Week 3 Simulation 2 1.

) Cough (produces frothy or blood-tinged mucus) Decreased urine production Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath Fatigue, weakness, faintness Irregular or rapid pulse Sensation of feeling the heartbeat (palpitations) Shortness of breath Waking up due to shortness of breath (paroxysmal nocturnal dyspnea) Weight gain from fluid retention Symptoms in infants may include: Failure to thrive Poor feeding Weight loss 2.) 3.) Destruction of lung tissue occurs in several ways. First, cigarette smoke directly affects the cells in the airway responsible for clearing mucus and other secretions. Occasional smoking temporarily disrupts the sweeping action of tiny hairs called cilia that line the airways. Continued smoking leads to damage to the cilia that prevents them working properly to clear secretions. Long-term exposure to cigarette smoke causes the cilia to disappear completely from the cells lining the air passages. Without the constant sweeping motion of the cilia, mucus secretions cannot be cleared from the lower respiratory tract. Furthermore, smoke causes mucus secretion to be increased at the same time that the ability to clear the secretions is decreased. The resulting mucus build-up can provide bacteria with a rich source of food and lead to infection. The immune cells in the lung, whose job it is to prevent and fight infection, are also affected by cigarette smoke. They cannot fight bacteria as effectively or clear the lungs of the many particles (such as tar) that cigarette smoke contains. In these ways cigarette smoke sets the stage for frequent lung infections. Although these infections may not even be serious enough to require medical care, the inflammation caused by the immune system constantly attacking bacteria or tar leads to the release of destructive enzymes from the immune cells. Shortness of breath Swelling of feet and ankles Urinating more frequently at night Pronounced neck veins Palpitations (sensation of feeling the heart beat) Irregular fast heartbeat Fatigue Weakness Fainting

4.) General o Duration and complexity of regimen o Lack of informal support Patient (intentional) o Concerns about the side-effects o Few perceived benefits o Stigma of taking medication o Adjustment to suit daily routine o Concerns about cost o Concerns about availability o Concerns about dependency Patient (non-intentional) o Slips and lapses o External distractors o Misunderstanding instructions Clinician o Poor doctorpatient relationship o Poor empathy o Poor explanation/communication o Inadequate follow-up Illness o Severe illness o Depression or distress o Psychosis o Cognitive impairment

5.) Many pharmaceutical companies offer free or discounted medications to low-income individuals who meet certain criteria. Information on these Prescription Assistance Programs can be found at these websites: o www.needymeds.org o www.rxassist.org o www.pparxpa.org

6.) Hospice Community out reach Social services Medicare/Medicaid

7.) 8.) Educate the patient multiple times about the consequences of refusing treatment. Educate the patient about financial resources available. Document attempts and refusals in detail. Benefits of treatments. Obtain an AMA before the patient leaves. You have the right to choose health care providers who can give you high-quality health care when you need it. Nope Altered mental status