Caring for the Patient and the Family in the Last Hours of Life

2008 ◽  
Vol 20 (5) ◽  
pp. 408-413 ◽  
Author(s):  
Karen A. Kehl
Keyword(s):  
Breathing Pattern ◽  
Vital Signs ◽  
Signs And Symptoms ◽  
Good Death ◽  
Home Setting ◽  
The Family ◽  
Basic Understanding ◽  
State Changes ◽  
Respiratory Signs And Symptoms ◽  
Cold Extremities

Recognition of the signs and symptoms that are common in the final hours of life and a basic understanding of how to manage these signs and symptoms are important to helping the patient and family experience a good death in the home setting. The most common signs and symptoms, including pain, dyspnea, and terminal restlessness or delirium, and their management are discussed. Also addressed are other signs and symptoms, such as cardiovascular signs and symptoms including cold extremities, mottling, and changes in vital signs; respiratory signs and symptoms such as changes in breathing pattern, noisy breathing, and mandibular breathing; and neurological signs and symptoms such as disorientation, sensory changes, and semicomatose state. Changes in metabolism such as fatigue, surge of energy, and increased temperature are presented, along with decreased intake, excretion, and communication changes.

scholarly journals Effectiveness of Chest Physiotherapy on Cardio-Respiratory Signs & Symptoms in COVID-19 Positive Patients

2021 ◽  
Vol 11 (5) ◽  
pp. 284-289
Author(s):  
Ayesha Gadhawala ◽  
Sweety Shah
Keyword(s):  
Neurological Disorders ◽  
Vital Signs ◽  
Signs And Symptoms ◽  
Chest Physiotherapy ◽  
Exclusion Criteria ◽  
Sit To Stand ◽  
Significant Difference ◽  
Oxygen Supplement ◽  
Respiratory Signs And Symptoms

Introduction: Covid-19 is considered as world pandemic disease in which patient suffers from several respiratory impairments along with weakness which affects overall body functions, thus aim of this review is to highlight role of chest physiotherapy in improving respiratory signs/symptoms of Covid-19 positive patients. Method: The interventional study, convenient sampling with sample size of 41 subjects. Subjects of 35-80 years both male and female diagnosed with covid-19 positive were included in study. The exclusion criteria were any recent fracture, any medically diagnosed mental illness, neurological disorders and post covid-19 patients. The subjects are assessed of respiratory signs and symptoms like vital-signs, cough, dyspnea by American thoracic society grading of breathlessness, 1 minute sit to stand test, external oxygen supplement on the 1st day and again on 14th day physiotherapy administration for data analysis. The symptomatic chest physiotherapy was administered to each patient from day of reference until the discharge, 2 times in a day and 7 days/week. Results: There was decrease in mean ATS dyspnea scoring, respiratory rate, cough and oxygen supplement and increase in mean 1 minute sit to stand repetition, oxygen saturation (spo2) from 1st day to 14th day of physiotherapy treatment which is statistically significant comparing within groups. There was no significant difference noted in pre and post heart rate values comparing within groups. Conclusion: The study concluded that chest physiotherapy proved to be effective in improving the respiratory signs and symptoms and overall health of covid-19 positive patients. Key words: Covid-19 positive, chest physiotherapy, cough, dyspnea, oxygen supplement.

Planning for the Actual Death

2019 ◽  
pp. 420-431
Author(s):  
Patricia Berry ◽  
Julie Griffie
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Critical Role ◽  
Vital Signs ◽  
Signs And Symptoms ◽  
Good Death ◽  
Postmortem Changes ◽  
Care Planning ◽  
Grieving Process ◽  
Before And After ◽  
Advance Care

This chapter examines and addresses the critical role that nursing has in facilitating a “good death”—however the patient and family define it—including care before and after the death. As death nears, there is only one chance to “get it right.” In addition to summarizing the symptoms that are common and intensify as death nears, the chapter presents a nursing framework for working with patients and families during this stressful yet meaningful time. The chapter also revisits and discusses, in the context of approaching death, issues related to advance care planning, a family goals of care conference, vital signs, medically administered fluids, cardiopulmonary resuscitation, and discontinuing dialysis. Signs and symptoms of impending death and postmortem changes are summarized to enable the nurse to interpret and normalize these changes to those present before and after the death. The chapter concludes with a discussion of how the nurse can facilitate the early grieving process.

