applied for pneumonia. Two age groups at highest risk are infants/children and older people. These risk factors can be a chronic disease, for example, asthma, COPD, and heart disease; suppressed immune system, which can be developed by drug treatment and/or diseases (HIV/AIDS), and surgery; smoking; and client being placed on a ventilator during hospitalization. Still, some signal and symptoms presented because of pneumonia are fever, sweating, hypothermia (in older adults and people with weakened immune system), cough (can be productive or not), chest pain during cough and/or deep breathing, shortness of breath, fatigue, muscle aches, nausea and vomiting (most common for infants/children), and mental awareness (most common for seniors) (Hinkle Cheever, 2010). Another pathology presented in Mrs. S. was Chronic Obstructive Pulmonary Disease is characterized by Lewis, Dirksen, Heitkemper, Bucher Camera (2014) as an airflow limitation, which is not reversible. This airflow limitation is progressive and related to an abnormal inflammatory response of the lungs to noxious particles or gases. COPD is composed of three different pathologic processes, which can possibly combine to develop the clinical case. They are: chronic bronchitis, emphysema, and asthma. The pathophysiology involves gradual destruction of alveolar septum and destruction of the lung parenchyma, which increase the incapacity to provide gas exchange among alveolus and blood. The definitions of the three possible pathology are: a) chronic bronchitis: it describes as an excessive production of mucus in the bronchial tree, and it has chronic productive cough or recurrent during unless three months by year, which is two years consecutive; b) emphysema: it is understood how an anatomic alteration, which is characterized with abnormal alteration in the air spaces distal to the terminal bronchioles, and it is accomplished with destructives alterations in the alveolar walls; c) asthma: it is a chronic inflammatory disease, which is characterized with lower airway hyper responsiveness and variable limitation in the air flux. It can be spontaneously reversible or with treatment. Asthma has clinical manifestation by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing (Hinkle Cheever, 2010). Furthermore, according to Hinkle Cheever (2010) some risk factors are related to COPD can be: first, cigarette smoking, which is considered the major risk factor. Second, occupational chemicals and dusts, which involve two main factors air pollution and infection – air pollution is a problem for urban people although a comparison among cigarette smokers and air pollution, the first has a high level of influence. Thrid, heredity, which is a deficit in the ÃŽ ±1 –Antitrypsin (AAT) deficiency autosomal recessive disorder), but it is only 1% 2% in the United States. Last one, aging: where some degree of emphysema is common in older adults, even non-smokers. Also, some signals and symptoms must be present in the client, who has COPD. These signals and symptoms can be shortness of breath, wheezing, chest tightness, chronic cough, which produces excess mucus, respiratory infection, lack of energy, cyanosis, and weight loss, which must be in the chronic stage. These symptoms and signals must varies person to person, and they can be present on worse stage in some parts of the day. After all, a connection is applied between COPD and pneumonia. Both diseases have a rouge link. First, COPD provides to people, who have this pulmonary disease, a facility to contract pneumonia and difficult to diagnose pneumonia because of similar signals and symptoms. Also, COPD does a difficulty treat pneumonia because the patient has a restriction in his/her immune system, so the antibodies cannot provide the adequate defense. Another situation is inflammation and irritation present in the lungs of COPD, so pneumonia increases these both factors and restricts more the breathing and oxygen exchange. In relation to the diagnoses, if pneumonia is diagnosed early, the recovery can be more satisfactory although COPD restricts it. In fact, management with antibiotics to promote better recovery and care needs to be applied, and prevention must be considered by the client and health professional, so vaccine must be used a method of prevention (Lewis et al, 2014). Client’s Prescription Thirdly, the physician provided prescriptions to the client. Mrs. S’s. physician provided a medical prescription based on her diagnosed (COPD and pneumonia) to provide adequate management and recovery. The physician requested lung X-ray, which showed the presence of opacity in the lower thirds as a result of pneumonia. The medications were: 1- Dipyrone 2ml + 10 ml of distilled water (IV), every 6 hours if pain or fever; 2- Omeprazole 20mg (oral) on an empty stomach, in the morning; 3- Rocephin 1g + 100ml (IV) of saline 0.9%, every 12 hours; 4- Levofloxacin 500mg (IV), every 24 hours; 5- Bamifylline 300 mg (oral), 8 a.m. and p.m; 6- Nebulization therapy with saline 0.9% 5ml + Atrovent 35 drops + Berotec 5 drops (inhalation), every 6 hours; and 8- Oxygen therapy by spectacle-type nasal catheter with 2L/min if saturation ≠¤ 90%. Consequently, some interventions can be understood by this prescription. The medication aspects understand that Mrs. S. was doing management of the presented and the subsequent disease. Medication for pain helps to relieve the discomfort caused by the difficult to breathe and the intercostal muscles, and bronchodilator drugs help to facilitate the air passage, so the air volume in the upper and low airway and gas exchange in the alveolus will increase, and it helps in the chronic disease keeping a bronchodilation the airway (promotion of the health conditions). Antibiotic medication works to eliminate the pathologic agent, which provided pneumonia. The drug referent to proton pump inhibitors is utilized to prevent stomach injuries because of antibiotic therapy (Deglin Vallerand, 2013). Nebulization helps to humidify airway. Oxygen therapy provides a supplement of oxygen to increase the available quantity in the alveolus (Potter Perry, 2009). Likewise, chest x-ray was asked to clarify and provide adequate diagnostic for Mrs. S., and it confirmed what part and the expansion of the lungs had pneumonia (presence of opacity in the lower thirds). Another factor to ask for this exam is because of the COPD, so it helps the physician to evaluate shortness of breath, support the diagnosis, and analyzes for advanced emphysema (Kee, 2010). Furthermore, pharmacology should have attention to Mrs. S. because she had a variety of medications during hospitalization, so nurses must know medication information such as main effect and nursing care for this client. The according with Deglin Vallerand (2013) Mrs. S’ medications are described as follows: Dipyrone 2ml + 10 ml of distilled water (IV), every 6 hours if pain or fever. Main effect: it is an analgesic and antipyretic. Nursing care: Teaching the client about the side effects related to use this medication. Side effects that are more common are allergy and/or breathing discomfort; if it is present, the nurse immediately communicates the physician. This medication must be administrated if the patient refers pain or fever, so the nurse is responsible to verify vital signs and pain scale. Omeprazole 20mg (oral), an empty stomach, in the morning. Main effect: it provides protection for the gastric wall because of the high quantity of medicaments administrated. Nursing care: The nurse asks the patient about allergy. Nurse administrates one hour before breakfast (according to the physician’s prescription). Rocephin 1g + 100ml (IV) of saline 0.9%, every 12 hours. Main effect: it is an antimicrobial to act in gram negatives. Nursing care: Medicament reconstruction must be in saline 0.9%. The administration needs to be slow (minimum 30 minutes). Levofloxacin 500mg (IV), every 24 hours. Main effect: it is an antimicrobial. It is used for the treatment of pneumonia. Nursing care: The nurse must administrate the medication slowly. The nurse should orient the client about side effects such as nauseas and vomiting. The nurse must not administrate other antimicrobial drug in the same time. Bamifylline 300 mg (oral), 8 a.m. and p.m. Main effect: it is a bronchodilator. Nursing care: The nurse should monitor for drug hypersensitivity. The nurse should assess for low bone density and periodically during therapy. Nebulization therapy with saline 0.9% 5ml + Atrovent 35 drops + Berotec 5 drops (inhalation). Main effect: Atrovent acts as a bronchodilator (parasympathetic nervous system), and Berotec acts as a bronchodilator (sympathetic nervous system). Nursing care: Nebulization needs to be done according to the physician’s prescription. The nurse should monitor for side effect such as tachycardia. Nursing Diagnoses and Interventions Finally, Wilkinson Ahern (2009) emphasize that nurses provide their actions using the Nursing Care Systematization, which consists in to analyze the affected client’s conditions and to implement actions to restore his/her normal conditions of daily life. Indeed, Mrs. S’ nursing diagnoses and interventions could be applied, so these actions are described as a follower: Ineffective Breathing Pattern: inspiration and expiration that do not provide adequate ventilation, which is characterized by increased restlessness, oxygen saturation decreased, and using accessory muscles for breathing. Thus, the goal is to provide adequate ventilation pattern. Interventions: Keeping superior airway clear, so it can be done using a suction catheter where necessary. The position of the patient where he/she feels a relieve in dyspnea. The client has a frequent stimulating change of position in bed, keeping elevation in the headboard, and stimulating deep breathing and cough. If necessary, the client can use oxygen therapy, which is conform physician’s prescription. It can be offered by spectacle-type nasal catheter. This catheter must be changed every 24 hours if the presence of secretion. The nurse should monitor humidification the oxygen for oxygen therapy. 