Providing Care of Mild Traumatic Brain Injury by the Family Practice/Primary Care Optometrist

2018 ◽  
pp. 110-119
Keyword(s):  
Primary Care ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Family Practice ◽  
Advanced Training ◽  
Entry Level ◽  
The Family ◽  
Basic Understanding ◽  
The Brain

Primary Objectives: By extending the scope of knowledge of the primary care optometrist, the brain injury population will have expanded access to entry level neurooptometric care by optometric providers who have a basic understanding of their neurovisual problems, be able to provide some treatment and know when to refer to their colleagues who have advanced training in neuro-optometric rehabilitation.

Orthodontic Aspects on the Chronological and Dental Age in Children with Down Syndrome

2018 ◽  
Vol 69 (1) ◽  
pp. 208-213
Author(s):  
Mariana Pacurar ◽  
Bogdan Dragomir ◽  
Alina Silvana Szalontay ◽  
Cristian Romanec
Keyword(s):  
Down Syndrome ◽  
Emotional Disorders ◽  
Metabolic Diseases ◽  
Genetic Disorder ◽  
Signs And Symptoms ◽  
Deciduous Teeth ◽  
Healthy Children ◽  
Dental Maturation ◽  
Children With Down Syndrome ◽  
The Family

Genetics is a key discipline in medicine, but also a clinical discipline with medical and social implications. The interest in reducing the number of genetic disorders and recognizing the risk of them repeating when a family confronts itself with a genetic anomaly becomes more and more important in the hierarchy of prophylactic emergencies. Presenting themselves as metabolic diseases (monogenic mutations) or malformations (polygenic and multifactorial heredity) because of their frequency, these disorders position themselves on an ascendant curve. They become difficult to deal with for the society, for the family and for the interested individual and cause emotional disorders. The Down syndrome is the most frequent type of genetic disorder. It is characterized by a specific set of signs and symptoms. People with Down syndrome require special medical care that, apart from the family, must include a team of doctors of various specializations and also a dentist. They are predisposed to hearing and sight disorders and thyroid problems as well. In 50% of the cases there are also anomalies of the heart, and the risk of leukaemia is 20 times higher. Some of them even develop an Alzheimer type dementia during their life. The people with Down syndrome can have an average IQ up to a moderate form of handicap. In particular, the studies on Down syndrome in dentistry are quite frequent, but they focus more on cavities, periodontal disease and hypodontia. In spite of this, the connection of Down syndrome and dental eruption is less studied. Consequently, the present study is intended to fill this missing part from the specialized literature, focusing on the relation between the Down syndrome and the chronological and dental ages in children. The health of the oral cavity is neglected in these patients, their parents focusing more on the treatment of the other systemic disorders of their children; the lack of interest is reflected in their poor oral hygiene.The trial group included 94 children with mixt dentition, aged between 6 and 12, divided as follows: 36 children with Down syndrome enrolled at the Educational Centre for Inclusive Education no. 1 of Tg. Mures and Alpha Transilvana Foundation. The chronology and the eruption sequences are subjected to certain variations and they are influenced by the presence of cavities, the premature loss or, on the contrary, the prolonged retention of deciduous teeth as well as dental anchylosis. Dental maturation is less subjected to variations, as it is a progressive, continuous and cumulative process. The presence of Down syndrome in children generates a delay in teeth eruption by 1.27 years compared to the data identified in the specialized literature and to the information obtained on the healthy children included in the study.

scholarly journals Severity of respiratory signs and symptoms and virus profiles in Japanese children with acute respiratory illness