2- Ineffective Airway Clearance: client’s inability to clear secretions or obstructions from the respiratory tract to keep a clear airway when it is presented, which is characterized by adventitious breath sounds, changes in the respiratory rate and rhythm, cyanosis, dyspnea, and absent cough. As a result, the goal is to keep or perform a clear airway. a) Interventions: i. Teaching the client how to provide adequate coughing. It can use specific techniques to perform such as tapotement. ii. Encouraging ambulation, so it helps the client to eliminate lung’s secretion and facilitate breathing. iii. Encouraging the client does a deeply breathing, coughing, and teaching him/her the importance to do this. iv. Checking for client’s hydration, it must be adequate because dehydration difficult to breath and eliminate airway secretion. 3- Risk for Infection: it is related to increased environmental and pathogens exposition, invasive procedures, and a deficit in knowledge to avoid pathogen’s exposition. Therefore, the goal is to prevent hospital infection or sepsis. a) Interventions: i. The nurse should monitor and check for local and systemic signs and symptoms of infection. ii. Providing adequate hydric and nutritional ingest. The nurse can stimulate the client to keep adequate alimentary ingest, orient the client and his/her family about the necessity of adequately ingest of fibers, vitamins, proteins, and water. iii. The nurse must teach the client and his/her family about signs and symptoms of infection, so they can go to a health professional, who will evaluate it. The discharge plan and education about health habits must be presented and constructed during the hospitalization with the client and his/her family, so it will provide adequate management and quality of the life for the client (Ackley Ladwig, 2014). In brief, in the following paper was described Mrs. S’s historical and physical examination, her physiopathology, her exams and medicaments, and nursing diagnoses and interventions about COPD and pneumonia once both diseases were presented by Mrs. S. Besides these processes, nurses provide their diagnoses and interventions in the heath plan to care and provide promotion and prevention for the client, who was diagnosed with pulmonary disease. Nurses must continue to implement their nursing diagnoses and interventions with doing research because it is fundamental for the health care system to improve quality of recovery and life for clients and their family.

Massimo Vignelli Essay

In this modern day of computers and information technology, creating and designing an amazing object or place will be much easier due to the graphic design programs that are available to help modern day artist and designers. Nevertheless, it still involves the knowledge, skills, and experience of the designer. The talent of the designer to recreate a detailed yet beautiful design for a particular object is the one that are being paid for. One of the respected and successful designers in New York is Massimo Vignelli. He dedicated his life in designing and almost involved in various areas that requires his skills in creating and organizing beauty out of nothing. This well-known designer was born in Milan, Italy. He took up his bachelors’ degree in architecture at the Milan Polytechnic from 1950 to 1953 before completing it at the Universita di Architettura in Venice where he met his wife, Leila Vignelli. Massimo Vignelli’s first professional work was at Venini where he used to be a glassware designer. He taught at the Chicago Institute of Design from 1958 up to 1960 while his wife, Leila, worked as an architect for Skidmore, Owing and Merrill in New York. With their intention to still be connected to their homeland, they returned to Milan and open a practice institution for design which was named Leila and Massimo Vignelli Office for Design and Architecture. In 1965, Vignelli came to Chicago where he arranged a meeting with Ralph Eckerstrom, once a design director at Container Corporation of America (CCA) and a good friend. In this meeting came the idea of establishing a new design firm. Then, Unimark International was born with its co-founders Vignelli and Eckerstrom. With their similar viewpoints and principles in design, Vignelli and Eckerstrom took the challenge in the corporate design world. The firm’s vision: combining American marketing techniques with European modernist design within the same organization, creating an international firm that would get its strength through the best designs in the world, refinement of communications and educating the American design market. The beginning of Unimark International would not be