2013 ◽  
Vol 57 (12) ◽  
pp. 811-821 ◽  
Author(s):  
Yumiko Miyaji ◽  
Miho Kobayashi ◽  
Kazuko Sugai ◽  
Hiroyuki Tsukagoshi ◽  
Shoichi Niwa ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
Respiratory Illness ◽  
Acute Respiratory Illness ◽  
Japanese Children ◽  
Respiratory Signs And Symptoms

Cross-sectional associations between ambient air pollution and respiratory signs and symptoms among young children in Tehran

2020 ◽  
Vol 223 ◽  
pp. 117268 ◽  
Author(s):  
Zahra Namvar ◽  
Masud Yunesian ◽  
Mansour Shamsipour ◽  
Mohammad Sadegh Hassanvand ◽  
Kazem Naddafi ◽  
...  
Keyword(s):  
Air Pollution ◽  
Young Children ◽  
Signs And Symptoms ◽  
Ambient Air ◽  
Ambient Air Pollution ◽  
Cross Sectional ◽  
Respiratory Signs And Symptoms

Counseling Parents of Children With Behavior Problems: The Use of Extinction and Time-Out Techniques

PEDIATRICS ◽  
1977 ◽  
Vol 59 (1) ◽  
pp. 78-85
Author(s):  
Ronald S. Drabman ◽  
Greg Jarvie
Keyword(s):  
Problem Behaviors ◽  
Inappropriate Behavior ◽  
Time Intervals ◽  
Alternative Behavior ◽  
Home Setting ◽  
Time Out ◽  
Behavior Response ◽  
Disciplinary Problems ◽  
The Family ◽  
Selection Of

The pediatrician is the professional most frequently sought out for advice concerning disciplinary problems with children in the home. Behavioral psychologists have advocated the use of contingent ignoring and time-out procedures to help reduce problem behaviors; however, practicing pediatricians have found that these two procedures are often not successful. In fact, sometimes the two procedures seem to exacerbate inappropriate behavior. This paper documents the difficulties found in using the ignoring and/or time-out procedures in the home setting. Potential pitfalls in the use of ignoring, including not specifying the target behavior, not taking a baseline, inadvertently, intermittently reinforcing the inappropriate behavior, response bursts, spontaneous recovery, and not reinforcing an appropriate alternative behavior, are described. In addition, several pitfalls in the use of the time-out procedure, including selection of isolation area, inappropriate selection of time intervals, interference from others in the family, and escape attempts on the part of the child are discussed. For each potential problem a remedy is suggested.

scholarly journals Contactless Monitoring of Breathing Patterns and Respiratory Rate at the Pit of the Neck: A Single Camera Approach

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Carlo Massaroni ◽  
Daniel Simões Lopes ◽  
Daniela Lo Presti ◽  
Emiliano Schena ◽  
Sergio Silvestri
Keyword(s):  
Respiratory Rate ◽  
Frequency Domain ◽  
Time Domain ◽  
Breathing Pattern ◽  
Vital Signs ◽  
Image Resolution ◽  
Measuring System ◽  
Respiratory Pattern ◽  
Breathing Patterns ◽  
Vital Signs Monitoring

Vital signs monitoring is pivotal not only in clinical settings but also in home environments. Remote monitoring devices, systems, and services are emerging as tracking vital signs must be performed on a daily basis. Different types of sensors can be used to monitor breathing patterns and respiratory rate. However, the latter remains the least measured vital sign in several scenarios due to the intrusiveness of most adopted sensors. In this paper, we propose an inexpensive, off-the-shelf, and contactless measuring system for respiration signals taking as region of interest the pit of the neck. The system analyses video recorded by a single RGB camera and extracts the respiratory pattern from intensity variations of reflected light at the level of the collar bones and above the sternum. Breath-by-breath respiratory rate is then estimated from the processed breathing pattern. In addition, the effect of image resolution on monitoring breathing patterns and respiratory rate has been investigated. The proposed system was tested on twelve healthy volunteers (males and females) during quiet breathing at different sensor resolution (i.e., HD 720, PAL, WVGA, VGA, SVGA, and NTSC). Signals collected with the proposed system have been compared against a reference signal in both the frequency domain and time domain. By using the HD 720 resolution, frequency domain analysis showed perfect agreement between average breathing frequency values gathered by the proposed measuring system and reference instrument. An average mean absolute error (MAE) of 0.55 breaths/min was assessed in breath-by-breath monitoring in the time domain, while Bland-Altman showed a bias of −0.03 ± 1.78 breaths/min. Even in the case of lower camera resolution setting (i.e., NTSC), the system demonstrated good performances (MAE of 1.53 breaths/min, bias of −0.06 ± 2.08 breaths/min) for contactless monitoring of both breathing pattern and breath-by-breath respiratory rate over time.