successful without the people who believed in the concept of the two founders. Among those people who join the team of Vignelli and Eckerstrom were Bob Noorda, Larry Klein, James Fogelman, Robert Moldafsky, and at that time the respected design specialist Herbert Bayer. In 1971, Massimo Vignelli together with his wife, Leila Vignelli, founded the Vignelli Associates in New York. At the early years of the design firm, they have attained many corporate projects from Knoll, American Airlines, Bloomingdales, Xerox, Lancia, Cinzano, United Colors of Benetton, International Design Center New York and Ford Motors. Additional contracts from Venini, Steuben, and Sasaki for glassware design were also taken by the firm. Vignelli Associates was also responsible for the design of the showrooms of Artemide and Hauserman. Soon, Vignelli put his attention in designing furniture for Sunar, Posenthal, Morphos and Knoll. Among the well-known works of Vignelli are the Handkerchief Chair and Paper Clip table of Knoll. With the reputation of the Vignelli as a designer of versatility with illustrious design characteristic of clean work and the reputation of using bold lines and pure color in their design, they took the responsibility in designing the New York Subway signage. The Vignelli Associates first design the subway in 1968. Vignelli together with Bob Noorda planned to make a signage based on simple principle of delivering the necessary information to the people through the use of the Helvetica Medium which was then an exotic medium from Switzerland. The New York Standard Medium was used in the design due to the unavailability of the first proposed medium. After four years, Vignelli proposed a new design of the New York subway that replaced his previous work. This time, no more obscured angle of train routes instead all angles are set to 45 and 90 degree angle. Each stop was represented by a dot and each train line was represented by a color. The final work was a beauty of design art yet it still taken geographical correctness. Internationally, Massimo Vignelli’s works were published to various museums and art galleries. Among the notable museums and galleries that houses Vignelli’s work are the Museum of Modern Art, the Metropolitan Museum of Art, and Cooper Hewitt Museum in New York. His works can also be seen at the Musee des Arts Decoratifs in Montreal and at Die Neue Sammlung in Munich. He also became a lecturer in design at premier universities in the United States. Vignelli assumed many positions in various organizations in the US. These include the American Institute of Graphic Arts (AIGA) and the Alliance Graphique Internationale as president in both organizations. He was also the past vice president of the Architectural League in the US and a member of the Industrial Designers Society of America (IDSA). Vignelli’s work was also been aired worldwide through the two feature-length television programs. A Europe tour of his work between 1989 and 1993 allow some places to discover and see his magnificent art works. Vignelli received many awards and appreciation for his art works. Among Vignelli’s many awards are as follows: Gran Premio Triennale di Milano (1964), Compasso d’Oro (1964, 1998) from the Italian Association for Industrial Design, Industrial Arts Medal of the American Institute of Architects (1973), Visionary Award from the Museum of Art and Design (2004), and the most recent is the Architecture Award from the American Academy of Arts and Letters in 2005. His latest work was the e-book entitled â€Å"The Vignelli Canon† which was released in January 2009. The copy of this modern version of Vignelli’s work can be downloaded for free from his website. References Art Directors Club biography, portrait and images of work. Retrieved April 5, 2009 @ http://www.adcglobal.org/archive/hof/1982/?id=255 â€Å"Massimo Vignelli of vignelli associates†. Designboom (2000). Retrieved April 6, 2009 @ http://www.designboom.com/eng/interview/vignelli.html Unimark International. Retrieved April 6, 2009 @ http://www.unimark-international.com/beginnings1.html#beginnings1

The Atomic Bomb Was The Right Decision - 835 Words

World War II began September 1, 1939 and ended September 2, 1945. When this war began, many young boys and men were drafted into the war. Most of them left what they were doing and all they’ve known, to fight in the war. It was the war that advanced technology and created social changes. The United States was the first country to use the atomic bomb in warfare. On August 6, 1945, the first of two atomic bombs were dropped. The first bomb was named, â€Å"Little Boy,† and was dropped on the city of Hiroshima. The second bomb was named, â€Å"Fat Man,† (History.com Staff 2009) and was dropped on the city of Nagasaki three days later. The bombs resulted in thousands of casualties and radiation among the civilians. Dropping the atomic bomb was the right decision because the bomb would end the war, it was revenge for Pearl Harbor, and it saved the lives of more Americans. The first reason as to why dropping the atomic bomb was the right decision is because it would en d the war. Ending the war would be a good idea because at this time in the war, the United States along with many other nations have lost too many lives. This war was the most catastrophic war in history because of the number of casualties. â€Å"The most destructive war in all of history, its exact cost in human lives is unknown, but casualties in World War II may have totaled 50 million service personnel and civilians killed.† (HistoryNet) Other nations suffered losses including the USSR (42,000,000), Germany (4,000,000) ,Show MoreRelatedTruman and Atomic Bombs649 Words   |  3 Pagesa side and then write an editorial on Harry S Truman’s decision to order the dropping of the atom bomb. HARRY S TRUMAN amp; THE DECISION TO ORDER THE DROPPING OF THE ATOMIC BOMB Boom! Boom! Seventy thousands Japanese citizens were perished instantly after the first atomic bomb was dropped in Hiroshima on August 6, 1945. Japanese still refused to surrender to Allied forces. 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Truman made the right choice of choosing to drop the bomb on Hiroshima and Nagasaki because it sa ved livesRead MoreThe Dropping of the Atomic Bomb1290 Words   |  6 PagesTruman Had the Right to Drop the Atomic Bomb â€Å"On the morning of August 6, 1945, the American B-29 Enola Gay dropped an atomic bomb on the Japanese city of Hiroshima. Three days later another B-29, Bock’s Car, released one over Nagasaki. Both caused enormous casualties and physical destruction.† (Maddox 1). These disastrous events have weighted upon the American conscience ever since that day in history. Even though there are some people that disagree with the dropping of the atomic bomb, President Truman’sRead MoreThe Nuclear Of The Atomic Bomb1551 Words   |  7 PagesThe atomic bomb was developed in an effort to counter proposed technologies by the Nazis in Germany, who were trying to develop superweapons in their effort to conquer Europe. 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Minutes later the signal was given, that new weapon, the atomic bomb, was released. Its enormous destructive energy detonated in the sky, killing one hundred thousand Japanese civilians instantly. Three days later, on August 9, 1945, the UnitedRead MoreThe Atomic Bomb Was A Revolutionary Invention1528 Words   |  7 Pagesand geared to kill more people. This was especially true in the early 20th century with World Wars I and II, when tactics and weaponry were being developed to kill as many people as possible (i.e. total war, civilian bombing, etc), and reached its peak with the US dropping atomic bombs on Hiroshima and Nagasaki in August of 1945. The atomic bomb was a revolutionary invention that raised many questions, most comprehensively, why? Why did we drop the atom ic bombs? This question regarding the motivations

The Song Of Roland And The Iliad - 933 Words

The Song of Roland and The Iliad are both epics that represent the cultural viewpoints of medieval France, and Ancient Greece, respectively. The Song of Roland, based on historical fact, details the heroism of one of Charlemagne’s knights, Roland, when fighting against an overwhelming force of foreigners to defend the rear of Charlemagne’s army. In comparison, The Iliad accounts the triumphs of Achilles during the mythical Trojan Wars to win possession over the beauty of Helen. Despite similarities between the two epics such as the presence of conflict against a formidable foe and volatile alliances, there are also marked differences with regards to the elements which comprise the epic heroes. The key similarities between The Song of Roland and The Iliad can be found in the ambience in which the story is taking place, and the presence of volatile alliances. With regards to the ambience of both epics, The Song of Roland is based on the military excursion of Charlemagneâ €™s Franks into Spain in order to convert its people to Christianity, while The Iliad has a similar backdrop of conflict with the Trojan War and Greek effort to win the beauty of Helen. In addition to the setting of warfare, both epics contain a formidable foe with the numerically advantageous Moslem Saracens in The Song of Roland, and the relentless defenders of Troy in The Iliad. The epics also provide a substantial challenge to the heroes in the form of strained alliances with others. 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Because there were very few works composed for children, children borrowed from stories they enjoyed listening to such as the Iliad, the Odyssey, and Aesop’s Fables. Plato specifically mentions children’s education in Book VI of The Republic. Though he holds rather liberal views on education and directly states that children’s lessons should â€Å"take the form of play,† Plato held