scholarly journals A Novel Mobile Health Tool for Home-Based Identification of Neonatal Illness in Uganda: Formative Usability Study

10.2196/14540 ◽  
2019 ◽  
Vol 7 (8) ◽  
pp. e14540 ◽  
Author(s):  
Madison Vanosdoll ◽  
Natalie Ng ◽  
Anthony Ho ◽  
Allison Wallingford ◽  
Shicheng Xu ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Health Workers ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Ease Of Use ◽  
World Health ◽  
Severe Illness ◽  
Home Setting ◽  
Danger Signs ◽  
Neonatal Assessment

Background While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children’s Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. Objective This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. Methods Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort’s use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. Results A total of 13/22 subjects (59%) using app version I and 9/10 subjects (90%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app’s audio instructions in version II, participants’ ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. Conclusions The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda.

Vancomycin-Induced Red Man Syndrome

PEDIATRICS ◽  
1990 ◽  
Vol 86 (4) ◽  
pp. 572-580
Author(s):  
Maurice Levy ◽  
Gideon Koren ◽  
Lee Dupuis ◽  
Stanley E. Read
Keyword(s):  
Signs And Symptoms ◽  
The Body ◽  
Control Group ◽  
Severe Hypotension ◽  
The Face ◽  
Red Man Syndrome ◽  
History Of ◽  
Serum Vancomycin ◽  
Mild Temperature ◽  
Cold Extremities

A total of 11 cases of red man syndrome collected among 650 children who had received vancomycin in our hospital between 1986 and 1988 (estimated prevalence 1.6%) were retrospectively analyzed. These 11 children were compared with 11 age-matched children who received vancomycin in whom red man syndrome did not develop. Of the patients with red man syndrome, 73%, and of the patients with no reaction, 45.4% received vancomycin for penicillin-resistant Staphylococcus epidermidis-positive cultures, or because of history of penicillin allergy. No difference was observed in the dose per kilogram given to both groups (12.9 ± 3.5 mg/kg per dose in those with red man syndrome vs 12.3 ± 6.9 mg/kg per dose in control childrens. The duration (mean ± standard deviation) of vancomycin infusion was 45.9 ± 16.7 minutes (range 10 to 90 minutes) in patients with red man syndrome and 54.5 ± 7.6 minutes (range 45 to 65 minutes) in the control group (P = .07). In the 5 children with red man syndrome rechallenged with vancomycin, slower infusion rates prevented or reduced the syndrome, which emphasized the fact that the rate of administration is the important determinant of red man syndrome in susceptible cases. Clinically, the syndrome developed at the end of the infusion in most patients, but appeared as early as 15 minutes after initiation of the infusion. It was mostly manifested as a flushed, erythematous rash on the face, neck, and around the ears. Less frequently, the rash was distributed all over the body. Pruritus was usually localized to the upper trunk but was also generalized (2 of 11 children). Associated signs and symptoms were hypotension, watery puffy eyes, tachycardia, respiratory distress, dizziness, agitation, and mild temperature increase. A premature infant with the red man syndrome had skin rash associated with poor perfusion, cold extremities, increased need for oxygen, and severe hypotension. The rash disappeared within 20 minutes (range 5 minutes to 7 hours) after vancomycin infusion was stopped. There was no association between serum vancomycin concentrations and red man syndrome; in both groups of patients therapeutic as well as subtherapeutic concentrations were observed, suggesting that this is an idiosyncratic and not a concentration-dependent phenomenon.

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